BMED- substance-realted/addictive disorders

What does the outdated term "substance abuse" mean?

Use of any drug in a manner that deviates from approved social or medical patterns

What does the outdated term "addiction" mean?

Chronic, relapsing disorder with compulsive drug seeking and continued use despite harm, causing long-lasting brain changes

What is the current term replacing "substance abuse" and "addiction"?

Substance use disorder

What is substance use disorder?

Treatable mental disorder affecting brain and behavior, leading to inability to control substance use

What is tolerance?

After repeated use, a drug's effect decreases or larger doses are needed for the same effect

What is cross-tolerance (or cross-dependence)?

Ability of one drug to substitute for another with similar physiological and psychological effects

Give an example of cross-tolerance.

Benzodiazepines and barbiturates; amphetamine and methamphetamine

What is dependence?

Repeated use of a substance with or without physical dependence

What does "physical dependence" mean?

Altered physiological state due to repeated use; stopping causes specific withdrawal syndrome

What is withdrawal (abstinence or discontinuation syndrome)?

Substance-specific syndrome after stopping or reducing long-term use

What are characteristics of withdrawal?

Physiological signs plus psychological changes in thinking, feeling, and behavior

What is legal intoxication?

Reversible syndrome from substance use affecting memory, mood, orientation, judgment, and functioning

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

Caffeine

What type of drug is caffeine?

Methylxanthine alkaloid

What neurotransmitter system does caffeine act on?

Adenosine receptors (antagonist)

How does caffeine's mechanism affect neurotransmitters?

Adenosine antagonism → increased dopamine, glutamate, and adrenaline

When does caffeine peak and what is its half-life?

Peaks at 30-60 min; half-life 3-10 hours

What are sources of caffeine?

Foods/beverages (coffee, soda), prescription meds, OTC meds

What are the physical effects of 20-200 mg caffeine?

Well-being, energy, concentration, decreased drowsiness, motivation

What are the physical effects of 300-800 mg caffeine?

Toxicity with anxiety and nervousness

What small protective effects does caffeine have?

Alzheimer's, MI, diabetes, bowel function

What are adverse effects of caffeine?

Restlessness, nervousness, insomnia, flushed face, diuresis, GI upset, twitching, tachycardia, psychomotor agitation

What percentage of caffeine users experience withdrawal symptoms?

50-75 %

What are common caffeine withdrawal symptoms?

Headache, fatigue, anxiety, depression, nausea, vomiting, muscle aches

How is caffeine withdrawal treated?

Caffeine, aspirin, or short-term benzodiazepines

What is the planned cessation strategy for caffeine?

Taper slowly over 1-2 weeks; do not stop abruptly

What type of drug is alcohol?

Ethanol; CNS depressant

What type of drug is tobacco/nicotine?

Stimulant

What type of drug is cannabis?

Psychoactive (includes dronabinol, sativex)

How does alcohol affect neurotransmitters?

Potentiates GABA inhibition, inhibits glutamate excitation, stimulates 5HT3 receptors

How does nicotine affect neurotransmitters?

Agonist at nicotinic ACh receptors → activates dopaminergic pathway

How do cannabinoids affect neurotransmitters?

Affect GABA neurons

What are high-risk groups for alcohol use disorder?

Younger adults, males, Native Americans, those with disability, other substance or mood disorders, genetics

Who is high-risk for tobacco/nicotine use?

Psychiatric patients, lower education, mean onset age 16

Who is high-risk for cannabis use?

Adolescents, young adults, those with mental health disorders

At what blood alcohol level is thought and judgment loosened?

0.05 %

What is the legal intoxication blood alcohol level?

0.08 %

At what blood level does motor control become clumsy?

0.10 %

At what blood level is motor area depressed and emotional control affected?

0.20 %

At what level does confusion or stupor occur?

0.30 %

At what blood alcohol level may coma or death occur?

0.40-0.50 %

What does nicotine release in the body?

Epinephrine → ↑ HR, BP, respiration, blood glucose

What are common effects of cannabis?

Euphoria, munchies, dry mouth, red eyes, mild tachycardia, relaxation, altered senses

What are low-level alcohol effects (30-100 mg/dL)?

Euphoria, disinhibition, impaired coordination

What are alcohol effects at 100-150 mg/dL?

Mental clouding, ataxia, memory impairment, drowsiness

What are alcohol effects at 150-200 mg/dL?

Slurred speech, loss of judgment, drunkenness

What are alcohol effects at 200-300 mg/dL?

Stupor and unconsciousness

What are tobacco's adverse effects?

Lung cancer, COPD, cardiovascular disease, MI, stroke, PAD, low-birth-weight infants

What are acute cannabis adverse effects?

