Substance Use & Addictive Disorders (329 E2)

Question 1

substance addiction

Answer 1

a chronic medical condition w/ roots in environment, neurotransmission, genetics & life experiences -> a strong craving of substance & person has desire to cut down w/o success

Question 2

what is the biggest barrier towards treatment of addiction

Answer 2

stigma

Question 3

countertransference

Answer 3

unconscious feelings that the healthcare worker has toward the pt

• occurs when the provider unconsciously displaces feelings r/t significant figures in the providers past
• impairs therapeutic relationship
  provider needs to examine their own attitudes before treating a person w/ SUD

Question 4

risk factors for addiction

Answer 4

Biologic: genetic predisposition, inc extracellular dopamine, immature brain dev., function of acetate, having another mental health disorder, being male

neurobio: neurotransmitters associated w/ substance use disorder (dec dopamine)

environment: chronic stressors, anxiety, abuse or trauma, etc

starting alc, nicotine or other drug use at an early age

Question 5

increased extracellular dopamine in brain leads to

Answer 5

excess of dopamine causing the person to feel high
substances like cocaine, amphetamines, heroin & alc increase extracellular dopamine

Question 6

front vs back of brain

Answer 6

back: emotion, memory, impulse, psychomotor activity

front: area of executive function, planning, problem solving, judgment, impulse control, organization

if given oxy before front is developed, will develop memory that the drug made me feel good and I don’t have the judgement to not use drugs

Question 7

alcohol craving & acetate

Answer 7

alcohol breaks down into acetate -> acetate triggers a craving for more acetate -> in normal person acetate moves through system quickly and exits but a person w/ addiction processes alcohol at 1/3 to 1/10 the rate of a normal pancreas and liver -> the slow metabolism from 1 drink causes the acetate to barley be processed out and it makes the body crave more -> loss of control

Question 8

reasons for continued used (of alc?)

Answer 8

• alcohol craving
• repeated use leads to tolerance & w/draw via fundamental changes in neurotransmitters and decreased D2 receptors and decreased dopamine release
• results in compulsive behavior, dec inhibitory control, impulsivity, and impaired regulation of intentional action

Question 9

what metabolizes down into acetate

Answer 9

alcohol and nicotine

Question 10

substance intoxication

Answer 10

recent overuse/excessive use of a substance, such as an acute alcohol intoxication, that results in a reversible substance specific syndrome

• judgement is impaired
• CNS changes occur
  sx are drug specific

Question 11

tolerance

Answer 11

occurs when a person no longer responds to the drug or substance in the way that the person initially responded

Question 12

blackouts

Answer 12

not the same as passing out, caused excessive consumption of alcohol followed by episodes of amnesia. during these periods of time, a person actively engages in behaviors, can perform complicated tasks and appears normal

Question 13

relapse

Answer 13

the recurrence of alcohol - or drug - dependent behavior in an individual who has previously achieved and maintained abstinence for a significant time beyond the period of detox

Question 14

dual diagnosis

Answer 14

co occurring mental illness and substance use or addictive disorder

Question 15

substance withdrawal

Answer 15

a set of physiological symptoms that occur when a person stops using a substance

• differ and are specific to each substance
• can be mild to life threatening
• the more intense sx a person has, the more likely the person to start using the substance again to avoid the sx

Question 16

estimated timing of symptom appearance followign alc intake

Answer 16

6-12: insomnia, tremulousness, mild anxiety, GI upset, headache

12-24: alcoholic hallucinosis, visual, auditory or tactile hallucinations

24-48: w/draw seizures (gen tonic clonic)

48-72: alcohol w/draw delirium, hallucination, disorientation, tachycardia, htn, low grade fever, agitation, diaphoresis

peaks at 48hrs, use CIWA assessment q4
people can die from alc & benzo w/draw

Question 17

CIWA symptoms of sedative hypnotic / alc withdrawal that need to be asked about

Answer 17

• N/v
• tremors
• anxiety
• agitation
• paroxysmal sweats
• orientation
• headache
• tactile disturbance
• auditory disturbance
• visual disturbance

Question 18

goal for alc w/draw mgt

Answer 18

to control agitation, decrease the risk of seizures and decrease morbidity and mortality

Question 19

what drugs can be given for alc w/draw if pt scores 8+ on the CIWA

Answer 19

• chlordiaxepoxide
• diazepam
• lorazepam

Question 20

what vitamin needs to be given daily during alc w/draw

Answer 20

thiamine -> critical to give and should be given prior to IV dextrose support to prevent precipitation of Wernicke’s syndrome

Question 21

delirium tremens (DTS)

Answer 21

• most severe form of alc w/draw
• medical emergency that can result in the death that occurs anytime in the first 72 hours after cessation of heavy drinking
• serious physical illness such as hepatitis or pancreatitis may increase the likelihood of alcohol w/draw delirium
• it is rare to see this syndrome in individuals in good physical health

