LMBR9: TOBACCO & ALCOHOL MCQs 3 EtOH

Question 1

What proportion of US adults exceed the NIH daily limits for alcohol at least once per year ?

What is the breakdown of EtOH use disorder in these people ?

BR 300

Answer 1

• 30% (~ 1/3) of US adults exceed NIH EtOH daily limits at least once/year
• Breakdown:

26% are ‘at risk drinkers’ or have mild EtOH use disorder

3% have moderate EtOH use disorder

1% have severe EtOH use disorder

BR 300

Question 2

What proportion of people with alcohol use disorder receive appropriate assessment and treatment from primary care providers ?

BR 300

Answer 2

• 10%

BR 300

Question 3

Is addiction counselling the only option for subjects with mild to moderate alcohol use disorder ?

Is there any role for brief advice by a health care provider ?

BR 300

Answer 3

No - anti-relapse medication plus medical managment is as effective at addiction counselling for mild-moderate alcohol use disorder.

Identification and brief advice by a health care provider is an effective way to reduce drinking & its risks (USPSTF grade B)

BR 300

Mn: “If M-M use MM+M”

Question 4

17 million adults in the US have some form of alcohol use disorder, 30% of adults exceed daily limits at least once per year, why is this so important

a. Excess alcohol is associated with 50% of all cancers
b. Excess alcohol is associated with 60% of all injuries
c. Excess alcohol is related to 7% of all deaths including road crash injury, cancer, and suicide
d. 10,000 deaths per year are attributable to alcohol
e. 1 million lives a year are lost due to alcohol

BR 300

Answer 4

Answer C

• 88,000 deaths/yr in US from EtOH
• 2.5 million yrs of life lost/yr in US from EtOH

Question 5

What proportion of some common health outcomes are due to alcohol ?

Total # US deaths/yr & YOL Lost
BR 300

Answer 5

Excessive alcohol use assoc with:
20% of all unintentional injuries

10% of all cancers

7% of all deaths including:

• car accidents
• cancer
• suicide

USA:

• 88,000 deaths/yr
• 2.5 million YOL lost per yr in US adults

Question 6

What some standard definitions of amounts for

a) Beer
b) Table wine
c) Liquor (80 proof)
d) Drinks in a wine bottle (750 ml)
e) Drinks in “fifth” of spirits (amt = __)
f) Drinks in 1 L spirits

BR 301

Answer 6

Standard definitions of amounts for

a) Beer = 12 oz = 340 g
b) Table wine = 5 oz = 142 g
c) Liquor (80 proof) = 1.5 oz = 43 g
d) Drinks in a wine bottle (750 ml) = 5 drinks
e) Drinks in “fifth” of spirits (amt = 750 ml)= 18 drinks
f) Drinks in 1 L spirits = 24 drinks

Question 7

All of the following are true except

a. Heavy drinking increases the risk for hypertension, stroke, unintentional injuries, cancer
b. Moderate alcohol consumption can have some health benefits, but likely due to the health properties of grapes and you can acquire the same benefits by eating the grapes

c. High risk for alcohol misuse is seen in Northeast, upper Midwest, Alaska, Hawaii
d. Higher prevalence seen in ages 18-34, whites, higher income, men, smokers, psychiatric patients, trauma patients and positive family history
e. All of the above are true

BR300

Answer 7

Answer E

Question 8

Name 4 diseases that heavy drinking puts you at an increased risk for

BR 300

Answer 8

4 diseases that heavy drinking puts you at an increased risk for:

S - Stroke

H - High blood pressure

U - Unintentional injuries (20% of all “ )

N - Neoplasm (10% of all cancers)

cf smoking => 1 in 3 cancers.

