Practice Questions

Treatment plans should be updated: A) Once per month B) Continuously C) Every 8 weeks D) After a relapse

B) Continuously Rationale: Tx plans should be updated to reflect progress and regressions.

In 12-step programs, what is the sponsor's responsibility when it comes to recommending hospitalization? A) Hospitalization is not part of a 12-step program, and a sponsor is no substitution for a physician; recommending hospitalization is not the responsibility of a sponsor B) Hospitalization can be a helpful part of recovery, and as such, a sponsor can play a key role with staff C) Sponsors should recommend hospitalization if the person's health has clearly declined to the point of danger D) A sponsor can engage a helpful intervention

A) Explanation: Hospitalization is not part of 12-step programs, always remaining forever non-professional. Common sense is to prevail. If anyone believes someone is in medical crisis, they should take the steps they believe need to be taken, but not as a result of the program.

Which option correctly represents the Stages of Change Model? A) Pre-contemplation, contemplation, preparation, action, maintenance B) Pre-contemplation, contemplation, action, relapse C) Contemplation, preparation, action and maintenance D) Contemplation, preparation, action, maintenance, relapse

A) Pre-contemplation, Contemplation, Preparation, Action, Maintenance

In regard to crisis situations, the most useful criterion for evaluating the effectiveness of actions taken between sessions is: A) Whether client keeps scheduled appointments B) Level of functioning, compared to pre-crisis level C) Observed effect of client(s) D) Level of cooperation

B) Rationale: Crisis workers should plan for a follow-up contact with the client after the initial intervention to ensure that the crisis is on its way to being resolved and to evaluate the postcrisis status of the client.

Which statement is true about the assessment process? A) It is not a multidisciplinary process B) It is developed by the case management team C) Although emphasized early in treatment, it is an on-going process D) It is complete when the treatment plan goes into effect

C)

All of the following are models of case management except: A) Strengths perspective B) Clinical/rehabilitation C) Weakness/growth perspective D) Broker/generalist

C) Weakness/growth perspective Rationale: The models of case management are strengths perspective, clinical/ rehabilitation, broker/ generalist and assertive community treatment.

Providing therapy to clients who have a different cultural background than the therapist: A) Requires that the therapist should only see clients from their own culture B) Means that it is okay to see these clients if you enjoy working with them C) Means that the therapist should not treat anybody as different D) Requires that the therapist obtains additional training to work with diverse clients

D)

Once infected with HIV, how long is it possible to remain asymptomatic? A) 1 month or less B) 6 months or less C) 18 months or more D) 10 years or more

D) 10 years or more

Cocaine relapse triggers include A) Positive, upbeat feelings B) Negative, dysphoric feelings C) Sexual encounters D) All of the above

D) All of the above

Which of the following is not a "drug cue" ? A) Drug avoidance strategies B) A prior drug-use setting C) Drug use paraphernalia D) Seeing others use drugs

A) Drug avoidance strategies

Which of the following subcategories of alcohol use disorder onset is NOT in the elderly? A) Early-onset alcoholism B) Late-onset exacerbation drinking C) Delayed-onset alcoholism D) Late-onset alcoholism

A) Early-onset alcoholism

A user's expectation of how a drug will make the user feel... A) can enhance a drug's intensity, but not diminish it B) can diminish a drug's intensity, but not enhance it C) has a significant effect upon the user's experience of the drug D) is of little significance

C) Has a significant effect upon the user's experience of the drug

Jerry began drinking at age 13 when his 19-year-old uncle moved into the house. By age 15, Jerry was smoking pot daily, and by age 17 he is using stimulants several times per week. Jerry has several arrests related to intoxication and possession. Jerry is now 27, is separated from his wife, has two children with two different women, and continues using alcohol, smoking pot daily, and using stimulants. He shows up at your office and says, "I can't live this way anymore! I have to change but don't know how to live sober. Please help me find options to finally put all this stuff down and start living life for real." Jerry's diagnosis is consistent with: A) Alcohol use disorder, cannabis use disorder, stimulant use disorder B) Suicidality, polysubstance use disorder C) Alcohol dependence, cannabis use, stimulant use D) Polysubstance use disorder

A) Alcohol use disorder, Cannabis use disorder, Stimulant use disorder Rationale: Polysubstance is a concept the DSM 5 no longer uses. Instead, each substance-related diagnosis is given. In this case, Jerry has Alcohol Use Disorder, Cannabis Use Disorder, and Stimulant Use Disorder.

What does the experienced effect of a drug depend upon? A) All of these answer choices B) The modality of administration C) Poly drug use, setting, and circumstance D) The amount taken and past drug experiences

A) All of these answer choices

Greg attends a fraternity party and is introduced to amphetamines. He joins in and finds himself feeling outside himself, his heart pounding in his ears, nauseated, agitated by feeling like everything is suddenly in slow motion. Greg begins to sweat, followed by chills. The diagnosis most consistent with Greg's presentation is: A) Amphetamine intoxication B) Amphetamine experimentation C) Stimulant use disorder D) Amphetamine poisoning

A) Amphetamine intoxication Rationale: Greg's presentation is most consistent with amphetamine intoxication, which also may include tachycardia, dilated pupils, altered blood pressure, vomiting, appearance of weight loss, psychomotor retardation or of agitation, respiratory depression, chest pain, confusion, hallucination, seizure, and coma.

Mary just completed her intake session with you. Her use of alcohol has had a significant negative impact on her life. Consequences of her use were discord with her husband, missing her children's soccer games, daily use of alcohol and decreased productivity at work. Which consequence should be addressed first? A) Attain and maintain sobriety B) Attend her children's soccer game this week C) Improve communications with her husband D) Improve her performance at work

A) Attain and maintain sobriety

What is the MOST common symptom of Wernicke's encephalopathy? A) Confusion B) Loss of older memories C) Psychosis D) New memory formation

A) Confusion

All of the following are indicators that a person would be appropriate for inpatient treatment except: A) Continued use of marijuana B) Use of alcohol to prevent alcohol symptoms C) Cocaine use that impairs functioning at work D) Inability to engage with daily living skills

A) Continued use of marijuana Rationale: Answer A does not include a description of any impact on daily living skills/functioning or safety of self or others or risk of death.

