Addiction Medicine Flashcards

Question

How can we treat opioid addiction?

Answer 1

1. Abstinence based therapy (Requires complete abstinence) • Naltrexone • Long-acting opioid receptor antagonist • Block opioid effects if relapse occurs • Does not treat physical symptoms of abstinence • Protracted abstinence syndrome: Anhedonia from downregulation of dopamine and opioid receptors • Person feels physically unwell • 90%+ failure rate 2. Replacement therapy (Reduces severe risk of harm) • More successful that abstinence-based therapy because it avoids anhedonia and physical discomfort during withdrawal as seen with abstinence • Special restrictions when used to treat opioid addiction • Not a “silver bullet” • Does not resolve mental health and social-environmental systems that increase risk of addiction • Why is the addict taking the drug in the first place? ``` 2. Replacement therapy (Reduces severe risk of harm) • Methadone • Full opioid agonist • Addictive and potentially dangerous • Available at regulated Opioid Treatment Program (OTP) • Not prescribed – only administered ```

Answer 2

Replacement therapy (Reduces severe risk of harm) • More successful that abstinence-based therapy because it avoids anhedonia and physical discomfort during withdrawal as seen with abstinence • Special restrictions when used to treat opioid addiction • Not a “silver bullet” • Does not resolve mental health and social-environmental systems that increase risk of addiction • Why is the addict taking the drug in the first place? ``` 2. Replacement therapy (Reduces severe risk of harm) • Methadone • Full opioid agonist • Addictive and potentially dangerous • Available at regulated Opioid Treatment Program (OTP) • Not prescribed – only administered ``` Replacement therapy (Reduces severe risk of harm) • Buprenorphine • Partial opioid agonist • Less addictive and dangerous • Available from physician (prescribed, administered, dispensed) • Buprenorphine + naloxone* * Naloxone counteracts buprenorphine if it is abused (e.g., injected) ``` 2. Replacement therapy (Reduces severe risk of harm) • Duration and Benefits • Usually continues for at least 1-2 years • Oral administration • Stable drug levels • Less euphoria and less drowsiness • Improved overall health, productivity • Reduced crime ```

Answer 3

Summary of pupil response Miosis (pupil constriction): • Opioid intoxication (pinpoint) • Stimulant withdrawal Mydriasis (pupil dilation): • Stimulant intoxication • LSD intoxication • Opioid withdrawal

Answer 4

``` • Used in primary care: 1.History taking 2.Screening Tools (e.g., CAGE, AUDIT, NDA-Modified ASSIST) 3. Advising ```

Answer 5

CAGE – Have you ever felt you should Cut down your drinking? – Have people Annoyed you by criticizing your drinking? – Have you ever felt bad or Guilty about your drinking? – Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)? 2 or more YES = clinically significant: Follow-up

Answer 6

Patient Advising: • Review screening results • Based on risk level: – Review potential drug-related health consequences – Recommend reducing/quitting drug use (with or without medical supervision) – Evaluate for co-existing problems (e.g., depression, anxiety, infectious diseases) – Refer for a comprehensive alcohol/drug assessment (screening tools do not provide a diagnosis) – Educate about treatment options – Assist in making changes, if patient is ready to change (goal setting, Rx meds)

Answer 7

• In-patient setting for maximal environmental structure • Usually 90+ days • No “cure” - ongoing management • Fraction receive help (20.7 million people (age 12+) needed treatment for a SUD; 4 million (19%) received it (2017) * Acute treatment phase: * Detoxification and management of withdrawal symptoms/cravings • Treat associated medical problems * Plan to address comorbid psychiatric illnesses

Answer 8

• Treating SUDs is complex • Substance use can impact frontal cortex (executive functions): • Impulse control & inhibition • Judgement & Decision-making • Planning • Reward pathway, tolerance, withdrawal, craving • Behavior conflict can cause justifications: denial, minimization, defiance, rationalization • “Replacement” of the frontal cortex (proxy executive functions) followed by resilience-building to life stressors • Just “suck it up and do it” not likely to work

Answer 9

Recovery Phase – medium environmental structure • Goal is to prevent relapse • Avoid the Abstinence Violation Effect • Multi-modal approach • Cognitive therapy (identify & correct self-defeating thoughts) • Behavioral therapy (remove/recondition cues, contingency management) • Community groups (12-step programs) for impulse control (sponsors) • Family therapy • Medication-assisted treatment to decrease craving or replacement therapy (e.g., naltrexone, buprenorphine, disulfiram)

Answer 10

Self-Help Groups for Relatives/Friends * Forum to share experiences (challenges and successes) regarding loved- one’s addiction * Learn effective ways to cope with loved-one’s addiction - avoidance of enabling behaviors: * Actions and/or reactions to the addicted person that perpetuate the addictive behavior

Answer 11

Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting 4+ of the following (9 symptoms) in a 12-month period * Not due to manic episode * Related to impulse control

Answer 12

* Preoccupationwithgambling * Gambling increasing amounts of money to achieve excitement * Unable to control ,cut back or stop * Used to escape from problems * Gambling to recoup losses * Lying to conceal extent of gambling * Illegal acts to finance gambling * Jeopardizing or losing relationships * Reliant on others for money to pay debts

Answer 13

SSRIs, opioid antagonists • To control gambling “cravings” Cognitive behavioral therapy • Understand stress triggers • Relaxation techniques to manage cravings Gamblers anonymous • 12-step process to admit and understand underlying contributing factors Family therapy • Support of loved ones for stress managemen

Addiction Medicine Flashcards

(41 cards)