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Benzodiazepines have a high potential for abuse when used to treat alcohol withdrawal syndrome.
Benzodiazepines have a high potential for abuse when used to treat alcohol withdrawal syndrome.
False
The mechanism of action for Acamprosate in the treatment of alcohol dependence is well understood.
The mechanism of action for Acamprosate in the treatment of alcohol dependence is well understood.
False
Combined use of alcohol and benzodiazepines is considered safe for treating alcohol dependence.
Combined use of alcohol and benzodiazepines is considered safe for treating alcohol dependence.
False
Agonist therapy involves using a long-acting medication from a different class than the abused drug.
Agonist therapy involves using a long-acting medication from a different class than the abused drug.
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Methadone therapy is appropriate for individuals over the age of 18, with some exceptions for those aged 16 to 17.
Methadone therapy is appropriate for individuals over the age of 18, with some exceptions for those aged 16 to 17.
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Pharmacotherapy should not be considered for those with moderate to severe consequences of their substance abuse.
Pharmacotherapy should not be considered for those with moderate to severe consequences of their substance abuse.
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Patients undergoing opioid therapy during pregnancy should avoid medications that may have adverse effects.
Patients undergoing opioid therapy during pregnancy should avoid medications that may have adverse effects.
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Pharmacotherapy alone is sufficient to address all behaviors associated with addiction.
Pharmacotherapy alone is sufficient to address all behaviors associated with addiction.
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Cocaine is a substance for which pharmacotherapy is currently available.
Cocaine is a substance for which pharmacotherapy is currently available.
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The phases of substance use that pharmacotherapy targets include relapse prevention.
The phases of substance use that pharmacotherapy targets include relapse prevention.
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Patients must be fully withdrawn from substances before taking maintenance medications.
Patients must be fully withdrawn from substances before taking maintenance medications.
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Benzodiazepines have pharmacotherapy available for their dependence.
Benzodiazepines have pharmacotherapy available for their dependence.
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The acute phase of alcohol dependence refers to the stage of maintenance and recovery.
The acute phase of alcohol dependence refers to the stage of maintenance and recovery.
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Methadone can block withdrawal symptoms but does not address cravings at low doses.
Methadone can block withdrawal symptoms but does not address cravings at low doses.
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A dosage of 80-100 mg of methadone is less effective at reducing opioid use than lower doses.
A dosage of 80-100 mg of methadone is less effective at reducing opioid use than lower doses.
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Methadone has a duration of action that typically lasts between 12 to 24 hours.
Methadone has a duration of action that typically lasts between 12 to 24 hours.
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Naloxone can be used to determine if a patient is dependent on opioids.
Naloxone can be used to determine if a patient is dependent on opioids.
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Methadone does not interact with any commonly used medications.
Methadone does not interact with any commonly used medications.
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Maintenance therapy with methadone can lead to improved health and nutritional status.
Maintenance therapy with methadone can lead to improved health and nutritional status.
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Pentazocine is known to increase methadone concentrations in the body.
Pentazocine is known to increase methadone concentrations in the body.
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Clinical Opiate Withdrawal Scale can help determine the extent of opiate withdrawal symptoms.
Clinical Opiate Withdrawal Scale can help determine the extent of opiate withdrawal symptoms.
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Naltrexone is a pure opioid antagonist that blocks the activity of opioids.
Naltrexone is a pure opioid antagonist that blocks the activity of opioids.
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Relapse rates for individuals detoxified without medication treatment can drop below 50%.
Relapse rates for individuals detoxified without medication treatment can drop below 50%.
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Disulfiram works by enhancing the metabolism of alcohol in the body.
Disulfiram works by enhancing the metabolism of alcohol in the body.
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Naltrexone can be administered both orally and through extended-release injections.
Naltrexone can be administered both orally and through extended-release injections.
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Buprenorphine is a complete agonist that can lead to life-threatening respiratory depression in cases of abuse.
Buprenorphine is a complete agonist that can lead to life-threatening respiratory depression in cases of abuse.
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More than half of individuals with non-alcohol drug disorders also have a comorbid mental disorder.
More than half of individuals with non-alcohol drug disorders also have a comorbid mental disorder.
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A common side effect of Disulfiram is the development of hepatotoxicity.
A common side effect of Disulfiram is the development of hepatotoxicity.
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Among those with a mental disorder, the odds ratio of having an addictive disorder is higher than 3.0.
Among those with a mental disorder, the odds ratio of having an addictive disorder is higher than 3.0.
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The recommended dose for oral Naltrexone is 250 mg per day.
The recommended dose for oral Naltrexone is 250 mg per day.
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The use of naloxone with buprenorphine helps decrease the risk of misuse due to naloxone's absorption when taken orally.
The use of naloxone with buprenorphine helps decrease the risk of misuse due to naloxone's absorption when taken orally.
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Patients taking Naltrexone should monitor liver function regularly.
Patients taking Naltrexone should monitor liver function regularly.
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Psychiatric medications are used in patients with substance use disorders primarily to treat addictive disorders.
