Ch. 15 - Alcohol and Substance Use Disorders Flashcards
Why is alcohol and substance use a concern in life underwriting?
Because it can significantly increase mortality risk due to health complications, accidents, and co-morbid conditions.
What is the difference between substance use and substance use disorder?
Substance use is occasional or recreational; a disorder involves dependency, addiction, or impaired functioning.
What are the two most common substances of concern in underwriting?
Alcohol and opioids.
What are signs of problematic alcohol use in an application?
History of DUI, legal problems, job loss, medical concerns, or treatment for alcoholism.
What health issues are associated with alcohol use disorder?
Liver disease, pancreatitis, hypertension, cardiac issues, gastrointestinal bleeding, and neurological impairment.
What is a key underwriting concern with intravenous drug use?
Increased risk of infections such as HIV and hepatitis.
What is the standard underwriting approach to current substance abuse?
Usually postponed or declined due to high risk.
What is important when assessing a history of substance use disorder?
Time since last use, treatment history, relapses, and current stability or support systems.
What evidence supports a more favorable risk decision for past substance use?
Long-term sobriety, successful rehab, support group participation, negative lab results, and stable lifestyle.
What underwriting tools are helpful for alcohol/substance history?
Attending physician statements, lab results (e.g., liver function tests), motor vehicle reports, and questionnaires.
What liver enzymes might be elevated in someone with heavy alcohol use?
GGT (gamma-glutamyl transferase), AST, ALT.
What is CDT and why is it used?
Carbohydrate-Deficient Transferrin – a biomarker specific to heavy alcohol use.
What is the significance of a DUI in underwriting?
Suggests risky behavior; multiple DUIs may indicate alcohol dependence and raise mortality risk.
How long must sobriety typically be maintained for standard consideration?
Often 2–5 years depending on the severity and other risk factors.
What is considered in a substance abuse questionnaire?
Type of substance, duration, frequency, treatment history, relapses, and current support or lifestyle.
What role do support systems play in risk evaluation?
Strong support (family, job, treatment programs) can reduce relapse risk and improve underwriting outcomes.
What is co-morbidity and how does it relate to substance abuse?
The presence of additional health conditions (e.g., depression, liver disease) that compound mortality risk.
What psychiatric conditions commonly co-occur with substance use disorders?
Depression, anxiety, bipolar disorder, and personality disorders.
What is the general approach to a recovered alcoholic applying for coverage?
If recovery is stable with no relapses and good medical follow-up, they may qualify for standard or mildly rated coverage.
Why are drug screens or labs important in underwriting substance use?
Provide objective evidence of current use or abstinence to support decision-making.
All the following statements regarding benefits from obtaining a prescription database during the underwriting process are correct EXCEPT:
1. it can identify increased patterns of specific drug use
2. it can provide information about the number and type of drugs being prescribed
3. it can accurately identify all the prescription drugs the proposed insured is using
4. it can alert the underwriter to multiple doctors prescribing similar medications
- it can accurately identify all the prescription drugs the proposed insured is using
Alcohol abuse is associated with elevation of all the following blood tests EXCEPT:
1. MCV
2. HDL
3. GGTP
4. BUN
- BUN
Complications of cocaine use include which of the following?
A. respiratory failure
B. seizures
C. arrhythmias
A, B, and C are correct
A need for markedly increased amounts of alcohol to achieve intoxication is:
1. dependence
2. abuse
3. withdrawal
4. tolerance
- tolerance
