Chapter14 Psychological Disorders
True / False
1. Simply imaging something pleasant is not sufficient to stimulate the release of dopamine in the nucleus accumbens; the event must actually be experienced.
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a.
True
b.
False
2. Addictive drugs strongly activate the nucleus accumbens by releasing dopamine or norepinephrine there.
a.
True
b.
False
3. After a long period of abstinence, exposure to cues associated with the substance are very unlikely to trigger a renewed craving.
a.
True
b.
False
4. Symptoms of marijuana withdrawal include anxiety, sweating, vomiting, and diarrhea.
a.
True
b.
False
5. Studies of the genetics of addiction have implicated the gene that controls COMT, an enzyme that breaks down norepinephrine.
a.
True
b.
False
6. Medications like Antabuse combat alcohol abuse by blocking opiate receptors and thereby decrease the pleasure from alcohol.
a.
True
b.
False
7. Autism spectrum disorder encompasses both autism and what used to be called Asperger’s syndrome.
a.
True
b.
False
8. Many fad treatments for autism spectrum disorders make the parents feel good that they are trying something, but otherwise, they are a waste of time and money.
a.
True
b.
False
9. Less than 5% of mothers who have children with autism have antibodies that attack certain brain proteins.
a.
True
b.
False
10. Most depressed people have decreased activity in the left and increased activity in the right prefrontal cortex.
a.
True
b.
False
11. The first successful treatment for bipolar disorder, and still the most common one, is lithium salts.
a.
True
b.
False
12. Antidepressant drugs have effects at the synapse within hours, but may take weeks to change behavior.
a.
True
b.
False
13. Exposure to bright lights is one effective treatment for SAD.
a.
True
b.
False
14. The ventricles are larger than normal in people with schizophrenia.
a.
True
b.
False
15. Atypical antipsychotics are effective in treating only the positive symptoms of schizophrenia.
a.
True
b.
False
Multiple Choice
16. A drug that mimics or increases the effects of a neurotransmitter is called a(n) ____.
a.
agonist
b.
antagonist
c.
stimulant
d.
protagonist
17. A drug that blocks the effects of a neurotransmitter is called a(n) ____.
a.
agonist
b.
antagonist
c.
depressant
d.
protagonist
18. A drug that blocks the effects of a neurotransmitter is a(n) ____; a drug that mimics or increases the effects is a(n) ____.
a.
neuromodulator; synergist
b.
agonist; antagonist
c.
depressant; stimulant
d.
antagonist; agonist
19. Which effect would be considered to be antagonistic?
a.
blocking the synthesis of neurotransmitters
b.
stimulating the release of neurotransmitters
c.
blocking the reuptake of neurotransmitters
d.
interfering with the breakdown of neurotransmitters
20. Which effect would be considered to be agonistic?
a.
blocking the synthesis of neurotransmitters
b.
stimulating the release of neurotransmitters
c.
blocking the postsynaptic receptors
d.
mimicking enzymes that breakdown neurotransmitters
21. To say that a drug has an affinity for a particular type of receptor is to imply that the drug ____.
a.
breaks down neurotransmitter chemicals at that receptor site
b.
will always excite the postsynaptic receptor
c.
will always inhibit the postsynaptic receptor
d.
binds to that receptor
22. With respect to drug effects, “efficacy” means the tendency of a drug to ____.
a.
have inhibitory effects
b.
have excitatory effects
c.
attach to a receptor
d.
activate a receptor
23. The brain area most often linked to drug addiction is the ____.
a.
nucleus accumbens
b.
whole limbic system
c.
frontal lobes
d.
brain stem
24. Which neurotransmitter has been repeatedly connected with addictive drugs?
a.
epinephrine
b.
acetylcholine
c.
serotonin
d.
dopamine
25. An insistent search for the substance or activity to which the individual is addicted is called ____.
a.
tolerance
b.
craving
c.
withdrawal
d.
abstinence
26. As an addiction develops, many of its effects, especially the enjoyable effects, decrease, a phenomenon known as____.
a.
tolerance
b.
craving
c.
withdrawal
d.
abstinence
27. As the body comes to expect the drug under certain circumstances, it reacts strongly when the drug is absent, a reaction known as ____.
a.
tolerance
b.
craving
c.
withdrawal
d.
abstinence
28. Attempts to identify individual genes associated with addiction have found ____.
a.
many genes, each with a small effect
b.
a small number of genes with limited cumulative effects
c.
many genes, each with a substantial effect
d.
a small number of genes with substantial cumulative effects
29. A key gene in addiction controls COMT, an enzyme that breaks down ____ after its release.
a.
serotonin
b.
norepinephrine
c.
dopamine
d.
