ADM Addiction Treatment Modalities & Therapeutic Approaches 3 — Questions and Answers
Question 1: Extended-release naltrexone (Vivitrol) for opioid use disorder offers which key clinical advantage over daily oral naltrexone?
- Lower cost
- Improved adherence due to monthly injection eliminating daily pill burden (Correct answer)
- Fewer side effects including nausea
- Can be given during active opioid use without precipitating withdrawal
Correct answer: Improved adherence due to monthly injection eliminating daily pill burden
Monthly injectable naltrexone removes the need for daily adherence decisions, substantially improving treatment compliance compared to oral formulations.
Question 2: The Community Reinforcement Approach (CRA) for addiction treatment is primarily based on which theoretical framework?
- Psychodynamic theory
- Operant behavioral principles that identify and restructure environmental contingencies (Correct answer)
- Attachment theory
- Motivational theory of change
Correct answer: Operant behavioral principles that identify and restructure environmental contingencies
CRA uses operant conditioning principles to rearrange social and environmental reinforcers so that a sober lifestyle becomes more rewarding than substance use.
Question 3: A patient with severe alcohol use disorder presents during medically supervised withdrawal. Which benzodiazepine property is most important when selecting an agent for withdrawal management in a patient with advanced liver disease?
- Long half-life to prevent seizures
- High lipid solubility for rapid onset
- Minimal hepatic metabolism (e.g., oxazepam, lorazepam) (Correct answer)
- High potency to reduce total dose needed
Correct answer: Minimal hepatic metabolism (e.g., oxazepam, lorazepam)
Oxazepam and lorazepam undergo direct glucuronidation rather than extensive hepatic oxidative metabolism, making them safer in patients with severe liver disease.
Question 4: Which statement best describes the role of Twelve-Step Facilitation (TSF) therapy in addiction treatment?
- It is a professionally led psychotherapy replacing self-help groups
- It is a structured clinical intervention designed to promote engagement with AA/NA and acceptance of addiction (Correct answer)
- It focuses exclusively on relapse prevention skills training
- It uses pharmacological support alongside group therapy
Correct answer: It is a structured clinical intervention designed to promote engagement with AA/NA and acceptance of addiction
TSF is a manualized clinical approach that encourages patients to accept their addiction, engage in step work, and actively participate in 12-step mutual-help programs.
Question 5: For a patient with co-occurring opioid use disorder and chronic pain, which treatment strategy is generally recommended?
- Taper all opioids immediately before addressing the pain condition
- Treat both conditions simultaneously, often with buprenorphine which provides analgesia while treating OUD (Correct answer)
- Defer OUD treatment until chronic pain is fully controlled
- Use extended-release opioids only for pain management
Correct answer: Treat both conditions simultaneously, often with buprenorphine which provides analgesia while treating OUD
Buprenorphine is an ideal option for co-occurring OUD and chronic pain because it provides analgesia while simultaneously treating addiction, supporting integrated care.
Question 6: Dialectical Behavior Therapy (DBT) adapted for substance use disorders emphasizes which core skill set as particularly relevant to addiction?
- Psychoeducation about drug mechanisms
- Distress tolerance and emotion regulation to cope with urges without using substances (Correct answer)
- Systematic desensitization to drug cues
- Stimulus control and environmental modification only
Correct answer: Distress tolerance and emotion regulation to cope with urges without using substances
DBT's distress tolerance and emotion regulation modules help patients manage intense negative emotions and urges that commonly trigger substance use without resorting to substances.
Question 7: In medication-assisted treatment for OUD, which finding from the X:BOT trial is clinically significant?
- Methadone was superior to buprenorphine in all patient populations
- Both buprenorphine and extended-release naltrexone were similarly effective once treatment was initiated, but naltrexone had a higher induction failure rate (Correct answer)
- Extended-release naltrexone had fewer side effects and superior outcomes
- Buprenorphine was associated with higher rates of diversion
Correct answer: Both buprenorphine and extended-release naltrexone were similarly effective once treatment was initiated, but naltrexone had a higher induction failure rate
The X:BOT trial found comparable outcomes for buprenorphine and extended-release naltrexone once patients were successfully inducted, but the naltrexone arm had significantly more induction failures due to the requirement for prior opioid abstinence.
ADM Addiction Treatment Modalities & Therapeutic Approaches 3
Extended-release naltrexone (Vivitrol) for opioid use disorder offers which key clinical advantage over daily oral naltrexone?