Chapter 25: Substance Use Disorders

a. Her own alienation and rebelliousness Individual risk factors include early antisocial behavior, alienation and rebelliousness, susceptibility to peer influence, and low self-esteem. The other answers are all related to her family, which would be environmental factors.

A 15-year-old high school junior girl drank alcohol constantly. Which of the following would be a personal host factor? a. Her own alienation and rebelliousness b. High expectations for success from family and friends c. Inconsistent or absent parental discipline, supervision, and support d. Parents who are against the consumption of liquor

d. Relaxation, alertness, and readiness to study for his examinations Because both nicotine and caffeine are legal drugs, accepted in many American subcultures, the college student was probably relaxed and alert. He was not concerned about addiction, although if he got jittery he may eventually feel he needs to cut back a bit.

A 19-year-old college student was smoking a cigarette and drinking a cup of coffee. What effect would he expect these substances to have on how he is feeling? a. Euphoria, with decreased fear and anxiety, and ready for a nap b. Immunity from pain, anxiety, or fear, and ready for an intimate encounter c. Ostracism because no one appreciates being very close to a smoker d. Relaxation, alertness, and readiness to study for his examinations

d. Relapses are common in early recovery; he should go back to AA and try again. Relapses are common in early recovery. The addict should be encouraged to quickly resume attendance and discuss the problem with peers.

A man had been attending Alcoholics Anonymous (AA) meetings. Following an argument with his former wife over appropriate child care arrangements and need for financial support, he stopped by his favorite tavern. On the basis of what he had been taught at AA, what should he conclude? a. He had made a horrible mistake and inpatient therapy was now his only option. b. He needs to see a therapist to understand why, when he had been doing so well, he voluntarily entered that tavern. c. He was a miserable failure doomed to be an alcoholic forever. d. Relapses are common in early recovery; he should go back to AA and try again.

d. Walk home along a different route rather than his former route by the bar. Useful methods to avoid alcohol or drugs include changing ones circle of friends from drinkers to nondrinkers and avoiding environments that pose dangerous temptations.

A man was trying to avoid drinking. In addition to attending Alcoholics Anonymous meetings, what might his sponsor suggest he do? a. Eat more, so his stomach would be too full for a drink. b. Smoke whenever he felt the need for a drink. c. Try to persuade his drinking buddies to join him in abstaining. d. Walk home along a different route rather than his former route by the bar.

c. Learning disabilities Alcohol exposure during pregnancy has serious consequences. Common symptoms observed may include learning disabilities, intellectual disabilities or low IQ, speech and language delays, poor reasoning and judgment skills, attention deficits, poor memory, and poor coordination. These behaviors are on a spectrum of severity that depends on the individual. Children of mothers who have used cocaine or heroin are at greater risk for experiencing child abuse and may demonstrate rapid mood changes as infants.

A mother defensively said, I consumed alcohol while I was pregnant with my baby, and except for being small, she is okay. What characteristics would the nurse expect the infant to exhibit when grown? a. Hyperactivity b. Suffering consequences of child abuse c. Learning disabilities d. Rapid mood changes

a. Limiting the harmful consequences of the users behavior A co-dependent person, or enabler, is one who works at limiting or eliminating the harmful consequences of the users behavior, thereby enabling the user to continue the abuse pattern. Helping the user obtain the substance, establishing trust within the family, and referring the user to a treatment program are not typical behaviors of someone who is co-dependent.

A nurse is counseling the wife of a substance abuser, who states that she may be co-dependent. Which of the following behaviors would most likely be reported? a. Limiting the harmful consequences of the users behavior b. Helping the user obtain the substance needed c. Establishing trust with the user in the family d. Referring the user to a treatment program

d. To feel normal The first stage in addiction is experimental use and social use. The second stage is when problem use or abuse occurs. The substances are used to manipulate felt emotions. After this stage, the drug is used to avoid pain and depression and to try to feel normal; this condition is termed dependency.

A nurse states that a client is experiencing dependency. Which of the following reasons for drug use has the client probably reported? a. To express independence from parents and authority figures b. To experiment with new substances c. To manipulate his or her own emotions d. To feel normal

c. Law enforcement to reduce supply of available drugs Although the evidence-based solutions for substance use disorders require increased prevention and treatment, the funding of such efforts lags behind. In 2009, the budget of the Office of National Drug Control Policy (ONDCP) allotted 35% for prevention and treatment research to reduce demand, whereas law enforcement to reduce supply received 65%. Budget allocation is a reflection of priority.

As of 2011, what is the federal governments priority in addressing substance abuse? a. Treatment of substance abuse b. Prevention of substance abuse c. Law enforcement to reduce supply of available drugs d. Research about how to successfully decrease the use of drugs

c. Using substances with recurrent and significant adverse consequences By definition in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), the term substance abuse refers to a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences occurring within a 12-month period.