GABA
30. People with Type II (Type B) alcoholism ____.
a.
have rapid onset alcoholism
b.
have few symptoms prior to middle age
c.
are typically female
d.
experience few problems as a result of their alcoholism
31. Studies of individuals at high risk of alcoholism show that ____.
a.
sons of alcoholics show more than average intoxication after drinking a moderate amount of alcohol
b.
daughters of alcoholics show less than average intoxication after drinking a moderate amount of alcohol
c.
alcohol paradoxically increases stress for sons of alcoholics rather than decreasing it
d.
alcohol decreases stress more for sons of alcoholics than it does for others
32. Which drug is used in the treatment of opiate addiction and has the advantage of producing a long-lasting effect so that the person visits a clinic three times a week instead of daily?
a.
Antabuse
b.
naloxone
c.
LAAM
d.
methodone
33. A common drug to treat alcoholism that produces illness after consuming alcohol is ____.
a.
Antabuse
b.
naloxone
c.
LAAM
d.
methodone
34. Which drug is used in the treatment of alcoholism to block opiate receptors and thus reduce the pleasure from alcohol?
a.
Antabuse
b.
naloxone
c.
LAAM
d.
methodone
35. Which drug is viewed as a less potentially harmful substitute for heroin and is taken orally every day?
a.
Antabuse
b.
naloxone
c.
LAAMmethodone
d.
36. Worldwide, the median incidence estimate for autism spectrum disorders is about one in ____.
a.
60
b.
160
c.
260
d.
600
37. Several studies on the role of genetics in autism have focused on ____ —enzymes that regulate the repair and replication of DNA and the production of certain types of RNA
a.
topoisomerases
b.
proteases
c.
lipases
d.
hydrolases
38. Women who take folic acid pills during pregnancy have about ____ the probability of having a child with autism as compared to other women.
a.
one-tenth
b.
half
c.
twice
d.
ten times
39. About 12% of the mothers of children who have autism spectrum disorders have ____.
a.
a family history of autism spectrum disorders
b.
antibodies that attack certain brain proteins
c.
extremely low levels of folic acid
d.
a history of heavy alcohol use during pregnancy
40. Studies of the genetics of autism spectrum disorders indicate that ____.
a.
many cases result from new mutations or microdeletions in any of a number of genes
b.
a small number of genes appear to be involved in autism spectrum disorders
c.
most mutations and deletions implicated in autism spectrum disorders are inherited from mothers
d.
very young maternal age and very young paternal age independently increase the risk of autism spectrum disorders
41. The primary symptoms of autism spectrum disorders include ____.
a.
deficits in social exchanges
b.
severe intellectual disabilities
c.
excessive, unwavering eye contact
d.
extremely powerful memory skills
42. Which autism treatment is most widely used?
a.
the use of first generation antipsychotics
b.
increase action potential velocity
c.
dietary modifications such as elimination of sugar or food dyes
d.
the use of chelation to remove heavy metals from the blood
43. As compared to non-depressed people, depressed individuals ____.
a.
have greater unpleasant events
b.
react worse to unpleasant events
c.
have fewer pleasant experiences
d.
react more to pleasant experiences
44. What can be said about treatment for autism spectrum disorders?
a.
While drugs like risperidone can be used to reduce stereotyped behaviors, they have a risk of dangerous side-effects.
b.
The use of stimulant drugs may increase social behavior and communication.
c.
New treatments, including chelation, appear to have great promise.
d.
Use of the high fat, ketogenic diet used for some children with intractable epilepsy, appears helpful.
45. People with late-onset depression are more likely than other people to have relatives with which type of disorder?
a.
diabetes
b.
circulatory problems
c.
mental retardation
d.
skin diseases
46. Which is true when considering the role of genetics in depression?
a.
Late-onset depression has higher heritability than early-onset depression.
b.
Depression in males runs in families, depression in females does not.
c.
Adopted children who become depressed are more likely to have depressed biological relatives than depressed adoptive relatives.
d.