Impaired attention, concentration, memory, motor coordination

What are chronic cannabis adverse effects?

Cerebral atrophy, seizures, lung cancer, low sperm, hyperemesis syndrome

What are alcohol withdrawal complications?

Delirium, seizures, autonomic hyperactivity

What are alcohol withdrawal symptoms?

Tremors, hallucinations, disorientation, tachycardia, HTN, hyperthermia, agitation, diaphoresis

What are nicotine withdrawal symptoms?

Cravings, tension, irritability, concentration problems, appetite ↑, weight gain

What are cannabis withdrawal symptoms?

Irritability, sleep disturbance, appetite loss, cravings

What is the main treatment for alcohol withdrawal?

Benzodiazepines (diazepam, lorazepam, chlordiazepoxide)

What other meds aid alcohol withdrawal?

Beta-blockers (atenolol, propranolol), alpha-blocker (clonidine), antiepileptic (carbamazepine)

What nutritional support is given in alcohol withdrawal?

High-calorie/high-carb diet, thiamine, folate

What are treatments for nicotine withdrawal?

Behavior therapy, nicotine replacement, bupropion, chantix, clonidine, benzos

What are components of e-cigs?

Vapor, nicotine, flavoring

How is cannabis withdrawal treated?

Abstinence and support

What are steps of alcohol addiction treatment?

Intervention, detoxification, rehabilitation

Name three alcohol addiction medications.

Disulfiram, acamprosate, naltrexone

What are lab findings in alcohol abuse?

Macrocytosis, AST:ALT 2:1, ↑ GGT, ↑ CDT, ↑ ethanol level

What test detects tobacco use?

Cotinine level

What test detects cannabis use?

Urine or blood THC levels

What does C in CAGE stand for?

Cut down

What does A in CAGE stand for?

Annoyed

What does G in CAGE stand for?

Guilty

What does E in CAGE stand for?

Eye-opener

What is the MAST questionnaire used for?

Screens for drinking problem; self-scoring

What type of drug is an opiate?

Subgroup of opioids

What type of drug is a barbiturate?

CNS depressant

What type of drug is a benzodiazepine?

CNS depressant

How do opiates affect neurotransmitters?

Inhibit GABA → ↑ dopamine

How do barbiturates affect neurotransmitters?

GABA receptor agonist

How do benzodiazepines affect neurotransmitters?

Enhance GABA at receptor

Who is high-risk for opiate addiction?

Chronic pain, prior substance abuse

Who is high-risk for barbiturate addiction?

Anxiety, insomnia, prior substance abuse

Who is high-risk for benzodiazepine addiction?

Anxiety disorders, prior substance abuse

What are opiate physical effects?

Euphoria, warmth, nodding off, constricted pupils, ↓ respiration, ↓ bowel sounds

What are barbiturate physical effects?

Sluggishness, poor coordination, faulty judgment, disinhibition, emotional lability

What are benzodiazepine physical effects?

Mild intoxication, relaxation, euphoria, ↑ sexual feelings

What are opiate adverse effects?

Respiratory depression, constipation, dependency

What are barbiturate adverse effects?

Fatal overdose, respiratory depression, coma, CV failure

What are benzodiazepine adverse effects?

Drowsiness, ataxia, confusion, mild vital sign depression

What are Grade 0 opiate withdrawal symptoms?

Craving and anxiety

What are Grade 1 opiate withdrawal symptoms?

Yawning, lacrimation, rhinorrhea, sweating

What are Grade 2 opiate withdrawal symptoms?

Mydriasis, tremors, anorexia, hot/cold flashes, aches

What are Grades 3-4 opiate withdrawal symptoms?

↑ Temp, BP, pulse, diarrhea, vomiting, weight loss, orgasm

How long may opiate residual symptoms last?

Months

What are barbiturate withdrawal symptoms?

Dysphoria, N/V, rhinorrhea, seizures, sweating, hallucinations, hypotension

What are benzodiazepine withdrawal symptoms?

Tremors, anxiety, perceptual changes, psychosis, seizures

What drugs treat opiate withdrawal?

Naltrexone, buprenorphine, methadone

When should methadone or buprenorphine start?

At Grade 2 symptoms

What are short-term adjunct meds in opiate withdrawal?

Zofran, gabapentin, clonidine

How is barbiturate withdrawal managed?

Long-acting barbiturate taper (phenobarbital or pentobarbital)

How is benzodiazepine withdrawal treated?

Long-acting BZD (diazepam) tapered over months

What are opiate addiction treatments?

Psychotherapy, naloxone/nalmefene, rehab referral

What are barbiturate addiction treatments?

Gradual taper, CBT

What are benzodiazepine addiction treatments?

Gradual taper, CBT, supportive therapy