Relapse prevention strategies US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Relapse prevention strategies. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Relapse prevention strategies US Medical PG Question 1: A 47-year-old male presents to a psychiatrist for the first time, explaining that he is tired of living his 'double life.' At church, he preaches vehemently against the sin of drinking alcohol, but at home he gets drunk every night. Which of the following ego defenses best explains his behavior?
- A. Acting out
- B. Projection
- C. Rationalization
- D. Reaction formation (Correct Answer)
- E. Displacement
Relapse prevention strategies Explanation: ***Correct: Reaction formation***
- **Reaction formation** involves unconsciously replacing an unacceptable feeling or urge with its directly opposing, more acceptable counterpart.
- The patient's vehement preaching against alcohol (opposite of his secret drinking) is a classic example of this defense mechanism.
- This defense allows him to manage the anxiety from his unacceptable impulse by adopting an extreme opposite public stance.
*Incorrect: Acting out*
- **Acting out** is the expression of an unconscious emotional conflict or impulse through action, often destructive or inappropriate behaviors.
- While his drinking could be considered acting out, the key feature of this case is his public preaching against the very behavior he engages in privately, which is more specific to reaction formation.
*Incorrect: Projection*
- **Projection** is attributing one's own unacceptable thoughts, feelings, or impulses to another person.
- The patient is not attributing his drinking problem to others; he is actively opposing it publicly while engaging in it privately.
*Incorrect: Rationalization*
- **Rationalization** is concocting a seemingly logical reason or excuse for an unacceptable behavior or impulse.
- The patient is not trying to explain away his drinking; rather, he is defending against the impulse by adopting an extreme opposing stance.
*Incorrect: Displacement*
- **Displacement** is redirecting one's feelings (often hostility or anger) from the original target to a less threatening substitute.
- There is no evidence of him redirecting emotions from one target to another in this scenario.
Relapse prevention strategies US Medical PG Question 2: A 22-year-old man seeks help from a physician for his heroin addiction. He tells the doctor that he started using heroin at the age of 17 and gradually started increasing the dose. He has been trying to quit for the last 6 months after realizing the negative consequences of his addiction but has not succeeded because of the withdrawal symptoms. The physician suggests a drug that can be taken within a supervised rehabilitation program as a substitute for heroin to help alleviate withdrawal symptoms. The drug will then be tapered over time. He is further informed by the physician that this drug is not to be taken by the patient on his own and is not used for emergency reversal of opioid overdose. Which of the following drugs is most likely to have been recommended by the physician?
- A. Clonidine
- B. Naltrexone
- C. Methadone (Correct Answer)
- D. Naloxone
- E. Codeine
Relapse prevention strategies Explanation: **Methadone**
- **Methadone** is a long-acting opioid agonist used in **medically supervised settings** for opioid addiction treatment, acting as a substitute to alleviate withdrawal symptoms and cravings.
- Its long half-life allows for **once-daily dosing**, making it suitable for gradual tapering and preventing acute withdrawal, but it is **not used for emergency reversal** of opioid overdose due to its slow onset and prolonged effects.
*Clonidine*
- **Clonidine** is an alpha-2 adrenergic agonist used to manage **autonomic symptoms of opioid withdrawal** (e.g., sweating, anxiety, muscle aches) but does not directly address opioid cravings or act as an opioid substitute.
- It works by **reducing sympathetic nervous system activity** and can cause sedation and hypotension, but it's not the primary opioid substitution therapy.
*Naltrexone*
- **Naltrexone** is an **opioid receptor antagonist** used to prevent relapse by blocking the euphoric effects of opioids, but it is not used to treat acute withdrawal symptoms.
- It should only be administered after **opioid detoxification is complete**, as giving it to someone with opioids in their system can precipitate severe, acute withdrawal.
*Naloxone*
- **Naloxone** is a pure **opioid receptor antagonist** used primarily to **rapidly reverse opioid overdose** by displacing opioids from their receptors in emergency situations.
- Due to its **short half-life** and immediate action, it is not suitable for the sustained management of withdrawal symptoms or as a substitute for opioids in addiction treatment programs.
