Substance Use Disorder (Chat)

What characterizes a substance use disorder (SUD)?

Compulsive engagement despite adverse consequences, involving reward, control, and functioning.

What behaviors can be classified as non-substance use disorders?

Gambling, sexual behavior, and internet use.

What are common SUD categories in the lecture?

Alcohol, stimulants, cannabis, hallucinogens, opioids, benzodiazepines, tobacco, prescriptions, gambling, pornography.

What genetic contribution to SUD risk does the lecture estimate?

Heritability is estimated at 40–70%; no single gene determines SUD.

How do genes and environment contribute to SUD?

Risk reflects interactions among multiple genes and environmental factors.

How were adverse childhood experiences associated with relapse?

Each one-unit increase in ACE score increased relapse odds by 17% in the cited study.

Which terms replaced addiction, dependence, and abuse in DSM diagnosis?

Substance use disorder (e.g., OUD, AUD).

How many DSM criteria within 12 months are needed for SUD?

At least 2 of 11 criteria.

How is SUD severity classified?

Mild: 2–3 symptoms; moderate: 4–5; severe: 6 or more.

What are the three DSM substance-related categories?

Intoxication, withdrawal, and substance use disorder.

What is tolerance?

Repeated use reduces a substance’s effect; a person may need more to achieve it.

Why can usual doses cause overdose after abstinence?

Tolerance decreases during abstinence, making previous doses dangerous.

What is withdrawal?

Symptoms that emerge after stopping or reducing substance use.

Why might a person continue using to avoid withdrawal?

Withdrawal avoidance negatively reinforces continued substance use.

Which withdrawals can be life-threatening?

Alcohol and benzodiazepine withdrawal.

What happens as use shifts from voluntary to compulsive?

Drug-seeking becomes harder to regulate and use may be driven by avoiding withdrawal.

What are the four survival-related psychological constructs?

Reward, drive, memory, and control.

How does substance use affect natural rewards and impulses?

Substance use is reinforced strongly, shifting impulses toward seeking the substance.

When is outpatient SUD treatment most appropriate?

Lower risk of severe withdrawal or medical complications; counseling and follow-up may be included.

When is inpatient SUD treatment most appropriate?

Higher risk of severe withdrawal or instability requiring close monitoring and intensive support.

What are common routes of substance administration?

Oral, intravenous, inhaled, and mucosal (nasal or oral).

What is a key risk of oral administration?

Delayed effects may lead to repeated dosing before the first dose is felt.

Why does IV administration increase SUD risk?

Immediate, intense effects create rapid reinforcement.

What infections can be associated with IV substance use and needle sharing?

Sepsis, endocarditis, and bloodborne diseases.

What labs or screenings may be considered with IV substance use?

Hepatitis testing, CMP/LFTs, CBC, HIV, syphilis, and other STI testing.

What are risks of inhaled substance use?

Local tissue and lung burns, respiratory complications, lung injury, and lung cancers.

What are examples of mucosal administration?

Nasal insufflation, buccal, and sublingual administration.

What are risks of mucosal administration?

Local tissue damage, unpredictable absorption, accidental overdose, and oral cancers with smokeless tobacco.

Which opioid receptors mediate primary opioid effects?

Mu opioid receptors.

What are major effects of mu opioid receptor activation?

Euphoria, analgesia, respiratory depression, pleasure, tranquility, and drowsiness.

What are signs of opioid intoxication?

Respiratory depression, impaired judgment, pinpoint pupils, drowsiness/coma, slurred speech, and impaired attention or memory.

What is the major life-threatening effect of opioid overdose?

Respiratory depression.

Why must a patient be monitored after naloxone?

Naloxone has a short half-life; opioid effects may return and additional doses may be needed.

Re-overdose can occur because naloxone wears off quickly.

What harm-reduction education is emphasized for opioid use?

Recognize overdose signs, avoid using alone, and carry naloxone.

What are autonomic opioid withdrawal symptoms?

Diaphoresis, tachycardia, hypertension, mydriasis, and fever/hot-cold flashes.

What are somatic/GI opioid withdrawal symptoms?

