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Lecture 9: Substance Abuse Part 1 Flashcards

1
Q

What are the two types of substance uses?

A

Substance use, which is just sporadic consumption with NO MAJOR ADVERSE COMPLICATIONS.
At-Risk Substance use, which is consumption that risks MAJOR ADVERSE COMPLICATIONS.

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2
Q

Define codependency.

A

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

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3
Q

What qualifies as substance abuse?

A

At least ONE of these occurring over a 12-month period:
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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4
Q

Define dependence.

A

State of adaptation manifested by a SUBSTANCE CLASS SPECIFIC WITHDRAWAL SYNDROME.

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5
Q

What 3 things can cause withdrawal syndromes?

A

Rapid dose reduction or cessation of a substance. (EX: You try to quit alcohol cold turkey and you get the DTs)
Administration of an antagonist (EX: you get narcan and start withdrawal symptoms instantly.)
Tolerance to the substance (EX: you keep upping your dose to get the same high)

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6
Q

What are the two types of dependence?

A

Psychological
Physiological

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7
Q

Define addiction.

A

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

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8
Q

What 4 things characterize addiction?

A

Impaired control over substance use
Compulsive substance use
Continued substance use DESPITE HARM
Craving for substance

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9
Q

What is the key difference between substance use and dependence or addiction?

A

Pts have control of their use in substance use.

Once they start having changes that affect their dopamine levels in the mesolimbic system, it becomes much harder to control their desires consciously.

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10
Q

How many criteria do you need to meet to have a substance use disorder according to the DSM V TR?

A

2+

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11
Q

How common is illicit drug use?

A

12+ have used an illicit drug at least once in the past month. AKA 1 in 10 (14%)

49% of people use illicit drugs at least once in their life.

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12
Q

How common is marijuana use?

A

Almost identical to illicit drug use stats.
12+ in past month are 1 in 10 or 13%.
45% of people have used marijuana in their lifetime.

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13
Q

How unaware are people of their substance abuse problem?

A

95% ):

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14
Q

When are people most at risk of become addicted?

A

Late teens and early 20s.

The lower the age of their first use, the higher the risk of a later addiction.

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15
Q

What is the second most common illicit drug use after marijuana?

A

Opioids.

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16
Q

How has drinking prevalence changed since 2021?

A

Decreased in current and binge drinking

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17
Q

What is the lifetime prevalence of ETOH use?

A

4 out of 5, 78% of pts 12+.

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18
Q

How common is ETOH use in the past year? In the past year for ages 12-20?

A

2 out of 3 overall (62%)

1 in 10 for underage drinking. (15%

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19
Q

What demographic is more susceptible to binge drinking and heavy drinking?

A

Males.
2x binge drinking likelihood.
3x heavy drinking likelihood.

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20
Q

How common is lifetime cigarette/vaping use?

A

1 out of 2 pts (58%)

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21
Q

How common is cigarette/vaping use in the past yr for 12+?

A

1 out of 5 (26%)

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22
Q

What is the #1 substance for dependence and abuse in the US?

A

Alcohol.

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23
Q

What is the leading preventable cause of death in the US?

A

Tobacco.

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24
Q

How much does substance abuse cost us annually?

