CASAC - Credentialed Alcoholism and Substance Abuse Counselor Pharmacology & Co-Occurring Disorders Questions and Answers — Questions and Answers
Question 1: A client with a dual diagnosis of Opioid Use Disorder (OUD) and Major Depressive Disorder (MDD) is being treated with buprenorphine. The client reports a significant reduction in both cravings and depressive symptoms. Which pharmacological property of buprenorphine is most likely contributing to the antidepressant effect?
- Partial agonism at mu-opioid receptors
- Antagonism at kappa-opioid receptors (Correct answer)
- Full agonism at delta-opioid receptors
- Blockade of serotonin reuptake
Correct answer: Antagonism at kappa-opioid receptors
Buprenorphine is a partial agonist at mu-opioid receptors, which addresses opioid cravings and withdrawal. However, its role as an antagonist at kappa-opioid receptors is believed to contribute significantly to its antidepressant effects. Activation of kappa-opioid receptors can lead to dysphoria and stress, so blocking them can have an antidepressant and anxiolytic effect.
Question 2: A CASAC is working with a client who is taking disulfiram (Antabuse) for Alcohol Use Disorder (AUD). The client reports accidentally using a mouthwash that contained alcohol and is now experiencing nausea, flushing, and a throbbing headache. What is the most important piece of information for the CASAC to reinforce with the client?
- These symptoms are a sign of an allergic reaction and require immediate medical attention.
- The client should drink plenty of water to flush the alcohol from their system.
- The disulfiram-alcohol reaction can occur with even small amounts of alcohol from unexpected sources and can last for up to 14 days after the last dose. (Correct answer)
- The client likely needs a higher dose of disulfiram to prevent this from happening again.
Correct answer: The disulfiram-alcohol reaction can occur with even small amounts of alcohol from unexpected sources and can last for up to 14 days after the last dose.
Disulfiram works by blocking the enzyme aldehyde dehydrogenase, causing a buildup of toxic acetaldehyde if alcohol is consumed. This leads to the unpleasant reaction the client experienced. It is crucial for clients to understand that this reaction can be triggered by hidden sources of alcohol (like mouthwash, some foods, or even perfumes) and that the effect of the drug can persist for up to two weeks after discontinuing it.
Question 3: A client in a methadone maintenance program has a co-occurring Panic Disorder and is prescribed a benzodiazepine by their psychiatrist. The CASAC should be aware that the concurrent use of methadone and benzodiazepines significantly increases the risk of which of the following?
- Hypertensive crisis
- Serotonin syndrome
- Acute liver failure
- Respiratory depression and overdose (Correct answer)
Correct answer: Respiratory depression and overdose
Both methadone (an opioid) and benzodiazepines are central nervous system (CNS) depressants. When taken together, they potentiate each other's effects, leading to a dangerously high risk of profound sedation, slowed or stopped breathing (respiratory depression), coma, and fatal overdose. This is a critical safety concern in co-occurring disorder treatment.
Question 4: Which of the following medications for Alcohol Use Disorder (AUD) works by reducing the rewarding, euphoric effects of alcohol, thereby decreasing cravings, by acting as an opioid receptor antagonist?
- Acamprosate (Campral)
- Naltrexone (Vivitrol, Revia) (Correct answer)
- Disulfiram (Antabuse)
- Buprenorphine (Sublocade)
Correct answer: Naltrexone (Vivitrol, Revia)
Naltrexone is an opioid receptor antagonist. It works in AUD by blocking the mu-opioid receptors, which interferes with the dopamine reward pathway associated with alcohol consumption. This makes drinking less pleasurable and reduces the craving to drink. Acamprosate is thought to work on glutamate and GABA systems, while disulfiram creates an aversive reaction to alcohol.
Question 5: A client with Alcohol Use Disorder (AUD) and co-occurring anxiety has recently completed detoxification and is motivated to maintain abstinence. They have a history of liver problems. The medical provider is considering acamprosate (Campral). For the CASAC, what is a key counseling point about this medication?
- The medication will cause severe sickness if the client has even a small amount of alcohol.
- It primarily works by blocking the pleasurable effects of alcohol, making relapse less likely.
- Acamprosate helps restore chemical balance in the brain and is generally considered safe for patients with liver issues as it is not metabolized by the liver. (Correct answer)
- It is an opioid-based medication that will also help reduce the client's anxiety symptoms directly.
Correct answer: Acamprosate helps restore chemical balance in the brain and is generally considered safe for patients with liver issues as it is not metabolized by the liver.
Acamprosate is believed to work by restoring the balance between GABA and glutamate neurotransmitter systems that is disrupted by chronic alcohol use. A key advantage, particularly for clients with compromised liver function due to alcohol, is that it is not metabolized by the liver and is excreted by the kidneys. It does not cause a disulfiram-like reaction or block opioid receptors.
Question 6: When working with a client who has a co-occurring anxiety disorder and a Substance Use Disorder (SUD), an integrated treatment approach is considered best practice. From a pharmacological standpoint, what does this primarily involve?
- Treating the SUD first, and only addressing the anxiety with medication once sobriety is achieved.
- Using benzodiazepines as a first-line treatment for anxiety to provide immediate relief.
- Coordinating care with medical providers to ensure medications for both disorders are managed safely and concurrently. (Correct answer)
- Focusing solely on non-pharmacological interventions for anxiety to avoid potential for addiction.
Correct answer: Coordinating care with medical providers to ensure medications for both disorders are managed safely and concurrently.
Integrated treatment for co-occurring disorders involves addressing both the mental health condition and the SUD at the same time. From a pharmacology perspective, this requires careful coordination between the CASAC and medical/psychiatric providers to manage medications for both conditions. This approach ensures that potential drug interactions are monitored and that the client receives comprehensive care, which has been shown to be superior to treating each disorder separately.
CASAC - Credentialed Alcoholism and Substance Abuse Counselor Pharmacology & Co-Occurring Disorders Questions and Answers
A client with a dual diagnosis of Opioid Use Disorder (OUD) and Major Depressive Disorder (MDD) is being treated with buprenorphine.
The client reports a significant reduction in both cravings and depressive symptoms.
Which pharmacological property of buprenorphine is most likely contributing to the antidepressant effect?