Substance Related Disorders and Treatment of Substance Abuse Flashcards Preview

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Define the following:
1. Substance use?
2. Abuse?
3. Physical dependance?
4. Psychological dependence?
5. Addiction?

1. Substance use: sporadic consumption of alcohol/drugs w/ no adverse consequences

2. Abuse: frequency of alcohol/drug use may vary, there are adverse consequences experienced by the user

3. Physical dependence: state of adaptation that is manifested by a drug class-specific withdrawal syndrome

4. Psychological dependence: a subjective need for a specific psychoactive substance, either for its positive effect or to avoid negative effects of its abstinence

5. Addiction: primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations


Addiction is characterized by what kind of behaviors?

Characterized by behaviors that include
1. impaired control over drug use,
2. compulsive use,
3. continued use despite harm and craving
4. Continuing use despite adverse consequences in the abusers life


Special Populations at risk for addiction

1. Adolescents

2. Anyone with a psychiatric comorbidity

3. Those who smoke or who abuse alcohol (polysubstance abuse is the norm)

4. Elderly

5. Health care workers

6. Pregnant women may fear admitting to drug use


Recognizing the Drug Abuser: For each substance what do you need to ask?

1. Quantity
2. Amount of money spent daily/weekly/monthly
3. Frequency of use and time of last use
4. Route of administration
5. If history of use is disclosed ask about prior detox or addiction treatment and abstinence periods


Physical Changes
in addicts

1. Drug use is the leading cause of impotence in the U.S.

2. Weight loss and sleep disturbance

3. Evidence of localized or systemic infections

4. On abdominal exam may palpate enlarged or shrunken liver

5. Respiratory or nasal problems

6. Needle marks: “tracks”

7. STIs in patients who are trading sex for drugs


What indicates a likely diagnosis of alcohol dependence on the CAGE questionaire?

Two or more positive answers


CAGE Questionnaire

1. Have you ever felt the need to Cut down on your drinking?

2. Have you ever felt Annoyed by criticism of your drinking?

3. Have you ever had Guilty feelings about your drinking?

4. Do you ever take a morning Eye-opener? (a drink first thing in the morning to steady your nerves or get rid of a hangover)


1. Risky or hazardous drinking: men less than 65YO?

2. women less than 65YO?

1. > 14 drinks a week

2. > 7 drinks a week


Alcohol abuse: associated w/ one or more of the following, occurring in a 12-month period.

1. Failure to fulfill work, school or social obligations

2. Recurrent substance use in physically hazardous situations

3. Recurrent legal problems related to substance use

4. Continued use despite alcohol-related social or interpersonal problems


Alcohol dependence (“alcoholism”) is defined as?

a maladaptive patterns of use associated with 3 or more of the following, occurring at any time in the same 12-month period:

1. Tolerance
2. Withdrawal
3. Substance taken in larger quantity than intended
4. Persistent desire to cut down or control use
5. Time is spent obtaining, using, or recovering from the substance
6. Social, occupational or recreational tasks are sacrificed
7. Use continues despite physical and psychosocial problems


Alcohol abuse associated with greater risk of:


1. HTN, cardiomyopathy

2. Hepatitis, cirrhosis (½ the cases in U.S. Secondary to alcohol), pancreatitis

3. TB, Pneumonia

4. Psych problems: anxiety, depression and eating disorders

5. Cancers of the stomach, mouth, larynx, breast and esophagus


Other screening tools for alcohol abuse?

1. Single item screening

2. Alcohol Use Disorders Identification Test (AUDIT)

3. CAGE questions (not as reliable for Caucasian women)


1. Intervention most likely to succeed in patients who are in what categories?

2. Who needs to be screened to achieve benefit?

3. Screening essential patients such as?

1. “risky drinking” or “hazardous drinking”

2. A large number of patients (everyone)

-w/ + family hx,
-who smoke,
-have frequent ER visits, or
-who are on meds that interact w/ alcohol


For Adolescents and College Students: Questions to ask to assess for high risk alcoholic behavior?


1. Have you ever ridden in a Car driven by someone (including yourself) who was “high” or had been using alcohol or drugs”

2. Do you ever use alcohol or drugs to Relax, feel better about yourself, or fit in?

3. Do you ever use alcohol or drugs while you are Alone?

4. Do you ever Forget things you did while using alcohol or drugs?

5. Do you family or Friends ever tell you that you should cut down on your drinking or drug use?

6. Have you ever gotten into Trouble while you were using alcohol or drugs?


CRAFFT: What indicates a problem of abuse or dependance?

