Chapter 10 Flashcards by Renee English

In most countries globally, non-medical use of psychoactive substances is illegal (apart from alcohol). What is the exception?
A) Cannabis 
B) Morphine 
C) Cocaine 
D) Heroin

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Define addiction
A) It’s largely understood to involve some of the following: use of a substance or participation in a problematic behaviour, unsuccessful attempts to control use, compulsiveness, and withdrawal
B) Reliance on a substance or behaviour. Can be physical or psychological.
C) An approach that aims to make drug use or addictive behaviours safer and less stigmatized, often involving aspects of public policy to accomplish this aim
D) A social movement that advocated for the complete prohibition of alcohol

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Define harm reduction
A) It’s largely understood to involve some of the following: use of a substance or participation in a problematic behaviour, unsuccessful attempts to control use, compulsiveness, and withdrawal
B) Reliance on a substance or behaviour. Can be physical or psychological.
C) An approach that aims to make drug use or addictive behaviours safer and less stigmatized, often involving aspects of public policy to accomplish this aim
D) A social movement that advocated for the complete prohibition of alcohol

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Define dependence
A) It’s largely understood to involve some of the following: use of a substance or participation in a problematic behaviour, unsuccessful attempts to control use, compulsiveness, and withdrawal
B) Reliance on a substance or behaviour. Can be physical or psychological.
C) An approach that aims to make drug use or addictive behaviours safer and less stigmatized, often involving aspects of public policy to accomplish this aim
D) A social movement that advocated for the complete prohibition of alcohol

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Define temperance movement
A) It’s largely understood to involve some of the following: use of a substance or participation in a problematic behaviour, unsuccessful attempts to control use, compulsiveness, and withdrawal
B) Reliance on a substance or behaviour. Can be physical or psychological.
C) An American campaign, initiated by Richard Nixon, to decrease drug use and trade
D) A social movement that advocated for the complete prohibition of alcohol

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Define War on Drugs
A) It’s largely understood to involve some of the following: use of a substance or participation in a problematic behaviour, unsuccessful attempts to control use, compulsiveness, and withdrawal
B) Reliance on a substance or behaviour. Can be physical or psychological.
C) An American campaign, initiated by Richard Nixon, to decrease drug use and trade
D) A social movement that advocated for the complete prohibition of alcohol

Since the 1970s, the War on Drugs has advocated for stricter criminal punishment for drug use and distribution.

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Addiction essentially represents the __________ consumption of a substance or repetitive engagement in an activity that is considered problematic
A) Repetitive
B) Nonrepetitive

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The idea that these problematic behaviours were in fact an addiction, and not something else, emerged in the \_\_\_\_\_\_\_\_\_ century.
A) 19th
B) 17th
C) 18th
D) 20th

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True or False?
Temperance advocates, who frequently had ties with emerging forms of Christianity, identified the main problem as the alcohol or drug itself, not necessarily the consumer.

True

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True or False?

Addiction can be shaped by a number of external factors, including age, housing status, the city in which you live.

True

Maxine’s story from textbook

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In 1964, a WHO expert committee introduced the term dependence to replace the terms \_\_\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_\_\_.
A) tolerance, withdrawal
B) addiction, habituation 
C) tolerance, habituation 
D) addiction, withdrawal

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True or False?

Dependence is typically assumed to be physiological in nature

True

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The key terms of dependence are:
A) tolerance, withdrawal
B) addiction, habituation 
C) tolerance, habituation 
D) addiction, withdrawal

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Define tolerance
A) The idea that one needs more of a substance to achieve the same effect
B) The idea that one needs less of a substance to achieve the same effect
C) A set of unpleasant symptoms, ranging from headaches to hallucinations, that people experience when stopping substance use
D) A set of pleasant symptoms

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Define withdrawal
A) The idea that one needs more of a substance to achieve the same effect
B) The idea that one needs less of a substance to achieve the same effect
C) A set of unpleasant symptoms, ranging from headaches to hallucinations, that people experience when stopping substance use
D) A set of pleasant symptoms

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True or False?
The word “addiction” has returned in the current version of the Diagnostic and Statistical Manual (DSM-5), in a section now called “Addiction and Related Disorders.”