How is substance abuse defined? a. Evidence of tolerance and symptoms if use of the substance is decreased b. Experiencing loss of control over use of the substance c. Using substances with recurrent and significant adverse consequences d. Using substances to feel good or avoid feeling bad

a. Constructive, effective suggestions for living without the alcohol Self-help groups primarily provide fellowship, social support, useful suggestions, methods that have been seen to be effective by others, sponsorship, and hope.

In addition to fellowship, what do self-help groups such as Alcoholics Anonymous provide for the alcoholic? a. Constructive, effective suggestions for living without the alcohol b. Encouragement for a slow withdrawal from alcohol to prevent withdrawal symptoms and desperate action c. Referrals to attorneys who are willing to assist with financial and legal problems without reimbursement d. Referrals to mental health centers in which hospitalization is always an option

d. Sharing information about support groups such as Al-Anon or Alateen Hope must be encouraged, and so the family needs information about addiction and referrals to community support groups such as Al-Anon. The family needs emotional support and comfort and also to hear the nurse say that the problem is no ones fault but that everyone is responsible for actively engaging the alcoholic adult in treatment and self-help.

In addition to getting the alcoholic adult into treatment, what is the most useful intervention the nurse can implement with the family? a. Clarifying that the family members must begin to meet their own needs b. Helping the family adapt to daily life without the family member c. Encouraging the family to limit contact with the family member while in treatment d. Sharing information about support groups such as Al-Anon or Alateen

a. Arranging a planned confrontation from people with leverage Assisting individuals from referral into treatment may involve anticipation of negative circumstances. They may require a collaboration of many facets of their life; family members, a partner or parent, a health care professional, an employer, the school system, the social services system, or legal system may be involved. The beliefs that one has to hit bottom before entering treatment, has to want treatment, or has to act on his or her own to get help are unfounded in current research.

What intervention is considered the most effective approach for getting an addict into treatment? a. Arranging a planned confrontation from people with leverage b. Taking the addict to the emergency department for a psychiatric admission c. Calling the police and having the addict taken to jail d. Waiting until the addict recognizes the need for treatment

c. The family reorganizes, excluding the ill person from the family. The family may blame the addict for all problems and perceive the other family members as very responsible. Sometimes families reorganize and exclude the addicted individual.

What is one approach to coping that is used by many families who have a family member addicted to drugs or alcohol? a. The family does not function but disintegrates. b. The family functions around the ill person. c. The family reorganizes, excluding the ill person from the family. d. The family tries desperately to function exactly as before.

c. Paper-and-pencil tests concerning self-report of personal habits Screening must be easy, convenient, low-cost, and noninvasive. Paper-and-pencil surveys have been found to be both valid and reliable and hence effective for such screenings.

What is the easiest way for a nurse to screen for persons who have or are at risk for developing alcohol- or drug-related problems? a. A laboratory test, which, although somewhat expensive, is very accurate b. Having teachers watch for inappropriate, inebriated behaviors in the classroom c. Paper-and-pencil tests concerning self-report of personal habits d. Testing a hair sample, which is nonintrusive and relatively inexpensive

d. Marijuana Marijuana is still the most commonly abused illicit drug.

What is the most commonly abused illicit (illegal) substance? a. Cocaine b. Methamphetamine c. Heroin d. Marijuana

c. The higher the persons educational level, the less likely that person is to use tobacco. Persons who have graduated from college are the population least likely to use tobacco products. The use of tobacco products decreases with an increased educational level.

What is the relationship between tobacco use and educational level? a. Those who attend college likely used tobacco as adolescents and will continue use. b. The higher the persons educational level, the more likely that person is to be able to afford and use tobacco. c. The higher the persons educational level, the less likely that person is to use tobacco. d. There is no relationship between educational level and tobacco use.

d. Young adults (aged 18 to 25 years) Addictions are considered problems of youth or adulthood, not old age. The rate of dependence and abuse is highest among young persons, especially those aged 18 to 25.

Which aggregate is most at risk for alcohol and drug abuse? a. Elderly persons (aged 65 and older) b. Middle-aged persons (aged 20 to 64 years) c. Teenagers (aged 12 to 17 years) d. Young adults (aged 18 to 25 years)

a. Disorders of impaired attention b. Social inadequacy c. Difficulty with authority figures f. Increased risk of exposure to domestic violence The children of impaired parents commonly experience such characteristics as feelings of low self-esteem, impaired attention disorders, difficulty with authority figures, social inadequacy, and a heightened sense of responsibility. They have a higher risk of exposure to domestic violence both in observation and experience.

Which of the following characteristics is most likely experienced by children of impaired parents? (Select all that apply.) a. Disorders of impaired attention b. Social inadequacy c. Difficulty with authority figures d. Increased self-esteem e. Decreased sense of responsibility f. Increased risk of exposure to domestic violence

d. Tolerance of the substance, presence of withdrawal symptoms, and continuation of use despite recurrent physical problems According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), dependence can be diagnosed when at least three of the following symptoms have occurred within a 12-month period: tolerance of or a marked need for increased amounts of a substance to achieve the desired effect; withdrawal symptoms; unsuccessful attempts to cut down or control use; abandonment or reduction of important social, occupational, or recreational activities as a result of substance abuse; and continuation of use despite knowledge of recurrent physical or psychological problems.

