Substance Abuse, Part 1 Flashcards
(127 cards)
1
Q
Define substance.
A
Alcohol, tobacco, illicit drugs or improperly used medication
2
Q
Define substance use.
A
Sporadic consumption with no major adverse consequences
3
Q
Define at-risk substance use.
A
Consumption that risks major adverse consequences
4
Q
Define codependency.
A
Condition characterized by an individual who is significantly affected by another person’s substance use or addiction
5
Q
Define substance abuse.
A
Maladaptive use causing impairment or distress over a 12-month period where 1+ 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
6
Q
What conditions help define substance abuse?
A
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
7
Q
Define dependence.
A
State of adaptation manifested by a substance class-specific withdrawal syndrome
8
Q
How can dependence be produced by?
A
Rapid dose reduction or cessation of a substance
Administration of an antagonist
Tolerance to the substance
9
Q
What types of dependence are there? (2)
A
Psychological dependence
Physiologic dependence
10
Q
Define addiction.
A
Primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations
11
Q
What behaviors define addiction?
A
Impaired control of use
Compulsive use
Continued use despite harm
Craving for substance
12
Q
What is the difference between substance use and dependence/addiction?
A
substance use: pts retain control of their use.
-control can be affected by judgement, social factors, environment
Dependence/addiction: pts don’t have full control
Measurable brain abnormalities-often predate the initial substance use, though to be genetically predisposed
13
Q
What often predates the initial substance use?
A
Measurable brain abnormalities
thought to be genetically predisposed
14
Q
How does substance use affect our hormones?
A
Affect dopamine levels in mesolimbic system
Changes are often permanent
15
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
16
Q
What percentage of pts 12yrs and up with any illicit dug use in the past month? lifetime?
A
Over 1 in 10 - 14%
About half- 49% in lifetime
17
Q
What percentage of pts 12 years and up with marijuana use in the past 1 month? lifetime?
A
over 1 in 10 (13%)
45% of people over their entire lifetime
18
Q
How many people are unaware that they have a substance abuse problem?
A
95%
19
Q
Who are the highest risk for substance abuse?
A
Late teens and early 20s
20
Q
What increases the risk of later addiction?
A
The lower the age of first use
21
Q
Who are likely to engage in binge drinking?
A
Males (2x likely)
3x for heavy drinking
22
Q
What are young adults now likely to use instead of cigarettes?
A
Vaporized cigarettes (vapes)
23
Q
What is the #1 substance for dependence and abuse?
A
Alcohol
24
Q
What it the most expensive substance abuse cost in society?
A
Tobacco
25
What is the lifetime prevalence of ETOH for patients age 12+?
almost 4 out of 5 (78%)
ETOH within past 12 months-almost 2 out of 3 (62%)
ETOH within past 12 months, ages 12-20 over 1 in 10 (15%)
26
How many pts 12 and up have vaped or used cigarettes in their lifetime?
What about in the past 1 year?
over 1 out to 2 pts (58%)
over 1 out of 5 pts (26%)
27
What is the most leading preventable cause of death in the US?
Tobacco
28
What medical conditions arise from substance abuse?
Hepatitis
Cirrhosis
HIV/AIDS
Sexually Transmitted Infections (STIs)
Motor vehicle crashes/fatalities
29
What social conditions arise from substance abuse?
Teenage pregnancy
Domestic violence
Child abuse
Physical fights
Overall crime
Homicide/Suicide
30
What are some risk factors for substance use?
Substance factors
Societal influence
Static pt demographics
Modifiable pt demographics
Associated psychiatric disorders
Personality traits
31
What are the substance factors?
Early onset tobacco use
Early experimentation with substances
Type of substance tried
32
What are the societal influence factors?
Family
Peer groups
Religious groups
Cultural and societal norms
33
What are the static patient demographics factor?
Male gender
Black, AI/AN or NHOPI ethnicity
Gay or lesbian status
Genetic predisposition
34
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
35
What are the patient personality traits factors?
Risk-takers, thrill-seekers, novelty seekers
Poor impulse control or emotional control
Difficulty relating to others
36
What are the associated psychiatric disorders?
Conduct disorder
MDD or Bipolar disorder
ADHD
Antisocial personality disorder
37
Why do people use substances?
