123b - Substance Use Disorders Flashcards
According to the motivational model of use, what are the 4 types of motivations for alcohol use?
Which carry the highest risk of alcohol dependence?
- External source
- Social
- Positive valence: drinking is social and fun
- Conformity
- Negative valence: if I don’t drink, I won’t fit in
- Social
-
Internal source - increased risk of alcohol use disorder
-
Enhancement
- Positve valence: drinking is exciting (even if alone)
-
Coping - highest risk of alcohol use disorder
- Negative valence: drink to not feel sad
-
Enhancement
How do THC and CBD affect the CB1 receptor?
What about synthetic cannabinoids?
THC = partial agonist -> psychoactive effects
CBD = antagonist -> relaxation
Synthetic = full agonist at CB1
List 5 adverse effects of marijuana use that we have “high conficence” in
- Cannabis use disorder
- Motor vehicle accidents
- Chronic bronchitis
- Diminished lifetime achievement
- Development of schizophrenia
Which peer group characteristics increase a person’s risk of substance use disorder?
- Heavy drinking
- Deviant behavior
- Decreased academic competence
Which of the 3 FDA approved medications for the treatment of alcohol use disorder has the least evidence for decreasing drinking?
Disulfram
(Naltrexone, acamprosate are the other 2 - good evidence supporting both, naltrexone is better toldrated but not good for anyone with liver failure or on opioids)
What family factors can increase a person’s risk of substance use disorder?
- Parental drinking
- Permissiveness
- Lower levels of bonding and support
What adverse events migth increase a person’s risk of substance use disorder?
- Emotional neglect
- Emotional abuse
- Sexual abuse
What might make the use of synthetic cannabinoids more dangerous than marijuana?
Synthetic cannabinoids are full agonists at the CB1 receptor
- Risks
- Extreme anxiety
- Confusion
- Psychosis
A patient explains that they drink to relax, expecially when they are bored or frustrated with work or their relationship
What is their motivation for drinking? (of the 4 motives)
Coping
This motivation carries the highest risk of alcohol use disorder
What is the genetic contribution to substance use disorder?
Genetics contribute 50% of the risk for alcohol use disorder
- Low sensitivity to alcohol = higher risk of substance use disorder
Which hormone is affected by most drugs of abuse?
Dopamine
- Increase dopamine release when using
- But downregulate dopamine D2 receptor long term
- Reverses if person stops using the drug, but the pathway is “already built”; relapse is easier than starting initially
What social/cultural factors can increase a person’s risk of a substance use disorder?
- Norms/expectations of substance use
- Role model use
How likely are symptoms of depression to resolve with abstinence alone in a patient with alcohol use disorder, who is actively engaging in heavy episodic drinking?
50%
What medications can be used to treat alcohol dependence?
-
Naltrexone
- Mu opioid receptors antagonist
- Well tolerated
- Do not use in people with liver disease
-
Acamprosate
- Inhibits NMDA receptors -> decreased alcohol craving
- Need to dose 3x daily, harder to adhere to
- GI upset is a side effect
- Disulfram
- Irreversivly inhibits acetaldehyde dehydrogenase
- Least evidence to support use in treating alcohol dependence
Which psychosocial treatments are most effective for substance use disorders?
- Motivational interviewing
- 12 step lans
- CBT
- Contingency management
- Lose license if you fail a urine tox
- Keep job if you complete the 12 step program
- Couples and family therapy