Adopted children who become depressed are more likely to have depressed adoptive relatives than depressed biological relatives.
47. On average, those with the short form of the ____ transporter gene and a history of stressful experiences reported more than average symptoms of depression.
a.
acetylcholine
b.
dopamine
c.
serotonin
d.
calcium
48. Most depressed people show ____ activity in the ____ prefrontal cortex.
a.
increased; left
b.
decreased; left
c.
decreased; right
d.
increased; right and left
49. Which symptoms are the most likely side effects of tricyclic antidepressants?
a.
increased reaction to eating cheese
b.
nausea and headaches
c.
drowsiness and dry mouth
d.
cramping and diarrhea
50. Which category of antidepressant drugs operates by blocking the transporter proteins that reabsorb serotonin, dopamine, and norepinephrine into the presynaptic neuron after their release?
a.
tricyclics
b.
MAOIs
c.
selective serotonin reuptake inhibitors
d.
atypical antidepressants
51. Selective serotonin reuptake inhibitors operate similarly to ____.
a.
tricyclics
b.
MAOIs
c.
Antabuse
d.
L-Dopa
52. Which category of antidepressant drugs operates by blocking the enzyme that metabolizes catecholamines and serotonin into inactive forms?
a.
tricyclics
b.
MAOIs
c.
selective serotonin reuptake inhibitors
d.
atypical antidepressants
53. In contrast to tricyclics, selective serotonin reuptake inhibitors (SSRIs) ____.
a.
block reuptake of both catecholamines and serotonin
b.
increase action potential velocity
c.
block the reuptake of only serotonin
d.
act on the left hemisphere while tricyclics act on the right
54. One potentially dangerous side effect of St. John’s wort is that it ____.
a.
increases the effectiveness of other medications the person may be taking
b.
decreases the effectiveness of other medications the person may be taking
c.
prevents the reuptake of serotonin
d.
raises blood pressure after the person eats tyramine-rich food
55. ____ is a treatment for depression that electrically induces a seizure.
a.
Electromagnetic therapy
b.
Repetitive transcranial magnetic stimulation
c.
Electroconvulsive shock therapy
d.
Transcranial magnetic stimulation
56. The use of electroconvulsive shock declined in the 1950s because ____.
a.
legal concerns arose with its use as a therapy
b.
a new theory of depression called the treatment into question
c.
antidepressant drugs became available
d.
a federal report concluded that it was almost never effective
57. Electroconvulsive therapy is sometimes recommended for patients with strong suicidal tendencies because it ____.
a.
produces its benefits faster
b.
does not impair memory
c.
produces permanent, not temporary, relief
d.
is based on a theory, not just trial and error discoveries
58. The most common side effect of electroconvulsive shock therapy is ____.
a.
dry mouth and blurred vision
b.
damage to the frontal lobes
c.
memory loss
d.
high probability of broken bones during the treatment
59. Repetitive transcranial magnetic stimulation is similar to ECT in that ____.
a.
both deal with magnetic stimulation
b.
both increase the frequency of action potentials
c.
both are effective in alleviating depression and no one knows why
d.
neither requires patient consent
60. In certain cases, it is possible to relieve depression by changing a person’s ____.
a.
sleeping schedule
b.
eating schedule
c.
exercise schedule
d.
self-grooming habits
61. Which of the following characterizes the total brain activity, as measured by the rate of glucose metabolism, in those suffering from mood disorders?
a.
high in both mania and depression
b.
low in both mania and depression
c.
low in mania and high in depression
d.
high in mania and low in depression
62. Bipolar I disorder and bipolar II disorder differ with regard to ____.
a.
how many relatives also have the condition
b.
how rapidly the cycles occur
c.
whether they include full-blown manic phases
d.
whether they develop suddenly at an early age or gradually at a later age
63. Lithium is most commonly prescribed for which disorder?
a.
seasonal affective disorder
b.
endogenous depression
c.
reactive depression
d.
bipolar disorder
64. Physicians must carefully monitor the dose of lithium they give to bipolar patients because ____.
a.
people develop a tolerance to the drug and must gradually increase their dosage
b.
people develop a sensitivity to the drug and must gradually decrease their dosage
c.
the amount of drug needed to achieve a good effect varies from one time of year to another
d.
the most beneficial dosage is just less than the dosage that is toxic
65. What do the drugs valproate and carbamazepine share in common with lithium?
a.
