The College of Physicians and Surgeons of Columbia University is Accredited by the Accreditation Council of Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. The College of Physicians and Surgeons designates this continuing medical education activity for a maximum of 6.5 hours (total conference) in Category I Credit toward the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he or she has actually spent in this educational activity.

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Term of approval is for two years from beginning distribution of August 1st, 1999.

Credit designation expires August 1, 2001.

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Center for Continuing Education
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Telephone: (212) 781-5990 Fax: (212) 781-6047
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Post-Test: Drug Addiction Treatment

CONTINGENCY MANAGEMENT WITH COCAINE DEPENDENT AND SPECIAL TREATMENT POPULATIONS - Steven T. Higgins

Questions and Answers

(True or False)

1. Cocaine dependence can be managed effectively in outpatient settings.

 
2. Contingent incentives can increase retention and cocaine abstinence among cocaine-dependent outpatients.

 
3. The efficacy of incentives is limited to "lighter" cocaine abusers.

 
4. There is evidence demonstrating that the use of incentives early in treatment can produce discernible improvements during later follow-up.

 
5. Judicious use of contingent positive reinforcement can be very important to effective treatment of cocaine-dependent patients

COGNITIVE BEHAVIORAL TREATMENTS OF DRUG ADDICTION - Kathleen M. Carroll, M.D.

1. Which of the following is true regarding the use of manuals in treatment:

a. Manuals are usually geared to experienced clinicians rather than novice therapists.
b. Manuals do not allow clinical flexibility.
c. A good manual overrides the need to build working relationships with patients.
d. Manual-guided therapies bear no relationship to actual clinical practice.
e. Manuals make treatment overly complicated.
f. All of the above are true.

2. You are an underappreciated and overworked clinician in a busy substance abuse treatment clinic. You're using a cognitive-behavioral approach with a very bright, but somewhat antisocial young cocaine abuser. While she clearly understands the coping skills you've reviewed with her, and her drug use has decreased significantly, she's never done any of the practice exercises you've assigned. Do you:

a. Not push it because she already has all the skills she needs.
b. Explore her reasons for not practicing skills outside of sessions; review consequences of the decision to implement or not implement skills; encourage her to pick the next assignment.
c. Tell her if she doesn't do her homework, you'll assign her to group treatment.
d. Point out that she's clearly in denial of her drug use.
e. Call her probation officer to ask him to increase the pressure on her.
f. All of the above. .

Which of the following is true regarding psychotherapy for substance use?

a. There is strong evidence that cognitive-behavioral approaches are superior to disease model, dynamically oriented- and behavioral treatments for the addictions.
b. Most substance abusers lack the education, motivation, and ego resources to effectively participate in psychotherapy.
c. Referral to self-help groups is usually more effective than psychotherapeutic treatments.
d. Outcomes for most pharmacotherapies (e.g., detoxification, naltrexone, methadone maintenance) can be enhanced and extended through adding psychotherapy.

4. Which of the following is not a major feature of CBT:

a. Organization around a functional analysis of substance use
b. Emphasis on individualized skill training
c. Emphasis on extra-session practice to achieve mastery of coping skills
d. Focus on strategies to foster and maintain abstinence.
e. Emphasis on identifying examples of 'stinking thinking'.

5. Which of the following is not a basic principle of CBT?

a. basic skills should be mastered before more complex ones,
b. material should be presented exactly as described in the manual
c. repetition fosters the development of skills,
d. practice is needed for mastery of skills,
e. skills taught are generalizable to a variety of problem areas.
 

BIOLOGY OF REWARD MECHANISMS - Eliot L. Gardner, Ph.D.

1. Electrical stimulation of which of the following brain nuclei/tracts appears most closely correlated with the elicitation of reward/reinforcement?

a. Spinothalamic tract
b. Medial forebrain bundle
c. Orbital frontal cortex
d. Hippocampus
e. Amygdala

2. Into which of the following brain loci will laboratory animals voluntarily self-administer microinjections of heroin?

a. Intralaminar thalamic nuclei
b. Hypothalamus
c. Ventral tegmental area
d. Periaqueductal gray matter

3. With the possible exception of the LSD-like hallucinogens, drugs of abuse:

a. Are voluntarily self-administered by laboratory animals
b. Enhance electrical intracranial self-stimulation
c. Enhance dopaminergic synaptic transmission in the nucleus accumbens
d. All of the above

4. For a drug to be habit-forming, it must produce

a. Pharmacodynamic (functional) tolerance
b. Metabolic tolerance
c. Physical dependence
d. All of the above
e. None of the above

5. In a normal human, which of the following has the highest probability of producing significant dysphoria?

a. an opiate agonist
b. an opiate antagonist
c. a dopamine agonist
d. a dopamine antagonist
 

OVERVIEW OF DRUG ADDICTION TREATMENT - Herbert D. Kleber

1. The most commonly abused drug is:

1. Heroin
2. Alcohol
3. Cocaine
4. Marijuana

1. Alcohol
2. Cocaine
3. Heroin
4. Marijuana

1. Decreased drug use
2. Improved employment
3. Long term abstinence
4. Improvement in psychological problems

1. Providing a "window of opportunity" for psychological interventions
2. "Cure" of withdrawal or overdose
3. Long term maintenance
4. All of the above

