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Addiction - Neurobiology, Prevention, and Treatment

Chapter 1: Introduction and Overview of the Report

1. Which of the following is a feature that make alcohol, illicit drugs, and over-the-counter drugs important to public health and safety?

A. Many people use and misuse these substances.

B. Individuals can use these substances in a manner that causes harm to the user or those around them.

C. Prolonged, repeated misuse of any of these substances can produce changes to the brain that can lead to a substance use disorder, an independent illness that significantly impairs health and function and may require specialty treatment.

D. All of the above.

2. A medical illness caused by repeated misuse of a substance or substances is known as:

A. A substance use disorder

B. Addiction

C. Substance use

D. Substance misuse

3. Many people who misuse substance do not meet the diagnostic criteria for a substance use disorder.

A. True

B. False

4. Seventy-six percent of alcohol overdose deaths occur among those between ages 15 and 35, and 76% of those who die from alcohol overdose are women.

A. True

B. False

5. Over-prescription of powerful opioid pain relievers beginning in the 1990’s led to a rapid escalation of use and misuse of these substances by a broad demographic of men and women across the country, which led to a resurgence of heroin use, as some users transitioned to using this cheaper street cousin of expensive prescription opioids.

A. True

B. False

6. Recent systematic reviews have found that substance use is:

A. A risk factor for intimate partner violence.

B. A consequence of intimate partner violence.

C. Both (A) and (B).

D. None of the above.

7. Which of the following single factors will determine whether an individual will develop a substance misuse problem or disorder?

A. Easy access to inexpensive alcohol and other substances.

B. Low parental monitoring.

C. Low involvement in school.

D. None of the above.

8. Neither risk nor protective factors can be modified through preventive programs or policies to reduce vulnerability.

A. True

B. False

9. Although substance misuse problems and disorders may occur at any age, adolescence and young adulthood are particularly critical at-risk periods.

A. True

B. False

10. Among the last brain regions to reach maturity, and an area of the brain that is one of the most affected regions in a substance use disorder, the _____ is primarily responsible for “adult” abilities, such as delay of reward, extended reasoning, and impulse control.

A. Thalamus

B. Prefrontal cortex

C. Broca’s area

D. Amygdala

11. Tolerance and withdrawal are major clinical symptoms and are the deciding factor in whether an individual has an addiction.

A. True

B. False

12. Confrontational intervention approaches in general, though once the norm even in many behavioral treatment settings, have not been found effective and may backfire by heightening resistance and diminishing self-esteem on the part of the targeted individual.

A. True

B. False

13. The presence of a substance use disorder often _____ the odds for the subsequent development of chronic and expensive medical illnesses, such as arthritis, chronic pain, heart disease, stroke, hypertension, diabetes, and asthma.

A. Doubles

B. Triples

C. Quadruples

D. None of the above

14. To address the problem of fatal medication errors due to interactions between a prescribed medication for a diagnosed medical condition and patient substance use, researchers suggest:

A. Screening patients for use of alcohol and/or street drugs.

B. Taking extra precautions when prescribing medicines with known dangerous interactions with alcohol and/or street drugs.

C. Teaching the patient the risks of mixing medicines with alcohol and/or street drugs.

D. All of the above.

Chapter 2: The Neurobiology of Substance Use, Misuse, and Addiction

15. All of the following statements are true with regard to neuroadaptations, except for:

A. They compromise brain function.

B. They drive the transition from controlled, occasional substance use to chronic misuse, which can be difficult to control.

C. They diminish shortly after an individual stops using substances.

D. They may produce continued, periodic craving for the substance that can lead to relapse.

16. Addiction is an inevitable consequence of substance use.

A. True

B. False

17. The addiction cycle disrupts the normal functions of some neuronal networks.

A. True

B. False

18. Which of the following key component regions is involved in stress and the feelings of unease, anxiety, and irritability that typically accompany substance withdrawal?

A. The basal ganglia

B. The extended amygdala

C. The prefrontal cortex

D. All of the above

19. The dorsal striatum, a sub-region of the basal ganglia, is involved in motivation and the experience of reward.

A. True

B. False

20. The stage at which one seeks substances again after a period of abstinence is known as:

A. The preoccupation / anticipation stage of addiction.

B. The Binge / intoxication stage of addiction.

C. The withdrawal / negative affect stage of addiction.

D. None of the above.

21. Positive and negative reinforcement is driven solely by the effects of the drugs.

A. True

B. False

22. Dopamine is released in the brains of people addicted to cocaine when they are exposed to cues they have come to associate with cocaine, and occurs even though cocaine itself causes less dopamine to be released in these individuals compared to those who are not addicted to cocaine.

A. True

B. False

23. The negative feelings associated with withdrawal are thought to come from:

A. Diminished activation in the reward circuitry of the basal ganglia.

B. Activation of the brain’s stress systems in the extended amygdala.

C. Both (A) and (B).

D. None of the above.

24. Which neurotransmitter plays a key role in the negative feelings associated with withdrawal and in stress-triggered substance use?

