clinicians' self-assessment

Journal ofSubstance Abuse Treafment, Vol. 8, pp. 309-31 I, 1991 Printed in the USA. All rights reserved.

0740-5472/91 $3.00 + .OO Copyright 0 1991 Pergamon Press plc

QUESTIONS AND ANSWERS

Clinicians’ Self -Assessment

Questions and Answers in Substance Abuse Treatment

ROBERT HIRSCH, MD, AND JOHN E. IMHOF, PhD

1. Cerebral blood flow research has emerged as important in relation to substance abuse for a variety of rea- sons. Among the most important of these is that drugs of abuse induce behavioral changes that in all prob- ability are related to altered brain function. Which of the following statements is true?

a) In humans, small doses of ethanol (alcohol) produce cerebral vasodilation; higher doses induce cerebral vasoconstriction.

b) Sedatives and antianxiety drugs lead to global reduction in cerebral blood flow and cerebral metabolism. c) Caffeine, even in small doses, is a potent cerebral vasoconstrictor. d) A number of drugs of abuse, including ethanol (alcohol), amphetamines, cocaine, nicotine, and caffeine-

phenylpropanolamine combinations, increase the risk for stroke. e) all of the above

2. The physiological and behavioral effects of stimulants have become important with the increasing popular- ity of cocaine as a drug of abuse. Which of the following statements is not true?

a) Stimulants increase pulse rate, blood pressure, and autonomic nervous system activity. b) Many of these drugs stimulate the respiratory center and cause hypocapnia. c) Most stimulants are sympathetic nervous system antagonists. d) The multiple mechanisms through which stimulants can influence cerebral blood flow make study of their

effects difficult. e) The amphetamine molecule strongly resembles the catecholamine neurotransmitters norepinephrine and

dopamine.

3. A young adult patient comes into an emergency room presenting central nervous system irritability, auto- nomic nervous system hyperactivity, psychotic symptoms (auditory and/or visual hallucinations), seizures, and hyperpyrexia. There is also a history of mood lability, paranoia, and parasitosis (i.e., picking at imag- inary bugs crawling on the skin). Which would be a likely diagnosis?

a) acute heroin toxicity b) acute barbiturate toxicity c) acute amphetamine toxicity d) acute sedative-hypnotic toxicity e) acute alcohol toxicity

4. Countertransference is the therapist’s subjective response to interactional pressures, a blend of both patient- evoked responses and experiences deriving from the therapist’s unresolved biographical and psychological conflicts. The single most important factor in recognizing and effectively utilizing countertransference re- actions is:

309

310 R. Hirsch and J.E. Imhof

a) peer group supervision b) advanced clinical training c) a prior personal drug-using experience d) a successful personal therapy e) continued medical/psychological courses on substance abuse

5. All treatment applicants to a drug treatment program should be assessed for the presence of major psychi- atric illness (dual diagnosis). If such illness is present and is left untreated or otherwise ignored, the prog- nosis for successful recovery for the drug abuser will be markedly diminished. Which of the following pairs of personality disorders is most often present in the diagnostic assessment of compulsive substance abusers?

a) self-defeating and dependent b) histrionic and dependent c) borderline and narcissistic d) schizoid and schizotypal e) organic and paranoid

6. Which of the following statements is correct?

a) Prior personal drug-using experience is particularly helpful to a clinician in formulating a diagnostic im- pression of the substance abuser.

b) The therapist’s revelations of personal drug-abusing experiences to the drug abuse patient will, in most cases, strengthen the therapeutic bond and increase the chances for a successful rehabilitation.

c) It is often easier for therapists to manage their countertransference reactions to substance abuse patients as opposed to patients in non-drug-related diagnostic categories.

d) The history of substance abuse treatment is replete with examples of psychiatry’s unwavering commit- ment to the treatment of addictive disorders.

e) None of the above.

7. The understanding of the etiology and symptomatology of drug addiction from a psychoanalytic perspec- tive was first advanced with the publication of:

a) Wurmser’s The Hidden Dimension b) Freud’s Uber Coca c) Rado’s The Psychoanalysis of Pharmacothymia d) Meerloo’s Artificial Ecstasy e) Fenichel’s The Psychoanalytic Theory of the Neuroses

8. A few days following a substance abuser’s admission to an inpatient unit for detoxification, treatment staff find themselves experiencing vastly different feelings toward the patient. Some staff members find the pa- tient to be extremely likeable and cooperative, while others find the patient loathsome and despicable. This diversity of opinion among staff members is not unusual, given the substance abuser’s use of which defense mechanisms?

a) intellectualization and rationalization b) denial and repression c) denial and displacement d) splitting and projective identification e) identification with the aggressor and repression

9. There is a substance that is, without question, the most commonly used psychoactive drug in the world. It is present in a wide range of over-the-counter preparations and combination prescription drugs. It is esti- mated that 20 to 30 percent of adult Americans consume more than 500 mg per day of this substance. What is it?

a) alcohol b) Benadryl

Clinicians’ Self-Assessment 311

c) caffeine d) nicotine e) none of the above

10. Before alcoholism (or “alcohol dependence,” as DSM-III-R calls it) can be treated, it must first be recog- nized and diagnosed, despite the characteristic mechanism of denial by the individual. Physicians are in a particularly good position to identify an alcohol problem early because they can do a physical examination and order laboratory tests. Which of the following phenomena suggest possible alcohol dependence?

a) arcus senilis (a ring-like opacity of the cornea) b) acne rosacea (a red nose) c) palmar erythema (red palms) d) cigarette burns between the index and middle fingers or on the chest, along with contusions and bruises e) any of the above

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