Alcohol/Drug Detoxification
Text: Detoxification from Alcohol and Other Drugs:
Treatment Improvement Protocol (TIP) Series No. 19
by: Donald R. Wesson, M.D.
Exam Copyright (C) 1998 by:
Institute of Addiction Awareness
24831 Alicia Parkway, Suite C-519
Laguna Hills, CA 92653
1-888-333-CEUS
1. Detoxification does not include the period during which the
body of an addicted person adjusts to the absence of drugs.
a. True
b. False
2. How is the detoxification period usually defined?
a. The length of time it takes for a person to adjust to the
absence of drugs.
b. The period during which the patient receives
detoxification medications.
c. The period of time a person detoxifying from alcohol or
other drugs requires an intensive level of care.
d. all of the above
3. For persons who are severely dependent on alcohol:
a. abrupt, unsupervised cessation of drinking produces
severe discomfort but is not life threatening.
b. detoxification can be safely done in a social model
detoxification setting.
c. abrupt, unsupervised cessation of drinking may result in
delirium tremens or death.
d. detoxification requires no special medical supervision.
4. The CALDATA study suggests that:
a. treatment of addiction has no effect on crime.
b. methadone-maintenance programs are least effective with
opioid addicts.
c. for every dollar spent on treatment $7 in future costs
were saved.
d. both a. and c. above
5. What is "neuroadaptation"?
a. A synonym for drug tolerance.
b. The condition in which brain cells require the drug in
order to function.
c. A synonym for psychological dependence.
d. The adaptive change in an individuals brain cells and
neural functioning that results from continued exposure
to alcohol and other drugs.
6. Current policies concerning reimbursement for detoxification
services:
a. give insufficient weight to the variety of factors that
affect the selection of a setting in which the patient
has the greatest likelihood of achieving satisfactory
detoxification.
b. overemphasize the social motivation of a patient
seeking detoxification.
c. consider only the cost of initial detoxification
treatment.
d. give too much weight to the social situation of the
patient seeking detoxification when approving a
detoxification setting.
7. Medical model detoxification programs are always
hospital-based inpatient programs supervised by a physician.
a. True
b. False
8. Outpatient detoxification has the following advantage(s):
a. Less expensive.
b. Less disruptive.
c. Allows the patient to remain in the same setting where
he or she will function when drug free.
d. all of the above
9. Social model programs that provide medical detoxification
services under medical supervision include the:
a. socio-medical model program.
b. traditional medical model program.
c. modified medical model program.
d. rehabilitation model program.
10. According to the ASAM Patient Placement Criteria, a
major goal for management of detoxification is:
a. prevention of drug use in the detoxification period.
b. promotion of patient dignity and easing of discomfort
during the withdrawal process.
c. minimal sedation during detoxification.
d. timely referral to outpatient recovery treatment.
11. Detoxification alone is often adequate treatment for
alcohol and other drug dependencies.
a. True
b. False
12. Which if the following is not an important consideration
in Detoxification?
a. Psychological support.
b. Adequate medication to relieve detoxification symptoms.
c. short-acting medication that mimic the drug(s) of
addiction.
d. all of the above
13. During detoxification, who should control patients'
access to medication?
a. The patients.
b. The providers.
c. The patients' significant other.
d. Any of the above may control the patients' access
to medication.
14. What serious condition may be the first sign of
acute alcohol abstinence syndrome?
a. A grand mal seizure.
b. Delirium tremens.
c. Hallucinations.
d. Restlessness.
15. Patients "treated with symptom-triggered therapy completed
their treatment courses _______ and required ________
medication than patients treated using the standard fixed-
schedule approach.
a. as soon as/an equal amount of
b. later/more
c. sooner/more
d. sooner/less
16. What symptoms can beta-blockers treat in withdrawal?
a. Hallucinations.
b. Convulsions.
c. Autonomic hyperactivity.
d. all of the above
17. There is no specific treatment for stimulant withdrawal.
a. True
b. False
18. Abrupt discontinuation of a sedative-hypnotic in
patients who are severely physically dependent on it:
a. may result in severe gastrointestinal discomfort.
b. has no proven physical consequences.
c. can result in serious medical complications and
even death.
d. does not affect a healthy person physically.
19. How long is a patient required to wait between concluding
a short-term methadone detoxification program and
beginning another?
a. 7 days
b. 10 days
c. there is no waiting time
d. 21 days
20. Which of the following statements are true of LAMM?
a. It is safe for pregnant women.
b. Take-home doses are allowed after 14 days of treatment.
c. It can be dispensed only by licensed clinics.
d. The FDA has approved its use for heroin detoxification.
21. Patients who have been on methadone maintenance therapy
before incarceration:
a. should begin detoxification immediately.
b. should continue to receive their usual dose of medication
if incarceration is less than 2 weeks.
c. should have medication gradually discontinued.
d. should be changed to LAAM.
22. How can opiate withdrawal affect a fetus?
a. It has no affect and should be done upon mothers request.
b. It can lead to fetal distress.
c. The fetus is protected by the placental barrier
after 12 weeks.
d. both b. and c. above
23. Methadone detoxification is never an option
with an adolescent patient.
a. True
b. False
24. When a major mental illness is suspected in an addicted
client, a psychiatric evaluation should be conducted:
a. during the detoxification period.
b. after 6 months of abstinence.
c. only if symptoms persist for more than 1 week.
d. after several weeks of abstinence.
