Substance Use Flashcards
Which of the following is one of the diagnostic criteria for substance dependence?
A. Absence from work
B. Use of the substance in hazardous situations
C. Substance-related legal problems
D. Withdrawal symptoms
E. Neglect of children because of substance use
D. Withdrawal symptoms
The diagnostic criteria for substance dependence require a presence of three or more of the following in a 12-month period: tolerance, withdrawal, use of substance in larger amounts and for longer periods than intended, persistent desire to control use or unsuccessful efforts to control use, spending a great deal of time in obtaining the substance, impairment of social occupational or recreational activities, and use of the substance despite knowledge that it is harmful.
Which of the following is true?
A. Withdrawal symptoms are needed for a diagnosis of dependence.
B. Withdrawal is seen only when the substance used is stopped.
C. The signs and symptoms of withdrawal are the same for all drugs.
D. The severity of withdrawal is not related to the amount of substance used.
E. The severity of withdrawal is related to the duration and pattern of use.
E. The severity of withdrawal is related to the duration and pattern of use.
The severity of withdrawal symptoms is related to the duration and pattern of use. It is also related to the amount of substance used. The signs and symptoms vary for different drugs and may emerge even on reduction of the dose. Withdrawal symptoms are one of the criteria to diagnose dependence, but are not essential.
Which of the following is associated with use of illicit drugs? A. High socioeconomic status B. Low availability of drugs C. High crime rate D. Low unemployment E. Good schools
C. High crime rate
Use of illicit substances is associated with low socioeconomic class, high availability of the substance, high unemployment, poor innercity schools, and a high crime rate.
Which of the following is a risk factor for alcoholism? A. Female sex B. Identical twin with alcoholism C. Adoptive father with alcoholism D. Family history of schizophrenia E. Family history of ADHD
B. Identical twin with alcoholism
Males are at increased risk of developing alcoholism. The rate of alcohol problems increases with the number of alcoholic relatives, the severity of their illness, and the closeness of their genetic relationship to the person. There is an enhanced risk of alcoholism in the offspring of alcoholic parents, even when the children are separated from the biological parents. The risk is not enhanced by being raised by an alcoholic adoptive family. A family history of ADHD or schizophrenia is not a risk factor for alcoholism although patients with this disorder and PTSD, social anxiety, etc. may use alcohol to excess sometimes as a means of self-medication.
In women, which of the following is the most common comorbid condition seen with drug abuse and dependence? A. Antisocial personality disorder B. Phobic disorder C. Alcohol abuse or dependence D. Major depression E. Dysthymia
C. Alcohol abuse or dependence
Antisocial personality disorder, phobic disorder, major depression, dysthymia, social phobia, and PTSD are all comorbid with drugs of abuse. However, alcohol dependence and abuse is the most likely comorbidity to be seen with drug abuse and dependence.
What is the most common comorbid psychiatric disorder in prisoners with addictive disorders? A. Antisocial personality disorder B. Schizophrenia C. Depression D. Bipolar disorder E. Phobic disorder
A. Antisocial personality disorder
Antisocial personality disorder is a most common comorbid condition seen in prisoners with substance abuse.
Alcoholism is associated with all of the following personality types except A. Low self-directedness B. High novelty seeking C. High harm avoidance D. Low reward dependence E. Low cooperativeness
C. High harm avoidance
Alcoholism is associated with low self-directedness, high novelty seeking (impulsivity), low reward dependence (aloofness), low cooperativeness, and low harm avoidance (risk-taking). Novelty seeking predicts early-onset alcoholism, criminality, and other substance use
Severe alcohol withdrawal is associated with all the following medical complications except A. Magnesium deficiency B. Wernicke's encephalopathy C. Hypertension D. Hyperglycemia E. Seizures
D. Hyperglycemia
Alcohol withdrawal is sometimes associated with hypoglycemia. It can also cause withdrawal seizures, delirium, tremors, insomnia, vomiting, hallucinations, agitation, anxiety, and autonomic hyperactivity. Magnesium deficiency, Wernicke’s encephalopathy, and hypertension may also be seen as sequelae of heavy drinking and even withdrawal.
Which of the following is a good first-line drug for alcohol detoxification? A. Chlorpromazine B. Chlordiazepoxide C. Carbamazepine D. Clonidine E. Barbiturates
B. Chlordiazepoxide
Various benzodiazepines, including lorazepam, chlordiazepoxide, or diazepam, can be used to enable patients to withdraw from alcohol over a period of 4 to 7 days. Antipsychotics like haloperidol can be used in severe withdrawal. Carbamazepine, clonidine, and beta-blockers are also used. However, most clinicians prefer to use benzodiazepines as first-line agents.
When depression and anxiety are prominent before detoxification, which of the following is true?
A. Treatment with an antidepressant should be started.
B. Their presence indicates the need for inpatient detoxification.
C. Their presence predicts dropout from detoxification.
D. Symptoms usually disappear in about 3 to 4 weeks.
E. A DSM-IV Axis I diagnosis should be made immediately.
D. Symptoms usually disappear in about 3 to 4 weeks.
Depressive symptoms are present in about 40-80% of people with heavy alcohol intake. However, after about 3 to 4 weeks of abstinence, only about 5-10% of patients continue to have depressive symptoms, even without any treatment. Hence, such patients should not be diagnosed with major depression without a fair period of abstinence. The presence of depression does not indicate the need for inpatient detoxification, nor does it predict dropout from detoxification.