Muscle/bone pain, abdominal cramping, nausea, vomiting, GI upset, piloerection, rhinorrhea, lacrimation, and yawning.

What are psychological opioid withdrawal symptoms?

Restlessness, anxiety, irritability, insomnia, dysphoria, mood changes, and craving.

What are nonpharmacological supports for OUD?

Basic needs support, inpatient rehabilitation, outpatient programs, and peer support such as Narcotics Anonymous.

What are the three goals of pharmacologic harm reduction for OUD?

Suppress withdrawal, reduce cravings, and block reinforcing effects of illicit opioids.

What are benefits of OUD medications described in the slides?

Less illicit use and morbidity, improved health and social functioning, and reduced mortality.

What is xylazine?

Veterinary sedative ('tranq') in illicit opioid supply; an alpha-2 agonist, not an opioid.

Does naloxone reverse xylazine?

No, but give naloxone for suspected opioid overdose because opioids may also be present.

What wound complication is associated with xylazine?

Severe necrotic wounds, including away from injection sites.

What is medetomidine in the illicit opioid supply?

An emerging alpha-2 agonist; naloxone does not directly reverse it.

What withdrawal concern is associated with medetomidine?

Severe withdrawal with autonomic instability and marked hypertension.

What factors are associated with alcohol use disorder?

Conduct problems, depression, anxiety, insomnia, cultural attitudes, availability, stress, trauma, and genetic influences.

How does alcohol affect GABA and dopamine?

Enhances inhibitory GABA activity and activates the mesolimbic dopamine pathway.

What are common effects of alcohol intoxication?

Sedation, euphoria, and disinhibition.

Why can alcohol withdrawal cause autonomic instability?

Neuroadaptation increases glutamate and decreases endogenous GABA, leaving the CNS hyperexcitable.

What does BAC measure?

Concentration of alcohol in the blood; it correlates with symptoms and risk.

What lab findings may suggest chronic heavy alcohol use or liver injury?

Elevated MCV, AST:ALT ratio greater than 2:1, and elevated GGT. (Liver function tests)

What are signs of alcohol intoxication?

Slurred speech, incoordination, unsteady gait, nystagmus, impaired attention/memory, stupor, or coma.

What are priorities in acute alcohol intoxication care?

ABC assessment, oxygen if needed, hydration/electrolyte correction, vitamins, antiemetics, and sedation only if essential.

Why is alcohol withdrawal a major safety priority?

It can be life-threatening and requires early recognition and planning.

What are mild alcohol withdrawal symptoms?

Elevated vital signs, sweats, fine hand tremor, anxiety, irritability, restlessness, nausea/vomiting, and headache.

What are severe alcohol withdrawal symptoms?

Seizures, delirium, and hallucinosis.

What does CIWA-Ar assess?

Severity of alcohol withdrawal.

How are CIWA-Ar scores interpreted in the slides?

0–9 absent/minimal; 10–19 mild/moderate; greater than 20 severe.

When can alcohol withdrawal delirium occur?

Typically 3–8 days after alcohol cessation.

What are the goals of alcohol withdrawal treatment?

Safe, comfortable detoxification and increased motivation for abstinence and recovery.

What is Wernicke encephalopathy caused by?

Thiamine deficiency associated with chronic alcohol use, poor nutrition, and impaired absorption.

What are signs of Wernicke encephalopathy?

Confusion/altered mental status, ataxia, and oculomotor dysfunction/nystagmus.

What can untreated Wernicke encephalopathy lead to?

Korsakoff syndrome, a chronic and often irreversible memory disorder.

What does FASD include?

Fetal alcohol syndrome, ARND, ARBDs, and ND-PAE.

Is there a safe amount or trimester for alcohol use during pregnancy?

No. The slides state no safe amount and no safe trimester.

What are three facial features associated with FASD?

Short palpebral fissures, thin upper lip, and smooth philtrum.

What can neonatal meconium FAEE testing detect?

Alcohol exposure during the second or third trimester.

What are possible Fetal Alcohol ASD developmental effects?

Growth, motor, cognitive/learning, behavioral, speech/language, and sensory problems.