*Codeine*
- **Codeine** is an opioid analgesic and antitussive that has a **high potential for abuse and dependence** itself, making it unsuitable as a substitute treatment for heroin addiction.
- Although it can alleviate pain and cough, using codeine in this context would essentially be **substituting one opioid addiction for another**, which is contrary to the goals of addiction treatment.
Relapse prevention strategies US Medical PG Question 3: A 25-year-old man comes to the physician because of an 8-hour history of painful leg cramping, runny nose, chills, diarrhea, and abdominal pain. Examination shows cool, damp skin with piloerection. The pupils are 7 mm in diameter and equal in size. Deep tendon reflexes are 3+ bilaterally. The diagnosis of opioid withdrawal is made. After the patient is stabilized, the physician initiates a withdrawal regimen with methadone. Which of the following characteristics makes this drug a suitable substance for the treatment of this patient's addiction?
- A. Rapid onset of action
- B. Low tolerance potential
- C. Long elimination half-life (Correct Answer)
- D. Low dependence risk
- E. Limited potency
Relapse prevention strategies Explanation: ***Long elimination half-life***
- **Methadone's long half-life** allows for steady drug levels, preventing the rapid fluctuations that trigger severe withdrawal symptoms.
- This characteristic enables **once-daily dosing**, simplifying treatment and reducing the likelihood of illicit drug-seeking behavior.
*Rapid onset of action*
- While methadone does have a relatively quick onset, it's not its primary advantage in **opioid addiction treatment**.
- **Buprenorphine** often has a faster onset and is used in a different capacity for induction of treatment.
*Low tolerance potential*
- **Methadone** is an opioid agonist and, like other opioids, patients can develop **tolerance** to its effects over time.
- Its utility in addiction treatment comes from its ability to stabilize opioid receptors, not from a lack of tolerance development.
*Low dependence risk*
- **Methadone** is an opioid and carries a significant risk of **physical dependence**.
- The goal of methadone maintenance is to manage this dependence in a controlled medical setting, reducing harm associated with illicit opioid use.
*Limited potency*
- **Methadone** is a potent opioid, similar in potency to morphine, which contributes to its effectiveness in managing severe withdrawal symptoms and cravings.
- Its high potency is a key factor in its therapeutic benefit, not a limitation.
Relapse prevention strategies US Medical PG Question 4: A 10-year-old child is sent to the school psychologist in May because he refuses to comply with the class rules. His teacher says this has been going on since school started back in August. He gets upset at the teacher regularly when he is told to complete a homework assignment in class. Sometimes he refuses to complete them altogether. Several of his teachers have reported that he intentionally creates noises in class to interrupt the class. He tells the psychologist that the teacher and his classmates are at fault. What is the most appropriate treatment?
- A. Cognitive-behavioral therapy (Correct Answer)
- B. Interpersonal therapy
- C. Administration of lithium
- D. Motivational interviewing
- E. Administration of clozapine
Relapse prevention strategies Explanation: ***Cognitive-behavioral therapy***
- This child exhibits symptoms consistent with **Oppositional Defiant Disorder (ODD)**, including persistent refusal to comply with rules, anger outbursts, and blaming others. **CBT** is a highly effective treatment for ODD, teaching children coping skills, anger management, and problem-solving.
- CBT helps children identify and change **maladaptive thought patterns** and behaviors, which is crucial for managing the defiant and argumentative behaviors seen in ODD.
*Interpersonal therapy*
- **Interpersonal therapy (IPT)** primarily focuses on improving interpersonal relationships and communication patterns, often used for depression or eating disorders.
- While improved relationships might be a secondary benefit, IPT does not directly target the core **defiant behaviors** and **anger management** issues central to ODD.
*Administration of lithium*
- **Lithium** is a mood stabilizer primarily used in the treatment of **bipolar disorder** and severe mood dysregulation.
- There is no indication from the provided symptoms (defiance, anger, blaming others) that the child is experiencing a mood disorder that would warrant lithium.
*Motivational interviewing*
- **Motivational interviewing** is a counseling approach that helps individuals resolve ambivalence to change, often used in substance abuse or health behavior change.
- While it can be useful in encouraging willingness to engage in therapy, it is not a direct therapeutic modality for addressing the specific **behavioral challenges** and **underlying cognitive distortions** of ODD.