False
The word “addiction” has returned in the current version of the Diagnostic and Statistical Manual (DSM-5), in a section now called “Substance Use and Addictive Disorders.”

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Define one major reason for the use of cannabis.
A) It’s fun to use
B) People enjoy using it and they don’t care what health authorities tell them
C) People aren’t aware of the side effects of cannabis
D) Cannabis use is often understood as largely benign, since there is less of a risk for dependence when compared to many other substances, both licit and illicit, such as nicotine or heroin

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What is a Schedule 1 drug?
A) A toxic drug
B) A drug who usage has resulted in over 50 deaths per year
C) A drug seen as having a low tendency for abuse
D) A drug seen as having a high tendency for abuse

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What is the National Institute on Drug Abuse or “hijacked” brain model of addiction?
A) A model that highlights the negative side effects of drugs
B) A general notion that addiction is something that involves compulsiveness, loss of control, and continued use despite negative consequences, and initially, pleasurable or rewarding behaviour can lead, in some individuals, to the subsequent development of compulsion or addiction with commonalities of neurochemical change being found between chemical and non-chemical addictive disorders
C) A model that highlights the positive side effects of drugs
D) A model that highlights the negative side effects of drugs and votes to get rid of drugs, altogether

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What is the basic premise of most people’s understanding of addiction?
A) That it is a disease that robs individuals of their ability to exercise their will
B) That it is a chronic disease
C) That it is an acute disease

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What does CBD stand for?
A) Cognitive behavioural disease
B) Cognitive behavioural dysfunction 
C) Compulsive buying disorder
D) Compulsive brain disorder

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How is CBD characterized?
A) A form of electric shock treatment
B) A type of psychoactive drug
C) Characterized by excessive shopping cognitions and buying behavior that leads to distress or impairment
D) Characterized by excessive shopping cognitions and buying behavior that leads to higher energy levels and happiness

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Found worldwide, CBD has a lifetime prevalence of \_\_\_\_\_\_\_ in the US general population.
A) 6.7% 
B) 5.8% 
C) 4.9%
D) 13%

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True or False?

Most subjects studied clinically for CBD are women (~80 per cent), though this gender difference may be artifactual.

True

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True or False? There are no standard treatments for CBD, and compulsive shopping tends to run in families that are full of mood and substance use disorders

True

``` Which of the following is a contemporary issue? A) The use of cannabis B) The use of social media C) Talk therapy D) The opioid crisis ```

True or False? Over the last 60 years, Alcoholics Anonymous (AA) and other related programs, such as Narcotics Anonymous and Gamblers Anonymous, have come to dominate the narrative of addiction and recovery

True

``` Alcoholics Anonymous (AA) was founded in the United States in ________. A) The 1950s B) The 1970s C) The 1940s D) The 1930s ```

``` AA has its origins in the _________, a popular religious movement in early twentieth-century Europe and America. A) Oxford team B) Oxford group C) Tribecca team D) Tribecca group ```

Which of the following is false about the Oxford Group? A) Its members studied geography B) Its members practised self-reflection C) Its members practised admitting their wrongdoings, making amends, praying, meditating, and preaching their message to others D) Its members practised self-improvement

The connection between alcoholism and the Oxford Group was formed when ____________, an alcoholic from Rhode Island, visited psychoanalyst __________ for help with his addiction, and was told he was medically hopeless and that his addiction could only be adequately addressed through a spiritual experience. A) Rowland Hazard, Edwin (“Ebby”) T. B) Carl Jung, Edwin (“Ebby”) T. C) Rowland Hazard, Carl Jung

``` Rowland and his friend, Edwin (“Ebby”) T., discovered they were able to avoid drinking by adhering to the Oxford group’s principles, and the success of the group eventually reached the ears of _________, a Wall Street stockbroker whose career had been affected by ___________. A) Bill W., depression B) Bill W., anxiety C) Bill W., alcoholism D) Bill W., marital abuse ```

``` After another hospitalization for alcoholism in _________, Bill had a _________ with the Oxford Group and began spreading the word of Alcoholics Anonymous. A) 1955, physical experience B) 1955, spiritual experience C) 1934, physical experience D) 1934, spiritual experience ```

