Ultimate NAADAC Study Set

Allrounders *Cannabis* *What is Amotivational Syndrome?*

This is where regular users of cannabis are reported to develop a lack of motivation to pursue goals, have reduced productivity, poor short-term memory, difficulty concentrating and are *apathetic to their future.* Many advocates against legalization of cannabis site amotivational syndrome among their reasons to restrict cannabis use; however, amotivational syndrome is *strictly anecdotal and has not been confirmed* by clinical research. Page 108 in study guide one 2016 version https://en.wikipedia.org/wiki/Amotivational_syndrome

Considerations in making ethical decisions: STEWARDSHIP

To use available resources in a judicious and conscientious manner, to give back.

what is STEWARDSHIP?

To use available resources in a judicious and conscientious manner, to give back.

Considerations in making ethical decisions: DILIGENCE:

To work hard in the chosen profession, to be mindful, careful and thorough in the services delivered

what is DILIGENCE?

To work hard in the chosen profession, to be mindful, careful and thorough in the services delivered

Considerations in making ethical decisions: SELF-IMPROVEMENT:

To work on professional and personal growth to be the best you can be

what is SELF-IMPROVEMENT?

To work on professional and personal growth to be the best you can be

Collaborate

To work together with other individuals or agencies to bring about a desired result.

Behavior Therapy *How is it applied?*

Tokens for sobriety i.e. AA Chips Cue Exposure Treatment Aversion Therapy i.e. Antabuse - Schick Shadel

Counter-adaption

Tolerance

Tolerance for hallucinogens

Tolerance develops to acute effects after repeated doses

Long term effects of Talwin and Ritalin use

Toxic psychosis, Delusions and confusion.

Another name for barbiturates

Tranquilizers or "tranqs"

Unfinished business

Unexpressed feelings from childhood that now interfere with healthy functioning

Tolerance markedly diminished effect with continued use of the same amount of the substance unless

Unless individual is taking medications under medical supervision such as analgesics, antidepressants, ant-anxiety medications or beta- blockers.

Crisis *External Factors*

bereavement unemployment natural disaster surgery imprisonment terrorism trauma other severe loss

opioid derivatives treatment application

bio-psycho-social-spiritual therapy: methadone, bupreenorphine, naltrexone, and naloxone

Narcotic antagonists

block or verse the euphoric effects of opioids

Methadone and buprenorphine

block symptoms of withdrawal and psychoactive substance cravings to heroin

Barbituates & Benzodiazapines

work on GABA, "standard" depressant effects, withdrawal sx can be toxic and present almost identical to alcohol

Alcohol causes....

Increased breathing at low levels

Tolerance

Increased need for markedly more of the same substance in order to acheive the deisred effect (decreased need without a change in the substance is reverse tolerance) Can occur in as little as 3-4 weeks of use

Short term effects of amphetamine use

Increased temperature, fever or increased blood pressure Irregular heart rate or rapid heart beat Paranoia, anxiety and increased hostility towards others Heightened sense of well-being, increased sense of alertness Suppressed appetite, dryness of the mouth, dehydration Increased energy, reduction of drowsiness or fatigue Nausea and vomiting Headache Increased feelings of power or confidence

Acute intox Sx of uppers

Increased: heart rate, blood pressure, breathing, alertness, activity, anxiety, aggression, confidence, constriction of blood vessels, body temperature, dilated pupils, runny nose, dry mouth, muscle twitching, sexual stimulation Decreased: appetite for both food and water

Treatment Modalities

Indiv Counseling, Group Counseling Family or Systems Counseling, Detox Tx Inpatient- hospital style, 24 hr staff Residential- 24 staff, medical on call IOP- OP- assessment/referral programs, education programs, Therapeutic community, transitional programs,

Types of counseling

Individual, group and Family

Indicator that a drug or other substance (OS) has a potential for abuse

Individuals are taking the drug or OS on their own initiative vs medical direction

Addiction Treatment Modalities *Brief Therapy Parts*

Induction Phase Alliance (Pretreatment) Refocus/Change Termination/Homework Continuation/Followup

Client walfare-Ethical Principles

Inform all client of the code of ethics, professional loyalties, and responsibilities

Pharmacotherapy

Medications prescribed to treat SUD

Allodynia

Painful response to a normally innocuous stimulus.