*Administration of clozapine*
- **Clozapine** is an antipsychotic medication reserved for severe mental illnesses like **treatment-resistant schizophrenia** due to its significant side effects.
- The child's symptoms of defiance and rule-breaking are not indicative of a psychotic disorder requiring antipsychotic medication.
Relapse prevention strategies US Medical PG Question 5: A 40-year-old man is brought into the emergency department because he was involved in a bar fight and sustained an injury to the head. The next day, as requested by the patient, the psychiatry team is called to address some of the concerns he has regarding his drinking habits. He admits that he got irate last night at the bar because his driver’s license was recently taken away and his wife had taken his children to live with her parents because of his drinking problem. He drinks 4–6 beers on a weeknight and more on the weekends. He wants to know if there is anything that could help him at this point. Which stage of overcoming his addiction is this patient currently in?
- A. Action
- B. Precontemplation
- C. Maintenance
- D. Contemplation (Correct Answer)
- E. Preparation
Relapse prevention strategies Explanation: ***Contemplation***
- The patient acknowledges his drinking problem and its serious consequences (loss of driver's license, family separation), demonstrating awareness that change is needed.
- He actively requests psychiatric consultation and asks "if there is anything that could help him," indicating he is **exploring options and gathering information** about change.
- However, he has not yet made a firm commitment to take action or developed a specific plan, which distinguishes contemplation from preparation.
- The **contemplation stage** is characterized by recognition of the problem and consideration of change, with typical ambivalence about taking action—this patient is in this exploratory phase.
*Preparation*
- The **preparation stage** requires a clear commitment and intent to take action in the immediate future (typically within 30 days), often with a specific plan in place.
- This patient is asking exploratory questions rather than stating he is ready to start treatment or outlining steps he will take.
- Simply requesting information does not constitute preparation; there must be demonstrated readiness to act.
*Precontemplation*
- In the **precontemplation stage**, individuals deny having a problem or have no intention of changing their behavior.
- This patient clearly acknowledges his drinking problem and recognizes the negative consequences, moving him well beyond precontemplation.
*Action*
- The **action stage** involves actively modifying behavior and implementing specific strategies to overcome the addiction.
- This patient has not yet begun any treatment or behavioral changes related to his drinking.
*Maintenance*
- The **maintenance stage** occurs after sustained behavior change for at least six months, focusing on preventing relapse.
- This patient has not yet initiated any changes to maintain.
Relapse prevention strategies US Medical PG Question 6: A 35-year-old man comes to the Veterans Affairs hospital because of a 2-month history of anxiety. He recently returned from his third deployment to Iraq, where he served as a combat medic. He has had difficulty readjusting to civilian life. He works as a taxi driver but had to take a leave of absence because of difficulties with driving. Last week, he hit a stop sign because he swerved out of the way of a grocery bag that was in the street. He has difficulty sleeping because of nightmares about the deaths of some of the other soldiers in his unit and states, “it's my fault, I could have saved them. Please help me.” Mental status examination shows a depressed mood and a restricted affect. There is no evidence of suicidal ideation. Which of the following is the most appropriate initial step in treatment?
- A. Dialectical behavioral therapy
- B. Venlafaxine therapy
- C. Cognitive behavioral therapy (Correct Answer)
- D. Motivational interviewing
- E. Prazosin therapy
Relapse prevention strategies Explanation: ***Cognitive behavioral therapy***
- **Cognitive Behavioral Therapy (CBT)** is considered a first-line psychological treatment for **Post-Traumatic Stress Disorder (PTSD)**, which the patient's symptoms (deployments, intrusive thoughts, nightmares, avoidance, guilt) strongly suggest.
- CBT helps individuals identify and challenge **maladaptive thought patterns** and behaviors related to the trauma, fostering new coping mechanisms.
*Dialectical behavioral therapy*
- **Dialectical Behavioral Therapy (DBT)** is primarily used for individuals with **Borderline Personality Disorder** or severe emotional dysregulation.
- While it can help with emotional regulation, it is not the **first-line therapy** specifically targeting trauma-related cognitive distortions and avoidance behaviors seen in PTSD.
