Substance abuse

Question 1

Pharmacological treatment strategies

Answer 1

• Agnoist (replacement/substition)
• Antagonist (blockade)
• Aversive (negative reinforcement)
• Correction of underlying/associated disorders (such as depression etc.)

Question 2

Opioid dependence maintenance therapy

Answer 2

Methadone (must be administered through a registered narcotic treatment program)

Characteristics:

• long acting mu agonist
• duration of action: 24-36h
• dose: important issue and philosophical issue for many programs
• 30-40 mg will block withdrawal, but not craving
• illicit opiate use decrease with increasing methadone dose
• 80-100 mg is more effective at reducing opiod use than lower dose

Question 3

Antagonist treatment

Answer 3

Naltrexone

• block effects of a dose of opiate
• prevent impulsive use of drug
• relapse rates high (90%) following detoxification with no medication treatment
• dose (oral): 50mg daily, 100 mg every 2 days, 150mg every third day
• blocks agonist effects
• side effects: hepatotoxicity, monitor liver function test every 3 months
• biggest issue is lack of compliance.

Question 4

Candidate for nalterxone

Answer 4

• the patient is opioid free for 7-10 days
• the patient does not have severe or active liver or kidney problems
• the patient is not allergic to laterxone

Question 5

Abuse potential of psychiatric medication

Answer 5

LITTLE/NONE

• antipsychotic
• mood stabilizer
• buspirone

SOME

• tricyclic antidepressants
• Anticholinergic antiparkinsonians

SIGNIFICANT

• benzodiazepines
• barbiturates
• stimulants