Substance Use Disorders Pt.1, Ch 14

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Questions and Answers

Which biological factor is specifically associated with alcoholism?

Genetics (correct)

Cognitive patterns

Social learning

Developmental influences

What psychological factor may lead individuals to use drugs to alleviate anxiety?

Social reinforcement

Oral fixation

Punitive superego (correct)

Cognitive dissonance

Which of the following symptoms are indicative of CNS depressant overdose?

Increased anxiety and agitation

Shock and coma (correct)

Impaired judgment and functioning (correct)

Elevated vital signs

Which of the following psychoactive substances is NOT included in the provided list?

Hallucinogens Signup and view all the answers

In which phase of Alcohol Use Disorder does the individual first require alcohol to function?

Phase II: Early alcoholic phase Signup and view all the answers

What cognitive factor is recognized as central to addictive behaviors?

Irrational thinking patterns Signup and view all the answers

What symptom is NOT part of withdrawal from opioids?

Hallucinations Signup and view all the answers

Which sociocultural factor can influence substance use among adolescents?

Parental modeling Signup and view all the answers

Which of the following assessments would provide insight into a patient's coping mechanisms?

Psychosocial history Signup and view all the answers

What is a common sign of alcohol intoxication?

Slurred speech Signup and view all the answers

What is NOT a criterion for diagnosing Substance Use Disorder?

Increased social interactions Signup and view all the answers

Which of the following best describes substance intoxication?

Development of a reversible syndrome of symptoms Signup and view all the answers

What is a potential risk of substance withdrawal?

Life-threatening symptoms Signup and view all the answers

Which symptom would indicate the development of tolerance in a person using a substance?

Increased amount needed for the same effect Signup and view all the answers

What does 'cross-dependence' refer to in substance use?

Dependence on one substance reducing withdrawal symptoms of another. Signup and view all the answers

Which of the following is NOT a sign of substance use disorder?

Consistent fulfillment of role obligations Signup and view all the answers

What effect does substance use have on a person’s social interactions?

Causes difficulty with interpersonal relationships Signup and view all the answers

What condition can result from abrupt discontinuation of substance use?

Development of specific withdrawal symptoms Signup and view all the answers

What condition is characterized by confusion, loss of recent memory, and confabulation in alcoholics?

Korsakoff's psychosis Signup and view all the answers

Which of the following are symptoms associated with Fetal Alcohol Syndrome?

Abnormal facial features Signup and view all the answers

What is a serious consequence of chronic alcohol use that affects the liver?

Cirrhosis Signup and view all the answers

Alcohol withdrawal symptoms can occur within what time frame after cessation?

4 to 12 hours Signup and view all the answers

What is a common symptom of alcohol intoxication at blood alcohol levels between 100 and 200 mg/dL?

Impaired judgment Signup and view all the answers

What severe condition can result from alcohol withdrawal that peaks around 48-72 hours after ingestions cease?

Withdrawal delirium Signup and view all the answers

Which of the following is NOT typically associated with peripheral neuropathy due to alcohol use?

Severe mood changes Signup and view all the answers

What is a typical treatment approach for acute alcohol withdrawal?

Sedation and stabilization Signup and view all the answers

Which vitamin is essential for the replacement therapy in withdrawal from alcohol?

Thiamine (B1) Signup and view all the answers

What is the role of naloxone in opioid overdose treatment?

Reverses opioid effects Signup and view all the answers

Which symptom is NOT typically associated with CNS stimulant intoxication?

Nausea Signup and view all the answers

What is a common withdrawal symptom for caffeine?

Headache Signup and view all the answers

Which medication is used to maintain sobriety from alcohol?

Disulfiram (Antabuse) Signup and view all the answers

What is one of the most dangerous consequences of inhalant overdose?

Respiratory arrest Signup and view all the answers

What substring treatment is recommended to reduce discomfort during opioid withdrawal?

Clonidine Signup and view all the answers

Which of the following is a common symptom of nicotine withdrawal?

Irritability Signup and view all the answers

Which of these medications is NOT typically used in managing opioid withdrawal?

Disulfiram Signup and view all the answers

During an opioid overdose, what type of care is necessary besides administering naloxone?

Supportive care Signup and view all the answers

What symptom would indicate a person is in the crucial phase of Alcohol Use Disorder?

Loss of control over drinking Signup and view all the answers

Which symptom is associated with the withdrawal process of CNS depressants?

Elevated vital signs and muscle aches Signup and view all the answers

During which phase of Alcohol Use Disorder does a person experience blackouts as a symptom?

Early alcoholic phase Signup and view all the answers

What is a common physiological effect observed in overdose situations involving opioids?

Respiratory depression Signup and view all the answers

What describes a common behavior in the chronic phase of Alcohol Use Disorder?