Which of the following does not predict a risk of suicide in patients with alcoholism? A. Comorbid depression B. Severity of alcoholism C. Parental alcoholism D. Early age of onset of drinking E. Previous self-harm
B. Severity of alcoholism
Civility of alcoholism has not been shown to be predictive of suicide in patients with alcoholism (Berglund & Ojehagen 1998). The other factors mentioned are known risk factors.
Which of the following is not useful in the assessment of a patient with alcoholism? A. CAGE B. AUDIT C. CAMCOG D. MCV E. CDT
C. CAMCOG
CAMCOG is used in the assessment of dementia in the elderly. CAGE is a four-item questionnaire to screen for a problem with alcohol use. AUDIT (Alcohol Use Disorders Identification Test) is a standardized questionnaire regarding quantity and frequency of drinking. MCV (mean corpuscular volume) is increased in patients with alcoholism. CDT (carbohydratedeficient transferrin) is a reasonably sensitive and specific marker of heavy drinking and may be used in monitoring abstinence during treatment.
Which of the following is a stage in the theory of change? A. Revision B. Contemplation C. Realism D. Denial E. Shock
B. Contemplation
Assessing the patient’s motivation for change using the motivational interview (Miller & Rollinck 1991) involves gaining an understanding of the patient’s reasons for seeking treatment. The stages may be classified along a continuum from precontemplation to contemplation to determination to action to maintenance.
Which of the following is a feature of Cloninger's type 1 alcoholism? A. Early onset B. Incidence in both men and women C. Impulsivity D. Antisocial personality traits E. Positive family history
B. Incidence in both men and women
Cloninger classified alcoholics into two distinct subtypes: type 1, or milieu limited alcoholism, and type 2, or male-limited alcoholism. Type 1 affects both male and females and has onset after age 25. Persons with this type of alcoholism do not have a strong family history of alcoholism or criminality and rarely engage in fights or are arrested while drinking. Type 2 alcoholism occurs only in men and is characterized by an inability to abstain from alcohol and heavy consumption rates. Dependence begins before the age of 25 and is associated with recurrent medical and social consequences of alcoholism as well as a personal and family history of criminality.
Which of the following is the origin of motivation-enhancing techniques in treating substance abuse? A. Cognitive-behavioral therapy B. Operant conditioning C. Psychodynamic theories D. Milan school of family therapy E. Theory of change
E. Theory of change
Motivation-enhancing techniques (Miller & Rollinck) have their origins in the theories of change.
Which of the following is associated with withdrawal from alcohol? A. Elevated dopaminergic function B. Reduced dopaminergic function C. Increased GABA activity D. Decreased glutaminergic activity E. Increased serotonin function
B. Reduced dopaminergic function
Withdrawal symptoms from alcohol are associated with reduced dopaminergic function. They are also associated with reduced GABA, increased glutaminergic function, and reduced 5-HT3 function.
Which of the following receptors is postulated to be essential for the development of opiate dependence? A. Kappa B. Delta C. Mu D. Serotonin E. Dopamine
C. Mu
The three major types of opioid receptors are mu, kappa, and delta. Most of the opioid drugs are mu agonists. They produce analgesia, altered mood, decreased anxiety, respiratory depression, and suppression of cough. Most of the new agonists are full agonists and produce maximal response in opioid responsive types. When any mu agonist is used chronically, tolerance and physical dependence develop.
Which of the following receptors associated with ion channel activities is inhibited by alcohol? A. 5-HT3 B. Glutamate C. GABA-A D. Acetylcholine
B. Glutamate
Alcohol enhances ion channel activities associated with nicotinic acetylcholine, serotonin 5-HT3, and GABA type A receptors, whereas it inhibits ion channel activities associated with glutamate receptors and voltage-gated calcium channels.
You are asked to see a 42-year-old male patient on a surgical ward who had a major operation 2 days ago and is now exhibiting bizarre behavior. He expresses fears that aliens are coming to take him away and appears to be responding to hallucinations. On examination he is tremulous and sweating but appears oriented and denies any hallucinations. His laboratory workup is subnormal with increased MCV and GGT. What is the most likely cause of his symptoms? A. Alcohol withdrawal B. Schizophrenia C. Severe depression D. Delirium tremens E. Alcoholic hallucinosis
D. Delirium tremens
The symptoms described are strongly suggestive of delirium tremens. Such symptoms can arise in patients being admitted to the hospital for an operation and hence abstaining from alcohol. The clinical features are clouding of consciousness, difficulty sustaining attention, disorientation, autonomic hyperactivity with tachycardia, excess sweating, and lability of blood pressure. Patients also have fleeting delusions and hallucinations. The symptoms should resolve with adequate treatment.
Which of the following is not true of delirium tremens?
