Naltrexone and Alcoholism Treatment Test

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1 Naltrexone and Alcoholism Treatment Test Following your reading of the course material found in TIP No. 28. Please read the following statements and indicate the correct answer on the answer sheet. A score of 32 correct must be obtained to pass the course (you may miss 13). Following payment, the test may be taken as many times as necessary to obtain a passing grade. Your score and the status of your certificate will be sent to you. CEU certificates are provided only if we have received your payment. You may also take the test online through the course link at any time. The online test supports automated scoring for quick automatic results. Text: Naltrexone And Alcoholism Treatment Treatment Improvement Protocol (TIP) Series Naltrexone, an opioid antagonist medication was initially developed to treat opiate addiction. Subsequently, research found that naltrexone can help prevent relapse to alcohol use disorder when combined with traditional treatment modalities. 2. Naltrexone, relieves the craving for alcohol (and opiates) and decreases the relapse rate regardless if psychotherapy is used. 3. Naltrexone has been proven safe for all adults. 4. Naltrexone has been approved as a replacement for psychosocial interventions. 5. All individuals who have been diagnosed as alcohol dependent, are suitable candidates for naltrexone therapy. 6. Appropriate candidates should be willing to be in a supportive relationship with a health care provider or support group to enhance treatment compliance and work toward a common goal of sobriety.

2 7. The use of other substances during naltrexone treatment, particularly illegal opiates and opioid-containing medications, may pose the same level of concern and possible adverse consequences as the use of alcohol. 8. Because naltrexone may cause or worsen opiate withdrawal in subjects who are physiologically dependent on opiates or who are in active opiate withdrawal, it is contraindicated in these patients until after they have been abstinent from opiates for at least 5 to 10 days. 9. Naltrexone does not interfere with nonopioid pain medications such as ibuprofen, acetaminophen, and aspirin. 10. Patients on naltrexone are less likely to relapse to heavy drinking following a lapse in abstinence. 11. Naltrexone does not make people "sober up" and does not alter alcohol's acute effects on cognitive functioning. 12. The Consensus Panel recommends focusing the psychiatric interview on anxiety symptoms, depression, psychosis, and cognitive functioning because these elements may complicate therapy. 13. Naltrexone can be initiated safely during acute alcohol withdrawal. There is no need for patients to be abstinent before initiating naltrexone treatment. 14. The FDA guidelines recommend an initiation and maintenance dose of 50 mg/day of naltrexone for most patients, usually supplied in a single tablet.

3 15. Common adverse effects, which may include nausea, headache, dizziness, fatigue, nervousness, insomnia, vomiting, and anxiety, occur at the initiation of treatment in approximately 10 percent of patients. 16. FDA guidelines indicate that naltrexone should be used for up to 12 months to treat alcoholism. 17. The continued or periodic drinking of alcohol may not be a sufficient reason to discontinue naltrexone: Some patients respond to naltrexone treatment at first by reducing rather than stopping their drinking. 18. Naltrexone is not addicting. 19. Patients who stop taking the medication do not suffer from withdrawal symptoms, so naltrexone therapy can be discontinued without tapering the dose. 20. Naltrexone may not safely be restarted for 12 months even if the patient and the treating clinicians feel that it may be helpful in preventing relapse. 21. Researchers calculate that about 18 million Americans with alcohol abuse problems need treatment, but only one-fourth of them receive it. 22. People who have mental illness have a higher rate of substance abuse and alcoholism than everyone else; they also have a harder time getting help and staying in treatment.

4 23. Naltrexone has been proven to decrease problem drinking--in some cases by almost half even when used without other treatments. 24. Naltrexone was initially developed for the treatment of narcotic or opioid addiction, including heroin, morphine, and oxycodone (e.g., Percocet). Naltrexone is an opioid antagonist, which means that it blocks the effects of opioids. 25. Opioid antagonists, including naltrexone, which the FDA approved in 1984 for treating opiate addiction, also decreased alcohol consumption by blocking certain opioid receptors (i.e., action sites) in the brain that help to maintain drinking behavior. 26. Naltrexone is effective for every person with alcohol abuse disorder. 27. Naltrexone has few, if any, intrinsic actions besides its opioid-blocking properties: It does not block the physiological or psychological effects of any other class of drug. Because alcohol, like opiates, stimulates opioid receptor activity, naltrexone also appears to reduce the reinforcing/rewarding "high" that usually accompanies drinking. With the reduction in euphoria, alcohol consumption seems to be less rewarding. This may be one reason naltrexone works. 28. Although it is not yet known who will succeed or who will fail when treated in this way, some studies suggest that those patients with high levels of craving, poor cognitive abilities, little education, or high levels of physical and emotional distress may derive particular benefit from the addition of naltrexone therapy to their psychosocial treatment.

