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Chapter 11: Substance-Related and Addictive Disorders Multiple Choice 1. According the World Health Organization, ______ use was responsible for 5 percent of the total burden of disease and disability worldwide in 2004. a. heroin b. alcohol c. cocaine d. marijuana Answer: b. 2. Your friend misses work and has serious family difficulties because he uses drugs. However, he is not addicted to drugs. What DSM-5 diagnosis should be made in this case? a. substance use disorder b. substance abuse c. substance dependence d. substance ingestion habit Answer: a. 3. DSM-5 defines substance use disorders in terms of a. addiction. b. tolerance and withdrawal. c. craving and lack of control. d. a maladaptive pattern of behaviors. Answer: d. 4. Previous versions of the diagnostic manual used the term ____________________ to describe substance use disorders that were at least moderate in severity. a. substance abuse b. anhedonia c. substance dependence d. self-destructive tendencies Answer: c. 5. What term is used to describe chemicals that can alter a person's mood, perception, or brain functioning? a. legal drugs b. illegal drugs c. psychoactive substances d. exogenous brain substances Answer: c. 6. Polysubstance abuse refers to abuse of a. synthetic drugs. b. more serious drugs. c. prescription drugs. d. several types of drugs. Answer: d. 7. While watching a television show, you hear one of the characters, a physician, talking about narcotic analgesics. What is another name for these drugs? a. opiates b. hypnotics c. cannabinoids d. benzodiazepines Answer: a. 8. What type of drug is alcohol? a. opiate b. analgesic c. central nervous system stimulant d. central nervous system depressant Answer: d. 9. Which term describes central nervous system depressants that are used to relieve anxiety? a. opiates b. hypnotics c. analgesics d. anxiolytics Answer: d. 10. For a class assignment, you are asked to find information on cocaine. A reference book on drugs lists them by major category. Under which category will you find cocaine? a. opiates b. stimulants c. depressants d. hallucinogens Answer: b. 11. In recent years, the term addiction is being used to describe other kinds of impulsive behavior problems, including a. obsessive-compulsive disorder. b. pathological gambling. c. antisocial personality disorder. d. specific phobias. Answer: b. 12. Ernest Hemingway, whose case is presented in your textbook, suffered from a. anxiety disorder. b. cocaine use disorder. c. alcohol use disorder. d. borderline personality disorder. Answer: c. 13. Which of the following offers a useful basis for distinguishing between people who are dependent on alcohol and those who are not? a. legal involvement due to drinking b. the amount of money spent on alcohol c. the number of problems due to drinking d. the amount of alcohol consumed each week Answer: c. 14. Which of the following is an example of psychological dependence on alcohol? a. not wanting to drink alone b. drinking to relieve negative moods c. the ability to drink more and more over time d. cognitive impairments due to alcohol abuse Answer: b. 15. You are designing a research study to test the effectiveness of a new type of treatment program for alcohol use disorder, and you want to be able to assess changes in your subjects' craving for alcohol. Which of the following would be a good index of their craving? a. the amount of alcohol they drink b. the discomfort they experience when they don't drink c. their need to increase the amount that they drink d. the amount of time they spend planning to drink Answer: d. 16. Tolerance for a psychoactive substance refers to a. withdrawal. b. psychological dependence. c. the ability to consume several drugs at the same time with limited adverse effects. d. requiring more of the substance to achieve the same effect that lower doses once achieved. Answer: d. 17. Metabolic tolerance involves changes in _____________ while pharmacodynamic tolerance involves changes in _____________. a. neurons / enzymes b. enzymes / neurons c. brain / neuron d. neuron / brain Answer: b. 18. The process in which neurons adapt to psychoactive drug use by reducing the number of receptors or by reducing their sensitivity to the drug is known __________ regulation. a. down b. up c. neuron d. metabolic Answer: a. 19. In one type of tolerance, cues that are regularly associated with the administration of a drug begin to function as conditioned stimuli and elicit a conditioned response that is opposite in direction to the natural effect of the drug in the process of __________ conditioning. a. tolerance b. drug c. metabolic d. behavioral Answer: d. 20. When a heavy drinker stops drinking alcohol, what happens to his biological system that causes withdrawal symptoms? a. It is deprived of essential vitamins. b. It has become psychologically dependent. c. It rebounds after functioning in a chronically depressed state. d. It rebounds after functioning in a chronically stimulated state. Answer: c. 21. Which of the following might a person suffering from alcohol withdrawal delirium experience? a. amnesia b. auditory hallucinations c. pharmacodynamic tolerance d. metabolic tolerance Answer: b. 22. The police find a man in a seedy part of town; he looks in "bad shape," so they call for an ambulance. On the way