A. If untreated, it has a high mortality rate.
B. Hallucinations may involve the patient’s occupation.
C. Aphasia is common.
D. Patients are highly suggestible.
E. The delusions are fragmented and unsystematized.
C. Aphasia is common.
Aphasia is not seen in delirium tremens. Patients are highly suggestible. Hallucinations may include any modality but typically are visual or auditory and are persecutory. Delusions are usually fragmented and unsystematized, unlike those of schizophrenia. The condition has a high mortality rate (15-20%) if untreated.
Which of the following is a characteristic feature of alcohol dependence?
A. Rapid reinstatement after abstinence
B. Absenteeism on Fridays
C. Tendency to exaggerate drinking
D. Drinking only in the company of others
E. Ability to control drinking when interpersonal problems increase
A. Rapid reinstatement after abstinence
Rapid reinstatement to previous levels of tolerance after a period of abstinence is a feature of dependence. Absenteeism on Mondays is typically associated with alcoholism. Patients tend to minimize their drinking. Patients with alcoholism typically tend to drink alone. They also have an inability to control their drinking in the presence of increasing personal problems.
Which of the following is not true of alcohol withdrawal?
A. It is associated with increased autonomic activity.
B. Mild cases can be treated at home.
C. Severity of symptoms peaks on the day that the drinking stops.
D. Benzodiazepines are effective in suppressing hallucinations.
E. Home detoxification is contraindicated if patient has a history of seizure disorder.
C. Severity of symptoms peaks on the day that the drinking stops.
Severe alcohol withdrawal may be characterized by a wide variety of symptoms, including autonomic instability. The symptoms peak 2 to 3 days after cessation of drinking. Mild cases may be treated at home. Patients with a history of seizure disorder should be treated in hospital because of the risk of reemergence of seizures. Hallucinations are seen in withdrawal, and the use of benzodiazepines to suppress withdrawal can help with the suppression of hallucinations.
Alcohol dependence is associated with A. Maternal separation in childhood B. Family history of depression C. Paranoid personality disorder D. Family history of alcoholism E. Alcohol dehydrogenase deficiency
D. Family history of alcoholism
A family history of alcoholism is strongly associated with development of alcoholism in the proband. The closer the affected relative genetically and the greater the number of affected relatives, the higher the risk of alcoholism.
Alcohol withdrawal is associated with all the following EXCEPT: A. Affect-laden dreams B. Absence seizures C. Coarse tremors D. Auditory hallucinations E. Hypersomnolence
B. Absence seizures
Alcohol withdrawal is typically associated with tonic-clonic seizures. It does not cause petit mal seizures. Coarse tremors, auditory hallucinations, paranoid delusions, visual hallucinations, hypersomnolence, and insomnia may also be seen.
Which of the following is not a complication of alcohol abuse? A. Decreased serum testosterone B. Carcinoma esophagus C. Hypertension D. Cardiomyopathy E. Parkinson's disease
E. Parkinson’s disease
Long-term use of alcohol can affect a number of systems in the body and can cause blackouts, peripheral neuropathy, cerebellar degeneration, liver damage (including fatty liver and cirrhosis), carcinoma esophagus, pancreatitis, hypertension, hypercholesterolemia, alcoholic cardiomyopathy, reduced serum testosterone, and cancer of the liver and stomach. It does not cause Parkinson’s disease per se.
Which of the following is an effect of alcohol on sleep? A. Increased sleep latency B. Decreased sleep fragmentation C. Decreased episodes of waking D. Decreased REM sleep E. Increased stage IV sleep
D. Decreased REM sleep
Alcohol consumed in the evening decreases sleep latency. It also causes a decrease in REM sleep and stage IV (deep) sleep. It causes more sleep fragmentation and more and longer episodes of awakening.
Methyl alcohol poisoning can cause all of the following except A. Blindness B. Metabolic alkalosis C. Convulsions D. Vomiting E. Death
B. Metabolic alkalosis
Methyl alcohol consumption results in increased serum osmolality, severe anion gap metabolic acidosis, tachypnoea, confusion, convulsions, blindness, vomiting, and death.
All of the following arouse a suspicion of alcohol dependence except A. Unexplained absence from work B. Smell of alcohol on breath C. Hypnogogic hallucination D. Morning nausea E. Morning tremors
C. Hypnogogic hallucination
Hypnagogic hallucination is a phenomenon that occurs in normal persons as they fall asleep. Unexplained absence from work, smell of alcohol on the breath, morning nausea, and tremors all arouse a suspicion of alcohol dependence.
Which of the following is true of Korsakoff syndrome?
A. Disorientation is usually present.
B. Confabulation is essential for diagnosis.
C. Immediate memory is affected.
D. It can be caused by continuous vomiting.
E. Clouding of consciousness is a characteristic feature.
D. It can be caused by continuous vomiting.
Korsakoff syndrome is characterized by anterograde and retrograde amnesia and impairment in visuospatial, abstract, and other types of learning. The level of recent memory is out of proportion to the global level of cognitive impairment. Immediate memory is usually preserved. Confabulation may be seen. The patient has a clear consciousness. In addition to alcohol use, prolonged severe vomiting can cause Korsakoff syndrome.
