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Chapter 36. Substance-Related Disorders

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According to recent US national estimates, which of the following substances is associated with the highest incidence of new drug initiates among individuals younger than 18 years?

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A. Alcohol

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B. Opioids

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C. Cannabinoids

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D. Nicotine

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E. Stimulants

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The rewarding effects of acute drug use are partially the result of the activation of which of the following neuronal pathways?

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A. The hypothalamic pituitary circuit, resulting in corticotropin-releasing factor (CRF) release

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B. The tuberoinfundibular dopamine (DA) pathway, resulting in release of endorphins

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C. The mesocorticolimbic DA pathway, resulting in activation of nucleus accumbens (NA)

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D. The serotonin projections from the raphe nuclei, activating the hippocampus and amygdala

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E. The dopamine receptors (D1) in the caudate, resulting in the release of glutamate in the NA

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Which of the following substances is not associated with a DSM-5 intoxication criteria set?

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A. Alcohol

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B. Opioids

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C. Cannabinoids

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D. Nicotine

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E. Stimulant

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A young college student is brought into the emergency department (ED) after a party at his fraternity house. His fraternity brothers are alarmed because they were not able to arouse him when they found him slumped on the floor in the bathroom. His blood alcohol concentration (BAC) is 580 mg/dL (0.58% or 126 mmol/L). Which of the following best explains his current state?

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A. His blood ethanol level is likely to explain his current state, but it would be prudent to check for the presence of other drugs that could potentiate ethanol effects.

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B. His blood ethanol level is unlikely to explain his current state. He has probably fallen in the bathroom, so he should be rushed to radiology to check for a cerebral hemorrhage.

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C. His blood ethanol level could explain his current state, but only if he has also used an opioid; it would potentiate the CNS and respiratory depressant effects of ethanol.

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D. His blood ethanol level could explain his current state, but he should be sent home to “sleep it off” because ethanol self-ingestion is never fatal, and ...

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