Stage two of the comprehensive assessment process, screening, refers to all, EXCEPT: A) Determining which treatment program is best for the client B) Identify that there is a need for further evaluation C) Brief procedures used to determine the presence of a problem D) Substantiate that there is reason for concern

A) Determining which treatment program is best for the client Rationale: The other three choices are parts of the screening stage of the comprehensive assessment process

John shares during group therapy about his intense issues with insomnia, not sleeping for days at a time, feeling like he's in a haze, and desiring help. Ted shares his past experience with this issue and offers tips about how he used a specific progressive relaxation technique, altered his caffeine intake, drinks chamomile tea and added exercise in the morning and stretching an hour before bed, suggesting John try the same. This is an example of: A) Direct advice B) Interpersonal learning C) Instillation of hope D) Imitative behavior

A) Direct advice Rationale: Ted provides direct advice to John, suggesting his solution may work for him, as well. It is not interpersonal learning or a new way of relating. It may offer hope, but in the context of group treatment it refers to the modality providing hope for overall treatment. Nor is this imitative behavior in which one member seeks to mimic another who has greater adaptive skills.

Which is NOT an MAO inhibitor? A) Elavil B) Parnate C) Marplan D) Nardil

A) Elavil Rationale: Elavil (amitriptyline) belongs to a class of similar drugs called tricyclic antidepressants. Elavil is prescribed to treat depression, bulimia (an Eating Disorder characterized by bingeing and purging), chronic pain from a variety of conditions including fibromyalgia, reduce the incidence of chronic headache or migraine, ulcers, uncontrollable hiccups, primary (childhood onset) insomnia, and to control the involuntary crying and laughing experienced by individuals with Multiple Sclerosis.

When conducting a psychoeducational group, the level of facilitator activity is: A) High, with a strong focus on the leader B) High, with a strong focus on group involvement C) Low, with a strong focus on the leader D) Moderate, with a strong focus on the group

A) High, with a strong focus on the leader Rationale: n psychoeducational groups, the focus in on the leader and what the leader is presenting. Little attention is given to group process or the specific issues of group membership.

The substance abuse rates among the LGBTQ community are: A) Higher than the non-LGBT population B) Lower than the non-LGBT population C) About the same as the non-LGBT population D) Dependent upon orientation

A) Higher than the non-LGBT population

The magnitude of a drug's effect is... A) How intensely the user feels the drug's effects B) The level of quantity of the drug C) The rate of absorption of the drug into the user's system D) The dosage of the drug

A) How intensely the user feels the drug's effects

The term "drug use trajectory" refers to: A) Individual drug use patterns over the lifespan B) The rate at which a given drug enters the body C) Drug metabolism over time D) Behavioral patterns of intoxication

A) Individual drug use patterns over the lifespan

Why do some users prefer the route of injection for drug administration? A) It provides a fast and high-peak effect B) Injection has a lower chance of overdose C) Needles are safer to use than other routes D) It is easier to inject a drug than to take it other ways

A) It provides a fast and high-peak effect

Which of the following routes of administration achieves the longest-lasting results for the user? A) oral B) injection C) oral and nasal D) inhalation and nasal

A) Oral

A wife refers her husband for substance abuse counseling. His drug of choice is cocaine, which he has been using episodically with friends—biweekly to weekly—for some years. She is disturbed at the illicit nature of the drug and the long-standing quality of the use. Given the information provided, how is his use of cocaine BEST described? A) Recreational use B) Cocaine dependence C) Cocaine addiction D) Substance abuse

A) Recreational use Rationale: Psychoactive substance use rises to the threshold of abuse only when it is accompanied by concurrent marked dysfunction in social, occupational, educational, relational, or health circumstances. Recreational use commonly occurs biweekly (every other week—not semi-weekly or twice a week) or weekly, and the use is typically for reasons of sociality. Dependence suggests the presence of withdrawal symptoms upon abstinence, and addiction suggests a physiological or psychological compulsion to use in spite of harmful consequences. Absent these key features, the client's use of cocaine is best described as recreational in nature. Substance abuse counseling is therefore not indicated. However, counseling regarding the potential for life circumstances, stressors, or other unexpected losses or burdens to precipitate a future substance abuse problem should be discussed.

Alcoholics Anonymous is classified as: A) Self-help B) Psychotherapy C) Psychoeducational D) Group focused

A) Self-help Rationale: Alcoholics Anonymous is a self-help group, not led by a professional or para-professional as in psychotherapy or a psychoeducational group

The marriage and family treatment approach to alcohol addiction involves all but: A) Shared martial drinking for control B) Relationship strengthening C) Family stress reduction D) Sobriety support via family resources

A) Shared marital drinking for control

All the following are benefits of aftercare treatment except: A) Step work B) Continued routine C) Validation from others in a similar situation D) Continued support in a therapeutic environment

A) Step work Rationale: Step work is part of AA and other similar groups which are not necessarily a part of aftercare programs

All but one of the following may undermine treatment of cannabis abuse: A) The benign nature of cannabis use B) Perception of cannabis as a 'soft' drug C) Efforts for medical legalization D) Positive depictions of cannabis in movies and music

A) The benign nature of cannabis use

During orientation to a program, which individual is NOT involved? A) The client's probation officer B) The client's family C) The client's counselor D) The client's significant other

A) The client's probation officer Rationale: During Orientation to a program, all of these individuals are involved except any probation officer. The client's immediate family and significant other needs to be involved if at all possible. Most recovering individuals are coming from a place of social isolation. The more social support is present and involved in the transition for the client the better.

