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Detoxification and Substance Abuse Treatment (Updated)

Overview, Essential Concepts, and Definitions in Detoxification

1. All of the following pertain to detoxification, except for:

A. Detoxification includes the acute medical management of life-threatening intoxication and related medical problems.

B. Detoxification is a set of interventions aimed at managing acute intoxication and withdrawal.

C. Detoxification denotes a clearing of toxins from the body of the patient who is acutely intoxicated and/or dependent on substances of abuse.

D. Detoxification seeks to minimize the physical harm caused by the abuse of substances.


2. A detoxification program is designed to resolve the long-standing psychological, social, and behavioral problems associated with alcohol and drug abuse.

A. True

B. False


3. Patients undergoing detoxification need to know that:

A. Someone cares about them.

B. Someone respects them as individuals.

C. Someone has hope for their future.

D. All of the above.


4. A cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems, is known as:

A. Substance abuse

B. Substance dependence

C. Substance-induced disorders

D. Substance use disorders


5. Which of the following is involved in treatment / rehabilitation?

A. Ongoing, continual assessment of the patient’s physical, psychological, and social status.

B. An analysis of environmental risk factors that may be contributing to substance use and the identification of immediate relapse triggers as well as prevention strategies for coping with them.

C. The delivery of primary medical care and psychiatric care, if necessary, to help the patient abstain from substance use and minimize the physical harm caused by it.

D. All of the above.


6. The detoxification process consists of all of the following essential components, except for:

A. Evaluation

B. Treatment

C. Stabilization

D. Fostering patient readiness for and entry into treatment


7. A successful detoxification process can be measured, in part, by whether an individual who is substance dependent enters, remains in, and is compliant with the treatment protocol of a substance abuse treatment / rehabilitation program after detoxification.

A. True

B. False


Settings, Levels of Care, and Patient Placement

8. All of the following are specific themes of historical and clinical importance to least restrictive care, except for:

A. Patients should be treated in those settings that least interfere with their civil rights and freedom to participate in society.

B. Patients should not disagree with clinician recommendations for care.

C. Patients should be informed participants in defining their care plan.

D. Careful consideration of State laws and agency policies is required for patients who are unable to act in their own self-interest.


9. The domain of detoxification refers to:

A. The reduction of the physiological and psychological features of withdrawal syndromes.

B. The process of interrupting the momentum of compulsive use in persons diagnosed with substance dependence.

C. Both (A) and (B).

D. None of the above.


10. As a general rule, outpatient treatment is just as effective as inpatient treatment for patients with mild to moderate withdrawal symptoms.

A. True

B. False


11. Ambulatory detoxification is considered appropriate only when:

A. A positive and helpful social support network is available to the patient.

B. Patients have mild to moderate withdrawal symptoms.

C. Physicians and nurses are present in the treatment setting at all times.

D. All of the above.


12. Which of the following is a requisite skill and knowledge base for assessing and treating patients undergoing detoxification?

A. Understanding how to interpret the signs and symptoms of alcohol and other drug intoxication and withdrawal.

B. Understanding the appropriate treatment and monitoring of alcohol and other drug intoxication and withdrawal.

C. The ability to facilitate the individual’s entry into treatment.

D. All of the above.


13. Primary emphasis during medically monitored inpatient detoxification should be placed on all of the following, except for:

A. Ensuring that the patient is medically stable, including the initiation and tapering of medications used for the treatment of substance use withdrawal.

B. Assessing for adequate biopsychosocial stability, quickly intervening to establish this adequately.

C. Providing 24-hour supervision, observation, and support for patients.

D. Facilitating effective linkage to and engagement in other appropriate inpatient and outpatient services.


14. Outpatient treatment should be delivered in conjunction with all components of detoxification.

A. True

B. False


15. Careful screening of patients with withdrawal symptoms is essential to reserve for inpatient treatment for those clients with possibly complicated withdrawal, such as:

A. Patients with subacute medical or psychiatric conditions that in and of themselves would not require hospitalization.

B. Those in danger of seizures or delirium tremens.

C. Both (A) and (B).

D. None of the above.


16. The American Society of Addiction Medicine placement guidelines are always the best guide to placing a patient in the proper setting at the proper level.