to the hospital, the paramedic calls the hospital base with the following description: approximately 50-year-old white male, heavy sweating, hand tremors, seems delirious, and appears to be experiencing hallucinations. When the patient arrives at the hospital, the emergency room physician suspects that the patient is experiencing a. cocaine withdrawal. b. barbiturate overdose. c. a schizophrenic episode. d. alcohol withdrawal delirium. Answer: d. 23. Based on reports from people who use drugs, which psychoactive substance is least associated with tolerance and withdrawal effects? a. opiates b. sedatives and hypnotics c. hallucinogens d. cocaine Answer: c. 24. Which of the following are signs of alcohol intoxication according to DSM-5? a. anhedonia, hallucinations, and delusions b. nystagmus, rapid heart beat, and convulsions c. slurred speech, lack of coordination, and nystagmus d. feelings of pleasure, nausea, and constriction of the pupils of the eye Answer: c. 25. The police found a man along the highway. They immediately transported him to the emergency room where it was determined that his alcohol concentration was 600 mg percent. The police report probably described him as a. dead. b. stuporous. c. unconscious. d. uncoordinated. Answer: a. 26. What is the legal limit of alcohol concentration for driving in most states, as measured in the number of milligrams (mg) of alcohol per 100 milliliters of blood (percent)? a. 10 mg percent b. 80 mg percent c. 160 mg percent d. 300 mg percent Answer: b. 27. Charles is administered a blood alcohol level test, and the results show 400 mg percent. Which of the following characterizes his state? a. slightly intoxicated b. very intoxicated, at risk of slipping into coma c. unaffected by the small amount he drank earlier d. his driving is impaired, but he could walk home Answer: b. 28. What is a blackout? a. losing consciousness and passing out b. a time-limited period of dementia c. an experience of nausea and vomiting d. an inability to remember what has happened Answer: d. 29. Which of the following statements is true about the relationship between death and the misuse of alcohol? a. Alcohol is responsible for relatively few deaths directly. b. Alcohol related deaths due to injury are more common among young men. c. Alcohol related deaths due to disease are more common among young men. d. The number of alcohol-related deaths in the U.S. has been steadily declining for the past 20 years. Answer: b. 30. What is the physiological basis of the short-term effects of nicotine? a. blocks the release of GABA and acetylcholine b. increases the release of GABA and acetylcholine c. blocks the release of norepinephrine and dopamine d. increases the release of norepinephrine and dopamine Answer: d. 31. Your textbook suggests that withdrawal from nicotine is on a par with withdrawal from a. heroin. b. LSD. c. marijuana. d. sugar. Answer: a. 32. Why are cocaine and amphetamines called stimulant drugs? a. They activate the sympathetic nervous system. b. They activate the parasympathetic nervous system. c. They reduce the level of GABA available in the brain. d. They increase the level of GABA available in the brain. Answer: a. 33. In your role as a police officer, you sometimes come across individuals who seem to be hallucinating and have delusions of persecution. In addition to the possibility that these individuals may have a mental disorder or be under the influence of various hallucinogenic drugs, you must also consider the possibility of a. marijuana withdrawal. b. amphetamine use. c. acute depression. d. nicotine withdrawal. Answer: b. 34. Prolonged use of amphetamines has been linked to an increase in violent behavior, but it is not easy to interpret this link because a. there are many different definitions of violence. b. people are usually not willing to admit that they have taken amphetamines. c. the violence could be due to a drug user's lifestyle, not the drug itself. d. very few people actually engage in prolonged use of amphetamines. Answer: c. 35. Alex is listening to a lecture on the history of opiate drugs, and he learns something that he finds very surprising. What has he heard the lecturer say? a. "Heroin is a synthetic opiate made from morphine." b. "Heroin has actually been legally available by prescription in the U.S. for years." c. "Heroin is a synthetic drug that was originally developed as an antidepressant." d. "Heroin is not really an opiate because it is synthetic and does not actually come from poppies." Answer: a. 36. The active substances in opium are a. LSD and PCP. b. cocaine and heroin. c. codeine and morphine. d. marijuana and cocaine. Answer: c. 37. A research participant in a study of drug effects has experienced a brief, intense, dreamlike euphoria with a sense of increased visual and auditory sensitivity. The brief sense of pleasure is very powerful. Which drug has this subject likely received? a. PCP b. LSD c. heroin d. cocaine Answer: c. 38. Which category of drugs is made up of those used to treat anxiety disorders and sleeping problems? a. opiates b. stimulants c. benzodiazepines d. selective serotonin reuptake blockers Answer: c. 39. The families of drugs that include barbiturates and benzodiazepines are also known informally as a. opiates. b. sedatives. c. narcotics. d. neuroleptics. Answer: b. 40. People who