Chapter 12

Question 1

What is the primary source of information on the use of illicit drugs, alcohol, and tobacco in the U.S. for 12+

Answer 1

The NAtional survey on drugs Use andhealth (NSDUH), sponsered by Substance abuse and MEntal health service administration (SAMHSA), a division of the Department of HEalth and Human Services (DHHS).

Question 2

Substance-related disorders are subdivided into two groups according to the new DSM-V (diagnostic and statistical manual of mental disorders, 5th edition)

Answer 2

1. substance use disorders

2. substance-induced disorders.

Question 3

Define substance use disorder:

Answer 3

patterns of sxs resulting from use of a substance that the individual continues to take, despite experiencing problems as a result.

Question 4

What are examples of substance-induced disorders?

Answer 4

intoxication, withdrawal, and substance abuse- mental disorders (depression, psychosis, bipolar, axiety, sleep, neurocogniitive, sexual dysfunction, delirium)

Question 5

The presence and severity of substance use disorders is determined using 11 criterias. What are they.

Answer 5

1. substance is ofeten taken in larger amounts or over a longer period than was intended
2. a persistent desire or unsuccessful effort to cut down or control use
3. a great deal of time is spent in activities necessary to obtain, use, or recover from the effects of substance.
4. craving of a strong desire to urge to use the substance is present
5. recurrent use, resulting in failure to fulfill major role obligations at work, school, or home
6. continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance if present.
7. important social, occupational, or recreational acitvities are given up or reduced because of use.
8. recurrent use in situations in which it is physically hazadous occurs
9. use is continued despite knowledge of having a persistent or persisten or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. the repsence of tolerance,
11. occurance of withdrawl,

Question 6

define tolerance

Answer 6

1) need for markedly increased amount of the substance to acheive intozication or desired effect
2) a markedly dimished effect with contined use of the asame amount of the subtance.

Question 7

define withdrawal

Answer 7

a) the characterisitics withdrawl syndrome from the subtance,
b) the substance or closely related substance is taken to relieve or avoid wihtdrawl symtpoms

Question 8

How does one classify the severity of substance use disorder

Answer 8

1. mild: presence of 2-3 criteria as above
2. moderate: presence of 405 criteria
3. severe: presence of 6 or more criteria

Question 9

True or False

Alcohol is the 3rd leading cause of preventable deaths in the U.S. ?

Answer 9

YEs, only exceeded by tobacco use and obesity.

Question 10

Describe the metabolism of alcohol

Answer 10

ethanol > CNS > depressant. [ ] depends on the ^ ETOH.

• 1/4 absorbed into the stomach and rest in small intestine.
• metabolized at 0.5 ounc/hour
• is a depressant, but has byphasic effect. Low levels stimulate nerve cells, high levels depress.

Question 11

What affects the degree in which the alcohol affects the body?

Answer 11

1. amount consumed
2. concentration of the drink
3. the speed of consumption
4. the presence of absence of food in the stomach
5. level of hydration
6. body type

Question 12

How does alcohol affect the two type of neuronal receptors: GABA and NMDA?

Answer 12

increases GABA receptor inhibitory acitvity (sedative effects), chronic use creates dependence.
decrease the excitatory activity of the NMDA receptor, (memory formation, complex thiking, and neuronal excitability. chronic use followed by withdrawal can lead to seizures.

Question 13

Does alcohol increase the release of dopamine?

Answer 13

yes, which causes the increase of pleasure feeling,s. it can also decrease, and people will seek to keep drinking to get the same feeling back.

Question 14

there are studies being done to assess the dependence of alcohol on the population. What are some epudemiology traits of substance dependence

Answer 14

1. alterations in the metabolism of alcohol via the ALDH enzymes.
2. serotonin dysfunction- implicated as a predoisposing factor
3. rate of alcoholosm are substantially higher in relatives with alcoholics.

Question 15

What systems in the body are affected by chronic alochol use?

Answer 15

1. liver
2. Gastrointestinal tract (GI)
3. the cardiovascular
4. nervous
5. immune systems

Question 16

How does chronic alcohol use affect the GI system?

Answer 16

1. suppressed appetitie
2. inflammation of digestive tract
3. decreased peristalsis and esophageal sphincter tone - GERD.
4. impaired enzyme activity/vitamin absorption
5. gi bleeds
6. chronic pancreatitis.

Question 17

How does chronic alcohol use affect the liver?

Answer 17

1. hepatic steatosis
2. alcoholic hepatitis
3. cirrhosis.
   - — mechanisms that damage the liver
4. production of acetaldehydes, free radicals, and cytokines as alcohol metabolizes. Alcohol indcued inflammation and cell dealth > Scarrring.

Question 18

How does chronic alcoholism affect the cardiovascular system ?