1. They view it as a self-inflicted problem
2. They see it as a moral issue, not a medical problem
3. They all know of failures
4. They rarely know of successes
5. All of the above

1. A reasonable outcome goal for most addicts
2. The goal most adicts strive for
3. A frequent reason for relapse
4. A condition almost all addicts had initially

1. Natrexone
2. LAAM
3. Methadone
4. Buprenorphine
5. Clonicline

1. Is usually sufficient for treating the addiction
2. If not done, relapse is more likel
3. May involve using pharmacotherap
4. Is often ignored because of inadequate psychiatric involvement

1. Is usually not severe
2. Is addressed by a number of medications
3. Should be treated on an impatient basis
4. May involve seizures and delirium

1. Anti-cocaine catalytic antibodies bind most tightly to:

1. the cocaine receptor
2. the dopamine reuptake transporter
3. cocaine
4. cocaine transition-state analog

1. brain tissue
2. cerebrospinal fluid
3. blood
4. intracellular compartments

1. norcocaine
2. ecgonine
3. ecgonine methyl ester
4. benzoyl ecgonine

1. binds cocaine
2. binds transition-state analog for cocaine hydrolysis
3. binds ecgonine methyl ester but not tightly
4. all of the above

1. lowers the energy of the ground state
2. raises the energy of the ground state
3. lowers the energy of the transition state
4. raises the energy of the transition state

Please circle the one correct answer

1 . It is unrealistic to expect any one pharmacologic treatment for drug abuse to

1. reduce craving
2. "cure" drug abuse
3. reduce relapse episodes
4. increase length of abstinence

1. nicotine
2. alcohol
3. marijuana
4. cocaine
5. heroin
6. sedative-hypnotics

1. inhibiting acetylaldehyde dehyrogenase
2. acting as an opiate antagonist
3. acting as a partial opiate agonist
4. inhibiting alcohol dehydrogenase

1. produce a toxic effect when combined with alcohol
2. reduce craving to cocaine
3. reduce the likelihood that a "lapse" will become a "relapse"
4. decrease the likelihood of drinking six months after naltrexone has been discontinued

1. methadone is long-acting
2. methadone is well-absorbed orally
3. methadone has a long half-life
4. methadone produces greater euphoria
5. methadone is well-tolerated

1. combined with additional services
2. patients are encouraged to attend narcotics anonymous
3. methadone doses are maintained below 60 mg
4. patients are encouraged to remain on methadone less than 6 months

1. it produces less withdrawal symptoms
2. produces less respiratory depression
3. it must be taken sublingually
4. it is a good "transition" agent from heroin
5. it produces no rebound withdrawal symptoms

1. medications that target psychiatric comorbidity
2. nonpharmacologic interventions
3. anti-cocaine catalytic antibodies
4. medications that reduce craving
5. none

1. May show a reduction in psychiatric symptoms when treated with psychiatric medication
2. Do not show a reduction in psychiatric symptoms when treated with psychiatric medication
3. Have better treatment outcome than those without psychiatric comorbidity
4. Are infrequently found in treatment settings

1. substitution of a long-acting medication in the same drug class
2. slow taper of the substitute medication
3. use of additional palliative medication
4. substitution of a short-acting medication in the same drug class

1. PET is an imaging method that enables to study in the human brain:

1. Neurochernical function
2. Physiological function
3. Effects of drugs
4. Regional distribution and kinetics of labeled drugs
5. None of the above
6. All of the above

1. Higher spatial resolution that MRI
2. Higher temporal resolution than MRI and EEG
3. Higher sensitivity than MRI
4. None of the above
5. All of the above

1. The availbility of carbon- I I as a positron emitter that allows to label compounds without affecting their pharmacological properties
2. The relatively short half life of positron emitters that limitzx the dosimetry to subjects and minimizes waste disposal problems
3. The high sensitivity of PET instruments
4. All of the above
5. None of the above

1. Decreases in dopamine D2 receptors
2. Decreases in frontal metabolism
3. Disruption of Cerebral Blood Flow
4. Decreased relase of doparnine
5. All of the above

1. Cocaine and methylphenidate are equipotent in blocking doparnine transporters
2. Dopamine transporter blockade is involved in the perception of the "high" induced by psychostimulants
3. The fast uptake of cocaine and methylphenidate when administered intravenously are important in their reinforcing effects.
4. All of the above
5. None of the above

1. Decreases in D2 receptors in cocaine abusers
2. Decreases in D2 receptors in heroine abusers
3. Decreases in D2 receptors in heroine abusers
4. All of the above
5. None of the above

1. Is due to an enhancement of the pleasurable effects of drugs
2. Is due to lack of commitment to stop taking drugs
3. Is associated with changes in brain function that favor compulsive drug intake
4. All of the above
5. None of the above

1. Are due to nicotine
2. May involve inhibition of MAO B and increase in doparnine in brain
3. Can lead to addiction
4. All of the above
5. None of the above

1. Is frequently co-asscociated with alcohol and/or nicotine use
2. Is favored by stressful situations
3. May have a genetic predispoistion component
4. All of the above
5. None of the above

1. It can induce severe addiction
2. It can induce brain strokes and hemorrhages
3. It can induce toxic arrythmias
4. All of the above
5. None of the above

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