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Flashcards in Substances of Abuse: Deck (22):
1

Methadone

μ Opioid agonist
Long acting
Usual starting dose 20-40 mg
Usual dose 50-150 mg per day
Specialized clinics

2

Methadone yes/no

Complete abstinence- no

yes:
Reduce use of heroin
Reduce harm
Increase employment
Reduce crime
Engage in treatment
Save lives
Be cost effective

problem: only in special clinic

3

Buprenorphine

Partial agonist- good since it will max out
Subutex/suboxone- (combo w/ antag to prevent IV use)
Usual dose 4-24 mg of buprenorphine per day; 16 mg ~80-95% receptor occupancy
Can precipitate withdrawal
Retention in treatment and reduction in opioid use
Office-based

4

Naltrexone

Blocks effects of heroin
Poor retention

Groups with strong contingency (physicians or people on parole)

Depot preparation approved for opioid dependence in 2010

5

Nicotine Dependence
Medications

Bupropion
Nicotine replacement
Varenicline

6

Bupropion

(Wellbutrin- antidep/Zyban- smoking):

↑ risk of sz w/ higher dose

7

Doubles quit rates
Better outcomes when combined with psychosocial treatments
Contraindicated: hx seizure disorder, MAO inhibitor, eating disorder
Insomnia/agitation common side effects

Bupropion
Wellbutrin/Zyban

8

Nicotine replacement

Nicotine content per cigarette varies (by brand, behavior of smoker and physiology)
General approximation is 1mg nicotine per cigarette
General approximate for 1 pack per day is about 20mg of nicotine

9

Nicotine Dependence Gum

Gum 1 piece 2 mg

No food or drink 15 min before

Problem include TMJ, hiccups, dyspepsia, difficult with dentures

Avoid if 1 month post MI, serious arrhythmias, gastric ulcers

10

Nicotine Dependence Patch

High dose (21 mg) 6-8 weeks, medium dose (14 mg) 2-4 weeks, low dose (7 mg) 2-4 weeks

Skin irritation (avoid if systemic eczema), slow delivery, wearing at night may cause sleep problems
Same cardiovascular warnings

11

Varenicline (Chantix):

Partial agonist α4β2 nicotinic acetylcholine receptor

Smoking cessation

Worries about mood changes, suicidality, small increase in cardiovascular events

12

Nicotine Vaccine

Future

vax- stops nicotine from crossing BBB

AB vs nicotine
-But will it attach body?

CB1- blockers may stop wt gain when quitting

13

Psychosocial treatments techniques

Motivational interviewing
Contingency management/motivational incentives

14

Motivational Interviewing

Open ended questions
Affirmations- recognize
Reflective listening
Summarizing

15

Direct confrontation is not?

Motivational Intview

16

Education may not work if?

Substance abuse is the driving factor

17

Motivational Interviewing

The issue is not …to confront or not to confront

The issue is…

The issue is not …to confront or not to confront

The issue is…how to confront effectively

18

Motivational Interviewing strategy

Express empathy- genuine
Roll with resistance- tug of war- let it go
Develop discrepancies
Support self-efficacy

19

Other psychosocial treatments

CBT
12-step facilitation
MST
BSFT

20

Motivational Interviewing

Eliciting self-motivating statements

“In what ways has this been a problem for you?”

“How much does this concern you?”

“What things make you think that you need to make a change at this point?”

“What makes you think that if you decided to change, you could do it now?”

21

Motivational Interviewing:
Eliciting self-motivating statements
“On a scale of 1 to 10 how ready are you to stop?”
“I’m not ready. Maybe I’m a 2.”

Explain Responses

A) “Look at all your problems. I can’t believe it’s not a 10.”

B) “Good. How can we make you a 3?”

C) “Good. Why aren’t you a 1?”

a- confrontation

b- cheerleader

c- MOTIV INT

22

Contingency management

ex: cocaine contract

Detection- UA (wont work with etoh)

Reinforcers provided with behavior - needs close temporal

Reinforcers are withheld when behavior not occur

reward points- retained rx 12 wks off crack