Addiction

Question 1

general def. of dependence

Answer 1

patient find the drug so pleasurable and reinforcing that they have difficulty controlling their use of the substrance

Question 2

what is neurobio explanation

Answer 2

• in nucleaus accumbens and medial forebrain, DA is transmitter
• tied with memory and executive function

Question 3

what does DA drive

Answer 3

survival benefits - food, sex, nurturing

Question 4

how do drugs tie into these pathways

Answer 4

• cocaine directly blocks DA reuptake

- other drugs do so via other neurotransmitters

Question 5

5 things that give a drug addictive potential

Answer 5

1. rapid onset of action
2. high potency at receptor
3. short duration of action
4. tolerance
5. withdrawal

Question 6

2 ways tolerance is increased

Answer 6

1. # of receptors and sensitivity

2. levels of neurotransmitters

Question 7

what does rate of tolerance developlment depend on

Answer 7

the effects - for opiods

1. pain is slow
2. sedation is fast

Question 8

what happens in withdrawal

Answer 8

receptors that resist the drugs are now unoppsed - get opposite effects

Question 9

how do genes inflence alc.

Answer 9

for naive drinkers

1. fewer adverse effects
2. greater tolerance
3. more pos. effects

Question 10

2 psychiatric risk factors

Answer 10

1. use releives negative mood states

2. have other mental disorders

Question 11

4 social risk factors

Answer 11

nothing to do, nothing to lose

1. lack of meaningful life
2. lack of social support
3. cultural attitudes towards
4. peer influences

Question 12

6 clinical features of dep

Answer 12

1. drug becomes main focus of time and life
2. neglects major responsiblities
3. continued use despite consequences
4. try to quit but relapse
5. tolerance, withdrawal
6. cravings

Question 13

4 Cs

Answer 13

Compulsive use
Cut down (unable)
Cravings
Consequences

Question 14

steps to a substance use Hx

Answer 14

IPTARRR
Initiation
Pattern
Treatment hx
Abstinence
Relapse
Risk assessment
Readiness to change

Question 15

why is it important to address smoking

Answer 15

• killa

- smoking cessation counselling is one of the most cost-effective interventions available

Question 16

benefits to quit

Answer 16

• breathe easier in 24hr
• cough better in 2 weeks
• risk of CAD down 50% in one year
• risk of stroke normalizes in 5 years
• risk of dying normalizes in 15 years

Question 17

4 effects of nicotine

Answer 17

1. psychoactive effects - chamelon
2. CV effects - incre HR, output, BP
3. app suppresion
4. incr. metabolic rate

Question 18

pharma of nicotine

Answer 18

binds to ACH receptor in nuleaus accumbens

Question 19

why so addictive

Answer 19

• rapid onset
• 200 puffs a day
• easy to self regulate
• very reinforcing - hardest to quit

Question 20

what is withdrawal timing of nicotine

Answer 20

24hr - beings - irritable, anxiety, depressed mood
5day - severe withdrawal last
months - still have the urge

Question 21

4 general types of intervention

Answer 21

1. init. smoking cessions
2. counselling
3. pharma
4. combo - more effective than either alone

Question 22

5 As of smoking cessation

Answer 22

1. ask - do you smoke
2. advise - clear and strong
3. assess - within 30 days
4. assist - START
5. arrange follow up

Question 23

what is START for assisste

Answer 23

Set a quit date
Tell friends/fam
Anticipate and plan for challenges
Remove all cigs
Talk to doc

Question 24

4 meds

Answer 24

1. nicotine replacement
2. buproprion
3. varenicline
4. combo therapy

Question 25

what is effect of meds

Answer 25

double chance

Question 26

2 types of NRTs

Answer 26

patch - good in first 2 weeks | gum - good for breakthrough cravings

Question 27

what is buproprion

Answer 27

atypical antidep - elevates DA levels | - 1-2 weeks to work

Question 28

what is veranacline

Answer 28

champix | - partial nictotine agonist - give effect and blocks other nictoine

Question 29

5 effective public health strategies

Answer 29

1. incr. cost 2. pass clean air leg. 3. create effective anti-smoking 4. ban tobacco advertising 5. provide cessation aids

Question 30

what is alc. epi

Answer 30

80% men and 60% of women use at some time 30-50% have an adverse effect 15% chance of disorder

