Substance Abuse

Question 1

Use

Answer 1

When one drinks, swallows, smokes, sniffs, inhales or injects a mind altering substance

Question 2

Abuse

Answer 2

Use of alcohol or drugs for the purpose of intoxication, or, in the case of prescription drugs, for purposes beyond their intended use

Question 3

Addiction

Answer 3

An irresistible psychological and/or physiological need to continue the substance use or behavior despite the harm it causes

Question 4

Physical Dependence

Answer 4

Physiological requirement for the substance by the brain, as evidence by development of tolerance and withdrawal when use decreases or stops

Question 5

Craving

Answer 5

An urgent desire for a substance or behavior to which one is addicted, often in response to triggers, that is very difficult to resist

Question 6

Tolerance

Answer 6

patient need more of the substance to have the same affect

Question 7

Cross tolerance

Answer 7

substances that are pharmacologically interchangeable in terms of how the body responds ( Ex: alcohol and most benzodiazepines )

• can use this to treat dependence

Question 8

Withdrawal

Answer 8

state characterized by adverse physical and psychological symptoms occurring when one ceases using a substance to which the brain is acclimated

Question 9

Trigger

Answer 9

Anything which cues or prompts a response ex. seeing a bar may trigger a craving for alcohol

Question 10

Detoxification

Answer 10

Safely withdrawing a person from an addictive substance, usually under medical supervision ( uses cross tolerance and gradually decreasing amounts )

Question 11

Relapse

Answer 11

The recurrence of alcohol - or drug - dependent behavior in an individual after detoxication

Question 12

Chemical Hook Theory

Answer 12

Once the brain has been exposed to the substance –> “the brain has to have it”

Question 13

Alexander experiment

Answer 13

Conclusion, if we have what we need, we will not self medicate with drugs

Question 14

Impaired response inhibition and salience attribution (iRSA)

Answer 14

With increasing exposure to rewarding activities/substances, the brain starts to focus more on the exposure to activities/substances

• the brain becomes less and less able to control one’s response to cue ( ex: seeking cocaine after seeing white powder- the white powder is the cue)

Question 15

Alcohol

Answer 15

• CNS Depressant and euphoria
• measure by blood alcohol level
• prenatal use= Fetal alcohol syndrome

Question 16

Alcohol abuse ( > 1 of the following in a year)

Answer 16

• Recurrent use and hazardous situation’s.
  -Recurrent alcohol – related legal problems. - Recurrent use and failure to meet role obligations.
• Continue use despite social or interpersonal problems.

Question 17

Alcohol Dependence ( > 3 of the following in a year)

Answer 17

• Tolerance.
• Withdrawal. Increase time spent in alcohol related activities.
• Important activities given up or reduced.
• Drinking more or longer than desired. Persistent desire or unsuccessful efforts to cut down on alcohol use.
• Continue use despite knowledge of self harm.

Question 18

Biological response to Alcohol

Answer 18

1. Increase GABA activity = causes relaxation and sedation
2. Acute CNS, depression, and euphoria
3. Long term: physical tolerance independence
4. Wernicke’s Encephalopathy
5. Korsakoff’s Syndrome
6. Wernicke - Korasakoff Syndrome

Question 19

What is Wernicke’s Encephalopathy

Answer 19

• Alcohol causes gastric irritation, reduce absorption of B vitamins, interferes with conversion of thiamine into thiamine pyrophosphate (bioactive form of thiamine)
• Characterized By: acute onset of ocular motor dysfunction (eyes are misaligned) ataxia (impaired coordination), ptosis (drooping eye) and confusion (may have any or all of the symptoms.)
• REQUIRES EMERGENCY TREATMENT = IV THIAMINE TO PREVENT PERMANENT DAMAGE

Question 20

what is Korsakoff’s Syndrome

Answer 20

• Gradual onset of retrograde and anterograde amnesia w/sparing of intellectual function and some aspects of memory
• Characteristic features: Apathy (lack of emotion), or increased talkativeness; confabulation ( created fictional stories about past events or present situation )

Question 21

Alcohol withdrawal ( when does it happen? S/SX?, Alcohol withdrawal syndrome)

Answer 21

• Alcohol withdrawal can begin as soon as two hours after the last drink or dosage of last cross tolerance med
• Early symptoms: tremors, diaphoresis, rapid pulse, elevated blood pressure and headache
• Treatment of early sx
  • may feed pt
  • B-complex IM: multivitamis
  • Best treatment: prevention

ALCOHOL WITHDRAWAL SYNDROME
- early sx above worsen
- hallucination
- grand mal seizures
- changes in cognition

Question 22

Severe Alcohol Withdrawal : DELIRIUM TREMENS

Answer 22

MEDICAL EMERGENCY

• ANS instability: tachycardia, HTN, pyrexia ( fever)

-MENTAL STATUS CHANGE: disorientation, reduced awareness of environment, delusions hallucinations, marked tremors agitation, and diaphoresis