To feel good/better (experience new feelings, and lessen anxiety)
To fit in (peer pressure)
38
How does anandamide affect the brain?
NT involved in regulation of pain, appetite, memory, mood
39
What is THC?
Active ingredient in marijuana
40
What is similar about THC and anandamide?
Similar structure
41
What hormones does drug abuse affect?
Dopamine
Serotonin
Glutamate
Endorphins
GABA
42
What is the function of Dopamine?
Movement, motivation, reward, addiction, well-being
43
What is the function of serotonin?
Mood, memory, sleep, cognition
44
What is the function of glutamate?
Learning, memory
45
What is the function of endorphins?
Lessened pain, euphoria
46
What is the function of GABA?
Relaxation, anxiolytic
47
What are other naturally rewarding things?
Food
Sex
Exercise
Excitement
Comfort
48
What do nearly all drugs of abuse have in common?
Increase dopamine levels
Affect serotonin and glutamate levels
49
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
50
What are the 3 C's of addiction?
Control
Compulsion
Chronicity
51
What are the control factors?
Early social & recreational use
Eventual loss of emotional & behavioral control
Cognitive distortions (denial and minimization)
Tolerance and withdrawal
52
What are compulsion factors?
Drug-seeking activities and craving → addiction
Continued use despite adverse consequences
53
What are chronicity factors?
Natural history of multiple relapses preceding stable recovery
Possible relapse after years of sobriety
54
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)
55
How many substance abuse pts have a mental disorder?
50%
56
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
57
How does drug addiction work over time?
Early: high pleasure, low withdrawal
Overtime: pleasure decreases, withdrawal increases
58
How do we treat drug addiction?
block high pleasure
block withdrawal symptoms
59
What other disorders are alcohol-related disorders commonly associated with?
Mood disorders(depression)
Anxiety disorders
Suicide
Personality disorders
60
Define at-risk drinking.
Repetitive use of alcohol, often to alleviate emotional problems
61
What is considered at-risk drinking for men?
15+/week
Moderate: 1-2/day
Binge: 5+/single occasion
62
What is considered at-risk drinking for women?
8+/week
Moderate: 1/day
Binge: 4+/day
63
What is considered at-risk drinking for elderly?
1+/day
7+/week
64
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%
65
How much alcohol can a liver process?
0.5oz/hr
66
What is the telescoping effect?
Faster timeline from 1st drink to alcohol dependence?
67
Who is seen with the telescoping effect?
Women who use alcohol
68
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
69
What specific psychiatric disorder is associated with alcohol-related disorders?
Depression
70
Who are likely to have alcohol-related disorders?
Males 4:1
Women are more likely to delay seeking help
71
What is the 3rd leading preventable cause of death in the US?
Excessive alcohol use
72
What are some effects of alcohol addiction?
Recurrent alcohol use despite disruption of social roles
Alcohol-related legal problems
Taking safety risks
73
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)
74
What are the key questions for Cage(screening substance abuse)?
Cutdown
Annoyed
Guility
Eye opener
75
How many "yes" do you need for the cage-aid questionnaire?
2+: need a more in depth assessment
1+: possible substance use
76
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
77
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
78
What drug also affects GABA receptors?
Benzodiazepines
79
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
80
What are symptoms of 0.05% BAC?
Thought, judgement, and restraint are loosened
81
What are symptoms of 0.1% BAC?
Voluntary motor actions become clumsy
82
What are symptoms of 0.2% BAC?
Depression of motor control and emotional control areas of brain
83
What are symptoms of 0.3% BAC?
Confusion, stupor
84
What are symptoms of 0.4-0.5% BAC?
Coma; respiratory depression
85
What are effects of alcohol withdrawal?
Decreased cognitive function
Tremulousness
Anxiety, irritability, and hyperreactivity
N/V
Delirium Tremens
86
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
87
What are the affects of chronic use of alcohol?
Wernicke encephalopathy
Korsakoff psychosis
GI symptoms
Cardiac
Cancer
Endocrine
88
What are the effects of chronic use of alcohol?
Wernicke encephalopathy
Korsakoff psychosis
GI symptoms
Cardiac
Cancer
Endocrine
89
How does wernicke encephalopathy present as?