Regular intoxication more than sobriety Signup and view all the answers

What effect do pleasurable aspects of substance use have on individuals?

They act as positive reinforcement for continued use. Signup and view all the answers

Which personality trait is thought to increase the risk of developing addictive behavior?

Impulsiveness Signup and view all the answers

What is a significant psychological factor contributing to the use of psychoactive substances?

Punitive superego Signup and view all the answers

How might social learning influence substance use in adolescents?

Imitation of parental substance use behavior. Signup and view all the answers

Which of the following factors may culturally influence substance abuse rates?

Cultural acceptance of use. Signup and view all the answers

What behavior is indicative of substance use disorder?

Engaging in hazardous activities while impaired Signup and view all the answers

Which of the following is a symptom of withdrawal that can be life-threatening?

Development of specific withdrawal symptoms Signup and view all the answers

What does tolerance in substance use refer to?

The body's decreased response to the same amount of substance Signup and view all the answers

Which option best describes substance intoxication?

A reversible syndrome following excessive use of a substance Signup and view all the answers

What condition is characterized by the intense desire to consume a substance?

Cravings Signup and view all the answers

What is a common interpersonal problem associated with substance use disorders?

Social isolation Signup and view all the answers

Which factor is NOT typically involved in the criteria for diagnosing substance use disorder?

Involvement in non-substance related hobbies Signup and view all the answers

Which of the following is a potential side effect of substance use that affects physical functioning?

Aggravated physical and psychological functioning Signup and view all the answers

Which neurological condition is primarily characterized by confusion, loss of recent memory, and confabulation in alcohol-dependent individuals?

Korsakoff's psychosis Signup and view all the answers

What is a serious and acute complication related to alcohol withdrawal that can lead to death?

Withdrawal delirium Signup and view all the answers

Which of the following symptoms is most commonly associated with Fetal Alcohol Syndrome?

Low body weight Signup and view all the answers

What type of cardiovascular concern is directly associated with chronic excessive alcohol consumption?

Alcoholic cardiomyopathy Signup and view all the answers

Within what time frame do alcohol withdrawal symptoms typically begin after the cessation of heavy drinking?

4 to 12 hours Signup and view all the answers

Which of these symptoms would NOT be characteristic of acute alcohol intoxication?

Addiction Signup and view all the answers

What is a common digestive complication associated with chronic alcohol use?

Esophagitis Signup and view all the answers

What symptom is most indicative of peripheral neuropathy due to chronic alcohol use?

Numbness and tingling Signup and view all the answers

What is an appropriate treatment for alcohol withdrawal symptoms?

Benzodiazepines or barbiturates taper Signup and view all the answers

Which medication is primarily used for maintaining sobriety from alcohol?

Naltrexone Signup and view all the answers

Which of the following substances is NOT typically associated with opioid misuse?

Cocaine Signup and view all the answers

Which symptom is most likely associated with caffeine withdrawal?

Restlessness and insomnia Signup and view all the answers

What part of the CNS is primarily affected by the intoxication of amphetamines?

Imbalance of neurotransmitters Signup and view all the answers

What is a common withdrawal symptom associated with nicotine?

Irritability and anxiety Signup and view all the answers

Which treatment is indicated for opioid withdrawal symptoms?

Methadone or Buprenorphine Signup and view all the answers

What significant risk is associated with inhalant overdose?

Sudden Sniffing Death Signup and view all the answers

How soon do opioid withdrawal symptoms typically begin after last use?

Hours after the last use Signup and view all the answers

Which vitamin is critical for B-vitamin replacement during alcohol withdrawal?

B1 Signup and view all the answers

Study Notes

Substance Use Disorder Criteria

Requires two or more symptoms from a list of eleven
Symptoms include increased use, hazardous use, interpersonal problems, neglected responsibilities, abandoned interests, time spent using, cravings, failed attempts to quit, mental and physical health problems, tolerance, and withdrawal

Intoxication: Reversible syndrome caused by excessive substance use, impacting CNS and physical/psychological functioning.
Overdose: Occurs when substance use exceeds the body's ability to metabolize it, leading to life-threatening complications.
Withdrawal: Symptoms that occur upon abrupt reduction or discontinuation of a substance, causing physical and psychological disruptions.
Blackouts: Periods of amnesia that occur during or following alcohol consumption.
Tolerance: Decreased effect with repeated use, requiring larger doses for the same effect.
Cross tolerance: Tolerance to one substance, leading to tolerance for similar substances.
Synergistic effects: Combined effect of two or more substances, resulting in a greater effect than when used individually.
Cross-dependence: Dependence on one substance, reducing withdrawal symptoms with another substance.
Antagonistic effects: When two substances counteract each other, reducing the effect of one or both substances.
Flashbacks: Re-experiencing sensory or emotional components of intoxication after substance use has stopped.
Co-occurring disease/dual diagnosis: Having both a substance use disorder and another mental health disorder.
Codependency: A dysfunctional relationship pattern where one person enables another's substance use.