A. Corticotropin-releasing factor

B. Norepinephrine

C. Dynorphin

D. All of the above

25. Taking drugs or alcohol to lessen the symptoms of withdrawal that occur during a period of abstinence actually causes those symptoms to be even worse the next time a person stops taking the substance, making it even harder to maintain abstinence.

A. True

B. False

26. People with alcohol, cocaine, or opioid use disorders show impairments in executive function, including disruption of decision-making and behavioral inhibition, which parallel changes in the prefrontal cortex and suggest greater activity of the _____ in response to substance-related stimuli.

A. Stop system

B. Go system

C. Both (A) and (B)

D. None of the above

27. Cannabis addiction follows a pattern similar to:

A. Opioids

B. Alcohol

C. Stimulants

D. None of the above

Chapter 3: Prevention Programs and Policies

28. Evidence-based prevention interventions, carried out before the need for treatment, are critical because they can delay early use and stop the progression from use to problematic use or to a substance use disorder, all of which are associated with costly individual, social, and public health consequences.

A. True

B. False

29. When does the likelihood of substance use peak?

A. Adolescence

B. Twenties

C. Thirties

D. Forties

30. At the policy level, research shows that higher alcohol prices do not reduce alcohol misuse and related harms.

A. True

B. False

31. Research has shown that binge drinking is more common among individual in:

A. Higher income households

B. Lower income households

C. Equally between higher and lower income households

D. None of the above

32. Which category of prevention intervention is targeted to individuals who are already using substances but have not developed a substance use disorder?

A. Universal

B. Selective

C. Indicated

D. All of the above

33. Which of the following is the target audience for selective interventions?

A. Families living in poverty.

B. Children of depressed or substance-using parents.

C. Children who have difficulties with social skills.

D. All of the above.

34. The Classroom-Centered Intervention, which combined the Good Behavior Game with additional models of teacher instruction, reduced rates of _____ in middle and high school.

A. Cocaine and heroin use

B. Alcohol initiation

C. Marijuana initiation

D. All of the above

35. A 10% increase in the price of alcohol is expected to decrease binge drinking by 9.5% among women and 35.4% among men aged 18 to 21.

A. True

B. False

36. Policies that increase alcohol prices:

A. Delay the time when young people start to drink.

B. Slow the progression towards drinking larger amounts.

C. Reduce heavy drinking and the volume of alcohol drunk on each occasion.

D. All of the above.

37. Banning sales of alcohol on Sundays has been recognized as a cost-effective strategy.

A. True

B. False

38. Through which of the following city- or county-level laws can adults be held responsible for underage drinking parties held on their property, regardless of whether they directly provided alcohol to minors?

A. Zero tolerance laws

B. Criminal social host liability laws

C. Civil social host liability laws

D. Use / lose laws

39. One study found that for every additional advertisement seen by youth per month, they drank _____ more.

A. 1%

B. 3%

C. 9%

D. 12%

40. One study followed people from age 13 to 38 and found that those who began marijuana use in their teens and developed a persistent cannabis use disorder had up to _____ point drop in IQ, even if they stopped using in adulthood.

A. A four

B. An eight

C. A twelve

D. A sixteen

41. EBIs that are poorly implemented tend to have weak or no effect on participants.

A. True

B. False

Chapter 4: Early Intervention, Treatment, and Management of Substance Use Disorders

42. The U.S. Food and Drug Administration has approved medications to treat which of the following substance use disorders?

A. Cocaine

B. Opioid

C. Methamphetamine

D. All of the above

43. Addressing individual and environmental risk factors for substance use through evidence-based programs, policies, and strategies is which of the following?

A. Enhancing health

B. Primary prevention

C. Early intervention

D. Treatment

44. What is the goal of early intervention?

A. Reduce the harms associated with substance misuse.

B. Reduce risk behaviors before they lead to injury.

C. Prevent progression to a disorder and subsequent need for specialty substances use disorder services.

D. All of the above.

45. All of the following groups are particularly likely to benefit from early intervention, except for:

A. People who binge drink.

B. People who use substances while driving.

C. People who use prescription pain relievers.

D. Women who use substances while pregnant.

46. Five or more drinks in a day for women has been validated and shown in primary care to accurately identify individuals at risk for or experiencing a substance use disorder.

A. True

B. False

47. The main purpose of motivational interviewing is to:

A. Examine and resolve ambivalence.

B. Give feedback to the individual about their level of use relative to safe limits.

C. Identify the severity of the individual’s substance use and whether substance use disorder treatment may be necessary.

D. All of the above.

48. Among all individuals who met criteria for a substance use disorder, _____ was by far the most prevalent substance reported.

A. Marijuana

B. Prescription pain relievers

C. Alcohol

D. Methamphetamines

49. The most common reason that people do not seek treatment is:

A. That they are not ready to stop using.

B. That they are unaware that they need treatment.

C. That they do not have health care coverage / cannot afford it.

D. That it might have a negative effect on their job or cause neighbors / community to have a negative opinion.

50. Which of the following is a strategy to reduce harm?

A. Outreach and education programs.

B. Needle / syringe exchange programs.

C. Access to naloxone to reverse potentially lethal opioid overdose.

D. All of the above.

51. How long after a user has taken the drug do bystanders have in order to take action to prevent the user’s opioid overdose death?