Drug-using smokers differ from non-drug-using smokers in the following ways: A) They tend to. be heavier smokers. B) they tend to be lighter smokers. C) There are no differences between them. D) They tend to smoke only socially.

A) They tend to be heavier smokers

Due to its short half-life, which requires a divided dosing? A) Wellbutrin B) Prozac C) Elavil D) Paxil

A) Wellbutrin Rationale: WELLBUTRIN is clinically proven to effectively treat depression with a low risk of sexual side effects. However, because of its short half-life, a divided dosing is necessary. Divided doses is the term used when they want to specify a max dose per 24 hours, as maybe when a total dose given all at once might not be safe (toxicity, perhaps) or because its half-life is so short that there won't be an effective blood level over the course of the day and it has to stay on board all day and all night.

Mary is an 18 year old female who is currently engaged in outpatient treatment with you. She has been actively using cocaine and has reported continued discord with her mother. Mary has not signed a consent for her mother at this time. While in your office, you receive a phone call from her mother insisting to know the results from Mary's recent drug screens. Mary's mother stated that she believes her daughter is using cocaine based on her current behaviors and "attitude". What is your most appropriate response? A) You should ignore the phone call since there's no consent B) "Let me call her and make sure she is OK with me sharing her results with you" C) "At this time I do not have her permission to share information with you" D) "I cannot confirm or deny that your daughter is a client. However, I am happy to listen to concerns you may have about your daughters use"

A) You should ignore the phone call since there's no consent Rationale: Since you do not have a consent signed, you are not able to disclose that she is a client of yours. As a counselor, you are able to listen to concerns that anyone has regarding a person in active addiction. After the phone call, you should clearly document what you said as well as inform Mary of her mother's phone call.

Which is FALSE regarding chemical drug testing? A) It is the least reliable way to determine current or recent drug use B) It can determine the specific drugs recently used by the client C) It is the most accurate way to determine current or recent drug use D) It can't replace the assessment process in diagnosing an addiction disorder

A) it is the least reliable way to determine current or recent drug use Rationale: Chemical testing will tell the counselor the specific drug recently used by the client, and it is very reliable. However, only the counselor can diagnose an addictive disorder.

Which of the statements below is MOST correct? A) THC content in all marijuana is about the same B) THC content in marijuana varies widely C) THC content in hashish is lower than in a joint D) THC content in marijuana is predictable

B) THC content in marijuana varies widely

What is/are the organ(s) most damaged by cocaine abuse? A) The kidneys B) The heart C) The brain D) The lungs

B) The heart

When you ask a client if he has had thoughts of killing himself, he changes the subject. What is the best intervention? A) You follow the client's lead, respecting his autonomy B) You go on to the next item on your checklist C) You continue to assess the client's suicidal risk D) You confront the client about his rudeness

C) You continue to assess the client's suicidal risk Rationale: Never be afraid to ask about ideations, intention, plans, means

What is transference? A) Having romantic feelings for a client B) When your feelings about one person is transferred to another C) When a client goes from an active status in treatment to non-active D) Transferring a client from your case load to a colleague

B) When your feelings about one person is transferred to another Rationale: Transference often occurs when a client reminds a clinician of someone in their personal life. The feelings transferred can be positive or negative. Should a clinician feel as though they are experiencing transference, this should be brought up in supervision to address appropriately.

Gary smokes angel dust several times per week. He lost access to his children last year, and his family has all but disowned him. Gary has tried to quit many times, but loves the high and finds the cravings too strong to overcome. He has been to prison for things he has done to support his habit, been arrested for DUI, and always returns to using. Over time, tolerance has developed. Tonight, he sprinkles angel dust on tobacco and smokes to numb his feelings. Soon, he is numb, he cannot easily control the muscles in his mouth, and he struggles to control his body. Gary's presentation is consistent with: A) Phencyclidine Intoxication coded to indicate co-morbidity with Phencyclidine Use Disorder, mild B) Phencyclidine Intoxication coded to indicate co-morbidity with Phencyclidine Use Disorder, severe C) Phencyclidine Intoxication D) Phencyclidine Use Disorder, severe

B) Rationale: Gary has the following symptoms of a use disorder: unsuccessful efforts to stop use, cravings, using despite inability to fulfill major roles (fatherhood), using despite persistent interpersonal issues (family discord and separation), giving up social or other activities (prison), uses when it is hazardous to do so (DUI), tolerance. His current presentation is acute intoxication. ICD-10-CM coding requires Phencyclidine Intoxication to specify whether there is an associated use disorder, and at what level (mild, moderate, severe). Gary's presentation is consistent with Phencyclidine Intoxication, accompanying Phencyclidine Use Disorder, severe (6 or more symptoms)

Substance abuse affects homosexual and heterosexual individuals in distinctly different ways, largely due to the social constructs involved. One such construct is referred to as 'heterosexism'. The most accurate definition of heterosexism is: A) An identification with and/or practice of heterosexuality B) A belief system that favors heterosexuality and rejects homosexuality C) A prejudice against the belief or practice of heterosexuality D) Discrimination against the belief in or practice of heterosexuality

B) A belief system that favors heterosexuality and rejects homosexuality

Phenomenology is best described as: A) The role that prominent life events play in shaping the psyche B) A person's subjective reality and experience as a human being C) The study of the meaning of life D) The branch of psychology dealing with interrelationships

B) A person's subjective reality and experience

Which of the following is the BEST description of a drug? A) A substance that can have both positive and negative effects B) A substance taken for a desired effect (other than food, water, or air) C) Any substance taken for effect D) A substance used to produce a high

B) A substance taken for a desired effect (other than food, water, or air) Rationale: There are many types of drugs. Some drugs are taken for reasons that are beneficial to the user. Some are addictive, and others are not. Drugs that alter behavior and/or mood are referred to as psychoactive drugs. Whatever the type of drug, the term drug does not alone imply a substance that is illegal or harmful.

