Quantum Units Education®

1. In a 2005 Department of Defense (DOD) survey, ___________ percent of military personnel anonymously reported one or more serious consequences associated with alcohol use during the year.

Unhealthy Alcohol Use

2. Risky alcohol users are in danger of increasing physical, psychological, or social harm with increased consumption, and ______________ of these users are at risk for dependence.  

Module A: Screening And Initial Assessment For Alcohol Use

3. Patients in general and mental health care settings should be screened for unhealthy alcohol use annually.

Does the Person Screen Positive or Drink Despite Contraindications?

4. A screening should be considered positive for Unhealthy Alcohol Use if, on the single-item screening question, patients report drinking 3 or more (women) or 4 or more (men) drinks in a day in the past year.

Does the Person Drink Above Recommended Limits or Despite Contraindications?

5. Contraindications for any alcohol use includes each of the following EXCEPT:      

6. During a brief intervention for alcohol use, professionals should provide general feedback on the heath risks associated with drinking, but personalized feedback is not recommended.  

Is Referral for Alcohol Use Disorder Also Indicated or Requested?-Discussion

7. Studies of 8,389 patients with alcohol dependence who were treated with medication or behavior interventions indicated that ____________ maintained total abstinence for 12 months.

Does Patient Agree to the Referral or is the Referral Mandated?-Recommendations

8. Patients at high risk for alcohol use disorder but who are not ready for specialty addictions treatment should be engaged in monitoring of alcohol-related medical problems in the clinical setting.

Module B: Management Of Substance Use Disorders In Specialty SUD Care

9. Patients may be referred to specialty Substance Use Disorder (SUD) care because of:

Obtain a Comprehensive Biopsychosocial Assessment

10. When obtaining a biopsychosocial assessment for SUD patients, family social history should include each of the following EXCEPT:  

11. A comprehensive biopsychosocial assessment covers physical, emotional, cognitive, environmental and ____________ domains.

12. Which of the following is NOT one of the likely benefits of the clinician being empathic and non-judgmental during the assessment?

13. If it is possible to gain permission from the patient to do so, consulting with collateral informants such as spouse/partner, family, friends and co-workers will provide a useful adjunct to gathering information directly from the patient.

14. A comprehensive intake assessment report should include a diagnostic formulation summary of past treatment response and an integrated summary of all clinically relevant information, and treatment recommendations should incorporate:

Treatment Plan and Expected Outcomes

15. An expected outcome for a patient seeking help but not committed to abstinence is:  

16. Motivational Interviewing (MI) techniques and style are preferred in SUD treatment sessions, while confrontational counseling styles should be used as the secondary intervention.

17. Addiction-focused pharmacotherapy should be considered, available, and offered for all patients with  __________________ and/or alcohol dependence.    

Address Psychosocial Functioning and Recovery Environment

18. Many patients have co-existing psychosocial problems that are consequences of the SUD and persist even after early recovery is established, while others occur independently of the SUD, but can complicate access to care or can increase relapse risk.

19. Throughout the course of sub-treatment, clinical response should be reassessed and documented at what time period?

Reevaluate Treatment Plan Regarding Setting and Strategies-Background

20. Relapse usually indicates that the patient was not sufficiently motivated for SUD treatment.

Module C: Management of SUD in (Primary) General Health Care

21. Management of SUD in general or mental health care settings is likely to be a more acceptable and effective alternative for the patient when:

Assess Co-Occurring Condition: Discussion

22. Studies in mental health settings found that 20 to 50 percent of patients with lifetime co-occurring SUD had a lifetime co-occurring mental disorder, while studies in SU/SUD treatment settings found that _____________ percent of patients had such a disorder.  

23. Pharmacologic treatments for problem alcohol consumption can serve as an effective adjunct to non-pharmacologic treatments to help patients reduce or eliminate alcohol consumption.

24. Medical management is delivered by a clinical professional to help increase medication adherence and monitoring of substance use and consequences, as well as to support abstinence through referral to support groups and:

Treatment: Psychosocial Support for Recovery

25. Referral rehabilitation services should be offered to individuals with identified unmet psychosocial needs, regardless of the population setting or type of pharmacotherapy or psychotherapy being administered.  

Assess Response to Treatments-Recommendations

26. When monitoring progress toward SUD treatment goals, obtaining biological markers of recent substance use is recommended.

Reevaluate Treatment Plan Regarding Setting and Strategies

27. For patients who are not improving in treatment, consideration should be given to:      

Module P: Addiction-Focused Pharmacotherapy for Opioid Dependence

28. Opioid agonist treatment (OAT) is the first line treatment for chronic opioid dependence that meets DSM-IV-TR criteria, and it is highly recommended for DOD active duty members.

Recommendations

29. When comparing buprenorphine to methadone, buprenorphine appears to be more effective at reducing opioid consumption and for use in the maintenance of patients with co-occurring cocaine dependence.

30. Office-based treatment of opioid dependence (OBOT) can only be provided by credentialed physicians, and ____________ is the only medication approved for OBOT.    

Patient Suitability for Office-Based Opioid Treatment versus Opioid Treatment Program

31. An Opioid Agonist Treatment Program (OATP) is recommended for pregnant patients or for those with dependence on central nervous system (CNS) depressants.

