Substance Abuse Disorder

Question 1

Cost of Substance Abuse

Answer 1

very costly generating $7-8 billion annually costs in crime, lost work productivity, and healthcare in US

Question 2

Tolerance

Answer 2

need for greater doses to produce same level of effect

Question 3

Withdrawal

Answer 3

physical symptoms occurring once regular dosing of substance stops

Question 4

Physical Dependence

Answer 4

experience withdrawal if dosage is suddenly lowered or stopped

Question 5

Psychological Dependence

Answer 5

mental discomfort despite no evert symptoms of physical withdrawal

Question 6

Substance Abuse

Answer 6

repeated use of substances in an inappropriate manner

Question 7

Pseudo-Addiction

Answer 7

addiction-like behaviors by patients when pain is not controlled (may increase the dose or hord meds)

Question 8

Substance Abuse Disorder

Answer 8

primary, chronic, neurobiological disease with genetic, psychosocial and environmental factors influencing the development and manifestations

Question 9

4 C’s of Addiction

Answer 9

• Impaired CONTROL over drug use
• COMPULSION to use
• Continued use despite CONSEQUENCES
• CRAVING

characterized by 1 or more of the following

Question 10

Demographics

Answer 10

• 10% with no family history
• 45% increase when 1 parent has a problem
• 90% increase when both parents have problem
• the average alcoholic has a home, family, job, and responsibilities
• 97% are functional alcoholics, 3% are not

Question 11

Understanding Abuse

Answer 11

Abusers:
- generally not physically addicted
- not lost control
- not had unsuccessful attempts to quit or cut down
- far more likely to be able to quit drinking with little or no help after negative consequence

Question 12

Abuse vs Addiction

Answer 12

Abuse: preventable behavior

Addiction: treatable primary disease

Question 13

Does abuse lead to dependence

Answer 13

5-year follow-up showed only 3% of abusers met criteria for dependence

Question 14

Evidence for Dependence as a Disease

Answer 14

Concordant Twins:
- concordance rate (both twins developing condition) was double for monozygotic compared to dizygotic twins

Adoption Studies
- individuals were separated soon after birth from biological parents to be raised by non-relative parents
- subjects who had a biological parent with alcohol problems were more likely to have alcohol problems themselves compared to if there environment (new parents) had an alcohol problem

Question 15

Grey Matter Differences

Answer 15

• brain waves of young sons of alcoholics who had never been exposed to alcohol were shown to have a reduced amplitude of P-300 brain waves after a single small drink –> something different with their brain chemistry

Question 16

Definition of Addiction

Answer 16

a chronic, progressive disease that involves the use of alcohol or drugs to an extent that it re-accurringly interferes in the functional life of the individual

uncontrolled, persistent use of dependency-producing substances that results in negative outcomes

Question 17

Defining Characteristics of Addiction

Answer 17

REOCCURINGLY INTERFERES

UNCONTROLLED, PERSISTENT USE

Question 18

What are the key issues with addiction?

Answer 18

Persistency
Denial
Professional Blind Spot

Question 19

How does addiction begin?

Answer 19

the acceptable drug use that may be therapeutic, religious, cultural, or social that turns into the individual exceeding the patterns

Question 20

Timing of Development in HC Professional

Answer 20

• the development of addiction is most likely to occur within the first 15 years of their career
• more common in younger workers
• pharmacists overwhelmingly take oral dosage forms compared to IV

Question 21

Drugs of Choice for HC

Answer 21

1. Codeine/Opiates
2. Alcohol
3. Cocaine
4. Marijuana
5. Tranquilizers
6. Amphetamines

Question 22

Incidence and Prevalence in HC

Answer 22

6-8% in females
10-12% in males
8-10% overall (just slightly over general population)

Question 23

Why do HC professionals turn to addiction?

Answer 23

Drug availability
- no strong evidence that access leads to addiction
- when the ball gets rolling, it is very hard to stop
- in general population, access can slightly limit the incidence

Attitudinal changes

Occupational stress/burnout
- pharmacy is stressful and we exist in a culture that wants to use pharmaceutical products for everything

Question 24

Denial

Answer 24

the addicted individual will create a system of denial to avoid confronting the consequences of their use

Question 25

Most reliable difference between abuse and addiction?

Answer 25

the lengths to which the person will maintain the denial system and convince themselves

Question 26

Co-Dependency

Answer 26

the individuals around the addict become inured to the denial system and enlists its maintenance

Question 27

Enabling

Answer 27

the individuals around the addict will fix the problems and help them to avoid the consequences of their use

we need to let them fall down or bloody their nose to break the denial system

Question 28

Documentation

Answer 28

• trust your instincts
• observe, document, and report to build a database of repetitive instances that provide evidence of addiction

Question 29

3 Concepts to Explain the Disease

Answer 29

NEED: the addict needs the drug more than anything (obsession)
ACCESS: the addict needs to be with the drug
USE: the addict needs to take advantage of being with drug

Question 30

What to do when diagnosis is certain?

Answer 30

• Indiana Pharmacist Alliance/State Board

DO NOT CONFRONT THE COLLEAGUE ALONE

Question 31

Treatment Results

Answer 31

• report success rates of 80%-95% over 5 years