CASAC Pharmacology and Co-Occurring Disorders 5 — Questions and Answers
Question 1: A client with alcohol use disorder is also prescribed warfarin for a heart condition. The counselor should be aware that alcohol:
- Has no interaction with warfarin at moderate amounts
- Chronic heavy use decreases warfarin efficacy; acute intoxication increases bleeding risk (Correct answer)
- Consistently decreases warfarin levels regardless of drinking pattern
- Only interacts with warfarin if consumed within 2 hours of the dose
Correct answer: Chronic heavy use decreases warfarin efficacy; acute intoxication increases bleeding risk
Chronic heavy alcohol use induces CYP enzymes that increase warfarin metabolism (reducing efficacy), while acute intoxication inhibits these enzymes, increasing bleeding risk.
Question 2: Which of the following best describes 'dual diagnosis' or 'co-occurring disorders'?
- The presence of two or more substance use disorders simultaneously
- The simultaneous presence of a substance use disorder and at least one mental health disorder (Correct answer)
- A diagnosis requiring two separate clinical evaluations over time
- The presence of both a physical and a mental health condition
Correct answer: The simultaneous presence of a substance use disorder and at least one mental health disorder
Co-occurring disorders (dual diagnosis) refers to the simultaneous presence of at least one substance use disorder and at least one mental health disorder in the same individual.
Question 3: A client stabilized on methadone maintenance needs surgery requiring pain management. What is the most appropriate approach?
- Discontinue methadone before surgery to avoid drug interactions
- Continue methadone and add non-opioid analgesics or additional opioids as needed for acute pain (Correct answer)
- Switch to buprenorphine immediately before the procedure
- Reduce methadone dose by 50% and substitute with short-acting opioids
Correct answer: Continue methadone and add non-opioid analgesics or additional opioids as needed for acute pain
Methadone should be continued during surgery; additional analgesics — including opioids — can be used for acute pain management, as methadone alone may not provide adequate surgical analgesia.
Question 4: Which statement about cannabis use and anxiety disorders is most accurate?
- Cannabis consistently reduces anxiety symptoms in all individuals
- Short-term use may relieve anxiety, but chronic use is associated with increased anxiety and panic (Correct answer)
- Cannabis has no effect on anxiety disorders
- High-CBD, low-THC products are proven anxiolytics by FDA standards
Correct answer: Short-term use may relieve anxiety, but chronic use is associated with increased anxiety and panic
While some individuals use cannabis to manage anxiety short-term, chronic use—especially high-THC products—is associated with increased anxiety, panic attacks, and worsening anxiety disorders.
Question 5: A client is prescribed clonidine during opioid detoxification. What is the primary purpose of this medication?
- To block opioid receptors and prevent relapse
- To manage autonomic symptoms of opioid withdrawal such as sweating, anxiety, and elevated heart rate (Correct answer)
- To replace the opioid with a safer substitute
- To prevent seizures during opioid withdrawal
Correct answer: To manage autonomic symptoms of opioid withdrawal such as sweating, anxiety, and elevated heart rate
Clonidine is an alpha-2 adrenergic agonist that reduces the noradrenergic hyperactivity responsible for autonomic symptoms during opioid withdrawal.
Question 6: When treating a client with co-occurring opioid use disorder and chronic pain, the integrated treatment approach should prioritize:
- Achieving complete opioid abstinence as the primary pain management goal
- Addressing both conditions simultaneously using a multimodal, individualized treatment plan (Correct answer)
- Treating chronic pain first before addressing opioid use disorder
- Referring chronic pain exclusively to a pain specialist with no SUD coordination
Correct answer: Addressing both conditions simultaneously using a multimodal, individualized treatment plan
Integrated treatment that simultaneously addresses both chronic pain and opioid use disorder with a multimodal, individualized approach is the evidence-based standard of care.
Question 7: A client with alcohol use disorder is started on naltrexone. The counselor should educate the client that naltrexone works primarily by:
- Causing a toxic reaction if alcohol is consumed
- Blocking opioid receptors, thereby reducing the euphoric reward and craving associated with alcohol (Correct answer)
- Replacing the need for alcohol by stimulating GABA receptors directly
- Increasing serotonin levels to improve mood and reduce drinking motivation
Correct answer: Blocking opioid receptors, thereby reducing the euphoric reward and craving associated with alcohol
Naltrexone reduces alcohol's rewarding effects by blocking opioid receptors, since the brain's opioid system mediates much of the pleasurable effects of alcohol.
CASAC Pharmacology and Co-Occurring Disorders 5
A client with alcohol use disorder is also prescribed warfarin for a heart condition.
The counselor should be aware that alcohol: