Chapter 22 - Substance-Related & Addictive Disorders

Question 1

Substances that lead to use disorders

Answer 1

• Alcohol
• Caffeine
• Cannabis
• Hallucinogens
• Inhalants
• Opioids
• Sedative-hypnotics
• Stimulants
• Tobacco
• Other (Process Addictions): gambling, sex, shopping, etc.

Question 2

What is addiction?

KNOW THIS!!!

Answer 2

• Chronic medical condition
• Individual is dependent on something (toxic or chemical substance)
• Patient has a need for using the substance

Question 3

What is intoxication?

KNOW THIS!!!

Answer 3

using a substance in excess

• causing physical, physiological, & psychological effects

Question 4

What is tolerance?

KNOW THIS!!!

Answer 4

Takes higher doses to achieve the initial / desired level of response

Question 5

What is withdrawal?

KNOW THIS!!!

Answer 5

Symptoms that occur when a person stops using a substance

Question 6

Comorbidities with Subtance-Related & Addictive Disorders

Answer 6

Psychiatric (dual diagnosis)
* 6 out of 10 people

Medical
* EtOH-related medical problems are the most commonly seen comorbiditiy
* DM, Hepatitis C, Psoriasis

Question 7

What is a dual diagnosis?

KNOW THIS!!!

Answer 7

Mental Health Disorder + Substance-Use Disorder

Question 8

Risk factors of substance use disorders

KNOW THIS!!!

Answer 8

• Genetics
• Enviornmental (social & cultural norms; socioeconomics)
• Psychological Factors (lack of tolerance, success, or self-regard, low self-esteem, risk-taking propensity)

Question 9

What is the most widely used psychoactive substance in the world?

Answer 9

Caffeine

Question 10

List different types of inhalants

Answer 10

• Propellants (aerosol paint sprays, hair sprays, & shaking cream)
• Thinners (i.e. for pain products & correction fluids)
• Fuels (i.e. gasoline, propane)
• Solvents (for glues & adhesives)

Question 11

Signs & Symptoms of Opioid Intoxication / Overdose

KNOW THIS!!!

Answer 11

• Coma
• Pinpoint Pupils
• Respiratory depression
• Hypothermia
• Hypotension
• Bradycardia
• Unresponsiveness

Question 12

What is the antidote for opioid intoxication / overdose?

KNOW THIS!!!

Answer 12

naloxone (Narcan)

• Intranasal
• IM
• Subcutaneous
• IV

Question 13

What medications are commonly used for opioid withdrawal?

KNOW THIS!!!

Answer 13

• methadone (Dolphine, Methadose)
• clonidine (Catapres)
• Buprenophine/naloxone

Question 14

What substances are used in sedative, hypnotic, & anti-anxiety medication use disorder?

KNOW THIS!!!

Answer 14

Benzodiazepines
* alprazolam (Xanax)
* clonazepam (Klonopin)
* diazepam (Valium)
* lorazepam (Ativan)

Benzodiazepine-like drugs (Z-hypnotics)
* zolpidem (Ambien)
* zaleplon (Sonata)
* eszopiclone (Lunesta)

Carbamates
Barbituates
Barbituate-like hypnotics

Question 15

What is the treatment for overdose on sedatives, hypnotics, or anti-anxiety medications?

Answer 15

Gastric lavage (pump stomach)

Question 16

What types of drugs are abused / used in stimulant use disorder?

KNOW THIS!!!

Answer 16

• Amphetamine type drugs (amphetamine, methamphetamine, Adderall, Ritalin, etc.)
• Cocaine
• MDMA (ecstasy or molly)

Question 17

What can be done for withdrawal in a patient with stimulant use disorder?

Answer 17

• Diazepam for agitation
• Group & individual therapy

Question 18

How long does cocaine withdrawal take? What medications are often used after withdrawal is complete?

KNOW THIS!!!

Answer 18

1-2 weeks of withdrawal

• Antidepressants are often used once withdrawal is complete

Question 19

A person requests help for cocaine withdrawal symptoms. Which is least likely to be part of the individual’s treatment plan?

a.) Diazepam
b.) Bupropion
c.) In-patient care
d.) Group therapy

Answer 19

c.) In-patient care

Cocaine withdrawal does NOT require in-patient treatment

• Can be a day program, check in regularly, etc.

