Substance use disorders

Substance use disorders US Medical PG Question 1: The prison doctor sees a 25-year-old man for some minor injuries sustained during a recent lunchroom brawl. The patient has a long history of getting into trouble. During his interview, he seems very charming and carefully deflects all responsibility to others and gets irritable and hostile once probed on the issues. He is married and has 2 young children for whom he does not pay child support. Which of the following details is most critical for diagnosing this patient’s condition?

• A. Criminal record
• B. History of substance abuse
• C. Family history
• D. Evidence of lack of remorse
• E. Childhood history (Correct Answer)

Substance use disorders Explanation: ***Childhood history*** - A diagnosis of **Antisocial Personality Disorder (ASPD)** requires evidence of **conduct disorder** symptoms beginning before age 15. The childhood history provides insight into the chronicity and developmental pattern of pervasive disregard and violation of the rights of others. - The patient's current presentation of deceitfulness, impulsivity, irritability, and irresponsibility, along with a "long history of getting into trouble," aligns with ASPD criteria, which must be contextualized by their early onset of behavioral problems. *Criminal record* - While a criminal record often accompanies ASPD, it is a consequence of the disorder rather than a diagnostic criterion in itself. Many individuals with ASPD engage in criminal behavior, but the diagnosis focuses on a broader pattern of *disregard for the rights of others*, not just legal infractions. - While it supports the pattern of antisocial behavior, it doesn't provide the crucial developmental information (onset before age 15) required for diagnosis. *History of substance abuse* - **Substance abuse** is highly comorbid with ASPD, often used as a coping mechanism or as a direct consequence of impulsive and risky behaviors. However, it is not a direct criterion for ASPD itself. - While relevant to the patient's overall clinical picture and management, it does not directly contribute to the diagnostic criteria for ASPD. *Family history* - A family history of mental health disorders, including personality disorders, can increase the risk of developing ASPD, indicating a genetic predisposition. However, it is not a diagnostic criterion. - While useful for understanding risk factors, family history does not provide specific information about the patient's individual behavioral patterns or the onset of symptoms crucial for diagnosis. *Evidence of lack of remorse* - **Lack of remorse** is an important diagnostic criterion for ASPD, demonstrating a profound deficit in empathy and moral reasoning. It's evident in the patient's deflection of responsibility. - While a critical symptom, it's one of several criteria. Without evidence of a conduct disorder in childhood, even significant interpersonal impairment and lack of remorse in adulthood may not lead to an ASPD diagnosis.

Substance use disorders US Medical PG Question 2: A 52-year-old man presents to his physician with a chief concern of not feeling well. The patient states that since yesterday he has experienced nausea, vomiting, diarrhea, general muscle cramps, a runny nose, and aches and pains in his muscles and joints. The patient has a past medical history of obesity, chronic pulmonary disease, lower back pain, and fibromyalgia. His current medications include varenicline, oxycodone, and an albuterol inhaler. The patient is requesting antibiotics and a refill on his current medications at this visit. He works at a local public school and presented with a similar chief complaint a week ago, at which time he had his prescriptions refilled. You have also seen several of his coworkers this past week and sent them home with conservative measures. Which of the following is the best next step in management?

• A. Oseltamivir
• B. Azithromycin
• C. Metronidazole
• D. Methadone
• E. Supportive therapy (Correct Answer)

Substance use disorders Explanation: ***Supportive therapy*** - The patient's symptoms (nausea, vomiting, diarrhea, myalgias, flu-like symptoms) are highly suggestive of a **viral illness**, given the recent similar presentations in his coworkers where conservative measures were sufficient. - Antibiotics are ineffective against viral infections, and the patient has no signs or symptoms indicating a bacterial infection, making **supportive care** (hydration, rest, symptomatic relief) the most appropriate management. *Oseltamivir* - This antiviral medication is primarily used for the treatment of **influenza**, typically within 48 hours of symptom onset. - While the patient's symptoms are flu-like, the timing (symptoms began yesterday, and he presented a week ago with similar complaints) and the general viral presentation among coworkers make targeted antiviral therapy less indicated without a confirmed influenza diagnosis. *Azithromycin* - **Azithromycin is an antibiotic** used to treat bacterial infections, particularly respiratory tract infections, skin infections, and some sexually transmitted infections. - There is no indication of a bacterial infection in this patient; therefore, administering an antibiotic would be inappropriate and contribute to **antibiotic resistance**. *Metronidazole* - **Metronidazole is an antibiotic** primarily used for anaerobic bacterial infections and parasitic infections (e.g., *Clostridium difficile*, *Giardia*). - The patient's symptoms do not suggest these specific types of infections, making its use unwarranted. *Methadone* - **Methadone is an opioid analgesic** and is also used in medication-assisted treatment for opioid use disorder. - Prescribing methadone for the patient's current symptoms or for **opioid pain management** without further assessment, considering his current oxycodone prescription and potential for drug-seeking behavior given his request for refills, is inappropriate and potentially harmful.