A. True

B. False


An Overview of Psychosocial and Biomedical Issues During Detoxification

17. Which of the following is a sign or symptom of conditions that require immediate medical attention?

A. Increasing anxiety and panic

B. Temperature greater than 100.4 degrees Fahrenheit

C. Insomnia

D. All of the above


18. All of the following may be associated with increased risk of violence, except for:

A. Heroin

B. Alcohol

C. Cocaine

D. Amphetamine


19. As a precaution, all patients who are intoxicated should be considered potentially violent.

A. True

B. False


20. All of the following are strategies for de-escalating aggressive behaviors, except for:

A. Speak in a soft voice.

B. Isolate the individual from loud noises or distractions.

C. Ensure that the patient cannot exit the examination room.

D. Offer medications when appropriate.


21. The American Psychiatric Association and the American Society of Addiction Medicine guidelines recommend a period of 1 to 2 weeks of abstinence before attempting to diagnose a psychiatric disorder.

A. True

B. False


22. An evaluation of nutritional status should occur after:

A. The patient is adequately hydrated.

B. The patient has completed detoxification.

C. Both (A) and (B).

D. None of the above.


23. Consuming excessive amounts of caffeine or sugar can compromise the detoxification process and lead to relapse.

A. True

B. False


24. Which of the following is an important and unique consideration for adolescent patients?

A. Adolescents are more likely than adults to drink large quantities of alcohol in a short period of time, making it especially important that detoxification providers be alert to escalating blood alcohol levels in these patients.

B. Adolescents are more likely than adults to use drugs they cannot identify, to combine multiple substances with alcohol, and to ingest unidentified substances.

C. Adolescents are more likely than adults to be unwilling to disclose drug use.

D. All of the above.


25. The consensus panel recommends the use of direct confrontation in helping a person with a substance use disorder begin the process of detoxification and subsequent substance abuse treatment.

A. True

B. False


26. Helping the patient understand that ambivalent feelings about changing substance use behaviors are normal and expected can be particularly useful at which stage?

A. Precontemplation

B. Contemplation

C. Preparation

D. Action


27. Patients are more likely to engage in treatment if they believe the full array of their problems will be addressed, including those needs typically addressed by wraparound services, such as housing, vocational assistance, childcare, and transportation.

A. True

B. False


Physical Detoxification Services for Withdrawal From Specific Substances

28. All of the following are common uses of biochemical markers, except for:

A. As screening or assessment instruments.

B. In the initial screening setting to support or refute other information that leads to proper diagnosis, assessment, and management.

C. For forensic purposes.

D. In detecting occult use of alcohol and other substance in therapeutic settings where abstinence, rehabilitation, and treatment are being promoted.


29. In an individual whose blood alcohol level is _____ but who is already showing tremulousness, brisk reflexes, tachycardia, diaphoresis, and perhaps a CIWA-Ar score in the moderate or high range, it can be reasonably predicted that the withdrawal will be relatively severe.

A. 100mg percent

B. 200mg percent

C. 300mg percent

D. 400mg percent


30. Gamma-glutamyltransferase elevation automatically means liver damage from alcohol use.

A. True

B. False


31. All of the following may be signs and symptoms of alcohol withdrawal, except for:

A. Restlessness, irritability, anxiety, agitation

B. Increased sensitivity to sound, light, and tactile sensations

C. Hypothermia

D. Delusions, usually of paranoid or persecutory varieties


32. Benzodiazepines remain the medication class of choice for treating alcohol withdrawal.

A. True

B. False


33. Before beginning any tapering regimen, the patient must be fully stabilized; that is, all signs and symptoms of withdrawal must be improved.

A. True

B. False


34. Doses of withdrawal medication are omitted if the patient:

A. Is sleeping soundly

B. Shows signs of oversedation

C. Exhibits marked ataxia

D. Any of the above


35. When managing delirium and/or seizures, all of the following are true, except for:

A. In most cases it is safer to overmedicate than to undertreat and allow DTs to develop.

B. Giving the patient a benzodiazepine should not be delayed by waiting for the return of laboratory studies, transportation problems, or the availability of a hospital bed.

C. Loading doses of IV diazepam or lorazepam are recommended, as are IV thiamine following IV glucose, and multiple vitamins.

D. Patients who have had a single witnessed or suspected alcohol withdrawal seizure should be immediately given a benzodiazepine, preferably with IV administration.


36. Like alcohol and sedative withdrawal, uncomplicated opioid withdrawal can be life-threatening.

A. True

B. False


37. Regulations specify that if a patient has failed two detoxification attempts in a _____ period, he or she must be evaluated for a course of treatment other than methadone.

A. 6-month

B. 12-month

C. 18-month

D. 24-month


38. Regardless of the length of time methadone is maintained, the stabilizing effect cannot reverse the immunologic or endocrinologic defects caused by long-term heroin addiction.

