Post Test: Seniors Addiction Treatment
Text: Substance Abuse Among Older Adults
Treatment Improvement Protocol (TIP) Series 26
by: Frederic C. Blow, Ph.D.
Exam Copyright (c) 2000 by:
Institute of Addiction Awareness
24881 Alicia Pkwy., #E-519
Laguna Hills, CA 92653-4696
949-643-3802
A. Introduction
1. The Consensus Panel for the TIP Substance Abuse in Older Adults
recommends that older men consume:
A. no more than one drink per day.
B. a maximum of two drinks on any drinking occasion.
C. both A and B above
D. None of the above
2. What is the maximum length of time recommended for benzodiazepine
use for geriatric patients?
A. 4 weeks
B. 4 months
C. 6 weeks
D. 6 months
3. The Consensus Panel recommends that _________________ should
be screened for alcohol and prescription drug abuse as part of a regular
physical examination.
A. every 60-year-old
B. 60+-year-old men with cognitive or motor problems
C. all seniors with alcohol-related physical symptoms
D. seniors who live alone
4. Why should patients not be screened for cognitive dysfunction until
several weeks after medical detoxification?
A. Insurance carriers are likely to attribute the dysfunction to substance
abuse and deny coverage for neurological disorders.
B. The patient may be too fragile to accept permanent deterioration.
C. Cognitive dysfunctions are a normal part of the aging process.
D. A patient not fully recovered from detoxification may exhibit some
reversible cognitive impairment.
5. Brief intervention, using older adult-specific techniques, is the first step
recommended by the Panel for engaging seniors in treatment of a
substance abuse problem.
A. TRUE
B. FALSE
6.. How many relatives or close associates should be included in an
intervention with an older adult?
A. As many as can be engaged in the process.
B. None, as this is an embarrassing process best avoided with seniors.
C. One or two along with the health care provider.
D. All children and grandchildren old enough to understand the
consequences of substance abuse.
B. Substance Abuse Among Older Adults: An Invisible Epidemic
7. Alcohol and prescription drug abuse effects ________ of adults over
60.
A. 10%
B. 17%
C. 20%
D. 23%
8. Health care providers who currently care for Americans age 60 and
over will mainly encounter abuse or misuse of
______________________.
A. alcohol and marijuana
B. alcohol and heroin
C. prescription pain medications and hypnotic drugs
D. alcohol and prescription drugs
9. What percent of prescriptions written for older adults are categorized
as benzodiazepines?
A. 12% - 25%
B. < 10%
C. 17% - 23%
D. 35% - 50%
10. Older substance abusers are ______________ to have undiagnosed
psychiatric and medical comorbidities than younger substance abusers.
A. just as likely
B. less likely
C. more likely
D. none of the above
11. The tendency of society to assign negative stereotypes to older
adults and explain away their problems as a function of being old rather
than looking for specific medical, social or psychological causes is the
result of _____________.
A. ageism
B. lack of awareness
C. clinician behavior
D. comorbidity
12. If adults attribute their alcohol problems to a breakdown in morals,
they are more likely to seek substance abuse treatment.
A. TRUE
B. FALSE
13. What does research indicate about the outcomes for older adults
completing substance abuse treatment?
A. Older adults have worse outcomes than younger patients.
B. Older adults have the same outcomes as younger patients.
C. Older adults have better outcomes than younger patients.
D. Both B and C
14. What is the gender distribution of substance abuse among older
adults?
A. Men are the majority.
B. Women are the majority.
C. Men and women are equally represented.
D. More men abuse alcohol; more women abuse prescription drugs.
15. In a gatekeeper system who watches for signs of psychiatric illness
in the elderly?
A. A designated relative or close friend who sees the senior daily.
B. Therapists and physicians.
C. Members of the community such as meter readers, bank tellers, postal
workers, apartment managers, etc.
D. both A & B
16. Compared with the rates for heart attacks, hospitalizations that are
alcohol related are:
A. dissimilar.
B. similar.
C. equivalent.
D. too subjective to be accurately compared.
C. Alcohol
17. As a person ages, the body?s response to alcohol is characterized
by:
A. decreased sensitivity and increased tolerance.
B. increased sensitivity and increased tolerance.
C. decreased sensitivity and decreased tolerance.
D. increased sensitivity and decreased tolerance.
18. Why is a normal decrease of dehydrogenase important in alcohol
metabolism in older adults?