stop taking relatively high doses of benzodiazepines can experience an abrupt return of the original anxiety they were using the drugs to suppress. This is called a. a return of the repressed. b. high anxiety. c. the rebound anxiety syndrome. d. a discontinuance syndrome. Answer: d. 41. What is the most common active ingredient in marijuana? a. LSD b. PCP c. THC d. LOB Answer: c. 42. Cannabis intoxication is often accompanied by temporal disintegration. This means that a. the drug breaks down quickly in the body. b. people have trouble retaining and organizing information. c. intoxication can quickly lead to a nervous breakdown. d. intoxication leads to social withdrawal and isolation. Answer: b. 43. Follow-up studies of adults who used cannabis over a period of several years a. found some evidence of cognitive decline associated with the drug. b. did not find evidence of cognitive decline associated with the drug. c. found evidence of brain damage in several areas of the central nervous system. d. found evidence of cognitive enhancement in creative skills. Answer: a. 44. While out in the wild, a group of vacationers pick some mushrooms. Later in the day, they use them in cooking the evening meal. Several members of the group begin to experience strange sensations and even hallucinations. The drug in the mushrooms was most likely a. PCP. b. marijuana. c. psilocybin. d. exogenous opiates. Answer: c. 45. Which of the following is likely to be experienced while under the influence of MDMA, also known as ecstasy? a. trouble retaining and organizing information b. increased aggressive behaviors c. difficulty regulating body temperature d. vivid hallucinations Answer: c. 46. What hallucinogen, at high doses, can induce psychotic behavior, including delusional thinking, catatonic behavior, manic excitement, and sudden mood changes? a. LSD b. PCP c. cocaine d. alcohol Answer: b. 47. You are a psychologist for a drug treatment program aimed at adolescents. In evaluating new clients, you would be most concerned about the long-term continuous use of which substance? a. PCP b. psilocybin mushrooms c. LSD d. MDMA Answer: a. 48. People who stop taking hallucinogens after continued use a. usually experience flashbacks. b. show significant withdrawal effects. c. often return to drug use. d. show no withdrawal effects. Answer: d. 49. What evidence led developers of DSM-5 to remove the distinction between substance abuse and substance dependence? a. Substance abuse was moved to the impulse control disorders section. b. Substance abuse was removed because abusers do not suffer serious impairment. c. People who abuse substances are always dependent on substances. d. Evidence suggests dependence and abuse are not clearly distinct forms of disorder. Answer: d. 50. Which of the following must a person exhibit in order to be diagnosed with alcohol use disorder in DSM-5? a. hallucinations b. difficulty regulating body temperature c. a problematic pattern of use d. high levels of anxiety Answer: c. 51. Tolerance and withdrawal are considered the __________ criteria included in the definition of alcohol use disorder. a. impaired control b. social impairment c. pharmacological d. risky use Answer: c. 52. Mindy was just arrested for driving while intoxicated (DWI). Why would we not necessarily diagnose Mindy with an alcohol use disorder? a. She is female, and alcohol use disorder is only seen in males. b. DSM excludes DWI as a criterion for alcohol use disorder. c. DSM requires a recurrent pattern of problematic use. d. Intoxication is not pathological. Answer: c. 53. The workgroup that prepared the definition of substance use disorders that is used in DSM-5 collapsed substance dependence and substance abuse into a single disorder with a continuous range of severity. In the case of alcohol, this disorder is called a. delirium tremens. b. alcohol use disorder. c. Korsakoff's disorder. d. alcoholism. Answer: b. 54. Although the course of alcoholism is different in every individual, nearly all cases of alcoholism involve a. onset before age 20. b. antisocial behavior. c. a predictable sequence of phases. d. alternating periods of heavy use and abstinence. Answer: d. 55. What pattern of drinking-related behavior was reported by Vaillant in his longitudinal study of males? a. Most of the men stopped drinking prior to age 30. b. Those who remained abstinent for six years were unlikely to relapse. c. The majority of the men drank so heavily, they were dead before the age of 40. d. The rate of abstinence was low and changed little over the course of the follow-up. Answer: b. 56. Which problems commonly occur along with alcoholism? a. schizophrenia and bipolar disorder b. adjustment disorder and somatization disorder c. mood disorder and antisocial personality disorder d. dependent personality disorder and specific phobia Answer: c. 57. Why are amphetamines the most serious drug problem in Japan? a. Amphetamines are readily available as over-the-counter diet aids. b. There is a limited amount of land for cultivation of plant-based drugs; since amphetamines are synthetic drugs, they are more easily available. c. Government agencies have managed to intercept most shipments of drugs that have a detectable odor. d. These drugs have a long history of use by people who want to boost their energy so that they can work an