Renee is a 21-year-old college student who started drinking over the past year. She loves to party with her social crowd. However, her grades have dropped, her boyfriend left her after she took her clothes off in a bar on a dare one night, and her sister no longer speaks to her after Renee drove drunk, damaging the sister's car. Renee does not experience tolerance or withdrawal though she is developing an ulcer. The most consistent diagnostic impression for Renee is A) Alcohol intoxication B) Alcohol use disorder, moderate C) Alcohol withdrawal D) Alcohol use disorder, mild

B) Alcohol use disorder, moderate Rationale: Renee's presentation is consistent with Alcohol Use Disorder. Renee meets 4 of the 11 criteria for Alcohol Use Disorder (i.e. failing classes at school, interpersonal problems, driving while intoxicated, and using alcohol despite a physical problem - ulcer - that is likely to have have been caused by alcohol), so the "moderate" specifier is used. Mild = 2-3 symptoms, Moderate = 4-5 symptoms, and Severe = 6 or more symptoms.

You work in an outpatient program with a team of addiction counselors, social workers, a nurse and a physician. You facilitate an intensive outpatient group in the mornings from 9am-12. Around 9:30 am you notice that Scott appears to be nodding off in the group. You also observe that group members have noticed him as well and appear uncomfortable. You are aware that Scott uses opiates and has been struggling to abstain from use. What is your best course of action? A) Continue facilitating the group as normal B) Ask Scott to come into the hall with you, explain what you observed and that you would like him to be assessed by the nurse and/or physician C) Call on Scott in the group to engage in discussion D) Ask Scott to come into the hall with you, explain what you observed and ask him to go home

B) Ask Scott to come into the hall with you, explain what you observed and that you would like him to be assessed by the nurse and/or physician Rationale: Scott may be inebriated, or he may be tired. Either way, the appearance of nodding off is often triggering for other group members which means that he is not appropriate for the group at this time. Since your concern is that he may be inebriated, he should be assessed by a medical professional before going home to ensure safety. Once you return to the group after Scott leaves, it may be necessary to process how group members were impacted after seeing Scott's presentation in group. If this is the case, keep the discussion off of Scott and on how others felt when seeing someone appear inebriated (ie. Triggered, sad, anxious, angry, etc.).

James was engaged in group and individual counseling in your outpatient program. He has maintained his sobriety and has found a medication regimen that helps him manage his depressive symptoms. James attends Alcoholic Anonymous four times per week and has been active in working the steps with his sponsor. Which of the following recommendations would be the least effective at his discharge? A) Attend AA regularly; maintain contact with his sponsor B) Begin another outpatient program C) Step work D) Continue contact with prescribing doctor for psychotropic medications

B) Begin another outpatient program Rationale: Once an outpatient program is completed, it is not necessary for the client to engage in an additional program. Programs usually begin in phases which would not align with a person who has attained and maintained recovery.

Fetal alcohol syndrome is characterized by maternal drinking leading to all but one of the following being evident in a fetus and following birth: A) Growth retardation B) Blindness and/or deafness C) Facial anomalies D) Brain damage

B) Blindness and/or deafness

In the practice of Addictions Counseling, the systematic approach to the screening and assessment process in which the counselor identifies and evaluates the individual's presenting issues and identifies his/or her treatment and referral needs is known as: A) Treatment planning B) Clinical evaluation C) Clinical process D) Clinical review

B) Clinical evaluation

All case management approaches can be considered _____________ ? A) Individually-based B) Community-based C) Crisis-based D) Routine-based

B) Community-based Rationale: Case management is community based. The main goal is to help the client's familiarize themselves with their community and services available. Examples would be self-help groups, church, individual resources and family resources.

Who should be involved in developing the treatment plan? A) Counselor and their supervisor B) Counselor and the client C) Counselor only D) Counselor, their supervisor, and the client

B) Counselor and the client

The q/f/t formula refers to: A) What drug, where obtained, what route of administration B) How much, how often, how long C) Drug burdens that are physical, familial, and legal D) Drug cost, health cost, societal impact

B) How much, how often, how long

Steven is a 15 year old male who was referred to treatment by his school counselor after he was observed impaired at school. Steven has been abusing Xanax and acknowledges use at school. He currently lives with his mother who has a legal prescription for Xanax which she does not keep in a locked location. Steven's mother is aware that this is her son's drug of choice and has decided to not keep her prescription in a secure location. Knowing that your client's drug of choice is not securely locked in the house, what would be the best course of action to discuss with your supervisor? A) Do nothing B) Involve CPS C) Document that you told his mom to secure her medication D) Have a family session to create a safe space for an open discussion regarding boundaries

B) Involve CPS Rationale: When meeting with your supervisor, it would be best to discuss making a CPS report. Steven's mother is aware of his use of Xanax and has continued to leave her prescription in an unsecured location. The use of Xanax does cause concern for his safety and would warrant a mandated report.

Which of the following drugs would be present on a Urine Drug Screen 5 days after use? A) Cocaine B) Marijuana C) Methamphetamine D) Heroin

B) Marijuana

Which therapeutic approach is the most effective when working with a resistant client? A) Cognitive Behavioral therapy B) Motivational interviewing C) Psychodynamic D) EMDR

B) Motivational Interviewing

Matt is a heroin addict. Which group would be an appropriate suggestion for him? A) AA B) NA C) GA D) CA

B) NA Rationale: NA refers to a Narcotics Anonymous group. Should Matt feel as though he does not like the groups offered and/or the others in the group, attending Alcoholic Anonymous may be more appropriate. Each group follows the 12 step model, however they have individual differences.

