Two More Questions for the Addiction Medicine Exam

The Addiction Medicine Exam is right around the corner this October. Are you ready?

Test your knowledge with two more free addiction medicine questions from the BoardVitals test bank. These are in addition to the addiction medicine practice questions we recently posted.

Question 1
You have a 27-year old male who presents to your methadone treatment program brought by his family for treatment of opioid use disorder. You want to plan his care and monitor effectively using the multiple clinical scales available for the assessment of patients’ multiple domains such as motivation or resistance to treatment, adherence to treatment, and relapse prevention risk. Which of the following is correct regarding these clinical tools?

Answers

A. Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES); is a tool that assesses the motivational level of patients using the trans-theoretical model of change. (Correct)

B. Inventory of Drinking Situations; is an assessment instrument to provide an assessment of patient’s adherence to treatment.

C. The coping response inventory is used as part of the assessment of the severity of addiction.

D. Situational Confidence Questionnaire (SCQ) is another test for patient’s motivational level.

Answer: A

Explanation

A: Correct. It is important to assess the motivational level of the patient for engaging in treatment. Self-report instruments are available, including the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES).

The 19-item short form of the self-report instrument assesses motivation to change drinking behavior. SOCRATES is based on the transtheoretical model of change. SOCRATES assesses patient’s level of recognition of a problem, ambivalence, or uncertainty about changing and whether the patient is taking steps to change. It has been employed to monitor motivational level and predict compliance with and outcome of treatment. B: Incorrect. The Inventory of Drinking Situations is a 100-item self-report instrument that allows a patient to assess his or her tendency to drink in a variety of situations that can be categorized as urges and temptations, personal control, unpleasant emotions, pleasant emotions, conflict, social pressure, physical discomfort, and pleasant times with others. The patient’s knowledge of the situations that trigger the use of substances is an important element in any relapse prevention plan. C: Incorrect. CRI helps in assessing coping skills of patients which is part of preparation for relapse prevention. CRI contains 48 self-report questions that assesses four types of avoidant coping (emotional discharge, cognitive avoidance, seeking alternative rewards, resigned acceptance) and four types of approach coping (logical analysis, problem solving, seeking guidance and support, positive reappraisal). D: Incorrect. SCQ is a measurement of adherence to treatment in patients with addiction. SCQ as 39 self-report questions. It asks patients to imagine themselves in a variety of situations and rate their confidence that they can resist the urge to drink in these situations.

References

Theodore V. Parran J, McCormick RA, Reyes CMD. Assessment In: Ries RK, ed. ASAM Principles of Addiction Medicine 2014. Miller W, Tonigan JS. Assessing drinker’s motivations for change: the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Psychol Addict Behav 1996;10(2):81–89. Annis HM, Graham JM, Davis CS. Inventory of drinking situations (IDS): user’s guide. Toronto: Addiction Research Foundation, 1987. Moos R. Coping response inventory manual. Palo Alto, CA: Center for Health Care Evaluation, Department of Veterans Affairs and Stanford University Medical Center, 1992. Annis HM, Skylar Turner NE. The Drug Taking Confidence Questionnaire: user’s guide. Toronto: Addiction Research Foundation, 1997.

Question 2
You are seeing a 50-year-old patient in your clinic who has been prescribed alprazolam for years by a different provider. You are concerned about the long-term and short-term risks to continuing to prescribe this medication for her. You speak to her old provider and he tells you that he has never had problems with the patient abusing or overusing her medication. After a long discussion, your patient is willing to taper off the alprazolam. Which of the following is the safest approach to taper her off alprazolam?

Answers

A. 4 week taper with alprazolam

B. 4 week taper with clonazepam

C. 12 week taper with alprazolam

D. 12 week taper with clonazepam

E. 12 week taper with chlordiazepoxide

Answer: C

Explanation

Correct: C. Explanations: The approach with the most data to support its safety and efficacy is to initiate a taper that uses decreasing doses of the therapeutic agent over the course of four to twelve weeks. While this method could be used in settings where there are issues of misuse, abuse, or dependence, this approach is not recommended because it would provide the patient with continued doses of the drug for a period of weeks to months. There is an increased likelihood of withdrawal symptoms with medications with a short half-life, such as alprazolam, even during prolonged tapers; and so one strategy would be a conversion of the therapeutic agent to an equivalent dose of a longer-acting agent with a gradual reduction of the latter. However, alprazolam warrants special consideration. This agent (along with triazolam) may have a higher binding affinity at a subpopulation of benzodiazepine GABA receptors that are not targeted by other benzodiazepines. Because of this, other benzodiazepines may not have fully effective cross-tolerance and therefore may be less effective when they are used for tapering and withdrawal.

References: Pharmacologic Intervention for Sedative-Hypnotic Addiction, pp. 730-1. The ASAM Principles of Addiction Medicine, Fifth Edition. Ed. Richard K. Ries. 2014.

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