Substance Use Disorder Characteristics

Impacts ability to fulfill role obligations.
Attempts to cut down or control use fail.
Intense cravings for the substance.
Excessive time spent obtaining or recovering from substance use.
Difficulty in interpersonal relationships or social isolation.
Engaging in hazardous activities while impaired.
Tolerance development and increased dosage needed for desired effect.
Substance-specific withdrawal symptoms after discontinuation.

States of Substance Use

Substance intoxication: Reversible syndrome characterized by CNS disruption, impaired judgment, and social/occupational dysfunction.
Substance withdrawal: Symptoms are specific to the substance and cause physical and psychological disruptions.

Classes of Psychoactive Substances

Alcohol
Caffeine
Inhalants
Cannabis
Opioids
Stimulants
Tobacco
Sedatives/hypnotics/anxiolytics

Predisposing Factors of Substance Use Disorder

Biological factors:
- Genetics: Hereditary component, particularly in alcoholism.
- Biochemical: Alcohol may produce morphine-like substances in the brain, potentially contributing to addiction.
Psychological factors:
- Developmental influences
  - Punitive superego: Individuals with punitive superegos may turn to drugs to reduce anxiety and enhance feelings of power and self-worth.
  - Fixation in the oral stage of psychosexual development
- Personality factors: Certain personality traits may increase susceptibility to addictive behaviors.
- Cognitive factors: Irrational thinking patterns are often linked to substance use and addiction.
Sociocultural factors:
- Social learning: Children and adolescents may be more likely to use substances when their parents model substance use.
- Peer group influences: Substance use may be promoted within peer groups.
- Conditioning: Pleasurable effects of substance use provide positive reinforcement, encouraging continued use.
- Cultural and ethnic influences: Some cultures have higher rates of substance abuse compared to others.

Assessment Guidelines for Substance Use Disorder

Specific drugs used: Type and frequency of use.
Route of administration: How the substance is consumed.
Signs and symptoms of intoxication, overdose, and withdrawal: Physical and mental changes experienced.
Vital signs: Heart rate, blood pressure, respiration, etc.
Physical and mental health assessments and history: Past and present health conditions.
Screening tools: Standardized tests to assess substance use and dependence.
Psychosocial history: Coping mechanisms, job, support system, etc.
Insight and interest in additional treatment: Individual's understanding and willingness to engage in treatment.

CNS Depressants and Opioids

Include alcohol, benzodiazepines, barbiturates, and opioids.
Intoxication symptoms: Disinhibition, drowsiness, impaired judgment, slurred speech, unsteady gait, and decreased vital signs.
Overdose symptoms: Cardiovascular and respiratory depression, shock, convulsions, coma, and death.
Withdrawal symptoms: Elevated vital signs, tremors, nausea, muscle aches, sweating, anxiety, insomnia, disorientation, hallucinations, delirium, and seizures (except for opioids).

Alcohol Use Disorder

Patterns of use:
- Phase I (Pre-alcoholic phase): Alcohol is used to relieve everyday stress and tension.
- Phase II (Early alcoholic phase): Blackouts occur, indicating a reliance on alcohol.
- Phase III (Crucial phase): Loss of control and physiological dependence become apparent.
- Phase IV (Chronic phase): Emotional and physical disintegration, with frequent intoxication.
Effects on the body:
- Wernicke's encephalopathy: Severe thiamine deficiency in alcoholic patients.
- Korsakoff's psychosis: Confusion, memory loss, and confabulation in alcoholic patients.
- Peripheral neuropathy: Nerve damage in the extremities.
- Alcoholic myopathy: Muscle weakness and atrophy.
- Leukopenia and thrombocytopenia: Reduced white blood cell count and platelet count respectively.
- Sexual dysfunction: Erectile dysfunction, decreased libido, and menstrual irregularities.
- Esophagitis, gastritis, and pancreatitis: Inflammation of the esophagus, stomach, and pancreas.
- Alcoholic cardiomyopathy: Heart muscle damage and weakness.
- Alcoholic hepatitis: Liver inflammation.
- Cirrhosis of the liver: Scarring of the liver, leading to portal hypertension, ascites, esophageal varices, and hepatic encephalopathy.
Fetal Alcohol Syndrome (FAS): A set of birth defects caused by maternal alcohol consumption during pregnancy. Children with FAS may experience learning difficulties, speech and language delays, behavioral problems, and physical abnormalities.

