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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