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Behavioral Dynamicssss > Lecture 9 (substance abuse) brendans > Flashcards

Lecture 9 (substance abuse) brendans Flashcards

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1
Q

Define substance.

A

Alcohol, tobacco, illicit drugs or improperly used medication

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2
Q

Define substance use.

A

Sporadic consumption with no major adverse consequences

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3
Q

Define at-risk substance use.

A

Consumption that risks major adverse consequences

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4
Q

Define codependency.

A

Condition characterized by an individual who is significantly affected by another person’s substance use or addiction

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5
Q

Define substance abuse.

A

Maladaptive use causing impairment or distress over a 12-month period where 1+ of the following has occurred.

Failure to fulfill major role obligations
Use of drugs in hazardous situations
Recurrent legal problems due to substance use
Continued drug use despite persistent social or interpersonal
problems because of use

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6
Q

Define dependence.

A

State of adaptation manifested by a substance class-specific withdrawal syndrome

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7
Q

what can withdrawal be produced by?

A

Rapid dose reduction or cessation of a substance
Administration of an antagonist
Increased Tolerance to the substance

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8
Q

What types of dependence are there? (2)

A

Psychological dependence
Physiologic dependence

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9
Q

Define addiction.

A

Primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations

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10
Q

What behaviors characterize addiction?

A

Impaired control over substance use
Compulsive substance use
Continued substance use despite harm
Craving for substance

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11
Q

What is the difference between substance use and dependence/addiction?

A

Substance use a person still has control of their own use

Dependence/addiction: pts don’t have full control

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12
Q

What often predates the initial substance use?

A

Measurable brain abnormalities
thought to be genetically predisposed

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13
Q

How does substance use affect our hormones?

A

Affect dopamine levels in mesolimbic system

Changes are often permanent

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14
Q

Define substance use disorder.

A

Maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2+ defining conditions within a 12-month period

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15
Q

What percentage of pts 12yrs and up with any illicit dug use in the past month? lifetime?

A

14% over 1 in 10
49% in lifetime about half

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16
Q

What percentage of pts 12 years and u p with marijuana use in the past 1 month? lifetime?

A

13% (over 1 in 10)
45% (almost half)

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17
Q

How many people are unaware that they have a substance abuse problem?

A

95%

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18
Q

alcohol or drug use is involved in ____% of medical admissions and ____% of psychiatric admissions

A

14%
26%

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19
Q

Who are the highest risk for substance abuse?

A

Late teens and early 20s

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20
Q

What increases the risk of later addiction?

A

The lower the age of first use

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21
Q

what is the lifetime prevalence of ETOH use in patients 12+

A

almost 4 out of 5 (78%)

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22
Q

what is the prevalence of ETOH use in the past 12 months of patients 12+

A

almost 2 out of 3 (62%)

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23
Q

what is the prevalence of ETOH use in the past 12 months in patients ages 12-20?

A

1 in 10 (15%)

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24
Q

how does being male impact drinking ETOH

A

Males are 2x as likely to participate in binge drinking and 3x as likley to participate in heavy drinking