increased number of hours. Answer: b. 58. As a behavioral advisor to the World Health Organization, you are required to assess drug use and abuse in indigenous populations. You have been assigned to study the South American natives’ use of coca leaves, which are part of the plant from which cocaine is derived. In reading about past findings, you discover that these native groups a. have very few drug use problems. b. have very serious drug use problems. c. are so hostile to the World Health Organization that no studies have been done. d. have almost been wiped out due to local drug wars. Answer: a. 59. You have been asked to design a targeted drug prevention program. Your task is to decide on which sex, if any, should receive more attention. You decide that it depends on which drug or drugs are under consideration and that a. for alcohol abuse only, the focus should be on women, who have a higher rate of alcohol abuse. b. for drug abuse, in general, the focus should be on women, who have a higher rate than men. c. for drug abuse, in general, the focus should be on men, who have the highest rate. d. for drug abuse, in general, the rates are equal, so each sex will have to be targeted. Answer: c. 60. Out of all men and women who have ever used alcohol, approximately ____ percent will develop serious alcohol related problems. a. 10 b. 20 c. 30 d. 50 Answer: b. 61. According to the National Epidemiologic Survey on Alcohol and Related Conditions, the lifetime prevalence of alcohol abuse is approximately what percentage of the general population? a. 5 b. 15 c. 30 d. 50 Answer: c. 62. Alcohol-related disorders are a. on the decline in the United States. b. relatively rare forms of mental disorders. c. among the most common forms of mental disorders in the United States. d. not studied extensively enough to draw firm conclusions. Answer: c. 63. How does the rate of alcohol problems compare in men and women? a. Although the difference in the rates is narrowing, the rate is still much higher among men. b. The rate is much higher among males, and the difference in rates between males and females is growing larger. c. Community surveys indicate that the rates are virtually identical. d. Although in the past males have had much higher rates, females now have higher rates. Answer: a. 64. Dwayne and Rhonda each weigh 150 pounds. They go out drinking and each has three beers. According to your textbook, why does Rhonda become intoxicated sooner? a. Men's bodies have lower water content. b. Women's bodies have lower water content. c. Men's digestive functioning is less efficient. d. Women's digestive functioning is less efficient. Answer: b. 65. According the National Comorbidity Study, the lifetime prevalence of nicotine dependence is approximately ______ percent. a. 2 b. 12 c. 24 d. 40 Answer: c. 66. Which of the following statements is most accurate? a. Younger people do not drink as much alcohol as older people drink. b. Older people do not drink as much alcohol as younger people drink. c. Younger men drink less alcohol than older men drink. d. There is not a significant difference in the drinking habits between young and old. Answer: b. 67. Which age group has the highest prevalence rates for alcohol dependence? a. adolescents b. the elderly c. young adults d. the middle aged Answer: c. 68. Which of the following are you most likely to find among the elderly in the United States? a. higher rates of alcohol abuse than among younger people b. higher rates of drug abuse than among younger people c. prescription drug abuse and dependence d. illegal drug abuse and dependence Answer: c. 69. Which of the following characteristics are strong predictors of adolescents' initial experimentation with drugs? a. extroversion and agreeableness b. introversion and impulsiveness c. rebelliousness and extroversion d. introversion and conscientiousness Answer: c. 70. Why are investigators interested in the fast flush phenomenon? a. It is often seen in people of Asian ancestry and might explain why they drink less. b. It is often seen in people of Asian ancestry and might explain why they drink more. c. It is often seen in young people and might explain why they drink more. d. It is often seen in females and might explain why they drink less. Answer: a. 71. The lifetime prevalence of alcoholism among families of alcoholics is higher than in the general population, by a factor of about a. 2. b. 3 to 5. c. 10 to15. d. 20. Answer: b. 72. What have researchers concluded from research on the concordance rates of monozygotic (MZ) and dizygotic (DZ) twins? a. The role for genetics is much larger for males than it is for females. b. Genetic factors play a small role in etiology of alcoholism among women. c. Similar concordance rates for MZ and DZ twins suggest no significant role for genetics. d. Concordance rates suggest a role for genetics, and higher concordance rates among males reflect the higher prevalence of alcoholism among males. Answer: d. 73. What is the estimated heritability of serious alcohol-related problems? a. 13 percent b. 33 percent c. 66 percent d. 86 percent Answer: c. 74. Genetic factors in the cause of alcohol abuse could be somewhat indirect. It has been suggested, for example, that genes that influence __________________ may cause a person to be more likely to risk alcohol dependence. a. intelligence