``` Who were the co-founders of Alcoholics Anonymous (AA)? A) Bill W. and Edwin (“Ebby”) T. B) Bill W. and Dr Bob Smith C) Dr Bob Smith and Carl Jung D) Rowland Hazard and Carl Jung ```

True or False? Psychoanalysis viewed addiction as being the result of underlying neurosis and psychic conflict, rather than the central problem itself

True

Mental, physical, and sexual abuse in childhood is known to ____________ vulnerability to addiction in adult life, as are genetic factors. A) Increase B) Decrease

``` Which of the following drugs has been marketed for people trying to reduce alcohol consumption in the context of mild to moderate dependency? A) Heroin B) Disulfiram C) Nalmefene D) Naltrexone ```

C (Nalmefene seems to act by reducing the rewarding and pleasurable effects of alcohol by dampening certain neurochemical consequences of its use)

The War on Drugs was formally introduced by President Richard Nixon with the aim of ___________. A) Ending the international drug trade through the use of military force B) Increasing the international drug trade through the use of military force C) Decreasing the international drug trade through the use of military force, but not ending it

True or False? | Rates of drug consumption and drug addiction have been radically reduced over the course of the War on Drugs.

False (Despite tremendous sums spent carrying out this war and enforcing harsh drug laws, rates of drug consumption and drug addiction have not been radically reduced over the course of the War on Drugs. In fact, rates of addiction might actually have increased during this period.)

True or False? | Harm reduction models seek to produce absolute abstinence from drug use

False (Harm reduction models do not overtly seek to produce absolute abstinence from drug use, but instead work to minimize the harmful effects through non-judgmental and non-coercive services.)

``` Which of the following states have begun to push for the decriminalization—or even full-scale legalization—of illicit narcotics? A) Switzerland and Canada B) Switzerland and the United States C) Portugal and the United States D) Switzerland and Portugal ```

True or False? | Harm reduction does not explicitly aim to punish the addict, or even necessarily get them to cease using drugs

True

``` Which of the following is not an illicit (highly addictive and illegal substances) drug? A) Heroin B) Cocaine C) Cannabis D) Prescription opioids E) All of these are illicit drugs ```

Which term has replaced “drug addiction” in the ICD? A) Drug tolerance B) Drug dependence C) The term hasn’t been replaced and remains “drug addiction” D) Drug use

``` When was a distinction between “normal” drinking and “abnormal” drinking made? A) In the 18th century B) In the 20th century C) In the 16th century D) In the 17th century ```

``` If we see addiction as a disease, we are likely to favour ___________ to addiction. A) Criminal Justice (punitive) responses B) Systemic or social drivers (causes) C) medical responses D) severe responses ```

``` If we see addiction as a bad behaviour (moral view), we are likely to favour ___________ to addiction. A) Criminal Justice (punitive) responses B) Systemic or social drivers (causes) C) medical responses D) severe responses ```

``` If we consider social determinants of health, we might look at ___________ of addiction. A) Criminal Justice (punitive) responses B) Systemic or social drivers (causes) C) medical responses D) severe responses ```

True or False? In the 1900s, the term “addiction” was applied to a wide range of compulsive behaviours, including gambling, shopping, and sex.

True

``` The term ________ became common in the mid 1960s, replacing ________, and referring to physiological dependence. A) tolerance, “addiction” B) tolerance, “dependence” C) addiction “withdrawal” D) dependence, “addiction” ```

True or False? | The DSM-5 uses the term “addiction”

True

To diagnose dependence, ICD-11 focuses on the following criteria, except: A) Impaired control over substance use B) Increasing anxiety and depression levels from the drug C) Substance use becoming an overriding priority in the user’s life D) Tolerance to or withdrawal symptoms from the drug

True or False? | ICD focuses on 3 criteria, and any 2 quality as a diagnosis

True

True or False? | Principles of drug dependence do not apply equally to all psychoactive substances

True

Which of the following is not true about how drugs cause harm? A) Intoxication (accidents, violence, injury) B) Acute harms (drug-induced psychosis, overdose) C) Chronic harms (long-term use = organ damage) D) Dependence or substance use disorders (leads to prolonged use in a high risk pattern) E) Social problems (unemployment, partner/child abuse) F) Direct harms

