kaplan susbtance

What are the three types of dependence discussed in substance use disorders?

Behavioral dependence, physical dependence, and psychological dependence.

What is the term for the behavioral patterns of family members significantly affected by another family member's substance use?

Codependence.

What is enabling in the context of substance use disorders?

A person who facilitates the abuser's addictive behavior (e.g., providing drugs directly or money to buy drugs).

What is the definition of tolerance?

Phenomenon in which, after repeated administration, a given dose of drug produces a decreased effect or increasingly larger doses must be administered to obtain the effect observed with the original dose.

What is cross-tolerance?

The ability of one drug to be substituted for another, each usually producing the same physiological and psychological effect.

What is neuroadaptation?

Neurochemical or neurophysiologic changes in the body that result from the repeated administration of a drug.

What is the estimated number of persons older than age 12 in the US classified as having a substance-related disorder as of 2012?

More than 22 million persons (about 10 percent of the total US population).

Among adults aged 21 or older who first tried alcohol at age 14 or younger, what percent were classified as alcoholics?

15 percent.

What is the rate of dependence or abuse among adults age 18 to 25 in 2012?

19 percent.

What is the model of substance use disorders according to the text?

The result of a process in which multiple interacting factors influence drug-using behavior and the loss of judgment.

What is alexithymia?

Being unable to find words to describe their feelings.

What are the major neurotransmitters possibly involved in developing substance abuse?

Opioid, catecholamine (particularly dopamine), and GABA systems.

What is the brain-reward circuitry?

The dopaminergic neurons in the ventral tegmental area that project to cortical and limbic regions, especially the nucleus accumbens.

What percentage of patients with substance abuse or dependence also meet criteria for antisocial personality disorder?

35 to 60 percent.

What is the suicide risk for persons who abuse substances compared to the general population?

About 20 times more likely to die by suicide.

What are the four major diagnostic categories in DSM-5 for substance-related disorders?

Substance Use Disorder, Substance Intoxication, Substance Withdrawal, and Substance-Induced Mental Disorder.

What are the five stages in the gradual process of addictive behaviors change?

Precontemplation, contemplation, preparation, action, and maintenance.

What is the primary medication to control alcohol withdrawal symptoms?

Benzodiazepines.

What is the classic sign of alcohol withdrawal?

Tremulousness.

What is the mortality rate of untreated delirium tremens (DTs)?

20 percent.

What is the treatment for Wernicke's encephalopathy?

Large doses of parenteral thiamine.

What is Korsakoff's syndrome?

The chronic amnestic syndrome that can follow Wernicke's encephalopathy.

What is the typical dosage of thiamine for Korsakoff's syndrome?

100 mg by mouth two to three times daily for 3 to 12 months.

What are alcoholic blackouts?

Discrete episodes of anterograde amnesia that occur in association with alcohol intoxication.

What is the alcohol-sensitizing agent used in treatment?

Disulfiram.

What is the opioid antagonist used to decrease craving for alcohol?

Naltrexone.

What medication affects glutamate and GABA neurotransmitter systems for alcohol dependence?

Acamprosate.

What is the most widely consumed psychoactive substance in the world?

Caffeine.

What is the half-life of caffeine?

3 to 10 hours.

What are the five disorders associated with caffeine use?

Caffeine use disorder, caffeine intoxication, caffeine withdrawal, caffeine-induced anxiety disorder, and caffeine-induced sleep disorder.

What is the most common symptom of caffeine withdrawal?

Headache and fatigue.

What is the typical onset of caffeine withdrawal symptoms?

12 to 24 hours after the last dose.

What is the principal psychoactive component of cannabis?

Delta-9-tetrahydrocannabinol (Δ9-THC).

What are the common physical effects of cannabis?

Dilation of conjunctival blood vessels (red eye) and mild tachycardia.

What is the risk of developing dependence for anyone who uses cannabis?

Around one in ten.

What are the withdrawal symptoms of cannabis?

