Specific substance use and/or addiction/impulse control disorder.

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Teach your peers about a specific substance use and/or addiction/impulse control disorder. A Blog is a conversational, informal written piece on a topic. Your faculty will assign you a particular illness and the approved treatment for the illness to create a presentation to share with your peers.
Construct a Blog post, not to exceed 1,500–2,000 words, written for a PMHNP provider audience to post in the Discussion area.
Although you are not required to respond to colleagues, collegial discussion is welcome. Also, it will be important for you to read your peers’ Blog posts in order to learn about all of the medications on the assigned list.
You will be assigned from the following list:
• Opioid Use Disorder
o Vivitrol
o Suboxone
o Methadone
o Lofexidine
• Alcohol Use Disorder
o Acamprosate
o Naltrexone
o Disulfiram
o Phenobarbital (seizure control due to alcohol withdrawal)
o Chlordiazepoxide
• Cannabis Use Disorder
o Nefazodone*
o Fluoxetine*
o Gabapentin*
o Buspirone*
• Stimulant Use Disorder (cocaine, methamphetamine)
o Antipsychotic Medications*
o Combination Injectable Naltrexone*
o Bupropion*
o Gabapentin*
• Tobacco Use Disorder
o Nicotine replacement patch
o Nicotine replacement gum
o Nicotine replacement inhaler
o Zyban
• Sedative/Hypnotic Anxiolytic Use Disorder
o Gabapentin*
o Buspirone*
o Flumazenil*
o Trazodone*
• Binge Eating Disorder (BED)
o Lisdexamphetamine
*Indicates not FDA approved.

Post your Blog response by doing the following:
• Identify the substance or addiction with discussion on pertinent diagnostic criteria for the use disorder.
• Identify the street names of the substance for the use disorder.
• Describe how someone can use or abuse the substance (oral, smoke, IV, etc.).
• Describe the symptoms of someone under the influence of this substance.
• Describe the symptoms of someone under the withdrawal of this substance.
After describing the substance, discuss the treatment recommendations by doing the following:
• Identify the first-line treatment options.
• Identify the FDA-approved medications for the substance.
Note: If there are no FDA-approved medications, describe any evidenced-based, clinically acceptable off-label medications to treat the illness.
• Identify the proposed mechanisms of action for the medication to treat the illness.
• Describe the common side effects of the medication.
• Describe how the patient should take the medication.
• Identify any baseline and/or ongoing tests and assessment(s) needed when taking the medication.
• Describe the non-pharmacologic intervention recommendations.

Sample Solution

Stimulant use disorder (SUD) is a complex and chronic condition characterized by the uncontrolled use of stimulant drugs, despite negative consequences. Stimulants are a class of drugs that increase alertness, focus, and energy. Common stimulants include cocaine, methamphetamine (meth), and amphetamines (Adderall, Ritalin).

Diagnostic Criteria for Stimulant Use Disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines the criteria for diagnosing stimulant SUD. Key criteria include:

  • Impaired Control: Repeated use of the stimulant in larger amounts or for longer than intended.
  • Social and Occupational Problems: Continued stimulant use despite causing problems at work, school, or in relationships.
  • Risky Use: Using stimulants in dangerous situations, like driving under the influence.
  • Tolerance: Needing to use increasingly larger amounts of the stimulant to get the same effect (tolerance).
  • Withdrawal Symptoms: Experiencing withdrawal symptoms when you stop using the stimulant (withdrawal).
  • Cravings: Strong urges or cravings to use the stimulant.
  • Time Spent: Spending a significant amount of time obtaining, using, or recovering from the effects of the stimulant.
  • Reduced Activities: Giving up important social, recreational, or occupational activities because of stimulant use.

Street Names for Stimulants

Stimulants have various street names, depending on the specific drug and its form. Here are some common examples:

  • Cocaine: Coke, blow, snow, rock
  • Methamphetamine: Meth, ice, crystal
  • Amphetamines: Uppers, speed, beans

Routes of Administration

Stimulants can be used in various ways, impacting their effects and withdrawal symptoms:

  • Snorting: The most common method for cocaine and crushed meth.
  • Smoking: Crack cocaine (a rock form of cocaine) is typically smoked.
  • Injection: Intravenous injection delivers a fast and intense high for both cocaine and meth.
  • Oral Ingestion: Less common, but stimulants can be swallowed in pill form or crushed and ingested.

Symptoms of Stimulant Intoxication

When someone is under the influence of stimulants, they may exhibit some of the following symptoms:

  • Increased energy and alertness
  • Talkativeness and rapid speech
  • Decreased appetite
  • Euphoria and heightened pleasure
  • Increased heart rate and blood pressure
  • Dilated pupils
  • Insomnia or difficulty sleeping
  • Irritability and aggression
  • Anxiety and paranoia
  • Psychosis (in severe cases)

Symptoms of Stimulant Withdrawal

Stopping stimulant use after prolonged use can lead to withdrawal symptoms, including:

  • Fatigue and lethargy
  • Cravings for the drug
  • Irritability and depression
  • Anxiety and dysphoria (feeling unwell)
  • Difficulty concentrating
  • Sleep disturbances (insomnia or excessive sleep)
  • Increased appetite
  • Muscle aches and tremors

Treatment Approaches for Stimulant Use Disorder

First-Line Treatment:

Stimulant use disorder requires a comprehensive treatment approach, with a combination of medication and non-pharmacological interventions. Behavioral therapy is considered the first-line treatment for stimulant use disorder. Cognitive Behavioral Therapy (CBT) is a highly effective form of therapy that helps individuals identify and change negative thought patterns and behaviors related to stimulant use.

FDA-Approved Medications:

There are currently no medications specifically FDA-approved for treating stimulant use disorder. However, some medications can be helpful in managing symptoms and reducing cravings. These include:

  • Antidepressants: Medications like bupropion (Wellbutrin) may help with symptoms of depression and anhedonia (inability to experience pleasure) that can occur during withdrawal.
  • Stimulants: In some cases, using low-dose stimulants like methylphenidate (Ritalin) can be paradoxically helpful in reducing cravings and promoting abstinence.

Proposed Mechanism of Action:

  • Bupropion: The exact mechanism for bupropion’s effectiveness in stimulant use disorder is not fully understood, but it may involve its effects on dopamine and norepinephrine reuptake in the brain.
  • Stimulants (paradoxical effect): Low-dose stimulants may work by replenishing dopamine stores depleted by chronic stimulant use, reducing cravings and the need for higher doses of the street drug.

Common Side Effects:

  • Bupropion: Dry mouth, nausea, insomnia, headache, agitation, anxiety.
  • Stimulants: Insomnia, anxiety, increased heart rate, blood pressure, and appetite.

Medication Administration:

  • Bupropion: Typically taken orally, once or twice daily.
  • Stimulants: Usually prescribed in low doses and taken under close supervision by a healthcare professional.

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