b. depression c. ADHD d. sensation seeking Answer: d. 75. In the absence of other etiological factors for alcohol use disorder, being raised by an alcoholic parent a. still significantly increases the chance of developing the disorder. b. does not appear to be a critical consideration in the development of the disorder. c. increases the risk of alcohol dependence, but decreases the risk of abuse. d. reduces the risk of alcohol related problems but increases the risk of drug related problems. Answer: b. 76. Which of the following conclusions about the genetics of alcohol use disorders can be legitimately drawn from adoption studies? a. Genetics do not play a very significant role. b. There appears to be a strong association between genetics and the etiology of alcohol use disorder. c. Being reared by an alcoholic parent can fully account for the known risk. d. There is too much inconsistency in the studies to allow us to draw any conclusions. Answer: b. 77. Scientists who study the biological basis of addiction have devoted considerable attention to understanding the rewarding properties of drugs. Much of this attention has focused on a. serotonin. b. dopamine. c. norepinephrine. d. GABA. Answer: b. 78. You have access to an fMRI facility and plan to study brain regions associated with drug addiction. You advise your team that it would be wise to focus on the a. reward pathways of the brain. b. hippocampus. c. cerebellum. d. substantia nigra. Answer: a. 79. What evidence has been cited by scientists who propose that alcoholism is related to endogenous opioid production? a. Alcohol is an opioid derivative. b. Rats given morphine refuse alcohol. c. The symptoms of withdrawal from alcohol and heroin are similar. d. Opioid-antagonists can reduce the subjective "high" of drinking. Answer: d. 80. Several genes that affect the reception of which neurotransmitter have been seen to correlate with the risk of alcohol dependence? a. norepinephrine b. GABA c. serotonin d. MAO Answer: b. 81. Some theorists associate alcoholism with exaggerated activation of an endogenous system in response to alcohol stimulation. Which system do they suggest? a. the alcohol system b. the dopamine system c. the opiod system d. the amygdala system Answer: c. 82. Traditional learning theory has held that people drink because a. parents model drinking behavior. b. drinking is reinforced by stress reduction. c. abstinence is punished through social disapproval. d. drinking is on an intermittent reinforcement schedule. Answer: b. 83. A researcher is using the balanced placebo design to investigate the effects of alcohol on aggression. What has this research added to our knowledge of alcohol? a. Given a choice, most participants prefer tonic to alcohol. b. Expectations play an important role in the effects attributed to alcohol. c. Alcohol has powerful placebo effects in the treatment of many medical conditions. d. The effects of alcohol are the result of an inherited failure to metabolize the drug. Answer: b. 84. Longitudinal studies of adolescent alcohol use and their expectancy patterns have found that a. those with positive expectations go on to consume greater amounts of alcohol. b. those with negative expectations go on to consume greater amounts of alcohol. c. those with positive expectations go on to consume lesser amounts of alcohol. d. those who consume greater amounts of alcohol go on to have more positive expectations. Answer: a. 85. A team of researchers has decided to employ the high-risk research design in a longitudinal study of adolescent alcohol use. What will these researchers have to do to conduct such a study? a. put their subjects in risky situations b. select subjects based on the presence of specific risk factors c. take the risk of investigating an unlikely cause d. assess the risky behaviors displayed by the subjects Answer: b. 86. The treatment of alcoholism and other types of substance use disorders is an especially difficult task because a. no effective treatment techniques have been developed. b. it is unethical to use drugs in the treatment of substance use disorders. c. many people with substance use disorders do not acknowledge their difficulties. d. very few professionals have any expertise in the treatment of substance use disorders. Answer: c. 87. One of the controversies involving the treatment of substance use disorders is whether a. total abstinence from drinking or drug use is the only acceptable goal. b. people recovering from substance use disorders should be allowed to treat others. c. treatment should begin before the person has stopped drinking or drug use. d. it is appropriate to encourage people to seek help when they are not ready to admit to a problem. Answer: a. 88. Detoxification refers to a. psychotherapy for substance abuse. b. symptoms of withdrawal from drug dependence. c. the removal of a drug on which a person is dependent. d. deterioration of brain tissue secondary to drug abuse. Answer: c. 89. What is Antabuse? a. a safe substitute for alcohol b. a 12-step program for alcoholism c. a drug that blocks the breakdown of alcohol d. a drug that induces an altered state of consciousness Answer: c. 90. What is likely to occur if Javier takes Antabuse and then has a shot of whiskey? a. He will become aggressive. b. He will become violently ill. c. He will become