Substance Abuse and Addiction Quiz

Substance Use/Abuse History

• Opiates derived from opium were used to treat ailments like cholera, smallpox, dental pain, and dysentery as far back as the Mayflower in 1620.
• As late as 1890, Bayer promoted both aspirin and heroin as remedies for coughs, colds, and pain, even for children.

Substance Use/Abuse Legislation and Stigma

• The Harrison Tax Acts of 1914 were the first government attempts at drug legislation, taxing opium derivatives.
• By 1920, medical professionals recognized the addictive nature of opiates.
• Addiction was then viewed as a moral, not medical, issue, leading to its stigmatization.
• The 1970s saw the rise of synthetic opiates like hydrocodone and oxycodone.

Substance Use Disorder (SUD) Definitions

• Substance Use Disorder (SUD) is a maladaptive pattern of substance use leading to impairment or distress in school, work, family, and physical/social difficulties.
• Key terms include dependence (psychological or physiological), withdrawal, detoxification, and tolerance.

Screening for Substance Abuse

• The question arises as to what type of primary care visit should include screening for substance abuse.

Substance Use Pathophysiology

• Addiction is thought to result from interactions among genetic, temperamental, psychosocial factors, resources, and substance accessibility.
• Changes in brain pathways and increased vulnerability to drug effects contribute to continued dependence.
• Both a "brain reward" system and avoidance of withdrawal contribute to substance use.
• Brain reward involves dopamine, norepinephrine, endogenous opioids (endorphins), GABA, serotonin, acetylcholine, and adrenergic systems.

Common Substances of Abuse

• The presented table lists various substances categorized by their effects on the central nervous system (CNS), such as opioids, stimulants, psychotomimetics (hallucinogens), inhalants, and anabolic steroids.
• Examples of substances include alcohol, benzodiazepines, heroin, morphine, cocaine, amphetamines, LSD, PCP, cannabinoids, solvents, nitrous oxide, volatile nitrites, synthetic methadone, and fentanyl..

Diagnostic Criteria for Abuse/Dependence

• Abuse (1 or more in a 12-month period): failure to fulfill roles, hazardous situations, legal problems, and social/interpersonal issues.
• Dependence (3 or more in a 12-month period): tolerance, withdrawal, increased use, efforts to cut down, excessive time on activities to get the drug, important social, occupational, or recreational activities, and continued use despite knowledge of negative consequences.

Clinical Presentation: Signs and Symptoms

• Physical and behavioral signs of substance abuse are highlighted in the notes.
  • Physical signs include: sleeplessness, unusual activity levels, appetite changes, physical symptoms, and hygiene deterioration.
  • Behavioral signs encompass attitude changes, academic/work performance decline, dishonesty, sudden mood shifts, and motivation loss.

Screening Tools: CAGE and DAST

• CAGE (Concern, Anger, Guilt, Eye-Opener) and DAST (Drug Abuse Screening Test) are presented as screening tools.

Physical Exam: Red Flag Findings

• Frequent absences from school/work and a history of trauma or accidents
• Depression, anxiety, labile hypertension
• Gastrintestinal issues, sexual dysfunction, and sleep disorders are also listed.
• Physical signs like tremors, breath odor, enlarged/tender liver, and nasal/conjunctival irritation are significant symptoms.

Diagnostic Tests

• A range of diagnostic tests, some needing individualization, are suggested, including a complete blood count (CBC) with differential, comprehensive metabolic panel (CMP), drug screening, hepatitis panel, HIV, syphilis (RPR), thyroid stimulating hormone (TSH), and B-hCG, as needed.

Management Strategies

• Risk reduction strategies include inpatient detox, residential and outpatient treatment programs, Alcoholics Anonymous (AA), and Narcotics Anonymous (NA).
• Medical management of comorbidities, psychotherapy, and pharmacological agents to reduce cravings and control dependence are also crucial components of comprehensive treatment.

Pharmacological Management: Alcohol

• 12-step programs are considered the most effective long-term management method for alcohol use disorders.
• Pharmacologic interventions including Librium (chlordiazepoxide) or other benzodiazepines are frequently employed to treat alcohol withdrawal.
• Naltrexone, Campral, and Antabuse are discussed as potentially helpful medications for cravings, GABA enhancement, and aversion therapy.

Pharmacological Management: Opioids

• Medications are the first-line treatment for opioid use disorder, supplemented by 12-step programs.
• Naloxone is a first-line overdose reversal agent.
• Methadone and buprenorphine, with or without naloxone, are used for withdrawal and maintenance phases.
• Clonidine is an anti-hypertensive medication utilized for withdrawal management.

NJ Stats (2016): Opioid Overdose Data and Rates

• Data displays the significant increase in opioid-related overdose deaths in New Jersey from 1999 to 2016, contrasted with national figures.

Opioid Epidemic: Background and Implications

• The opioid crisis emerged from well-intentioned healthcare policies focusing on pain management as a vital sign, leading to over-prescription of opioids.
• The risk-benefit ratio tilted heavily towards opioids, overlooking potential consequences.
• Increased awareness of risks and restricted opioid use followed.

Overprescription and the Epidemic's Path

• Over-prescription of opioids occurred due to the mistaken notion of treating pain as a vital sign and the absence of complete awareness of the long-term risks.
• Consequently, an opioid crisis emerged and caused addiction and death.