A. Alcohol is metabolized more quickly.
B. Alcohol is metabolized more slowly.
C. Strain on the liver is reduced.
D. Metabolism in the stomach increases.
19. The thresholds of consumption often considered by clinicians as
indicative of tolerance:
A. may be set too high for older adults.
B. may be set too low for older adults.
C. should be the same for all adults.
D. are inaccurate with older adults because of their altered metabolism.
20. In the two stage conceptualization recommended by the Consensus
Panel:
A. at-risk drinkers, problem drinkers and heavy drinkers are considered
discrete categories.
B. problem drinkers and heavy drinkers are classed as at-risk.
C. at-risk and heavy drinkers are the only categories used.
D. the problem drinking category includes those who would otherwise fall
into the heavy and problem drinker classifications.
21. At what age does the late onset drinker usually experience their first
alcohol-related problem?
A. After age 35
B. After age 40 or 50
C. After retirement
D. After age 65
22. The majority of older patients receiving treatment for alcohol abuse
are:
A. early onset drinkers.
B. late onset drinkers.
23. Early onset drinkers appear to be physically and psychologically
healthier than late onset drinkers.
A. TRUE
B. FALSE
24. ____________ is defined as regular, perhaps daily, heavy drinking
that has resumed after a stable period of abstinence of 3 to 5 years or
more.
A. Binge drinking
B. Relapse
C. Intermittent drinking
D. Late onset alcoholism
25. _____________ is generally defined as short periods of loss of
control over drinking alternating with periods of abstinence of much
lighter alcohol use.
A. Binge drinking
B. Relapse
C. Intermittent drinking
D. Late onset alcoholism
26. What do anecdotal observations indicate about younger binge
drinkers who survive to their later years?
A. Binges become more rare and are less intense.
B. They are more likely to remain sober.
C. They become intermittent drinkers.
D. They often become continuous or near-daily drinkers.
27. Men who drink have been found to be:
A. as likely as women who drink to have medical problems.
B. less likely than women who drink to have medical problems.
C. two to six times as likely as women who drink to have medical
problems.
D. none of the above
28. Women of all ages are __________ than men to appear at treatment
facilities.
A. more likely
B. less likely
C. as likely
D. none of the above
29. The highest rate of completed suicide among all population groups is
in:
A. older white men who become excessively depressed and drink heavily
following the death of their spouses.
B. older white women who become excessively depressed and drink
heavily following the death of their spouses.
C. older white men who become excessively depressed and drink heavily
following a diagnosis of a progressive illness.
D. older white men with a history of untreated alcoholism.
30. What is the major preventable cause of premature death in the
United States?
A. Automobile accidents
B. Homicide
C. Smoking
D. Alcohol consumption
31. Older smokers are _________ to quit smoking than younger smokers.
A. less likely
B. as likely
C. more likely
32. What is the most common source of adverse drug reactions among
older adults?
A. The combination of alcohol and over-the-counter pain medications.
B. The combination of alcohol and prescription psychoactive
medications.
C. The combination of prescription pain medications and
over-the-counter sleep medication.
D. The combination of alcohol and prescription pain medication.
33. Which of the following statements is true of Prozac and Zoloft?
A. Both are antidepressants.
B. Both are among the top ten medications prescribed in nursing homes
in 1996.
C. Both are primary medications of abuse.
D. A and B
34. Adults can become physiologically dependent on psychoactive
medications without meeting dependence criteria.
A. TRUE
B. FALSE
D. Use and Abuse of Psychoactive Prescription Drugs and
Over-the-counter Medications
35. In older adults, anxiety disorders are:
A. equally likely to be diagnosed in men as in women.
B. twice as likely to be diagnosed in women as in men.
C. twice as likely to be diagnosed in men as in women.
D. unlikely to be diagnosed in men or women.
36. Older patients with substance dependence disorders are _________
than younger addicts to have a dual diagnosis.
A. more likely
B. less likely
37. The chronic administration of psychoactive substances, even at
therapeutic doses, has been associated with:
A. physical and psychological dependence.
B. addiction.
C. adverse central nervous system effects.
D. impaired cognition.
38. What per cent of people experience withdrawal symptoms from
benzodiazepines, even if the dose is tapered?
A. 20% to 50%
B. 15% to 35%
C. 50% to 75%
D. 40% to 80%
39. Rebound effects of discontinuation of benzodiazepines:
A. usually mimic the original symptoms for which the medication was
prescribed.