Psychiatric medications are used in patients with substance use disorders primarily to treat addictive disorders.
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Benzodiazepines and non-benzodiazepines are considered maintenance medications for alcohol use disorder.
Benzodiazepines and non-benzodiazepines are considered maintenance medications for alcohol use disorder.
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Naltrexone has been shown to be less effective than acamprosate in reducing relapses and craving.
Naltrexone has been shown to be less effective than acamprosate in reducing relapses and craving.
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In patients with a comorbid mental disorder and substance use disorder, approximately 22% overlap with alcoholism.
In patients with a comorbid mental disorder and substance use disorder, approximately 22% overlap with alcoholism.
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Harm reduction seeks to completely eliminate substance use.
Harm reduction seeks to completely eliminate substance use.
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Cognitive Behavioral Therapy (CBT) helps patients develop effective coping strategies.
Cognitive Behavioral Therapy (CBT) helps patients develop effective coping strategies.
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Patients using Disulfiram can safely consume alcohol-containing foods.
Patients using Disulfiram can safely consume alcohol-containing foods.
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Cold turkey refers to a gradual decrease in substance use.
Cold turkey refers to a gradual decrease in substance use.
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Hypersensitivity to naltrexone is one of its contraindications.
Hypersensitivity to naltrexone is one of its contraindications.
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Needle exchange programs are a form of harm reduction intervention.
Needle exchange programs are a form of harm reduction intervention.
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The clinical dose of Disulfiram can range from 125 to 500 mg per day.
The clinical dose of Disulfiram can range from 125 to 500 mg per day.
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Behavioral approaches in treatment modify attitudes related to drug abuse.
Behavioral approaches in treatment modify attitudes related to drug abuse.
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Harm reduction is a short-term intervention for improving the health of drug users.
Harm reduction is a short-term intervention for improving the health of drug users.
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Social isolation is a trigger for relapse in substance use disorders.
Social isolation is a trigger for relapse in substance use disorders.
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Gradual reduction of substance use is also known as 'cold turkey'.
Gradual reduction of substance use is also known as 'cold turkey'.
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Study Notes
Treatment and Rehabilitation of Drug Addiction
- Drug addiction treatment involves pharmacological and non-pharmacological interventions.
- Assessment for concomitant medical illnesses, pregnancy, and phase of recovery is crucial for determining appropriate pharmacotherapy.
Pharmacotherapy
- When to Consider Pharmacotherapy?: Assess patients for ability to tolerate medication and presence of medical conditions (e.g., pregnancy). Avoid medications with adverse effects (e.g., disulfiram) if contraindicated.
- Phase of Recovery: Medications can be used for medical withdrawal or maintenance of abstinence after withdrawal.
- Candidates for Pharmacotherapy: Individuals with moderate to severe substance abuse consequences, no contraindications for medication, ability to understand and adhere to medication use, willing to participate in psychosocial treatment, fully medically withdrawn, and vulnerable to relapse.
Phases of Substance Use
- Intoxication/overdose
- Withdrawal/detoxification
- Abstinence initiation/use reduction
- Relapse prevention
- Sequelae (e.g., psychosis, agitation)
Strategies for Substance Use Disorders (SUDs)
- Agonist (replacement/substitution)
- Antagonist (blockade)
- Aversive (negative reinforcement)
- Correction of underlying/associated disorders (e.g., depression)
Available and Unavailable Pharmacotherapies
- Available: Opioids, Alcohol, Benzodiazepines, Tobacco (nicotine dependence)
- Unavailable: Cocaine, Methamphetamine, Hallucinogens, Cannabis, Solvents/Inhalants
Alcohol Dependence Pharmacotherapy
- Two Phases: Acute alcohol withdrawal and relapse prevention.
- Relapse Prevention Medications: Disulfiram (Antabuse), Naltrexone (oral and injectable), Acamprosate.
- Note: Monitor patients for depression, anxiety, or suicidality during treatment.
- Benzodiazepines and non-benzodiazepines: Used for acute alcohol withdrawal.
- Important Considerations: Potential side effects, appropriate dosages (Clinical Dose: 250 mg daily), contraindications (cardiac disease, etc.), and need to avoid alcohol-containing foods.
Disulfiram (Antabuse)
- Mechanism: Blocks alcohol metabolism, increasing acetaldehyde levels to create unpleasant effects if alcohol is consumed.
- Uses: Relapse prevention for alcohol dependence.
- Side Effects: Metallic taste, sulfur-like odor, hepatotoxicity, neuropathy, psychosis.
- Treatment of reaction: Supportive therapies (fluids, oxygen).
Naltrexone
- Mechanism: Opioid receptor antagonist, blocking the reinforcing effects of alcohol and reducing cravings.
- Formulations: Oral and extended-release injectable (Vivitrol).
- Uses: Alcohol dependence and opioid dependence.
