ABPN Addiction Psychiatry flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Mesolimbic dopamine pathway

The ventral tegmental area-to-nucleus accumbens projection is central to acute drug reward and is modulated by glutamatergic and GABAergic inputs.

Allostasis in addiction

Repeated drug use shifts reward set-points downward and recruits stress systems, so escalating use is needed to restore homeostasis and withdrawal drives continued use.

Heritability of alcohol use disorder

Twin and family studies estimate heritability near 50%; risk is polygenic and shaped by gene-environment interaction rather than a single gene.

Pharmacodynamic tolerance

Repeated exposure causes receptor desensitization or downregulation, reducing response at a given drug concentration; this underlies escalating doses in opioid and alcohol use disorders.

Pharmacokinetic tolerance

Repeated exposure induces metabolic enzymes, such as CYP2E1 by ethanol, lowering drug concentrations; this can increase clearance of co-administered drugs and alter withdrawal risk.

Opponent-process withdrawal

Withdrawal signs often mirror the opposite of acute drug effects, such as hyperalgesia and autonomic arousal after opioids, reflecting compensatory adaptation in stress and reward circuits.

Buprenorphine receptor activity

Buprenorphine is a high-affinity mu-opioid partial agonist; it produces submaximal effects, reduces craving, and can precipitate withdrawal by displacing full agonists.

CYP3A4 methadone interaction

Methadone is a CYP3A4 substrate; inhibitors such as ketoconazole raise levels and risk QT prolongation, while inducers such as rifampin lower levels and can precipitate withdrawal.

DSM-5 SUD severity

Eleven criteria yield mild with 2-3, moderate with 4-5, and severe with 6 or more; tolerance and withdrawal are excluded when they reflect appropriate prescribed use.

DSM-5 craving criterion

Craving was added as a criterion in DSM-5, replacing recurrent legal problems; it reflects a strong desire or urge to use the substance.

AUDIT-C cutoffs

Three alcohol screening items; a score of 4 or more in men or 3 or more in women is positive, though cutoffs may be lowered in older adults.

CAGE questionnaire

Four yes/no items about cutting down, annoyance, guilt, and eye-opener; two or more affirmative answers suggest alcohol problems but sensitivity varies by setting and population.

CIWA-Ar thresholds

The 10-item alcohol withdrawal scale guides benzodiazepine dosing; scores of 8-15 indicate moderate withdrawal and scores above 15 indicate severe withdrawal requiring aggressive treatment.

COWS opioid withdrawal

The Clinical Opiate Withdrawal Scale quantifies 11 signs; scores of 13-24 indicate moderate withdrawal, and buprenorphine initiation is typically timed to mild-to-moderate withdrawal.

Urine cocaine detection

Cocaine metabolite benzoylecgonine is typically detectable for 2-4 days after use, longer in chronic heavy users; it is not detectable for weeks like chronic cannabis.

Substance-induced disorder

Symptoms arise during or soon after intoxication or withdrawal and resolve with abstinence; an independent disorder is diagnosed when symptoms predate use or persist beyond expected windows.

Naltrexone for alcohol use disorder

An opioid antagonist that reduces heavy drinking and craving; it requires opioid-free status for 7-10 days and is contraindicated in acute hepatitis or liver failure.

Acamprosate mechanism

Acamprosate modulates glutamatergic NMDA receptors and is dosed 666 mg three times daily; it supports abstinence and is preferred when liver disease limits naltrexone.

Disulfiram use requirement

Disulfiram inhibits aldehyde dehydrogenase, causing aversive flushing and hypotension with alcohol; it is effective only with supervised adherence and requires abstinence and normal liver function.

Buprenorphine initiation rule

Start buprenorphine when mild-to-moderate opioid withdrawal is present to avoid precipitated withdrawal; the first dose is followed by observation and titration, often with a naloxone combination product.

Methadone in pregnancy

Methadone or buprenorphine maintenance is preferred for opioid use disorder in pregnancy; supervised dosing reduces illicit opioid use and improves prenatal care and neonatal outcomes.

Naloxone overdose reversal

Naloxone is a short-acting opioid antagonist that reverses respiratory depression; repeat doses may be needed because its duration is shorter than many opioids, and ventilation support is essential.

Contingency management evidence

Providing tangible, escalating rewards for verified abstinence is the most effective psychosocial treatment for stimulant use disorder and improves outcomes in other substance use disorders.

Benzodiazepine taper rate

For dependence, a gradual taper often reduces the dose by 10-25% every 2-4 weeks; abrupt cessation risks seizures, and slower tapers suit long-term users.

OUD treatment in pregnancy

Methadone or buprenorphine maintenance is standard; medically supervised withdrawal is not recommended because relapse risk outweighs fetal benefit, and neonatal opioid withdrawal should be anticipated.

Acamprosate renal contraindication

Acamprosate is contraindicated when creatinine clearance is below 30 mL/min; dose reduction is needed for moderate renal impairment, and it is generally safer than naltrexone in liver disease.

Alcohol use in older adults

Lower body water and reduced hepatic metabolism raise blood alcohol levels; screening cutoffs may be lower, and alcohol interacts with benzodiazepines, opioids, and anticoagulants.

Integrated dual diagnosis care

Treating substance use and psychiatric disorders in the same setting improves engagement and outcomes; sequential or parallel models are less effective for co-occurring severe mental illness.

Adolescent SUD treatment

Family-based therapies, motivational enhancement, and contingency management are first-line; medications may be used for opioid or alcohol use disorder, with buprenorphine approved for ages 16 and older.

Liver disease medication choice

Acamprosate is preferred over naltrexone in advanced liver disease; disulfiram is contraindicated, and naltrexone should be avoided in acute hepatitis or hepatic failure.

SBIRT model

Screening, Brief Intervention, and Referral to Treatment identifies risky substance use in medical settings; brief motivational interventions suit mild risk, while dependence requires specialty referral and medication.

Medication for OUD access

Buprenorphine can be prescribed in primary care without a special waiver after 2023; methadone remains dispensed through opioid treatment programs, and telehealth improves retention.