Joshua is treated for his Attention-Deficit/Hyperactivity Disorder over the course of several years. At 15, Joshua reports he needs more of his medication to achieve the same results. His physician increases Joshua's dosage according to Joshua's reports, and his parents concurred that Joshua seems to be happier. Joshua notices getting a "rush" one day when he doubled his dose, so he began regularly taking the higher dose pursuing the same feeling again and again. His tolerance quickly began to increase, and he began feeling highly agitated when skipping a dose. Joshua's presentation is consistent with A) Stimulant withdrawal B) Stimulant use disorder C) Phencyclidine use disorder D) Stimulant intoxication

B) Stimulant use disorder Rationale: Joshua is developing Stimulant Use Disorder. While he is prescribed the medication, he has begun to abuse it by taking more than is prescribed and taking it for different uses than what is intended. Withdrawal and tolerance are both symptoms of the disorder, along with his strong desire to take more than was prescribed

Susan was referred for an alcohol assessment by her primary care physician. She scored a 17 on the AUDIT assessment. Which risk zone and action recommendation would be the most appropriate? A) Zone 1: Brief Education B) Zone 3: Brief education or referral for specialized treatment C) Zone 2: Brief intervention D) Zone 3: Referral to a specialist for treatment

B) Zone 3: Brief education or referral for specialized treatment Rationale: AUDIT scores ranging from 13-19 for a woman fall into Zone III with the recommendation of simple advice plus brief counseling and continued monitoring. When scoring the AUDIT, the gender of the client will aide in determining the recommendation. Zone recommendations are as follows: Zone I: Brief education Zone II: Brief intervention Zone III: Brief intervention or referral to specialized treatment Zone IV: Referral to specialized treatment

Which form of counseling has been shown to have the most benefit with addiction? A) Family counseling B) Crisis counseling C) Group counseling D) Individual counseling

C) Group counseling Rationale: Often times in addiction, a person becomes isolated and feels as though no one can understand their situation. Being a group setting, a client is exposed to others who have similar experiences, thoughts and feelings which can normalize a person's experience. Group sessions also allow others to observe others being vulnerable which increase the chances of others doing the same. Group sessions can be a place where clients can learn from each other's struggles and triumphs.

Thomas is currently engaged in group and individual counseling with you and has a diagnosis of Alcohol Use Disorder, Severe and ADHD. Thomas has a positive Urine Drug Screen for stimulants and reported that he is currently prescribed stimulants for his ADHD by Dr. Smith. Which of the following actions would not be appropriate for you to do? A) Collaborate with Dr. Smith regularly B) Continue to have Urine Drug screens to monitor medication compliance C) Encourage Thomas to stop using his medication due to risk for cross addiction D) Sign a consent of release for Dr. Smith

C) Encourage Thomas to stop using his medication due to risk for cross addiction Rationale: That's not in your professional scope, dummy. You could communicate concerns to Dr. with appropriate consent.

Family boundaries that leave no room for individual differences are known as: A) Rigid boundaries B) Disengaged boundaries C) Enmeshed boundaries D) Diffuse boundaries

C) Enmeshed boundaries

Katherine is a substance abuse counselor in an outpatient program. Her client, Donovan, is dependent on methamphetamine and told Katherine that he deals drugs to others to support his habit. Which is the CORRECT ethical choice for Katherine? A) To fulfill her obligation to her community, Katherine must disclose Donovan's drug dealing with law enforcement. B) Katherine should decline to provide services to Donovan unless he agrees to stop drug dealing. C) Legally and ethically, Katherine cannot divulge client information that was told to her in confidence. D) Katherine should tell the program's lawyer what Donovan is doing and let him advise her about what she should do.

C)

The informed consent for treatment document should always contain: A) The client's venogram B) An estimate about the length of treatment for that client C) Information about confidentiality and its exceptions D) The clients goals for treatment

C) Rationale: herapists may consult with a supervisor or other professional therapist in order to provide the best service. In the event that the therapist consults with another therapist, no identifying information such as the patient's name would be released. Therapists are required by law to release information when the client poses a risk to themselves or others and in cases of abuse to children or older adults. If a therapist receives a court order or subpoena, he or she may be required to release some information. In such a case, the therapist will consult with other professionals and limit the release to only what is necessary by law.

What happens as tolerance for barbiturates develops? A) The margin between intoxication and lethality stays the same B) The margin between intoxication and lethality decreases C) The margin between intoxication and lethality increases D) Tolerance does not develop for barbiturates

C) While tolerance for barbiturates does develop, tolerance for an otherwise lethal dose only marginally increases and never exceeds twofold. This means that the likelihood of an unintentional fatal dose increases substantially over time as the need for the intoxicating effect pushes that threshold ever closer to a lethal dose. Given the impairments in memory and judgment that typically accompany CNS depressant intoxication, simple forgetfulness can lead to a fatal overdose. Finally, using barbiturates with any other CNS depressant substance, such as alcohol, can result in an additive CNS depression that can readily be fatal. Death most often occurs via respiratory or cardiac suppression.

