Week 11: Substance abuse

Question 1

What topics did the clinician raise during the

“Provide feedback” part of the interview

Answer 1

Outlined the risk category
Explained guidelines and specific recommendations
Discussed medical consequences
Connected drinking habits to specific problems (BP)

Question 2

• Enhance motivation clinician strategies

- Reasons patient IDed for wanting to reduce drinking

Answer 2

Used readiness for change ruler
Jill IDs blood pressure and recent fall as consequences
Jill IDs other harmful consequences

Question 3

Use

Answer 3

Ingestion, smoking, sniffing, or injection of mind-altering substance

Question 4

Misuse*

Answer 4

Use of prescribed drugs in a way that deviates from expected use

Question 5

Abuse*

Answer 5

Use of a substance in a way that deviates from approved social or medical patterns

Question 6

Tolerance*

Answer 6

Pattern in which higher doses are needed to achieve same effect

Question 7

Withdrawal*

Answer 7

Symptoms occurring when substance is no longer used

Question 8

Physical dependence***

Answer 8

Physiological effects of multiple episodes of substance use

Question 9

Behavioral dependence*

Answer 9

Substance-seeking activities and related evidence of pathological use (cravings, mood changes related to use)

Question 10

Hazardous/risky/harmful use***

Answer 10

Lesser form of substance use, does not meet criteria for substance use disorder,
but intervention is warranted

Question 11

Addiction***

Answer 11

Continued use despite adverse consequences, deprivation of substance causes sig. distress and an irresistible urge to use

Question 12

Substance use disorder***

Answer 12

Occurs when individual continues using substance despite cog, behavioral, and physiological symptoms. Substance use disorder occurs when there is an underlying change in brain circuitry that may persist after detox

Question 13

SBIRT

Answer 13

Screening
Brief Interview
Refer to treatment

Question 14

Risky drinking - Healthy men under age 65

Answer 14

• more than 4 drinks in a day

- more than 14 drinks a week

Question 15

For all healthy women and healthy men over age 65

Answer 15

• more than 3 drinks in a day AND

- more than 7 drinks in a week

Question 16

Pyramid of alcohol use

Answer 16

1: 3-7% drinkers with an alcohol use disorder
2: 10-15% hazardous drinkers
3: 35-40% low-risk drinkers
4: 40% abstainers

Question 17

What part of pyramid does CAGE target

Answer 17

Rank 1: alcohol use disorder

Question 18

What part of pyramid does AUDIT target

Answer 18

Rank 2: hazardous drinkers

Question 19

Brief intervention steps

Answer 19

1. raise the subject
2. provide feedback
3. enhance motivation
4. negotiate and advise

Question 20

Enhance motivation considerations

Answer 20

Assess readiness for change (use rulers)
Explore pros and cons
Develop discrepancy
Elicit their reasons for change

Question 21

Audit questions

Answer 21

1. How often do you have a drink containing alcohol
2. How many drinks containing alcohol do you have on a typical day when you are drinking
3. Wo often do you have 5 or more drinks on one occasion

Question 22

AUDIT positive scoring

Answer 22

Men – 4 or more
Women – 3 or more
Older adults – 3 or more
8 or above suggests AUD

Question 23

CAGE

Answer 23

C – thought to cut down on you drinking or durg use
A – have people annoyed you by criticizing your drinking or drug use
G – have you felt bad or guilty about your drinking or durg use
E – Have you ever had a drink or used drugs first thing in the morning? (Eye-opener)

Question 24

DAST scoring

Answer 24

1-2: low level of risk – monitor, reassess later
3-5: moderate level of risk – further investigation needed
6-8: substantial risk – intensive assessment needed

Question 25

4 microskills of motivational interviewing | OARs

Answer 25

O - open-ended questions A – affirmations R – reflections S – summarize

Question 26

Assumptions to avoid with regards to stages of behavior change

Answer 26

1. That person’s health should be primary motivation 2. That patients are either motivated to change or not 3. That now is the right time to consider change 4. That change needs a tough approach/discipline that the patient lacks 5. That patient should seize this opportunity with an expert 6. That consultation was a failure if patient decides not to change