A

800b

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25
What are the 3 risk factors for substance use that are substance factors?
Early onset tobacco use Early experimentation with substances Type of substance tried.
26
What associated psychiatric disorders are risk factors for substance use?
Conduct disorder MDD or bipolar disorder ADHD Antisocial personality disorder
27
What NT does THC mimic?
Anandamide
28
What are the 5 NTs that drugs affect?
Dopamine Serotonin Glutamate Endorphins GABA
29
What does dopamine do?
Movement, motivation, REWARD, ADDICTION, well-being
30
What does serotonin do?
Mood, memory, sleep, cognition
31
What does glutamate do?
Learning, memory
32
What do endorphins do?
Lessened PAIN, euphoria
33
What does GABA do?
Relaxation, anxiolytic
34
What do nearly all drugs of abuse affect NT-wise?
Increase dopamine levels. Affect serotonin and glutamate levels.
35
What happens to dopamine receptors as drugs of abuse are used?
Decreased availability.
36
What are the 3 C's of addiction?
Control Compulsion Chronicity
37
How are mental illness and substance use related?
Self-medication occurs due to one trying to alleviate symptoms of mental illness. Causal effects of drugs may lead one to become more vulnerable to mental illness. Correlated causes, in that both have similar risk factors. Up to 50% of substance abuse pts have a mental disorder as well.
38
What is opponent-process theory?
Every process that is either pleasant or unpleasant has a secondary "opponent" that sets in afterwards. With repetition, the primary process becomes weaker while the opponent process is strengthened.
39
How does drug addiction evolve in opponent-process theory?
Early, drug use results in high pleasure with low withdrawal. Over time, the pleasure decreases and withdrawal increases.
40
How do we treat addiction via opponent-process theory?
Interfering with the drug cycle.
41
How many US adults use alcohol in a risky manner?
3 in 10 are at risk for substance use issues.
42
How prevalent is alcohol use disorder?
14% of US adults meet criteria.
43
How many drinks is too many for men? women? Elderly?
Men is 15+ drinks/week, binge is 5+ drinks on a single occasion. Women is 8+ drinks/week, binge is 4+ drinks on a single occasion. Elderly is 1+/day or 7+/week
44
How much alcohol does our liver process per hour?
0.5oz of alcohol, aka a drink.
45
What is the telescoping effect?
Faster timeline from first drink to alcohol dependence.
46
Who is most susceptible to the telescoping effect? Why?
Females. Lower ETOH dehydrogenase Lower Total body water Smaller volume of distribution Drink like partner
47
What gender is more prone to alcohol dependence and abuse?
Men, 4:1.
48
What is the most common psychiatric disorder associated with alcohol abuse?
Depression.
49
What preventable cause of death # is alcohol abuse in the US?
3rd. 1st is smoking. 2nd is obesity.
50
What ethnicities are most susceptible to alcohol dependence?
White or Native Americans
51
What are the 4 CAGE questions?
Have you ever felt you ought to CUT DOWN on your drinking/drug use? Have people ANNOYED you by criticizing your drinking or drug use? Have you felt GUILTY about your drinking or drug use? Have you ever needed a drink/drug as an EYE OPENER?
52
What amount of CAGE criteria is a red flag?
At least 1 yes out of 4. 2+ requires a more in-depth assessment.
53
What are some other alcohol/drug screening questionaires?
AUDIT DAST-10 NIDA Quick screen
54
What is the MOA of alcohol?
Crosses BBB, acting as a sedative-hypnotic substance. It affects CNS receptors like GABA, NMDA, 5HT-3. Facilitates dopamine release. Suppresses our inhibitory control systems.
55
At what BAC do we start losing voluntary motor control?
0.1% BAC
56
What BAC puts people in confusion/stupor usually?
0.3 BAC
57
What are delirium tremens?
A set of withdrawal symptoms from prolonged ETOH consumption. It is caused by the reduction of GABA receptors, so our sympathetic nervous system can run rampant.
58
What are the neuro & psych symptoms of DTs?
Neuro: Confusion, tremor, seizures, sensory hyperacuity, hallucinations, hyperreflexia. Psych: Anxiety, agitation, panic attacks, paranoia.
59
What are the other symptoms of DTs?
Diaphoresis, dehydration, electrolyte abnormalities (AKA things that we actually need to monitor medically) CV abnormalities
60
What two diseases/disorders can be caused by chronic alcohol use?
Wernicke's Encephalopathy Korsakoff psychosis
61
What is the triad of symptoms that suggest Wernicke's encephalopathy? What is the treatment?
Triad of CONFUSION, ATAXIA, OPTHALMOPLEGIA Treated via thiamine and other B vitamins. Usually completely reversible.
62
What are the symptoms of Korsakoff psychosis? What is the treatment?
Amnesia, both anterograde and retrograde. Aphasia, apraxia, agnosia. Treated via thiamine and other B vitamins. Only 20% is reversible.
63
What is apraxia?
Loss of fine motor skills.
64
What is agnosia?
Inability to recognize
65
Why is thiamine the treatment for disorders arising from chronic alcohol use?
Alcohol stops the absorption of thiamine.
66
What liver enzyme is raised in chronic alcohol use?
AST. AST: ALT will usually be > 2:1
67
What can alcohol do to BP?
Portal HTN
68
What meds are used to treat alcohol withdrawal? Why?
Benzos (medium-long acting) AntiHTNs Nutrition (B vitamins and Vit C) Treating CNS hyperexcitability.
69
What are the 3 preferred benzos for alcohol withdrawal?
Valium Ativan Librium
70
What are the preferred antiHTNs for alcohol withdrawal?
Clonidine (A2 agonist) Atenolol (BB)
71
What MUST be administered prior to IV glucose supplementation when treating alcohol withdrawal?
THIAMINE. Thiamine is required for the brain to uptake glucose.
72
What is used to assess the severity of a person's alcohol withdrawal?
CIWA Clinical institute withdrawal assessment. A mild score is at least 8-10.
73
Is thiamine water or fat soluble?
Water soluble.
74
What are the 3 indications for thiamine supplementation?
Acute withdrawal Wernicke-Korsakoff Syndrome Chronic alcohol use
75
What is naltrexone for?
Blocks the release of dopamine in the brain. Good for people who crave alcohol or have a family hx of it. FIRST LINE
76
When can I put someone on naltrexone?
ASAP. They can start it even if they are still drinking.
77
What are the BBW for naltrexone?
Hepatocellular injury, Hepatotoxicity
78
What are the two routes of administration for naltrexone?
50 mg PO (daily) 380mg IM (monthly) for vivitrol
79
What drug class does naltrexone interact with?
Opiates
80
What is acamprosate?
Restores normal glutamate/NMDA action. Same rate of return to drinking as naltrexone. FIRST LINE
81
When can I put someone on acamprosate?
Only after a pt is abstinent.
82
What is the dosing for acamprosate?
666mg TID
83
What is the CI for acamprosate?
Severe renal impairment CrCl < 30
84
What are the CIs for naltrexone?
Hypersensitivity Opioid dependence or current use
85
What is disulfiram?
Inhibitor of aldehyde dehydrogenase, so you feel really crappy if you drink any alcohol. 2nd line No long-term efficacy proven.
86
What are the CIs of disulfiram?
Severe heart disease or CAD Acute intoxication
87
What is something to counsel pts on regarding disulfiram use?
Avoid mouthwash and other things that may contain ethanol.
88
What drugs does disulfiram interact with?
Metronidazole Warfarin Amitriptyline
89
What are the second-line treatments for chronic alcohol use?
Anticonvulsants (Topamax or Neurontin) Muscle relaxants (baclofen) Antidepressants (SSRIs) Antinausea (Zofran)
90
What is the preferred 2nd line therapy for chronic alcohol use?
Anticonvulsants. Zofran for young people < 25 but can cause a greater serontenergic abnormality.

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