*Venlafaxine therapy*
- **Venlafaxine**, an SNRI, is an antidepressant that can be effective for PTSD symptoms. However, current guidelines recommend **psychotherapy (like CBT)** as the initial step, especially when feasible.
- While pharmacotherapy can be used, it's typically considered **adjunctive** or for cases where psychotherapy alone is insufficient or not preferred.
*Motivational interviewing*
- **Motivational interviewing** is a patient-centered counseling style used to address ambivalence and enhance a person's **intrinsic motivation** for change.
- It is often utilized in substance abuse treatment or when patients are resistant to treatment, but it is not a primary, standalone treatment for the core symptoms of PTSD.
*Prazosin therapy*
- **Prazosin** is an alpha-1 antagonist used off-label to treat **PTSD-related nightmares** and sleep disturbances.
- While it can be helpful for a specific symptom, it does not address the broader spectrum of PTSD symptoms, such as intrusive thoughts, avoidance, or negative cognitions.
Relapse prevention strategies US Medical PG Question 7: A 30-year-old man presents to his family physician admitting to using heroin. He says he started using about 6-months ago when his back pain medication ran out. At first, he says he would borrow his wife’s Percocet but, eventually, that ran out and he had to find a different source. Since then, he has been having more and more issues related to his heroin use, and it has started to affect his work and home life. He is concerned that, if he continues like this, he might end up in real trouble. He denies sharing needles and is sincerely interested in quitting. He recalls trying to quit last month but recounts how horrible the withdrawal symptoms were. Because of this and the strong cravings, he relapsed shortly after his initial attempt. Methadone maintenance therapy is prescribed. Which of the following would most likely be the most important benefit of this new treatment plan in this patient?
- A. Decreases methadone dependence
- B. Euphoria without the side effects
- C. Prevention of withdrawal symptoms and reduced cravings (Correct Answer)
- D. Reduced risk of hepatitis B and C transmission
- E. Improved interpersonal relationships
Relapse prevention strategies Explanation: ***Prevention of withdrawal symptoms and reduced cravings***
- **Methadone maintenance therapy** is a long-acting μ-opioid receptor agonist that prevents withdrawal symptoms and reduces cravings—this is the **primary therapeutic benefit** and mechanism of action.
- By providing a stable, long-acting opioid, methadone eliminates the cycle of withdrawal and drug-seeking behavior that characterizes heroin addiction.
- This patient's previous quit attempt failed specifically due to **"horrible withdrawal symptoms"** and **strong cravings**, making this the most directly relevant benefit for his situation.
- All other benefits of methadone maintenance (improved functioning, better relationships, reduced risk behaviors) are **secondary consequences** that stem from this primary pharmacological effect.
- Evidence-based guidelines consistently identify withdrawal prevention and craving reduction as the core therapeutic goals of opioid agonist therapy.
*Improved interpersonal relationships*
- While this is an important **downstream benefit** of successful methadone maintenance, it is an indirect consequence rather than the primary therapeutic effect.
- Improved relationships result FROM the stabilization achieved through withdrawal prevention and craving reduction, not as a direct pharmacological action.
- Though clinically meaningful, this represents a **psychosocial outcome** rather than the most important direct benefit of the medication itself.
*Decreases methadone dependence*
- This is **incorrect**—methadone itself is an opioid agonist and patients on maintenance therapy develop **physical dependence** on methadone.
- The goal is to substitute unstable illicit opioid use (heroin) with stable, medically supervised opioid therapy (methadone), not to eliminate opioid dependence immediately.
- Methadone maintenance is harm reduction, not abstinence-based treatment initially.
*Euphoria without the side effects*
- Methadone is **not intended to produce euphoria**—it is administered at stable doses to maintain normal functioning without intoxication.
- Its slow onset and long duration of action when taken orally minimize the "rush" or euphoric effects associated with rapid-acting opioids like heroin.
- The goal is stabilization and normal functioning, not achieving a "high."
*Reduced risk of hepatitis B and C transmission*
- This is a valuable **harm reduction benefit**, particularly for those who inject drugs and share needles.
- However, this patient specifically **denies sharing needles**, making this less relevant to his individual case.