Stages of Change *Action*

Takes the steps to change, with or without the help of others

Considerations in making ethical decisions: HONESTY AND CANDOR

Tell the truth in all dealing with clients, colleagues, business associates and the community

what is HONESTY AND CANDOR?

Tell the truth in all dealing with clients, colleagues, business associates and the community

Hyperalgesia

Temporary increase in sensitivity of nerve cells, in the body's attempt to get you to pay attention and give it what it needs.

How substance abuse and domestic violence programs may be in conflict.

Terms such as denial, codependency, and powerlessness are seen as stigmatizing and self defeating in helping people who are in violence abuse situations.

All-Arounders

psychedelics (LSD, mushrooms, MDMA/Ecstacy, PCP, DXM) and Cannabis

Agonist

psychoactive substance binds to neurons and elicits a reaction as if it were a neurotransmittor

anxiolytics

psychoactive substance that reduces anxiety

transference is a key aspect of what therapy.

psychoanalysis

long term cocaine use has sometimes been inked to

psychosis

Anesthetic

sub used to induce a controlled state of unconsciousness

Analgesic

sub used to relieve pain

BAC 0.01 to 0.05

subclinical

skin popping

subcutaneously admiistering heroin

Buprenorhine

suboxone, subutext,

Antagonist

substance binds and prevents other neurotransmitters form binding to that neuron

Agonist

substance that binds to a neuron and elicits a reaction as if it was that neurotransmitter

Antagonist

substance that binds to a neuron and prevents other neurotransmitters from binding to it

Controlled Substance analogues

substances that are not controlled substances but may be found in illicit trafficking

two or more drugs taken together and have an additive effect means

summation of effects 1+1 = 2

Autonomy

supporting the clients independence, freedom, and self-determination

Cirrhosis

swollen, scarred or dead liver tissue

Opioids

synthetic opiates- demeral, hydros, oxys, etc

standard drink of 5 oz

table wine

Short term effects of inhalant/solvent use include

temporary euphoria and reduced inhibitions

Termination & Continuing Care

termination is when the client leaves treatment and the relationship is severed. continuing care plan- an individualized outline of how the ct will continue to receive services and support

Meth results in the release of so much dopamine

that it can take YEARS for the person to learn to feel pleasure again.

PNS is

the Autonomic Nervous System (unconscious bodily functions) which is sympathetic nervous system *increases breathing, etc) and parasympathetic (decreases)

treatment applications

the method of detoxification, stabilization and maintenance that is unique to each client in order to facilitate sobrierty

Medical uses for amphetamines

-Weight loss -Treating Narcolepsy -Treating ADHD -Respiratory problems

Anabolic Steroids

Muscle growth, heart attacks, strokes, hair loss, genital shrinking, acne

Client Relationship-Ethical Principles

Must be safe guarded so that the moral soundness of the counseling relationship is preserved.

Ryan Haight online pharmacy consumer protection act of 2008

No controlled substance can be ordered by the internet unless the online pharmacy holds DEA registration authorizing it to operate as an online pharmacy

Schedule *Schedule I*

No currently accepted medical use and a high potential for abuse. Some examples of Schedule I drugs are: *Heroin* lysergic acid diethylamide *(LSD)* *marijuana* (cannabis) 3,4-methylenedioxymethamphetamine *(ecstasy)* methaqualone peyote

Schedule I

No medical Use, cannot be dispensed by a prescriber. Severe dependence, high potential for abuse

I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #4 of 11: Sex & clients

No sex with current or former clients under any circumstances!

Mutual Support Groups *Primary Basis*

Non-professional - An alternative/addition to professional counseling where group members share and discuss experiences with a similar condition.

What it the medical value of ethanol?

None. Other drugs do its job in a more effective and safer manner

Where was tobacco first grown?

North America, around 600 B.C.

Transfer of addictive behaviors

Not good because compulsive behavior take away the ability to have free choice in one's actions.

