Categories of General Substance Use Disorder
What are the different classes of severity?
Mild: 2-3 Criteria
Severe: 6 or more
What are the different timelines for remission?
Early: 3-12 mo
Sustained: > 12 mo
What is the definition of substance abuse?
Problematic pattern of substance use within a 12 mo period manifest by two or more symptoms that cause impairment in functioning
Examples of symptoms in substance abuse
Taken in larger amounts or for longer than intended.
Persistent desire or unsuccessful efforts to cut down use.
Great deal of time spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
Important social, occupational, or recreational activities are reduced or given up because of substance use.
Craving or a strong desire or urge to use the substance.
Psychological and/or physiological dependence are not necessary for diagnosis
What is the definition of dependence vs abuse?
Dependence: Abuse + Withdrawal/Tolerance/Physical Signs
How is intoxication defined?
Specific criteria for each substance
Use by history
Physiological correlates of use
Clinically significant maladaptive behavior/physiological changes
No other medical condition or substance
What is the definition of withdrawal?
Cessation of prolonged use
Specific physiologic correlates
Clinically significant distress or impairment in social, occupational, or other important areas of functioning
What are other substance induced disorders?
Depression, Psychosis, Anxiety, Bipolar, etc.
Develop during use and not due to outside causes
Which chemical is the traditional basis of addiction?
What is the neurological significance of dopamine regarding substance abuse?
What characteristic do almost all addictive drugs display?
What occurs without drug-induced dopamine release?
Common reward pathway – Opiates, cannabis, cocaine, alcohols, amphetamines
Ventral Tegmental Area to Nucleus Accumbens
Almost all addictive drugs exhibit tolerance
Lack of dopamine due to use stoppage results in conscious dysphoria or unconscious craving
What genetic variant plays a role in codeine?
CYP2D6 to convert to morphine
Inability to process is more common in African Americans
What psychodynamic and personality factors play a role in addiction?
Affective dysregulation – Cannot tolerate bad moods
Impulse control deficits – More reliance on reward
Ego defects – Harder to cope with pain
What family dynamics play a role in addiction?
Multigenerational drug dependence
Parental loss through divorce, death, abandonment, incarceration
What are the stages of treatment?
How are alcohol, opiates, and stimulants detoxed?
Alcohol – Benzo, Phenobarbital, Folate, Thiamine
Opiates – Clonidine, Loperamide, Analgesics
Stimulants – Sleep, food, water
What is involved in active treatment?
Separation from substance
Family and relationship work
Conversion process – Give control back to patient, make patient understand that the substance will kill them
What is the purpose of maintenace treatment?
What is the prognosis of it?
What does it involve?
Change is key and maintain change
Relapse rates are very high if not taken seriously
Involves medications, aftercare, personal commitment
What are the major concerns with relapse?
Often as bad or worse than former use
Changes in tolerance, often reach worse highs because less tolerance but still use elevated dosing
What is the realistic best prognosis for addicts?
Addicts seek normalcy, but often not actually possible
Recovery is a mindset patients need to reach and maintain
What is the goal of motivational enhancement therapy?
Recognize the stage the patient currently is in
Create conditions that enhance patient’s efforts
Support intrinsic motivation of patient
What are the principles of motivational enhancement therapy?
Develop Discrepancy (between where patient is and where they want to be)
Roll with Resistance