MCQ Quiz: Epidemiology of Substance Use Disorders

The study of Substance Use Disorders (SUDs) extends beyond the individual to encompass entire populations. This is the realm of epidemiology, the scientific discipline focused on the distribution, patterns, and determinants of health and disease conditions. For PharmD students, understanding the epidemiology of SUDs is crucial for grasping the scale of the problem, identifying at-risk populations, and evaluating the impact of public health interventions. As covered in the Patient Care VII curriculum, this field provides the data-driven foundation for everything from national policy on the opioid crisis to community-level harm reduction programs. This quiz will test your knowledge of the core concepts of SUD epidemiology, including prevalence, incidence, risk factors, and major trends.

1. Epidemiology is the study of the what in populations?

• a) Distribution and determinants of health-related states or events
• b) Chemical structure of drugs
• c) Individual patient counseling techniques
• d) The history of pharmaceutical manufacturing Answer: a) Distribution and determinants of health-related states or events

2. The proportion of a population that has a substance use disorder at a specific point in time is known as the:

• a) Incidence
• b) Mortality rate
• c) Point prevalence
• d) Relative risk Answer: c) Point prevalence

3. The number of new cases of opioid use disorder diagnosed in a specific year represents the:

• a) Prevalence
• b) Incidence
• c) Case-fatality rate
• d) Morbidity Answer: b) Incidence

4. According to national survey data, which of the following is the most prevalent substance use disorder in the United States?

• a) Opioid Use Disorder
• b) Cannabis Use Disorder
• c) Alcohol Use Disorder
• d) Stimulant Use Disorder Answer: c) Alcohol Use Disorder

5. The co-occurrence of a substance use disorder with another mental health condition, such as major depression, is often referred to as:

• a) A dual diagnosis or co-occurring disorder
• b) A synergistic effect
• c) Tachyphylaxis
• d) A contraindication Answer: a) A dual diagnosis or co-occurring disorder

6. From an epidemiological perspective, what age group represents the highest-risk period for the initiation of substance use?

• a) Ages 5-10
• b) Ages 65 and older
• c) Ages 40-50
• d) Adolescence and young adulthood (ages 12-25) Answer: d) Adolescence and young adulthood (ages 12-25)

7. Which type of epidemiological study follows a group of individuals (a cohort) over time to see who develops a disorder?

• a) Case-control study
• b) Cross-sectional study
• c) Prospective cohort study
• d) Case report Answer: c) Prospective cohort study

8. To investigate risk factors for a rare SUD, researchers identify a group of people with the disorder and a group without it, and then look back in time to compare their past exposures. This study design is a:

• a) Randomized controlled trial
• b) Cohort study
• c) Case-control study
• d) Cross-sectional study Answer: c) Case-control study

9. The dramatic increase in overdose deaths in the U.S. over the past two decades is largely driven by:

• a) Alcohol
• b) Cocaine
• c) Opioids, particularly synthetic opioids like fentanyl
• d) Benzodiazepines Answer: c) Opioids, particularly synthetic opioids like fentanyl

10. Which of the following is considered a significant social determinant of health that acts as a risk factor for SUDs?

• a) High socioeconomic status
• b) Stable housing and employment
• c) Poverty and community disorganization
• d) Access to higher education Answer: c) Poverty and community disorganization

11. Men have higher rates of use and dependence than women for most illicit substances. This epidemiological finding points to what as a key demographic risk factor?

• a) Age
• b) Gender
• c) Education level
• d) Marital status Answer: b) Gender

12. Prescription Drug Monitoring Programs (PDMPs) are an epidemiological tool and public health intervention designed to:

• a) Increase the number of opioid prescriptions written.
• b) Track controlled substance prescriptions to prevent diversion and identify at-risk patients.
• c) Provide real-time stock levels of medications in a pharmacy.
• d) Bill insurance companies for prescriptions. Answer: b) Track controlled substance prescriptions to prevent diversion and identify at-risk patients.