Irritability, cannabis cravings, nervousness, anxiety, insomnia, disturbed or vivid dreaming, decreased appetite, weight loss, depressed mood, restlessness, headache, chills, stomach pain, sweating, and tremors.

What is the most common adverse reaction to moderate use of smoked cannabis?

Anxiety symptoms.

What is amotivational syndrome?

A controversial cannabis-related syndrome characterized by unwillingness to persist in a task, apathy, and anergia.

What is the classic synthetic hallucinogen?

Lysergic acid diethylamide (LSD).

What is the primary pharmacodynamic effect of PCP and ketamine?

Antagonist at the NMDA subtype of glutamate receptors.

What is the treatment of choice for hallucinogen intoxication?

Talking down the patient.

What is hallucinogen persisting perception disorder?

Flashbacks of hallucinogenic symptoms long after ingesting a hallucinogen.

What are the common physical effects of inhalants?

They act as a central nervous system depressant.

What is the most serious adverse effect of inhalant use?

Death, which can result from respiratory depression, cardiac arrhythmias, asphyxiation, etc.

What is the primary effect of opioid drugs mediated via?

Opioid receptors.

What are the three classes of endogenous opioids?

Endorphins, dynorphins, and enkephalins.

What is the most common comorbid psychiatric diagnosis in persons with opioid dependence?

Major depressive disorder, alcohol use disorders, antisocial personality disorder, and anxiety disorders.

What is the treatment for opioid overdose?

Naloxone.

What is the gold standard treatment for opioid dependence?

Methadone.

What is the advantage of buprenorphine over methadone?

It can be dispensed on an outpatient basis and has a slow dissociation from opioid receptors.

What are the three major groups of drugs in sedative-, hypnotic-, or anxiolytic-related disorders?

Benzodiazepines, barbiturates, and barbiturate-like substances.

What is the primary effect of benzodiazepines on the GABA receptor complex?

Increase the affinity of the receptor for GABA and increase the flow of chloride ions.

What is the lethal dose to effective dose ratio for benzodiazepines?

About 200 to 1 or higher.

What is the antidote for benzodiazepine overdose?

Flumazenil.

What is the most widely used illicit substance in the United States after cannabis?

Amphetamines and amphetamine-like drugs.

What is the primary mechanism of action of cocaine?

Competitive blockade of dopamine reuptake.

What is the most common cerebrovascular disease associated with cocaine use?

Nonhemorrhagic cerebral infarctions.

What is the treatment for amphetamine-induced psychotic disorder?

Short-term use of an antipsychotic medication such as haloperidol.

What is the psychoactive component of tobacco?

Nicotine.

What is the half-life of nicotine?

About 2 hours.

What are the common symptoms of nicotine withdrawal?

Intense craving for tobacco, tension, irritability, difficulty concentrating, drowsiness, trouble sleeping, decreased heart rate and blood pressure, increased appetite and weight gain, decreased motor performance, and increased muscle tension.

What is the most effective treatment for smoking cessation?

Behavior therapy combined with pharmacological therapy.

What are anabolic-androgenic steroids (AAS)?

A family of hormones that includes testosterone and synthetic analogs.

What is the major reason for taking illicit AAS?

To enhance either athletic performance or physical appearance.

What is muscle dysmorphia?

A form of body dysmorphic disorder in which the individual feels that he or she is not sufficiently muscular and lean.

What is the treatment goal for patients with AAS abuse or dependence?

Abstinence.

What is the definition of gambling disorder?

Persistent and recurrent maladaptive gambling that causes economic problems and significant disturbances in personal, social, or occupational functioning.

What are the four phases of pathological gambling?

The winning phase, the progressive-loss phase, the desperate phase, and the hopeless stage.

What is the self-help group for gambling disorder?

Gamblers Anonymous (GA).

What is polysubstance-related disorder?

A diagnosis appropriate if, for at least 12 months, a person has repeatedly used substances from at least three categories (not including nicotine and caffeine).