CASAC Pharmacology & Co-Occurring Disorders 5 — Questions and Answers
Question 1: A client presents with methamphetamine use disorder and co-occurring psychosis. The counselor should understand that methamphetamine-induced psychosis:
- Is permanent and identical to primary schizophrenia
- Typically resolves with abstinence but may persist weeks to months in heavy users (Correct answer)
- Requires lifelong antipsychotic treatment regardless of abstinence
- Only occurs with IV methamphetamine use, not smoked or snorted use
Correct answer: Typically resolves with abstinence but may persist weeks to months in heavy users
Methamphetamine-induced psychosis commonly resolves with sustained abstinence, though heavy long-term users may experience prolonged or recurrent psychotic symptoms.
Question 2: Which pharmacodynamic property makes fentanyl particularly dangerous compared to heroin in the context of overdose?
- Fentanyl has a longer half-life, prolonging respiratory depression
- Fentanyl is approximately 50–100 times more potent, making therapeutic doses indistinguishable from lethal doses (Correct answer)
- Fentanyl is resistant to naloxone reversal in overdose
- Fentanyl uniquely suppresses the gag reflex more than other opioids
Correct answer: Fentanyl is approximately 50–100 times more potent, making therapeutic doses indistinguishable from lethal doses
Fentanyl's extreme potency means that even a tiny dose miscalculation can cause fatal respiratory depression, and street supplies are inconsistently dosed.
Question 3: A CASAC counselor is working with a client whose antidepressant dose was recently increased while the client also uses heavy amounts of alcohol. The counselor's PRIORITY concern should be:
- Alcohol will induce liver enzymes and reduce antidepressant plasma levels over time
- The combination may cause serotonin syndrome immediately
- Alcohol's CNS depressant effects may be additive with sedating antidepressants, increasing accident risk (Correct answer)
- The antidepressant will eliminate the reinforcing effects of alcohol
Correct answer: Alcohol's CNS depressant effects may be additive with sedating antidepressants, increasing accident risk
Alcohol's CNS depression combined with sedating antidepressants (e.g., tricyclics, mirtazapine) increases risk of psychomotor impairment, sedation, and accidental injury.
Question 4: The term 'dual diagnosis' or 'co-occurring disorders' is most precisely defined as:
- The presence of two substance use disorders simultaneously
- The co-existence of at least one substance use disorder and at least one mental health disorder (Correct answer)
- Any combination of medical and psychiatric conditions in a substance user
- Two separate episodes of substance use disorder over a lifetime
Correct answer: The co-existence of at least one substance use disorder and at least one mental health disorder
Dual diagnosis refers specifically to the co-occurrence of a substance use disorder alongside a diagnosable psychiatric/mental health disorder in the same individual.
Question 5: Varenicline (Chantix) aids smoking cessation primarily by:
- Replacing nicotine fully as a complete agonist at nicotinic receptors
- Acting as a partial agonist at alpha-4 beta-2 nicotinic receptors, reducing withdrawal and blocking nicotine's reinforcing effects (Correct answer)
- Inhibiting dopamine reuptake to manage nicotine withdrawal symptoms
- Blocking mu opioid receptors to reduce the social reinforcement of smoking
Correct answer: Acting as a partial agonist at alpha-4 beta-2 nicotinic receptors, reducing withdrawal and blocking nicotine's reinforcing effects
Varenicline's partial agonism at nicotinic acetylcholine receptors provides enough stimulation to reduce cravings while blocking nicotine from producing its full reinforcing effect.
Question 6: A client with alcohol use disorder reports using gabapentin obtained from a friend. The counselor should recognize that gabapentin in SUD populations:
- Has no misuse potential and requires no further clinical attention
- Has emerging evidence of misuse potential, particularly in those with opioid use disorder (Correct answer)
- Is the FDA-approved first-line treatment for alcohol use disorder
- Blocks alcohol's GABA effects and is therapeutically beneficial without concern
Correct answer: Has emerging evidence of misuse potential, particularly in those with opioid use disorder
Gabapentin has demonstrated misuse potential, especially among individuals with opioid use disorder who use it to potentiate opioid effects or self-medicate withdrawal.
Question 7: The 'integrated treatment' model for co-occurring disorders means:
- Treating substance use disorder first until stable, then addressing psychiatric disorders separately
- Providing substance use and mental health treatment simultaneously within a unified, coordinated approach (Correct answer)
- Integrating peer support only into the psychiatric treatment team
- Using one medication to treat both disorders at the same time
Correct answer: Providing substance use and mental health treatment simultaneously within a unified, coordinated approach
Integrated treatment addresses both substance use and mental health disorders concurrently by the same team or in coordinated collaboration, which produces better outcomes than sequential treatment.
CASAC Pharmacology & Co-Occurring Disorders 5
A client presents with methamphetamine use disorder and co-occurring psychosis.
The counselor should understand that methamphetamine-induced psychosis: