Substance Use Disorders

The criteria ______ can be summed up by recurrent use in physically hazardous situations and recurrent use despite knowledge of its dangerousness.

Risky Use

The neurotransmitter _____ is involved in mood modulation and appetite suppression.

Serotonin

The criteria ____ can be identified by the following signs: major work, home, school obligation neglect; recurrent problems made worse by substance use; and important activities given up because of substance use.

Social Impairment

What is the treatment of Wernicke-Korsakoff Syndrome (Alcohol-Induced Persisting Amnestic Disorder)?

Thiamine (PO, IM, or IV)

_______ is an indirect GABA agonist that decreases heavy drinking and increases the percentage of sober days.

Topiramate

________ binds with high affinity and selectively α4β2 neuronal nicotinic acetylcholine receptors and stimulates receptor-mediated activity but at a lower level than nicotine.

Varenicline (Chantix) -Blocks the ability of nicotine to activate α4β2receptors and thus stimulate the central nervous mesolimbic dopamine system, which is believed to be the neuronal mechanism underlying the reinforcement and reward experienced with smoking.

In opioid overdose treatment what is the most important intervention?

Ventilatory support

What is the onset for alcohol withdrawal delirium ?

Within 1 week after last or reduced use

Tobacco use is ______ correlated with education.

negatively -Tobacco use is strongly associated with many primary psychiatric (Axis I) diagnoses [50% of psychiatric diagnoses]

The pharmacological criteria involve _____ & _____.

tolerance and withdrawal

A mild substance use disorder is characterized by ______ symptoms. A moderate disorder is characterized by ____ symptoms, and a severe substance use disorder has ____ symptoms.

(1) 2 to 3 (2) 4 to 5 (3) 6 or more symptoms

What time do withdrawal symptoms begin for the following opioids? (1) Morphine/Heroin (2) Meperidine (3) Methadone

(1) Morphine/Heroin: 6-8 hours (2) Meperidine: 8-12 hours (3) Methadone: 1-3 days

Substance use disorders according to the DSM-V require at least ___ symptoms of the criteria that occur within a ______ period.

(1) two (2) 12

_____ is the leading cause of mental retardation in the US.

Alcohol -It inhibits intrauterine growth and postnatal development.

_____ is due to cessation or reduction in heavy use and has (2 or more) autonomic hyperactivity, hand tremor, insomnia, nausea/vomiting, transient visual, tactile or auditory hallucinations or illusions, psychomotor agitation, anxiety and grand mal seizures.

Alcohol Withdrawal -Impaired judgement, impaired social or occupational functioning result from above.

______ is a disturbance of short-term memory caused by heavy alcohol use. Is rare inpersons younger than 35.

Alcohol-Induced Persisting Amnestic Disorder (Wernicke-Korsakoff Syndrome) -Treatment: Thiamine (PO, IM, or IV).

_______ intoxication is marked by recent ingestion and maladaptive behavior or psychological changes with two or more of the following symptoms: Pupillary dilation; tachycardia or bradycardia; elevated or lowered blood pressure; perspiration or chills; N/V; evidence of weight loss; psychomotor agitation or retardation; muscular weakness; respiratory depression; chest pain or cardiac arrhythmias; confusion; seizures; dyskinesias; dystonias or coma.

Amphetamine

_____ and ______ are under the umbrella of stimulant use disorders.

Amphetamine and Cocaine

What psychiatric co-morbidities often exist with alcohol usage and withdrawal?

Antisocial Personality Disorder Mood Disorders Anxiety Disorders Suicide

_____ is a VTA GABA receptor agonist that decreases craving and is used in abstinence maintenance.

Baclofen

The treatment for alcohol withdrawal symptoms are _______.

Benzodiazepines -Oral, intravenous, or IM routes of administration.

What pharmacotherapy options are used to treat tobacco cessation?

Buproprion/Zyban Welbutrin -Dopamine, NE, NAR antagonism Varenicline/Chantrix -Without inhaled nicotine: NAR partial agonist -With inhaled nicotine: NAR antagonist Nortriptyline/Pamelor -NE Re-Uptake Inhibitor -NAR anatgonist CLonidine/Catapress -Decreases sympathetic activation

What are the questions involved in a CAGE screening?

C: Have you ever tried to Cut down? A: Do you feel Annoyed by others' concern? G: Do you ever feel Guilty about your drinking E: Do you wake up in the morning and feel like you need a drink (Eye-Opener).

How does Acamprosite work?

Cleared through renal metabolism and is thought to resemble GABA & Glutamate. -glutamate antagonist -NDMA antagonist

What psychotherapy modalities can you use to treat alcohol dependence?

Cognitive Behavioral Therapy (CBT) Motivational Enhancement Therapy (MET) Twelve Step Facilitation

_______ modalities are the most useful for sustaining prolonged amphetamine abstinence.

Combined Therapeutic

What is substance intoxication/withdrawal delirium?