Substance use disorders US Medical PG Question 3: A mother presents to the family physician with her 16-year-old son. She explains, "There's something wrong with him doc. His grades are getting worse, he's cutting class, he's gaining weight, and his eyes are often bloodshot." Upon interviewing the patient apart from his mother, he seems withdrawn and angry at times when probed about his social history. The patient denies abuse and sexual history. What initial test should be sent to rule out the most likely culprit of this patient's behavior?

• A. Complete blood count
• B. Sexually transmitted infection (STI) testing
• C. Blood culture
• D. Urine toxicology screen (Correct Answer)
• E. Slit lamp examination

Substance use disorders Explanation: ***Urine toxicology screen*** - The patient's presentation with **declining grades**, **cutting class**, **weight gain**, **bloodshot eyes**, and **irritability** are classic signs of **substance abuse** in an adolescent. - A **urine toxicology screen** is the most appropriate initial test to detect common illicit substances, especially given the clear signs pointing towards drug use. *Slit lamp examination* - This test is used to examine the **anterior segment of the eye**, including the conjunctiva, cornea, iris, and lens. - While the patient has **bloodshot eyes**, this specific test would be more relevant for ruling out ocular infections or injuries, not for diagnosing the underlying cause of systemic behavioral changes. *Complete blood count* - A **complete blood count (CBC)** measures different components of the blood, such as red blood cells, white blood cells, and platelets. - A CBC is a general health indicator and while it can detect infections or anemia, it is not specific or sensitive enough to identify the cause of the behavioral changes described. *Sexually transmitted infection (STI) testing* - Although the patient denies sexual history, all adolescents presenting with certain risk factors or symptoms may warrant STI testing in a broader health assessment. - However, in this scenario, the primary cluster of symptoms (poor grades, cutting class, bloodshot eyes, irritability) points more directly to substance abuse than to an STI. *Blood culture* - A **blood culture** is used to detect the presence of bacteria or other microorganisms in the bloodstream, indicating a systemic infection (sepsis). - The patient's symptoms are not indicative of an acute bacterial bloodstream infection, and a blood culture would not be the initial test for the presented behavioral changes.

Substance use disorders US Medical PG Question 4: A researcher is trying to determine whether a newly discovered substance X can be useful in promoting wound healing after surgery. She conducts this study by enrolling the next 100 patients that will be undergoing this surgery and separating them into 2 groups. She decides which patient will be in which group by using a random number generator. Subsequently, she prepares 1 set of syringes with the novel substance X and 1 set of syringes with a saline control. Both of these sets of syringes are unlabeled and the substances inside cannot be distinguished. She gives the surgeon performing the surgery 1 of the syringes and does not inform him nor the patient which syringe was used. After the study is complete, she analyzes all the data that was collected and performs statistical analysis. This study most likely provides which level of evidence for use of substance X?

• A. Level 3
• B. Level 1 (Correct Answer)
• C. Level 4
• D. Level 5
• E. Level 2

Substance use disorders Explanation: ***Level 1*** - The study design described is a **randomized controlled trial (RCT)**, which is considered the **highest level of evidence (Level 1)** in the hierarchy of medical evidence. - Key features like **randomization**, **control group**, and **blinding (double-blind)** help minimize bias and strengthen the validity of the findings. *Level 2* - Level 2 evidence typically comprises **well-designed controlled trials without randomization** (non-randomized controlled trials) or **high-quality cohort studies**. - While strong, they do not possess the same level of internal validity as randomized controlled trials. *Level 3* - Level 3 evidence typically includes **case-control studies** or **cohort studies**, which are observational designs and carry a higher risk of bias compared to RCTs. - These studies generally do not involve randomization or intervention assignment by the researchers. *Level 4* - Level 4 evidence is usually derived from **case series** or **poor quality cohort and case-control studies**. - These studies provide descriptive information or investigate associations without strong control for confounding factors. *Level 5* - Level 5 evidence is the **lowest level of evidence**, consisting of **expert opinion** or **animal research/bench research**. - This level lacks human clinical data or systematic investigative rigor needed for higher evidence levels.

