The Addiction Medicine Board Exam is right around the corner. Are you ready? Test your knowledge with these free addiction medicine board review questions below from the BoardVitals Addiction Medicine test bank.
You have a patient in your outpatient practice who quit drinking alcohol six months ago on his own, but is struggling with managing his stress and worries about relapse. You feel he would benefit from a group environment where he could learn techniques to manage his cravings as well as work on his interpersonal skills. One thing you know about the patient is has never liked school and prefers a group where there is more interactive discussion. Which of the following groups would be most appropriate for you to refer him to?
A. Coping skills group
B. Psychoeducational recovery group
C. Milieu group
D. Counseling group
E. Specialized group
Correct Answer: A
Skill groups are aimed at helping patients develop or improve their intrapersonal and interpersonal skills. For example, these groups teach problem-solving methods and stress management, cognitive, and relapse prevention strategies. Relapse prevention strategies help patients identify and manage early signs of relapse (the relapse “process”), identify and manage high-risk factors, or learn steps to take to intervene with a lapse or relapse.
B: Psychoeducational recovery groups provide information about specific topics related to addiction and recovery and help patients begin to learn how to cope with the challenges of recovery. These groups use a combination of lectures, discussions, educational videos, behavioral rehearsals and completion of written assignments such as a recovery workbook or personal journal.
C: Milieu groups are offered in residential and hospital programs and usually involve a group meeting to start and/or end the day. A morning group may review the upcoming day’s schedule, whereas an evening group may review the day’s treatment and recovery activities and allow participants to reflect on their experiences that day.
D: Counseling groups (also called therapy groups, problem-solving groups, or process groups) are less structured and give the participants an opportunity to create their own agenda in terms of problems, conflicts, or struggles to work on during group sessions. These groups focus more on gaining insight and raising self-awareness than on education or skill development.
E: Specialized groups may be based on developmental stage (adolescents, young adults, adults, older adults), gender, different clinical populations (pregnant women or women with small children addicted to opioids, or anyone involved in the criminal justice system), or groups addressing specific issues or populations (parenting issues, anger or mood management, or trauma).
Group Therapies, pp. 847-8. The ASAM Principles of Addiction Medicine, Fifth Edition. Ed. Richard K. Ries. 2014.
You are seeing a patient in the emergency room that has been taking methadone for an opioid use disorder for the past two years. He has given you permission to call his clinic and you have confirmed his daily methadone dose. He is there in your emergency room because he slipped and fell on the ice outside. You have confirmed a foot fracture with imaging and the patient is complaining of severe pain. Which of the following principles is important to follow when managing acute pain in a patient with addiction?
A. Hold the methadone until the patient is in withdrawal, then treat the pain
B. Leave the patient out of the clinical decision making process
C. Increase the patient’s methadone in order to treat the pain
D. Switch the methadone to a different opioid to treat the pain
E. Continue the methadone and supplement with a different opioid for acute pain
Correct Answer: E
Individuals who are physically dependent on opioids prescribed for pain or for addiction or who are dependent on illicit opioids must have their baseline opioid requirements met in addition to receiving additional opioids for analgesia. Chronically administered opioids will not usually address additional acute pain.
A: One of the principles of treatment of pain management in persons with addiction is the prevention or treatment of withdrawal. It is permissible under the U.S. Controlled Substances Act for a treating physician to provide opioids to prevent withdrawal in a patient who is hospitalized for a diagnosis other than addiction.
B: It is often helpful to include the individual with pain in the decision-making process regarding medication choices, dosing, and scheduling. This provides a sense of control and allays anxiety. It may also afford information that is useful in designing an effective treatment regimen.
C: Though an increase in methadone may be effective for pain management its long half-life makes it difficult to safely titrate for acute pain. Incomplete cross-tolerance of methadone with other mu agonists has been noted and methadone withdrawal has been observed in some patients despite calculated equianalgesic doses of alternative mu agonists.
Reference: Opioid Therapy of Pain, pp. 1514-1516. The ASAM Principles of Addiction Medicine, Fifth Edition. Ed. Richard K. Ries. 2014.
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