A. True

B. False


39. Which of the following is an advantage of clonidine over methadone in the treatment of opioid withdrawal?

A. Clonidine does not produce opioid intoxication and is not reinforcing.

B. The FDA does not classify clonidine as having abuse potential.

C. No specific licensing is required for the dispensing of this medication.

D. All of the above.


40. Why is it important for opioid detoxification to be concluded without significant patient discomfort?

A. The compassionate goal of preventing unnecessary suffering.

B. The strengthening of the therapeutic alliance between the patient and the clinician.

C. The prevention of patients from leaving treatment prematurely.

D. All of the above.


41. An often overlooked but potentially lethal “medical danger” during stimulant withdrawal is the risk of a profound dysphoria that may include suicidal ideas or attempts.

A. True

B. False


42. The most effective means of treating stimulant withdrawal involves:

A. Establishing a period of abstinence from these agents.

B. Inpatient hospitalization.

C. Medication management.

D. All of the above.


43. It can be assumed that the patient is in inhalant withdrawal when they present with:

A. A history of extensive inhalant usage.

B. A sedative-like withdrawal syndrome.

C. No significant history or laboratory data that supports other substances.

D. All of the above.


44. Nicotine withdrawal is noted by abrupt cessation of nicotine use, or reduction in the amount of nicotine used, followed within 24 hours by 4 or more signs, including any of the following, except for:

A. Insomnia

B. Anxiety

C. Increased heart rate

D. Increased appetite or weight gain


45. Nicotine withdrawal symptoms can masquerade as other psychiatric conditions, especially:

A. Bipolar disorder

B. Anxiety and depression

C. ADHD

D. All of the above


46. Which of the following improved success rates for smoking cessation?

A. The ability of patients to develop problemsolving and coping skills.

B. Gradually decreasing the number of cigarettes smoked over a period of time.

C. Relaxation training.

D. All of the above.


47. Bupropion SR should not be used in patients with:

A. A history of seizures

B. Heavy alcohol use

C. Head trauma

D. Any of the above


48. It must be emphasized that nicotine dependence is a chronic relapsing disorder and that patients often make several attempts at quitting before succeeding.

A. True

B. False


49. The most frequently seen symptoms of THC withdrawal include all of the following, except for:

A. Restlessness and irritability

B. Changes in appetite, usually anorexia

C. Diaphoresis

D. Sleep disturbances


50. Which of the following withdrawal symptoms of abrupt discontinuation of anabolic steroids is most prevalent?

A. Reduced libido

B. Fatigue

C. Depression

D. Restlessness


51. Withdrawal syndromes are more likely to be seen than overdose syndromes with GHB and may require airway and respiratory management.

A. True

B. False


52. For the contemporary drug addict, multiple drug use and addiction that includes alcohol is the rule.

A. True

B. False


53. When detoxifying a patient who has been dependent upon multiple substances, which must be addressed first?

A. Sedative-hypnotics

B. Alcohol

C. Stimulants

D. Opioids


54. All of the following are true with regard to acupuncture, except for:

A. Acupuncture is one of the more widely used alternative therapies within the context of addiction treatment.

B. Acupuncture has been viewed as an effective adjunct to treatment for alcohol and cocaine disorders, and it also has played an important role in opioid treatment.

C. Acupuncture is recommended as a stand-alone treatment for opioid withdrawal.

D. All of the above are true.


55. Ideally, programs detoxifying pregnant women from alcohol and illicit drugs should include which of the following?

A. Detoxification on demand

B. Woman-centered medical services

C. Transportation services to and from detoxification

D. All of the above


56. When pregnant women are detoxified from alcohol, long-acting benzodiazepines are the practice of choice.

A. True

B. False


57. Comprehensive care for the pregnant woman who is opioid dependent must include a combination of all of the following, except:

A. Detoxification

B. Methadone maintenance

C. Prenatal care

D. Substance abuse treatment


58. One of the most important practices that should be in place as a standard in any detoxification setting is routine screening for disabilities and co-occurring medical and/or psychiatric conditions.

A. True

B. False


59. African Americans are more likely to have less of the enzyme activity needed to eliminate _____ than others, so it may have a longer half-life in African Americans than it does in other ethnic groups.

A. Methadone

B. Diazepam

C. Carbamazepine

D. Phenobarbital


Co-Occurring Medical and Psychiatric Conditions

60. Urgent attention is needed if the patient is diagnosed with which of the following?

A. Abdominal aortic aneurysm

B. Perforated peptic ulcer

C. Obstructed or strangulated bowel

D. Any of the above


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