| What are types of addiction? | Substances (drugs, tobacco, alcohol, medications)
Behavioral (gambling, sport, work, shopping, internet, sex, eating...) |
| How is screening for addiction? | Questions carefully designed to determine whether there is a need for more evaluation.
Differs from assessment in terms of that it is just a tool of evaluation whether a problem is present (yes/no), while assessment is defining it, dx, tx recommendations...
May be a single question (how many times have you used illegal drugs?) or scales/questionnaires |
| How is assessment of addiction? | Substance use:
- type, frequency and amount
- route of administration
- overdose history
- history of prior SUD, treatment
Mental Health
General Medical
Family History
Social History
DSM5 Criteria
Substance Use Disorder
Substance-induced Disorders:
- Intoxication
- Withdrawal |
| What are the DSM-V criteria of SUD? | Impaired control (taken in larger amounts/longer periods than intended, persistent unsuccessful effort to cut down/control substance use, alot of time spent to get the substance use it or recover, craving/strong urge to use)
Social impairment (failure in work and education by substance use, continuous usage regardless of all social issues caused by it, important social activities given up due to substance use)
Risky use (recurrent use in physically dangerous situations, continuous usage despite knowledge of damage)
Physical dependence (Tolerance [need for increased amount to achieve desire, or diminished effects of substance], and withdrawal [withdrawal symptoms or same substance taken to relieve the symptoms]) |
| How do we assess SUD severity? | Mild: Presence of 2-3 symptoms
Moderate: Presence of 4-5 symptoms
Severe: Presence of 6 or more symptoms |
| What are diagnostic criteria for acute intoxication? | G1. There must be clear evidence of recent use of a psychoactive substance (or substances) at sufficiently high dose levels to be consistent with intoxication.
G2. There must be symptoms or signs of intoxication compatible with the known actions of the particular substance (or substances), and of sufficient severity to produce disturbances in the level of consciousness, cognition, perception, affect, or behavior that are of clinical importance.
G3. The symptoms or signs present cannot be accounted for by a medical disorder unrelated to substance use, and are not better accounted for by another mental or behavioral disorder. |
| What is intoxication? | Intoxication is the result of being under the influence of, and responding to, the acute effects of alcohol or another drug.
The recognition of intoxication states is important in the appropriate treatment of substance-using patients
Intoxication states can range from euphoria or sedation to life-threatening emergencies when overdose occurs
The initial challenge to the clinician, however, is diagnosis, because intoxication can mimic many psychiatric and medical conditions.
It is important to determine not only the severity of the substance ingestion but also the patient’s level of consciousness, the substances involved, and any complicating medical disorders.
Often, more than one substance is involved, and it is critical to know what substances have been ingested, as well as how much of each substance. |
| What are diagnostic criteria of withdrawal? | G1. There must be clear evidence of recent cessation or reduction of substance use after repeated, and usually prolonged and/or high-dose, use of that substance.
G2. Symptoms and signs are compatible with the known features of a withdrawal state from the particular substance or substances .
G3. Symptoms and signs are not accounted for by a medical disorder unrelated to substance use, and not better accounted for by another mental or behavioral disorder. |
| How is addiction a developmental disease? | It starts early (1.5% <12, 67% teens, 26% 18-25 yrs, 5.5% >25 yrs)
All adolescents brains are still developing, when reading emotions, adults rely more on frontal cortex while teens more on amygdala. |
| What is the SUD biopsychosocial model? | Biological factors (genetics [fam hx], brain chemistry [altered reward system, neurotransmitters, dependency], mental health disorders [co-occurring mental health disorders, depression, anxiety])
Psychological (self-medication hypothesis [high level of stress, coping mechanism], trauma [early trauma], personality traits [impulsive, excitement])
Social factors (peer pressure [adolescence], family environment [lack of supervision, hx of use], socioeconomic status [poverty, lack of access to education, unemployment]) |
| What are environmental factors leading to SUD? | Availability: Easy access to substances can lead to higher rates of use and, subsequently, SUD.
Cultural Norms: Societal attitudes towards substance use can influence individual behavior.
Policy and Regulation: The legal status and regulation of substances affect their use and the potential for disorder. |
| What are genes and environment interplay in addiction? | . |
| What is the brain biology of drugs? | . |
| How is reward pathophysio? | Dopamine is central to reward in all pathways |
| What does prolonged use lead to? | Changes the brain in fundamental and long-lasting ways |
| What is driving addiction? | Positive Reinforcement - rewards that strengthen a conditioned response after it has occurred, such as the feeling of euphoria after taking a hit
Negative Reinforcement – stimuli (e.g., stress, withdrawal) that are removed when the desired response (e.g., drug use) has been obtained |
| What are main substances in SUD? | Alcohol
Cannabinoids
Opiates
Stimulants
Psychedelics
Dissociatives
Ecstasy
GHB
Inhalants
Sedatives |
| What are the main methods of use of substances in SUD? | Oral
Intranasal (snorting, sniffing)
Intravenous
Subcutaneous
Inhaling
Smoking |
| What are different types of drinking? | Social (occasional, not causing problems)
Harmful (causes damage, adverse social consequences)
Dependence (compulsion to drink daily, gradual increase of amount to fell well) |
| What is the max alchohol consumption for low-risk drinking? | . |
| What is alcohol intoxication? | Recent ingestion of alcohol, one or more of the signs during/shortly after ingestion (slurred speech, incoordination, unsteady gait, nystagmus, impaired memory/attention, stupor/coma) |
| What are the different presentations of different blood alcohol levels? | . |
| What are CNS effects of alcohol? | Blackout (memory impairment [anterograde amnesia], remain awake)
Sleep impairment (depress REM and inhibit stage 4 sleep, frequent alternations between sleep stages and more dreams late night as blood alcohol level falls) |
| What are general health problems caused by alcohol? | Brain damage, loss of memory, hallucination, fits, dementia.
Risk of chest infection
hepatitis and cirrhosis
Tingling nerves, numbness and trembling hands
Risk of STD and HIV and AIDS.
Poor diabetes control
Loss of muscle
Carditis, HTA, irregular pulse
Gastric ulcers, gastritis, vomit blood
Pancreatitis
Impotence (Men) infertility (women) |
| What are mental health issues caused by alcohol? | Psychological dependence, typical symptoms of common mental disorder (sleep problem, irritable, sad), hallucination (hears and sees things), unreasonable jealousy.
Chronic cases memory loss, orientation and becomes helpless person.
Epileptic fits, increased suicide risk |
| How is alcohol withdrawal? | Cessation of (or reduction in) alcohol use that has been heavy and prolonged.
Two (or more) of the following, developing within several hours to a few days after Criterion A:
(1) Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100)
(2) Increased hand tremor
(3) Insomnia
(4) Nausea or vomiting
(5) Transient visual, tactile, or auditory hallucinations or illusions
(6) Psychomotor agitation
(7) Anxiety
(8) Grand mal seizures |
| What are alcohol withdrawal symptoms? | . |