What are examples of illicit stimulants?

Methamphetamine, cocaine, and crack.

What are examples of prescription stimulants?

Amphetamine (Adderall), methylphenidates (Ritalin/Concerta), bupropion, and modafinil.

How do stimulants affect the mesolimbic pathway?

Directly stimulate dopamine neurons, increasing dopamine and rapid firing.

Which substances may not appear on standard urine drug screens?

MDMA and methylphenidate.

What can standard stimulant urine drug screens detect?

Amphetamines, methamphetamine, and cocaine via benzoylecgonine.

What is the amphetamine urine detection window listed?

1–3 days, up to 4 days.

How long can hair testing detect stimulants?

Up to 90 days.

What are physiologic signs of stimulant intoxication?

Tachycardia, dilated pupils, diaphoresis, nausea, tremor, dyskinesias, appetite suppression, and weight loss.

What are behavioral or psychiatric signs of stimulant intoxication?

Restlessness, agitation, repetitive behaviors, anxiety, panic, suspiciousness, paranoia, grandiosity, and impaired judgment.

What serious events should be monitored for during stimulant intoxication?

Cardiovascular or cerebrovascular events, including MI and stroke.

What are stimulant withdrawal symptoms?

Anxiety, anhedonia, depression, irritability, pain, tremors, chills, and involuntary muscle movements.

How long do most stimulant withdrawal symptoms last?

Usually mild and resolve within 1–2 weeks without medical treatment.

What is the 'crash' during stimulant withdrawal?

Early withdrawal with slowed movement, depression, and possible suicidal thoughts.

What caution applies to long-acting stimulants used for stimulant use disorder?

Risk of misuse/diversion; tight monitoring and limited dispensing are needed.

What is THC’s action at cannabinoid receptors?

THC is psychoactive and a partial agonist at CB1 and CB2 receptors.

What happens when CB1 receptors are activated?

Dopamine release increases in the mesolimbic reward pathway.

What does the lecture say about CB2 receptors?

Their role is not well understood; they appear related to immune functioning.

How is CBD (weed) described in the slides?

Not considered psychoactive; may modulate other systems and have anxiolytic/anticonvulsant properties.

What are potential risks associated with chronic/severe cannabis use?

Psychosis, hyperemesis, insomnia, and anxiety.

What factors increase risk of psychosis in cannabis users?

Adolescent onset, frequent/long-term use, psychotic-like experiences, family history, and prior cannabis-induced psychosis.

What are common cannabis intoxication symptoms?

Impaired judgment/coordination, slowed-time sensation, euphoria, anxiety, psychosis, red eyes, dry mouth, tachycardia, increased appetite.

What is cannabinoid hyperemesis syndrome (CHS)?

Chronic cannabis use causing recurrent nausea, vomiting, and abdominal pain.

What behavior can provide a diagnostic clue for CHS?

Hot baths or showers that provide immediate, short-term relief.

What is the definitive treatment for Cannabinoid Hyperemesis Syndrome?

Complete cannabis cessation; symptoms resolve only with abstinence.

What are cannabis withdrawal symptoms?

Irritability, anger, anxiety, restlessness, depressed mood, abdominal pain, appetite/weight loss, sweating, fever, chills, sleep difficulty, tremors, and headache.

What are the three nicotine product forms listed?

Combustible, buccal/mucosal, and electronic nicotine delivery systems (ENDS).

What are ENDS?

Electronic nicotine delivery systems, also called vaping products or e-cigarettes.

Why should nurses screen specifically for vaping?

Teens may not identify ENDS use as smoking.

What safety teaching is important for liquid nicotine?

Teach parents safe storage and the risk of accidental poisoning in young children.

How does nicotine affect reward pathways?

Acts on nicotinic cholinergic receptors and activates dopamine in multiple regions, reinforcing use.

What should nurses assess when evaluating nicotine use disorder?

Withdrawal, cravings, health consequences, and time/resources spent using.

What questions are included in the Fagerström assessment examples?

Time to first cigarette after waking, nighttime smoking, and cigarettes per day.