intoxicated more quickly. d. He will not feel the effects of the alcohol. Answer: b. 91. What is one of the major problems in treating alcoholism with Antabuse? a. The treatment has a high mortality rate. b. Voluntary compliance with drug taking is low. c. The side effects of the drug include tardive dyskinesia. d. The treatment must be court ordered. Answer: b. 92. A relative was admitted to the hospital and given doses of naltrexone for problems related to alcohol. How will this drug affect the man? a. It will block the action of GABA. b. It will block the action of norepinephrine. c. It will increase levels of dopamine in the brain. d. It will decrease the level of endogenous opioids. Answer: d. 93. In the long term treatment of alcoholic patients, SSRIs a. appear to be very helpful. b. can significantly reduce the occurrence of acute withdrawal symptoms. c. can be helpful with patients who also have a diagnosis of major depression. d. have not been shown to be of any value. Answer: c. 94. What is the first step of Alcoholics Anonymous’s 12-step program? a. seeing a psychotherapist b. checking into a hospital detox program c. admitting that one is powerless over alcohol d. recognizing that one must recover on one's own Answer: c. 95. What is an underlying notion that supports the 12-step program of Alcoholics Anonymous? a. spiritual ideas about recovery b. psychological theories of defense mechanisms c. biological evidence of changes accompanying abstinence d. scientific evidence of cognitive changes accompanying abstinence Answer: a. 96. What is one principal assumption of Alcoholics Anonymous? a. People cannot recover on their own. b. The first step is to improve overall physical health. c. Only mental health professionals are successful in treating alcoholism. d. Treatment must include a biological intervention, such as Antabuse. Answer: a. 97. Barbara is seeing a therapist to help her with her drinking problem, and her therapist is trying to improve Barbara’s social skills and ability to solve problems. This therapist is probably a a. psychiatrist. b. recovering alcoholic. c. cognitive behavior therapist. d. motivational counselor. Answer: c. 98. The cognitive behavioral model of relapse prevention is concerned with the abstinence violation effect. What is the abstinence violation effect? a. a patient's tendency to lie about concealed drinking b. the fact that drinking in public is illegal in some states c. a patient's feeling that he or she is being controlled by the therapist d. the pattern of going back to chronic drinking if one slips up even a little Answer: d. 99. Rebecca is trying to recover from alcoholism. Her therapist is attempting to help her reduce the abstinence violation effect. This is a problem for Rebecca because as soon as she has even a small drink, she thinks, a. "I am a worthless person." b. "I can recover on my own; I don't need help." c. "I'm only doing something wrong if it's illegal." d. "I've messed up; I may as well go ahead and get drunk." Answer: d. 100. At the mental health center, a young man will begin what is called motivational interviewing. What can this man expect during the session that will follow? a. Several members of law enforcement organizations will "lay it out" for this client: either he "shapes up or he will go to jail." b. A physician will try to ascertain the reasons behind this man's failure to comply with instructions to take Antabuse on a daily basis. c. Using a nonconfrontational approach, an interviewer will help him to resolve his ambivalence about using drugs and to make a definite commitment to change. d. A number of recovered drug addicts will confront him with what awaits if he does not change his ways. Answer: c. 101. Comprehensive reviews of the research literature regarding treatment of alcoholism and drug abuse tell us that a. most people in treatment show long-term improvement. b. many people improve for a while, but relapse is common. c. success rates are higher for alcoholism than for drug abuse. d. success rates are higher for drug abuse than for alcoholism. Answer: b. 102. What is the general conclusion on research designed to match certain types of patients to particular alcohol treatment programs? a. There is little evidence for the effectiveness of matching. b. The primary variable predicting treatment success is the accuracy of the match. c. The success of these matches depends primarily on the client's level of comorbid conditions. d. Age, socioeconomic status, and other demographic factors are the key to creating a good match. Answer: a. 103. Comprehensive reviews of the research literature regarding treatment of alcoholism and drug abuse tell us that a. in-patient treatment is more effective than out-patient treatment. b. professional treatment is more effective than self-help approaches such as AA. c. treatment aimed at reducing alcohol or drug use is more effective than treatment aimed at total abstinence. d. there is little evidence to suggest that one form of treatment is more effective than another. Answer: d. 104. Successful long-term outcome for the treatment of alcoholism is best predicted by a. how much treatment the person receives. b. whether the person can afford private treatment. c. the person's coping resources and available social support. d. the severity of the negative consequences that