Confusion, ataxia, opthalmoplegia
Impaired vision/hearing, psychological dysfunction, memory deficit, hypothermia, hypotension
90
How do we treat wernicke encephalopathy?
Thiamine other B vitamins
*Can be completely reversible with treatment*
91
What are symptoms of Korsakoff psychosis?
Amnesia: anterograde and retrograde
Aphasia, apraxia, agnosia
*20% are reversible*
92
How is the liver affected with chronic alcohol use?
Fatty liver
Alcoholic hepatitis
Cirrhosis
93
How is the vascular system affected with chronic alcohol use?
Portal HTN, varices
94
How is the pancreas affected with chronic alcohol use?
Pancreatitis
Pancreatic insufficiency
Cancer
95
How is the GI affected with chronic alcohol use?
Esophagitis
Gastritis
Gastric ulcers
Cancers
96
How would labs be affected with chronic alcohol use?
Increased GGT, AST/ALT (ratio >2:1) *assesses liver damage
97
How is the CV system affected with chronic alcohol use?
HTN
Increase HR
Increased myocardial O2 consumption
98
Where are the cancers formed from chronic alcohol use?
Head/neck
Esophageal
Liver
Breast
Colorectal
Pancreas
99
How are the endocrine systemic affected from chronic alcohol use?
Dysregulation of lipoproteins and triglycerides
100
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
101
When does alcohol withdrawal occur, when are the peak intensity of symptoms?
8-12hours
48-72hours
102
What is the main treatment for alcohol withdrawals? Examples?
Benzodiazepines(BZDs)
Diazepam(valium), lorazepam(altivan), chlordiazepoxide (Librium), Gabapentin or carbamazepine (Tegretol)
103
What are anti-hypertensives we give to alcohol withdrawal pts?
Clonidine
Atenolol
104
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
105
How do we assess withdrawal severity?
CIWA scoring
Facilities own standardized protocol
106
What are the stages of security for withdrawals?
Mild
Moderate
Severe
107
What type of consolation does a withdrawal pt may need?
Social work
Psychology
108
What can be given to treat chronic use?
Thiamine
Naltrexone
Acamprostae(Campral) (first-line)
Disulfiram(Antabuse) (2nd-line)
109
What are SE of thiamine use?
Low BP
Affect glucose metabolisms
(rare) anaphylaxis, bronchospasm
110
What is the MOA of naltrexone?
Blocks release of dopamine in the brain
Antagonist at Mu receptors in brain (decrease craving and reward)
111
What is naltrexone usually given together with?
Behaviorally therapy
Acamprosate
SSRI
112
What is the BBW for naltrexone?
Hepatocellular injury
Heptotoxicity
113
What are the SE of naltrexone?
N/V/D/C
Abd pain
Dizziness
HA
Anxiety
Fatigue
114
What is CI in naltrexone?
Hx if hypersensitivity
Opioid dependence on current use
115
What does naltrexone have drug interactions with?
Opiates
116
What do you have to monitor when taking neltrexone?
Liver function tests
117
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*
118
What is the SE of acamprosate?
N/D
Abd pain
Fatigue
HA
Amnesia
119
What do you have to monitor while on acamprosate?
Anxiety
Depression
Suicidality
120
What is CI in acamprosate?
Renal impairment
121
What is the MOA of disulfiram?
Inhibits enzyme aldehyde dehydrogenase
Causes acetaldehyde to accumulate → sweating, headache, dyspnea, lowered BP, flushing, palpitations, N/V
Does not influence motivation/withdrawal directly
No proven long-term efficacy in alcohol abuse
122
What is the SE of disulfiram?
Metalic taste
Sweating
HA
Dyspnea
Lowered BP
Flushing
Palpitations
NV
123
What is CI when taking disulfiram?
Heart disease/CAD
acute intoxication
124
What are the DI of disulfiram?
Metronidazole
Warfarin
Amitriptyline
125
What are the DI of disulfiram?
Metronidazole
Warfarin
Amitriptyline
126
What are other 2nd line therapy drugs for chronic alcohol withdrawal?
Anticonvulsants
Muscle relaxants
Antidepressants
Antinausea
127
What are some non-medicine treatments for alcohol withdrawal?
Motivational interviewing
Cognitive Behaviorally therapy
Peer support groups
