Substance Abuse Disorders

Question 1

categories of substance use disorders: sedative, hypnotics and anxiolytics

Answer 1

barbiturates, non-barbiturates, benzodiazepines

Question 2

categories of substance use disorders: opiates

Answer 2

heroin, meperidine, codeine/hydromorphone

Question 3

categories of substance use disorders: other

Answer 3

hallucinogens, phencyclidine, cannabis, inhalants, nicotine, caffeine, anabolic steroids, spice

Question 4

DSM-V

Answer 4

eliminated the distinction between abuse and dependence in 2013 dude to absence of physiologic withdrawal from cannabis

Question 5

DSM-IV: criteria for substance abuse

Answer 5

a maladaptive pattern of substance leading to impairment or distress as manifested by one or more of the following:

• failure to fulfill major role obligations at work, school, home
• reoccurring situations that are physically hazardous
• recurrent legal problems
• continued use despite having persistent social/interpersonal problems

Question 6

DSM-IV: criteria for substance dependence

Answer 6

a maladaptive pattern leading to impairment or distress as manifested by 3 or more 7 things all occurring within 1 year

Question 7

DSM-IV: 7 patterns

Answer 7

1. tolerance - a need for markedly increased amounts of the substance to achieve intoxication/desired effect + markedly diminished effect with continued use of the same substance
2. withdrawal - the characteristic withdrawal syndrome for the substance/the same substance is taken to relieve or avoid withdrawal symptoms
3. the substance is often taken in larger amounts or over a longer period of time than what was intended
4. there is a persistent desire/unsuccessful efforts to cut down/control substance us
5. a great deal of time is spent in activities necessary to obtain the substance, use it and recover from its effects
6. important social, occupational or recreational activites are given up/reduced because of substance use
7. substance use is continued despite knowldge of having a persisent or recurrent physicla or psychological problem (that is likely to have been caused or exacerbated by the substance)

Question 8

are men more or less likely than women to have a substance abuse problem?

Answer 8

more

Question 9

white more than black?

Answer 9

yes whites more than blacks

Question 10

consequences of alcohol dependence: GI

Answer 10

esophageal bleeding, gastritis

Question 11

consequences of alcohol dependence: liver diseases

Answer 11

fatty infiltration, alcoholic hepatitis, cirrhosis

Question 12

consequences of alcohol dependence: nutritional deficiency

Answer 12

B12 deficiency, gastiris

Question 13

consequences of alcohol dependence: neuropsychiatric

Answer 13

wernick-korsakoff syndrome, alcohol-induced dementia

Question 14

consequences of alcohol dependence: alcohol withdrawal syndromes

Answer 14

uncomplicated withdrawal-shakes, withdrawal seizures, alcoholic hallucinations, alcohol withdrawal delirium

Question 15

consequences of alcohol dependence: cardiovascular

Answer 15

cardiomyopathy

Question 16

consequences of alcohol dependence: others

Answer 16

drug-drug interaction, FAS, pancreatitis

Question 17

motivational interviewing

Answer 17

this is an evidence based intervention designed to enhance client motivation for change

Question 18

motivational interviewing: clinical intervention modalities

Answer 18

brief 30 min interventions, multiple sessions, ongoing counseling, client assessment

Question 19

motivational interviewing: structure

Answer 19

feedback - construction/nonconfrontation feedback
responsibility - clearly placed on the client
advice - recommend to reduce or stop
options - to help reduce dropout rate
empathetic - warm, respect, caring commitment
self-efficacy - optimistic, empowerment

Question 20

motivational enhancement therapy

Answer 20

created by Miller
a systematic intervention to evoke change in problem drinkers
based on principle of motivational psychology
designed to produce rapid change, internally motivated

Question 21

motivational enhancement therapy: 4 Key assumptions

Answer 21

1. ambivalence about substance use & change is normal and constitutes an important motivational obstacle in recover
2. ambivalence can be resolved by working with your clients intrinsic motivations and values
3. the alliance between you and your client is a collaborative partnership to which you each bring importance expertise
4. empathetic, supportive, direct counseling style provides conditions under which change can occur

Question 22

motivational enhancement therapy: opening strategies

Answer 22

• ask open questions
• listen reflectively
• affirm with compliments/appreciation
• summarization to reinforce
• elicit self-motivating statements

Question 23

motivational enhancement therapy: 5 basic principles, 1. express empathy

Answer 23

communication that implies superior/inferior relationships are avoided, your role is supportive companion/knowledgable consultant.
client has freedom of choice
persuasion is gentle and subtle