F | Should be: “Indirect harms (incarceration for drug offences”

Which of the following is not true about how alcohol causes harm? A) Intoxication B) Acute effects C) No chronic effects D) Dependence E) Social problems (unemployment, violence, etc.) F) Toxic effects

C | Chronic effects

True or False? A mediator is an intervening or intermediate factor (Eg. Intoxication) that occurs in a causal pathway from a risk factor (Eg. Alcohol consumption) to a health or social problem (Eg. Accidental injury)

True

Drinking patterns are characterized by the following, except: A) Gender of the individual B) Frequency of drinking C) Quantity per occasion D) Variation between one occasion and another

Which problem might sustained drinking (wine producing countries) patterns lead to? A) May not produce intoxication, but may cause tissue damage and dependence B) Can lead to cirrhosis due to cumulative effects on the liver C) Low frequency/High number of drinks per occasion might lead to medical and social problems

Which problem might daily drinking patterns lead to? A) May not produce intoxication, but may cause tissue damage and dependence B) Can lead to cirrhosis due to cumulative effects on the liver C) Low frequency/High number of drinks per occasion might lead to medical and social problems

Which problem might binge drinking patterns lead to? A) May not produce intoxication, but may cause tissue damage and dependence B) Can lead to cirrhosis due to cumulative effects on the liver C) Low frequency/High number of drinks per occasion might lead to medical and social problems

``` Which of the following is not one of the 3 aspects of use shaping risk/harm? A) Dose B) Pattern of use C) Emotions and reactions after use D) Mode of administration ```

``` Which of the following is not one of the 3 dimensions to consider in relation to each substance? A) Organic or inorganic use B) Natural or synthetic form C) Route of administration D) Medicinal or non-medicinal use ```

True or False? The AA model claims that people with addiction are intrinsically predisposed to addiction, and different from “normal” people

True

``` Which of the following is not an action AA suggests using to help oneself heal/recover from addiction? A) Prayer B) Self-reflection C) Self-improvement D) Despising yourself for your addiction ```

True or False? The AA model has been adopted for a wide variety of addictive substances and behaviours, beyond alcohol and other substances to include gambling, shopping, etc.

True

Which of the following is not one of the consequences related to medicalization (disease model)? A) Arguably refuses individual responsibility and imperative to improve/reform B) It helps the individual improve/reform themselves C) Decreases emphasis on social, economic, and cultural contexts in shaping substance use and outcomes D) Less attention to systemic and underlying issues if we view it solely as a medical problem

Which of the following is true about public health? A) It tends to adopt a very biological view B) It tends to adopt a very individually-focused, brain based view C) It doesn’t focus on individuals in context (generalizes) D) It tends to focus more on individuals in context and the role of socio-cultural influences in shaping behaviour and outcomes

Which of the models of addiction focuses on the individual? A) Medical model B) Public Health: social model, bio-psycho social, risk-reduction interventions C) Moral model

Which of the models of addiction focuses on the environment? A) Medical model B) Public Health: social model, bio-psycho social, risk-reduction interventions C) Moral model

Which of the models of addiction focuses on the substance? A) Medical model B) Public Health: social model, bio-psycho social, risk-reduction interventions C) Moral model

``` The risk environment framework does not include which of the following: A) policy B) social C) physical D) economic E) individual F) psychological ```

Define risk environment A) “The space - whether social or physical - in which a variety of factors interact to increase/decrease the chance of (drug-related) harm occurring” B) Wider range of disruptive, repetitive, compulsive behaviours including gambling, shopping, etc.