Which of the following clients demonstrates symptoms that would lead to a diagnosis of dependence? a. Involvement in an auto accident in association with using substances while driving b. Consumption of the substance on a regular basis, withdrawal symptoms when the substance is not used, and failure to successfully complete a treatment program c. Inability to function appropriately and unsuccessful attempts to cut down or control use d. Tolerance of the substance, presence of withdrawal symptoms, and continuation of use despite recurrent physical problems

a. A client who uses substances despite serving jail time for previous use By definition, addiction refers to a chronic, relapsing brain disease characterized by compulsive drug seeking despite negative consequences. This acknowledges that the brain undergoes significant changes in its structure and function because of the illicit substances.

Which of the following clients demonstrates the characteristics of addiction? a. A client who uses substances despite serving jail time for previous use b. A client who demonstrates evidence of tolerance and symptoms if substance is decreased c. A client who reports experiencing loss of control when using substances d. A client who uses substances to feel good or at least avoid feeling bad

c. Stigma Stigma has been identified as one of the major treatment barriers for persons with a substance use disorder. Stigma focuses on a persons difference, not his or her commonality, and on the personal challenge, not the strength. The other factors may also be barriers to treatment but have not been identified as major problems.

Which of the following has been identified as one of the major treatment barriers for persons with a substance abuse disorder? a. Fear b. Availability c. Stigma d. Access

b. Providing coping skills and antidrug education to school-aged children Primary prevention is providing education, assisting with development of coping life skills, helping the community set appropriate norms, and providing alternative experiences. Focusing on the families and alcoholic persons for treatment is secondary or tertiary prevention.

Which of the following interventions would a community/public health nurse implement as a primary strategy to prevent drug and alcohol abuse? a. Referring alcoholic persons and their families into support groups b. Providing coping skills and antidrug education to school-aged children c. Refusing to consume alcohol when in public d. Counseling children from families who have a history of alcoholism

b. Irritability Signs of drug use in the work place include altered and slow reactions, irritability, and low productivity. Nervousness is not described as one of the signs of drug use in the workplace.

Which of the following is a sign of drug use in the workplace? a. Improved reactions b. Irritability c. Improved productivity d. Nervousness

d. Genetic predisposition The host factor in addiction resides within the person who has the addiction. Genetic inheritance is the only example listed that relates to the characteristics of the host. All the other answers represent environmental factors. Genetic inheritance is unique to the involved individual.

Which of the following is an example of a host factor in addiction? a. Community norms b. Economic deprivation c. Free drinks at parties d. Genetic predisposition

a. Cultural expectations around celebrations An environmental factor in addiction includes the social, economic, physical, political, and cultural settings in which the host and agent interact. The environment also includes the meaning, values, and norms assigned to a drug by its culture, community, and society. All the options represent host factors except for cultural expectations, which are environmental.

Which of the following is an example of an environmental factor in addiction? a. Cultural expectations around celebrations b. Ethnic group endowment c. Genetic predisposition d. Psychological trauma early in life

b. Drug abuse may bring about symptoms of another mental illness. Drug abuse may bring about symptoms of another mental illness (for example, increased risk of psychosis in vulnerable marijuana users). It is very difficult to determine which disorder caused the other, even if one behavior was observed first. Comorbidity usually involves exhibiting psychiatric and substance use disorders. Persons with diagnosed personality disorders have a higher incidence of substance use disorders.

Which of the following statements about persons experiencing a comorbidity is accurate? a. Through careful questioning, it is possible to distinguish which problems are caused by which diagnosis. b. Drug abuse may bring about symptoms of another mental illness. c. The comorbid condition usually involves the diagnosis of a chronic disease and substance abuse. d. Persons with diagnosed personality disorders have a lower incidence of substance use disorders.

a. Adolescents begin experimenting with alcohol and progress to marijuana use. In the gateway theory of drug use, adolescents begin experimenting with alcohol or tobacco, sometimes later progressing to marijuana. Addiction is a disease of the brain, but that does not apply to the gateway theory of drug use. Adolescents may begin with occasional use and gradually increase use to a regular occurrence; however, this describes a different type of progression of drug use. Drug-seeking behavior is a primitive response that occurs before conscious awareness.

Which of the following statements is the best description of the gateway theory of drug use? a. Adolescents begin experimenting with alcohol and progress to marijuana use. b. Addiction is a disease of the brain. c. Adolescents begin with occasional use, and it gradually becomes a regular occurrence. d. Addiction occurs before conscious awareness.

b. Children and adolescents The primary focus is on children and adolescents to discourage the initial use of substances. The older the person is before he or she experiments with substances, the less probable it is that the person will become addicted.

Who is the primary focus of community efforts in relation to substance abuse? a. Elderly persons b. Children and adolescents c. Middle-aged persons, especially women d. Young adults