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25
what is the lifetime prevalence of cigarette or vape use in patients 12+
over 1 out of 2 patients (58%)
26
what is the prevalence of patients 12+ using cigarettes or vapes in the past 1 year
over 1 out of 5 (26%)
27
What are young adults now likely to use instead of cigarettes?
Vaporized cigarettes (vapes)
28
What is the #1 substance for dependence and abuse?
Alcohol
29
What it he most expensive substance abuse cost on society?
Tobacco
30
What is the most leading preventable cause of death in the US?
Tabacco
31
What medical conditions arise from substance abuse?
Hepatitis Cirrhosis HIV/AIDS Sexually Transmitted Infections (STIs) Motor vehicle crashes/fatalities
32
What social conditions arise from substance abuse?
Teenage pregnancy Domestic violence Child abuse Physical fights Overall crime Homicide/Suicide
33
What are some risk factors for substance use?
Substance factors Societal influence Static pt demographics Modifiable pt demographics Personality traits Associated psychiatric disorders
34
What are the substance factors?
Early onset tobacco use Early experimentation with substances Type of substance tried
35
What are the societal influence factors?
Family Peer groups Religious groups Cultural and societal norms
36
What are the static patient demographics factor?
Male gender Black, AI/AN or NHOPI ethnicity1 Gay or lesbian status Genetic predisposition
37
What are the the modifiable pt demographics factors?
Low socioeconomic status Single or divorced Low educational level Violent or high-crime neighborhood Personal history of abuse
38
What are the patient personality traits factors?
Risk-takers, thrill-seekers, novelty seekers Poor impulse control or emotional control Difficulty relating to others
39
What are the associated psychiatric disorders with increased substance use risk?
Conduct disorder MDD or Bipolar disorder ADHD Antisocial personality disorder
40
Why do people use substances?
To feel good/better (experience new feelings, and lessen anxiety) To fit in (peer pressure)
41
How does anandamide affect the brain?
NT involved in regulation of pain, appetite, memory, mood
42
What is THC?
Active ingredient in marijuana
43
What is similar about THC and anandamide/
Similar chemical structure
44
What hormones does drug abuse affect?
Dopamine Serotonin Glutamate Endorphins GABA
45
What is the function of Dopamine?
Movement, motivation, reward, 
addiction, well-being
46
What is the function of serotonin?
Mood, memory, sleep, cognition
47
What is the function of glutamate?
Learning, memory
48
What is the function of endorphins?
Lessened pain, euphoria
49
What is the function of GABA?
Relaxation, anxiolytic
50
What are other naturally rewarding things?
Food Sex Exercise Excitement Comfort
51
What do nearly all drugs of abuse have in common?
Increase dopamine levels Affect serotonin and glutamate levels
52
What are common cognitive defects with addiction?
Short-term memory loss Impaired abstract thinking Impaired problem-solving strategies Loss of impulse control ...similar to those defects seen in brain damage
53
What are the 3 C's of addiction?
Control Compulsion Chronicity
54
What are control factors?
Early social & recreational use Eventual loss of emotional & behavioral control Cognitive distortions (denial and minimization) Tolerance and withdrawal
55
What are compulsion factors?
Drug-seeking activities and craving → addiction Continued use despite adverse consequences
56
What are chronicity factors?
Natural history of multiple relapses preceding stable recovery Possible relapse after years of sobriety
57
How does mental illness relate to substance use?
Self-medication (try to alleviate symptoms of mental illness) Casual effects (increase vulnerability to mental illness) Correlated causes (similar risk factors for substance abuse and mental illness)
58
How many substance abuse pts have a mental disorder?
50%
59
What is the opponent-process theory?
Process (either pleasant or unpleasant) has a 2ndary opponent(opposite) process that sets in after With repetition, the primary gets weaker while opponent process is strengthened
60
How does drug addiction work over time?
Early: high pleasure, low withdrawal Overtime: pleasure decreases, withdrawal increases
61
How do we treat drug addiction?
Interfering the cycle of withdrawal and use??
62
What other disorders are alcohol-related disorders commonly associated with?
Mood disorders(depression) Anxiety disorders Suicide Personality disorders
63
Define at-risk drinking.
Repetitive use of alcohol, often to alleviate emotional problems
64
What is considered at-risk drinking for men?
15+/week Moderate: 1-2/day Binge: 5+/single occasion
65
What is considered at-risk drinking for women?
8+/week Moderate: 1/day Binge: 4+/day
66
What is considered at-risk drinking for elderly?
1+/day 7+/week
67
What is considered 1 "drink"
0.5-0.6oz of alcohol Beer: 12oz 4% Malt liquor: 8oz 7% Wine: 5oz 12% Hard liquor: 1.5oz(1shot) 40%
68
How much alcohol can a liver process?
0.5oz/hr
69
What is the telescoping effect?
Faster timeline from 1st drink to alcohol dependence?
70
Who is seen with the telescoping effect?
Women who use alcohol
71
Why are women more likely to be seen with the telescoping effect?
Lower EtOH dehydrogenase Lower total body water Smaller volume of distribution Drink like partner
72
What specific psychiatric disorder is associated with alcohol-related disorders?
Depression
73
Who are likely to have alcohol-related disorders?
Males 4:1 Women are more likely to delay seeking help
74
What is the 3rd leading preventable cause of death in the US?
Excessive alcohol use
75
What are some effects of alcohol addiction?
