A 33-year-old male client presents to the PMHNP with a chief complaint of depression. During the evaluation he states that he drinks "up to 3 beers nightly.” He has a positive CAGE test and agrees to a longer screening tool for alcohol use disorder (AUD). Which of the following is the most appropriate?
Clinical Institute Withdrawal Assessment for Alcohol (CIWA-AR)
T-ACE
Screening, brief intervention referral to treatment (SBIRT)
Alcohol Use Disorders Identification Test (AUDIT)
The Correct Answer is D
Choice A reason: CIWA-AR is used to assess and monitor alcohol withdrawal symptoms in patients undergoing detoxification. It is not a screening tool for identifying alcohol use disorder.
Choice B reason: T-ACE is a brief screening tool often used in prenatal settings. While useful, it is not as comprehensive as AUDIT for general adult populations.
Choice C reason: SBIRT is a framework for screening and intervention but does not refer to a specific diagnostic tool. It includes the use of validated instruments like AUDIT.
Choice D reason: AUDIT is a validated, comprehensive screening tool developed by the World Health Organization to identify alcohol use disorders. It assesses consumption, dependence symptoms, and alcohol-related problems, making it the most appropriate choice.
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Related Questions
Correct Answer is A
Explanation
Choice A reason: The ventral tegmental area (VTA) and nucleus accumbens are central components of the mesolimbic dopamine pathway, which is the primary reward circuit in the brain. Dopamine release in this pathway reinforces behaviors and is heavily involved in addiction and substance use disorders.
Choice B reason: The mesocortical pathway connects the VTA to the prefrontal cortex and is involved in cognition, emotion, and executive function. While it plays a role in psychiatric conditions, it is not the primary reward center.
Choice C reason: The locus coeruleus is involved in arousal and stress responses via norepinephrine, not dopamine. It is not part of the reward system central to substance use disorders.
Choice D reason: The raphe nucleus is the primary source of serotonin in the brain and is involved in mood regulation. It does not mediate dopamine-driven reward processes.
Correct Answer is B
Explanation
Choice A reason: This statement reflects the motivational interviewing principle of expressing empathy. It validates the client’s emotional experience and builds rapport but does not focus the conversation on change or the specific issue of cocaine use.
Choice B reason: This statement exemplifies the principle of focusing. It acknowledges the client’s perceived benefits of cocaine use while gently steering the conversation toward exploring the negative consequences. This helps the client begin to consider change by weighing pros and cons.
Choice C reason: This is an open-ended question that aligns with the principle of engaging, not focusing. It invites the client to share but does not direct attention to the specific issue or encourage reflection on change.
Choice D reason: This statement may come across as confrontational or dismissive. It risks eliciting defensiveness and does not align with motivational interviewing principles, which emphasize collaboration and evoking the client’s own motivations for change.
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