Consciousness disturbance Cognition change rapid onset with fluctuation over day Symptoms developed during substance use or cessation of substance use. Is a medical emergency!

What are the criterion for substance induced disorders?

Criterion A: Problematic Clinical Intoxication Criterion B: 2° Problematic Behavioral or Physiological Changes shortly after use. Criterion C: Social and/or Occupational Functional Impairment Criterion D: Symptoms not due to another medical condition.

What characterizes tobacco withdrawal?

Daily use of nicotine for at least several with with abrupt cessation of nicotine use or reduction in the amount used. Results in four or more of the following: -Dysphoric/depressed mood; insomnia; irritability, frustration, anger, anxiety; difficulty concentrating; restlessness; decreased heart rate; increased appetite or weight gain. Impaired judgement, impaired social or occupational functioning result from above & a medical condition or disorder is not the cuase.

What should you expect to see in Ecstasy (MDMA) intoxication?

Dehydration (with combination w/ Alcohol) and bruxism (teeth grinding) with chronic use. Other symptoms pictured

What are the amphetamine preparations?

Dextroamphetamine (Dexdrine) Methamphetamine (Desoxyn) Dextroamphetamine-Amphetamine salt (Adderall) Methylphenidate (Ritalin)

What pharmacological treatments are available for alcohol dependence disorder?

Disulfiram (can treat problem drinking by creating an unpleasant reaction to alcohol. It's used in recovery programs that include medical supervision and counseling) Naltrexone Acamprosite Baclofen

Amphetamine and Amphetamine-like (MDMA) result in what?

Dopamine & catecholamine RELEASE from the mesolimbic/mesocortical reward pathways

What is the addiction cycle?

Drug Reinforcement (intoxication) Craving Binging Withdrawal

_________ are release neurotransmitters that are involved in anxiety/tension reduction.

Endogenous Opioids

What are the amphetamine-like substances?

Ephedrine Pseudoephedrine Phenylpropanolamine (PPA) Methamphetamine (3,4-Methylenedioxyamphetamine (NDMA) or "Ectasy"

________ is a neurotransmitter involved in agonism that reduce anxiety/tension and reduction; cause sedation and amnesia.

GABA

The neurotransmitter _______ is excitatory and is involved in anxiety/tension reduction; sedation and amnesia.

Glutamate

The criteria _____ involves signs such as: more ingested than intended/longer periods of time; unsuccessful cut down/has desire to cut down; unusual time spent with a acquisition, use, and/or recovery; and having cravings.

Impaired Control

What are the criteria for a substance use disorder?

Impaired Control Social Impairment Risky Use Pharmacological Criteria

What are substance-induced disorders?

Intoxication Withdrawal Other Substance/Medication Induced Disorder Unspecified Substance Use Disorder

What do you see in alcohol intoxication?

Maladaptive behavior or psychological changes that developed during ingestions. -Slurred speech, poor coordination, unsteady gait, nystagmus, attention or memory impairment, stupor or coma. Nothing is due to a medical condition or another disorder.

What drugs are used in medication assisted treatment of opioid withdrawal?

Methadone (synthetic narcotic with oral administration that reduces withdrawal symptoms) Buprenorphine (opiate partial mu agonist) Naltrexone (opiate antagonist with no narcotic effects; discourages and de-conditions opiate-seeking behavior)

What are the different dopamine pathways?

Nigrastratial: Substantia Nigra to Caudate/Putamen Mesolimbic: VTA to Ventral Striatum (Nucleus Accumbens) Mesocortical: VTA to Frontal Cortex

What neurotransmitters are involved in tobacco?

Norepinephrine: arousal/appetite suppression Acetylcholine: arousal/cognitive enhancement Glutamate: learning/memory enhancement Serotonin: mood modulation/appetite suppression Beta-Endorphin: anxiety/tension reduction GABA: anxiety/tension reduction

________ intoxication is characterized by recent ingestion and maladaptive behavior or psychological changes that result in pupillary constriction and 1 or more: slurred speech, poor coordination, unsteady gait, nystagmus, attention or memory impairment, stupor or coma.

Opioid

_______ is due to recent cessation or reduction in heavy use or induction of an antagonist. It results in three or more of the following: dysphoric mood; nausea or vomiting; muscle aches; crying or runny nose; pupillary dilation; piloerection (cold turkey), or sweating; diarrhea; yawning; fever and insomnia.

Opioid Withdrawal

What are the symptoms of amphetamine withdrawal?

Recent cessation or reduction in Amphetamine use that had previously been heavy or prolonged. Dysphoric mood plus 2 or more of the following within a few hours of above: -Fatigue -Vivid, unpleasant dreams -Hypersomnia or Insomnia -Increased Appetite -Psychomotor Retardation or Agitation