Substance use disorders US Medical PG Question 5: A 28-year-old man presents to the emergency department with vomiting. He states that he has experienced severe vomiting starting last night that has not been improving. He states that his symptoms improve with hot showers. The patient has presented to the emergency department with a similar complaint several times in the past as well as for intravenous drug abuse. His temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 110/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam is deferred as the patient is actively vomiting. Which of the following is associated with the most likely diagnosis?

• A. Viral gastroenteritis
• B. Marijuana use (Correct Answer)
• C. Substance withdrawal
• D. Alcohol use
• E. Toxin ingestion

Substance use disorders Explanation: ***Marijuana use*** - The patient's history of recurrent vomiting, improvement with hot showers, and a history of intravenous drug abuse are highly suggestive of **cannabinoid hyperemesis syndrome (CHS)**. **Marijuana use** is directly associated with CHS, which presents with cyclical vomiting in chronic cannabis users. - While the patient has a history of intravenous drug use, the specific pattern of recurrent vomiting relieved by hot showers points strongly towards **CHS**, which is caused by long-term cannabis use. *Viral gastroenteritis* - Although **viral gastroenteritis** can cause severe vomiting, it typically resolves within a few days and does not usually present as a recurrent issue relieved by hot showers. - This condition does not explain the patient's history of multiple similar presentations or the specific alleviating factor of hot showers. *Substance withdrawal* - While some **substance withdrawal syndromes** can cause nausea and vomiting, the characteristic relief with hot showers is not typical for withdrawal symptoms. - The patient's symptoms are more indicative of a syndrome directly linked to substance use rather than withdrawal. *Alcohol use* - **Alcohol use** can cause vomiting in episodes of acute intoxication or withdrawal; however, repeated episodes of severe vomiting relieved specifically by hot showers are not a classic presentation of alcohol-related vomiting. - There is no specific mention of alcohol abuse in the patient's history as a cause for these symptoms. *Toxin ingestion* - **Toxin ingestion** can indeed cause severe vomiting, but it would not typically be a recurring problem that improves with hot showers. - The recurrent nature and specific relieving factor point away from a one-time toxic exposure.

Substance use disorders US Medical PG Question 6: A neuro-oncology investigator has recently conducted a randomized controlled trial in which the addition of a novel alkylating agent to radiotherapy was found to prolong survival in comparison to radiotherapy alone (HR = 0.7, p < 0.01). A number of surviving participants who took the alkylating agent reported that they had experienced significant nausea from the medication. The investigator surveyed all participants in both the treatment and the control group on their nausea symptoms by self-report rated mild, moderate, or severe. The investigator subsequently compared the two treatment groups with regards to nausea level. | | Mild nausea | Moderate nausea | Severe nausea | |---|---|---|---| | Treatment group (%) | 20 | 30 | 50 | | Control group (%) | 35 | 35 | 30 | Which of the following statistical methods would be most appropriate to assess the statistical significance of these results?

• A. Chi-square test (Correct Answer)
• B. Pearson correlation coefficient
• C. Multiple logistic regression
• D. Unpaired t-test
• E. Paired t-test

Substance use disorders Explanation: **Chi-square test** - The **Chi-square test** is appropriate for comparing **categorical data** (mild, moderate, severe) between two or more independent groups (treatment vs. control). - It assesses whether there is a statistically significant association between the two categorical variables (treatment group and nausea severity). *Pearson correlation coefficient* - The **Pearson correlation coefficient** is used to measure the **linear relationship** between two **continuous variables**. - Nausea severity (mild, moderate, severe) is an **ordinal categorical variable**, not a continuous one. *Multiple logistic regression* - **Multiple logistic regression** is used to predict a **binary outcome** (e.g., presence or absence of nausea) based on one or more independent variables, which can be continuous or categorical. - The outcome here is **ordinal categorical** (mild, moderate, severe nausea), not binary. While logistic regression can be adapted for ordinal outcomes, a simpler Chi-square test is more direct for comparing distributions without prediction. *Unpaired t-test* - An **unpaired t-test** is used to compare the **means of two independent continuous variables**. - Nausea levels are categorical, and we are interested in comparing proportions within categories, not means. *Paired t-test* - A **paired t-test** is used to compare the **means of two related (paired) continuous variables**. - The study involves independent treatment and control groups, and the nausea data is categorical, making the paired t-test unsuitable.

