Podcast
Questions and Answers
What are the three domains involved in substance use disorders?
What are the three domains involved in substance use disorders?
Which phase of the Brain Disease Model involves the increase of dopamine and the endogenous opioid systems?
Which phase of the Brain Disease Model involves the increase of dopamine and the endogenous opioid systems?
What should be included when taking a substance use history from a patient?
What should be included when taking a substance use history from a patient?
What is a common psychiatric condition that can mimic substance use disorders?
What is a common psychiatric condition that can mimic substance use disorders?
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Which symptom is indicative of withdrawal in the context of substance use disorders?
Which symptom is indicative of withdrawal in the context of substance use disorders?
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According to the criteria for diagnosing substance use disorder, how many symptoms must be present for a diagnosis of mild disorder?
According to the criteria for diagnosing substance use disorder, how many symptoms must be present for a diagnosis of mild disorder?
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Which factor is NOT considered a psychosocial stressor linked to worse substance use outcomes?
Which factor is NOT considered a psychosocial stressor linked to worse substance use outcomes?
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What is the role of FosB in the genetic model of addiction?
What is the role of FosB in the genetic model of addiction?
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Which of the following assessments should be conducted first when evaluating a patient for substance use disorder?
Which of the following assessments should be conducted first when evaluating a patient for substance use disorder?
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What is a key outcome of the preoccupation/anticipation phase in substance use disorders?
What is a key outcome of the preoccupation/anticipation phase in substance use disorders?
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Which neurotransmitter is primarily associated with the brain's reward circuitry in addiction?
Which neurotransmitter is primarily associated with the brain's reward circuitry in addiction?
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How do adverse childhood experiences (ACEs) impact addiction risk?
How do adverse childhood experiences (ACEs) impact addiction risk?
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What structural brain changes are commonly associated with prolonged substance use?
What structural brain changes are commonly associated with prolonged substance use?
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What role do epigenetic changes play in addiction risk?
What role do epigenetic changes play in addiction risk?
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Which of the following is a psychosocial factor influencing addiction risk?
Which of the following is a psychosocial factor influencing addiction risk?
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How can chronic stress affect an individual's susceptibility to addiction?
How can chronic stress affect an individual's susceptibility to addiction?
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What misconception do many physicians hold about substance use disorders?
What misconception do many physicians hold about substance use disorders?
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What role does serotonin play in addiction?
What role does serotonin play in addiction?
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In terms of epidemiology, how does the prevalence of substance use disorders in Mexico compare to that in the United States?
In terms of epidemiology, how does the prevalence of substance use disorders in Mexico compare to that in the United States?
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Which neurotransmitter is involved in the pleasure and relief aspects of substance use?
Which neurotransmitter is involved in the pleasure and relief aspects of substance use?
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Study Notes
Substance Use Disorders
- Substance use disorders are complex, chronic, relapsing, and remitting diseases linked to significant morbidity and mortality.
- Disorders involve three domains: medical, psychiatric, and substance use.
Diagnostic Assessment
- Objective Domain: Initial screening, mental status exam, physical exam, diagnostic tools (labs/imaging) are crucial.
- Medical: Medical conditions can mimic substance use disorder symptoms (intoxication, withdrawal, chronic use).
- Psychiatric: Psychiatric conditions (anxiety, depression, insomnia, flashbacks, memory problems) can mimic substance use disorders.
- Substance Use Domain: Assess substance use history using open-ended questioning, moving to a systemic approach including all substances (prescribed & non-prescribed), timing, frequency, route of administration.
- Assess social situations contributing to or exacerbating substance use (e.g., divorce, loss).
- Immediate Facts Needed: Substances used, frequency, amount, route, time of last use, alcohol/benzodiazepine withdrawal history.
- Assessment Facts: Age of first use, changes in use patterns, longest period of abstinence, treatment history, family history, overdose history.
- Further Facts and Feelings: Patient's perception of substance use as a problem, positive/negative aspects, motivation for change, financial consequences, triggers, adaptive strategies.
- Diagnosis: Requires at least 2 criteria; Mild (2-3 criteria), Moderate (4-5), Severe (6+).
Theories of Addiction
Brain Disease Model
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Binge/Intoxication: Dopamine increase, endogenous opioids & cannabinoids involved, reward circuitry (basal ganglia).
- Behavior model: Positive reinforcement, Incentive sensitization.
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Withdrawal/Negative Effect: Corticotropin-releasing factor, Noradrenaline, Dynorphin, Vasopressin, Substance P increase, dopamine decrease, Hypothalamic-pituitary-adrenal axis affected.
- Behavior model: Negative reinforcement, Conditioning.
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Preoccupation/Anticipation: Glutamate and GO systems increase, STOP systems decrease; impairments in decision-making, self-regulation, and behavioral inhibition (impacting relapse).
- Behavior model: Habit Forming.
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Genetic Model: Increased CREB and FosB, polygenicity; vulnerability to addiction.
- FosB: Protein regulating transcription in response to stimuli (stress, cytokines, etc.).
Neurobiological Factors
- Brain Reward Pathways: Addiction affects brain reward circuitry (mesolimbic dopamine pathway). Substances/behaviors increase dopamine in the nucleus accumbens, creating pleasure.
- Neurotransmitter Systems: Glutamate (learning, memory & addiction-related memories), GABA, serotonin, endogenous opioids also contribute.
- Changes in Brain Structure/Function: Prolonged use alters prefrontal cortex (decision-making, impulse control), impacting rational substance use choices, contributing to compulsive behaviors.
Psychosocial Factors
- Social Environment: Family, peers, socio-economic factors influence addiction risk. Limited support, peer pressure increase risk.
- Early Life Experiences: Trauma (abuse, neglect, family substance use) increase vulnerability. Adverse childhood experiences (ACEs) can disrupt stress response systems and increase substance use as coping mechanism.
- Mental Health/Coping Mechanisms: Conditions (anxiety, depression, PTSD, ADHD) may lead to substance use as self-medication. Maladaptive coping strategies reinforce addictive behaviors.
Epigenetic Factors
- Gene-Environment Interactions: Environmental factors alter gene expression without changing DNA sequence (epigenetic changes). Substance use causes epigenetic changes impacting stress response, reward sensitivity, and decision-making.
- Intergenerational Transmission: Epigenetic changes may pass down through generations (parents' exposure -> offspring's susceptibility).
- Stress & Epigenetic Modification: Chronic stress can alter epigenetic control, making the brain more vulnerable to addiction. Modification may result in long-term stress response changes, potentially increasing substance use as a coping mechanism.
- Interaction of These Factors: The interplay among these factors creates a cumulative effect.
Physician Role
- Physicians are often first points of contact & play a crucial role in lowering stigma.
- Stigma and perception of substance use disorders as a choice challenges effective care.
- Some physicians find substance use disorder care less fulfilling and challenging compared to other illnesses.
Epidemiology
- Substance use disorder prevalence (alcohol & drugs) is lower in Mexico compared to the US.
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Description
Explore the complexities of substance use disorders, including their medical, psychiatric, and substance use domains. This quiz covers diagnostic assessments and the underlying factors contributing to these disorders. Test your knowledge on the interplay between substance use and related health issues.
