Question 1

A population health perspective of addiction recognizes that addiction's causes, symptoms, and recovery outcomes occur at what level?&#10;A) Individual&#10;B) Family&#10;C) Community&#10;D) Societal

Accepted Answer

Social determinants of health, health inequities, and occupational injustice are particularly visible in addiction etiology and outcomes, suggesting the necessity of a population health approach. A population health approach to occupational therapy in addiction recovery moves beyond individual addiction treatments and addresses the social, cultural, and environmental factors responsible for health disparities and occupational injustices among and within populations. Shifting to a population health approach to treating addiction does not simply mean including family members in addiction recovery or utilizing group-based therapies, although both of these are evidence based practices with a significant amount of supporting literature (Substance Abuse and Mental Health Services Administration [SAMHSA], 2018). A true population health approach to the problem of addiction alters not only the level at which intervention needs to occur but also the fact that addiction's causes, symptoms, and recovery outcomes are understood as societal, rather than individual.

Question 2

Through the lens of Alexander's dislocation theory of addiction, people adopt addictive behaviors when they feel:&#10;A) Isolated&#10;B) Included&#10;C) Mentally ill&#10;D) Unsure

Accepted Answer

Alexander (2010, 2015) and others have emphasized that addiction is a societal, rather than an individual, problem. Through the lens of Alexander's dislocation theory of addiction, people adopt addictive behaviors when they feel deeply isolated, detached, fragmented, or dislocated from meaningful participation in life. Abuse, trauma, natural disasters, cultural assimilation, globalization met with disruption of local economies, and numerous other factors may contribute to the onset and pains of dislocation. Of note is his claim that modernization and postmodernization expand worldwide dislocation by undercutting local economies via free market trade and celebrating immediate and limitless gratification. The growing prevalence of addictive behavior despite modest improvements in addiction medicine and individual treatment approaches are, for Alexander, indicators of larger social problems (Alexander, 2010). Dislocation theory provides a framework within which innovative population health approaches to addiction recovery focused on reducing dislocation and creating supportive, inclusive societal contexts can be conceptualized. The need for such innovation is evident in the growing number of drug-related deaths despite the billions of dollars invested in reducing addiction-related problems (Centers for Disease Control and Prevention [CDC], 2018b).

Question 3

A school-based occupational therapist develops a stress-management regimen using yoga and meditation to help children vulnerable to addiction due to historical trauma and adverse childhood experiences adopt adaptive coping strategies. This an example of which level of intervention?

A) Microlevel
B) Mesolevel
C) Macrolevel
D) Not a population health intervention

Mesolevel

Accepted Answer

An understanding of addiction from a population health perspective can translate into interventions at multiple levels, including interventions designed for individual clients (microlevel), community-based interventions (mesolevel), and population-based interventions (macrolevel). For the occupational therapy practitioner, the ecological model of human performance (EHP; Dunn, Brown, McGuigan, 1994) may be a useful framework for adopting a population health approach to addiction prevention and intervention. The EHP encourages practitioners to consider how temporal, social, societal, historical, political, and other contexts influence task performance and thus participation in life. In addition, the model suggests skills, perceived roles, and abilities (all influenced by contextual factors) shape the occupations (tasks) available to a person and/or the way in which a person perceives and engages (or not) in those tasks. At the microlevel, an occupational therapist may assist a client in identifying contextual factors that have an impact on skill development, role identification, abilities, and availability of resources. Thus, even when treating at the individual level, addiction is viewed as a larger contextual problem. To apply a population health approach at the mesolevel, occupational therapists may develop community-based interventions designed to address the needs of a specific group within their local community context(s). A macrolevel population health approach using the EHP might aim to reduce health disparities and/or health-care inequities by examining, exposing, and correcting the social and occupational injustices that are contributing to the global substance use epidemic.

Question 4

Mr. Smith, a 67-year-old male, has liver disease due to a history of severe substance use disorder. According to the DSM-5, Mr. Smith meets how many of the criteria in the DSM to qualify as &#34;severe&#34;?&#10;A) 1&#10;B) 2&#10;C) 4&#10;D) 6

Accepted Answer

To be diagnosed with a mild substance-related or addictive behavior, a person must demonstrate at least two diagnostic criteria in any of the following groups: impaired control, social impairment, risky use, and pharmacological criteria such as neurobiological changes related to tolerance (see Box 19-2). Four to five criteria indicate a moderate SUD, and six or more suggest a severe SUD. In addition to the 10 substance-specific disorders, the DSM-5 also includes a heading for addictive behaviors, although the only addictive behavior listed is gambling disorder. Both substance use and gambling disorder are thought to change neurobiological structure and function in maladaptive ways, producing the behavioral phenomena seen in addiction (APA, 2013).

