Foundations of Addiction
DSM-5 eliminated the distinction between "substance abuse" and "substance dependence." Into what single diagnostic category were these conditions merged?
What is Substance Use Disorder (Addiction and Related Disorders)?
These are the three FDA-approved medications for Alcohol Use Disorder (AUD).
What are naltrexone, acamprosate, and disulfiram?
A 35-year-old man enrolled in an outpatient medication-assisted treatment program asks why he has to provide urine samples at nearly every visit.
What is the primary purpose of routine toxicology testing in substance use disorder treatment?
What is monitoring treatment progress while meeting state and federal prescribing guidelines?
A 29-year-old man with opioid use disorder tells you, "I've been on buprenorphine for six months. Do I still need to see a therapist? The medication is working."
What is your next move?
What is continuing medication while encouraging behavioral interventions as part of whole-person treatment?
A patient says, "If I'm not ready to quit using completely, there's no reason for me to come to clinic."
What is your response?
What is offering harm reduction strategies to reduce the risks associated with ongoing substance use?
According to the primer, addiction is characterized by three hallmark features beyond continued substance use
What are loss of control over intake, compulsive drug seeking despite adverse consequences, and the emergence of a negative emotional state during abstinence
This medication for Alcohol Use Disorder works by blocking opioid receptors, reducing alcohol craving and the rewarding effects of drinking.
What is naltrexone?
A patient's urine immunoassay is negative for opioids, but he reports heroin use yesterday and has physical exam findings consistent with opioid intoxication.
What is the next best step?
What is confirmatory gas chromatography–mass spectrometry (GC-MS) testing?
A patient tells you, "I know I should quit drinking, but I just don't think I'm ready."
Rather than confronting the patient, which counseling strategy would best help explore their ambivalence and strengthen their own motivation for change?
What is Motivational Enhancement Therapy using motivational interviewing?
A patient with opioid use disorder asks what services a harm reduction program might provide besides education.
Name two examples
What are syringe/needle exchange programs, naloxone rescue kit distribution and overdose education, supervised use sites, safer injection education, or encouraging designated drivers?
The neurobiology of addiction is commonly divided into these three sequential stages.
What are Binge/Intoxication, Withdrawal/Negative Affect, and Preoccupation/Anticipation (Craving)?
This medication is often preferred in patients with advanced liver disease because it is excreted unchanged by the kidneys.
What is acamprosate?
A patient receiving chronic hemodialysis is unable to produce a urine specimen for routine toxicology screening.
Which testing method should be used?
What is blood toxicology testing?
A patient in recovery continues arriving at appointments and providing negative urine drug screens. Your clinic wants to reward these positive behaviors using vouchers or prizes.
What behavioral intervention is being used?
What is Contingency Management (Voucher-Based Reinforcement)?
A patient with opioid use disorder has remained abstinent for several months but continues to struggle with depression and anxiety.
What is your next move?
What is evaluating and treating the co-occurring psychiatric disorder rather than focusing only on the substance use disorder?
During the binge-intoxication phase of addiction, supraphysiologic dopamine release primarily occurs in this brain structure.
What is the nucleus accumbens within the basal ganglia?
This medication's partial agonism at the μ-opioid receptor produces a ceiling effect on respiratory depression, contributing to its improved safety profile compared with methadone.
What is buprenorphine?
Your clinic is considering replacing urine drug screening with oral fluid testing.
What is one major advantage of oral fluid testing
What is allowing observed specimen collection without the privacy concerns associated with observed urine collection?
A patient with long-term non-prescribed alprazolam use is ready to stop taking benzodiazepines.
What is the recommended first step in developing a taper?
What is transitioning the patient to an equivalent dose of a longer-acting benzodiazepine?
A patient says, "I've stopped using drugs, so I don't understand why everyone keeps asking about my housing, employment, and family."
What is the rationale for addressing these issues?
What is treating the whole person, including the physical, social, emotional, and spiritual aspects of recovery?
Name two neurochemical changes that occur during the withdrawal-negative affect stage of addiction.
What are increased corticotropin-releasing factor (CRF) activity in the extended amygdala and decreased dopamine and GABA activity in the nucleus accumbens?
This FDA-approved medication for Opioid Use Disorder is a full μ-opioid receptor agonist, has no ceiling dose, reaches steady state in approximately 5–7 days, and may only be dispensed outside the hospital through a certified Opioid Treatment Program.
What is methadone?
A patient's urine drug screen is unexpectedly positive despite denying any recent substance use.
Before concluding the patient relapsed, what two major factors should always be considered when interpreting toxicology results?
What are the drug's detection window and the possibility of false-positive or false-negative results?
A patient with alcohol use disorder reports a depressed mood that began shortly after heavy drinking started. You are unsure whether this represents major depressive disorder or a substance-induced mood disorder.
What is your next move?
What is continuing treatment and reassessment after a sustained period of abstinence before diagnosing an independent psychiatric disorder?
A patient says, "I relapsed after eight months. I guess treatment didn't work."
What is the most appropriate response?
What is re-engaging the patient in treatment and reassessing the treatment plan rather than viewing relapse as treatment failure?