Recurrent alcohol use despite disruption of social roles Alcohol-related legal problems Taking safety risks
76
What are risk factors for alcohol dependence?
Male White, NA Younger age (18-29) Single Low income Past exposure to adverse events (military combat deployment) Genetic disposition Significant disability Psych disorders(SUD, depression, BPD, personality d/o)
77
What are the key questions for Cage(screening substance abuse)?
Cutdown Annoyed Guility Eye opener
78
How many "yes" do you need for the cage-aid questionnaire?
2+: need a more in depth assessment 1+: possible substance use
79
What other screening tools can we use to determine substance abuse?
Alcohol Use Disorders Identification Test (AUDIT) Drug Abuse Screening Test (DAST-10) NIDA Quick Screening Tool
80
What is the MOA of alcohol?
Crosses BBB Acts as a sedative-hypotonic substance Affects CNS receptors (GABA, NMDA(glutamate), 5HT-3(serotonin) Facilitates dopamine release Suppression of inhibitory control systems
81
What drug also affects GABA receptors?
Benzodiazepines
82
What are effects of alcohol?
Psychomotor dysfunction (disinhibition, dysarthria, ataxia, nystagmus, memory lapses) N/V Drowsiness; fragmented sleep Respiratory depression Hypoglycemia Severe: stupor, coma, death
83
What are symptoms of 0.05% BAC?
Thought, judgement, and restraint are loosened
84
What are symptoms of 0.1% BAC?
Voluntary motor actions become clumsy
85
What are symptoms of 0.2% BAC?
Depression of motor control and emotional control areas of brain
86
What are symptoms of 0.3% BAC?
Confusion, stupor
87
What are symptoms of 0.4-0.5% BAC?
Coma; respiratory depression
88
What are effects of alcohol withdrawal?
Decreased cognitive function Tremulousness Anxiety, irritability, and hyperreactivity Nausea and vomiting Delirium Tremens
89
What are symptoms of delirium tremens?
Prolonged ETOH consumption → fewer GABA receptors Unopposed sympathetic nervous system activity Neuro: confusion, tremor, seizures, sensory hyperacuity, hallucinations, hyperreflexia Psych: anxiety, agitation, panic attacks, paranoia Diaphoresis, dehydration, electrolyte abnormalities
90
What are the affects of chronic use of alcohol?
Wernicke encephalopathy Korsakoff psychosis GI symptoms Cardiac Cancer Endocrine
91
What are the affects of chronic use of alcohol?
Wernicke encephalopathy Korsakoff psychosis GI symptoms Cardiac Cancer Endocrine
92
How does wernicke encephalopathy present as?
Confusion, ataxia, opthalmoplegia Impaired vision/hearing, psychological dysfunction, memory deficit, hypothermia, hypotension
93
How do we treat wernicke encephalopathy?
Thiamine other B vitamins *Can be completely reversible with treatment*
94
What are symptoms of Korsakoff psychosis?
Amnesia: anterograde and retrograde Aphasia, apraxia, agnosia *20% are reversible*
95
How is the liver affected with chronic alcohol use?
Fatty liver Alcoholic hepatitis Cirrhosis
96
How is the vascular system affected with chronic alcohol use?
Portal HTN, varices
97
How is the pancreas affected with chronic alcohol use?
Pancreatitis Pancreatic insufficiency Cancer
98
How is the GI affected with chronic alcohol use?
Esophagitis Gastritis Gastric ulcers Cancers
99
How would labs be affected with chronic alcohol use?
Increased GGT, AST/ALT (ratio >2:1)
100
How is the CV system affected with chronic alcohol use?
HTN Increase HR Increased myocardial O2 consumption
101
Where are the cancers formed from chronic alcohol use?
Head/neck Esophageal Liver Breast Colorectal Pancreas
102
How are the endocrine systemic affected from chronic alcohol use?
Dysregulation of lipoproteins and triglycerides
103
What are the stages of liver damage?
Fatty liver (deposits of fat cause liver enlargement) Liver fibrosis(scar tissue forms) Cirrhosis(connective tissue destroys liver cells0
104
When does alcohol withdrawal occur, when are the peak intensity of symptoms?
8-12hours 48-72hours
105
What is the main treatment for alcohol withdrawals? Examples?
Benzodiazepines(BZDs) Diazepam(valium), lorazepam(altivan), chlordiazepoxide (Librium), Gabapentin or carbamazepine (Tegretol)
106
What are anti-hypertensives we give to alcohol withdrawal pts?
Clonidine Atenolol
107
What nutritional supplements can we give to alcohol withdrawal supplements?
B vitamins, vitamin C DONT give IV glucose before giving thiamine supplementation Fluid replacement PRN
108
How do we assess withdrawal severity?
CIWA scoring Facilities own standardized protocol
109
What are the stages of security for withdrawals?
Mild Moderate Severe
110
What type of consolation does a withdrawal pt may need?
Social work Psychology
111
What can be given to treat chronic use?
Thiamine Naltrexone Acamprostae(Campral) (first-line) Disulfiram(Antabuse) (2nd-line)
112
What are SE of thiamine use?
Low BP Affect glucose metabolisms (rare) anaphylaxis, bronchospasm
113
What is the MOA of naltrexone?
Blocks release of dopamine in the brain Antagonist at Mu receptors in brain (decrease craving and reward)
114
What is naltrexone usually given together with?
Behaviorally therapy Acamprosate SSRI
115
What is the BBW for naltrexone?
Hepatocellular injury Heptotoxicity
116
What are the SE of naltrexone?
N/V/D/C Abd pain Dizziness HA Anxiety Fatigue
117
What is CI in naltrexone?
Hx if hypersensitivity Opioid dependence on current use
118
What does naltrexone have drug interactions with?
Opiates
119
What do you have to monitor when taking neltrexone?
Liver function tests
120
What is the MOA of acamprosate?
Restore normal glutamate action Interferes with glutamate release stopping excitation that happens with withdrawal Affects GABA NT *Same rates of return to drinking/return to heavy drinking as naltrexone*
121
What is the SE of
122

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