Substance use disorders US Medical PG Question 7: A 42-year-old female presents to her primary care provider for an annual checkup. She reports feeling sad over the past few months for no apparent reason. She has lost interest in swimming, which she previously found enjoyable. Additionally, she has had trouble getting a full night’s sleep and has had trouble concentrating during the day. She has lost 15 pounds since her last visit one year prior. Which of the following sets of neurotransmitter levels is associated with this patient’s condition?

• A. Decreased acetylcholine, normal serotonin, normal dopamine
• B. Decreased norepinephrine, decreased serotonin, decreased dopamine (Correct Answer)
• C. Decreased GABA, decreased acetylcholine, increased dopamine
• D. Increased norepinephrine, decreased serotonin, decreased GABA
• E. Increased acetylcholine, increased serotonin, decreased dopamine

Substance use disorders Explanation: ***Decreased norepinephrine, decreased serotonin, decreased dopamine*** - The patient's symptoms of **sadness**, loss of interest (**anhedonia**), **insomnia**, **difficulty concentrating**, and **weight loss** are classic for **major depressive disorder**. - **Depression** is strongly associated with deficiencies in **monoamine neurotransmitters**: **norepinephrine**, **serotonin**, and **dopamine**. *Decreased acetylcholine, normal serotonin, normal dopamine* - While **acetylcholine** is involved in mood regulation, its isolated decrease with normal serotonin and dopamine levels is not characteristic of generalized depression. - More prominent roles for **acetylcholine dysfunction** are seen in conditions like **Alzheimer's disease** or **myasthenia gravis**. *Decreased GABA, decreased acetylcholine, increased dopamine* - **Decreased GABA** is often associated with **anxiety disorders** and seizures, not the primary presentation of depression here. - **Increased dopamine** is more characteristic of conditions like **schizophrenia** or **mania**, which contrasts with the patient's depressive symptoms. *Increased norepinephrine, decreased serotonin, decreased GABA* - **Increased norepinephrine** is typically associated with **anxiety**, **stress**, or sometimes **mania**, which is inconsistent with this patient's depressive state. - While **decreased serotonin** is correct for depression, the combination with increased norepinephrine and decreased GABA does not fit the typical neurotransmitter profile. *Increased acetylcholine, increased serotonin, decreased dopamine* - **Increased acetylcholine** is generally not associated with the full spectrum of depressive symptoms described. - **Increased serotonin** is often the goal of antidepressant treatments (SSRIs), making an endogenous increase unlikely to cause depression.

Substance use disorders US Medical PG Question 8: A 48-year-old man is brought to the emergency department after he was found in a stuporous state with a small cut on his forehead on a cold night in front of his apartment. Non-contrast head CT is normal, and he is monitored in the emergency department. Twelve hours later, he yells for help because he hears the wallpaper threatening his family. He also has a headache. The patient started drinking regularly 10 years ago and consumed a pint of vodka prior to admission. He occasionally smokes marijuana and uses cocaine. His vital signs are within normal limits. On mental status examination, the patient is alert and oriented. He appears markedly distressed and is diaphoretic. A fine digital tremor on his right hand is noted. The remainder of the neurological exam shows no abnormalities. Urine toxicologic screening is pending. Which of the following is the most likely diagnosis?

• A. Delirium tremens
• B. Alcoholic hallucinosis (Correct Answer)
• C. Cocaine intoxication
• D. Brief psychotic disorder
• E. Phencyclidine intoxication

Substance use disorders Explanation: ***Alcoholic hallucinosis*** - The patient's history of **heavy alcohol use**, followed by the development of **hallucinations** (hearing wallpaper threatening his family) within 12-48 hours of reduced or cessation of alcohol intake, is classic for alcoholic hallucinosis. - Unlike delirium tremens, **alcoholic hallucinosis** primarily involves prominent **auditory and visual hallucinations** without significant disorientation or vital sign instability. *Delirium tremens* - Delirium tremens typically presents later, usually **48-96 hours after alcohol cessation**, and is characterized by a more severe clinical picture including **global disorientation**, marked autonomic instability (fever, tachycardia, hypertension), and severe agitation. - While the patient is agitated and diaphoretic, the absence of significant disorientation, fever, or tachycardia makes delirium tremens less likely at this early stage. *Cocaine intoxication* - Cocaine intoxication would typically present with symptoms such as **tachycardia**, **hypertension**, **pupillary dilation**, **psychomotor agitation**, and potentially paranoia or hallucinations, but these would occur **acutely after cocaine use**, rather than 12 hours after being found in a stuporous state. - The patient's vital signs are noted to be normal, which argues against acute cocaine intoxication as the primary cause of his current symptoms. *Brief psychotic disorder* - Brief psychotic disorder is characterized by the sudden onset of psychotic symptoms (delusions, hallucinations, disorganized speech or behavior) lasting more than one day but less than one month, followed by full return to premorbid functioning. - While the patient exhibits hallucinations, the strong temporal link to **alcohol use and withdrawal** makes a substance-induced psychotic disorder, such as alcoholic hallucinosis, a more specific and likely diagnosis. *Phencyclidine intoxication* - PCP intoxication is associated with symptoms such as **nystagmus**, **ataxia**, **hypertension**, **tachycardia**, **violence**, and *dissociative symptoms*, along with hallucinations and delusions. - The patient does not exhibit the characteristic nystagmus, ataxia, or typical behavioral aggression associated with PCP intoxication.

Substance use disorders US Medical PG Question 9: A 20-year-old male is brought to a psychiatrist by his parents for bizarre behavior. His parents report that over the past two semesters in school, his personality and behavior have changed noticeably. He refuses to leave his room because he believes people are spying on him. He hears voices that are persecutory and is convinced that people at school have chips implanted in their brains to spy on him. Screenings for depression and mania are negative. His past medical history is unremarkable. His family history is notable for a maternal uncle with bipolar disorder. He does not drink alcohol or smoke. His temperature is 98.8°F (37.1°C), blood pressure is 115/70 mmHg, pulse is 85/min, and respirations are 18/min. On examination, he appears to be responding to internal stimuli. Which of the following pathways is primarily responsible for these symptoms?

• A. Papez circuit
• B. Mesocortical pathway
• C. Nigrostriatal pathway
• D. Tuberoinfundibular pathway
• E. Mesolimbic pathway (Correct Answer)

Substance use disorders Explanation: ***Mesolimbic pathway*** - The **mesolimbic pathway** is primarily associated with the **positive symptoms of psychosis**, such as **hallucinations and delusions**, due to **dopamine hyperactivity**. - The patient's **persecutory delusions, auditory hallucinations, and paranoia** are hallmark positive symptoms seen in conditions like schizophrenia, which are mediated by this pathway. *Papez circuit* - The **Papez circuit** is involved in **emotion and memory**, connecting structures like the hippocampus and cingulate gyrus. - Dysregulation of this circuit would more likely manifest as deficits in memory or emotional regulation rather than the prominent psychotic features described. *Mesocortical pathway* - The **mesocortical pathway** projects to the **prefrontal cortex** and is implicated in **negative symptoms** (e.g., apathy, flat affect) and **cognitive deficits** (e.g., executive dysfunction) of psychosis, often due to **dopamine hypoactivity**. - While cognitive and negative symptoms can co-occur in psychotic disorders, they are not the primary, most striking symptoms described here. *Nigrostriatal pathway* - The **nigrostriatal pathway** is crucial for **motor control**, connecting the substantia nigra to the striatum. - Dysfunction in this pathway leads to **extrapyramidal symptoms** (e.g., tremors, rigidity, dyskinesia), which are not present in this patient's presentation. *Tuberoinfundibular pathway* - The **tuberoinfundibular pathway** connects the hypothalamus to the pituitary gland and regulates **prolactin secretion**. - Its primary role is in neuroendocrine function, and its dysfunction would lead to **hyperprolactinemia** and related symptoms, not the psychotic features described.