They are used to treat schizophrenia.
b.
They block the synthesis of arachidonic acid.
c.
They inhibit GABA.
d.
They are 100% effective in treating bipolar disorder.
66. Similar to depressed patients, bipolar patients may benefit from a change in their ____.
a.
work schedule
b.
roommates
c.
sleep schedule
d.
exercise routine
67. People suffering from seasonal affective disorder are most likely become depressed ____.
a.
after the holidays
b.
in the fall
c.
in the winter
d.
at solstices
68. Where is seasonal affective disorder most common?
a.
in large cities
b.
in small towns and rural areas
c.
in tropical areas
d.
near the poles
69. What is one of the best treatments for seasonal affective disorder?
a.
bright light
b.
electroconvulsive shock therapy
c.
adrenal hormones
d.
dietary changes
70. Which disorder is characterized by a deteriorating ability to function in everyday life and some combination of hallucinations, delusions, disorganized speech, and grossly disorganized behavior?
a.
bipolar disorder
b.
hypomania
c.
multiple personality
d.
schizophrenia
71. Which behavior is most suggestive of schizophrenia?
a.
alternation between one personality and another
b.
outbursts of unprovoked violent behavior toward strangers
c.
deterioration of daily functioning with disorganized speech and behavior
d.
episodes of being unable to remember certain events of one’s past
72. ____ was originally called dementia praecox.
a.
Bipolar disorder
b.
Schizophrenia
c.
Dissociative identity disorder
d.
Huntington’s disease
73. Dissociative identity disorder was previously known as ____.
a.
multiple personality disorder
b.
schizophrenia
c.
borderline personality disorder
d.
bipolar disorder
74. An example of a “negative symptom” of schizophrenia is ____.
a.
hallucinations
b.
poor emotional expression
c.
delusions
d.
thought disorder
75. A schizophrenic patient whose main symptoms are lack of emotional expression, lack of social interaction, and lack of speech is suffering from ____.
a.
positive symptoms
b.
negative symptoms
c.
thought disorders
d.
delusions
76. One of the main problems with schizophrenia is ____ that result from abnormal interactions between the cortex and the thalamus and cerebellum.
a.
speech problem
b.
absent signs of emotion
c.
disordered thoughts
d.
delusions
77. What is the difference between positive and negative schizophrenic symptoms?
a.
beneficial behaviors versus harmful behaviors
b.
behaviors that are present versus behaviors that are absent
c.
behaviors that are related to abnormal brain functioning versus those that are not
d.
behaviors shown by one personality versus behaviors shown by another
78. Hallucinations, delusions, and grossly disorganized behavior are classified as which kind of symptoms?
a.
positive symptoms
b.
neutral symptoms
c.
negative symptoms
d.
ambiguous symptoms
79. A delusion is a(n) ____.
a.
sensory experience that does not correspond to reality
b.
inability to understand abstract concepts
c.
unfounded belief
d.
loss of memory for part of one’s past
80. What Bleuler meant by schizophrenia was a split between ____ and ____ aspects of experience.
a.
emotional; behavioral
b.
emotional; realistic
c.
intellectual; behavioral
d.
emotional; intellectual
81. Disorganized speech and grossly disorganized behavior represent the ____ in schizophrenia.
a.
a wide range of possible positive symptoms
b.
a concrete set of defining positive symptoms
c.
a wide range of possible negative symptoms
d.
a concrete set of defining negative symptoms
82. What is the most common cognitive symptom of schizophrenia?
a.
obsessive concentration on a single idea
b.
alternating between one personality and another
c.
excessive attention to detail when discussing a topic
d.
impaired understanding of abstract concepts
83. A first diagnosis of schizophrenia is usually made for a male in which age range?
a.
preteens
b.
20s
c.
30s or 40s
d.
50s or beyond
84. The concordance rate of schizophrenia among twins is ____.
a.
higher in dizygotic than monozygotic twins
b.
higher in monozygotic than dizygotic twins
c.
equally high in monozygotic and dizygotic twins
d.
very difficult to determine
85. The concordance rate for schizophrenia is around ____ percent for monozygotic twins.
a.
0
b.
10
c.
50
d.
