CARN Treatment Modalities and Interventions 5 — Questions and Answers
Question 1: A patient declines all pharmacotherapy and wants only behavioral treatment for alcohol use disorder. Which evidence-based behavioral intervention has the strongest research support for this population?
- Psychoanalytic therapy
- Cognitive-behavioral therapy / relapse prevention (Correct answer)
- Solution-focused brief therapy alone
- Bibliotherapy without professional support
Correct answer: Cognitive-behavioral therapy / relapse prevention
Cognitive-behavioral therapy and relapse prevention have the largest evidence base among behavioral interventions for alcohol use disorder.
Question 2: Which withdrawal syndrome is considered life-threatening without appropriate medical management and may include seizures and delirium tremens?
- Opioid withdrawal
- Stimulant withdrawal
- Cannabis withdrawal
- Alcohol withdrawal (Correct answer)
Correct answer: Alcohol withdrawal
Alcohol withdrawal is the most medically dangerous common withdrawal syndrome and can progress to seizures and delirium tremens with significant mortality if untreated.
Question 3: A nurse is using the FRAMES approach during a brief intervention. Which element involves providing the patient with a menu of options for changing their substance use?
- Feedback
- Responsibility
- Advice
- Menu of strategies (Correct answer)
Correct answer: Menu of strategies
The 'M' in FRAMES stands for Menu of strategies, offering multiple change options to enhance patient autonomy and self-efficacy.
Question 4: A patient with severe opioid use disorder who has repeatedly relapsed is interested in buprenorphine treatment. The nurse understands that the ceiling effect of buprenorphine (compared to full agonists) means:
- Buprenorphine produces euphoria at all dose levels equally
- Above a certain dose, increasing buprenorphine produces no additional respiratory depression (Correct answer)
- Buprenorphine has no analgesic properties
- Its effects are fully reversed by naloxone at any dose
Correct answer: Above a certain dose, increasing buprenorphine produces no additional respiratory depression
As a partial agonist, buprenorphine has a ceiling effect on respiratory depression, making it significantly safer in overdose than full opioid agonists like methadone or heroin.
Question 5: Which environmental intervention strategy involves removing or restricting access to the substance in the patient's home or social environment as a recovery support?
- Cue exposure therapy
- Stimulus control (Correct answer)
- Aversion therapy
- Social skills training
Correct answer: Stimulus control
Stimulus control involves modifying the environment to reduce exposure to cues associated with substance use, such as removing alcohol from the home.
Question 6: When educating a patient about SMART Recovery as an alternative to 12-step programs, the nurse explains that SMART Recovery is based on:
- Spiritual principles and surrender to a higher power
- Rational emotive behavior therapy and self-empowerment principles (Correct answer)
- Disease model and lifelong identity as an addict
- Medication-assisted treatment exclusively
Correct answer: Rational emotive behavior therapy and self-empowerment principles
SMART Recovery uses cognitive and behavioral tools derived from rational emotive behavior therapy and does not incorporate spirituality or a disease-model identity.
Question 7: A patient with cannabis use disorder reports intense cravings during urge surfing practice. The nurse explains that urge surfing is effective because:
- It permanently eliminates cravings through extinction
- It teaches patients that cravings peak and subside naturally without acting on them (Correct answer)
- It uses distraction to suppress awareness of cravings
- It replaces cannabis cravings with a craving for healthy behaviors
Correct answer: It teaches patients that cravings peak and subside naturally without acting on them
Urge surfing teaches patients to observe cravings mindfully, recognizing that they rise and fall like waves—resisting them does not require acting on them.
CARN Treatment Modalities and Interventions 5
A patient declines all pharmacotherapy and wants only behavioral treatment for alcohol use disorder.
Which evidence-based behavioral intervention has the strongest research support for this population?