Question 5

Historically, more black women using drugs during pregnancy have been arrested, despite higher rates of whites using the illegal substances. This higher rate of arrest is due to which societal issue?&#10;A) Intentional discrimination&#10;B) Implicit bias by health-care providers&#10;C) Blatant racism&#10;D) Stigma

Accepted Answer

When literature first began to examine the impact of illicit substances on newborns, the women arrested in delivery rooms and charged with endangering their infants were almost exclusively poor and black crack users, despite the prevalence of white, pregnant powder cocaine users at the time (Acker, 2010, p. 84). Likewise, "longer sentences for crack possession compared to equivalent weights of powder cocaine contributed to disproportionate levels of African Americans incarcerated for drug convictions (Currie, 1993). These periods of incarceration, in turn, further reduced young black men's engagement in education or legitimate employment and deepened their criminal involvement" (p. 84). Such policies not only increased the direct harms associated with drug use (e.g., incarceration, financial impacts) but also further increased risk factors by imposing barriers to meaningful and efficacious participation in life. Highlighting the relevance of race in discussions of addiction and health, Krieger (2014) emphasizes: "An important gap in current research concerns the racialized health consequences of contemporary legal discrimination such as the legally color-blind, albeit racially motivated, U.S. War on Drugs and its role in producing or exacerbating health-debilitating racial/ethnic inequalities" (p. 688).

Question 6

Which of the following is most vulnerable to opioid addiction?&#10;A) A person who has had a hip replacement for osteoarthritis&#10;B) A person who has had a carpal tunnel release for chronic CTS&#10;C) A person with a shoulder replacement who had preoperative pain&#10;D) A person who had their wisdom teeth removed

Accepted Answer

Who is most affected by the opioid epidemic in the United States? According to recent literature, postsurgical patients, adolescent athletes, and people with chronic pain who have been prescribed opioids are among those most affected (Brummett et al., 2017; NIDA, 2018a). According to NIDA (2018a), 21-29% of people with chronic pain with opioid prescriptions misuse them, and 8-12% develop an opioid use disorder. Approximately 4-6% of those who misuse their prescribed opioids transition to heroin use; conversely, 80% of heroin users first misused prescribed opioids. Brummett et al. (2017) reported that 5.9-6.5% of people who were prescribed opioids following a major or minor surgery demonstrated new, persistent opioid use-defined as those new to opioid use filling opioid prescriptions 90-180 days after surgery, long after post-surgery pharmacological pain relief would typically be needed. Incidences of persistent opioid use did not correlate with whether the participants of the study had a major or minor surgery. Instead, persistent opioid use was significantly linked to the presence of another SUD, anxiety, depression, or preoperative pain disorders, such as chronic neck or back pain or arthritis. Literature suggests that the duration of use (22.1 months or more) positively affects the likelihood of developing an addiction (Fishbain, Cole, Lewis, Rosomoff, & Rosomoff, 2007).

Question 7

Persons most likely to develop an opioid addiction are those who:&#10;A) Had a major surgery&#10;B) Had a minor surgery&#10;C) Have a long duration of opioid use&#10;D) Have chronic pain

Accepted Answer

Who is most affected by the opioid epidemic in the United States? According to recent literature, postsurgical patients, adolescent athletes, and people with chronic pain who have been prescribed opioids are among those most affected (Brummett et al., 2017; NIDA, 2018a). According to NIDA (2018a), 21-29% of people with chronic pain with opioid prescriptions misuse them, and 8-12% develop an opioid use disorder. Approximately 4-6% of those who misuse their prescribed opioids transition to heroin use; conversely, 80% of heroin users first misused prescribed opioids. Brummett et al. (2017) reported that 5.9-6.5% of people who were prescribed opioids following a major or minor surgery demonstrated new, persistent opioid use-defined as those new to opioid use filling opioid prescriptions 90-180 days after surgery, long after post-surgery pharmacological pain relief would typically be needed. Incidences of persistent opioid use did not correlate with whether the participants of the study had a major or minor surgery. Instead, persistent opioid use was significantly linked to the presence of another SUD, anxiety, depression, or preoperative pain disorders, such as chronic neck or back pain or arthritis. Literature suggests that the duration of use (22.1 months or more) positively affects the likelihood of developing an addiction (Fishbain, Cole, Lewis, Rosomoff, & Rosomoff, 2007).

