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Flashcards in Addiction IV Deck (26)
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summarize intoxication vs withdrawal on sedatives and stimulants


describe withdrawal from major stimulants

  • withdrawal
    • dysphoric mood (MUST BE SEEN)
    • fatigue and psychotomor slowing 
    • hypersomnia with vivid unpleasant dreams
    • increased appetite

note: overall, these symptoms are non-life threatening and thus considered relatively mild; no FDA-approved drug for stimulant addiction


describe ecstasy/MDMA

  • stimulant effects PLUS mild hallucinogenic effects (perceptual alterations)
    • common things look more interesting
    • empathogenesis
    • concern about neurotoxicity
    • other health consequences (e.g. hyperthermia)
    • reputation as a safe drug despite Schedule I status 


describe bath salts

  • designer drug containing, in part, amphetamine-like chemicals (MDPV)
  • acute toxicity includes:
    • agitation
    • paranoia
    • hallucinations
    • chest pain, tachycardia, hypertension
    • suicidality


describe nicotine (intoxication and withdrawal)

  • intoxication: DSM-5 does not recognize a category for nicotine intoxication
  • withdrawal
    • dysphoric mood
    • restlessness, anxiety
    • difficulties concentrating
    • irritability, anger
    • increased appetite 
    • decreased heart rate


describe treatment of nicotine use disorder

  • nicotine replacement therapies (e.g. gum)
    • these contain low amounts of "healthy" nicotine to decrease craving
  • buproprion (Zyban) and verenicline (Chantix)
    • there is a black box warning on these drugs due to reports of suicidal, erratic behavior for both drugs


describe caffeine (intoxication and withdrawal)

  • intoxication: typically after a dose of > 250 mg of caffeine
    • increased energy, insomnia, nervousness
    • rambling thoughts
    • tachycardia
    • diuresis, GI disturbance, muscle twitches
  • withdrawal
    • headache
    • dysphoria
    • fatigue
    • decreased concentration


DSM-5 does not recognize a "____-use" as a disorder

DSM-5 does not recognize a "caffeine-use" as a disorder


list the classic hallucinogens, cannabis and dissociative anesthetics


describe the main perceptual alterations seen with usage of classic hallucinogens, cannabis and dissociative anesthetics

  • classic hallucinogens = hallucinations
  • cannabis = distortions
  • dissociatve anesthetics = depersonalization


describe the classic hallucinogens

  • LSD is one of the most potent hallucinogens and is long lasting (8-12 hrs)
  • key symptoms:
    • visual, poorly formed hallucinations (unlike those in schizophrenia)
    • mydriasis (dilation of pupil)
  • no withdrawal syndrome is recognized 


describe hallucination persisting perception disorder

  • LSD is associated with "flashback" perceptual experiences long after LSD is metabolized
    • example symptoms:
      ​false perceptions of movement
    • intensifications of color


describe cannabis intoxication

  • psychological
    • perceptual distortions (e.g. intensification of senses, perception of slowed time)
  • physical
    • conjunctival injection
    • increased appetite
    • dry mouth


describe cannabis withdrawal

  • psychological
    • irritability and nervousness
    • dysphoric mood
    • sleep disturbance (insomnia, vivid dreams)
    • decreased appetite
  • physical
    • headaches, night sweats, stomach cramping, shakiness


describe dissociative anesthetics intoxication

  • intoxication
    • depersonlization
    • agitation, belligerence and confusion
    • impulsivity and unpredictability
    • nystagmus, hyperacusis
    • decreased responsiveness to pain
    • ataxia, muscle rigidity, seizures, coma


describe treatment of dissociative anesthetics acute intoxication

PCP intoxication is a psychiatric emergency because of violent and unpredictable behaviors

  • treatment of acute intoxication:
    • benzodiazepines/antipsychotics
    • reduced environmental stimulation
    • restraint may be needed
  • no withdrawal syndrome is recognized


summarize the hallucinogens and related substances (perceptions, symptom severity, eyes, behavior)


describe opioid intoxication

  • intoxication
    • initial intense rush followed by:
      • euphoria and drowsiness
      • dysphoria (as the high dissipates)
    • miosis 
    • unconscious
    • respiratory depression 
  • treatment of OD
    • naloxone (Narcan): a short-acting opioid receptor is not used for addiction treatment


describe opioid withdrawal

  • withdrawal
    • dysphoria
    • nausea, vomiting, diarrhea
    • muscle aches, lacrimation and rhinorrhea
    • piloerection, sweating, fever
    • yawning
    • pupillary dilation
  • although withdrawal is usually non-life threatening, opioid use is deadly from OD and from the health hazards associated with opioid addiction


describe abstinence-based therapy for opioid treatment

  • requires patient to be completely abstinent from opioid drugs
  • often involves use of naltrexone (a long-acting opioid receptor blocker) to block opioid effects if relapse occurs
  • tends to be unsuccessful


describe replacement therapy  for opioid treatment

  • involves giving patient a safer opioid durg (methadone or buprenorphine)
  • tends to be more successful than abstinence-based therapies


what is the rationale for replacement therapy in opioid treatment?

  • chronic, heavy opioid use results in:
    • anhedonia (due to reduced dopamine availability)
    • physical discomfort (due to reduced availability of endogenous opioids)
  • these combined effects make abstinence a difficult goal to achieve, therefore replacement therapy helps


describe methadone

  • methadone (a Schedule II opioid drug)
    • when used for addiction treatment, methadone:
      • is only available at an official federally-regulated Opioid Treatment Program (OTP)
      • cannot be "prescribed"; it can only be administered or dispensed at an OTP


describe buprenorphine (a Schedule III opioid drug)

  • buprenorphine
    • when used for addiction treatment, buprenorphine:
      • is available from a doctor's office after approval by the DEA
      • can be "prescribed", "administered" or "dispensed" from a doctor's office
  • note: Suboxone = buprenorphine + naloxone 
    • released only if medication is abused


describe duration and benefits of replacement therapy in opioid treatment

  • RT usually continues for at least 1-2 years
  • benefits of RT:
    • oral administration
    • stable drug levels
    • less euphoria and less drowsiness
  • RT (plus other interventions) results in healthier, productive and less crime-causing heroin addicts


summarize intoxication vs withdrawal of sedatives, stimulants, hallucinogens & related drugs, and opioids