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75 Cards in this Set
- Front
- Back
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Q: According to psychodynamic theory, behaviors in substance abuse are seated in which stage?
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A: Oral fixation stage
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Q: In genetic loading for substance abuse, individuals with a strong genetic vulnerability to addiction have defects where in the brain? This predisposes them to what kind of rewards that draw them to substance use?
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A: Reward center of the brain
Stronger than normal positive rewards |
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Q: What are the two neurobiological processes that are involved in substance use?
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A: Reinforcement and Neuroadaptation
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Q: In reinforcement, the process of positive and negative rewards is physiologically linked to what?
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A: Memory function
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Q: Reinforcement results in ____ _____ sensations when the drug is used and _____ _____ sensations when the drug exists the body
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A: Feel good; feel bad
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Q: Name two general positive rewards for drug use
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A: Disinhibition, euphoric mood, anxiety reduction
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Q: What are two negative rewards of drug use?
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A: Increased anxiety and dysphoria
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Q: In substance use, what neuro pathway mediates positive rewards? Negative rewards?
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A: Positive : Dopamine
Negative: GABA |
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Q: What are the two brain structures involved in the reward center?
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A: Ventral tegmental area and nucleus accumbens
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Q: What substance further enhances dopamine within the reward center?
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A: Neuropeptides (enkephalins, beta-endorphins)
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Q: What neurotransmitters further enhance the reinforcing pleasure experienced by the individual?
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A: Neuropeptides
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Q: True or False: With repeated drug use, the DA system becomes increasingly densensitized
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A: False, it becomes increasingly sensitized
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Q: Neuroadaptation are brain changes in structure and function that can lead to ________ and ________
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A: Tolerance and withdrawal
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Q: True or False: It is the neuroadaptive processes that become very significant when the individual stops substance use.
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A: True
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Q: In terms of the neuroadaptive processes in withdrawal symptoms, what happens to these adaptive responses when the substance is no longer present?
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A: The adaptive responses run unopposed
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Q: According to neuroadaptation, what will happen to an individual after a long period of sobriety returns to substance abuse?
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A: They will have the same level of tolerance and physical impact as experienced before sobriety
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Q: Which of the following percentages is U.S. clients with a psychiatric disorder also experience substance use or dependence?
A. 20% B. 30% C. 50% D. 70% |
A: 50%
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Q: What is the most commonly abused illegal drug? What is the most commonly abused drug?
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A: Marijuana; Alcohol
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Q: What is a medically-related and a psychiatrically-related risk factor for substance use?
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A: Chronic pain; Chronic pathological-level anxiety
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Q: Provide what the letters in CAGE screening tool for alcohol abuse mean.
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A: C: Have you ever thought to CUT down on your drinking?
A: Have people ANNOYED you by mentioning your drinking? G: Have you ever felt bad or GUILTY about your drinking? E: Have you every had a drink first thing in the morning to steady your nerves or get rid of a hangover EYE-OPENER |
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Q: How is the CAGE screening tool scored? Clients scoring 0-2 are at what risk? Clients score 3-4 are at what risk for alcohol dependency?
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A: Each positive answer gets one point
0-2: Moderate risk for alcohol dependency 3-4: High risk |
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Q: Substance abuse is defined as a maladaptive pattern of use manifested by __________ and ______________ related to repeated use of a substance
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A: Recurrent and significant adverse consequences
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Q: How long must the maladaptive pattern of sustained abuse be for substance abuse diagnosis?
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A: At least 12 months
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Q: In substance abuse, what happens to the person's role obligations?
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A: Does not fulfill them or has repeated failures
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Q: What specifically does the person do in terms of judgment that is a criteria for substance abuse?
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A: Uses in a situation that can be physically hazardous such as drinking and driving
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Q: In the diagnostic criteria for substance abuse, what does the person do when they have legal, interpersonal, and social problems related to substance use?
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A: They continue to use
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Q: For substance dependence, there must be 3 or more symptoms within a 12 month period. What are these criteria?
