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Mental Health Exam 4 > Week 11: Substance abuse > Flashcards

Week 11: Substance abuse Flashcards

1
Q

What topics did the clinician raise during the

“Provide feedback” part of the interview

A

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

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2
Q
  • Enhance motivation clinician strategies

- Reasons patient IDed for wanting to reduce drinking

A

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

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3
Q

Use

A

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

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4
Q

Misuse*

A

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

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5
Q

Abuse*

A

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

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6
Q

Tolerance*

A

Pattern in which higher doses are needed to achieve same effect

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7
Q

Withdrawal*

A

Symptoms occurring when substance is no longer used

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8
Q

Physical dependence***

A

Physiological effects of multiple episodes of substance use

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9
Q

Behavioral dependence*

A

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

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10
Q

Hazardous/risky/harmful use***

A

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

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11
Q

Addiction***

A

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

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12
Q

Substance use disorder***

A

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

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13
Q

SBIRT

A

Screening
Brief Interview
Refer to treatment

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14
Q

Risky drinking - Healthy men under age 65

A
  • more than 4 drinks in a day

- more than 14 drinks a week

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15
Q

For all healthy women and healthy men over age 65

A
  • more than 3 drinks in a day AND

- more than 7 drinks in a week

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16
Q

Pyramid of alcohol use

A

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

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17
Q

What part of pyramid does CAGE target

A

Rank 1: alcohol use disorder

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18
Q

What part of pyramid does AUDIT target

A

Rank 2: hazardous drinkers

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19
Q

Brief intervention steps

A
  1. raise the subject
  2. provide feedback
  3. enhance motivation
  4. negotiate and advise
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20
Q

Enhance motivation considerations

A

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

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21
Q

Audit questions

A
  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
22
Q

AUDIT positive scoring

A

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

23
Q

CAGE

A

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)

24
Q

DAST scoring

A

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

25
Q

4 microskills of motivational interviewing

OARs

A

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

26
Q

Assumptions to avoid with regards to stages of behavior change

A
  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
27
Q

Rulers (2)***

A

Readiness ruler

Confidence ruler

28
Q

Effective elements of Brief Intervention (FRAMES)***

A 
Feedback
Responsibility
Advice
Menu
Empathic Counseling
Self-efficacy
29
Q

Substance Use Disorder dx criteria***

Substance use disorder qualifiers

A

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
30
Q

Standard drink and NIAA guidelines***

A

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

31
Q

alcohol Withdrawal syndrome (4)

A

Tremors
Seizures
Elevated temp, pulse, BP
Delirium tremens

32
Q

Wernicke encephalopathy

Cause

A

Caused by thiamine deficiency (treated by administering vitamin B)

33
Q

Wernicke encephalopathy
s/s
(5)

A 
Visual impairments
Ataxia
Hypotension
Confusion
Coma
34
Q

Korsakoff amnestic syndrome

Cause

A

Multi-organ infovlentme caused by long term alcohol use

Primary problem is difficulty acquiring new info and inability in retrieving memories

35
Q

Korsakoff amnesic syndrome

s/s

A 
Attention deficit
Disorientation
Visual impairments
Amnesia
Use of confabulatio
36
Q

S/s delirium tremens

A

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

37
Q

CIWA scoring

A

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

38
Q

When can delirium tremens occur

A

Anytime during first week after last drink

39
Q

relapse prevention medication

A

disulfiram

naltrexone

40
Q

opioid effects

A 
Euphoria
Sedation
Analgesia
Constipation
Constricted pupils
41
Q

Opioid Withdrawal syndrome

A 
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
42
Q

opioid addiction Maintenance tx

A

Methadone therapy with behavioral therapy and counseling
Naltrexone
Buprenorphine

43
Q

Initial onset and duration opioid withdrawal

A

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

44
Q

Disulfiram:
Class
MOA
Considerations

A

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

45
Q 
Naltrexone:
Class
Indication
MOA
Consideration
A

Opiod antagonist

Narcotic or alcohol dependence

Blocks opioid receptors – reduced craving

Cannot be used with opioid analgesics

46
Q 
Naloxone:
Class
Indication
Route
Onset
Consideration
A

Opioid antagonist

Rescue drug to reverse opioid OD

IV, IM, intranasal

2-5 minutes

Rescue breathing while you wait for effect!

47
Q 
Methadone:
Class
MOA
Indication
Administration
Half-life
SE
Education
A

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
48
Q

Assessment

A 
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
49
Q

Interventions

A 
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)
50
Q

Therapeutic relationship

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

Mental Health Exam 4 (3 decks)

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