Spurious and Symbolic Diffusion of Independent Regulatory Agencies in Western Europe Independent regulatory agencies (IRAs) have become the most widespread form oforganisation for regulatory policies in Western Europe. Their pattern of emergencesuggests that a diffusion process may have been at work, namely a process wherethe decisions to set up IRAs have not been independent. This paper in
Microsoft word - naltrexone and alcoholism treatment testNaltrexone and Alcoholism Treatment Test
Following your reading of the course material found in TIP No. 28. Please read thefollowing statements and indicate the correct answer on the answer sheet. A score of 32correct must be obtained to pass the course (you may miss 13). Following payment, thetest may be taken as many times as necessary to obtain a passing grade. Your score andthe status of your certificate will be emailed to you. CEU certificates are provided only ifwe have received your payment. You may also take the test online through the courselink at any time. The online test supports automated scoring for quick automatic results.
Text: Naltrexone And Alcoholism Treatment Treatment Improvement Protocol (TIP)
1. Naltrexone, an opioid antagonist medication was initially developed to treat opiateaddiction. Subsequently, research found that naltrexone can help prevent relapse toalcohol use disorder when combined with traditional treatment modalities.
2. Naltrexone, relieves the craving for alcohol (and opiates) and decreases the relapse rateirregardless if psychotherapy is used.
3. Naltrexone has been proven safe for all adults.
4. Naltrexone has been approved as a replacement for psychosocial interventions.
5. All individuals who have been diagnosed as alcohol dependent, are suitable candidatesfor naltrexone therapy.
6. Appropriate candidates should be willing to be in a supportive relationship with ahealth care provider or support group to enhance treatment compliance and work towarda common goal of sobriety.
7. The use of other substances during naltrexone treatment, particularly illegal opiatesand opioid-containing medications, may pose the same level of concern and possibleadverse consequences as the use of alcohol.
8. Because naltrexone may cause or worsen opiate withdrawal in subjects who arephysiologically dependent on opiates or who are in active opiate withdrawal, it iscontraindicated in these patients until after they have been abstinent from opiates for atleast 5 to 10 days.
9. Naltrexone does not interfere with nonopioid pain medications such as ibuprofen,acetaminophen, and aspirin.
10. Patients on naltrexone are less likely to relapse to heavy drinking following a lapse inabstinence.
11. Naltrexone does not make people "sober up" and does not alter alcohol's acute effectson cognitive functioning.
12. The Consensus Panel recommends focusing the psychiatric interview on anxietysymptoms, depression, psychosis, and cognitive functioning because these elements maycomplicate therapy.
13. Naltrexone can be initiated safely during acute alcohol withdrawal. There is no needfor patients to be abstinent before initiating naltrexone treatment.
14. The FDA guidelines recommend an initiation and maintenance dose of 50 mg/day ofnaltrexone for most patients, usually supplied in a single tablet.
15. Common adverse effects, which may include nausea, headache, dizziness, fatigue,nervousness, insomnia, vomiting, and anxiety, occur at the initiation of treatment inapproximately 10 percent of patients.
16. FDA guidelines indicate that naltrexone should be used for up to 12 months to treatalcoholism.
17. The continued or periodic drinking of alcohol may not be a sufficient reason todiscontinue naltrexone: Some patients respond to naltrexone treatment at first byreducing rather than stopping their drinking.
19. Patients who stop taking the medication do not suffer from withdrawal symptoms, sonaltrexone therapy can be discontinued without tapering the dose.
20. Naltrexone may not safely be restarted for 12 months even if the patient and the treating clinicians feel that it may be helpful in preventing relapse.
21. Researchers calculate that about 18 million Americans with alcohol abuse problemsneed treatment, but only one-fourth of them receive it.
22. People who have mental illness have a higher rate of substance abuse and alcoholismthan everyone else; they also have a harder time getting help and staying in treatment.
23. Naltrexone has been proven to decrease problem drinking--in some cases by almosthalf—even when used without other treatments.