13. A major source of national data on substance use prevalence in the United States is the:

• a) Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR)
• b) National Survey on Drug Use and Health (NSDUH)
• c) American Hospital Association (AHA) Annual Survey
• d) U.S. Census Bureau Answer: b) National Survey on Drug Use and Health (NSDUH)

14. The concept of “morbidity” associated with SUDs refers to:

• a) The number of deaths caused by the substance.
• b) The economic cost of the disorder to society.
• c) The non-fatal diseases and disabilities caused by the substance use (e.g., liver cirrhosis, HIV).
• d) The social stigma associated with the disorder. Answer: c) The non-fatal diseases and disabilities caused by the substance use (e.g., liver cirrhosis, HIV).

15. Epidemiological studies have shown a strong correlation between Adverse Childhood Experiences (ACEs) and:

• a) A decreased risk of developing an SUD later in life.
• b) An increased risk of developing an SUD later in life.
• c) No change in the risk of developing an SUD.
• d) An increased risk of developing only alcohol use disorder. Answer: b) An increased risk of developing an SUD later in life.

16. The “treatment gap” in SUD epidemiology refers to:

• a) The time between when a new treatment is approved and when it is available.
• b) The difference in treatment outcomes between men and women.
• c) The large percentage of people with an SUD who need treatment but do not receive it.
• d) The lack of new medications being developed for SUDs. Answer: c) The large percentage of people with an SUD who need treatment but do not receive it.

17. Which of the following is a protective factor that can decrease the risk of an individual developing an SUD?

• a) Family history of addiction
• b) Co-occurring anxiety
• c) Strong community and family bonds
• d) Early age of first use Answer: c) Strong community and family bonds

18. The “opioid epidemic” has been described as occurring in multiple waves. The first wave was primarily driven by:

• a) An increase in heroin use.
• b) The rise of synthetic opioids like fentanyl.
• c) An increase in prescription opioid prescribing and misuse.
• d) A surge in cocaine use. Answer: c) An increase in prescription opioid prescribing and misuse.

19. A cross-sectional study is useful for determining the ________ of an SUD in a population.

• a) Incidence
• b) Cause
• c) Prevalence
• d) Prognosis Answer: c) Prevalence

20. The increased availability of naloxone through pharmacy standing orders is a public health strategy based on epidemiological data showing a rise in:

• a) Tobacco-related deaths
• b) Alcohol-related liver disease
• c) Opioid overdose deaths
• d) Stimulant-induced psychosis Answer: c) Opioid overdose deaths

21. Epidemiological data consistently shows that the majority of people who misuse prescription opioids obtain them from:

• a) Drug dealers
• b) The internet
• c) Friends or relatives for free
• d) Foreign countries Answer: c) Friends or relatives for free

22. Which of the following populations has a disproportionately high prevalence of tobacco use disorder?

• a) Individuals with higher education levels
• b) Individuals with serious mental illness
• c) High-income individuals
• d) Healthcare professionals Answer: b) Individuals with serious mental illness

23. What is a primary limitation of using arrest records or poison control data for SUD epidemiology?

• a) The data is perfectly accurate and complete.
• b) It only captures cases that come to the attention of law enforcement or healthcare, underestimating the true prevalence.
• c) The data is too expensive to collect.
• d) It provides too much information about individuals. Answer: b) It only captures cases that come to the attention of law enforcement or healthcare, underestimating the true prevalence.

24. The shift in recent years from prescription opioid misuse to heroin and fentanyl is an example of:

• a) A successful public health intervention.
• b) A trend identified through epidemiological surveillance.
• c) A decrease in the overall number of people with OUD.
• d) A change in the legality of the substances. Answer: b) A trend identified through epidemiological surveillance.

25. A risk factor is a variable that is:

• a) Proven to be the direct cause of a disease.
• b) Statistically associated with an increased probability of developing a disease.
• c) Only relevant in laboratory studies.
• d) A guaranteed predictor that someone will get a disease. Answer: b) Statistically associated with an increased probability of developing a disease.

26. Why is it important for pharmacists to understand local SUD epidemiology?

• a) To tailor services, such as naloxone dispensing and harm reduction education, to the community’s specific needs.
• b) It is not important; national data is sufficient for all practice settings.
• c) To decide which patients to serve.
• d) To set the price of medications. Answer: a) To tailor services, such as naloxone dispensing and harm reduction education, to the community’s specific needs.