• Onset: 3-5 days after last drink
• TREATMENT
  1. Replace thiamine, niacin, folate and magnesium – all IV
  2. Replace electrolytes- all IV
  3. Glycogen (D5W) - IV
  4. BENZODIAZEPINES - Sedative, increases GABA (used as cross tolerance)
  5. BACLOFEN- muscle relaxant, GABA agonist, REDUCES RELAPSE
  6. Antipsychotic

Question 23

Treatment for Alcohol Dependence

Answer 23

THE MEDS ARE USED TO REDUCE CRAVING AND OR REWARD FROM DRINKING

1. NALTREXONE- bind to opioid receptors to block euphoric effectes of alcohol
2. ACAMPROSATE- increases GABA ( used after detox )
3. CITALOPRAM- SSRI
4. ODANSTERONE- serotonin antagonist
5. BACLOFEN- muscle relaxant, reduces craving, withdrawal
6. GABAPENTIN- reduces relapse and amount of EtOH used.

• Assure adequate nutrition and supplemental vitamins ( vitamin B and thiamine )
• Omega 3 may limit neuro damage

Question 24

Cocaine

Answer 24

• CNS stimulant that produces a euphoric rush of mental alertness and energy feelings of self-confidence,
• Last for 10–20 minutes high followed by intense let down
• Biological effects of cocaine= Paranoia, hallucinations tachycardia, hypertension, dilated pupils in increase temperature.

Question 25

Intoxication ( Cocaine )

Answer 25

CNS stimulant followed by depression, -Increasing doses: restlessness --> tremors and agitation --> convulsions --> CNS depression

Question 26

Withdrawal ( cocaine )

Answer 26

- Norepinephrine depletion causes a person to sleep for 12–18 hours. Then sleep disturbances with rebound REM lethargy, decreased libido, depression, suicidality, anhedonia, poor concentration and cocaine craving

Question 27

Toxicity ( Cocaine )

Answer 27

- Mydriasis ( pupils are enlarged), encephalopathy, seizures, decreased responsiveness, hypertension, rapid, and possible, irregular pulse, hyperpyrexia ( very high fever > 41.5 C ) , respiratory and cardiovascular failure.

Question 28

Meds for cocaine addiction

Answer 28

1. METHYLPHENIDATE (ritalin)= may aid i self control and reduce craving ( but is abusable ) 2. GABAPENTIN (Neurotin)= may reduce tension, cravings 3. VIGABATRIN (Sabril)= increases GABA and reduces cravings 4. BACLOFEN (Gablofen, Lioresal)= reduces cravings 5. N-ACETYLCYSTEINE (NAC)= seems to improve glutamate levels and reduce cravings 6. NOCAINE= (experimental) mimics the effects of cocaine but at a weaker level but also blocks the effects of cocaine itself

Question 29

Amphetamines

Answer 29

- blocks of norepinephrine and dopamine, not as strong effect on serotonin as cocaine has -Affects the peripheral nervous system

Question 30

Treatment for Tobacco Addiction

Answer 30

- Is especially important in severe mental illness due to higher rates of smoking greater inhalation in 1. Nicotine replacement via e-cigarettes 2. BUPROPION (wellbutrin) = reduces cravings and weight gain associated with smoking cessation 3. VARENICLINE= block nicotine receptors

Question 31

Caffeine

Answer 31

- Stimulates cerebral cortex increases mental acuity. - 300 mg can cause tremors, poor motor performance, and insomnia. -POTENTIALLY FATAL

Question 32

Benzodiazepines

Answer 32

- Causes CNS depression - Decreases the duration of REM Sleep - Withdrawal sx may begin as long as 8 days after last taken Withdawal sx - rebound anxiety and autonomic ( syncope, brain fog, N/V , etc. ), sensory excitement, motor excitement, cognitive excitation Withdrawal tx = tapering

Question 33

Molly

Answer 33

Crystalline form of MDMA - can cause severe dehydration and hyperthermia

Question 34

MDMA (ecstacy)

Answer 34

Can cause potential hyponatremia and hyperpyrexia

Question 35

GHB (rupies)

Answer 35

- CNS depressant - "date rape drug" - Coma and seizures

Question 36

Opiate withdrawal sx

Answer 36

HYPEREXCITABILITY - Autonomic: diarrhea, rhinorrhea, N/V, bradycardia - CNS: sleeplessness, restlessness, agitation, -Pain: adb cramping, bone pain, backache, and muscle aching - Intense craving, erythema

Question 37

Meds use for Opiate Addiction

Answer 37

1. LAAM ( L-alpha acetyl methadol )- every other day 2. METHADONE- taken daily 1 & 2.) OPIOID AGONIST- intent is to replace other more disruptive and addictive opioids with meds that reduce craving 3. NALOXONE (narcan) 4. BUPRENORPHINE- ceiling action: blocks further effects of opioids when present in higher in amounts ( partial agonist/ antagonist) 5. BUPRENORPHINE/NALOXONE= naloxone blocks effect in med is crushed or ingested at higher doses in attempt to produce euphoria 6. NALMEFENE= blocks the effects of opioids

Question 38

Codependency ( signs)

Answer 38

staying in a abusive / unrewarding relationship, focusing on changing the other person while neglecting oneself