Answer 18

1. cardiomyopathy
2. HTN
3. stoke
4. A fib, atrial flutter, SVT, and Ventricular arrhthmias and sudden death.
5. ## ishemich/hemorrhagic stroke d/t HTN, coagulation and A fib.caused by ethanol or its metabolites acetaldehyde. Increases systemic BP caused by ETOH contribute to myocardial dysfunction.
   -

Question 19

How does chronic alcohol intake affect the nervouse system

Answer 19

CNS and PNS affected by ETOH-induced alterations in neurotransmitter levels and neuronal cell membrane function.

• Frontal lobe the most affected.
• toxic poluneuropahty is the most frequent CNS concequence, caused by deficiency of thiamine and B vitamins.

Question 20

how is the immune system affected by excessive alcohol intake?

Answer 20

1. increasing the risk of frequent and severe infections
2. immune system damaged from nutrition deficiency.
3. alcohol impaires B-cell lymphocyte production and function.
4. alcohol increases Hep C replication,

Question 21

How does excessive chronic alcohol intake affect cancer risk?

Answer 21

1. WHO classified ETOH as a Group 1 carcinogen. Organs most effected: oral cavities, pharynx, esophagus, laryns, stomach, liver, breast/ovary cancer.
   - works as a co-carcinogenic by enhancing the carcinogenic effects of other chemicals and by stimulating tumour growth.
   - acetaldehyde interferes with DNA replicatin and repair of DNA.
   inacitivate the tumourr suppressor gene BRCA1 and increase estrogen responsiveness.

Question 22

What affects the Effectiveness of alcohol dependence treatement?

Answer 22

1. individual motivation
2. age of onset of abuse
3. duration and extent of abuse
4. compliance with tx
5. successful tx of co-morbud factors.

Question 23

What is the most common form of alcohol therapy?

Answer 23

Psychoscocial approach- AA
based on the spiritual belief in a higher power, built on a 12 step approach used psychosocial teachniques such as rewards, social support nextworks and role models.

Question 24

How are moderation programs such as moderation management different from AA?

Answer 24

they do not madate complete abstinence byt allow low-risk drinking.
some success, but abstinence represents the most stable form of remission for most recovering alcoholics.

Question 25

What are some medications that can be used in the tx of alcohol-dependence?

Answer 25

1. disulfiram- prevents elimination of acetaldehydes. leading to A.E when ETOH is consumed 2. Naltrexone- competitive antagonist for opioid receptors, reduces the craving for alcohol. 3. acamprosate- restores the normal balance between neuronla excitation and inhibition that is altered by chornic alcohol use.

Question 26

What would an underwriter look for when u/w alcohol use hx?

Answer 26

1. hx of depression/mood disorders 2. sig personal or professional stressors 3. hx of violence 4. hx of another substance use disorder 5. adverse MVR 6. unstable employment record 7. family hx of acohol abuse 8. easy access to alcohol 9. frequent falls or accident 10. participation in high risk behaviours or avocations 11. tobacco use 12. physcical signs and sxs

Question 27

Which liver enzyme is primarily found in the liver?

Answer 27

ALT is found primarily in the liver, making it a more specific marker for liver injury, but AST is more sensitive marker for alcohol use; and AST/ALT ration greater than two is suspecious for liver disease. GGT has been found to be elevated in association with steady ETOH use over time, but other factors can cause GGT elevations.

Question 28

What is the MCV and how is it useful in detecting ETOH use?

Answer 28

its the mean corpuscular volume (MCV) a measure of the size of RBA. ^ [ ] represents macrocytosis, or presence of RBCs. Seen with B12 and folate deficiencies. there is a relationship between ETOH abuse and macrocytosis. Low levels are likely to be associate to alcohol-related abnormalities.

Question 29

How are Lipids affected by ETOH?

Answer 29

low/moderate alcohol use raises HDL. however excessive levels increase HDL to outside normal rance. Trigs, are elevated d/t the fatty liver changes. uric acid also can be increased.

Question 30

What are some common alcohol markers?

Answer 30

1. CDT- ETOH interferes with teh addition of carbohydrate groups or stimulates their removal from transferrin. 2. Acetaldehyde: when concentration levels are chornically elevated they cause elvated HAA concentrations.

Question 31

What are some good alcohol screening tools?

Answer 31

1. CAGE questionnaire- simple screening test for alcohol abuse. 2. Michigan Alcohol Screening TEst (MAST)- oldest and most accurate 3. the alcohol use disorders identification test (AUDIt)- developped internationally.

Question 32

What are the 4 questions asked on the CAGE questionnaire?

Answer 32

1. have you ever felt the need to cut down your drikning? 2. have poeple annoyed you by cirticizing your drinking? 3. have you ever felt guilty about drinking 4. have you ever felt you needed a drink first thing in the morning to steady your nerves or to get rid of a hangover?

Question 33

What are the mortality implications of increased/chronic alcohol consumption?

Answer 33

1. cirrhosis 2. CV disorders 3. cancers 4. unintentional deaths via MVA, and high risk behaviours.

