Substance Use Jeapordy

Drug effects

100

True or false? Alcohol increases REM and deep sleep by increasing drowsiness. 

False - alcohol helps people fall asleep, but they have worse sleep quality

200

THC, the active ingredient in cannabis, activates brain receptors that increase hunger signals, especially in the hypothalamus, leading to this famous side effect.

Munchies/Increased appetite

300

This uncomfortable effect of opioids is often mistaken for an allergic reaction, but it actually happens because opioids trigger histamine release in the skin.

Itching

400

Name at least one drug that can appear to make time pass slowly.

Acceptable answers: Cannabis, LSD, Psyilocybin, Mescaline, DMT, Ketamine, PCP, DXM, Nitrous Oxide, MDMA, Salvia

500

You screen two research participants, who you hope to recruit for your study on a well-known drug. During screening, both report their most recent use.

Participant A felt the effects within a couple of seconds. They felt a strong euphoria and experienced racing thoughts for about 5-10 minutes. Afterwards they felt an abrupt "crash" where they experienced low mood.

Participant B felt the effects within a couple of minutes. They felt euphoric, alert, and talkative for about 20-30 minutes. Afterwards, they noticed a gradual onset of irritability and depression. 

 
How could this be? And what drug did they use?

They used cocaine through different routes

Withdrawal

100

True or False? Cannabis (marijuana) does not produce any withdrawal effects.

False. Some examples: Irritability, anger, or aggression, Nervousness or anxiety, sleep difficulty, decreased appetite or weight loss, restlessness, depressed mood, restlessness, depressed mood, At least one of the following physical symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache.

200

Name a medication that can be used to treat opioid use disorder, that stops withdrawal symptoms.

Acceptable answers: Methadone, buprenorphine

300

Name at least one of three drug classes where withdrawal can be life-threatening due to the withdrawal process itself, rather than secondary complicataions.

Acceptable: Alcohol, Barbiturates, Benzodiazepines

400

True or false? After acute physical withdrawal symptoms fade, symptoms such as low mood, anhedonia, anxiety, and insomnia can persist for months after cessation of use. 

True - this is called post-acute withdrawal syndrome or protracted withdrawal, and occurs for several drug classes. 

500

This commonly used substance has the following withdrawal symptoms in the DSM-5-TR: 1) Headache, 2) Marked fatigue or drowsiness, 3) Depressed mood or irritability, 4) Difficulty concentrating, 5) Flu-like symptoms such as nausea or vomitting

Caffeine

Substance use disorders

100

In the DSM-5-TR, most hallucinogen-related use disorders are grouped under the umbrella of “Hallucinogen Use Disorder.” However, one hallucinogen is classified in its own separate category. Which hallucinogen is the exception?

a- MDMA

b- DMT 

c- Salvia

d- PCP

d- PCP (and PCP-like substances)

200

Which of the following is NOT a symptom of tobacco use disorder in the DSM-5-TR?

a - Tobacco is often taken in larger amounts or over a longer period than was intended.

b- Brief, involuntary gestures such as reaching for a cigarette or mimicking puffing movements during periods of stress or concentration, even when no cigarette is present.

c- A great deal of time is spent in activities necessary to obtain or use tobacco.

d- Recurrent tobacco use in situations in which it is physically hazardous (e.g., smoking in bed).

B - Brief, involuntary gestures such as reaching for a cigarette or mimicking puffing movements during periods of stress or concentration, even when no cigarette is present.

300

A symptom of every substance use disorder in the DSM-5-TR, and is described a strong urge to use the drug.

Craving

400

This is the only non-substance addiction currently recognized in the DSM-5-TR.

Gambling disorder. 

500

A 48 year-old patient completes an intake at your clinic. During their intake, they report using cannabis daily, and do not have a medical prescription. They live in a state where cannabis is illegal and their employer has a "drug free workplace" policy. They have used the same amount (a couple of puffs on a vape pen) each night for the last five years. Their use occurs right before bed, and never before driving or operating machinery. They aren't concerned about their use and don't crave cannabis during the day. They are married with three children, and work as an IT specialist. They report things are going well at work and home. They have a history of a major depressive episode in college, but no additional treatment. They have hypothyroidism and chronic hepatitis B (stable on antiviral therapy). Two years ago, they were hospitalized for a staph infection. They stopped using cannabis for a month while they were visiting family abroad and unable to access cannabis. During that time, they noticed that they had strange, vivid dreams and a harder time falling asleep, but no other changes.

Part A (250 points): Based on this information, do you suspect that they might meet DSM-5-TR criteria for a substance use disorder?

Part B (250 points): Name one follow-up question you would ask ?

Part A: No (but they do report some withdrawal symptoms, and the potential social risks should be assessed in more detail)

Part B: Multiple answers accepted.

Co-occurring disorders

100

True or false? The majority of people with a substance use disorder have another mental health or substance use disorder.

True

200

This mental health condition, often triggered by trauma, frequently co-occurs with substance use disorders (especially opioid use disorder, sedative use disorder, and alcohol use disorder), and often requires additional treatment.

Post-traumatic stress disorder

300

What substance use disorder most commonly co-occurs with other mental health or substance use disorders?

Nicotine/tobacco use disorder

400

This type of care combines mental health and substance use treatment in one setting.

Integrated treatment

500

You are treating a patient who is undergoing medically managed withdrawal for opioid use disorder. Ever since their intake two weeks ago, they have reported persistent low mood, low motivation, and trouble sleeping. You diagnose them with a major depressive episode. Your supervisor suggests that you should be cautious about making this diagnosis. Why might they make this suggestion?

Opioid withdrawal can include symptoms that mirror depression. 

Name that drug!

100

Certain goats and birds in South America have been observed chewing coca leaves, which are used to make this stimulant drug. 

Cocaine

200

This opioid is 50–100 times stronger than morphine and is a major contributor to overdose deaths in the U.S.

Fentanyl

300

A 22-year-old college student is brought to the emergency room after being found wandering outside on a cold night without a coat. She’s disoriented and has slurred speech. Her body temperature is low, and she reports that she doesn’t remember how she got there. Her eyes are darting back and forth and she is showing signs of dehydration. What substance most likely caused these effects?

Alcohol

400

Desoxyn is a legal drug that is prescribed for ADHD symptoms and obesity. However, it is rarely prescribed in practice due to stigma, availability of safer options, and misuse potential. It is the same chemical compound as this illicit drug (it differs in dosage and having regulated composition).

Methamphetamine

500

This drug is sometimes classified as a psychedelic (including in the DSM) but it's chemical structure is closer to amphetamine.

MDMA