CARN Treatment Modalities and Interventions 2 — Questions and Answers
Question 1: A patient with opioid use disorder is being considered for medication-assisted treatment. Which medication requires a DEA waiver (X-waiver) for outpatient prescribing by physicians?
- Methadone for OUD treatment
- Buprenorphine/naloxone (Correct answer)
- Naltrexone oral formulation
- Naltrexone extended-release injection
Correct answer: Buprenorphine/naloxone
Buprenorphine for OUD treatment in outpatient settings historically required a DEA X-waiver, though regulations have evolved; methadone for OUD must be dispensed through opioid treatment programs.
Question 2: When using motivational interviewing, a nurse reflects back a patient's ambivalence by saying 'So on one hand you want to quit drinking, but on the other, alcohol helps you cope with stress.' This technique is called:
- Simple reflection
- Double-sided reflection (Correct answer)
- Amplified reflection
- Reframing
Correct answer: Double-sided reflection
A double-sided reflection explicitly acknowledges both sides of ambivalence, helping the patient hear their own conflicting statements.
Question 3: A patient in early alcohol withdrawal presents with tremors, diaphoresis, and anxiety. Which pharmacological agent is the gold standard for managing alcohol withdrawal symptoms?
- Haloperidol
- Benzodiazepines (Correct answer)
- Gabapentin
- Propranolol
Correct answer: Benzodiazepines
Benzodiazepines are the gold standard for alcohol withdrawal due to their cross-tolerance with alcohol at GABA receptors, preventing seizures and delirium tremens.
Question 4: Which psychosocial intervention uses a structured 12-step philosophy and emphasizes peer support and spiritual growth as components of recovery?
- Cognitive Behavioral Therapy
- Dialectical Behavior Therapy
- Alcoholics Anonymous facilitation therapy (Correct answer)
- Contingency management
Correct answer: Alcoholics Anonymous facilitation therapy
Twelve-step facilitation therapy is based on the AA philosophy and actively engages patients in 12-step community programs emphasizing peer support and spirituality.
Question 5: A nurse is implementing contingency management for a patient with stimulant use disorder. The core mechanism of this intervention is:
- Providing insight into unconscious motivations
- Using vouchers or prizes to reinforce abstinence (Correct answer)
- Teaching relapse prevention cognitive skills
- Building a therapeutic alliance through empathy
Correct answer: Using vouchers or prizes to reinforce abstinence
Contingency management uses operant conditioning—rewarding verified abstinence with vouchers or prizes—to reinforce drug-free behavior.
Question 6: Extended-release naltrexone (Vivitrol) is appropriate for a patient who:
- Is currently using opioids daily
- Has acute hepatitis with ALT >10x normal
- Has completed opioid detoxification and is opioid-free (Correct answer)
- Is pregnant and seeking opioid use disorder treatment
Correct answer: Has completed opioid detoxification and is opioid-free
Naltrexone must only be initiated after full opioid detoxification to avoid precipitated withdrawal; patients must be opioid-free for 7–10 days before starting.
Question 7: Which level of care on the ASAM continuum involves medically managed intensive inpatient services (Level 4)?
- Residential treatment without 24-hour medical supervision
- Medically monitored inpatient detoxification only
- Hospital-based programs with 24-hour physician availability (Correct answer)
- Intensive outpatient programs meeting 3 days per week
Correct answer: Hospital-based programs with 24-hour physician availability
ASAM Level 4 is medically managed intensive inpatient treatment, requiring 24-hour physician-directed care in a hospital or equivalent setting.
CARN Treatment Modalities and Interventions 2
A patient with opioid use disorder is being considered for medication-assisted treatment.
Which medication requires a DEA waiver (X-waiver) for outpatient prescribing by physicians?