Chapter 62: Substance Abuse

the theory that substance dependence is caused by faulty physiologic processes is the

• biologic

• denial

• addiction

• codependent

Answer explanation

The majority of experts in substance-related disorders subscribe to the biologic theory that proposes that faulty physiologic processes contribute to addiction to a specific substance and that addiction is a physical illness. Most believe that it most likely involves a combination of biologic, cultural, and behavioral factors.

Mr. White was arrested for public intoxication and was advised by attorney to enroll in an alcohol treatment program. A nurse interviews him when he comes to a mental health center . He tells the nurse that he just had a few too many drinks while celebrating with a friend. This is an example of which defense mechanism

• rationalization

• denial

• intellectualization

• projection

Answer explanation

Defense mechanisms used by addicts include denial, rationalization, intellectualization, and projection. Denial is apparent when patients state that they do not have a problem with alcohol or drug use despite evidence to the contrary.

what is the chief advantage of using hair analysis to detect drug use?

• hair samples can be taken without patient permission

• hair samples will reveal drug use a long as 1 year later

• it is not possible for a patient to substitutes someone else's

• the chain of custody is unnecessary with hair sample

Answer explanation

Hair analysis is a recent addition to the methods for the detection of substance use. It requires sensitive technology but may be very helpful in monitoring patients for relapse. Depending on the length of the hair, a substance can be detected for up to 1 year after only 2 or 3 days of use. However, the presence of addiction or whether the person is currently under the influence of the substance cannot be inferred from a positive finding. The evidence this test provides regarding long-term substance use may be a valuable tool in the diagnosis and follow-up of substance use disorders. After collection, the sample is kept under chain of custody (i.e., each person handling the sample signs a special document that accompanies the sample until it can be analyzed). Any temporary storage of the sample is maintained under secure conditions.

An alcoholic patient was injured in an automobile accident. she said that she had her last drink 2 hours before the accident. About 8 hours after admission, she developed symptoms of early alcohol withdrawal. you should anticipates delirium tremens by blank hours after her last drink

• 3

• 8

• 72

• 120

Answer explanation

The second stage, major withdrawal, begins with the onset of seizures and hallucinations and can advance to life-threatening delirium tremens. This stage usually occurs after approximately 3 days (72 hours) and sometimes less without alcohol or treatment, and can be predicted from extreme elevations in temperature, pulse, and blood pressure. The patient typically becomes disoriented and confused. Hallucinations are often visual and “animal” in nature.

Mr. Jones calls the hospital to report that his wife, a dietitian, cannot come to work because she has "flu". In reality, she consumed a large amount of alcohol the previous evening and has a hangover. this has happened several time in the past. Mr. Jones' behavior is an example of the following?

• support

• enabling

• rationalization

• comprensation

Answer explanation

Enabling behaviors are any behaviors that “cover up” or protect alcoholics from the consequences of their drinking behaviors. Those who enable are sometimes

considered co-dependent, in that their behavior is highly structured around managing and adapting to the alcoholic’s dysfunctional behavior. Support is to give moral or psychological support, aid, or courage to someone. Rationalization is a defense mechanism in which people attempt to justify the reasons for substance use and make an “excuse” for addiction. Compensation is to give money or something else of value to (someone) in return for something (such as work) or as payment for something lost, damaged, etc.

when a patient who is taking disulfiram ( Antabuse) consumes alcohol expected outcomes include which of the following

SATA

• hypotension

• tachycardia

• confusion

• nausea and vomiting

Answer explanation

The treatment team may recommend the use of disulfiram (Antabuse) to assist the alcoholic who is highly motivated to remain sober but who recognizes that poor impulse control may increase the odds of relapse. Signs and symptoms of a disulfiram-alcohol reaction include hypotension, rapid heart rate, confusion, nausea, and vomiting. Flushing and not pallor also occur. Other symptoms include headache, dizziness, difficulty breathing, sweating, coma, convulsions, and death. The severity of the symptoms varies from person to person, and symptoms can last for 30 to 60 minutes or more.

young people should be warned that inhalants can cause which of the following

• progressive brain damage

• sexual dysfunction

• schizophrenia

• aggressive behavior

Answer explanation

Inhalants can cause central nervous system, progressive brain, and cardiac damage. Inhalants do not cause sexual dysfunction or schizophrenia. Euphoria and giddiness and not aggressive behavior may occur. Other symptoms, including headache, fatigue, drowsiness, and objective signs such as dysrhythmias, damage to kidneys, and liver abnormalities, can occur.

a patient being treated for an overdose of opioids is given Narcan. Narcan is given for which of the following reasons

• to stimulate the heart

• to raise BP

• to treat respiratory depression

• to sedate the patient and prevent seizures

Answer explanation

Naloxone hydrochloride (Narcan) is given to reverse the effects of opioids and prevent respiratory depression. Narcan and nalmefene (Revex) are opioid antagonists that counteract the dangerous respiratory depressant effects of heroin or other opiate overdose. When Narcan is given to a person who is addicted and under the influence of an opiate, the person may experience acute withdrawal symptoms. Narcan does not raise the blood pressure or stimulate the heart. One of the side effects of Narcan is fast or irregular pulse and seizures. Other possible side effects of Narcan include change in mood, increased sweating, nausea, nervousness, restlessness, trembling, vomiting, allergic reactions such as rash or swelling, dizziness, fainting, flushing, headache, heart rhythm changes, sudden chest pain, and pulmonary edema.

which of the following are among the drug most commonly used by older adults with substance use disorder

SATA

• cocaine

• pain medication

• sleeping aids

• alcohol

Answer explanation

Older adults are more likely to abuse over-the-counter (OTC) and prescription sleeping pills, pain medications, or tranquilizers than illegal drugs such as cocaine and marijuana. Although older adults use approximately 25% of the medications used in the United States, only about 2% to 5% of men and less than 1% of women older than 65 years abuse alcohol. Most of the older adults who abuse alcohol have maintained a regular pattern of use over many years without obvious problems, so alcohol is not one of the most commonly abused drugs.

which statement most accurately describe drug use among adolescents

• only 1 in 10 adolescents have problems with substance use

• adolescent tend to deny any possible negative outcomes of drug use

• most adolescents seek treatment for substance use on their own

• adolescent should be treated with adults who can model mature behavior

Answer explanation

Average adolescents view themselves as omnipotent and deny the likelihood of negative consequences of drug use and their behaviors. Breaking through adolescents’ denial is the most difficult aspect of treatment, especially because they seldom want to be in treatment and do not see the potential negative consequences of their behaviors. It is estimated that 1 in 4 adolescents, and not 1 in 10, become involved in substance abuse. Entry into treatment usually occurs as a result of a crisis situation and not the abuser seeking treatment on his or her own. It is controversial to mix adolescents with adults in treatment programs because of adolescents’ vulnerability to being influenced by the more experienced and usually charismatic adult substance user. Successful rehabilitation usually involves regular involvement in an Alcoholics Anonymous (AA) group made up of younger people to whom the adolescent can relate; successful development of a new, non–drug- using peer group; and reentry into school with the support of other recovering classmates. AA group meetings may be held at high schools in some cities.