Buprenorphine Treatment Protocol

32. The target zone for methadone is typically at least ____mg/day, while the buprenorphine target dose is generally up to ____ mg daily.

Is Naltrexone Appropriate For and Acceptable to the Patient?

33. Naltrexone is unpopular with many opioid dependent patients since it has no positive psychoactive effects, and because naltrexone maintenance therapy requires complete abstinence from opioids.  

Assure Patient is Withdrawn from Opioids and Opioid Free Before Continuing-Recommendations

34. Pharmacologically assisted withdrawal from opioids should be considered unless the patient has successfully completed a naloxone challenge and/or has had at least 7-10 days of verified abstinence.

Pharmacotherapy for Alcohol Dependence

35. Disulfiram and naltrexone combined with addiction-focused counseling may reduce the amount of drinking, the risk of relapse, the number of days of drinking and craving for many patients.  

Pharmacotherapy of Alcohol Dependence

36. Adverse effects of oral naltrexone include:          

37. The three drugs that have been FDA-approved for adjunctive therapy in alcohol dependence are naltrexone, acamprosate, and disulfiram.

38. Sufficient evidence suggests that acamprosate is superior to other medications in decreasing alcohol intake and abstinence.

Stabilization and Withdrawal Management

39. Alcohol-related delirium can be identified through each of the following EXCEPT:

40. The most common signs and symptoms of acute intoxication involve distrubance of perception, wakefulness, attention, thinking, judgment, psychomotor behavior, and interpersonal behavior.

Provide Appropriate Care To Stabilize Prior to Management Or Withdrawal

41. Agitation secondary to intoxication from a variety of substances is best initially managed through the addition of more medications such as fluvoxamine and diazepam.

Assess Level of Physiological Dependence and Indications for Stabilization Including Risk of Withdrawal

42. Untreated severe alcohol and other sedative-hypnotic withdrawal can lead to autonomic instability, seizures, delirium, and ________________.      

Is the Patient in Need of Withdrawal Management?-Background

43. Patients with legitimate pain and/or anxiety disorders who develop only physiological tolerance during long-term use of prescribed medications should be distinguished from those with markers of prescription misuse.  

Does Patient Require Inpatient Medically Supervised Withdrawal?

44. One advantage of ambulatory withdrawal management is that these patients have a higher likelihood of completing the withdrawal protocol.

Alcohol Withdrawal Management

45. For inpatient treatment of alcohol withdrawal, non-benzodiazepines sedative-hypnotics should be used over benzodiazepines because of documented efficacy, and a greater margin of safety.

46. Although agents such as beta-blockers and clonidine are generally not considered as appropriate monotherapy for alcohol withdrawal, they may be considered in conjunction with benzodiazepines in certain patients.

Opioid Withdrawal Management-Recommendations

47. Medically supervised opioid withdrawal is rarely as effective as a long-term strategy for treatment of opioid dependence because of high relapse rates, so opioid maintenance with buprenorphine/naloxone or methadone is the usually the treatment of choice.  

48. Which of the following accurately describes the use of methadone for opiate withdrawal?

Use of Buprenorphine or Methadone

49. Clonidine is effective in decreasing the signs and symptoms of opioid withdrawal in inpatient populations, with studies reporting an 80 to 90 percent success rate in detoxifying patients from methadone or heroin.  

50. Treatment of opioid withdrawal should focus on facilitating entrance into comprehensive long-term treatment and:        

Appendix B-1: Brief Alcohol Screening Questionnaires for Unhealthy Alcohol Use

51. The Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C are brief screening tools used to access alcohol consumption, and they can be administered by interview or self report.

Appendix B6: Signs and Symptoms of Intoxication and Withdrawal (DSM-IV-TR)

52. Signs and symptoms of amphetamine withdrawal include:

Appendix B-9: Brief Addiction Monitor (BAM)

53. The BAM assesses several areas of physical and emotional health by evaluating the patient's last 90 days for lifestyle factors, substance use, and other aspects.

Appendix B-10: Housing Options

54. Therapeutic Communites and Therapeutic Rehabilitation Communities are examples of which type of housing option?

Appendix C: Addiction-Focused Psychosocial Intervention-C1

55. Behavioral Couples Therapy (BCT) uses a series of behavioral assignments to increase positive feelings, shared activites, and constructive criticism, because these relationship factors are conducive to sobriety.

C2-Cognitive Behavioral Coping Skills Therapy

56. Which of the following is NOT one of the primary techniques used in Cognitive Behavioral Skills Therapy?

C3-Community Reinforcement Approach (CRA)

57. Community Reinforcement Approach is a comprehensive cognitive-behavioral intervention for treating substance abuse problems by dealing with family patterns and social histories and how they impact a patient's behavior.  

C4- Management for SUD Treatment

58. Contingency Management (CM) treatment strategies reward specific behavioral goals related to sobriety, and have been the most effective for:        

C6-Twelve Step Facilitation (TSF)

59. The goal of Twelve Step Facilitation (TSF) Therapy is to increase the patient's active involvement in AA or other 12-Step programs, while walking the patient through the first four steps of the AA program.

60. Numerous studies have shown an association between participation in 12-Step programs and improved overall outcomes as well as reduction in health care costs.