CARN Treatment Modalities and Interventions 3 — Questions and Answers
Question 1: A patient with alcohol use disorder is prescribed disulfiram (Antabuse). The nurse educates that a reaction will occur if the patient consumes alcohol because disulfiram inhibits which enzyme?
- Alcohol dehydrogenase
- Aldehyde dehydrogenase (Correct answer)
- Cytochrome P450 2E1
- Monoamine oxidase
Correct answer: Aldehyde dehydrogenase
Disulfiram inhibits aldehyde dehydrogenase, causing acetaldehyde accumulation when alcohol is consumed, producing an aversive reaction.
Question 2: Which cognitive-behavioral technique involves identifying high-risk situations for relapse and developing specific coping strategies in advance?
- Chain analysis
- Relapse prevention planning (Correct answer)
- Functional analysis of behavior
- Motivational enhancement therapy
Correct answer: Relapse prevention planning
Relapse prevention planning (Marlatt's model) focuses on identifying triggers and high-risk situations, then building individualized coping strategies to avoid or manage them.
Question 3: A patient with methamphetamine use disorder asks about pharmacological treatment options. The addictions nurse should inform the patient that:
- Bupropion is FDA-approved specifically for meth use disorder
- No FDA-approved pharmacotherapy currently exists for stimulant use disorder (Correct answer)
- Naltrexone is the first-line approved treatment for stimulant use disorder
- Methadone is used as maintenance therapy for stimulant dependence
Correct answer: No FDA-approved pharmacotherapy currently exists for stimulant use disorder
As of current guidelines, there is no FDA-approved medication for stimulant use disorder; treatment relies primarily on behavioral interventions such as contingency management.
Question 4: Which brief intervention strategy is most appropriate for a patient in the pre-contemplation stage of change who denies having a substance problem?
- Teaching specific coping skills for triggers
- Providing a self-help manual and action plan
- Raising awareness and planting seeds of doubt about use (Correct answer)
- Reviewing relapse prevention strategies
Correct answer: Raising awareness and planting seeds of doubt about use
Pre-contemplators are not yet ready to change, so the nurse's role is to raise consciousness and gently introduce the possibility that their use may be problematic.
Question 5: In dialectical behavior therapy (DBT) for co-occurring substance use and borderline personality disorder, which skill module teaches patients to tolerate distress without making it worse?
- Interpersonal effectiveness
- Distress tolerance (Correct answer)
- Emotion regulation
- Mindfulness
Correct answer: Distress tolerance
Distress tolerance skills in DBT help patients survive crises and painful emotions without engaging in impulsive behaviors such as substance use.
Question 6: A patient is enrolled in an opioid treatment program (OTP) receiving methadone. Federal regulations require that take-home doses be withheld if the patient:
- Has been in treatment for more than 2 years
- Tests positive for a non-opioid substance like cocaine (Correct answer)
- Demonstrates exemplary attendance and negative screens
- Requests a higher dose due to persistent cravings
Correct answer: Tests positive for a non-opioid substance like cocaine
Federal OTP regulations restrict take-home methadone doses when patients have unstable behavior, including recent illicit drug use shown by positive toxicology screens.
Question 7: The Community Reinforcement Approach (CRA) for substance use disorders primarily works by:
- Confronting denial through structured group feedback
- Restructuring environmental rewards to make sobriety more rewarding than use (Correct answer)
- Teaching mindfulness meditation to manage cravings
- Using aversive conditioning to create discomfort with substance use
Correct answer: Restructuring environmental rewards to make sobriety more rewarding than use
CRA rearranges the patient's environment so that sobriety becomes more reinforcing than substance use by enhancing prosocial activities, relationships, and vocational functioning.
CARN Treatment Modalities and Interventions 3
A patient with alcohol use disorder is prescribed disulfiram (Antabuse).
The nurse educates that a reaction will occur if the patient consumes alcohol because disulfiram inhibits which enzyme?