ADDICTION

Question 1

In order to diagnose a substance use disorder, there must be significant impairment or distress as manifested by at least 2 ways within a 12-month period. What are the 11 ways?

Answer 1

Taking in larger amounts or over a longer period of time than intended.
Persistent desire or unsuccessful efforts to cut down.
Significant time is spent in activities necessary to obtain substance
Craving
Tolerance
Withdrawal
Failure to fulfill major role obligations at work, school, or home
Continued use despite social or interpersonal problems
Recurrent use in situations that are physically hazardous
Continued use despite knowledge of having persistent problem

Question 2

What is physical dependence?

Answer 2

Withdrawal symptoms in the absence of the drug

Question 3

What is addiction?

Answer 3

A neurobiologic disease with genetic & psychosocial contributions leading to compulsive use and cravings despite harmful consequences

Question 4

What are host factors to addiction & dependence?

Answer 4

Genetics, hereditary, improperly treated chronic pain, unhealthy behavioral patterns as learned from childhood experiences, and social forces

Question 5

What often prevents those with addiction/dependency issues to enjoying fulfilling and enjoyable lives?

Answer 5

Stigma is a barrier to gainful employment and rewarding social contacts

Question 6

What is more than half of alcohol related deaths are due to?

Answer 6

Binge drinking

Question 7

What form of opiate use is increasing in the US?

Answer 7

Heroin

Question 8

At what point do you screen a patient for substance use problems

Answer 8

Report new or increasing difficulty with work, relationships, or legal issues. Areas of high prevalence; screen before prescribing a potentially addictive medication; during routine physical exams

Question 9

If you are interviewing a substance user, what do you need to as

Answer 9

Drug of choice; route of administration; first use; when did it become a problem; most recent pattern of use; last use; other substances; negative consequences of use (been arrested/work or family problems); what is a perceived benefit; prior treatment

Question 10

What are some other important factors you should consider with a substance user?

Answer 10

Social/sober support; Home Environment; Use in a significant other or family member; Mental health issues; prior suicide.

Question 11

In general, how do we treat substance abuse?

Answer 11

Inpatient care (detox); residential programs; partial hospitalization program (PHP); intensive outpatient program (IOP); outpatient visits; support groups; and Medications

Question 12

What type of medication can you prescribe to prevent the cravings?

Answer 12

Naltrexone & Baclofen (is on the $4 list)

Question 13

At what point of treatment is critical to treating substance use?

Answer 13

The first few weeks! Along with regular attendance to receive better outcomes

Question 14

What types of factors influence relapse?

Answer 14

co-morbid psychiatric issues; sleep difficulties; poor social support; low motivation; high levels of personal stress/low stress tolerance; previous Hx; and continued use of substance early in treatment

Question 15

What does excessive alcohol use lead to clinically?

Answer 15

HTN or arrhythmias (Holiday Heart à Afib), GI problems, neuropathy, liver disease, bone marrow suppression, electrolyte disturbance; pancreatitis; immunosuppression; increased risk of CA; exacerbation of depression or anxiety

Question 16

What are the sxs of withdrawal?

Answer 16

Tremor, seizure, alcohol hallucinosis, delirium tremens; unstable vitals, encephalopathy, alcoholic ketoacidosis, liver failure, GI bleed, death

Question 17

If a patient has disorientation, inattentiveness, oculomotor dysfunction, gait ataxia – what is occurring? What would you see on labs? Why?

Answer 17

Withdrawal; Wernicke encephalopathy. Due to ACUTE, metabolic brain damage relating to a THIAMINE deficiency

Question 18

What is the chronic consequence of wernicke encephalopathy?

Answer 18

Korsakoff Syndrome

Question 19

How do you treat Wernicke Encephalopathy?

Answer 19

Give Thiamine

Question 20

What 2 neuronal dysfunctions are occurring in ETOH withdrawal?

Answer 20

GABA & Glutamate

Question 21

Which neuronal dysfunction is excitatory & inhibitory?

Answer 21

Excitatory = Glutamate – Sudden cessation leads to increased excitatory activity
Inhibitory = GABA – this is how TOLERANCE develops (without alcohol no brakes left in the body) similar to benzos

Question 22

When you see a patient with tremor, seizure, and unstable vitals – you think it is withdrawal, but what do you need to do?

Answer 22

R/O ALTERNATE PATHOLOGY (trauma injury, CNS lesion, GL bleed, meningitis, thyrotoxicosis, drug overdose, sepsis)

Question 23

What kind of labs do you order when someone is going through withdrawal?

Answer 23

Serum ETOH CBC, CMP, Mg, Phosphorus, UA, UDS
Lipase, PT/INR, ammonia level, TSH
EKG & Imaging

Question 24

What does low Mg levels cause?

Answer 24

VTACH! (AKA death

Question 25

How do we treat alcohol withdrawal?

Answer 25

IV fluids! Vitamins (Thiamine, Mg, K), electrolytes, PRN meds (nausea, pain, GI for high acid levels, anxiety)
Control seizure (benzos)
 Need a really good discharge plan

Question 26

If we believe a patient is withdrawing from opiates, what do we need to look for during PE & labs?

Answer 26

Test for pregnancy
Assess injection sites for infection
STD testing
Hep C!!

Question 27

How do you treat opiate withdrawal?

Answer 27

Treat symptoms (muscle aches, stomach cramps, diarrhea, constipation) make sure they’re not due to anything else!
 Opiate replacement = suboxone, subutex (for preggo), methadone (hard to stop, daily clinic visits)

Question 28

How do you treat opiate withdrawal?

Answer 28

Treat symptoms (muscle aches, stomach cramps, diarrhea, constipation) make sure they’re not due to anything else!
 Opiate replacement = suboxone, subutex (for preggo), methadone (hard to stop, daily clinic visits)

Question 29

What is best to not ask an addict to do at the same time as they quit their substance?

Answer 29

Don’t ask them to quit smoking at the same time…

Question 30

If you learn that a healthcare provider is utilizing substances, what must you do?

Answer 30

You have a duty to report

Question 31

If a patient is on Ambien what MUST we educate them about?

Answer 31

Increased risk of death when combined with other sedatives or alcohol!!