Substance Use Disorders

Topics in this chapter

• Substance Use Disorder Diagnosis
• Alcohol Use and Withdrawal
• Opioid Intoxication and Overdose
• Cannabis, Hallucinogens, and Stimulants
• Addiction Neurobiology and Pharmacology
• Substance-Related Emergencies and Toxicology
• Substance Use Disorder Pharmacotherapy

Practice questions

1. Question 1Q-E27259

   A 32-year-old chronic user of alcohol is brought to the emergency department by his family with complaints of acute confusion, staggering gait, and abnormal eye movements including bilateral lateral rectus palsy and horizontal nystagmus. Which of the following brain structures is most characteristically involved in this condition?

   1. A.Mammillary bodies and periaqueductal gray matter
   2. B.Substantia nigra and locus coeruleus
   3. C.Nucleus accumbens and ventral tegmental area
   4. D.Hippocampus and amygdala
   See the answer and solution
2. Question 2Q-D32064

   A 28-year-old man presents with agitation, perceptual disturbances, grandiose delusions, impaired judgment, and tachycardia. Physical examination reveals pupillary dilation, elevated blood pressure, and perspiration. He mentions feeling a crawling sensation beneath his skin. Which substance is the most likely cause of this presentation?

   1. A.Heroin
   2. B.Cannabis
   3. C.Cocaine
   4. D.Alprazolam
   See the answer and solution
3. Question 3Q-957B77

   A patient with a history of severe opioid dependence is admitted to the hospital. Twelve hours after his last dose, he develops yawning, lacrimation, rhinorrhea, piloerection ('gooseflesh'), mydriasis, muscle cramps, and severe nausea and vomiting. Which medication is most appropriate for the immediate management of acute opioid withdrawal symptoms?

   1. A.Naltrexone
   2. B.Naloxone
   3. C.Clonidine
   4. D.Flumazenil
   See the answer and solution
4. Question 4Q-42583B

   A 45-year-old chronic alcoholic man is admitted for elective surgery. On the third postoperative day, he becomes increasingly confused, agitated, and tremulous. He reports seeing crawling insects on the walls and feels terrified. Examination reveals a temperature of 38.5 C, pulse rate of 124/min, blood pressure of 160/100 mmHg, and profuse diaphoresis. What is the most definitive first-line pharmacological treatment?

   1. A.Haloperidol alone
   2. B.Long-acting benzodiazepines (e.g., Diazepam or Chlordiazepoxide)
   3. C.Disulfiram
   4. D.Intramuscular Naltrexone
   See the answer and solution
5. Question 5Q-B1EAEE

   Which of the following pharmacotherapeutic agents acts as an irreversible inhibitor of aldehyde dehydrogenase, causing an unpleasant physiological reaction characterized by flushing, headache, nausea, and vomiting when alcohol is consumed?

   1. A.Naltrexone
   2. B.Acamprosate
   3. C.Disulfiram
   4. D.Methadone
   See the answer and solution