Question 9

Smoking(BR289)

a. Causes 32% of coronary heart disease deaths
b. 40+ cancers are related to tobacco use
c. Can cause cancer in almost every part of the body
d. Causes one in three cancer deaths
e. All of the above

Answer 9

Answer E

Question 10

Which of the following is correct regarding typical alcohol in the US(BR301)

a. Standard beer is 12 oz
b. Standard wine is 5 oz
c. 1.5 oz is shot of 80 proof spirit
d. 750ml wine bottle = 5 drinks
e. 750ml fifth of spirits = 18 drinks
f. 1 L spirits = 24 drinks
g. All of the above are true

Answer 10

Answer G

Question 11

Which of the following is accurate drinking guideline by NIH(BR301)

a. Men no more than 4 drinks on any day
b. Men no more than 14 drinks in a 7 day week
c. Women no more than 3 drinks in any day
d. Women no more than 7 drinks in any 7 day week
e. All of the above are true

Answer 11

Answer E

Question 12

What is binge drinking ?

How many drinks (time) is this ?

What is “heavy alcohol use” ?

BR 301

Answer 12

Binge drinking is drinking enough that [EtOH] increases to 0.08 mg/L

• Men: 5 drinks in 2 hrs
• Women: 4 drinks in 2 hrs

Heavy alcohol use is binge drinking on more than 5 days in the past month.

Question 13

According to the NIH low risk drinking guidelines:

a) What is low risk for intake of alcohol: per day ? per week ? (for men / women)
b) Define & give 3 examples of ‘at risk’ drinking

Which patient would you call ‘alcoholic’ (or suffering from alcoholism) ?

BR 301

Answer 13

a) Low risk (M/F):
- daily <= 4/3 drinks
- weekly <= 14/7 drinks
b) At risk= increased risk of future problems, even though there are no current symptoms.
- if exceed above
- if binge 1/month (or more)
- ‘alcholic’ and ‘alcoholism’ are imprecise & stimatizing - no longer used (‘alcohol use disorder’)

Question 14

Alcohol use problems - which is true:

a. Appropriate terms to refer to patients are alcoholics and alcoholism
b. binge drinking is blood alcohol of 1.0mg/L
c. Binging more than 3 days in the month is considered heavy alcohol use
d. At risk drinking is one that exceeds levels above for any day or week, binging once per month, or drinking that increases risk of future problems, even though there are no current symptoms
e. Alcohol use disorder is not an appropriate term because it is a continuous spectrum

BR 301

Answer 14

Answer D

• binge if blood [EtOH] > 0.08 mg/L
• ‘heavy EtOH use’ if > 5 days past month

Question 15

Common symptoms of alcohol use disorder are

a. Significant distress or impairment with 10% developing external consequences
b. Impaired control over use
c. Cravings and preoccupations
d. Persistent desire to cut down but unsuccessful

e. Use despite internal consequences, such as hangover, nausea, heartburn, depression, and other health problems
f. All of the above

BR 301

Answer 15

Answer F

Question 16

DSM-5 Lists 11 items in diagnostic criteria for alcohol use disorder(AUD) you ask your patients for screening over the past 12 months. Please review the 11 item screen which of the following is false

a. >4 signs or symptoms are indicative of AUD
b. 2 to 3 mild symptoms
c. 4 to 5 moderate symptoms
d. 6+ severe symptoms
BR 302

Answer 16

Answer A

Pt has ‘EtOH use disorder’ if >= 2 signs/syx in 12 mos:

0-1 = No disorder

2-3 = Mild (DSM4 ‘alcohol abuse’)

4-5 = Moderate (DSM4 ‘alcohol dependence)

6+ = severe

Question 17

Who are the high risk groups that need yearly screening for alcohol use disorder(AUD)

a. Younger people in high risk regions
b. Trauma /STDs
c. Family History
d. Heavy smokers
e. Pregnant or planning pregnancy
f. All of the above
BR302

Answer 17

Answer F

Question 18

What can you do if you don’t have time to ask the 10 questions for AUDIT ?