Federal Trafficking Penalties of Heroin (schedule I) 1K or more (first offence)

Not less than 10 years and not more than life. if death or serious injury, 20 or more than life. Fine up to $10M for individual $50M if not an individual

Federal Trafficking Penalties of Heroin 100 to 999 gms (first offence)

Not less than 10 years and not more than life. if death or serious injury, life imprisonment. Fine up to $8M for individual $50M if not an individual

Federal Trafficking Penalties of Heroin (schedule I) 1K or more (second offence)

Not less than 20 years and not more than life. if death or serious injury, life imprisonment. Fine up to $20M for individual $75M if not an individual

Federal Trafficking Penalties of Heroin (schedule I) 100 to 999 gms (first offence)

Not less than 5 years, and not more than 40 years. If dealth or serious injury not less than 20 or more than life. Fine up to $5M for indiv or $25M if not an individual

Non-Discrimination, responsibility, Competence, legal and moral standards for alcohol and drug abuse counselors

Not to discriminate against clients or members of the profession because of race, religion, age, gender, disability, ancestry, sexual orientation, or economic condition. Protect the rights of the client.

IV. Prof Responsibility: Standard 3: Records and Data: 7. NOTES NOT RELATING TO CLIENT SERVICES

Notes kept that assist pro in making appropriate decisions regarding client car, but not related to client services shall be maintained in separate, locked location

Depressants Alcohol *What speeds up recovery from a hangover?*

Nothing but time

Parts of the brain affected by cocaine use

Nucleus accumbens: Part of brain responsible for survival (reward) pathways responsible for reinforcing effects of rewarding behavior or substance

Addiction Treatment Modalities *Motivational Interviewing - OARS*

O = Ask *Open*-ended questions A = *Afflrm* the client for change R = Listen *Reflectively* S = Provide *Summaries*

I. Counseling relationship: Standard #5: PREVENTING HARM =

Obligation of Pro to consider whether decisions/actions have potential to produce harm of physical, pschol, financial, legal or spiritual nature before implementation - If harm done, Pro admits it, takes action to repair, ameliorate harm except when it might cause greater harm

Caffeinism

Occurs when 650mg+ caffeine is consumed

Identity achievement

Occurs when a person sets a goal based on his values.

Differences in the process of change between support groups and therapy groups

One group: Screened membership, limited size and Focus is on process. One has an : open membership, Unlimited size, Focus is on content

Protracted abstinence syndrome

Opiate abuse is a chronic disorder and maintaining abstinence represents a major challenge for addicts. Individuals recovering from opiate dependence have long reported that while the acute withdrawal symptoms from opiates may pass relatively quickly, they do not feel quite right for several weeks or even months thereafter. Called the "protracted abstinence syndrome," this cluster of vague depressive-like symptoms can include reduced concentration, low energy level, poor sleep quality, and anhedonia. New data in animals now implicates the serotonin system in this phenomenon.

Narcotics

Opiates, codine, oxycodone, morphine, perocet, percodan, vicodin,

Mech. of action for Naltrexone

Opioid receptor antagonist that prevents the pleasurable effects of ETOH (or opiod) consumption

Narcotics

Opioids and Opiates

Which of the following is a psychoactive drug?

Opium

Natural substances naroctics

Opium to codeine and Opium to morphine to heron

Treatment for heroin

Ovedose: Narcan (naloxone) Antagonists: Naloxone, Naltrexone Use of vivitrol- which is naltrexone

Over what percentage of SUD patients also have a mental illness?

Over 50%

IV. Professional Responsibility

Overall: -Pro espouses objectivity, integrity, highest standards of service -trust-worthiness is the basis for being effective -Pro assumes role of assisting others live more responsibly & ethically -For whatever reason, when Pro finds that she has done harm, she'll do whatever possible to repair/ameliorate the harm, except when to do so would cause greater harm.

Occipital

Overlaid to the occipital bone in the lobe of the brain of the back of the head

Definition *Drug Abuse*

People who abuse drugs *typically do not have a prescription for what they are taking.* Not only do they use it in a way other than it is prescribed, but they also use it to experience the feelings associated with the drug. Euphoria, relaxation, the general feeling of 'getting high' is always associated with drug abuse. The abuse of drugs in the opiate and benzodiazepine families frequently leads to unavoidable side effects, including dependency and addiction. For example, someone taking Vicodin frequently with no prescription, no symptoms and believing they 'need' it in order to feel better is an example of drug abuse. *Signs of Drug Abuse* - Using a drug to *get high* - Using without a prescription - Exceeding a recommended dose - Chronic or repeated abuse - Developed *tolerance* https://newlifehouse.com/drug-abuse-vs-misuse/

What is "tweaking"?

