SUBSTANCE USE, ADDICTION/IMPULSE CONTROL DISORDER

 

 

In this Blog, you will have the opportunity to 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.


o
o Alcohol Use Disorder
 Naltrexone

• 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.
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

Understanding Alcohol Use Disorder

Alcohol Use Disorder (AUD) is a complex chronic condition characterized by persistent or recurrent problematic alcohol use leading to impairment or distress. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines specific criteria for diagnosing AUD, including:

  • Impaired control (e.g., drinking more or longer than intended, unsuccessful attempts to cut down or quit)
  • Social impairment (e.g., failure to fulfill major role obligations, continued use despite social problems)
  • Risky use (e.g., drinking and driving, drinking despite physical problems)
  • Tolerance and withdrawal (physiological adaptations requiring increased amounts of alcohol to achieve the desired effect and experiencing withdrawal symptoms when alcohol use decreases)

Alcohol: The Substance

Alcohol, or ethanol, is a central nervous system depressant derived from the fermentation of grains, fruits, or other substances containing sugar. It’s widely available and socially accepted, making it one of the most commonly abused substances.

Street Names: While alcohol itself doesn’t have specific street names, alcoholic beverages often do. For example, beer might be referred to as “brew,” “hops,” or “sudz,” while liquor might be called “spirits,” “booze,” or “hard stuff.”

Methods of Use: Alcohol is typically consumed orally in various forms, including beer, wine, and spirits.

Symptoms of Intoxication: The effects of alcohol depend on the amount consumed, individual tolerance, and other factors. Common symptoms of intoxication include:

  • Impaired judgment and coordination
  • Slurred speech
  • Euphoria
  • Aggression
  • Blackouts
  • Nausea and vomiting

Symptoms of Withdrawal: Alcohol withdrawal can range from mild to severe and can include:

  • Tremors
  • Anxiety
  • Insomnia
  • Sweating
  • Nausea and vomiting
  • Seizures
  • Delirium tremens (in severe cases)

Treatment of Alcohol Use Disorder

A comprehensive treatment approach for AUD typically includes a combination of pharmacotherapy, psychotherapy, and psychosocial support.

First-Line Treatment Options

  • Psychotherapy: Cognitive-behavioral therapy (CBT), motivational enhancement therapy (MET), and support groups (e.g., Alcoholics Anonymous) are effective in addressing underlying psychological factors and coping skills.
  • Medication: Pharmacotherapy can be a valuable adjunct to psychotherapy, reducing cravings and relapse risk.

Naltrexone: A Closer Look

Naltrexone is an opioid receptor antagonist FDA-approved for the treatment of AUD. It works by blocking the reinforcing effects of alcohol, reducing cravings and the likelihood of heavy drinking.

  • Mechanism of Action: Naltrexone blocks opioid receptors in the brain, preventing the release of dopamine associated with alcohol consumption. This reduces the pleasurable effects of alcohol, making it less rewarding.
  • Common Side Effects: Nausea, headache, and insomnia are common side effects. Liver enzyme elevations have been reported but are usually transient.
  • Administration: Naltrexone is available in oral and injectable formulations. The oral form is taken daily, while the injectable form (Vivitrol) provides a longer-acting effect with a single monthly injection.
  • Monitoring: Baseline liver function tests are recommended before initiating treatment, with periodic monitoring thereafter. Blood pressure and heart rate should also be monitored.

Non-Pharmacologic Interventions

  • Psychotherapy: As mentioned earlier, CBT and MET are essential components of treatment.
  • Support Groups: Participation in support groups like Alcoholics Anonymous can provide social support and coping strategies.
  • Lifestyle Modifications: Addressing stress management, nutrition, and exercise can contribute to overall well-being and reduce the risk of relapse.

Note: It’s important to emphasize that naltrexone is most effective when combined with psychotherapy and other supportive measures. Individualized treatment plans should be tailored to the specific needs of each patient.

 

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