B. are sudden and transient.
C. may occur after only one or two months of benzodiazepine therapy.
D. A, B, and C
40. Insomnia complaints in older adults:
A. usually occurs in conjunction with a variety of psychiatric, medical or
pharmacological problems.
B. are closely associated with substance abuse or dependence.
C. are rare in medically healthy adults.
D. B and C above
41. How long should symptomatic treatment of insomnia with medications
continue?
A. Until normal sleep patterns are established.
B. No more than 2 to 3 weeks.
C. 7 to 10 days
D. 1 month
42. Why should the symptoms of withdrawal from benzodiazepines
always be treated?
A. Patient discomfort could lead to resumption of benzodiazepines abuse.
B. 20% to 30% of dependent persons experience a grand mal seizure if
withdrawal symptoms are not treated.
C. A and B
D. None of the above. Withdrawal symptoms are rare.
43. What effects are more likely to be seen in older adults taking
antihistamines than in younger person taking these medications?
A. central nervous system depression or confusion
B. orthostatic hypotension
C. A amd B above
D. increased blood pressure
44. Older adults are more likely to experience sedation when given
morphine or Talwin.
A. TRUE
B. FALSE
45. When compared with withdrawal from benzodiazepines, opioid
withdrawal is:
A. more life-threatening.
B. uncomfortable, but not life-threatening.
C. particularly dangerous.
D. A and C
E. Identification, Screening, and Assessment
46. Identification of substance abuse in older adults:
A. should be the purview of health care workers alone.
B. should not be the purview of health care workers alone.
C. should include all persons who see older adults on a regular basis.
D. B and C above
47. When should older adults be screened for alcohol and prescription
drug abuse?
A. At age 60 during their regular physical examinations.
B. After self-identification of physical symptoms of substance abuse.
C. At age 70 whether there are symptoms of abuse or not.
D. Whenever they express symptoms of major depression or anxiety.
48. If a non-medical caretaker administers the CAGE to an older person,
how many YES answers should prompt a referral to a clinician for
evaluation?
A. one
B. two or more
C. four
D. more than four
49. Which of the following characterize motivational interviewing?
A. confrontation
B. egalitarianism
C. values based
D. B amd C above
50. Which screening instrument was developed specifically for older
adults?
A. CAGE
B. MAST-G
C. AUDIT
D. MMSE
51. When communicating positive screening results to an older patient,
the Consensus Panel recommends that the therapist:
A. describe the impact that alcohol or prescription drug abuse is having
on the older adult?s health.
B. delay presenting options for addressing the problem until the patient
recognizes the problem.
C. immediately follow up by noting the condition is treatable.
D. A and C above
52. Older adults who have had a negative screening:
A. do not need screening in the future.
B. are likely to be knowledgeable about the dangers of alcohol abuse.
C. may need screening repeated in the future.
D. are unlikely to abuse alcohol or prescription medications as they get
older.
53. For older adults with positive screens, an assessment is needed to:
A. determine the need for treatment.
B. reinforce the deleterious effects of alcohol abuse.
C. characterize the dimensions of the problem.
D. A & B
54. To be useful in assessing older adults, the DSM-IV:
A. should be used only by a psychiatrist or psychologist.
B. must be interpreted age-appropriately.
C. must be used only after an alcohol-related disease has been
diagnosed.
D. A and B above
55. Functional health refers to a person?s capacity to:
A. perform activities of daily living, such as bathing, dressing, feeding and
toileting.
B. perform instrumental activities of daily living, such as preparing meals
and managing finances.
C. maintain independence in one?s living situation.
D. A and B above
56. Which of the following factors is more correlated with functional
impairment than alcohol use?
A. smoking
B. age
C. use of anxiolytics
D. none of the above
57. What is the most common health problem among alcohol-dependent
older adults?
A. heart disease
B. alcohol related dementia
C. alcoholic liver disease
D. organic brain disease
58. ____________ is a chronic, progressive, and generally irreversible
cognitive impairment sufficient to interfere with an individual?s daily living.
A. Dementia
B. Delirium
C. Alzheimer?s
D. Korsakoff?s syndrome
59. ______________ is a potentially life-threatening illness that requires
acute intervention.