Among psychiatric disorders in the elderly, where does alcohol abuse rank? A) 25th B) 15th C) 3rd D) 5th

C) 3rd

When a therapist steps out of the clinical role, there is: A) No problem as long as the client is not harmed B) No problem as long as the therapist is aware of the client's dynamics C) A potential boundary violation D) A legal problem

C) A potential boundary violation

Which of the following is NOT a basic chemical class of amphetamines? A) Methamphetamines B) Dextroamphetamine C) Benzedrine D) Amphetamine Sulfate

C) Benzedrine

You are facilitating a co-occurring mental health and substance abuse group. One of the group members, Sally, shares that she has been struggling with her depression symptoms and feels as though being sober is "too much". She noted that yesterday on her way home from work she was driving by a liquor store and stayed in the parking lot for approximately 35 minutes before calling her sponsor. Which approach are you least likely to use? A) Allow her to discuss her challenges, support her in the group B) Have the group help her in identifying healthy behaviors when her depressive symptoms occur C) Change the topic to avoid triggering other group members D) Process her experience yesterday and support her for calling her sponsor

C) Change the topic to avoid triggering other group members Rationale: Changing the topic would be the least helpful for both Sally and other group members. Process groups should offer a safe space for members to share about their difficulties, receive support from others and create a sense of normalization. Changing the topic would make others less likely to share about their struggles in the group.

Which of the following is a common side effect of sniffing/snorting a drug? A) Increased chance of infection B) Elevated chance of overdose C) Damage to the nasal membrane lining D) Vein scarring

C) Damage to the nasal membrane lining

The first stage in group process may be referred to as: A) Performing B) Cohesion C) Dependency D) Conflict

C) Dependency Rationale: The initial stage of a group is often referred to as "forming" or dependency. In this stage, the therapist might observe a dependency on the therapist for direction as members are uncertain of themselves and look to leadership for direction. Conflict is sometimes called storming, which may be overt or covert. Cohesion is a time when the group develops an identity and feels relaxed with one another and has a sense of cohesion. Performing is the time in which the primary work of the group begins. Members take on constructive roles and address personal issues.

What do short-term effects of drug use refer to? A) physiological effects of drug use only B) psychological effects prior to drug ingestion C) effects while the drug is still in the user's body D) only psychological effects of drug use after the drug enters the user's system

C) Effect while the drug is still in the user's body

While working in an outpatient clinic, you recognize the name of a person you are supposed to conduct an intake assessment with at 2pm in the afternoon. You recognize the name because this person is friends with your brother. What is the best course of action? A) Conduct the assessment as scheduled B) Conduct the assessment and work with them individually since you know them C) Have a colleague do the assessment and ensure they are not your client D) Have a colleague conduct the assessment and have them placed in your morning group

C) Have a colleague do the assessment and ensure they are not your client Rationale: Conducting the assessment, having this person in your group and/or working with them individually would all create a dual relationship which would blur the professional lines of this relationship. This could be explained to the person if they wonder why they do not work with you. Remembering the limits of confidentiality would be important as well to maintain this person's privacy.

All of the following are questions on the CAGE questionnaire EXCEPT: A) Have you ever felt the need to cut down on your drinking? B) Have you ever felt annoyed by others criticizing your drinking? C) Have you ever experienced delirium tremens? D) Have you ever felt guilty about your drinking?

C) Have you ever experienced delirium tremens?

Tom and Brenda co-facilitate a group on co-dependency. They observe the membership assuming a variety of roles, working on enabling behaviors, depression, and anger. The majority of their time is spent in observation, with occasional linking member stories or facilitating a specific intervention. The group is engaged in: A) Cohesion B) Conflict C) Interdependence D) Dependency

C) Interdependence Rationale: Interdependence is also called performing and occurs when members are comfortable with one another and occupy their time with problem-solving and engaging with one another for the group's primary purpose.

Jeff shares about the pain of his divorce, triggered by his spouse's affair with his brother. Jeff was left isolated from his family, feeling no support whatsoever. Other members have similar stories, but Mark's spouse specifically had an affair with his brother, leaving him feeling he had no support either. The group counselor said, "Mark, you shared your wife is now dating your brother. I wonder if there is any part of Jeff's story you relate to or that you would like to share about today." The group counselor has demonstrated: A) Blocking B) Summarizing C) Linking D) Active listening

C) Linking Rationale: Linking occurs when group leadership assists members in recognizing their similarities. Blocking occurs when leadership prevents unfocused members from being disruptive by redirecting or preventing them from monopolizing discussion. Summarizing occurs when leaders assist members in raising awareness of what occurs and how the group and membership have changed. Active listening is the leader's attention to language, nonverbal and tone around an individual's message.

Joseph comes into your office for an intake assessment required by his Probation Officer. Joseph is reluctant to discuss his opiate use. However, he is compliant because he knows that the results of the intake would be reported to his PO. He shared that he is on probation as a result of being arrested for stealing. Joseph explained that he was stealing to support his heroin use and has continued to use since his arrest. Joseph began using Oxycodone recreationally at age 17 which progressed to daily use soon after. Joseph began using heroin approximately 8 months later due to the cost difference. Joseph has used to avoid withdrawal symptoms. He recently began to share needles and noted that he is aware of the health risk that this behavior poses. Joseph's family began distancing themselves from him when he continued using heroin after being arrested. With the information provided, how would you diagnose Joseph? A) Opiate Use Disorder, Severe B) Opiate Use Disorder, Mild C) Opiate Use Disorder, Moderate D) Opiate Use Disorder

C) Opiate Use Disorder, Moderate Mild: 2-3 symptoms Moderate: 4-5 symptoms Severe: 6 or more symptoms Symptoms identified in this summary are as follows: Joseph continues to use despite persistent social and interpersonal issues (discord with family), in physically dangerous situations (sharing needles), developed a tolerate which led to use larger amounts over time, experienced withdrawal and uses to avoid symptoms

You facilitate an after care group for clients who have successfully completed your inpatient program. This group is on an outpatient basis and occurs once per week. You are notified that a person who was engaged in the inpatient treatment at the same time as some of your aftercare patients has overdosed and died. How should you proceed? A) Do not mention the death, re-direct if brought up in group B) Start your next group session by processing this loss and how the group members feel C) Process the death only if brought up by a group member D) Attend the funeral services to pay your respects

C) Process the death only if brought up by a group member Rationale: The best way to protect the confidentiality of the person who passed is to not bring up the conversation yourself. Group members may not be in contact with this person and/or remember being in treatment with them. Confidentiality continues in death. It may be necessary for some members to process the death in which case it is best to keep the conversation on how they are impacted by the loss and not to focus on the person who passed.