90
86. When an adopted child develops schizophrenia, the disease is significantly more probable among the ____.
a.
adopting relatives than the biological relatives
b.
biological relatives than the adopting relatives
c.
siblings than the parents
d.
fathers than the mothers
87. One important factor to consider when making judgments about the relative influence of genetics on schizophrenia is the ____.
a.
role of evolution
b.
age of the mother
c.
size of school they attend
d.
prenatal environment
88. Genetic studies of schizophrenia have found that ____.
a.
there are probably several possible genes that increase a person’s risk for schizophrenia
b.
a single gene on the X chromosome accounts for most cases of schizophrenia
c.
schizophrenia has about the same heritability as Huntington’s disease
d.
dizygotic twins are more concordant for schizophrenia than monozygotic twins
89. One gene of interest in schizophrenia is DISC1. This gene ____.
a.
controls differentiation and migration of neurons in brain development
b.
alters the metabolism of glucose, especially in the brain
c.
controls the breakdown of norepinephrine
d.
alters the responsiveness of the nucleus accumbens
90. Researchers have had trouble replicating studies that found a particular gene linked to schizophrenia. According to one recent hypothesis, ____.
a.
genes in fact have nothing to do with schizophrenia
b.
the same genes responsible for schizophrenia also produce Huntington’s disease
c.
spontaneous mutations in any of hundreds of genes can cause schizophrenia
d.
most genetic researchers fail to examine the X and Y chromosomes
91. Which of the following increases the probability that someone will develop schizophrenia?
a.
having an older than average father
b.
having at least one older brother
c.
being the only child in the family
d.
having a mother who is older than the father
92. What is one factor in prenatal development that has been found to be related to increased incidences of schizophrenia later in life?
a.
excess sex hormones during the third trimester
b.
prenatal exposure to Toxoplasma gondii
c.
lack of exercise by the mother early in pregnancy
d.
episodes of maternal depression
93. Which factor is sometimes taken as evidence that schizophrenia might be caused by a virus?
a.
the age at which symptoms appear
b.
the high concordance between paternal half-siblings
c.
the season-of-birth effect
d.
the relationship between schizophrenia and stressful experiences
94. Brain differences common to schizophrenia include ____.
a.
larger than normal cerebral ventricles
b.
a proliferation of glial cells
c.
loss of axons between the substantia nigra and the basal ganglia
d.
a heavier forebrain
95. The planum temporale is slightly ____ in the ____ temporal lobe of schizophrenics as compared to most other people.
a.
deformed; left
b.
larger; left
c.
larger; right
d.
smaller; right
96. The areas with the most consistent signs of abnormality in schizophrenics include the ____.
a.
dorsolateral prefrontal cortex
b.
medulla
c.
occipital lobes
d.
parietal lobes
97. The problems that schizophrenics have with memory and attention are most likely related to an increased tendency of having brain damage in the ____.
a.
cerebellum tentio
b.
prefrontal cortex
c.
occipital cortex
d.
medulla
98. People with schizophrenia have lower than normal overall activity in the ____.
a.
hypothalamus
b.
thalamus
c.
left hemisphere
d.
right hemisphere
99. Research suggests that the brain abnormalities of schizophrenics develop ____.
a.
early and progressively get worse
b.
early and then remain fairly steady
c.
late in life and progressively get worse
d.
late in life and remain fairly steady
100. Prior to the 1950s, few schizophrenic patients who entered a mental hospital ever left. The discovery most responsible for alleviating that situation was the discovery of ____.
a.
chlorpromazine
b.
the prefrontal lobotomy
c.
electroconvulsive therapy
d.
MAOIs
101. Another term for antipsychotic drugs is ____.
a.
benzodiazepines
b.
neuroleptics
c.
tricyclics
d.
stimulants
102. The two chemical families to which most antipsychotic drugs belong are ____.
a.
phenothiazines and butyrophenones
b.
tricyclics and MAOIs
c.
nitrates and glucocorticoids
d.
benzodiazepines and antihistamines
103. Which of the following is an effect of most antipsychotic drugs?
a.
increased release of acetylcholine
b.
decreased reuptake of serotonin
c.
increased synthesis of norepinephrine
d.
blockage of dopamine receptors
104. The doses of various drugs that are typically prescribed for schizophrenia are closely related to the strength of what effect?
a.
elevated alpha waves on an EEG
b.
blockage of dopamine receptors
c.
delays in the onset of REM sleep
d.
increases in the rate of dopamine synthesis
105. Repeated use of large doses of amphetamine or cocaine can lead to a behavioral condition similar to ____.
a.
schizophrenia
b.
bipolar disorder
c.
attention deficit disorder
d.
depression
106. An individual shows symptoms resembling schizophrenia, especially the positive symptoms, but is not schizophrenic. Which of the following disorders is most likely?
a.
seasonal affective disorder
b.
bipolar disorder
c.
substance-induced psychotic disorder
d.
