Mr Smith is diagnosed with alcohol dependence syndrome. He receives an educational session regarding the effects of drinking and the potential benefits of abstinence. He does not make any immediate change in his attitude or behaviour but is prepared to consider altering his drinking habits.
Which of the following phases of Prochaska’s transtheoretical model of change is he in?
C. The stages of change model by Prochaska and DiClemente are stages that a person goes through when involved in a behavioural change. This may include a change in substance misuse behaviour, starting daily exercise, going on a diet, or changing a health-related behaviour, e.g. attempting to obtain a cervical smear. The first stage is the precontemplation stage, where the person is not thinking of any imminent change and is happy the way things are. The second stage is contemplation, where he is considering a change in the near future. Preparation is when he gets ready or prepares to enforce the behavioural change. The action phase is when he implements the change, and in the maintenance phase he decides to continue the change in behaviour and attempts to prevent relapse.
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Which of the following best describes the learning theory behind the efficacy of supervised disulfiram treatment?
E. Disulfiram is generally considered a deterrent. Earlier works suggested disulfiram to be an aversion treatment. The theory underlying ‘aversion therapy’ is that ‘repeated pairing’ of alcohol with an unpleasant stimulus leads to a conditioned response in which drinking alcohol is increasingly perceived as unpleasant. This was previously considered to be the case with disulfiram, because it was common practice to induce the highly unpleasant but controlled disulfiram–ethanol reaction in a clinical setting before initiating regular therapy. This is now considered unnecessary for the efficacy of disulfiram therapy, i.e. the ‘unpleasant’ outcome need not be experienced by the person, but a ‘fear’ of the possibility of such experience is sufficient. An analogy is with police cars. Brewer states that no sane driver will exceed the speed limit if he sees a police car in front or behind; one does not need to be arrested for speeding before reducing the speed. Most patients who take disulfiram under supervision do not risk drinking. Those who do drink do not necessarily get a significant reaction on standard doses of disulfiram, but if the experience is unpleasant, they do not usually repeat it. Some people may consider this as a form of negative reinforcement, which again needs the subject to experience the ‘repeated conditioning’ in order to increase the abstinence behaviour. So, from the given choices, deterrence theory would be the best choice. Deterrence is an established theme in criminal justice. It refers to reduction in unwanted behaviour through knowledge of costs and risks involved in an act.
Which of the following is the most common intracranial complication of cocaine use?
A. High doses of cocaine have been associated with a wide variety of toxic effects, including cardiac arrhythmias, coronary artery spasms, myocardial infarction, and myocarditis. Most of the complications are related to vasoconstriction. The most common cerebrovascular diseases associated with cocaine use are non-haemorrhagic cerebral infarctions. When haemorrhagic infarctions do occur, they can include subarachnoid, intraparenchymal, intraventricular, and at times spinal cord haemorrhages. Other toxic effects on the central nervous system may include seizures, hyperpyrexia, respiratory depression, and death. Cocaine-related seizures and loss of consciousness are seen in heavy users. Rhabdomyolysis, after large doses of cocaine, may contribute to renal complications. Sniffing cocaine can cause ulcers of the mucosa in the nose and perforation of the nasal septum from persistent vasoconstriction. Inhaled cocaine freebase is believed to induce lung damage. By producing placental vasoconstriction, cocaine may contribute to foetal anoxia.
Chris and Ken are classmates at the local primary school. Chris’s father has problems related to alcohol use, while Ken’s parents are teetotal. How many times is Chris more likely to develop an alcohol-related problem in later life than Ken, assuming other psychosocial factors are comparable?
B. Alcohol use disorders run in families. A child with an alcoholic parent has a 4- to 10-fold increased risk of developing alcoholism themselves. This can be due to both genetic and environmental factors. Environmental influences include the availability of alcohol, parental attitudes, and peer pressure. Starting to drink before the age of 15 years is associated with a fourfold increased risk for lifetime alcoholism compared with starting at the age of 21 years. Severe childhood stressors, especially emotional, physical, and sexual abuse, are associated with up to seven times increased risk of alcoholism in adulthood. Childhood antisocial behaviour predicts regular alcohol use in early adolescence and the development of alcoholism later on.
Which of the following is the most common lifetime comorbid diagnosis in a person with cocaine dependence?
A. Cocaine use is associated with frequent co-occurrence of other psychiatric disorders. The presence of other psychiatric disorders sharply increases the odds of substance dependence, and substance-dependent people are more likely than the general population to meet the diagnostic criteria for additional psychiatric disorders. Among cocaine users seeking treatment, the rates of additional current and lifetime diagnoses are regularly found to be elevated. The most common additional lifetime diagnoses associated with cocaine use are alcoholism (60%), antisocial personality (30%), and major depression (30%).
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