Question 20

A patient is admitted to the ED experiencing respiratory distress due to opioid overdose. As soon as his respiration is stabilized, which drug should be administered?

a.) Naloxone
b.) Bupropion
c.) Methadone
d.) Clonidine

Answer 20

a.) Naloxone

Question 20

A patient is admitted to the ED experiencing respiratory distress due to opioid overdose. As soon as his respiration is stabilized, which drug should be administered?

a.) Naloxone
b.) Bupropion
c.) Methadone
d.) Clonidine

Answer 20

a.) Naloxone

Question 21

Describe alcohol use disorder

KNOW THIS!!!

Answer 21

initial euphoria –> sedation

• 2x prevalence in men than women
• Most common in American Indians / Alaskan Natives

Question 22

List comorbidities associated with alcohol use disorder

KNOW THIS!!!

Answer 22

• Bipolar disorder
• Schizophrenia
• Antisocial personality disorder
• Major depressive disorder

Question 23

What is the difference in binge drinking & heavy drinking?

KNOW THIS!!!

Answer 23

Binge Drinking: drinking too much too quickly (large amount at once)
* Men = 5+ drinks in 2 hours
* Women = 4+ drinks in 2 hours

Heavy Drinking: drinking too much too often (too much for a long period of time / too often)
* Men = 14+ drinks in 1 week
* Women = 8+ drinks in 1 week

Question 24

**What is the legal definition of alcohol intoxication?** | **KNOW THIS!!!**

Answer 24

Blood alcohol level of **0.08 - 0.10 g/dL**

Question 25

**Systemic effects from EtOH Use Disorder**

Answer 25

* Peripheral neuropathy * EtOH myopathy & cardiomyopathy * Esophagitis, gastritis, pancreatitis * EtOH hepatitis * Cirrhosis of the liver * Leukopenia * Thrombocytopenia * Cancer (head & neck)

Question 26

**What is CAGE screening for alcohol use disorder?** **What is the difference in CAGE & CAGE-AID Screening?** | **KNOW THIS!!!**

Answer 26

**C**utting down **A**nnoyed / criticized by others for your drinking **G**uilty **E**ye-opener (drink first thing in AM) ## Footnote **CAGE-AID = **screening for **EtOH & other drugs** **CAGE = **screening for **EtOH**

Question 27

**What is codependence?** | **KNOW THIS!!!**

Answer 27

* Co-dependent person** feels they are responsible for the individual who is using** * **Define their worth by caring for others** * Put their own needs aside

Question 28

**Treatment for alcohol use disorder** | **KNOW THIS!!!**

Answer 28

**Medications:** * naltrexone * benzodiazepines * **disulfiram (Antabuse) - will make patient sick if they use alcohol when taking this medication** * Therapy * Motivational interviewing

Question 29

**What is the most common medication used for the treatment alcohol use disorder & how does it work?** | **KNOW THIS!!!**

Answer 29

**disulfiram (Antabuse): makes the patient feel sick if they use alcohol while taking it** * avoid mouthwash with EtOH in it

Question 30

**What are the transtheoretical stages of change theory?** | **KNOW THIS!!!**

Answer 30

**1.) Precontemplation** (not ready to change) **2.) Contemplation** (deciding if they need to change their habits**;** considering change) **3.) Preparation** (preparing to change & start program) **4.) Action** (doing the work in order to change, participating in therapy, AA, NA, etc.) **5.) Maintenance** (continuing sobriety)

Question 31

**A nurse is assigned the care of 4 patients who are detoxifying from alcohol. The patient with which symptom would be the nurse's highest priority?** **a.)** Fine motor tremor **b.)** Diaphoresis **c.)** Diarrhea **d.)** Hallucinations & delusions

Answer 31

**d.) Hallucinations & delusions** ## Footnote Individual is unpredictable * they may act out, be aggressive or agitated or violent -- need to take this seriously & prioritize their care