Substance Use Disorders Flashcards
What happens to the concentration of D2 receptors in the striatum (i.e. nucleus accumbens) during addiction and why?
The concentration is decreased -> addictive substances cause massive amounts of dopamine to be released into Nucleus accumbens initially, until D2 receptors are downregulated -> addiction (from repeated overstimulation of D2 receptors)
What are the 11 behavioral criteria for any substance use disorder in the DSM?
- More excessive use than intended
- Persistent desire to control use
- Lots of time dedicated to finding, taking, and recovering from the drug
- Craving drug
- Failure to meet obligations of life
- Recurrent social / interpersonal problems because of drug
- Activities are given up / reduced for drug
- Use of alcohol where it is hazardous (i.e. DUI)
- Continued use despite knowledge that it is causing problems
- Tolerance
- Withdrawal
How is tolerance defined?
Need for markedly increased amounts of substance to achieve intoxication or desired effect
How many of the 11 symptoms need to be a present for a mild, moderate, and severe substance use disorder?
Mild: 2-3 symptoms
Moderate: 4-5 symptoms
Severe: 6+ symptoms
What is considered moderate, at risk, and heavy drinking for males? This is, number of drinks per day. Females?
Moderate = 2 drinks a day
At risk = 4+ drinks a day
Heavy = 5+ drinks a day
Females is 1 less than this in all categories.
What is standard drink size for beer, wine, and liquor?
Beer - 12 oz
Wine - 5 oz
Liquor - 1.5 oz of 80 proof
What is the legal limit for driving in Michigan? When does voluntary movement become clumsy? When do you go into coma?
Legal limit = 0.08%
Clumsy movement = 0.1%
Coma = 0.4%
What happens to the eyes even in mild alcohol intoxication?
Nystagmus
What happens during severe alcohol intoxication?
Aggressiveness, labile mood, psychomotor retardation, blackouts!
What is a blackout, and is it predictive of longterm cognitive impairment?
Blocked consolidation of memory between hipoocampus and temporal lobe
-> not predictive of longterm cognitive impairment
What are some common behavioral and physical signs of alcohol withdrawal?
Behavioral: Anxiety, agitation, hallucinations
Physical: Autonomic hyperactivity (increased HR / BP due to lack of depressant), sweating, seizures, tremor, N/V
What is the rough timeline of withdrawal symptoms for alcohol?
6 hours - tremor
8 - 12 hours - visual hallucinations
12-24 hours - seizures
72 hours - delirium tremens (preventable)
What is Delirium tremens / its symptoms?
Delirium (confusion, disorientation) + physical symptoms of alcohol withdrawal.
Can be fatal due to cardiovascular collapse and hypothermia
What is the best catch-all screening questioning for alcoholism?
How many times in the past year have you had 5+ drinks in 1 day (4 for women)?
What is CIWA / what is it used for?
Clinical Institute Withdrawal Assessment of alcohol scale
-> used for rating patient’s withdrawal symptoms on a scale and monitoring them
What are the CAGE questions? When might you have a disorder?
Have you ever thought about CUTTING down?
Have you ever felt ANNOYED by people criticizing the drinking?
Have you ever felt GUILTY about your drinking?
Have you ever used a drink as an EYE-OPENER? (to alleviate morning hang-over / nerves) -> counts as 2
2+ points = probably AUD
All 4 questions yes = diagnostic
What is AUDIT?
Alcohol Use Disorder Identification Test - screening questions used to assess a possible AUD
What liver enzymes suggest alcoholic liver damage vs viral hepatitis?
Elevated AST > ALT, ratio of AST:ALT is increased.
Also, elevated GGT levels
Why is uric acid increased in alcohol?
Beer has high uric acid levels
What are the symptoms of Wernicke’s encephalopathy? Is it reversible? What is the main symptom of Korsakoff’s dementia?
Yes - reversible with vitamin B1
ACO Ataxia Confusion Ophthalmoplegia (lateral gaze paralysis) Vestibular dysfunction
Korsakoff’s - Anterograde amnesia compensated w/confabulation
What is alcohol-induced psychotic disorder and how does it differ from delirium?
Psychotic symptoms in chronic alcohol users within a week of intoxication or withdrawal
-> differs from delirium in that sensorium is clear
How does alcohol affect sleep?
Reduced sleep latency, middle insomnia occurs, decreased REM, and inhibition of stage 4
When do people typically first start using tobacco, and is this more of a problem in men or women?
Age 12-13 years
Dependence occurs in 3-4 weeks, worse of a problem in women than men
Why do users often report relaxation with nicotine use, and when is the craving the strongest?
Because they are alleviating their withdrawal symptoms -> nicotine shouldn’t relax you, it’s a stimulant which increases adrenaline and head rush
Craving strongest in AM (8 hours of withdrawal)
What are the characteristics of nicotine overdose and when is it most likely to occur?
Most likely to occur during cessation -> too much gum / patches
GI distress, vomiting, cold sweats, seizures, arrhythmias (pretty much the same as alcohol withdrawal)
How long does nicotine withdrawal last and what are its key symptoms?
Lasts 1-3 months, peaking 2-3 days.
Tingling of hands and feet, insomnia, difficult concentrating, sweating
How is oil extracted from cannabis? Is this easy to do?
Via using a solvent like butane
Not easy to do -> dangerous like meth labs?
What is the “crack” of marijuana
Dabbing, smoking concentrated (75%) THC which is extracted via the process just mentioned, called shatter or wax
What are the common behavioral effects of cannabis?
Decreased goal-directed mental activity, relaxation, slowed sense of time, heightened sensitivity to external stimuli (smell, sound, taste), anterograde amnesia, increased appetite