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A: Tolerance, Withdrawal, Using larger amounts than intended, Persistent craving or unsuccessful attempts to cut down, Large amount of time spent obtaining the substance, using or recovering from the effects, Activities decrease or given up because of use, Using despite consequences
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Q: In substance dependence, there are two specifiers for dependence. What are they?
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A: With physiological dependence and without physiological dependence
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Q: Physiological dependence implies what?
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A: Tolerance and withdrawal
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Q: True or False: Symptoms of tolerance or withdrawal need not be present to meet criteria for substance dependence.
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A: True
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Q: True or False: Withdrawal symptoms are almost always the opposite of the acute action of the substance.
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A: True
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Q: Which drug types have obvious withdrawal symptoms?
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A: Alcohol, Opioids, Sedatives, Hypnotics, Anxiolytics
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Q: Which categories of abused substances have less obvious withdrawal?
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A: Stimulants, Nicotine, Cannabis
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Q: Which abused substance categories have little to no obvious withdrawal?
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A: Hallucinogens and PCP
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Q: What is the difference between early partial remission and sustained partial remission?
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A: Early partial remission: One or more criteria (but not full criteria) have been met for substance dependence for at least 1 month but less than 12 months
Sustained partial remission: One or more criteria (but not full criteria) have been met for substance dependence for 12 months or longer |
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Q: What is the difference between early full remission and sustained full remission?
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A: Early full remission: No criteria met for abuse or dependence for at least one month but less than 12 months
Sustained full remission: No criteria met for abuse or dependence for 12 months or longer |
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Q: Between intoxication and withdrawal, which one is reversible and which one is not?
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A: Intoxication: reversible
Withdrawal: Potentially nonreversible |
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Q: True or False: Blood alcohol levels (BAL) must be interpreted based on his or her degree of tolerance because with tolerant individuals, there are often higher blood levels with less impairment than nontolerant individuals
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A: True
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Q: There are general symptoms for criteria of substance withdrawal. For a diagnosis requires two of these. Name some.
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A: Hand tremor, insomnia, Autonomic hyperactivity (sweating, increased heart rate & BP), Nausea or vomiting, Hallucinations or illusions, Psychomotor agitation, Anxiety, Seizures
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Q: In the structured interview for substance use, there are categories of the kinds of questions you would use. Name them.
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A: Current drug use, Patterns of use, Social consequences, Relational/relationship aspects, Sequelae of dependency (e.g. physical health deficits, injury/traumas from use, noncompliant with medical care because had to be drug free)
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Q: What gastrointestinal findings would be suggestive of alcohol dependency? Cardiovascular? Respiratory? Dermatological?
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A: GI: Abdominal tenderness, splenomegaly, hepatomegaly
CV: Tachycardia, Cardiomyopathy, Arrhythmia, HTN Resp: Alcohol breath, Aspiration pneumonia, Chronic upper airway infection Derm: Telangiectasases or angiomas, Rosacea, Bruises, Distal extremity alopecia |
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Q: What are some significant clinical findings with persons abusing stimulant agents?
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A: Anxiety, agitation, aggression, elated mood, irritability, restlessness, dilated pupils, panic
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Q: What are some significant clinical findings in persons abusing depressant agents?
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A: Ataxia, disinhibition, impaired attention, memory, judgment, slurred speech, drowsiness, myalgia
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Q: What are some significant clinical findings in persons abusing hallucinogens?
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A: Paranoia, flashbacks, panic or severe anxiety, dilated pupils, nystagmus, inability to make decisions, tremors
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Q: What are some significant clinical findings in persons abusing cannabis?
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A: Paranoia, Time distortion, Confusion
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Q: What are some significant clinical findings in persons abusing inhalants?
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A: Confusion, Stupor, Ataxia, Delirium
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Q: For most all categories of abused substances, what is the one common possible symptom that could be present in each?
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A: Hallucinations
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Q: In alcohol dependence, which labs with be elevated?
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A: MCV, GGT, AST, ALT, PT, Amylase, lipids, triglycerides, uric acid
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Q: What blood alcohol level is suggestive of alcohol dependence at time of routine examination? Without gross evidence of intoxication? At any time?