Question 24

motivational enhancement therapy: 5 basic principles, 2. develop discrepancy

Answer 24

seeks to enhance and focus the clients attention on such discrepancies

Question 25

motivational enhancement therapy: 5 basic principles, 3. avoid argumentation

Answer 25

if you don't you could evoke resistance | don't try and label

Question 26

motivational enhancement therapy: 5 basic principles, 4. roll with resistance

Answer 26

new ways of thinking are invited not imposed ambivalence is viewed as normal solutions are evoked from client not that therapist

Question 27

motivational enhancement therapy: 5 basic principles, 5. support self-efficacy

Answer 27

belief that one can perform a particular behavior or accomplish a task they have to believe that they can change optimism

Question 28

screening, brief intervention, referral and treatment (SBIRT)

Answer 28

an evidence-based public health approach providing early intervention in treatment for individuals with substance abuse disorders and those at risk reduces frequency and severity of alcohol and drug use, reduces risk of trauma associated with it and increased number of clients to enter substance abuse treatment shown to reduce ER visits major significance in young adults

Question 29

screening, brief intervention, referral and treatment (SBIRT): screening

Answer 29

identification of client seen in medical and public health setting who require further treatment integration substance abuse screening into regular medical and public health care two elements: 1. attention to biomarkers/client reports 2. use of screening instruments

Question 30

screening, brief intervention, referral and treatment (SBIRT): brief intervention

Answer 30

single session or multiple sessions implementing motivational strategies intention is to increase motivation toward positive behavioral changes

Question 31

screening, brief intervention, referral and treatment (SBIRT): brief treatment

Answer 31

increased intensity but over a shorter period of time highly structured/focused cost less, effective

Question 32

screening, brief intervention, referral and treatment (SBIRT): referral to treatment

Answer 32

used when have a more severe substance abuse problem | intention is to appropriately address the issue

Question 33

pharmacotherapy to treat alcohol: disulfiram

Answer 33

blocks metabolism of ethanol metabolite stimulates severe nausea, vomiting, shortness of breath, sweating, drop in BP, heart racing 2nd line therapy little long term affect

Question 34

pharmacotherapy to treat alcohol: naltrexone (oral)

Answer 34

``` mu opioid antagonist reduces + reinforcement from alcohol and reduces craving 1st line therapy decrease in relapse to heavy drinking daily dose is kinda crappy ```

Question 35

pharmacotherapy to treat alcohol: naltrexone (injectable)

Answer 35

mu opioid antagonist reduces + reinforcement from alcohol and reduces craving better efficacy than oral super expensive

Question 36

pharmacotherapy to treat alcohol: acamprosate

Answer 36

unknown mechanism maintains abstinence good in europe (not so much in US ~ probably bc of therapy provided not many bad effects

Question 37

treatment for opiates: agonist treatment

Answer 37

most effective decreases in: illicit opioid use, other drugs, criminal activity, needle sharing improvements in: prosocial activities, mental health

Question 38

pharmacotherapy for opioid dependence: methadone

Answer 38

full mu opioid agonist levels go down with concurrent use of alcohols, dilatine levels go up with concurrent use of Tagamet, erythromycin usually comes with psychosocial support

Question 39

pharmacotherapy for opioid dependence: LAAM

Answer 39

a metabolite of methadone advantages: slower onset, longer duration disadvantages: potential for cardiac arrhythmias not really used anymore

Question 40

pharmacotherapy for opioid dependence: buprenorphine

Answer 40

the wonder drug!!! partial mu agonist desirable properties: low abuse, low physical dependence, safe if ingested at over dose quantity poor oral bioavailability - weak opioid effect used often with adolescents not much psychosocial support given

Question 41

pharmacotherapy for opioid dependence: naltrexone

Answer 41

mu antagonist poor compliance major limiting factor nonaddictive

Question 42

treatment for: cocaine/stimulatns/sedatives

Answer 42

nothing really | just try to decreases use slowly

Question 43

treatment for: nicotine

Answer 43

``` bupropion NRT Varenicline: the best! -partial nicotinic receptor agonist -1mg daily for 1 week then 1mg bid -decreased cotinine levels and enhanced abstinence -slight increase in psychiatric symptoms ```

Question 44

treatment for: designer drugs/ectasy/MDMA

Answer 44

don't really know whats in these guys, not really addictive but still dangerous

Question 45

goal of treatment: 1. Abstinence

Answer 45

historically goal standard, but lots of failures

Question 46

goal of treatment: 2. harm reduction

Answer 46

use of substitution therapies like methadone/suboxone for heroin, NRT for tobacco

Question 47

goal of treatment: 3. controlled use

Answer 47

subset of people can still use in a controlled way

Question 48

financing addiction

Answer 48

<1% of all healthcare goes to treatment of substance use disorders but 1/3 of healthcare goes toward treatment of complications of problems related to those disorders. 80% of function comes from public sources