25. Language competency entails:
a. the ability to communicate with a patient.
b. familiarity with street terminology.
c. written and verbal proficiency in a language.
d. both a. and b. above
26. Variables such as adequacy of dosing levels, staff turnover
rates, and difference among counselors at methadone clinics:
a. correlate significantly with patient performance.
b. are rarely taken into account by standard measures
of treatment effectiveness.
c. both a. and b. above
d. none of the above
27. The JCAHO standard for review of patient charts includes:
a. a discussion of problems in a weekly case conference.
b. a 15% sample of the patients seen.
c. monthly reviews.
d. both b. and c. above
28. Confirmation of patient self-reports of AOD use
or nonuse through either biochemical analysis
or corroborative reports is:
a. a JCAHO mandated standard of care.
b. considered desirable by ASAM.
c. not necessary in an inpatient detoxification setting.
d. too expensive to be routine in public sector programs.
29. Non-clinical quality improvement measures include assisting
patients obtain Medicaid and other entitlements.
a. True
b. False
30. Collection of program-based quality improvement
indicators allows administrators of a program to:
a. secure federal and state funding.
b. track the progress of individual patients.
c. rate individual care providers.
d. look at their entire patient population.
31. The annual cost of detoxification in the
United States is:
a. seven times less expensive than containment of addicts.
b. unknown because of the uncertainties inherent in
estimating the number of detoxification episodes
and the settings in which they occur.
c. variable according to the source.
d. both b. and c. above
32. ____________ is the major source of Federal support
for treatment and related services for persons who
are mentally ill or chemically dependent.
a. Medicaid
b. DHHS
c. SAMHSA
d. SSI
33. What percentage of annual Medicaid expenditures associated
with hospital care are associated with substance abuse?
a. 20%
b. <10%
c. 60%
d. unknown
34. Federal treatment standards recommend there should be:
a. a fixed cap of 2 inpatient detoxification episodes
of no more than five days in length.
b. no caps on the number of inpatient detoxification
episodes and no limits on length of stay.
c. a flexible cap on inpatient detoxification episodes.
d. a flexible length of stay for each detoxification
episode.
35. The primary concern in the placement of a patient in a
detoxification program should be:
a. the patient's financial resources.
b. the patient's drug(s) of choice.
c. the patient's family situation.
d. the patient's individual clinical need.
36. In states where parental permission is not required
for treatment, the Federal regulations permit
a program to withhold services if the minor will not
authorize a disclosure that the program needs in order
to obtain financial reimbursement for that minor's
treatment.
a. True
b. False
37. If public care is unavailable and a patient cannot
complete his/her course of treatment for financial
reasons, from a legal standpoint a program:
a. has no special obligation to that patient.
b. must continue treatment as long the patient
believes is necessary.
c. should probably continue to treat the patient.
d. none of the above
38. Immunity from criminal and civil liability granted
to programs in states that place a duty on them
to accept involuntarily committed patients:
a. also protects them from malpractice claims.
b. does not protect them from malpractice claims.
c. assumes a malpractice waiver from involuntarily
committed patients.
d. is a special section of the civil code.
39. Federal restrictions on disclosure apply:
a. to any information that would identify the patient
as an AOD abuser, either directly or by implication.
b. from the moment the patient makes an appointment.
c. to patients who are civilly or involuntarily committed.
d. all of the above
40. When may a patient revoke consent to release information?
a. After verbal notification of a responsible person
in the treatment program.
b. At any time.
c. After notifying the program in writing.
d. both a. and c. above
41. In order for a program to release information about a minor,
except to his parent or guardian, the minor must have signed
a consent form.
a. True
b. False
42. The fact that a patient has signed a proper consent form
authorizing the release of information:
a. forces the program to make the proposed disclosure.
b. requires the program to make the disclosure unless
they have also received a subpoena or court order.
c. does not force a program to make the proposed disclosure
unless the program has also received a subpoena or
court order.
d. All of the above may apply in individual states
43. Programs are legally obligated to refuse to honor
a consent that is deficient.
a. True
b. False
44. Programs need to be sensitive about the amount and kind of
information they disclose to third party payers because:
a. the insurer may not operate under the same
confidentiality rules as the program.
b. the patient may sue the program if information is
disclosed to the insurer that he/she did not want
the insurer to have.
c. the insurer may use this information to deny benefits
to the patient.
d. all of the above
45. Under what circumstances may a program reveal that a person
being inquired after by telephone is a patient at the
program?
a. If there is a family emergency.
b. If the caller is a first degree relative of the patient.
c. both a. and b. above
d. none of the above
46. If a patient referred by a criminal justice agency never
applies for or receives services from the program:
a. informing the referring agency is not allowed with
or without the patient's consent.
b. that fact must be communicated to the referring agency.
c. that fact must be communicated to a law enforcement
agency only with the patient's written consent.
d. that fact may be communicated to the referring agency
without the patient's consent.
47. Federal confidentiality law and regulations ____________
a program from making the type of disclosure that Tarasoff
and similar cases require.
a. prohibit under any circumstances
b. permit without exception
c. prohibit unless it can do so by using one
of the regulation's exceptions
d. allow with the patient's permission
48. If a program must use force to detain an intoxicated patient
from driving, the program:
a. can be sued by the patient for assault and battery.
b. is protected from liability.
c. cannot be sued by the patient for assault and battery.
d. both a. and b. above
49. A search warrant authorizes the program to permit police
to enter the premises.
a. True
b. False
50. The medical emergency exception to the Federal
confidentiality law:
a. permits disclosure to the patient's family members.
b. permits disclosure to police and firefighters
answering an emergency call.
c. permits disclosure to medical personnel only.
d. permits disclosure to other patient's who may be
exposed to an infectious disease.
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