BR 303-4

Answer 18

Do AUDIT-C (C=consumption)

• 3 questions, rated 0 to 4
• scoring: (+) if MORE than 5

Question 19

AUDIT(alcohol use disorder identification test) screening consists of 10 self reported items

Please review (BR303) which of the following is true

a. Higher scores have higher sensitivity
b. Audit scores help guide therapy
c. 5 to 10 score is at risk drinker
d. AUDIT-C refers to consumption
e. All of the above are true

Answer 19

Answer E

• AUDIT scores:

5 to 10 - ‘at risk’ (20% EtOH use disorder)

11 to 15 - more at risk (40% EtOH use disorder)

16+ - high risk (90%)

(AUDIT-C positive if greater than 5)

Question 20

At risk drinking with mild alcohol use disorder is characterized by (BR304)
a. Behavior intervention is not important because the patient will think you are judging
them
b. Increased risk of liver and marital problems
c. Exceeding 3+ per occasion at least monthly

d. Naltrexone hasn’t been shown to help drinking
e. Risk decreases with intensity and frequency of drinking

Answer 20

Answer B

Question 21

Behavior interventions for alcohol use disorder AUD are all of the following except
a. Rethinking Drinking developed by NIH is a useful tool free to order
b. Listen and reflect to assure understanding
c. Non-judgmental and accepting is important
d. Give matter of fact and clear opinions and recommendations
e. Avoid optimism, confidence and acceptance
BR304

Answer 21

Answer E

Question 22

Few receive treatment for mild to moderate alcohol use disorder, it usually occurs as an isolated episode lasting 3 to 4 years before resolving. Which is not a characteristic of this

a. Addiction clinic is necessary for treatment
b. Anti-relapse medication is as effective as addiction counseling and similar to SSRI
c. Symptoms include going over limits, impaired control, desire to cut down, tolerance, and use despite internal consequences
d. Similar to functional depression
(BR304)

Answer 22

Answer A

Question 23

Severe recurrent alcohol use disorder(AUD) risks include

a. Family history
b. Overachieving and good grades in school
c. Early childhood neglect
d. Behavior problems in childhood
e. A, C, and D are true

BR305

Answer 23

Answer E

Question 24

When treating severe recurrent alcohol use disorder all of the following are important except

a. Do not relate medical problems with drinking
b. Provide medical management for withdrawal symptoms
c. Recruit family members for assistance when appropriate

d. Refer to addiction specialist when patient is not compliant with lifestyle changes or initial interventions are not efective
e. Track outcomes with AUDIT or AUDIT-C

BR305

Answer 24

Answer A

Question 25

When treating severe recurrent alcohol use disorder how effective are medications ?

BR305

Answer 25

Medications (naltrexone, acamprosate, +/- off-label topiramate) are comparable to AA and counselling.

Question 26

There are several types of anti-relapse medication for severe recurrent alcohol use disorder which of the following is false

a. Naltrexone blocks mu-opiod receptor 50mg daily or BID can reduce the risk of heavy
drinking by 83% and reduce drinking days by 4%
b. Acamprosate, modulates glutamate transmission, and when compared to placebo reduced rate of any drinking and increased abstinence duration by 11 days, but not found to have an effect on heavy drinking
c. Disulfiram is first line treatment
d. Disulfiram is aversion agent working on aldehyde dehydrogenase and alcohol builds up causing nausea, vomiting, sweating, and headaches patients tend to be noncompliant with this treatment
e. Gabapentin is well tolerated, but has abuse potential
f. Topiramate decreased heavy drinking, but is used off label
BR305-306

Answer 26

Answer C

Question 27

41. Which of the following is not true regarding alcohol and tobacco:

a. Nicotine is a highly addictive chemical used in tobacco products and nicotine dependence is the most common form of dependence in the US
b. Nicotine replacement therapy is treatment to help people quit smoking and there are small doses of nicotine given to the user
c. Alcohol use disorder refers to disorders related to drinking
d. Anti-relapse medications are treatments used to help people prevent relapse with alcohol use disorders
e. All of the above are true
BR 307

Answer 27

Answer 41. E

Question 28

When should you refer someone with alcohol use disorder to an addiction specialist (2) ?
BR 305

Answer 28

a) When there is life impairment but pt non-compliant with lifestyle changes OR
b) When iniial interventions are not effective

Question 29

Why is it important to intervene in at-risk drinkers or those with mild alcohol use disorder (3) ?

BR 304

Answer 29

Because they are at risk of:

a) Alcohol use disorder development
b) Liver disease
c) Marital problems