CASAC - Credentialed Alcoholism and Substance Abuse Counselor Pharmacology and Co-Occurring Disorders 1

Question 1

Methadone, when used as medication-assisted treatment for opioid use disorder, differs from buprenorphine in a clinically significant way.
Which of the following statements accurately describes a key distinction?

Accepted Answer

Methadone for OUD must be dispensed through a federally certified Opioid Treatment Program (OTP), while buprenorphine can be prescribed in office-based settings

Answer

Methadone is a partial opioid agonist, while buprenorphine is a full opioid agonist

Answer

Methadone carries no risk of overdose, making it safer than buprenorphine for outpatient use

Answer

Methadone requires naloxone co-formulation to prevent misuse

Question 2

A client with co-occurring generalized anxiety disorder and alcohol use disorder is being assessed for pharmacological treatment of their anxiety. Which of the following medications would generally be considered the most appropriate first-line choice, given the risk profile in this population?

Accepted Answer

An SSRI such as sertraline, because it is non-addictive and effective for anxiety with a co-occurring SUD

Answer

A benzodiazepine such as lorazepam, because of its rapid anxiolytic onset

Answer

Alcohol itself can serve as a self-medication bridge while waiting for other treatments to take effect

Answer

Barbiturates, because they have less abuse potential than benzodiazepines

Question 3

Acamprosate (Campral) is an FDA-approved medication for alcohol use disorder. Which of the following best describes its primary mechanism of action?

Accepted Answer

It modulates glutamate and GABA neurotransmission to reduce protracted withdrawal symptoms and cravings

Answer

It blocks alcohol metabolism at the acetaldehyde stage, producing a severe aversive reaction when alcohol is consumed

Answer

It binds to opioid receptors to reduce the rewarding effects of alcohol

Answer

It acts as a dopamine reuptake inhibitor to normalize reward pathways disrupted by chronic alcohol use

Question 4

A client with a history of psychotic disorder reports daily cannabis use and states it helps them feel relaxed. Which of the following represents the most clinically important concern the counselor should communicate to this client?

Accepted Answer

THC can exacerbate psychotic symptoms, trigger relapses in schizophrenia, and reduce the efficacy of antipsychotic medications

Answer

Cannabis is a benign natural substance with no documented psychiatric risks when used in moderation

Answer

Cannabis is recommended as a harm reduction substitute for clients who use stimulants

Answer

The primary concern with cannabis in this population is respiratory damage, not psychiatric effects

Question 5

A client with co-occurring ADHD and stimulant use disorder is being evaluated for ADHD pharmacotherapy. Which medication class would raise the greatest concern for misuse and diversion in this population?

Accepted Answer

Amphetamine salts (Adderall), a Schedule II stimulant with high abuse potential

Answer

Atomoxetine (Strattera), a non-stimulant selective norepinephrine reuptake inhibitor

Answer

Bupropion (Wellbutrin), an atypical antidepressant sometimes used off-label for ADHD

Answer

Guanfacine (Intuniv), an alpha-2 adrenergic agonist approved for ADHD

Question 6

A client being treated with buprenorphine/naloxone (Suboxone) for opioid use disorder begins taking a benzodiazepine prescribed by another provider without informing their MAT physician. What is the primary pharmacological danger of this combination?

Accepted Answer

Combined CNS depression from both substances significantly increases the risk of respiratory depression and overdose death

Answer

The naloxone component of Suboxone will immediately reverse the benzodiazepine, causing acute withdrawal

Answer

Benzodiazepines accelerate buprenorphine metabolism, triggering opioid withdrawal symptoms

Answer

This combination causes a disulfiram-like reaction including flushing, nausea, and tachycardia