3060 Substance use disorders

What are the 4 aspects of substance use disorder

impaired control, social impairment, risky use, physical effects

difficulty stopping a medication

addiction

using a substance to a point of impairment

intoxication

the need to use more and more of a substance for it to have the same effect

tolerance

What do the following fall under?

alcohol

caffeine

cannabis

hallucinogens

inhalants

opioids

sedatives/hypnotics/anxiolytics

stimulants

tobacco

gambling disorder

Substance related and addictive disorders

What does the following describe?:

1 week after cessation

anger, irritability, aggression, anxiety, depression, insomnia, wt loss, HA

Withdrawal from cannabis

What is the treatment for withdrawal from cannabis?

abstinence, psychotherapy, antidepressants

What Intoxication does the following describe?:

restlessness, nervousness, agitation, flushing, diuresis, gi disturbance, tachycardia, arrhythmia, seizures, death

Intoxication of caffeine

What drugs are related to hallucinogen use disorder

LSD, PCP, ketamine

What intoxication does the following describe?:
belligerence

impulsiveness

psychomotor

agitation

PCP intoxication

What SUD does the following describe?:

Usually short term, but may continue for longer periods

huffing, sniffing, whippets

glues, paints, solvents, propellants, fuel

long term: diminished social/occupational functioning, aggressive behavior, poor judgment

Inhalant use disorder

What Intoxication does the following describe?:

·      Euphoria, disinhibition, hallucinations, anxiety; nausea/anorexia, nystagmus, double vision

·      Stupor, unconsciousness, amnesia, delirium, dementia, psychosis

·      Can result in death (arrhythmias) “sudden sniffing death”- butane & propane

Intoxication of inhalants 

What SUD treatment does the following describe?:

Haloperidol for psychosis

Treatment with inhalant use disorder

What intoxication does the following describe?: 

o   Nystagmus (eyes back and forth), HTN, tachycardia, decreased pain, seizures

o   Coma, hyperthermia

Intoxication of hallucinogens 

What SUD treatment does the following describe?:

·      “Talking down” ; haloperidol, diazepam; cooling blankets for hyperthermia

Treatment for Hallucinogen use disorder

What are the only two SUDs that have no official withdrawal?

Hallucinogens, inhalants

What SUD does the following describe?:

o   long-term, chronic disorder- high relapse

- Significant social/occupational impairment

-  Prescription medications, heroin

Opioid use disorder 

What does the following intoxication describe?:

·      Psychomotor impairment, drowsiness, slurred speech

·      Pupil constriction, bradypnea, bradycardia, hypothermia, coma

Opioid use disorder intoxication

What substance does the following withdrawal symptoms describe?:

·      Very physically uncomfortable symptoms: tearing, runny nose, yawning, anxiety, piloerection, tachycardia, HTN, bone/muscle pain

·      Begins 6-12 hrs. after last dose. Lasts 1 wk.

Opioid use disorder withdrawal

What substance do the following Overdose symptoms describe?:

§  respiratory depression/ arrest, coma, pinpoint pupils

Opioid use disorder overdose

What SUD is related to the following treatment options?:

·      Overdose: ventilatory support

·       Naloxone: IM, SQ, IV, intranasal (repeat)

·      Therapy (inpatient), methadone, clonidine, buprenorphine/buprenorphine & naloxone, naltrexone

Opioid use disorder 

How many doses of narcan do people normally require?

multiple doses

When you have a new admit who used to smoke, what should you ensure they get ordered?

a nicotine replacement

What SUD does the following describe?:

• Benzodiazepines, barbiturates, prescription sleep meds

• Depressants: may affect relationship & role performance; tolerance

Sedatives/ hypnotics/ anxiolytics 

What SUD intoxication does the following describe?:

·      Slurred speech, impaired coordination

Sedatives, hypnotics, anxiolytics

What SUD withdrawal symptoms does the following describe?:

·      Tremors, insomnia, psychomotor agitation, anxiety, seizures (may occur even if taken as intended!)

Sedatives, hypnotics, anxiolytics

What SUD does the following treatment describe?:

·      Overdose: gastric lavage, activated charcoal, support ventilation

·      Flumazenil for benzodiazepine overdose

·      Wean off meds

sedatives, hypnotics, anxiolytics 

What SUD does the following describe?:

-amphetamines, cocaine

• Use disorder may result even after short-term use

Stimulants

What SUD does the following intoxication describe?:

·      Elation, euphoria, sociability, hypervigilance, anxious, aggressive, decreased appetite, chest pain, arrhythmias, dilated pupils, sweating, nausea/vomiting, “crawling” skin

Stimulants

What SUD does the following withdrawal describe?:

·      Fatigue, nightmares, depression, suicidal thoughts, cravings

stimulants

What SUD does the following treatment relate to?:

·      Therapy (inpatient), antipsychotics, antidepressants (bupropion)

·      Symptomatic treatment: no FDA-approved meds; only help w symptoms

Stimulants

What SUD does the following describe?:
o   most substance-related deaths

§  Dependence results quickly

tobacco

What SUD withdrawal does the following describe?:

]·      Irritability, anxiety, depression, poor concentration, restlessness, insomnia

tobacco

What SUD does the following treatment relate to?:

·      Behavioral therapy, hypnosis,

·      nicotine replacements (gum, lozenges, patches): ensure new patients who used to smoke get replacement

·      bupropion, varenicline

Tobacco

What SUD does the following describe?:
- 5.8% of adults

Alcohol use disorder

What does the following describe?:

4 (women) or 5 (men) drinks/ 2 hours (26.5% of adults

binge drinking

What does the following describe?:
8 (women) or 14 (men) drinks/ week (6.6% of adults)

heavy drinking 

What SUD does the following intoxication relate to?:

·      Initially: euphoria, decreased inhibition

·      Impaired judgement, decreased motor function, slurred speech, vomiting, blackouts, hypothermia, hypotension, bradypnea

Alcohol

·What does the following describe?:

does not exhibit signs even if the concentration is high

tolerance

What SUD does the following withdrawal describe?:

·      Shakiness/jitters, nausea, vomiting, agitation, insomnia: common with heavy drinking

·      Hallucinations/impaired perception, seizures, delirium (DT’s): less common, but life-threatening

alcohol use disorder

What SUD does the following treatment relate to?:

·      Benzodiazepines: chlordiazepoxide (Librium): mild agitation

·      Diazepam (valium): seizures/delirium prevention

·      Lorazepam (Ativan): acute delirium

·      Disulfiram; Naltrexone; Acamproste

·      Therapy: inpatient/out

·      Withdrawal: inpatient

Alcohol use disorder

What SUD does the following describe?:

o   Possible future DSM process additions: social media, shopping, sex

o   Similar to other use disorders: related to anxiety

o   Significant family, social, and financial repercussions

o   Increased w stress/depression

Gambling disorder

What SUD does the following treatment relate to?:

• Support groups, inpatient treatment

• SSRIs, mood stabilizers (lithium), anticonvulsants

Gambling use disorder