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A: >100;
> 150 >300 |
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Q: What labs will be low in alcohol dependence?
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A: WBC, Sodium & Potassium levels
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Q: Which two medical conditions can mimic alcohol withdrawal?
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A: Hepatic encephalopathy and Hypoglycemia
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Q: Name the clinical stages of substance-related disorders that determine type of clinical management.
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A: Acute withdrawal, acute intoxication, long term sobriety maintenance, relapse prevention
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Q: The CIWA is used to determine the likelihood of withdrawal and delirium tremens which usually occurs in the first 24-72 hours after stopping alcohol. Name the 10 common alcohol withdrawal symptoms the CIWA assesses.
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A: Nausea/vomiting, tremors, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances, headaches, altered sensorium
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Q: What score on the CIWA is indicative of severe withdrawal and possible delirium tremens?
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A: > 15
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Q: Name four benzo's used in the clinical management of acute alcohol withdrawal
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A: Lorazepam, Chlodiazeepoxide (Librium), Diazepam, Oxazepam (Serax)
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Q: What are some other drugs besides benzo's that can be used in the clinical management of alcohol withdrawal?
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A: SSRI, Opioid antagonists (e.g. Revex, ReVia), NMDA agonists
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Q: In alcohol withdrawal, which two anticonvulsants can be used to decrease the risk of seizures?
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A: Tegretol or Depakote
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Q: What kind of medications are used to decrease BP and pulse associated with alcohol withdrawal?
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A: Adrenergic medications
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Q: Name some "anti-craving" medications used in abusive substances and maintain sobriety.
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A: Citalopram, Naltrexone (ReVia), onadesteron (Zofran), Buprenorphine (Buprenex)
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Q: What three vitamin deficiencies do persons with alcohol dependence usually need supplementation for?
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A: Thiamine, Folic Acid, and B-Complex Vitamins
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Q: True or False: Disulfram should be administered as soon as possible after stopping alcohol.
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A: False, individual must be alcohol free for at least 12 hours
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Q: What labs can disulfram elevate?
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A: LFTs
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Q: True or False: Antabuse can potentially induce mania in individuals with BP disorder
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A: True
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Q: What does disulfram inhibit?
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A: Inhibits the enzyme aldehyde dehydrogenase
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Q: What medication is used as an antidote for opioid overdose?
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A: Naloxone (Narcan)
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Q: Buprenorphine (Buprenex) is unique because it has two chemical properties. What are these properties?
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A: It is both an opioid partial agonist and opioid antagonist
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Q: Revia/Vivitrol (naltrexone) is a what kind of medication?
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A: Opioid antagonist
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Q: Suboxone combines two drugs. What are these?
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A: Buprenorphine and Naloxone (Narcan)
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Q: Campral (acamprosate) is a homotaurine that is supposed to decrease cravings. Define its action.
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A: Has agonist activity at GABA receptors and inhibitory activity at glutamate receptors
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Q: How is Zofran (onadesteron), a 5HT3 inhibitor do in substance abuse?
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A: Decreases craving
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Q: Name some general medical problems that will require further treatment in relation to alcohol abuse/dependence.
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A: Neurological sequelae of chronic alcohol use, nutritional deficiencies, Cardiomyopathy, HTN, Heart Disease, Arrhythmias, Blood Dyscrasias, GI inflammations, Esophageal, Liver, Nasopharyngeal, and Laryngeal Cancers
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Q: What percent of high-school students report at least a one-time use of illicit drugs?
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A: 50%
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Q: What residual signs/symptoms may persist for months after opioid dependence?
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A: Insomnia, bradycardia, temperature dysregulation, and craving
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Q: In screening for alcohol or drug problems what are the subjects for assessing level of consumption?
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A: Frequency, Quantity, Maximum Amount in One Day or Episode, Last Use
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Q: There are general subjects for assessing signs and symptoms of alcohol and drug abuse. What are these?
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A: Adverse Consequences of Use, Impaired Control, Tolerance, Withdrawal, Assessing Severity (e.g. how much time spent using and recovering), Assessing Motivation and Stage of Change
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