- More importantly, this is a secondary benefit that occurs as a result of reduced injection drug use, which itself results from the primary effect of withdrawal prevention and craving reduction.
Relapse prevention strategies US Medical PG Question 8: A 30-year-old man with schizophrenia stabilized on clozapine presents to establish care at a new clinic. Records show stable psychiatric symptoms for 2 years. Routine urine drug screen is positive for cocaine. He admits to using cocaine 2-3 times monthly at parties but denies it affects his functioning. He has maintained employment, housing, and medication adherence. He refuses substance use treatment, stating 'it's recreational and under control.' His last clozapine level was therapeutic. Evaluate the management approach balancing psychiatric stability, substance use, and patient autonomy.
- A. Mandate substance use treatment as condition for continuing clozapine
- B. Switch to long-acting injectable antipsychotic with lower risk profile
- C. Discontinue clozapine due to medication non-compliance and substance use risk
- D. Continue clozapine with harm reduction counseling, more frequent monitoring, and motivational interviewing for substance use (Correct Answer)
- E. Involuntarily hospitalize for dual diagnosis treatment program
Relapse prevention strategies Explanation: ***Continue clozapine with harm reduction counseling, more frequent monitoring, and motivational interviewing for substance use***
- The patient has been **psychiatrically stable** on clozapine for two years and maintains high functioning; discontinuing a life-saving medication for **treatment-resistant schizophrenia** due to intermittent substance use risks severe decompensation.
- A **harm reduction** approach utilizing **motivational interviewing** addresses the cocaine use without damaging the therapeutic alliance, while **increased monitoring** manages potential risks like a **lowered seizure threshold** or cardiac strain.
*Mandate substance use treatment as condition for continuing clozapine*
- Coercive strategies often lead to **patient dropout** and treatment non-adherence, which could result in a relapse of psychosis.
- Medical ethics prioritize **patient autonomy**; treatment mandates are generally reserved for situations where the patient lacks capacity or poses an immediate danger.
*Switch to long-acting injectable antipsychotic with lower risk profile*
- **Clozapine** is uniquely effective for patients who have failed other treatments; switching a stable patient to a **long-acting injectable (LAI)** may lead to a loss of symptom control.
- The patient's **medication adherence** is already documented as excellent, so the primary benefit of an LAI—improving compliance—is not a current clinical priority.
*Discontinue clozapine due to medication non-compliance and substance use risk*
- The patient is actually **compliant** with his clozapine regimen, as evidenced by his **therapeutic drug levels** and stable psychiatric status.
- Discontinuation represents a high-risk clinical decision that ignores the **biopsychosocial stability** the patient has achieved despite his recreational drug use.
*Involuntarily hospitalize for dual diagnosis treatment program*
- **Involuntary hospitalization** requires the patient to be a **danger to self or others** or be gravely disabled, none of which apply to this stable, employed individual.
- Forced treatment for substance use is not legally supported in this context and would be a significant overreach that violates **civil liberties**.
Relapse prevention strategies US Medical PG Question 9: A 42-year-old physician presents voluntarily to the state physician health program after colleagues noticed erratic behavior. He admits to diverting fentanyl from the operating room for 18 months, using it to manage work stress. He has no prior substance use history, maintains he can 'handle it,' but acknowledges his medical license and career are at risk. He completed detoxification last week. Evaluate the comprehensive management strategy that addresses medical, professional, and legal considerations.
- A. Intensive outpatient treatment, peer support, naltrexone, monitored return-to-work agreement, and restricted practice for minimum 1-2 years (Correct Answer)
- B. Outpatient naltrexone therapy with weekly random drug screens and return to work in 3 months
- C. Immediate return to practice with mandatory addiction counseling and quarterly monitoring
- D. 6-month residential treatment followed by career change recommendation due to access to controlled substances
- E. Report to medical board for license revocation due to diversion and patient safety risk
Relapse prevention strategies Explanation: ***Intensive outpatient treatment, peer support, naltrexone, monitored return-to-work agreement, and restricted practice for minimum 1-2 years***
- Physician health programs (PHPs) mandate a high-intensity approach including **monitored return-to-work** and **restricted practice** to ensure patient safety and professional accountability.