will motivate the person to seek help. Answer: c. 105. Gambling disorder was moved to the chapter on substance-related and addictive disorders because a. all gambling is seen as a mental disorder. b. people with serious gambling problems often suffer from substance use disorders. c. behavioral addictions involve the same exposure of toxic chemicals on the brain. d. all of the impulse control disorders were moved along with gambling disorder. Answer: b. Short Answer 106. Addiction and dependence are older terms that are often used to describe problems such as alcoholism. These terms have been replaced in official terminology by the term __________. Answer: substance use disorder 107. A term that is frequently used to describe a forceful urge to use drugs is a(n)__________. Answer: craving 108. The symptoms that can be thought of as the "flip side" of tolerance symptoms are known as __________. Answer: withdrawal 109. Some theorists have suggested that nicotine mimics the effects of which class of psychoactive medications? Answer: antidepressants 110. Cocaine is a member of a group of drugs known as __________ stimulants. Answer: psychomotor 111. The dried leaves and/or flowers of a cannabis plant are know as __________. Answer: marijuana 112. ___________ refers to the dried resin from the top of the female cannabis plant. Answer: Hashish 113. ____________ disorder (the childhood manifestation of ASPD) is strongly related to the subsequent development of alcohol dependence. Answer: Conduct 114. Natural rewards, such as food and sex, as well as many drugs of abuse increase __________ levels in brain reward pathways. Answer: dopamine 115. One of the most interesting and important advances in neuroscience research was the discovery of the endogenous opioids known as __________. Answer: endorphins and enkephalins 116. Abstinence during a treatment program that allows for the removal of a drug on which a person has become dependent is known as __________. Answer: detoxification Essay 117. What are the symptoms and causes of withdrawal? Which drugs cause serious signs of withdrawal? Answer: The symptoms occur when a person stops taking a drug, and they can persist for days. If a heavy drinker stops drinking alcohol, he may experience hand tremors, sweating, nausea, anxiety, and insomnia. The especially serious symptoms include convulsions and hallucinations. In some cases, delirium may develop. The symptoms of withdrawal related to other drugs vary. Withdrawal symptoms are most obvious for alcohol, opioids, and sedatives, hypnotics, and anxiolytics. Withdrawal signs are not often seen after repeated use of cannabis or hallucinogens and can be relatively light for cocaine. When an individual uses a psychoactive drug, the body, especially the brain, reacts against it. This process, known as tolerance, has the effect of reducing the impact of the drug. When this person stops taking the drug, the processes that caused his tolerance are still in place until his body has a chance to undo them. During this period of time, the individual will experience symptoms that are essentially the opposite of taking the drug, which are called withdrawal symptoms. 118. Discuss the other disorders commonly associated with substance use disorders. Answer: People with substance use disorders often exhibit other forms of mental disorder as well. Most prominent among these are antisocial personality disorder (ASPD), mood disorders, and anxiety disorders. Conduct disorder is strongly related to concurrent alcohol use in adolescence and the subsequent development of alcohol dependence. ASPD and alcohol/drug dependence frequently co-occur, and there is evidence to suggest that they represent alternative manifestations of a general predisposition toward behavioral disinhibition. 119. Discuss cultural differences in alcohol-related problems. Answer: People who don’t drink obviously won’t develop alcoholism, and culture can influence that decision. Some cultures prohibit or actively discourage alcohol consumption. Many Muslims, for example, believe that drinking alcohol is sinful. Other religions encourage the use of small amounts of alcohol in religious ceremonies—such as Jewish people drinking wine at Passover Seders—while also showing disdain for those who drink to the point of intoxication. This type of cultural constraint can decrease rates of alcohol use disorder. In one large epidemiological study, for example, Jews had significantly lower rates of alcoholism than Catholics and Protestants. 120. Discuss the ways that parent behaviors influence the likelihood that an adolescent will abuse substances. Answer: Parents can influence their children’s drinking behaviors in many ways. They can serve as models for using drugs to cope with stressful circumstances. They may also help promote attitudes and expectations regarding the benefits of drug consumption, or they may simply provide access to licit or illicit drugs. Adolescents with alcoholic parents are more likely to drink alcohol than those whose parents do not abuse alcohol. This increased risk seems to be due to several factors, including the fact that alcoholic parents monitor their children’s behavior less closely, thereby providing more opportunities for illicit drinking. Parental monitoring and discipline have an important impact on adolescent substance use; higher