27. The high rate of polysubstance use (using multiple substances) found in epidemiological surveys complicates:

• a) The diagnosis of SUD.
• b) The treatment of SUD.
• c) The determination of cause of death in overdoses.
• d) All of the above. Answer: d) All of the above.

28. What best describes the trend in cannabis use prevalence in the U.S. over the past decade, particularly in states with legalization?

• a) It has significantly decreased.
• b) It has remained completely stable.
• c) It has generally increased, especially among adults.
• d) Data is unavailable. Answer: c) It has generally increased, especially among adults.

29. The term “years of potential life lost” (YPLL) is an epidemiologic measure that highlights:

• a) The total number of people with a disease.
• b) The impact of premature death from conditions like overdose on a population.
• c) The number of years a person is expected to live with a disability.
• d) The average age of the population. Answer: b) The impact of premature death from conditions like overdose on a population.

30. Which factor complicates the epidemiology of benzodiazepine use disorder?

• a) The drugs are rarely prescribed.
• b) The frequent co-involvement of other substances, especially opioids.
• c) The lack of a withdrawal syndrome.
• d) The drugs have no medical use. Answer: b) The frequent co-involvement of other substances, especially opioids.

31. Harm reduction is an approach informed by epidemiology that focuses on:

• a) Increasing penalties for drug use.
• b) Reducing the negative health and social impacts of substance use.
• c) Abstinence as the only acceptable outcome.
• d) Ignoring substance use in a community. Answer: b) Reducing the negative health and social impacts of substance use.

32. The “Etiology and Epidemiology of Substance Use Disorders” lecture in the Patient Care VII course aims to provide students with a foundational understanding of:

• a) The causes and population-level patterns of SUDs.
• b) Only the treatment of SUDs.
• c) Only the history of SUDs.
• d) Only the medicinal chemistry of abused substances. Answer: a) The causes and population-level patterns of SUDs.

33. Studying the epidemiology of SUDs in veterans would likely reveal a high correlation with which co-occurring condition?

• a) Childhood asthma
• b) Post-Traumatic Stress Disorder (PTSD) and chronic pain
• c) Food allergies
• d) Acne Answer: b) Post-Traumatic Stress Disorder (PTSD) and chronic pain

34. The introduction of abuse-deterrent formulations for prescription opioids is an intervention whose population-level effectiveness would be evaluated using:

• a) A single case report.
• b) The manufacturer’s marketing materials.
• c) A pharmacist’s opinion.
• d) Pharmacoepidemiologic studies. Answer: d) Pharmacoepidemiologic studies.

35. A “syndemic” or “synergistic epidemic” refers to:

• a) Two or more epidemics that exist independently in a population.
• b) Two or more epidemics that interact with each other, worsening the burden of disease, such as the intersection of HIV, hepatitis C, and OUD.
• c) An epidemic that has been completely resolved.
• d) A fictional concept not used in public health. Answer: b) Two or more epidemics that interact with each other, worsening the burden of disease, such as the intersection of HIV, hepatitis C, and OUD.

36. A sudden cluster of overdose cases in a specific geographic area would be investigated by:

• a) Real estate agents
• b) Public health epidemiologists
• c) Historians
• d) The Federal Reserve Answer: b) Public health epidemiologists

37. How has the COVID-19 pandemic impacted the epidemiology of SUDs in the U.S.?

• a) It led to a significant and sustained decrease in substance use and overdose deaths.
• b) It had no measurable impact.
• c) It exacerbated the crisis, leading to increases in substance use and overdose deaths due to factors like social isolation and disrupted services.
• d) It only affected alcohol use, with no impact on opioid use. Answer: c) It exacerbated the crisis, leading to increases in substance use and overdose deaths due to factors like social isolation and disrupted services.

38. The “at-risk” population in epidemiology refers to:

• a) Only those individuals who currently have the disease.
• b) The group of individuals who are capable of developing the disease or condition of interest.
• c) A group of people who are immune to the disease.
• d) The entire population of the world. Answer: b) The group of individuals who are capable of developing the disease or condition of interest.

