CASAC Pharmacology & Co-Occurring Disorders 3 — Questions and Answers
Question 1: A client with PTSD and alcohol use disorder asks why their therapist recommended avoiding benzodiazepines for anxiety. What is the BEST explanation?
- Benzodiazepines have no anxiolytic effect in PTSD patients
- Benzodiazepines carry high misuse potential and may worsen PTSD outcomes over time (Correct answer)
- Benzodiazepines are contraindicated only when opioids are also prescribed
- Benzodiazepines cause permanent memory impairment in trauma survivors
Correct answer: Benzodiazepines carry high misuse potential and may worsen PTSD outcomes over time
Benzodiazepines have high addiction liability and research suggests they may interfere with fear extinction, potentially worsening long-term PTSD outcomes.
Question 2: Which medication for alcohol use disorder requires the client to be abstinent from opioids for 7–10 days before initiation?
- Acamprosate (Campral)
- Disulfiram (Antabuse)
- Naltrexone (Vivitrol/ReVia) (Correct answer)
- Topiramate (Topamax)
Correct answer: Naltrexone (Vivitrol/ReVia)
Naltrexone is an opioid antagonist; initiating it while opioids are present will precipitate acute withdrawal, so a washout period is required.
Question 3: Cannabis use disorder co-occurring with a psychotic disorder presents which UNIQUE clinical challenge?
- Cannabis eliminates positive symptoms of psychosis
- Cannabis use can precipitate or exacerbate psychotic symptoms, complicating diagnosis and treatment (Correct answer)
- Antipsychotics are ineffective when cannabis is used concurrently
- THC has a cross-tolerance with antipsychotic medications
Correct answer: Cannabis use can precipitate or exacerbate psychotic symptoms, complicating diagnosis and treatment
Cannabis, especially high-THC strains, can trigger or worsen psychotic symptoms and make it difficult to differentiate substance-induced from primary psychotic disorders.
Question 4: Methadone's extended half-life (24–36 hours) is clinically significant because it:
- Allows weekly dosing in stable patients
- Prevents once-daily dosing from being effective
- Provides steady plasma levels that reduce peaks of euphoria and troughs of withdrawal (Correct answer)
- Requires dose adjustments only during the first week of treatment
Correct answer: Provides steady plasma levels that reduce peaks of euphoria and troughs of withdrawal
Methadone's long half-life produces stable plasma concentrations, blunting euphoria from illicit opioids and preventing withdrawal between doses.
Question 5: A client taking an SSRI for depression begins using cocaine heavily. The counselor should be aware that cocaine's mechanism may DIRECTLY interact with the SSRI by:
- Blocking serotonin reuptake, potentially causing additive serotonin effects (Correct answer)
- Inducing CYP450 enzymes that metabolize SSRIs faster
- Binding to SSRI receptor sites, reducing antidepressant efficacy
- Causing dopamine depletion that worsens SSRI side effects
Correct answer: Blocking serotonin reuptake, potentially causing additive serotonin effects
Cocaine blocks monoamine reuptake transporters including SERT; combined with an SSRI, this may produce excessive serotonergic stimulation and increase risk of serotonin syndrome.
Question 6: In treating co-occurring ADHD and stimulant use disorder, which approach is generally preferred?
- Withhold all ADHD treatment until the client achieves 2 years of sobriety
- Use non-stimulant medications like atomoxetine or bupropion first (Correct answer)
- Prescribe high-dose amphetamines to replace illicit stimulant use
- Treat ADHD only with behavioral interventions, never medication
Correct answer: Use non-stimulant medications like atomoxetine or bupropion first
Non-stimulant options such as atomoxetine (Strattera) or bupropion (Wellbutrin) are preferred initially to treat ADHD without introducing stimulants with misuse potential.
Question 7: Acamprosate (Campral) is thought to support alcohol abstinence primarily by:
- Blocking opioid receptors to reduce alcohol's rewarding effects
- Modulating GABA and glutamate systems to reduce protracted withdrawal symptoms (Correct answer)
- Producing an aversive reaction when alcohol is consumed
- Increasing dopamine in the nucleus accumbens to reduce craving
Correct answer: Modulating GABA and glutamate systems to reduce protracted withdrawal symptoms
Acamprosate stabilizes the glutamate-GABA imbalance that persists after alcohol cessation, reducing the neurobiological distress that drives relapse.
CASAC Pharmacology & Co-Occurring Disorders 3
A client with PTSD and alcohol use disorder asks why their therapist recommended avoiding benzodiazepines for anxiety.
What is the BEST explanation?