Substance use disorders US Medical PG Question 10: A 23-year-old woman is admitted to the inpatient psychiatry unit after her boyfriend reported she was “acting funny and refusing to talk.” The patient’s boyfriend states that he came home from work and found the patient sitting up in bed staring at the wall. When he said her name or waved his hand in front of her, she did not respond. When he tried to move her, she would remain in whatever position she was placed. The patient’s temperature is 99°F (37.2°C), blood pressure is 122/79 mmHg, pulse is 68/min, and respirations are 12/min with an oxygen saturation of 98% O2 on room air. During the physical exam, the patient is lying on the bed with her left arm raised and pointing at the ceiling. She resists any attempt to change her position. The patient remains mute and ignores any external stimuli. The patient’s medical history is significant for depression. She was recently switched from phenelzine to fluoxetine. Which of the following is the best initial therapy?

• A. Electroconvulsive therapy
• B. Lorazepam (Correct Answer)
• C. Haloperidol
• D. Cyproheptadine
• E. Benztropine

Substance use disorders Explanation: **Lorazepam** - The patient presents with classic symptoms of **catatonia**, including **mutism**, **waxy flexibility**, and **posturing**, following a medication change from phenelzine (MAOI) to fluoxetine (SSRI), which could potentially precipitate catatonia or serotonin syndrome. - **Benzodiazepines**, particularly lorazepam, are the **first-line treatment** for catatonia, often showing a rapid and dramatic response. *Electroconvulsive therapy* - While **ECT** is a highly effective treatment for severe catatonia, especially when unresponsive to benzodiazepines, it is typically considered a **second-line intervention** or for cases involving medical instability. - Given the strong initial efficacy and safety profile of benzodiazepines, they are preferred as the first step before proceeding to ECT. *Haloperidol* - **Antipsychotics** like haloperidol are generally **contraindicated** in catatonia, as they can sometimes worsen the symptoms or even induce **neuroleptic malignant syndrome (NMS)**, which shares some features with severe catatonia. - NMS is a serious condition with high mortality, and introducing an antipsychotic in a catatonic patient could be dangerous. *Cyproheptadine* - **Cyproheptadine** is a **serotonin antagonist** used primarily in the treatment of **serotonin syndrome**, which involves symptoms like hyperthermia, agitation, and hyperreflexia. - While the medication change could raise suspicion for serotonin syndrome, the clinical picture of **waxy flexibility, mutism, and posturing** is much more indicative of catatonia, for which cyproheptadine is not an effective treatment. *Benztropine* - **Benztropine** is an **anticholinergic medication** primarily used to treat **extrapyramidal symptoms (EPS)** caused by antipsychotics, such as **dystonia** or **parkinsonism**. - The patient's symptoms are not indicative of EPS, and benztropine has no role in the treatment of catatonia.

Substance use disorders Flashcard 1 of 8

Question: _____ defenses, are mental processes (unconscious or conscious), that are used to resolve conflict and prevent undesirable feelings (e.g. anxiety, depression)

Answer: Ego

Substance use disorders Flashcard 2 of 8

Question: Neuro/PsychDo benzodiazepines have addictive potential? _____

Answer: Yes

Substance use disorders Flashcard 3 of 8

Question: Non-specific symptoms of _____ withdrawal (stimulant or depressant) include post-use "crash", depression, lethargy, and hypersomnia/weight gain

Answer: stimulant

Substance use disorders Flashcard 4 of 8

Question: What symptoms of alcohol withdrawal may occur during the 48 - 96 hour time period? _____

Answer: Delirium tremens (5% of cases)

Substance use disorders Flashcard 5 of 8

Question: D2 dopamine receptors are primarily found in the _____ (organ system)

Answer: CNS

Substance use disorders Flashcard 6 of 8

Question: Which ego defense is defined as involuntarily turning back the maturational clock and going back to earlier modes of dealing with the world? _____

Answer: Regression (immature defense)

Substance use disorders Flashcard 7 of 8

Question: Substance use disorder is defined as _____ of the following signs in 1 year related specifically to substance use:ToleranceWithdrawalSubstance taken in larger amounts than desiredPersistent desire or unsuccessful attempts to cut downSignificant energy spent obtaining, using, or recovering from substanceImportant social, occupational, or recreational activities reducedContinued use despite knowing it causes problemsCravingRecurrent use in physically dangerous situationsFailure to fulfill major obligations at work, school, or homeSocial or interpersonal conflicts

Answer: > 2

Substance use disorders Flashcard 8 of 8

Question: What emotional states are most associated with the nuceus accumbens?

Answer: reward, pleasure, addiction, fear mnemonic: accumulated rewards