24. Naltrexone was initially developed for the treatment of narcotic or opioid addiction,including heroin, morphine, and oxycodone (e.g., Percocet). Naltrexone is an opioidantagonist, which means that it blocks the effects of opioids.
25. Opioid antagonists, including naltrexone, which the FDA approved in 1984 fortreating opiate addiction, also decreased alcohol consumption by blocking certain opioidreceptors (i.e., action sites) in the brain that help to maintain drinking behavior.
26. Naltrexone is effective for every person with alcohol abuse disorder.
27. Naltrexone has few, if any, intrinsic actions besides its opioid-blocking properties: Itdoes not block the physiological or psychological effects of any other class of drug.
Because alcohol, like opiates, stimulates opioid receptor activity, naltrexone also appearsto reduce the reinforcing/rewarding "high" that usually accompanies drinking. With thereduction in euphoria, alcohol consumption seems to be less rewarding. This may be onereason naltrexone works.
28. Although it is not yet known who will succeed or who will fail when treated in thisway, some studies suggest that those patients with high levels of craving, poor cognitiveabilities, little education, or high levels of physical and emotional distress may deriveparticular benefit from the addition of naltrexone therapy to their psychosocial treatment.
29. Patients who have taken naltrexone before and quit because of nausea or headachesshould not try it again.
30. Psychosocial treatments are likely to enhance compliance with pharmacotherapy;likewise, pharmacotherapies, to the extent to which they reduce craving and helpmaintain abstinence, may make the patient more available for psychosocial interventions.
31. There is much resistance to pharmacotherapy--from third-party payers, someaddiction clinicians, and some self-help-oriented individuals who view medications assubstituting a pill for self-empowerment and taking responsibility for the disease.
32. Naltrexone can be addicting to some individuals.
33. Naltrexone is not only safe but it is considered inexpensive.
34. Significant liver disease is a relative contraindication to the use of naltrexone (likeother medications that may cause liver damage so it should not be used when alcoholicsalready have liver disease.
35. Because of its opiate antagonist properties, naltrexone may cause or worsen opiatewithdrawal in subjects who are physiologically dependent on opiates or who are in activeopiate withdrawal.
36. The use of naltrexone in adolescents is considered safe based on the data with in thispopulation.
37. Like disulfiram, naltrexone can alter the absorption or metabolism of alcohol andcannot have major adverse effects when combined with alcohol.
38. Natural reinforcers such as food, drink, and sex also activate reinforcement pathwaysin the brain, and it has been suggested that alcohol and other drugs act as chemicalsurrogates of the natural reinforcers. A key danger in this relationship, however, is thatthe pleasure produced by drugs of abuse can be more powerfully rewarding than thatproduced by natural reinforcers.
39. Like most other drugs of abuse alcohol interacts with a specific receptor in the brain.
40. Dopamine produces immediate feelings of pleasure and elation that reinforce suchnatural activities as sex and eating and motivates the repetition of these activities.
Dopamine is believed to play an important role in reinforcement and motivation forrepetitive actions.
41. Serotonin is associated with the reinforcing effects of many abused drugs through itsmood-regulating and anxiety-reducing effects. Low levels of serotonin are associatedwith depression and anxiety.
42. In addition to affecting neurotransmitters, it appears that chronic use of alcohol mayalter the structure and functioning of neurotransmitter receptors that have roles inintoxication, reinforcement, and dependence.
43. Men with alcoholic fathers are three to five times more likely than men without anyfamilial history of alcoholism to experience early onset of alcoholism or other drugdependence.
44. Opiates have often been described as a substitute drug for alcohol, and an increase inopiate availability has been reported to be accompanied by a decrease in alcohol drinking.
45. An addictive cycle may be established as a result of consuming a small dose ofalcohol, which like a small dose of morphine leads to modest increases in opioid receptoractivity. Once opioid receptor activity has been primed, more alcohol is needed to ensurecontinued opioid receptor activity.
Post-Test Mailed Answer Sheet
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1. Read the course material.
2. Take the Post Test using this Answer Sheet.
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PLEASE PRINT LEGIBLY
Course Title Naltrexone and Alcoholism Treatment
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Patrick McGinnis, PhD
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