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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.
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.
3. Patients in general and mental health care settings should be screened for unhealthy alcohol use annually.
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.
5. Contraindications for any alcohol use includes each of the following EXCEPT:
A. Pregnancy or trying to conceive
B. Other medical conditions potentially exacerbated or complicated by drinking
C. Kidney disease and hepatitis
D. Use of medications with clinically important interactions with alcohol or intoxication
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.
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.
A. 18 percent
B. 24 percent
C. 31 percent
D. 37 percent
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.
9. Patients may be referred to specialty Substance Use Disorder (SUD) care because of:
A. Hazardous substance use, substance abuse or substance dependence
B. Risk of relapse or suspected/possible SUD
C. Mandated referral within the DoD
D. All of the above
10. When obtaining a biopsychosocial assessment for SUD patients, family social history should include each of the following EXCEPT:
A. Profiles of parents and home atmosphere
B. Economic status and religions affiliation
C. Developmental histories and educational experiences of all family members
D. Cultural influences and leisure activities
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?
A. Helping the patient make sense of his or her condition
B. Decreasing the patient's sense of isolation and increasing the likelihood of treatment adherence
C. Increasing the likelihood that the patient will disclose current substance abuse
D. Fostering growth of the therapeutic alliance
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:
A. An interdisciplinary perspective
B. A multifaceted goal
C. A restorative theme
D. A rehabilitative outlook
15. An expected outcome for a patient seeking help but not committed to abstinence is:
A. Continuous enhancement of motivation to change
B. Improvement in coexisting medical, psychiatric, and social condtions
C. Reduction in the need for high-intensity health care services
D. Resolution or improvement of at least some co-existing problems and health-related quality of life
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.
A. Amphetamine dependence
B. Opioid dependence
C. Cannabis dependence
D. All of the above
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?
A. Bi-weekly in the acute inpatient setting
B. At least weekly in the residential setting
C. Daily in an outpatient setting for the first few weeks following a new episode
D. None of the above
20. Relapse usually indicates that the patient was not sufficiently motivated for SUD treatment.
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:
A. The patient refuses referral to specialty SUD care but continues to seek some services, especially medical and/or psychiatric services
B. The patient has serious co-morbidity that precludes participation in available specialty SUD care
C. The patient has been engaged repeatedly in specialty SUD treatment with minimal progress toward abstinence or sustained improvement
D. All of the above
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.
A. 50 to 75
B. 45 to 70
C. 40 to 65
D. 35 to 60
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:
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.
26. When monitoring progress toward SUD treatment goals, obtaining biological markers of recent substance use is recommended.
27. For patients who are not improving in treatment, consideration should be given to:
A. Adding crisis intervention
B. Assigning group and individual treatment
C. Consulting with a SUD specialist
D. Adding a medication to existing plan
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.
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.
31. An Opioid Agonist Treatment Program (OATP) is recommended for pregnant patients or for those with dependence on central nervous system (CNS) depressants.
32. The target zone for methadone is typically at least ____mg/day, while the buprenorphine target dose is generally up to ____ mg daily.
A. 60; 16
B. 50; 20
C. 40; 24
D. 30; 28
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.
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.
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.
36. Adverse effects of oral naltrexone include:
A. Depression and asthenia
B. Dry mouth and agitation
C. Changes in appetite and weight
D. Nausea and dizziness
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.
39. Alcohol-related delirium can be identified through each of the following EXCEPT:
A. Disturbance of consciousness
B. A change in cognition or the development of a perceptual disturbance that is not accounted for by a preexisting, established, or evolving dementia
C. The disturbance develops over several days does not fluctuate during the course of the day
D. There is evidence from the history, physical examination, or laboratory findings that the illness is characterized by an atypical course
40. The most common signs and symptoms of acute intoxication involve distrubance of perception, wakefulness, attention, thinking, judgment, psychomotor behavior, and interpersonal behavior.
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.
42. Untreated severe alcohol and other sedative-hypnotic withdrawal can lead to autonomic instability, seizures, delirium, and ________________.
B. Cognitive impairment
C. Heightened agitation
D. Psychomotor disturbances
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.
44. One advantage of ambulatory withdrawal management is that these patients have a higher likelihood of completing the withdrawal protocol.
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.
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?
A. Withdrawal using methadone can only be performed in the context of a federally licensed opioid treatment program where daily medication dispensing can occur
B. Withdrawal signs should be observed prior to starting methadone and initial daily doses can range from 10mg to a maximum of 20mg
C. Dose decrease of more that 10-20mg/day of methadone are generally poorly tolerated
D. A period of four to five weeks is generally sufficient for short term outpatient medically supervised withdrawal in the most stable and motivated individuals
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:
A. Reducing disruption in patients' life
B. Alleviating acute symptoms
C. Minimizing chronic pain
D. All of the above
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.
52. Signs and symptoms of amphetamine withdrawal include:
A. Symptoms such as yawning, muscle aches, fever, and diarrhea that cause clinically significant distress or impairment in social or occupational functioning
B. Autonomic hyperactivity, increased hand tremor, anxiety, hallucinations, or other symptoms that develop within several hours to a few days of apparent intoxication
C. Muscle aches, puppilary dilation, piloerection, sweating, insomnia, or other symptoms that cause clinically significant distress
D. Dysphoric mood and symptoms such as increased appetite, fatigue, and unpleasant dreams that develop within a several hours to a few days after apparent intoxication
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.
54. Therapeutic Communites and Therapeutic Rehabilitation Communities are examples of which type of housing option?
A. Intensive Medical Management
B. 24 hour Supervision
C. Clinical Management
D. Non-Supervised Housing
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.
56. Which of the following is NOT one of the primary techniques used in Cognitive Behavioral Skills Therapy?
A. Education of the patient about the treatment model
B. Collaboration with the patient and therapist to choose goals
C. Using guided discovery
D. Working with the patient to improve coping mechanisms
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.
58. Contingency Management (CM) treatment strategies reward specific behavioral goals related to sobriety, and have been the most effective for:
A. Drug use disorders
B. Alcohol dependence
C. Patients with co-occurring disorders and substance abuse
D. None of the above
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.
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