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Medication Assisted Treatment for Opioid Addiction - Phased Approach

Phases of Treatment

1. In general, most patients need more intensive treatment services:

A. At entry.

B. During stabilization.

C. After benchmarks of recovery begin to be met.

D. Most patients need the same level of care through all phases of treatment.

2. Patients admitted for detoxification may be treated for up to 30 days in an OTP.

A. True

B. False

3. What should occur for patients who meet Federal and State admission criteria who were admitted for detoxification but wishing to instead be admitted for comprehensive MAT?

A. Their medically supervised withdrawal from treatment medication should end.

B. Their medication should be restabilized at a dosage that eliminates withdrawal and craving.

C. Their treatment plans should be revised for long-term treatment.

D. All of the above.

4. The consensus panel believes that front-loading highly intensive services during the acute phase, especially for patients with serious co-occurring disorders or social or medical problems, engages patients in treatment and conveys that the OTP is concerned about all the issues connected to patients’ addiction.

A. True

B. False

5. Patients should be monitored closely for symptoms that interfere with treatment because immediate intervention might prevent patient dropout.

A. True

B. False

6. Patients consistently report that _____ is one of the most critical factors influencing treatment outcomes.

A. Developing coping skills

B. A strong therapeutic relationship

C. Positive reinforcement

D. Participation in peer support services

7. The consensus panel recommends that elimination of _____ be required to complete the rehabilitative phase.

A. Alcohol abuse

B. Illicit-drug use

C. Inappropriate use of substance other than alcohol and illicit drugs

D. All of the above

8. Patients who _____ are not eligible for take-home medication.

A. Continue to use illicit drugs

B. Demonstrate alcohol use problems

C. Both (A) and (B)

D. All patients are eligible for take-home medication

9. The consensus panel recommends that, before patients move beyond the rehabilitative phase:

A. They have their co-occurring disorders alleviated or stabilized.

B. They have joined supportive activities such as mutual-help, community, faith-based, peer, or acculturation groups.

C. They have gained employment.

D. They have solved all legal problems.

10. To receive the maximum 30-day supply of take-home medication, a patient must be demonstrably free from illicit substances for at least _____ of continuous treatment.

A. 6 months

B. 1 year

C. 2 years

D. None of the above

11. Patients progress in coping with their life domains should be assessed at least monthly to determine whether patients are eligible and ready for transition from supportive care to either the medical maintenance or tapering phase.

A. True

B. False

12. The consensus panel recommends random drug testing and callbacks of medication during the medical maintenance phase to make sure that patients are adhering to their medication schedules.

A. True

B. False

13. Even for patients who are rehabilitated and stable enough to qualify for medical maintenance, medication alone often is inadequate to treat their opioid addiction.

A. True

B. False

14. The consensus panel believes that a basic grounding in MAT pharmacology, the biology of addiction, and the endorphin system helps patients and treatment providers understand that _____ is a legitimate goal and commendable accomplishment.

A. Successful tapering from medical maintenance treatment.

B. Continued compliance with medical maintenance treatment.

C. Both (A) and (B).

D. None of the above.

15. Which of the following is a key indicator for transition from the tapering phase to the continuing-care phase?

A. Successful discontinuation of medication.

B. A positive self-image as someone who feels and functions well without medication.

C. Adoption of a socially productive lifestyle without involvement with substances of abuse.

D. All of the above.

Approaches to Providing Comprehensive Care and Maximizing Patient Retention

16. Studies of patients who left MAT prematurely have determined that _____ is the most important indicator of treatment outcomes.

A. Stable employment

B. Length of retention

C. Treated or stabilized co-occurring conditions

D. Home life free of drugs and alcohol

17. All of the following have been found to predict longer retention, except for:

A. Whether patient entered OTP voluntarily or by a court referral.

B. Older age of patient.

C. Less involvement with the criminal justice system by patient.

D. Patient motivation or readiness for treatment.

18. Which of the following is likely the most important factor in patient retention?

A. Clear program goals and treatment plans.

B. Adequate, individualized medication dosages.

C. Staff sensitivity.

D. A simple entry process.

19. Patients who are required to visit an OTP less frequently are _____ than patients on a daily attendance schedule.

A. Less likely to drop out of treatment.

B. More likely to use other drugs.

C. Both (A) and (B).

D. None of the above.

20. The consensus panel recommends that counseling in MAT focus on:

A. Providing support and guidance, especially to eliminate substance use.

B. Identifying problems that need extended services and referring patients for these services.

C. Providing motivational enhancement for positive changes in lifestyle.

D. All of the above.

21. Behavioral treatments such as contingency management, in which patients enter into agreements that provide positive incentives for treatment compliance, have been shown to be ineffective in MAT.

A. True

B. False

22. Cognitive behavioral therapy used in MAT is associated with:

A. Increased treatment compliance

B. Improved treatment outcomes

C. Both (A) and (B)

D. None of the above

23. Negative, punishing contingencies or threats are more effective than positive contingencies or rewards.

A. True

B. False

24. Dosage increases should be based on:

A. Good behavior

B. Evidence of withdrawal symptoms and other medical assessments

C. Both (A) and (B)

D. None of the above

25. Merely discussing heroin can be a trigger for resuming its use.

A. True

B. False

26. Which of the following is a warning sign for possible relapse that counselors and therapists should be mindful of in order to provide intervention?

A. The illusion of feeling cured after a few weeks or months of abstinence.

B. The belief that one can control his or her substance use and can use substances socially.

C. Overreactions to urges and cravings, leading to beliefs that treatment is ineffective or abstinence is unsustainable.

D. All of the above.

27. Which of the following is the first step to prevent administrative discharge?

A. Reevaluate medication dosage, plasma levels, and metabolic responses, and adjust dosage for adequacy and patient comfort.

B. Include program rules in patient orientation and education.

C. Assess co-occurring disorders, and provide psychotherapy and pharmacotherapy as needed.

D. Intensify counseling or add other types of counseling or ancillary services.

Drug Testing as a Tool

28. No reagent is commercially available at reasonable cost to test any specimens type for _____, therefore, the consensus panel recommends direct monitoring of patients receiving this medication.

A. Levo-alpha acetyl methadol

B. Methadone

C. Buprenorphine

D. All of the above

29. Urine drug tests for patients on relatively low methadone dosages may be methadone negative even though subjects have ingested medication as prescribed.

A. True

B. False

30. Which of the following tests can distinguish between drugs in a class?

A. Thin-layer chromatography

B. Enzyme immunoassay

C. Both (A) and (B)

D. None of the above

31. SAMHSA requires _____ drug tests per year for patients in maintenance treatment, which is, in the opinion of the consensus panel, the minimal requirement.

A. 4

B. 6

C. 8

D. 12

32. Reports indicating substance abuse should signal the need for:

A. A medical review of medication dosage.

B. Intensification of counseling and education aimed at preventing HIV and hepatitis transmission.

C. Both (A) and (B).

D. None of the above.

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