Period after a binge where user feels intense depression, with near total depletion of brain chemicals and catecholamines, paired with intense craving for drug, with no relief from further use. This results in paranoia, agitation, AVH, insomnia, and misinterpretation of a person's movements and intentions. This is when these clients are most hostile, dangerous, and least predictable.

Inhalants

Permanent brain damage, sudden death

Toticollis

Persistent unilateral next president causing the head to rotate

Carl Rogers

Person Centered Therapy

Identity formation

Process that a person goes through in becoming a distinctive individual.

Habituation

Process where regular and prolonged use of a substance results in readjustment of physiological baseline. Often seen as "physical dependence", but not necessarily addiction.

VI. Workplace Standards OVERVIEW

Profession is founded on NATIONAL STANDARDS OF COMPETENCY which promote best interests of society, clients, individual addition professionals and profession as a whole - Ongoing education is needed for competency and development

Diaphoresis

Profuse sweating even when cool

V. Working in a Culturally Diverse World: SHALL NOT DISCRIMINATE

Pros wil not discriminate in professional or personal lives against persons in respect to RACE, ETHNICITY, NATIONAL ORIGIN, COLOR, GENDER, SEXUAL ORIENTATION, VETERAN STATUS, GENDER IDENTITY OR EXPRESSION, AGE, MARITAL STATUS, POLITICAL BELIEFS, RELIGION, IMMIGRATION STATUS AND MENTAL OR PHYSICAL CHALLENGES.

VIII: Resolving Ethical Issues 4. COOPERATION W/ INVESTIGATIONS

Pros will cooperate with investigations, proceedings, & requirements of ethics committees

III. Confidentiality: 2. Safeguarding privacy & exceptions

Pros will do everything possible to safeguard privacy and confidentiality of client info -EXCEPT when: 1) client has given specific, written, informed/limited consent 2) client poses risk of harm to self or others

IV. Prof Responsibility: Standard 2: Legal & Ethical Standards: 1. HONESTY REPRESENTING SELF

Pros will honestly represent their prof qualifications, affiliations, credentials and experience

Crisis Counseling

Refers to a time in which the client is facing complete upheaval of his world coupled with extreme frustration. Three States: External factors, Internal distress, and Transitional states

Schedule II

Severe dependence, high potential for abuse. Some accepted medical use, but with severe restrictions

Infectious Diseases *Hep B - How it is contracted*

Sharing dirty needles Unprotected sexual intercourse Mother to child at birth

In group treatment, direct communication refers to....

Sharing one's feelings about the other person, and using the pronoun, you, when speaking.

What are "Sherms"?

Sherman cigarettes dipped in embalming fluid, and dusted with PCP

Brief Therapy

Shorter time period and fewer sessions. Good for those without insurance, etc. Stages: Induction: ct makes decision to seek therapy and the clinician assesses the client's willingness to change. Therapy matches motivation level Alliance: Counselor forms an alliance with the ct. Clinician assesses impediments to change and motivation to change as well as setting goals and doing tx plan and contract Refocus/Change: working phase. every session is on task with homework, goal setting, applying lessons, etc. Termination/Homework: assist with relapse prevention. Set long term goals Continuation/Follow up: check in or f/u apt for as long s homework is planned. make sure that they are connected.

Dialectical Behavior Therapy (DBT) *What else is DBT used for?*

Shown empirically to be useful for substance dependence, depression, post- traumatic stress disorder (PTSD) and eating disorders.

Components of central nervous system

The brain and the spinal cord

Stages of Change *Precontemplation*

The client has not considered changing his or her condition

Person Centered Therapy *Basis*

The client, not the counselor directs the course of the treatment process

buprenorphine

a synthetic narcotic mainly used as a replacement therapy for opioid dependents

Therapeutic Communities (NA, etc)

are being used in the criminal justice field in the treatment of heroin addicts.