Korsakoff’s syndrome
107. An alternative to the dopamine hypothesis of schizophrenia is the proposal that schizophrenia may be due to a deficiency of activity of ____ synapses.
a.
serotonin
b.
glutamate
c.
substance P
d.
acetylcholine
108. Phencyclidine (PCP), which can produce psychotic symptoms resembling schizophrenia, has which effect?
a.
It inhibits the NMDA glutamate receptors.
b.
It interferes with dopamine release.
c.
It prolongs activity at serotonin synapses.
d.
It directly stimulates acetylcholine receptors.
109. The amino acid, glycine, provides a possible co-treatment for schizophrenia because it ____.
a.
can be chemically converted into dopamine
b.
increases the effectiveness of glutamate
c.
decreases the effectiveness of glutamate
d.
increases the growth and division of glia cells
110. For schizophrenics, atypical antipsychotics are more effective than typical antipsychotics in ____.
a.
reducing positive symptoms
b.
reducing negative symptoms
c.
increasing negative symptoms
d.
blocking glutamate receptors
111. A serious side effect that develops in some people after prolonged use of neuroleptic drugs is ____.
a.
tardive dyskinesia
b.
attention deficit disorder
c.
saccadic eye movements
d.
seasonal affective disorder
112. The symptoms of tardive dyskinesia are ____.
a.
anterograde and retrograde amnesia
b.
tremors and other involuntary movements
c.
outbursts of unprovoked violent behavior
d.
attacks of anxiety that prevent active behavior
113. What happens when schizophrenics stop taking neuroleptic drugs?
a.
Auditory hallucinations dissipate slowly.
b.
Schizophrenic symptoms return immediately and with more intensity.
c.
Tardive dyskinesia may continue.
d.
Memory problems become more apparent.
114. Atypical antipsychotic drugs alleviate schizophrenia with fewer side effects than other drugs because they ____.
a.
stimulate dopamine synapses instead of blocking them
b.
act at acetylcholine synapses instead of dopamine synapses
c.
have a greater effect on dopamine type D2 receptors
d.
more strongly antagonize serotonin type 5-HT2 receptors
115. All things considered, the atypical antipsychotics ____.
a.
are far more cost-effective than the older drugs
b.
do not improve overall quality of life more than older drugs
c.
are preferable because they have, at most, only mild side-effects
d.
have a much higher risk of movement disorders
116. Which statement about the long-term course for people diagnosed with schizophrenia is true?
a.
About one-third recover from the first episode and do not become psychotic again.
b.
Up to one-fourth will have a serious disorder throughout their lives.
c.
About one-half will develop progressive brain deterioration that continues throughout life.
d.
Up to one-third will go on to develop dementia by their 40s.
Essay
117. Define major depression.
118. Briefly describe the four major categories of antidepressant drugs
LEARNING OBJECTIVES:
KALA.BIOP.16.14.05 – Describe medical and behavioral treatments for several psychological disorders.
TOPICS:
14.2 Mood Disorders
119. What are the key symptoms of autism spectrum disorders?
ANSWER:
DIFFICULTY:
REFERENCES:
LEARNING OBJECTIVES:
TOPICS:
120. Describe the difference between positive and negative symptoms of schizophrenia and give some examples of each.
ANSWER:
DIFFICULTY:
REFERENCES:
LEARNING OBJECTIVES:
KALA.BIOP.16.14.03 – Compare the role of genetics in substance abuse, depression, schizophrenia, and autism.
TOPICS:
14.3 Schizophrenia
121. Describe the differences between antagonists and agonists.
LEARNING OBJECTIVES:
KALA.BIOP.16.14.02 – Discuss cravings and their role in addiction.
TOPICS:
14.1 Substance Abuse and Addiction