Susan is being discharged as a result of continued relapses and inconsistent attendance for group therapy. Despite your best efforts, she is reluctant to agree with your recommendation for inpatient treatment. Which of the following would be the most appropriate course of action at the conclusion of her discharge session? A) Wish her the best in future endeavors B) Encourage her to re-engage in outpatient treatment when she is ready to stop drinking C) Provide her with written information about different inpatient options D) Inform her emergency contact of her discharging and non-compliance with your recommendation for inpatient treatment

C) Provide her with written information about different inpatient options Rationale: Providing Susan with written information gives her the opportunity to look into them should she change her mind about your recommendation. The information provided does not provide enough evidence to be concerned about her safety and is not appropriate to contact her emergency contact.

Vanessa keeps seeing pictures of her husband dying in the car wreck that killed him after being hit by a drunk driver. She thinks this means she is going crazy. She is also having sleep disturbance, irritability with her children, and difficulty making choices. The most appropriate intervention is: A) Hospitalize her for psychosis B) Put her children in a foster home C) Provide therapy for traumatic grief D) Ask a physician to prescribe antipsychotics

C) Provide therapy for traumatic grief

Motivational Interviewing is defined as: A) A way of interviewing and providing a safe structure to allow clients to reexamine problematic decision-making. B) A method for enhancing change by exploring and resolving faulty thinking C) A client-oriented system of guided steps used to plan and implement a recovery program to educate the client about his/or her need to change D) A client-centered method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.

D) Rationale: Motivational Interviewing is consciously directed as the interviewer elicits and enforces change-talk. It is also a way of communicating and evoking natural change. MI is about eliciting the person's intrinsic motivation for change.

Psychoactive drugs are drugs that... A) Alter only behavior B) Alter only mood C) Have little or no effect on mood or behavior D) Alter behavior or mood

D) Alter behavior or mood

What does metabolism do? A) Maintains the peak intensity of the drug B) Maintains the composition of the drug C) Alters the drug so it cannot be eliminated from the body D) Alters the composition of the drug

D) Alters the composition of the drug

At what phase of treatment does case management begin? A) At the first counseling session B) At t he first contact with client C) When the treatment plan is created D) At the client's intake session

D) At the client's intake session Rationale: Case management begins at a client's intake and continues throughout their treatment. The first goal of case management is to coordinate care which is appropriate for the client which can be done at the conclusion of the intake session.

Sara is currently engaged in group and individual sessions with you. A current goal is to receive the Vivitrol injection to aide in her abstinence from opiate use. As her counselor, how can you best support her? A) Trust that she is honest about her use with her prescriber B) Identify barriers to this goal and aide in developing skills to manage them C) Collaborate with her prescriber regarding compliance and treatment plan D) Both B and C

D) Both b and c Rationale: Collaborating with her prescriber will provide a team approach which will aide in communication. For example, if Sara were to relapse days before the injection, receiving the Vivitrol injection would induce withdrawal symptoms. Identifying barriers and identifying skills would help Sara maintain sobriety until she is able to receive the injection.

A 67 year old female, Mary, attends an intake assessment with you on Monday. You diagnosis her with Alcohol Use Disorder, Severe and Bipolar I. You gave her a treatment schedule to engage her in group sessions along with a referral for a doctor on staff to assess for medications. Mary lives alone and has limited mobility due to severe arthritis. Mary misses her group session on Wednesday. As her primary clinician, you call her to follow up regarding her absence. While on the phone, it becomes apparent that she is inebriated and she reported falling down stairs and is struggling to get up. You encourage her to call 911, however she refuses. Which would be the best course of action to present to your supervisor? A) Call her son so he can go check on her B) Talk to her about the incident when she comes in for group and discuss the danger she put herself in C) Document the call: process the call if she brings it up with you D) Call 911 for a wellness check

D) Call 911 for a wellness check Rationale: The best option to discuss with your supervisor would be to call for a Wellness Check. Her apparent intoxication, limited mobility, living alone and her self-report of falling with a difficulty of getting up poses a concern for her safety. Therefore, you have an ethical responsibility to break confidentiality to ensure her safety. Consulting with your supervisor or colleague allows you the opportunity to receive feedback regarding your plan of action.

Which of the following is not a consequence of glorifying drug use in a g group session? A) Triggering others B) Continuing in an additive behavior and thinking patterns for the person sharing C) A distraction in the group from appropriate topics D) Create group unity

D) Create group unity Rationale: Glorifying is talking about drinking and/or drug use in a manner that makes it sound exciting and positive. More times than not, this tends to have a negative impact on the group and can create some anger. Members often feel triggered by the topics and the person sharing continues to use their addictive thought processes. Should a person be glorifying in a group session, this should be addressed immediately before the negative impact intensifies.

How is tolerance BEST described? A) Increased sensitivity to a drug over time B) The need for more of a drug to get intoxicated C) The inability to get intoxicated D) Decreased sensitivity to a drug over time

D) Decreased sensitivity to a drug over time

Many drug users smoke primarily to achieve the following effect: A) Insomnia control B) Enhanced smell and taste C) Increased stamina D) Elevation of mood

D) Elevation of mood

Questions about HIV infection are a significant concern for: A) Homosexual males only B) Intravenous drug users and gays only C) IV drug users, gays, and multi partner heterosexuals only D) Everyone

D) Everyone

Sally and Joe have been married for 16 years and have a pattern of verbal and physical abuse when drinking. Both persons are engaged in treatment within your facility. You work with Joe and your colleague works with Sally individually. Joe informs you that he and Sally have been drinking every night to the point of blacking out. He explains that they often wake up in the living room and do not remember several hours of the evening before. You are aware that they have 2 children, ages 7 and 4 who live with them. You feel as though you need to do something regarding the children's safety. Which of the following is the best option to discuss with your supervisor? A) Engage in a family session with your colleague to provide psychoeducation about responsible parenting behaviors B) Provide psychoeducation to your client regarding responsible parenting behaviors C) Encourage Joe to abstain from alcohol use D) Involve CPS

D) Involve CPS Rationale: This scenario would warrant a mandated report as the children living with Joe are minors and unable to care for themselves. Joe reported drinking every night to the point of blacking out which means that he and his wife are no longer able to properly care for their children. Psychoeducation about parenting would be appropriate, however the children's safety is a priority.