Question 8

An EMS team comes upon a young woman experiencing an opioid overdose. They are likely to provide which intervention?&#10;A) Transport her to detox&#10;B) Administer naloxone&#10;C) Contact her provider to address opioid prescribing&#10;D) Administer methadone

Accepted Answer

According to CDC Principal Deputy Director Anne Schuchat, MD, "all branches of the federal government are working together to reduce the availability of illicit drugs, prevent deaths from overdoses, treat people with substance-use disorders, and prevent people from starting using drugs in the first place" (CDC, 2018b, para. 4). Reducing the availability of opioids, as mentioned above, has largely been accomplished by educating providers to modify prescribing practices. Preventing deaths from opioid overdose has been addressed via widespread generic naloxone distribution. Naloxone (brand name Narcan) is an opioid antagonist that can prevent death from overdose by counteracting the central nervous system and respiratory system depression resulting from excessive opioid use (CDC, 2018b).

Question 9

Which of the following is an evidence based intervention for addiction?&#10;A) Education on impact of substance use&#10;B) Monitoring provider prescribing habits&#10;C) Mindfulness training&#10;D) Community-based programs for youth

Accepted Answer

SAMHSA (2018) suggests using a recovery-oriented approach that includes evidence based practices for addiction (Box 19-4). Additionally, SAMHSA emphasizes that addiction treatment programs should provide options for long-term treatment, such as "ongoing counseling or recovery coaching and support [that] helps in meeting other basic needs like sober housing, employment supports, and continued family involvement" (SAMHSA, 2018, p. 1). Other evidence based practices include contingency management (Prendergast, Podus, Finney, Greenwell, & Roll, 2006), housing first (Padgett, Stanhope, Henwood, & Stefancic, 2011), and mindfulness training (Garland, Roberts-Lewis, Tronnier, Graves, & Kelley, 2016).

Question 10

Julia is a 28-year-old with depression and an opioid addiction. She would be benefit from what type of intervention?&#10;A) Detox&#10;B) Administration of naloxone&#10;C) Contingency management&#10;D) Integrated dual disorder treatment

Accepted Answer

Addiction rarely occurs in the absence of comorbid conditions. Dual-diagnosis refers to a person with an addiction and a severe mental illness (SMI). The literature suggests that dually diagnosed clients have had difficulties accessing care because some addiction treatment facilities are ill-equipped to treat persons with SMI, and conversely, SMI facilities are ill-equipped to address problems inherent in addiction recovery. Often SMI treatment centers require drug abstinence, which may not be realistic for someone with an SUD. Integrated Dual Disorder Treatment (IDDT) is an evidence based practice developed to concurrently address addiction and SMI (Kubek, Kruszynski, & Boyle, 2003). Providers are trained to address all aspects of addiction and SMI and understand the ways in which SMI may influence addictive behaviors while also recognizing how substance use may affect SMI symptoms and recovery. IDDT uses a stage-based approach to care and facilitates stable housing (despite drug use), harm reduction, employment, family involvement, continuity of care, and perhaps most importantly, true integration of services (Drake et al., 2001). IDDT treatment stages are described in Table 19-1. All providers are trained to treat both addiction and SMI. In addition to IDDT, widespread federal funding supports the development of integrated community behavioral health clinics that, recognizing the frequency with which physical and mental health conditions co-occur, bring together physical and mental health evaluation and treatment (Barnett et al., 2012).

Question 11

Greg is a 32-year-old male addicted to gambling. His gambling addiction is considered a:&#10;A) Personality disorder&#10;B) Behavioral addiction&#10;C) Psychotic disorder&#10;D) Emotion management deficit

Accepted Answer

The answer of Greg is a 32-year-old male addicted to...

Question 12

From an occupational therapy perspective, addiction is considered a:&#10;A) Substance use problem&#10;B) Behavioral addiction&#10;C) Personality disorder&#10;D) Maladaptive occupation

Accepted Answer

The answer of From an occupational therapy perspective, addiction is...

Question 13

An appropriate occupational therapy assessment tool used for clients with addiction to understand occupational performance is a:&#10;A) Role checklist&#10;B) Sensory profile&#10;C) COPM&#10;D) Skilled observation

Accepted Answer

The answer of An appropriate occupational therapy assessment tool used...

Question 14

Ariel is a 29-year-old addicted to prescription pain medications from an old ballet injury. She says she wants to recover from her addiction. As the occupational therapist, intervention may be more successful if you understand which aspect during evaluation?

A) Role function
B) Stages of change
C) Leisure interests
D) Family history

Accepted Answer

The answer of Ariel is a 29-year-old addicted to prescription...

Question 15

One benefit of the normative scale of occupations in the context of population health and addiction is that it:&#10;A) Cures addiction&#10;B) Promotes readiness to change&#10;C) Removes stigma&#10;D) Provides a population health intervention for addiction

Accepted Answer

The answer of One benefit of the normative scale of...

Deck 19: Community-Based Approaches to Substance Use Epidemics Introduction