Question 31

what is psych effect of alc

Answer 31

CNS depressent low dose - anxiolytic, pleasure, disinbi high dose - sedative/hyponotic

Question 32

2 main transmitters in alc

Answer 32

GABA - CNS inhibition | glutamate - CNS exitatation

Question 33

what happens in acute, chronic and withdrawal of alc

Answer 33

acute - GABA dominant chronic - equal withdrawal - glut dominante - autonomic arousal

Question 34

2 Sx with 6-24hrs of withdrawal

Answer 34

1. tremor | 2. diaphoresis

Question 35

Sx at 8-254hrs

Answer 35

hallucinations

Question 36

sx at 24-48 hours

Answer 36

seizures

Question 37

sx of 72+ hours

Answer 37

DTs - can be high mortality

Question 38

what are DTs

Answer 38

- tahcy - tremor - diaphoresis - fever - disorientation

Question 39

goals of detox

Answer 39

- manage sx of withdrawal - prevent serious events - bridge to treatment

Question 40

main treatment of withdrawal

Answer 40

benzos

Question 41

5 stages of alc intervention

Answer 41

1. ID 2. intervention 3. detoxification 4. rehabilitations 5. prevention

Question 42

what is SBIRT

Answer 42

Screening, Brief Intervention, Referral to Treatment

Question 43

3 important things to ask about

Answer 43

1. all patients 2. weekly amount 3. maximum in a day over last month

Question 44

CAGE

Answer 44

Cut down Annoyed Guilt Eye-opener

Question 45

what is brief screen

Answer 45

in past year how often have you have 5 or 4 drinks in one sitting

Question 46

what is safe drinking

Answer 46

men - 15/wk and max 3/day women 10/wk and max 2/day can have an extra on special occasions

Question 47

what is FRAMES brief intervention

Answer 47

``` Feedback Responsibilty is on patient Advice to change Menu of options Empathic style Self-efficacy ```

Question 48

3 drugs for alc. and mech

Answer 48

naltrexone - opiod antagonist - don't get high acamproate - enhances GABA to releive sub-acute withdrawal disulfram - ALDH inhib - get toxic buildup and feel bad

Question 49

what is effect of opiods

Answer 49

act on mu opiod receptors and get sense of peace/happiness

Question 50

why don't all pts become addicted

Answer 50

most don't have the reinforecing effects

Question 51

3 keys for doctors when prescribing opiods

Answer 51

1. select patients carefully 2. titrate doses slowly and carefully 3. watch for "aberrant behavior"

Question 52

what is opiod withdrawal

Answer 52

- flu-like sx | - psych sx predominate

Question 53

how does methadone work

Answer 53

has slow onset and long half-life | - releives sx without sedation or euphoria

Question 54

what is buprenorphine (suboxone)

Answer 54

- sub-lingual partial agonsit - binds tigtly and displaces other opiods - ceiling effect so can't OD

Question 55

what is contingency mgmt

Answer 55

- daily dispensing, supervised - gradual introduction of take home doses as well - urine screens

Question 56

compications of THC

Answer 56

- poor social funct. - depression - addiction - MVA - drug-induced psychosis

Question 57

who to be concerned about with THC

Answer 57

more than a joint/day

Question 58

what is THC use in pain

Answer 58

- weak evidence | - contains carconogens

Question 59

what is cocaine effect

Answer 59

blocks re-uptake of DA | - most reinforceing drug

Question 60

5 therapies of substance use

Answer 60

``` MI CBT AA contingency mgmt family therapy ```

Question 61

what is MI

Answer 61

- collaborative! and conversational - use PT strengths - style is as a guide - need to also be empathic

Question 62

3 keys to CBT

Answer 62

1. recognize triggers 2. avoid high risk situations 3. cope with cravings

Question 63

what is AA programs

Answer 63

12 steps - alc. is medical and spiritual disease - abstinence based - accept loss of control - need a sponsor

Question 64

what is contingency mgmt

Answer 64

based on operant conditioning - reward abstience - punish drug use

Question 65

what does contingency mgmt look like

Answer 65

- find target bahev. (eg drugs in urin) - clear consequences of success and failure - immediate reinforcement - incentives and punishments immediate

Question 66

what is family therapy

Answer 66

rewards and focus on abstinent behavior while retoring family system

Question 67

what is addiction among physician

Answer 67

lifetime 8-14% M>F 7:1 more alc, opiods, sedatives