A. Dementia
B. Delirium
C. Alzheimers
D. Korsakoffs syndrome
60. Significant memory loss is a part of the aging process.
A. TRUE
B. FALSE
61. _____________ use prior to hospitalization has been demonstrated
to be a significant risk factor for the development of delirium among
hospitalized older adults.
A. Alcohol
B. Benzodiazepine
C. Psychoactive medication
D. Over-the-counter pain medication
62. Why is it important to screen for Wernicke-Korsakoff syndrome?
A. It is potentially reversible.
B. It is irreversible.
C. It is often mistaken for delirium.
D. A and C above
63. Relapse rates for alcoholics:
A. are positively influenced by the presence of depression.
B. are negatively influenced by the presence of depression.
C. are not influenced by the presence of depression.
D. are positively influenced by the presence of anxiety.
64. What is the goal of brief intervention strategies with an older adult
problem drinker?
A. Identify the substance abuse problem.
B. Evaluate the person?s need for treatment.
C. Change the problem drinker?s behavior.
D. Provide a venue for more extensive interventions.
F. Referral and Treatment Approaches
65. Intervention strategies with older adults need to be especially
nonconfrontational and supportive.
A. TRUE
B. FALSE
66. _______________ acknowledges differences in readiness and offers
an approach for meeting people where they are.
A. Brief therapy
B. Active listening
C. Intervention
D. Motivational counseling
67. In general, the initial dose of a drug for suppression and management
of withdrawal symptoms should be:
A. one-fourth to one-third the usual adult dose sustained for 24 to 48
hours.
B. one-third to one-half the usual adult dose sustained for 24 to 48 hours.
C. one-half to two-thirds the usual adult dose sustained for 24 to 48
hours.
D. one-half the usual daily amount taken by the patient sustained for 24
to 48 hours.
68. The Consensus Panel recommends serving older adults who are
dependent on psychoactive prescription drugs in:
A. traditional stand alone substance abuse treatment facilities.
B. their own homes.
C. a medical setting with emergency back up.
D. flexible, community-oriented programs with case management.
69. There is some evidence that age-specific treatment:
A. has no impact on older adults compliance and outcomes.
B. improves older adults compliance and outcomes.
C. worsens older adults compliance and outcomes.
D. is an outgrowth of ageism in the substance abuse treatment
community.
70. Treatment providers should ___________ the older clients desire to
discuss the meaning and purpose of life.
A. redirect
B. encourage
C. respect
D. deflect
71. Treatment programs should take a:
A. broad holistic approach.
B. narrow, functional approach concentrating on the clients substance
abuse issues.
C. recognized 12-step or other formalized approach.
D. B and C above
72. Teaching the client to modify his or her overt behaviors as well as
internal or covert patterns refers to:
A. cognitive-behavioral techniques.
B. self-management.
C. behavior modification.
D. insight therapy.
73. ___________________ teach clients to identify and modify
self-defeating thoughts and beliefs.
A. Insight techniques
B. Self-management techniques
C. Behavior modification techniques
D. Cognitive-behavioral techniques
74. When using behavioral treatment __________ is particularly suited to
older adults.
A. individual sessions
B. group process
C. family sessions
D. B and C above
75. Perhaps the most beneficial aspect of groups for older adults is the
opportunity to learn self-acceptance through accepting others and in
return being accepted.
A. TRUE
B. FALSE
76. According to the Epidemiologic Catchment Area study, depressive
symptoms occur in _____ of community residents over 65 years of age.
A. 15%
B. 25%
C. 35%
D. 50%
77. How long must depressive symptoms persist following cessation of
drinking before an antidepressant is recommended?
A. Immediately
B. Several days
C. Several weeks
D. More that a month
78. Married older alcoholics are more likely to comply with treatment if
their spouse:
A. receives treatment at the same time.
B. is excluded from the treatment program.
C. becomes involved in the treatment process.
D. attends Al-Anon meetings.
79. Case management can best be defined as:
A. the coordination and monitoring of the varied social, health and
welfare services needed to support an older adult?s treatment and
recovery.
B. linkage to the most appropriate community resources.
C. oversight of the individual treatment plan.
D. the coordination of community services to the alcoholic/substance
abusing older adult.
80. Standard features of most discharge plans for older adults include all
of the following EXCEPT:
A. age-appropriate Alcoholics Anonymous womens support groups.
B. ongoing medical monitoring.
C. ancillary services needed to maintain independence in the community.
D. financial assistance for poor elders.
81. Many problems with prescription drug abuse arise from:
A. intentional misuse.
B. unintentional misuse.
C. deliberate falsification of symptoms by the older person.
D. medical complications of drug interactions.
82. Some experts estimate that 70% of depressed older patients fail to
take ______ of their medications.