parental monitoring is associated with reduced risk of tobacco and alcohol use. 121. Review the evidence for the role of the brain's reward systems in a model of the cause of drug addiction in general. Answer: A good deal of research into the etiology of drug abuse and addiction focuses on the brain’s reward systems. Older models of drug addiction looked at the effects of tolerance and withdrawal, but more recent research suggests that drugs that have the potential to contribute to addiction all share the property of directly or indirectly facilitating the firing of the brain’s reward centers. One primary circuit in this pathway is the medial forebrain bundle, which connects the ventral tegmental area to the nucleus accumbens. Connections from these structures to the frontal and prefrontal cortex as well as areas of the limbic system, such as the amygdala, also moderate the influence of reward. For many years, scientists have known electrical stimulation of the medial forebrain bundle can serve as a powerful source of positive reinforcement for animals. Now they know that addictive drugs injected into the mesolimbic dopamine pathway also act as powerful positive reinforcers. Different drugs produce these rewarding effects in different ways. Amphetamines, for example, block the reuptake of dopamine in the reward circuits which causes an increase in the firing of reward messages. Measures of brain concentrations of dopamine increase in the medial prefrontal cortex and the limbic system after ingesting cocaine. Alcohol, on the other hand, does fire these same reward systems, but much more indirectly. Its main effect is on the neurotransmitter GABA. Alcohol seems to eventually reduce the activity of GABA, which would normally inhibit the firing of pleasure systems. Some theorists associate alcoholism with exaggerated activation of the endogenous opioid system in response to alcohol consumption. Studies have suggested that blocking opioid receptors reduces an animal’s interest in alcohol. Overall there is considerable empirical and clinical evidence that points to a central role of the brain’s pleasure circuits in the creation of the craving that is the hallmark of current models of drug addiction. 122. Discuss what balanced placebo and longitudinal designs can tell us about the possible role of expectations as factors in both alcohol and drug effects and in the onset of alcohol and drug problems. Answer: Using the balanced placebo design, researchers have shown that subjects' expectations about how a drug will affect their behavior can account for many of the effects that are usually attributed to the drug itself. For example, subjects who believed they had ingested alcohol but who had actually consumed only tonic water displayed exaggerated aggression and reported enhanced feelings of sexual arousal. Expectations may constitute one of the primary reasons for continued and increasingly heavy consumption of alcoholic beverages. Longitudinal studies have found that adolescents who initially have the most positive expectations about the effects of alcohol go on to consume greater amounts of alcoholic beverages. 123. Describe the uses of short-term motivational therapy in the treatment of substance use disorders. Answer: Many people with substance use disorders do not seek or take full advantage of treatment opportunities because they fail to recognize the severity of their problems. Motivational interviewing is a nonconfrontational procedure that can be used to help people resolve their ambivalence about using drugs and make a definite commitment to change their behavior. The procedure is based on the notion that in order to make a meaningful change, people must begin by recognizing the inconsistency between their current behavior and their long-term goals. For example, chronic heavy drinking is not compatible with academic or occupational success. Motivational interviewing begins with a discussion of problems--issues reported by the patient as well as concerns that have been expressed by others, such as friends and family members. The person is asked to reflect on feedback that is provided in a non-threatening way. The therapist does not confront the person, argue about the reasons for drinking, or demand action. Instead, the therapist responds empathically in an effort to avoid or minimize defensive reactions that will interfere with attempts to change. 124. Describe the differences between the DSM-IV and DSM-5 definitions of gambling disorder. Answer: There are two noteworthy differences between the definitions of gambling disorder that appeared in the previous version of the manual (DSM-IV) and the current manual. First, one diagnostic criterion—illegal acts—was dropped from the previous list. That feature stipulated that the person “has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling.” Research studies demonstrated that the illegal acts criterion was rarely endorsed, was only associated with the most severe cases, and was not useful in distinguishing between people who do and who do not seek treatment for gambling. Second, the threshold for a diagnosis was dropped from five features to four. Empirical data support the validity of this change. Test Bank for Abnormal Psychology Thomas F. Oltmanns, Robert E. Emery 9780205997947, 9780205970742, 9780134899053, 9780134531830