Question 34

What is the most commony used illicit drug with current users?

Answer 34

MArijinana,

Question 35

How does MArijuana affect the system

Answer 35

1. enters the brain and lasts 1-3 hours. 2. heavy use impaires ability to form memories, recal events, and shift attention 3. disrupts coordination, and balance. 4. high dose can create acute toxic psychosis 5. long-term use increses risk of chronic lung diease and cancers of the head, neck and lungs.

Question 36

What are the short-term physiological effects of cocaine? And what are the most frequent complications of cocaine?

Answer 36

constricted blood evssels, dilated pupils, increased temperatures, heart rate, blood pressure. - -- 1. cardiovascular effects including arrhythmias and MI, 2. respiratory effects, including respiratory failure., 3. neurological effects, including strokes, seizures, headaches. 4. GI effect, including abdo pain and nausea.

Question 37

Define the mechanism of heroin?

Answer 37

absorbed quickly thorugh the blood-brain barrier where it is converted to morphine and rapidly binds to opioid receptors. > can cause resp depression

Question 38

Define the mechanism of methamphetamine

Answer 38

man-made substance structurally similar to amphetamine and dopamine. - increases alertness, decreases appetitie and creases sensation of pleasure. - longer duration in the body compared to coccaine. - long term use creases sxs of anxiety, confussion, insomnia, mood disturbances, and violent behavirous. Also brain structure changes, in areas of motion and memory.

Question 39

Define the mechanism of MDMA

Answer 39

semi-synthetic stimulant and hallucigen that is used to improve mood and maintain energy. - reduces mental abilities, memory and information-processing capabilities. These sxs can last up to a week and perhaps longer in regular uses.

Question 40

Define the mechanism of PCP (phencyclidime)

Answer 40

1. dissociative anaesthetic. 2. out-of body experience and sens of detachment from reality. 3. effects are unpredictable 4. can cause rapid, shallow breathing, HTN, tachycardia and elevated body temperatures.

Question 41

Define the mechanism of LSD (lysergic acid diethylamide)

Answer 41

semi-synthetic hallucinogenic drug derived from rye fungus and is the most potent mood and preception altering drug. - HTN, tachycardia, dizziness, dry mouthn, sweating, numbness and tremors. - emotion inbalanace - . hallucinations - develop high tolerance which also dissipates quickly after cessation of use. - Flash back concequence ( HPPD)

Question 42

How are substance use disorders treated?

Answer 42

successful tx is challanging d/t the changes that occured in the brain from chronic use. 1. drug-rehabilitation. 2. 12-step recovery programs such as NA and CA.

Question 43

Is there a relation between substance abuse and mental illness?

Answer 43

yes 6/10 people with substance use disorder have another form of mental illness, most commonly associated with: 1. antisocial personality disorder 2. schizophrenia 3. bipolar disorder, 4. major depressive disorder 5. ADHD 6. generalized anxiety disorer 7. PTSD

Question 44

What is the mortality and morbidity among drug addits?

Answer 44

high d/t rates of suicide attempts, consequences of high-risk behavors, and unintentional deaths from OD. and injuries.

Question 45

What are factors that affect the treatment success for drug abusers?

Answer 45

1. duration of use 2. drugs used 3. presence of polyp substance use 4. co-morbid mental health disorder 5. history of relapse 6. number of years drug-free

Question 46

What are some u/w considerations when reviewing a history of drug use?

Answer 46

1. drugs used 2. hx of poly-substance abuse incl ETOH 3. use of px Rx at risk of being abused 4. hx of depression/other mood disorders 5. suicidal ideations/ attempts. 6. duration of abuse 7. duration of abstinence 8. hx and number of relapses 9. type of tx and compliance 10. presence of ongoing support 11. hx of high risk behavior, accdients/falls or violent behavior 12. Adverse MVR findings 13. unstable employement records 14. +ve findings on drug screens

Question 47

What are the most commonly used paid relieves?

Answer 47

``` opioid compoused, which include: 1. hydrocodone 2. oxycodone 3. morphine 4. fentanyl 5. codeine benzodiazepines which includes 1. dizepam 2. alprazolam Px stimulants: 1. Dextroamphetamine 2. methylphenidate ```

Question 48

What was caused of the increase incidence of px drug abuse?

Answer 48

1. rising number of medicines being px for a variety of health problems 2. ease of obtaining this rx online 3. access by children and family members to the px medicines of others in the hosuehold.

Question 49

What is the most cmoon cause of mortality associated with teh nonmedical use of px drugs?

Answer 49

1. unintentional injury 2. suicide 3. death from injury of undetermined intent. 4. increases in poisoning mortality.

Question 50

What are the underwriting consideridarations in u/w px use?

Answer 50

its difficult to detect. 1. records from px databases are useful for determining patterns. 2. medical records- if all physicians are disclosed.