NAME THAT CATEGORY
A substance increases dopamine and norepinephrine activity and may produce increased alertness, decreased appetite, tachycardia, and insomnia. Which category best fits?
A. Opioid
B. Stimulant
C. Depressant
D. Cannabinoid
B — Stimulant
I am a powerful synthetic opioid. I am significantly more potent than morphine, and illicitly manufactured versions of me contribute substantially to overdose deaths. What am I?
Fentanyl.
True or False: Tolerance and withdrawal must both be present to diagnose a substance use disorder.
False. Neither tolerance nor withdrawal is universally required for a substance use disorder diagnosis.
A student arrives agitated, sweating heavily, speaking rapidly, and reporting that they have not slept for two days. Their pupils are dilated and heart rate is elevated. Which category should be high on your differential?
Stimulants. Cocaine, methamphetamine, or another stimulant should be considered while also ruling out medical and psychiatric causes.
“A person can meet criteria for a substance use disorder while maintaining employment and academic success.”
Fact. Functional success in some areas does not rule out a substance use disorder.
Which substance is a CNS depressant despite sometimes initially producing increased sociability and disinhibition?
A. Cocaine
B. Alcohol
C. MDMA
D. Methamphetamine
B — Alcohol
I am a stimulant that may cause euphoria, increased confidence, hypervigilance, dilated pupils, and cardiovascular complications. My effects are relatively short-lived when insufflated or smoked.
Cocaine.
A student reports cannabis use four nights per week. They maintain strong grades, relationships, and employment and report no unsuccessful attempts to reduce use or other consequences. Does frequency alone establish Cannabis Use Disorder?
No. Frequency alone does not establish an SUD. DSM criteria and clinically significant impairment or distress must be assessed.
A student appears extremely sleepy, has constricted pupils, slowed breathing, and is difficult to awaken. What substance category is the immediate concern?
Opioids. Respiratory depression makes this a medical emergency.
“Cannabis cannot produce withdrawal symptoms.”
Myth. Cannabis withdrawal is recognized diagnostically.
Which substance is most appropriately categorized as a dissociative anesthetic?
A. Ketamine
B. LSD
C. Psilocybin
D. Cocaine
A — Ketamine
I affect serotonin strongly while also influencing dopamine and norepinephrine. Users may experience increased empathy, emotional closeness, energy, and altered sensory experiences.
MDMA.
A college student reports drinking more than intended, repeatedly attempting to cut down, missing class because of drinking, continuing despite relationship problems, and experiencing tolerance. What DSM-5-TR diagnostic concept should you assess?
Alcohol Use Disorder, with severity determined by the number of criteria met during a 12-month period.
A student abruptly stops heavy, prolonged alcohol consumption and develops tremors, autonomic hyperactivity, agitation, and perceptual disturbances. Why is this different from many other withdrawal syndromes?
Alcohol withdrawal can become medically dangerous and potentially life-threatening, including seizures and delirium tremens, requiring appropriate medical evaluation.
“Prescription drugs are inherently safer than illicit drugs.”
Myth. Safety depends on the drug, dosage, interactions, route, individual factors, and whether it is taken as prescribed.
A substance produces analgesia, euphoria, sedation, and respiratory depression through activity at opioid receptors. Which category best fits?
Opioid.
I am a stimulant that can produce prolonged wakefulness, decreased appetite, increased activity, paranoia, and—in some cases—stimulant-induced psychosis. What am I?
Methamphetamine.
A client meets 3 DSM-5-TR substance use disorder criteria within a 12-month period. What severity level is indicated?
Mild Substance Use Disorder. DSM-5-TR severity is generally mild at 2–3 criteria, moderate at 4–5, and severe at 6 or more.
A student presents with severe anxiety, chest pain, tachycardia, and recent cocaine use. Why should a clinician avoid assuming this is “just anxiety”?
Stimulant use can produce serious cardiovascular complications. Acute medical causes must be considered and urgent medical evaluation may be necessary.
“Motivational Interviewing is primarily designed to convince clients that their substance use is problematic.”
Myth. MI emphasizes collaboration, autonomy, and evoking the person’s own reasons for change rather than persuasion.
A substance can alter perception, thought, and sensory experience primarily through serotonergic mechanisms, without being classified as a stimulant or depressant. What broad category best fits?
Hallucinogen / psychedelic. Examples include LSD and psilocybin.
I am an opioid antagonist commonly used to rapidly reverse opioid-induced respiratory depression during a suspected overdose. What am I?
Naloxone (Narcan).
A client takes an opioid medication exactly as prescribed under appropriate medical supervision and develops expected tolerance. Does tolerance by itself establish Opioid Use Disorder?
No. Expected tolerance or withdrawal occurring during appropriate medical treatment is not, by itself, sufficient to diagnose a substance use disorder. Assess the full pattern and applicable DSM-5-TR criteria.
A client is confused, unsteady, vomiting, and difficult to keep awake after a night of heavy drinking. Friends want the client to “sleep it off.” What is the safest clinical concern?
Possible alcohol poisoning or another medical emergency. Depressed consciousness, vomiting, and other concerning signs warrant emergency medical assessment rather than simply allowing the person to sleep.
“Abstinence is the only clinically appropriate treatment goal for every person with risky substance use.”
It depends. Goals should reflect clinical risk, diagnosis, setting, client preferences, evidence, and safety. Harm-reduction strategies may be appropriate in many situations, while some circumstances require stronger medical or safety recommendations.