Two or more positive answers indicate problem use, abuse or dependence

Performs better then the CAGE for this age group


Define the following for men and women:
1. Moderate drinking?
2. Heavy drinking?
3. Binge drinking?

1. Moderate drinking:
Men: 2 drinks or less a day
Women: 1 drink or less a day

2. Heavy drinking:
Men: > 14 drinks per week, or 4 drinks per occasion
Women: > 7 drinks per week or 3 drinks per occasion

3. Binge drinking:
Men: 5 or more drinks in a row
Women: 4 or more drinks in a row


Ethyl alcohol or ethanol
1. Absorption: 10% consumed alcohol absorbed in the what?
2. remainder from the where?

1. stomach
2. small intestines


When concentration of alcohol in stomach becomes too high—what results in slowed absorption? 2

Pylorospasm results in?

1. mucus secretion
2. pyloric valve closure



1. 90% metabolized in ____through oxidation
2. Metabolized by two enzymes what are they?

1. liver

-Alcohol dehydrogenase (ADH) catalyzes conversion of alcohol into acetaldehyde, which is toxic

-Aldehyde dehydrogenase(ALDH) catalyzes conversion of acetaldehyde into acetate


Effects of Alcohol on the Brain
1. CNS depression much like what?

2. Relatively mild levels: How is behavior changed?

3. Increasing levels: how is behavior changed?

4. Yet increasing levels— Behavior?
-What can this result in??

1. benzodiazepines

2. thought, judgment and restraint are loosened

3. voluntary muscle dysfunction and entire motor area of the brain depressed

4. confusion, stupor, coma and finally primitive centers that control breathing and heart rate are affected and can result in

--death either secondary to direct respiratory depression or aspiration of vomitus


Effects of Alcohol on the Liver
1. Metabolism of alcohol leads to _______attack on the liver (it is unknown if damage is caused by acetaldehyde or other metabolites)

2. Even after all alcohol intake has stopped and all alcohol has been metabolized, the processes that damage liver cells may continue for how long?

3. Clinical and chemical effects often become what before you get better?

1. chemical

2. weeks to months

3. worse before disease resolves


Three patterns of hepatocellular injury:

1. Fatty liver
2. Alcoholic hepatitis
3. Cirrhosis (rate is 10-15% of all alcoholics)


Wenicke-Korsakoff Syndrome
is what?

Occurs in persons who have been drinking heavily for many years—rare to see in persons younger then 35YO: Caused by thiamine deficiency due to poor nutrition/malabsorption


1. Wernicke's encephalopathy: acute symptoms are? 4

2. THese are completely reversible with what?

3. Why before the IV glucose?

1. Characterized by
-gait ataxia,
-vestibular dysfunction,
-confusion and
-ocular abnormalities

2. treated w/ high dose thiamine:

3. MIght cause encephalopathy


Alcoholic hepetitis Labs? 2

Tranaminines will be in the hundreds not thousands and Alk phos will be mildly elevated


1. Korsakoff's Syndrome: chronic condition characterized by what?

2. Treatment?

1. impaired recent memory and anterograde amnesia

2. condition where only 20% of patients recover—can be treated w/ po thiamine


Treating Alcohol Dependence
1. Short Term Goals? 3

2. Long term goals? 2

1. Short term goals:
-ID and initiate treatment fro patients at risk for withdrawal (determine stage)
-Promote attendance at AA or other support groups

2. Long term goals:
-Extended management over time
-Determining efficacy of treatment


Alcohol withdrawal—Mild Symptoms

1. Insomnia
2. Tremulousness
3. Mild anxiety
4. GI upset/anorexia
5. Headache
6. Diaphoresis
7. Palpitations


Withdrawal Symptoms
1. Mild symptoms begin within ___hrs. of cessation of drinking

2. They resolve within ____ hrs.

Withdrawal seizures:
3. Occur within ___ hrs. after last drink
4. What kind of seizures?
Occur in 3% of chronic alcoholics

5. Treat w/ what?

1. 6

2. 24-48

3. 48

4. Tonic-clonic

5. benzodiazepines


Alcoholic Hallucinosis
1. Develops within ____ hrs. of last drink
2. Resolves with _____ hrs.
NOT delirium tremens

3. Usually what kind of hallucination?

1. 12-24

2. 24-48

3. visual; but can be auditory or tactile