13 Abuse drugs Flashcards
(42 cards)
Withdrawl
- Cessation of prolonged use
- Specific physiological correlates
- Significant distress or impairrment in social, occupational, or other areas of functioning
- Not due to other medical condition or explained by another disorder
Substance abuse disorder features
- Impaired control: 1)more or longer use than directed, 2) unsuccessful stoppage, 3)great expenditure in obtaining, using, stopping 4)cravings
- Social impairment: 5)failure to fulfill obligations, 6) continued use despite problems, 7)important activities given up
- Risky use: 8) recurrent use in hazardous situations 9)use dispite problems caused
- Pharmacologic dependance: 10) tolerance, 11) Withdrawl symptoms
Mild: 2-3 Moderate: 4-5 Severe: 6+
Induced disorders
- Anxiety, panic attacks, or compulsions
- Evidence of :
- symptoms starting within 1 month of intoxication or withdrawl
- Medication use etiologically related to disturbance
- not better accounted for by other disorder
- not during Delirium
- Significant distress in social, occupational, or other functioning
Dopamine and addiction
- Involved in pleasure pathways including:
- Food
- Sex
- Excitement
- Comfort
- Acts on nucleus accumbens
- is deficient when use is stopped causing cravings and or dysphoria
Biological reinforcement
- not necessarily euphoric
- level of initial tolerance predicts addiction likelihood
- Most abused drugs will be self administered by rats (not LSD or cannabis
- Most addictive drugs have limbic effects
Non dopamine transmitter modulators and abuse
Naltrexone: Opiate antagonism (also reduces alcohol cravings)
Campral: Gaba action
Chantax: Nicotinic ACHr agonist
Classical conditioning
Like pavlov’s dogs
- association of conditioned stimulus (bell) with unconditioned stimulus (food)
i. e. drug periphrenalia brings back idea of drug euphoria
Operant conditioning
Result linked with action
- positive reinforcement- reward (drinks alcohol- becomse more socible)
- negative reinforcement- removal of adversive stimulus (using more BZD removes withdrawl smptoms)
- Punishment- adversive stimulus applied in conjunction
- Extinction- removal of reinforcement eliminates behavior (unlearned)
Psychodynamic and personality factors in addiction
- Personality disorders
- affective dysregulation: emotional
- imppulse control deficits: rely on reward
- Ego deficits: dont know who they are and cant cope with bad effects
- Family dynamics:
- codependence/enabling
- multigenerational drug dependence
- parental loss
Stage 1 treatment for addictions
Detox:
- can have risks (i.e. alcohol waithdrawl)
- usually many attempts
- inpatient more successful
- meds may be helpful or necessary
- range of settings- and expense
- Business model - rapid detox (anesthesia for a day and a shot of naltrexone- then deal on your own.
Detox meds
Alcohol: BZD, Phenobarbital, folate and thiamine
Opiates: Clonidine (a2 antagonist), Loperamide(peripheral mu receptor/ anti diarrheal), analgesics
Stimulats: Sleep food water
Stage 2 treatment for addictions
Active treatment:
- separation form substance
- conversion
- lifestyle changes
- family and relationship work
Stage 3 for addiction treatment
Maintainence:
- Often neglected
- Never curative (always a recovering alcoholic, never “normal” again)
- Change and stay changed!
- Meds and aftercare needed
- Personal commitment necessary
Relapse
Common
Often worse than former use- changes in tolerance
High morbidity
Motivational enhancement therapy stages
- Precontemplation: rapport and support of positive changes in progress
- Conetmplation: Encourage ambivalence: show pros and cons of use and treatment. Education
- Preparation: encourage work towards a specific goal
- Action: Continue to encourage and support, possibly recruit family if necessary
- maintainence: Relapse prevention, education, preparation, vigilance
Motivational enhancement therapy
Actions based on stage of abuser, but generally:
*recognize stage, create conditions to enhance patient efforts, Support intrinsic motivation of patient
*Express empathy, develop discrepancy, avoid argumentation, roll with resistance, support self efficacy
12- step approach
- residental centers use this
- confrontation used initially, emphasis on change and personal responsibility: boundries, limits, conseequences
*groups to help with reality testing, vigilence though emphasis is on acceptance not confrontation.
Self help
- can help, can confound
* Most commonly use 12 step model and “smart recovery”
How long should drug abuse treatment last
- Usually >30 days for effectiveness
* Controlled by insurer
Harm reduction approach
- Variety of interventions
- Do not demand sobriety
- Moderation management
- CBT approach; moderate intake- drink by counting
Abuse help medications
Alcohol: Naltrexone, Disulphram, acamprosate, topiramate, baclofen
Opiates: Naltrexone, methadone, buprenorphrine
Nicotine: Nicotine gum, Buproprion, chantax
Cocaine: ???, stimulants?
Opioid intoxication signs
- pupillary constricton
- drowsiness/coma
- slurred speech
- memory and attention impairment
Opioid withdrawl
3 or more within minutes to several days of cessation:
- Dysphoria
- N/V
- Muscle aches
- Pupillary dilation
- Piloerection/ Diaphoresis
- Diarrhea
- yawning
- fever
- insomnia
Bupenorphrine
"suboxone" Given with naloxone orally- naloxone orally inactive *partial mu agonist*** Mixed agonist Effective in pain and addiction SE: nausea and constipation
May need to discontinue for post surgery etc. severe pain and replace with opioids
