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Medication for the Treatment of Alcohol Use Disorder

Introduction

1. Although many experts in addiction believe that patients with moderate or severe alcohol related problems should be offered medication-assisted treatment (MAT) on a routine basis, considerable resistance to the use of MAT persists.

A. True

B. False


Considering Medications

2. Which of the following is an accurate statement about the use of medications approved for the treatment of alcohol use disorder?

A. Acamprosate calcium is recommended for selected patients who want to remain in a state of enforced sobriety so that supportive and psychotherapeutic treatment may be applied to best advantage

B. Oral naltrexone is indicated for the maintenance of abstinence from alcohol in patients dependent on alcohol who are abstinent at treatment initiation

C. Disulfiram is indicated for the treatment of alcohol dependence

D. Extended-release injectable naltrexone is indicated for the treatment of alcohol dependence in patients who have been able to abstain from alcohol in an outpatient setting


Screening and Assessing Patients

3. Screening for risky alcohol use is especially important in patients who are pregnant or trying to conceive, are at risk for binge drinking or heavy drinking, have one or more chronic health problems, and have social or legal problems that may be caused or worsened by alcohol use.

A. True

B. False


Assessing the Need for Medication-Assisted Treatment

4. A patient who reports five or more heavy drinking days in the past year should receive further assessment to determine severity of at-risk drinking and to provide brief interventions as needed.

A. True

B. False


Physical Examination

5. During the assessment process, the physical examination should evaluate neurocognitive function, identify sequelae of alcohol use, and look for evidence of:

A. Skin changes related to alcohol use

B. Abnormal swelling

C. Rectal bleeding or urine abnormalities

D. Hepatic dysfunction


Developing a Treatment Plan and Selecting a Medication

6. Steps to achieve the patient’s goal should be outlined in a treatment plan, which should be developed in consultation with the patient and address each of the following points EXCEPT:

A. The medication and other therapies to be employed, with a rationale for their use

B. Reasons for participation in mutual-help groups

C. Ways to access social, educational, employment and other community resources

D. Involvement of family or significant others in treatment


Evaluating the Need for Medically Managed Detoxification

7. Alcohol withdrawal syndrome can be severe and potentially fatal, and generally begins within ________ after the blood alcohol level drops and can persist for ________.

A. 24-48 hours; 5-7 days

B. 12-36 hours; 3-5 days

C. 18-42 hours; 7-9 days

D. 6-30 hours; 4-6 days


Addressing Co-Occurring Disorders

8. Research studies show that the most effective way to treat co-occurring disorders is through integrated treatment, which is defined as any mechanism by which treatment interventions for multiple co-occurring disorders are delivered within the context of a primary treatment relationship or service setting.

A. True

B. False


Treating Older Adults

9. Alcohol and other substance use are significant problems among older adults, and clinicians need to recognize the various challenges that impact this age group, including shame, the problem being ignored or minimized, and:

A. Lack of access to health care because of mobility issues

B. Misdiagnosis

C. The limited number of providers who have experience with this population

D. Poor follow-through


10. Pharmacotherapies for alcohol use disorder appear to be significantly less effective and less safe for older adults than for younger adults.

A. True

B. False


Selecting a Medication

11. Disulfiram, which was approved by the FDA as an alcohol abuse deterrent in 1951, disrupts the metabolism of alcohol, resulting in an unpleasant reaction, which can be severe whenever an individual taking disulfiram consumes alcohol.

A. True

B. False


Clinical Recommendations

12. Patients who are good candidates for treatment with disulfiram include:

A. Those who are motivated for treatment and want to achieve abstinence

B. Those who are medically appropriate and who can receive supervised dosing

C. Those who understand the consequences of drinking alcohol while taking disulfiram

D. All of the above


Naltrexone Efficacy

13. Short-term outcomes in favor of naltrexone included fewer patients relapsing to alcohol dependence, fewer patients returning to drinking, reduced craving for alcohol, and:

A. Greater ability to adhere to treatment

B. Higher success rates for adolescents and older adults

C. Fewer drinking days

D. Safe use with pregnant and nursing women


Clinical Recommendations: Oral Naltrexone

14. For patients who have a history of opioid use disorder and who are seeking treatment for an alcohol use disorder, naltrexone reduces the reinforcing effects of and curbs cravings for both opioids and alcohol.

A. True

B. False


Acamprosate

15. Although acamprosate has been shown to be an effective treatment for dependence on alcohol, there is significant potential for abuse among some populations and for interaction with medications commonly used to treat substance use and mental disorders.

A. True

B. False


Medication-Assisted Treatment

16. Which of the following is NOT one of the recommended steps in initiating treatment with disulfiram?  

A. Confirm the absence of allergy to disulfiram

B. Wait until the patient has abstained from alcohol for at least 24 hours

C. Perform an electrocardiogram if clinically indicated

D. Administer liver and kidney function tests to determine baselines after stabilization


Special Considerations in Pain Management

17. Pain management for patients using extended-release injectable naltrexone can be even more complicated than for those taking oral naltrexone, because of the long-acting nature of the injectable formulation.

A. True

B. False


Co-Occurring Medical Conditions and Complications

18. Individuals with alcohol use disorder are at high risk for co-occurring medical conditions, and patients who present to emergency departments and trauma centers with serious injuries are far more likely than members of the general population to have engaged in recent use of alcohol.

A. True

B. False


Monitoring Patient Progress

19. Monitoring patient progress is an ongoing process, during which the patient is assessed on adherence to the treatment plan, duration of and ability to maintain abstinence or reduced drinking, reduced cravings, and:

A. Improvement in quality of life factors

B. Ability to participate in MAT without side effects or extreme discomfort

C. Overall health status and social functioning

D. Level of involvement in ongoing recovery and treatment programs


Summary

20. As improvements are made in the quality and quantity of treatment options that are included in the Patient Protection and Affordable Care Act (ACA), there is considerable potential for expanding the use of medication-assisted treatment as clinicians recognize their safety, efficacy, and:

A. Necessity

B. Treatment implications

C. Advantages

D. Cost-effectiveness


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