Which of the following conditions does alcohol NOT induce? A) Steatosis B) Cirrhosis C) Hepatitis D) Nephrosis

D) Nephrosis Rationale: Hepatitis refers to inflammation of the liver. Alcohol is toxic to all body tissues. Because alcohol must be metabolized by the liver, it is particularly susceptible to the toxic effects. Consequently, many heavy drinkers suffer from alcoholic hepatitis, characterized by abdominal pain, nausea, vomiting, and a swollen liver. In more extreme cases, jaundice and bleeding can result. Jaundice (a yellowing of the skin and whites of the eyes) is from bilirubin, a by-product of aging red blood cells broken down in the liver, that should have been fully metabolized by the liver. Spontaneous bleeding occurs because key clotting factors are made in the liver, but production is inhibited by hepatitis. Steatosis consists of fatty deposits in the liver that, if severe, can prove fatal. Cirrhosis refers to scarring of the liver from alcohol damage, preventing its normal functioning. High blood toxins can also cause hepatic encephalopathy—a reversible dementia—if the toxins are reduced.

In terms of difficulty quitting (dependence), which of the following four drugs ranks the highest? A) Cocaine B) Alcohol C) Heroin D) Nicotine

D) Nicotine Rationale: In terms of difficulty quitting, relapse rates, cravings ratings, and persistent use despite known harm, nicotine is substantially more dependency producing than cocaine, heroin, and alcohol. In terms of withdrawal symptom severity, nicotine exceeds that of cocaine and is only slightly behind heroin. Thus, fewer than 7 percent of those trying to quit each year will succeed. Given that nicotine use greatly increases the risks of heart disease, stroke, lung diseases, and cancer, nicotine abuse is a serious public health issue. Even only occasional smoking produces lung and vascular damage, and almost one-fifth of all heart disease deaths are linked to smoking.

One of the following is not a factor in the development of a drug use trajectory: A) Perceptions about potential risks B) Beliefs about potential benefits C) Ideas about 'soft' vs. 'hard' drugs D) Personal beliefs about 'generic learning'

D) Personal beliefs about 'generic learning'

Regarding substance abuse, what does the Convergence Theory propose? A) Age is a key factor in eventual substance abuse abstinence B) As individuals age, gender disparities in rates of abuse tend to converge C) All individuals eventually narrow drug use to a drug of choice preference D) Rates of substance abuse among women are converging with those of men

D) Rates of substance abuse among women are converging with those of men Rationale: Convergence theory postulates that substance abuse rates are becoming more equal during the twenty-first century—currently, 1.6 men have substance abuse issues for every 1 woman with such issues. Others, however, suggest the data is flawed, as women are more likely to hide their substance abuse behavior and less likely to see help. Other gender differences include the following: (1) men externalize accountability, women internalize (self-blame); (2) issues of self-esteem are more common for women; (3) treatment barriers are higher, as women tend to have pregnancy issues and children needing their care; (4) women tend to increase substance abuse when depressed, while men are more likely to decrease use. Women prostitute to support a habit; men turn to selling drugs or other criminal behavior. Marriage is a deterrent to drug use for men but a risk factor for women. Women drinkers are four times more likely to live with a drinker than is a man.

What does formication refer to? A) Extrapyramidal symptoms of agitation B) Sex between two unmarried individuals C) The creation of freebase cocaine D) The sensation of bugs crawling under the skin

D) The sensation of bugs crawling under the skin Rationale: Chronic users of cocaine, crack cocaine, methamphetamine, and other such stimulants develop a profoundly unpleasant sensation of bugs crawling under their skin. They may even come to believe the bugs are present and needing to be removed. In less severe cases, users may pick at their skin to the point of causing sores and scabs. In more extreme cases, users may cut themselves in a desperate attempt to release the bugs and find relief. The condition is also known as Magnon's syndrome and may also be referred to colloquially as coke bugs or crank bugs, and so on.

How does a drug enter the user's bloodstream when snorted or sniffed? A) by passing through the small intestine B) through the stomach wall C) by entering a blood vessel directly D) through the membrane lining of the nasal passages

D) Through the membrane lining of the nasal passages

When a drug is ingested orally, which of the following BEST describes how the drug enters the bloodstream? A) Directly via a blood vessel B) Through the lungs C) Via nasal membranes D) Through the stomach or small intestines

D) Through the stomach or small intestines

How are drugs MOST often removed from the body? A) Through exhalation B) By vomiting C) By pumping the stomach contents D) Through the user's urine

D) Through the user's urine

Rob smoked for over 40 years but stopped smoking about 6 months ago. He continues to have strong cravings, but has managed to not give in to his urges and remains abstinent. Rob's presentation is most consistent with A) Tobacco fixation B) Tobacco use disorder, in sustained remission C) Tobacco withdrawal D) Tobacco use disorder, in early remission

D) Tobacco use disorder, in early remission Rationale: Rob's presentation is most consistent with Tobacco Use Disorder, in early remission, which is inclusive of a lack of symptoms, with the possible exception of cravings.