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Substance Abuse, Intoxication & Withdrawal, Uppers Downers & Hallucinogens MDMA LSD PCP

0:32 – Substance Abuse vs. Substance Dependence
2:51 – Miosis vs. Mydriasis
3:21 – Uppers/Stimulants (Cocaine, Meth & MDMA/Ecstacy)
5:57 – Downers/Depressants Intoxication & Overdose (Alcohol, Opioids, Heroin)
10:58 - Downer Withdrawal
12:18 – Hallucinogen (PCP, LSD & Mushrooms)
14:15 – Marijuana/Cannabis

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Substance dependence is an adaption to a pattern of substance use. It is primarily characterized by withdrawal (or symptoms that occur when use of the drug is discontinued), tolerance (or needing more to obtain the same desired effect), and spending a significant portion of their time engaged in drug related activities.
Substance abuse is an overindulgence in an addictive substance as a result of a lack of control. It can be thought of as a more extreme version of substance dependence in which individuals have significant negative life effects with work relationships or school), poor health, or legal problems as a result of their substance use. In the general public this pattern of substance abuse would more generally be referred to as an addiction.
There is very specific DSM criteria for each of these terms, but that isn’t important for the exam.
For simplicity sake we will break the drugs down into 3 different categories. The 3 categories are Uppers, Downers and Hallucinogens. There are slight differences between drugs within individual categories, but for the most part you can get questions right by just knowing the general characteristics of the entire group. For example, you won’t see both cocaine and MDMA listed as answers on the same question.

Also remember to not confuse intoxication and withdrawal. Most questions are on drug intoxication, but they may specifically ask you about withdrawal which usually has symptoms that are just the opposite of intoxication. So make sure you read the question carefully. For example, the question stem may fit stimulant withdrawal and depressant intoxication, but the last sentence of the question specifically asks about withdrawal.

Keep in mind the most important things for Step 1 questions are the changes to the vitals and pupils. These should be the buzzwords you are looking for. You will almost always be given this information in these types of questions and if you just have that info you can usually narrow it down to at least 2 options.

Also make sure you don’t get mydriasis vs. miosis confused. Mydriasis is the bigger word and has the bigger pupils. Miosis is the smaller word and has the smaller pupils.
And obviously the best way to confirm a diagnosis of drug use is a urine drug screen and mental health services are important in the treatment of addiction. However, that is too easy so you won’t see either of those as an answer on the exam so I’m not going to spend much time on that.

That brings us to Uppers or stimulants…. Now I’ll try my hardest to not make 20 references to Breaking Bad during this section, but I can’t make any promises.
Most of the questions related to this category will be about cocaine, which is usually smoked in the form of crack cocaine or snorted. However, other street drugs such as Methamphetamines (Meth) & MDMA (Ecstasy & Molly) are also in this group. Prescription drugs used for ADHD, narcolepsy and weight loss are also stimulants, but are less likely to show up in this type of Step 1 question.

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