Question 27

Rulers (2)***

Answer 27

Readiness ruler | Confidence ruler

Question 28

Effective elements of Brief Intervention (FRAMES)***

Answer 28

``` Feedback Responsibility Advice Menu Empathic Counseling Self-efficacy ```

Question 29

Substance Use Disorder dx criteria*** Substance use disorder qualifiers

Answer 29

Problematic pattern of substance use leading to clinically sig. impairment or distress w/n a 12 month period Manifested by 2 or more qualifiers - substance taken in large amounts - persistent desire/unsuccessful effort to cut down - significant amount of time spent trying to obtain the substance - important activities are given up or reduced - continued use despite recurrent social or interpersonal problems - recurrent use despite failure to fulfill major role obligations - recurrent use of alcohol in situations which are hazardous - use despite knowledge that physical problem is caused by substance - tolerance, withdrawal, cravings

Question 30

Standard drink and NIAA guidelines***

Answer 30

12 oz (5%) beer 8-9 oz malt liquor (7%) 5 oz wine (12%) 1.5 oz (40%)

Question 31

alcohol Withdrawal syndrome (4)

Answer 31

Tremors Seizures Elevated temp, pulse, BP Delirium tremens

Question 32

Wernicke encephalopathy | Cause

Answer 32

Caused by thiamine deficiency (treated by administering vitamin B)

Question 33

Wernicke encephalopathy s/s (5)

Answer 33

``` Visual impairments Ataxia Hypotension Confusion Coma ```

Question 34

Korsakoff amnestic syndrome | Cause

Answer 34

Multi-organ infovlentme caused by long term alcohol use | Primary problem is difficulty acquiring new info and inability in retrieving memories

Question 35

Korsakoff amnesic syndrome | s/s

Answer 35

``` Attention deficit Disorientation Visual impairments Amnesia Use of confabulatio ```

Question 36

S/s delirium tremens

Answer 36

Seizures, hallucination, disorientation, fever, high blood pressure, heavy sweating

Question 37

CIWA scoring

Answer 37

for monitoring severity of alcohol withdrawal symptoms 0-9: absent or minimal withdrawal (PRN med) 10-19: mild-moderate (scheduled + prn) 20+: severe withdrawal (hourly eval) 35+: consider ICU xfer

Question 38

When can delirium tremens occur

Answer 38

Anytime during first week after last drink

Question 39

relapse prevention medication

Answer 39

disulfiram | naltrexone

Question 40

opioid effects

Answer 40

``` Euphoria Sedation Analgesia Constipation Constricted pupils ```

Question 41

Opioid Withdrawal syndrome

Answer 41

``` Rebound hyperexcitability restlessness Irritability Nausea Diarrhea Goose flesh Dilated pupils Increased BP Increased HR ``` ``` Dysphoria, Pupillary dilation Piloerection Yawning Muscle aches Lacrimation Rhinorrhea Nausea Fever Sweating Vomiting Diarrhea ```

Question 42

opioid addiction Maintenance tx

Answer 42

Methadone therapy with behavioral therapy and counseling Naltrexone Buprenorphine

Question 43

Initial onset and duration opioid withdrawal

Answer 43

8-12 h after last use of short-acting opiods 1-3 days after last use for longer acting Severe symptoms peak between 48-72 hrs Symptoms abate in 7-10 days for short acting opioids Methadone duration can be several weeks

Question 44

Disulfiram: Class MOA Considerations

Answer 44

Anti-alcoholic agent, enzyme inhibitor Inhibits metabolism of alcohol, accumulated concentration oaf acetaldehyde -- sickness Only for very motivated patients Take daily NO alcohol Do not administer until 12 hrs after alcohol use

Question 45

``` Naltrexone: Class Indication MOA Consideration ```

Answer 45

Opiod antagonist Narcotic or alcohol dependence Blocks opioid receptors -- reduced craving Cannot be used with opioid analgesics

Question 46

``` Naloxone: Class Indication Route Onset Consideration ```

Answer 46

Opioid antagonist Rescue drug to reverse opioid OD IV, IM, intranasal 2-5 minutes Rescue breathing while you wait for effect!

Question 47

``` Methadone: Class MOA Indication Administration Half-life SE Education ```

Answer 47

Opioid agonist Occupies opioid receptors without the subjective high, Can satisfy craving Maintenance tx -dosed daily in conjunction with consueling 15 to 30 hours Sedation Respiratory depression Constipation Impaired cognition ``` Take as prescribed Avoid alcohol Take with food while lying quietiely to minimize nausea Eat small frequent meals Avoid driving if dizzy Use mild laxative ```

Question 48

Assessment

Answer 48

``` Substance use history -frequency, duration, binge -hx withdrawal -consequences of use -loss of control -desire/efforts to decrease/control use -preoccupation with use -social vocational or recreational activities affected by use Asses denial of problem Assess for physiological complications Assess motivation for change Assess co-dependence ```

Question 49

Interventions

Answer 49

``` Therapeutic interactions Monitor for SE SBIRT (BI specifically) CBT Psychoeducation Coping skills enhancement (25.13) Refer to group therapy and early recovery Refer to individual and family therapy Harm-reduction strategies 12 step program (25.14) ```

Question 50

Therapeutic relationship

Answer 50

- establish trust and rapport - encourage hones expression - listen - caring - hold individual responsible - provide consistent consequences - communicate tx plan - monitor own reactions - confrontation