- Long-term success is achieved through **multi-modal therapy**, which includes Pharmacotherapy (like **naltrexone**), **peer support groups**, and frequent **random drug screening**.
*Outpatient naltrexone therapy with weekly random drug screens and return to work in 3 months*
- This approach is insufficient as it lacks the **intensive structural support** and specific **practice restrictions** required for a high-risk role like an anesthesiologist.
- Returning to work in such a short timeframe without a formal **physician health program (PHP)** monitoring contract significantly increases the risk of **relapse**.
*Immediate return to practice with mandatory addiction counseling and quarterly monitoring*
- **Immediate return** is unsafe because the physician has recently diverted **fentanyl**, posing a direct risk to **patient safety** and his own health.
- **Quarterly monitoring** is too infrequent for early recovery; high-frequency **random drug screens** are standard to detect early diversion or relapse.
*6-month residential treatment followed by career change recommendation due to access to controlled substances*
- While **residential treatment** is an option, a **career change recommendation** is generally not required if the physician complies with a **restrictive monitoring agreement**.
- Most physicians can safely return to their specialty after successful **rehabilitation** and a period of **restricted access** to controlled substances.
*Report to medical board for license revocation due to diversion and patient safety risk*
- **Licensure revocation** is typically a last resort; many states encourage **voluntary participation** in PHPs to help physicians recover while maintaining their license.
- Reporting and revocation are usually reserved for cases where the physician **refuses treatment**, fails to comply with monitoring, or causes **direct patient harm**.
Relapse prevention strategies US Medical PG Question 10: A 26-year-old pregnant woman at 16 weeks gestation with opioid use disorder requests medication-assisted treatment. She has been using heroin daily for 3 years and is motivated for treatment. She has tried 'quitting cold turkey' previously but relapsed within days. Obstetrics has referred her urgently for addiction medicine consultation. Evaluate the treatment approach that optimizes both maternal and fetal outcomes.
- A. Buprenorphine initiation with obstetric monitoring and prenatal care coordination
- B. Medically supervised withdrawal to avoid fetal exposure to maintenance medications
- C. Naltrexone implant after medically supervised opioid detoxification
- D. Methadone maintenance with daily observed dosing at licensed clinic (Correct Answer)
- E. Delay treatment until second trimester completion to minimize teratogenic risk
Relapse prevention strategies Explanation: ***Methadone maintenance with daily observed dosing at licensed clinic***
- **Methadone** is the gold standard for opioid use disorder in pregnancy, providing a stable environment for the fetus by preventing **cycles of withdrawal** and illicit drug use.
- It is associated with improved **prenatal care** adherence and significantly reduced risks of **preterm labor** and **fetal demise** compared to untreated addiction.
*Buprenorphine initiation with obstetric monitoring and prenatal care coordination*
- While **buprenorphine** is a valid alternative, **methadone** remains the traditional first-line choice due to more extensive, long-term **safety data** regarding pregnancy outcomes.
- Buprenorphine is often preferred for lower severity cases, but the structured support of a **methadone clinic** is better for patients with long-term, high-frequency **heroin use**.
*Medically supervised withdrawal to avoid fetal exposure to maintenance medications*
- Withdrawal or "detox" during pregnancy carries a very high rate of **relapse**, which exposes the fetus to dangerous **stress and toxicity**.
- Stable maintenance therapy is preferred over withdrawal to prevent the severe maternal-fetal complications associated with **resumed illicit opioid use**.
*Naltrexone implant after medically supervised opioid detoxification*
- **Naltrexone** is generally avoided in pregnancy because it requires a complete **detoxification** phase, which triggers maternal-fetal distress.
- There is insufficient safety data regarding the use of **naltrexone implants** or long-acting formulations in pregnant patients compared to agonist therapies.
*Delay treatment until second trimester completion to minimize teratogenic risk*
- Opioid maintenance medications like methadone and buprenorphine are not considered **teratogenic**, and delaying treatment increases the risk of **fetal loss**.
- Treatment should be initiated as soon as possible to stabilize the **maternal-fetal unit** and reduce the risks associated with active addiction and infectious disease exposure.
More Relapse prevention strategies US Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