A. None, overdose occurs immediately.

B. A 15 to 30 minute window.

C. A 1 to 3 hour window.

D. None of the above.

52. Rapid or unmanaged withdrawal from which of the following can be protracted and can produce seizures and other health complications?

A. Alcohol and sedatives / tranquilizers

B. Stimulants

C. Opioids

D. All of the above

53. Beginning substance use disorder treatment within 14 days of discharge from withdrawal management has been shown to reduce readmission rates.

A. True

B. False

54. Which of the following accurately describe the treatment plan?

A. It should be person-centered and include strength-based approaches, or ones that draw upon an individual’s strengths, resources, potential, and ability to recover, to keep the patient engaged in care.

B. It should consider age, gender identity, race and ethnicity, language, health literacy, religion / spirituality, sexual orientation, culture, trauma history, and co-occurring physical and mental health problems.

C. It should be adjusted throughout treatment as individuals are periodically reassessed to determine response to treatment.

D. All of the above.

55. Studies have repeatedly demonstrated the efficacy of medication-assisted treatment at:

A. Reducing illicit drug use and overdose deaths.

B. Improving retention in treatment.

C. Reducing HIV transmission.

D. All of the above.

56. Patients who receive MAT for fewer than _____ have not shown improved outcomes.

A. 90 days

B. 6 months

C. 12 months

D. 3 years

57. All three FDA-approved medications currently available to treat alcohol use disorder carry the risk of misuse / addiction and thus are DEA-scheduled substances.

A. True

B. False

58. Research suggests that _____ skills can be learned during Cognitive-Behavioral Therapy and that those skills continue to be employed by the individual after treatment has concluded.

A. Self-monitoring

B. Craving-recognition

C. Both (A) and (B)

D. None of the above

59. Twelve-Step Facilitation has been effective in reducing alcohol use during the first month of treatment for individuals with alcohol use disorder, but these effects disappear rapidly following treatment completion.

A. True

B. False

60. Research has shown that incorporating tobacco sensation programs into substance use disorder treatment does not jeopardize treatment outcomes and is associated with a _____ increase in the likelihood of maintaining long-term abstinence from alcohol and drug misuse.

A. 10%

B. 25%

C. 40%

D. 65%

61. What is an advantage offered by technology-based interventions?

A. They can increase access to care in underserved areas and settings.

B. They free up time so that service providers can care for more clients.

C. They provide alternative care options for individuals hesitant to seek in-person treatment.

D. All of the above.

Chapter 5: Recovery: The Many Paths To Wellness

62. Even after a year or two of remission is achieved, it can take _____ more years before the risk of relapse drops below 15%, the level of risk that people in the general population have of developing a substance use disorder in their lifetime.

A. 2 to 3

B. 3 to 4

C. 4 to 5

D. 5 to 6

63. A recovery coach’s responsibilities include all of the following, except for:

A. Providing strategies to maintain abstinence.

B. Providing treatment.

C. Connecting people to recovery housing and social services.

D. Helping people develop personal skills that maintain recovery.

Chapter 6: Health Care Systems and Substance Use Disorders

64. Some health care professionals are hesitant to provide patients with medication-assisted treatment because research has shown that this is substituting one addiction for another.

A. True

B. False

65. The Guideline for Prescribing Opioids for Chronic Pain, released by the CDC, is intended to:

A. Regulate necessary and appropriate opioid prescribing.

B. Inform health care professionals about some of the consequences of treatment with opioids for chronic pain and to consider, when appropriate, tapering and changing prescribing practices, as well as considering alternative pain therapies.

C. Both (A) and (B).

D. None of the above.

66. Even one alcoholic drink per day may increase the risk of:

A. Breast cancer

B. Liver disease

C. Pancreatic disease

D. Reproductive system disorders

67. Which of the following may be caused by neonatal abstinence syndrome?

A. Neurological excitability

B. Gastrointestinal dysfunction

C. Autonomic dysfunction

D. All of the above

68. A study of a large health system found that _____ women were less likely to attend substance use disorder treatment.

A. Latina

B. Asian American

C. Black / African American

D. All of the above

Chapter 7: Vision For The Future: A Public Health Approach

69. Studies show that every dollar spent on substance use disorder treatment saves $4 in health care costs and $7 in criminal justice costs.

A. True

B. False

70. Which of the following is a key finding especially important of the significant advances in prevention science?

A. Science has shown that adolescence and young adulthood are major “at risk” periods for substance misuse and related harms.

B. Most of the major genetic, social, and environmental risk factors that predict substance misuse also predict many other serious adverse outcomes and risks.

C. Several community-delivered prevention programs and policies have been shown to significantly reduce rates of substance-use initiation and misuse-related harms.

D. All of the above.

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