5 29. Patients who have taken naltrexone before and quit because of nausea or headaches should not try it again. 30. Psychosocial treatments are likely to enhance compliance with pharmacotherapy; likewise, pharmacotherapies, to the extent to which they reduce craving and help maintain abstinence, may make the patient more available for psychosocial interventions. 31. There is much resistance to pharmacotherapy--from third-party payers, some addiction clinicians, and some self-help-oriented individuals who view medications as substituting a pill for self-empowerment and taking responsibility for the disease. 32. Naltrexone can be addicting to some individuals. 33. Naltrexone is not only safe but it is considered inexpensive. 34. Significant liver disease is a relative contraindication to the use of naltrexone (like other medications that may cause liver damage so it should not be used when alcoholics already have liver disease. 35. Because of its opiate antagonist properties, naltrexone may cause or worsen opiate withdrawal in subjects who are physiologically dependent on opiates or who are in active opiate withdrawal. 36. The use of naltrexone in adolescents is considered safe based on the data with in this population.

6 37. Like disulfiram, naltrexone can alter the absorption or metabolism of alcohol and cannot have major adverse effects when combined with alcohol. 38. Natural reinforcers such as food, drink, and sex also activate reinforcement pathways in the brain, and it has been suggested that alcohol and other drugs act as chemical surrogates of the natural reinforcers. A key danger in this relationship, however, is that the pleasure produced by drugs of abuse can be more powerfully rewarding than that produced by natural reinforcers. 39. Like most other drugs of abuse alcohol interacts with a specific receptor in the brain. 40. Dopamine produces immediate feelings of pleasure and elation that reinforce such natural activities as sex and eating and motivates the repetition of these activities. Dopamine is believed to play an important role in reinforcement and motivation for repetitive actions. 41. Serotonin is associated with the reinforcing effects of many abused drugs through its mood-regulating and anxiety-reducing effects. Low levels of serotonin are associated with depression and anxiety. 42. In addition to affecting neurotransmitters, it appears that chronic use of alcohol may alter the structure and functioning of neurotransmitter receptors that have roles in intoxication, reinforcement, and dependence. 43. Men with alcoholic fathers are three to five times more likely than men without any familial history of alcoholism to experience early onset of alcoholism or other drug dependence.

7 44. Opiates have often been described as a substitute drug for alcohol, and an increase in opiate availability has been reported to be accompanied by a decrease in alcohol drinking. 45. An addictive cycle may be established as a result of consuming a small dose of alcohol, which like a small dose of morphine leads to modest increases in opioid receptor activity. Once opioid receptor activity has been primed, more alcohol is needed to ensure continued opioid receptor activity.

8 Post-Test Mailed Answer Sheet Please use this answer sheet to transmit your responses to the course post-test if you do not use the online testing option. DO NOT SEND THE TEST QUESTIONS. INSTRUCTIONS: 1. Read the course material. 2. Take the Post Test using this Answer Sheet. 3. Verify Post Test responses by reviewing course text. 4. Complete this form (keep a copy for your files). 5. Mail or to the address at the bottom. PLEASE PRINT LEGIBLY Course Title Naltrexone and Alcoholism Treatment Date Taken Name (as you want it on your certificate) Mailing Address: Address: Phone: How do you want to receive your certificate: ( ) Mail or ( ) Is your address legible? Post Test Answer Sheet - Circle Correct Answers (Your test may not use all question numbers.) 01. T F a b c d e f g 26. T F a b c d e f g 02. T F a b c d e f g 27. T F a b c d e f g 03. T F a b c d e f g 28. T F a b c d e f g 04. T F a b c d e f g 29. T F a b c d e f g 05 T F a b c d e f g 30. T F a b c d e f g 06. T F a b c d e f g 31. T F a b c d e f g 07. T F a b c d e f g 32. T F a b c d e f g 08. T F a b c d e f g 33. T F a b c d e f g 09. T F a b c d e f g 34. T F a b c d e f g 10. T F a b c d e f g 35. T F a b c d e f g 11. T F a b c d e f g 36. T F a b c d e f g 12. T F a b c d e f g 37. T F a b c d e f g 13. T F a b c d e f g 38. T F a b c d e f g 14. T F a b c d e f g 39. T F a b c d e f g 15. T F a b c d e f g 40. T F a b c d e f g 16. T F a b c d e f g 41. T F a b c d e f g 17. T F a b c d e f g 42. T F a b c d e f g 18. T F a b c d e f g 43. T F a b c d e f g 19. T F a b c d e f g 44. T F a b c d e f g 20. T F a b c d e f g 45. T F a b c d e f g 21. T F a b c d e f g 46. T F a b c d e f g 22. T F a b c d e f g 47. T F a b c d e f g 23. T F a b c d e f g 48. T F a b c d e f g 24. T F a b c d e f g 49. T F a b c d e f g 25. T F a b c d e f g 50. T F a b c d e f g

9 Course Evaluation (Required) Thank you for your participation in this continuing education course. We are required to collect evaluation data on each course completed prior to the issuance of your certificate(s). Please complete the following and return with your post-test. Please evaluate the course using this scale: 1 = below average 2 = average 3 = above average 4 = excellent The extent to which this course met the objectives The adequacy of the author's mastery of the subject Efficiency of course mechanics (traditional homestudy or online procedures) The applicability or usability of the information for you. Additional Information for Your Certificate, Comments and/or Recommendations for Other Courses to be Offered: You may mail or , this answer sheet along with your check or money order payable to Patrick McGinnis, PhD for the full amount due. Please mail to: Patrick McGinnis, PhD th Place Vero Beach, Florida Phone: (772) Your score and the status of your certificate will be ed to you. CEU certificates are provided only if we have received your payment.

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