Alcohol Intoxication and Withdrawal

Alcohol intoxication: Occurs at blood alcohol levels between 100 and 200 milligrams per deciliter, characterized by impaired coordination, slurred speech, and altered behavior.
Alcohol withdrawal: Typically starts within 4 to 12 hours of cessation or reduction of alcohol use. It can range from mild symptoms (anxiety, tremors, and sweating) to severe symptoms (delirium tremens).

Withdrawal Delirium

A medical emergency that can be life-threatening.
Peaks around 48 to 72 hours after last or reduced alcohol intake.
Includes severe autonomic hyperactivity, changes in level of consciousness, delusions, hallucinations, and severe mood changes.

Treatment for Alcohol Withdrawal and Withdrawal Delirium

Prevent harm related to mental health manifestations: Ensure safety and manage symptoms effectively.
Medication management:
- Benzodiazepines or barbiturates: Used for gradual tapering to manage withdrawal symptoms.
- Clonidine: Reduces autonomic hyperactivity.
- Beta blockers: Help manage heart rate and blood pressure.
- Anticonvulsants: Prevent seizures.
- B-vitamin replacement: Thiamine (B1), folic acid, and cyanocobalamin (B12) are crucial to address vitamin deficiencies.
CIWA-Ar: Assessment tool used to measure the severity of alcohol withdrawal.

Medications to Maintain Sobriety from Alcohol

Disulfiram (Antabuse): Makes alcohol consumption unpleasant by inducing nausea, vomiting, and flushing.
Naltrexone: Reduces cravings and blocks the euphoric effects of alcohol: Available as a daily pill (Revia) and a monthly extended-release injection (Vivitrol).
Acamprosate: Reduces alcohol cravings and helps maintain abstinence.

Opioids

Most commonly misused: Heroin, oxycodone, hydrocodone, morphine, fentanyl, and codeine.
Overdose: Requires immediate medical attention and can be reversed with naloxone (Narcan) or nalmefene (Revex). Supportive care is also crucial.
Withdrawal: Begins hours after last use and can be unpleasant, but is usually not life-threatening.
Withdrawal treatment:
- COWS Score: Assessment tool to measure opioid withdrawal severity.
- Substitution and eventual taper: Gradually switching to a less potent opioid (e.g., methadone) and then tapering down.
- Medication-assisted treatment (MAT): Includes use of medications like methadone, buprenorphine, or naltrexone.
- Methadone: Long-acting opioid agonist that reduces cravings and prevents withdrawal.
- Buprenorphine or buprenorphine/naloxone (Suboxone): Partial opioid agonist that helps manage withdrawal and cravings.
- Naltrexone: Opioid antagonist that blocks the effects of opioids.
- Clonidine: Can help manage withdrawal symptoms like anxiety and muscle aches.

CNS Stimulants

Include amphetamines/methamphetamines, synthetic stimulants, non-amphetamine stimulants, cocaine/crack, caffeine, and nicotine.

Cocaine and Crack

Intoxication symptoms: Elevated heart rate, blood pressure, and body temperature; dilated pupils; euphoria and alertness; agitation and anxiety; paranoia and hallucinations; insomnia; and psychosis.
Overdose symptoms: Respiratory distress or arrest, stroke, heart attack, seizures, coma, and death.
Withdrawal symptoms: Severe fatigue, intense craving, depression, suicidal thoughts, and increased appetite.

Amphetamines and Methamphetamines

Intoxication symptoms: Similar to cocaine, but effects can last longer.
Overdose symptoms: Similar to cocaine overdose, but may also include hyperthermia, muscle breakdown, and kidney failure.
Withdrawal symptoms: Similar to cocaine withdrawal.

Caffeine

Intoxication symptoms: restlessness, insomnia, anxiety, and tremors.
Withdrawal symptoms: Headache, fatigue, irritability, and muscle aches.

Nicotine

Withdrawal symptoms: Dysphoria (unease or dissatisfaction), anxiety, irritability, difficulty concentrating, increased appetite, cravings.

Inhalants

Commonly abused inhalants include spray paint, glue, lighter fluid, aerosols, and paint thinners.
Intoxication symptoms: Drunkenness, slurred speech, dizziness, euphoria, lack of inhibitions, vision changes, and psychomotor retardation.
Overdose effects and treatment: Severe damage to liver, brain, and heart; respiratory arrest; fatal dysrhythmias; sudden sniffing death; coma and death.
- Treatment focuses on supporting affected organ systems. Vitamin B12 and folate may be used to address neurological symptoms.
Withdrawal symptoms: Mood changes, panic attacks, restlessness, body aches, tremors, nausea, runny nose, watery eyes, and seizures.

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Test your knowledge on the key concepts related to substance use disorders, including biological, psychological, and sociocultural factors. This quiz covers symptoms, diagnosis, and the cognitive aspects of addiction, providing a comprehensive overview for those studying these critical topics.