A. 10%
B. 30-40%
C. 45%
D. 25-50%
83. Who has responsibility for ensuring the patient understands all dosing
instructions, the purposes of the medications prescribed, and the adverse
reactions that should be reported to the doctor?
A. The healthcare practitioner.
B. The patient.
C. The patient?s family.
D. The patient and the healthcare practitioner share responsibility.
84. Unless a program treats a large number of older adults, it is not
necessary for staff members to be trained in gerontology within his or her
discipline.
A. TRUE
B. FALSE
85. _____________ personalities typically work better with older adults.
A. Nonconfrontational
B. Confrontational
C. Out-going
D. Accepting
G. Outcomes and Cost Issues in Alcohol Treatment for Older Adults
86. Older alcoholics are ___________ to complete treatment.
A. significantly less likely than younger alcoholics
B. significantly more likely than younger alcoholics
C. slightly less likely
D. slightly more likely
87. Evaluation of treatment should occur:
A. at the beginning and end of treatment.
B. at varying points in the treatment process.
C. when the therapist feels progress is being made.
D. at the beginning of treatment and whenever the client requests.
88. How soon do the majority (60-80%) of people who have received
substance abuse treatment relapse?
A. 3 to 4 weeks
B. 7 to 10 days
C. 3 to 4 months
D. 6 months or less
89. The most accurate method used to assess current alcohol
consumption is:
A. the AUDIT.
B. the HSS.
C. the TLFB.
D. the MAST-G.
90. The Addiction Severity Index (ASI) has been widely validated for use
with older adult patients.
A. TRUE
B. FALSE
91. Why is coverage for 12 days of inpatient substance abuse treatment
important for older adults?
A. They are likely to have a greater number of physical and cognitive
problems than younger patients.
B. It is a Medicare entitlement.
C. Medical treatment in a hospital is more acceptable to seniors than
community treatment.
D. Physician involvement is necessary for older adults?safety during
treatment.
92. What is the purpose of Federal confidentiality laws concerning
alcohol and drug abuse patient records?
A. To minimize the liability of the provider.
B. To encourage people to seek treatment.
C. To reduce the risk that individuals will be discriminated against.
D. Both B amd C above
93. Doctor-patient privilege, social worker-patient privilege,
and psychotherapist-patient privilege fall under the:
A. Professions Code.
B. Welfare and Institutions Code.
C. Rules of evidence.
D. Civil Code.
94. The scope of protection under state laws for therapist-client privilege:
A. is fairly uniform.
B. is based on federal confidentiality laws.
C. varies widely from state to state.
D. covers all professions equally.
95. When the provider enters only that information in the chart that is
required for accuracy and uses neutral terms wherever possible, the
provider is using the:
A. minimalist approach.
B. the rubber band approach.
C. the separate location approach.
D. the gatekeeper approach.
96. All states will permit professionals to disclose information about clients
and their treatment under what circumstances?
A. To save the clients live.
B. When the client gives permission.
C. To prevent the client from committing criminal acts.
D. When the client is judged incompetent to manage his/her own affairs.
97. Guardianship should be considered only as a last resort when dealing
with an older client because:
A. it is an expensive process.
B. it diminishes the older adult?s autonomy.
C. it should be reserved for individual?s with disabilities that prevent
him/her from performing tasks necessary to manage areas in his/her life.
D. All of the above
98. Providers should discuss with the patient what information they are
going to disclose to a clients HMO:
A. before any disclosures are made.
B. only if payment is declined by the insurer.
C. only if payment is sought from the insurer.
D. only if the client inquires.
99. When presented with a warrant by a law enforcement officer, a
therapist:
A. should seek legal advice before taking any action.
B. has no choice but to hand over the records listed on the warrant.
C. can refuse to turn over records the therapist believes are protected by
therapist-client privilege.
D. must notify his client before the law enforcement officer leaves the
premises
100. When served with a subpoena duces tecum, the healthcare
professional must:
A. testify by deposition or at a hearing.
B. release all confidential documents to the court.
C. appear in person at the court with the records listed in the subpeona.
D. immediately contact a lawyer to represent him/her in court.
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