True or False? The premise of risk environment is that risks/drug use are often driven by interactions between individual, social, and structural factors

True

True or False? | Compulsive shopping is recognized as a distinct behavioural addiction in the DSM-5

False | Compulsive shopping is not recognized as a distinct behavioural addiction in the DSM-5

``` The 1939 manual describing the path to sobriety - “Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism” - is also known as: A) “The Only Book” B) “The Main Book” C) “The Big Book” D) “The Bible ```

``` Which of the following blocks the effects of opioids and = no high euphoria? A) Naltrexone B) Alcohol C) Heroin D) Psychotherapy ```

``` In the 1950s, researchers investigated therapeutic use of psychedelic drugs, such as _______, in the treatment of __________, and success rates reported to be _________. A) NHL, alcohol poisoning, 90% B) NFL, alcohol dependence, 50% C) LSD, alcohol dependence, 50-90% D) MFR, alcohol withdrawal, 50-90% ```

Which of the following is not an unintended consequence of criminalization: A) Constrains opportunities for regulation measures due to prohibition and unregulated markets (key policy approaches we use with alcohol are not available) B) Interferes with provision of risk-reduction efforts, including evidence-based HIV/AIDS prevention and treatment of BBV C) All of these are unintended consequences of criminalization D) Drives many harms stemming from illicit drugs, including transmission of HIV and other blood-born viruses E) Marginalization and stigma reduce engagement with the healthcare system, leading to poor care experiences, and barriers to treatment

``` Globally, the primary response to drug use is: A) Prohibition and justification B) Prohibition and criminalization C) Prohibition and dependence D) Criminalization and independence ```

True or False? The dominant societal response to drug use is arrest and incarceration, and this impacts people who inject drugs particularly heavily

True

True or False? | Drug use continues behind bars

True

``` Approximately ________ of random urinalysis tests positive for opiates, cocaine, cannabis, or alcohol in Canadian federal penitentiaries A) 14% B) 21% C) 12% D) 41% ```

``` ________ of injectors reported injecting in custody in the past year in 6 Ontario prisons. A) 14% B) 41% C) 21% D) 11% ```

True or False? | Harm reduction is cost-effective, evidence-based, and incremental.

True

Incidence refers to: A) the proportion of persons in a population who have a particular disease or attribute at a specified point in time or over a specified period of time B) the occurrence of new cases of disease or injury in a population over a specified period of time C) the occurrence of old cases of disease or injury in a population over a specified period of time

Define prevalence: A) the proportion of persons in a population who have a particular disease or attribute at a specified point in time or over a specified period of time B) the occurrence of new cases of disease or injury in a population over a specified period of time C) the occurrence of old cases of disease or injury in a population over a specified period of time

True or False? | Incidence includes all cases, both new and pre-existing

False | That’s prevalence. Incidence is limited to new cases only.

Which of the following is not a factor contributing to medicalization of mental illness? A) Challenges to the authority and power of the Church in Europe B) The scientific revolution (idea that science could solve problems) C) The Enlightenment (skepticism about religion) D) Increased urbanization (led to increased visibility of people who appeared “mad”) E) None of the above

“Hallucinations” are best described as (choose from the following terms): A) lack of motivation or ability to complete tasks of daily living B) fixed false beliefs C) negative symptoms D) a sensory experience that occurs without any stimulus

``` Which class of medications does the drug “diazepam” (Valium) fall into? A) Benzodiazepines B) Atypical antipsychotics C) Typical antipsychotics D) Antidepressants ```

As 2 key components of “dependence,” tolerance is described as _______, while withdrawal refers to ________. A) unpleasant symptoms accompanying cessation or reduction of consumption, requiring more of a substance to achieve desires effect B) requiring more of a substance to achieve desired effect, unpleasant symptoms accompanying cessation or reduction of consumption C) requiring more of a substance to achieve desired effect, compulsion to use despite recognition of negative consequences D) unsuccessful efforts to cease or reduce use of the substance, unpleasant symptoms accompanying cessation or reduction of consumption

``` Which class(es) of medications does the drug Lithium (Lithobid) fall into? A) Antidepressant B) Anti-anxiety C) Antipsychotic D) Mood stabilizers E) A and B ```

``` Acrophobia is the fear of __________, and trypanophobia is the fear of _________. A) Spiders, needles or syringes B) Open spaces, water C) Heights, needles or syringes D) Entrapment, needles or syringes ```

True or False? The over-prescribing of opioids for chronic pain, which contributed to increasing levels of opioid dependence in North America, can be viewed as an example of iatrogenic harm.

True

True or False? The increasing contamination of the illegal drug supply, with illicitly manufactured (illegal market) fentanyl, can be viewed as an example of iatrogenic harm.

False