Question 22

DTS sx

Answer 22

agitation, inc anxiety, gross confusion & disorientation, coarse tremors, seizures, delusions, hallucinations, paranoia, autonomic hyperactivity (tachycardia, diaphoresis, fever, anxiety, insomnia & htn)
danger of misdiagnosis as psychiatric disorder

Question 23

best ways to treat DTS

Answer 23

1. prevent
2. medicate / sedate adequately
3. monitor
4. listen & respond to the pt’s report of sx
5. treat comps
6. give thiamine and other nutrients

• draw labs, hydrate, vitals, meds & life support as needed

Question 24

DTS medications for treatment

Answer 24

• phenytoin or phenobarbital (for seizures)
• oral diazepam (relief of acute agitation, tremors, impending or acute dts & hallucinosis)
• IV lorazepam (once delirium appears, severe sx)
• haloperidol
• clonidine (elevated BP)
• fluids

Question 25

sx to assess for opioid w/draw (using COWS)

Answer 25

- resting pulse rate - sweating - restlessness - pupil size - bone or joint aches - running nose or tearing - GI upset - tremor - yawning - anxiety or irritability - **gooseflesh skin**

Question 26

meds for opioid w/draw: N/v

Answer 26

- ondasetron - promethazine orally or rectal suppository **must see vomiting before giving**

Question 27

meds for opioid w/draw: anxiety, lacrimation, rhinorrhea

Answer 27

- hydroxyzine - avoid benzodiazepines

Question 28

meds for opioid w/draw: insomnia

Answer 28

trazodone

Question 29

meds for opioid w/draw: aches & pain

Answer 29

- acetaminophen - NSAIDs

Question 30

meds for opioid w/draw: diarrhea

Answer 30

- kaopectate - avoid loperamide bc sedation effect

Question 31

medication assisted treatment

Answer 31

a combination of medication, counseling and behavioral therapies are effective in the treatment of substance use disorders and can help some people to sustain recovery

Question 32

medications used in medication assisted treatment

Answer 32

naltrexone: blocks the effects of opioids & alc in the body -> helps to reduce cravings & prevents relapse (does not tx w/draw sx) - cannot use opioids for 10-14 days prior to start of med bc it will make them sick disulfiram: prevents the breakdown of acetaldehyde -> provides negative affect from drinking (does not reduce alc cravings) - will make you sick if you drink on it or come into contact w/ anything containing alcohol clonidine: used to reduce pt's BP and HR acamprosate: helps reduce alcohol cravings

Question 33

medications used to reduce cravings and controls w/draws sx for opioid abuse

Answer 33

methadone: reduces highs & lows of opioids while diminishing w/draw sx -> no ceiling effect, monitor closely - still an opioid that pt can become addicted to (start and stop slowly) buprenorphine & naloxone: reduces mortality of opioid use disorder by 50%, helps to relieve cravings and w/draw sx buprenorphine: reduces craving and w/draw sx and helps prevent relapse -> ceiling effect, limits overdose potential - replacement of drug they are craving

Question 34

naloxone kits

Answer 34

can be sent home w/ patients at risk for overdose

Question 35

psychological treatment for opioid use disorders

Answer 35

- individual therapy - behavioral therapy - CBT - family therapy - social skills training - support groups

Question 36

wernicke - korsakoff syndrome

Answer 36

- neurological disorder caused by lack of thiamine (B1) - 2 stages: wernicke encphalopathy & korsakoff syndrome (the more chronic, long lasting stage) - develops most often in people w/ alc use and malnut (chronic alc use can dec intestinal absorption of thiamine by 70%)

Question 37

wernicke's encephalopathy sx

Answer 37

- confusion - loss of muscle coordination (ataxia), affecting posture and balance - vision changes / abnormal eye movements / double vision / eyelid drooping

Question 38

wernkicke's encephalopathy

Answer 38

- acute and reversible condition - may clear up within a few wks or progress into korsakoff's - tx: thiamine replacement IV & improve nutritional status

Question 39

Korsakoff Syndrome

Answer 39

- chronic & debilitating, not reveresible - sx same as wern. + memory impairments, problems forming and recalling mems, confabulation, hallucinations, repetitious speech and actions, problems w/ decision making - tx: thiamine for 3 to 5 months

Question 40

CAGE

Answer 40

- felt you should CUT down - ANNOYED you with criticism - felt GUILTY - had EYE-OPENER drink

Question 41

goal of SBIRT (screening, brief intervention, and referral to treatment)

Answer 41

reduce and prevent related health consequences, disease, accidents and injuries, reduces costs and healthcare utilization

Question 42

AUDIT

Answer 42

the alcohol use disorder indentification test

Question 43

T-ACE

Answer 43

tolerance, annoyance, cut down, eye opener

Question 44

hazardous

Answer 44

pattern increases risk for adverse consequences

Question 45

harmful

Answer 45

negative consequences have already occurred

Question 46

OARS

Answer 46

* Opened ended questions * Affirmation * Reflective listening * Summarizing