39. Epidemiological data showing that stimulant use is rising among young adults would prompt public health officials to:

• a) Ignore the data as it is likely inaccurate.
• b) Develop targeted prevention and education campaigns for that age group.
• c) Focus all resources on alcohol use disorder instead.
• d) Conclude that stimulants are now safe to use. Answer: b) Develop targeted prevention and education campaigns for that age group.

40. A primary goal of collecting epidemiological data on SUDs is to:

• a) Stigmatize individuals who use substances.
• b) Inform the allocation of public health resources and policy decisions.
• c) Prove that treatment is ineffective.
• d) Increase the cost of insurance for everyone. Answer: b) Inform the allocation of public health resources and policy decisions.

41. The prevalence of SUDs is generally higher in individuals experiencing:

• a) Stable employment
• b) Homelessness
• c) Strong family support
• d) Higher education Answer: b) Homelessness

42. A limitation of self-report surveys for SUD epidemiology is:

• a) Over-reporting due to patient pride.
• b) Under-reporting due to social desirability bias, stigma, and fear of legal consequences.
• c) The high cost of mailing surveys.
• d) The fact that they are perfectly accurate. Answer: b) Under-reporting due to social desirability bias, stigma, and fear of legal consequences.

43. A pharmacoepidemiology study would be used to answer which of the following questions?

• a) What is the chemical structure of fentanyl?
• b) Does the use of a new medication for OUD reduce the risk of relapse in a real-world population?
• c) What is the mechanism of action of naltrexone?
• d) How should a pharmacist counsel a single patient on using a nicotine patch? Answer: b) Does the use of a new medication for OUD reduce the risk of relapse in a real-world population?

44. The increasing rate of overdose deaths involving both an opioid and a stimulant like cocaine or methamphetamine is an example of:

• a) A positive public health trend.
• b) A decreasing trend in polysubstance use.
• c) An important epidemiological trend that requires a specific response, such as education on the dangers of mixing substances.
• d) A data error. Answer: c) An important epidemiological trend that requires a specific response, such as education on the dangers of mixing substances.

45. Which of the following is an example of a “structural” or “policy-level” risk factor for SUDs?

• a) A person’s individual genetics.
• b) Laws and policies that criminalize addiction rather than treat it as a health issue.
• c) A person’s level of impulsivity.
• d) A single traumatic event. Answer: b) Laws and policies that criminalize addiction rather than treat it as a health issue.

46. “Disability-Adjusted Life Years” (DALYs) are a summary measure of population health that combines:

• a) The cost of medications and the number of hospital visits.
• b) Years of life lost due to premature mortality and years lived with a disability.
• c) The prevalence and incidence of a disease.
• d) The number of people who like a drug versus those who dislike it. Answer: b) Years of life lost due to premature mortality and years lived with a disability.

47. Why are emergency department visits a useful data source for SUD epidemiology?

• a) They capture the most severe, acute consequences of substance use, like overdoses and injuries.
• b) They represent the entire population of people who use substances.
• c) Everyone with an SUD visits the emergency department.
• d) The data is always complete and unbiased. Answer: a) They capture the most severe, acute consequences of substance use, like overdoses and injuries.

48. An increase in the non-medical use of prescription benzodiazepines is a concerning epidemiological trend because of the high risk of ________ when combined with opioids.

• a) Serotonin syndrome
• b) Hypertensive crisis
• c) Fatal respiratory depression
• d) Liver failure Answer: c) Fatal respiratory depression

49. The study of how different sub-populations are unequally affected by SUDs (e.g., by race, income, or geography) is the epidemiology of:

• a) Health disparities
• b) Communicable diseases
• c) Acute injuries
• d) Chronic disease management Answer: a) Health disparities

50. The ultimate purpose for a pharmacist to learn about SUD epidemiology is to:

• a) Be able to quote statistics to patients.
• b) Better understand the context of the patients they serve and contribute to population-level health improvement.
• c) Pass their board exams.
• d) Fulfill a curriculum requirement with no real-world application. Answer: b) Better understand the context of the patients they serve and contribute to population-level health improvement.