- Safety Issues: Hepatic injury (contraindication in acute hepatitis or liver failure), monitoring of liver function tests, caution with other medications (e.g., ibuprofen
- Contraindications: Concomitant opioid analgesics, opioid dependence/withdrawal, hypersensitivity, medical conditions requiring opioid analgesics, pregnancy
- Additional Notes: Cochrane review showed reduced relapse and return to heavy drinking, increased time to first drink, and reduced cravings.
Naltrexone Safety Issues
- Hepatotoxicity (liver damage), particularly at high doses.
- Contraindicated in acute hepatitis or liver failure.
- Monitor liver function tests regularly (q1 month initially, then q3 months later).
Other Safety Issues (Naltrexone)
- Concomitant opioid analgesics (blocks analgesic effect).
- Opioid dependence/withdrawal.
- Hypersensitivity to naltrexone.
- Medical conditions requiring opioid analgesics.
- Pregnancy (Category C).
Acamprosate
- Stabilises the chemical balance in the brain disrupted by alcohol withdrawal.
- Mechanism unknown, but believed to modulate the activity of glutamate receptors.
- Effective in combination with psychosocial support for reduced consumption and abstinence.
- Non-specific for alcohol; can be used to reduce the drive to use after withdrawal.
Opioid Dependence Pharmacotherapy
- Medications: Methadone, Naltrexone, Buprenorphine
- Agonist Treatment (Methadone): Long-acting opioid agonist used for opioid withdrawal and maintenance treatment.
Opioid Dependence Maintenance Therapy (Methadone)
- Administered through a registered narcotic treatment program.
- Long-acting mu agonist, 24-36 hours duration of action.
- Importance of dose: 30-40mg blocks withdrawal but doesn’t address cravings, 80-100mg more effective in reducing opioid use.
- Potential drug interactions exist with existing medications.
- Important benefits: Lifestyle stabilization, improved health/nutritional status, reduction in criminal behavior, increased employment, and decreased injection drug use and shared needles.
Opioid Dependence Therapy: Antagonist Treatment (Naltrexone)
- Pure opioid antagonist that blocks opioid activity.
- Prevents impulsive drug use.
- Relapse rates are high (90%) after detoxification without ongoing medication.
- Issues with compliance: some patients experience no effect with opioid use post-dosage and have better outcomes with continuous use.
- More frequently studied in the context of alcohol dependence.
Opioid Dependence Therapy: Antagonist Treatment (Buprenorphine)
- Mixed partial agonist (weak κ-opioid receptor antagonist), hence negates potential for life-threatening respiratory depression.
- Combined with naloxone to reduce risk of misuse. Naloxone doesn't affect the opioid effects when taken orally but blocks effects during injection.
Epidemiology of Mental Illness in SUDs
- High comorbidity between mental disorders and substance use disorders.
- 37% of those with alcohol disorders have comorbid mental disorders.
- More than half (53%) of those with non-alcohol drug disorders have a mental disorder (odds ratio 4.5).
SUDs in Mental Illness
- Individuals with mental disorders have increased odds of addictive disorders (odds ratio 2.7).
- Lifetime prevalence of addictive disorders among those with mental disorders is approximately 29%.
- Significant overlap (22%) with alcohol use disorders and 15% with other drug disorders.
Psychiatric Medications in SUD Comorbidity
- Medications used to treat psychiatric disorders and address substance use disorders (directly or indirectly).
Harm Reduction
- A concept that aims to prevent or reduce negative health consequences associated with certain behaviors, including those related to substance use.
- Primarily focused on reducing the harm from use rather than abstaining.
Interventions
- Information, education, and communication are critical.
- Important to consider safer sex practices to prevent the spread of sexually transmitted diseases, and consider injection technique education.
- Health care, screening, immunisation for infectious diseases.
- Substitution with oral medications.
- Needle exchange programs; linking with other services (medical, psychiatric, and social).
Cognitive and Behavioral Strategies
- CBT: Central component is anticipating likely problems and enhancing self-control through coping strategies.
- Cognitive Behavioral Therapy: Strategies focus on identifying relapse triggers (negative/positive mood states, poor coping skills, social isolation, craving, and family issues). Development of global self-management strategies (cognitive restructuring, coping skills training, lifestyle changes) assists in tackling these issues.
- Behavioral approaches: Engaging individuals in treatment, incentivizing abstinence, modifying attitudes and behaviours related to drug abuse, and improving life skills to manage stressful situations or environmental cues that might trigger intense cravings.
"Cold Turkey"
- Abrupt cessation of a substance.
- Unpleasant withdrawal symptoms, considerable stress.
- Potentially life-threatening.
Take Home Points
- Several medications are FDA-approved for addiction maintenance (disulfiram, naltrexone, acamprosate).
- Several medications are FDA-approved for opioid dependence; methadone, naltrexone, and buprenorphine/naloxone.
- Non-pharmacological strategies are crucial in addiction management.
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Description
This quiz covers the essential aspects of drug addiction treatment, focusing on both pharmacological and non-pharmacological interventions. It explores the criteria for pharmacotherapy, phases of recovery, and key considerations in treating individuals with substance use disorders.
