ABPN Addiction Psychiatry key terms

Circuit from the ventral tegmental area to the nucleus accumbens and frontal cortex that tags rewards as worth pursuing. Most addictive drugs raise dopamine transmission here, which helps explain drug-reinforced learning and repeated use.

Dopamine-receptive region of the ventral striatum that converts reward signals into motivated approach. It mediates drug seeking triggered by cues and is a key site for reinstatement of use after abstinence.

The motivational pull that drug-paired cues acquire, making them wanted and attention-grabbing. Sensitization of this process, which is distinct from liking, helps explain craving and relapse long after the drug's pleasure fades.

A diminished response to a drug after repeated exposure, so that higher doses are needed for the original effect. It may be metabolic or cellular and develops at different rates for different drug effects.

Tolerance built against one drug that extends to another acting on the same receptor system, as between alcohol and benzodiazepines. Clinically it explains shared withdrawal risk and dangerous combined sedation.

The finding that repeated withdrawal episodes become progressively more severe, with lowering of the seizure threshold in alcohol and sedative dependence. It argues for treating every withdrawal episode and for preventing relapse.

An explanation of compulsive use as escape from aversive withdrawal or stress states rather than pursuit of pleasure. It centers on the extended amygdala and stress peptides such as corticotropin-releasing factor.

Autonomic, emotional, and craving responses provoked by people, places, or objects previously paired with drug use. It predicts relapse and is targeted by cue-exposure and relapse-prevention techniques.

A drug that binds a receptor and activates it less than a full agonist, producing a ceiling on effect. Examples include buprenorphine at mu-opioid receptors and varenicline at nicotinic receptors.

Stress neuropeptide circuitry of the extended amygdala that is recruited during chronic drug exposure and withdrawal, contributing to anxiety, dysphoria, and stress-induced relapse.

Liver enzyme system that metabolizes many psychotropics; inducers such as rifampin lower methadone levels and can trigger withdrawal, while inhibitors such as ritonavir raise levels and risk toxicity.

A set of eleven symptoms grouped into impaired control, social impairment, risky use, and pharmacological criteria; two or more within twelve months indicate a disorder, and counts of two to three, four to five, or six or more define mild, moderate, or severe.

An intense desire or urge to use a substance. It is one of the DSM-5 criteria, often persists after physical withdrawal resolves, and predicts relapse; anticraving medications and coping skills target it.

Four yes-no questions about cutting down, annoyance at criticism, guilt, and morning use. It is quick but poorly sensitive for mild or hazardous drinking, so broader screens are preferred.

A three-item alcohol screen covering drinking frequency, typical quantity, and heavy episodic use, scored from 0 to 12. It detects hazardous drinking in primary care and is more sensitive than CAGE for lower levels of use.

A ten-item clinician-rated scale measuring alcohol withdrawal severity, including tremor, sweating, agitation, and perceptual disturbance. Scores guide symptom-triggered benzodiazepine dosing and help determine the appropriate level of care.

An eleven-item clinician-rated scale that scores opioid withdrawal signs and symptoms. It confirms physical dependence, guides the timing of buprenorphine induction, and documents response during withdrawal management.

Immunoassay screening of urine for drug classes is fast and inexpensive but prone to cross-reactivity. Unexpected or consequential results should be confirmed with chromatography-mass spectrometry, and patients should be told results may affect treatment.

Separating psychiatric symptoms caused by intoxication or withdrawal from a primary mental disorder requires reassessment after sustained abstinence, since withdrawal can mimic depression, anxiety, and psychosis.

Screening, Brief Intervention, and Referral to Treatment: a public-health model that screens all patients, gives short motivational feedback to those with risky use, and refers people with more severe disorders to specialty care.

An opioid antagonist taken orally or as a long-acting injection. It reduces alcohol's rewarding effects and blocks opioids; patients must be opioid-free to avoid precipitated withdrawal, and it can help treat opioid use disorder.

A medication that promotes abstinence in alcohol use disorder, thought to stabilize glutamatergic signaling during recovery. Taken three times daily, it requires dose adjustment in renal impairment and does not interact with alcohol.

An aversive agent that blocks aldehyde dehydrogenase, so any alcohol produces flushing, nausea, and hypotension. It works best with supervised dosing, motivated patients, and no contraindicated cardiac disease.

A partial mu-opioid agonist with high receptor affinity used for opioid use disorder. It suppresses withdrawal and craving with a ceiling on respiratory depression; because it can precipitate withdrawal, induction waits until mild withdrawal is present.

A full mu-opioid agonist used in federally regulated opioid treatment programs. Its long half-life controls withdrawal and craving without euphoria; QT prolongation and drug interactions require monitoring, and supervised dosing reduces diversion risk.

A partial nicotinic acetylcholine receptor agonist used for smoking cessation. It reduces craving and blunts the reward from cigarettes; nausea is common, and monitoring for neuropsychiatric symptoms is advised although serious risk was not confirmed.

A short-acting opioid antagonist that reverses overdose respiratory depression within minutes. It is dispensed to laypeople and first responders; because it wears off before many opioids, continued monitoring and repeat dosing are needed.

A collaborative, directive counseling style that strengthens a patient's own reasons for change while avoiding argument and confrontation. It is brief, evidence-based, and well suited to ambivalent patients in medical settings.

An intervention that provides tangible, verifiable rewards for biologically confirmed abstinence or treatment attendance. It is among the most effective treatments for stimulant use disorder and has strong evidence in opioid treatment programs.

A cognitive-behavioral approach that teaches patients to anticipate high-risk situations, manage craving and lapses, and restructure maladaptive beliefs about use, treating a small slip as a learning event rather than failure.

The presence of a substance use disorder together with another psychiatric condition in the same person. Both must be assessed and addressed; neither is reliably primary, and untreated symptoms in either worsen outcomes.

Care in which mental health and substance use services are delivered by one team in one setting with a single care plan. It improves engagement and outcomes compared with sequential or parallel treatment for co-occurring disorders.

Standardized dimensional assessment covering withdrawal risk, medical and psychiatric status, readiness, relapse potential, and recovery environment. It is used to match patients in the United States to appropriate levels of care.

A United States federal rule giving special confidentiality protection to records of federally assisted substance use disorder treatment. It generally requires written patient consent before disclosure and is stricter than HIPAA.

A state-run database of controlled-substance prescriptions that clinicians can query before prescribing opioids or benzodiazepines. It reveals overlapping prescriptions and multiple prescribers, supporting safer prescribing and identifying possible misuse.

A withdrawal syndrome in infants exposed to opioids in utero, marked by irritability, tremor, feeding difficulty, and autonomic signs. Treatment involves supportive care, standardized scoring, and sometimes opioid replacement such as morphine.

A United States law requiring group health plans that cover mental health and addiction care to apply financial requirements and treatment limits no more restrictively than they do for medical and surgical care.

Policies and services that reduce the harms of drug use without requiring abstinence, such as naloxone distribution, syringe services, and fentanyl test strips. It complements treatment and improves engagement and overdose survival.