Opiate and opioid

are narcotics, psychoactive drug

Probing/Questioning

ask ct her a question to further explore his emotions or and experiences- open ended questions, one at a time, no blame

Clients should be informed of a supervisory relationship because:

the supervisor has a relationship with the client through the counselor.

drugs are most often removed from the body by

the users urine

Alcohol withdrawal, second phase

tremors, visual and auditory hallucinations, exaggerated startle response. feels hot, rapid pulse and high blood pressure.

type of ethics that answers the question "Who should I be?"

virtue ethics

Multiple of dosage affecting the fetus when a mother consumes ETOH

7 times the amount. This is why total abstinence is recommended during pregnancy

VII: Supervision & Consultation: 7. INFORMED CONSENT WITH SUPERVISEES

** Supervisors are responsible for incorporating principles of informed consent into the supervision relationship ***

Depressants Alcohol *What BAC level is considered toxic?*

*0.40 or higher* At this point, the individual is probably in a coma, with a good chance of death without immediate medical attention.

Neurotransmitters *Monoamines (e.g., catecholamines)* *Histamine*

*Controls inflammation of tissues, local immune responses, and allergic reactions* It also helps regulate emotional behavior and sleep.

Nitrous oxide

-Anesthetic gases used by dentists and physicians for small procedures -Oldest abused inhalant in the U.S. -Can be purchased in tiny, portable tubes called "whippets"

CBT

*Counseling that focuses simultaneously learning new behaviors and restructuring automatic thoughts *Used for depression, anxiety SUD, pain d/o and other disorders *Ct can be assisted in recognizing and discarding selfdefeating behaviors, emotions, etc *"What keeps them doing _____" Client must have willingness to change for this method to work. there must be commitment.

NAADAC Ethical Model *NAADAC's Decision Making Model*

*1)* Identify and define the problem *2)* Review the NAADAC Code of Ethics to determine which principles are applicable *3)* Consult with a supervisor and/or colleagues *4)* Consider any potential legal concerns and identify if consultation with an attorney is needed *5)* Identify all courses of action and their consequences *6)* Decide on a course of action *7)* Implement the course of action and document it appropriately *8)* Reflect on the outcome of the course of action

Principles *Principal 2 - Client Welfare* *Nine reasons to break confidentiality*

*1)* If the addiction professional is aware that the client poses *clear and imminent danger to him or herself or others*, then appropriate individuals need to be notified. *2)* In the event of *suspected child or elder abuse and/or neglect*, the addiction professional is ethically and legally obligated to notify the authorities. *3)* When addiction professionals *seek consultation with direct supervisors, co-workers or other members of the client's multidisciplinary addiction treatment team for further assistance, if necessary*. However, the individual providing consultation must also abide by confidentiality guidelines. *4)* When addiction professionals *consult with a physician or seek assistance for clients during a medical emergency if the client is incapacitated to the point that he or she cannot volunteer the information or give consent.* The addiction professional may also disclose personal information necessary for identification if the client is unable to do so. *5)* If a client *files an ethical complaint against an addiction professional*, the client forfeits his or her right to confidentiality so that the addiction professional may defend him or herself sufficiently in the matter. *6)* When addiction professionals consult with an attorney, in accordance with their rights, federal law and professional ethics. *7)* In connection to a crime that occurred on the premises or against a staff member. *8)* If a client is asking an insurance company to help offset the costs of his or her treatment. In this case, information regarding the client's diagnosis and attendance history will need to be released. *9) When the client has given expressed, written consent.*

Addiction Counseling Practices *Assessment generally has five major objectives*

*1)* To identify those who have a condition related to a psychoactive substance use disorder. *2)* To assess the full range of difficulties currently experienced by the client. The addiction counselor or other helping professional should rate the symptom severity, diagnose evident mental health disorders and screen for related difficulties or challenges; *3)* To plan appropriate treatment interventions for the client; *4)* To involve the appropriate family members or significant others in the client's evaluation and treatment; *5)* To determine the methods for evaluating the effectiveness of the treatment interventions that will be implemented.

Termination and Continuing Care *Primary Basis*

*1.* Assess and summarize the overall progress of the client *2.* Generalize how new behaviors will translate into the client's world; *3.* Notify the client that he or she will no longer receive treatment services and the date the termination is effective. *4.* Plan for continuing care with the client.

Infectious Diseases *HIV/AIDs People Infected who do not know?*

*1.2 million* people in the U.S. are living with HIV with about *1O%-15%* of them not being aware of being infected

*35.* When is a client fully prepared to enter treatment? a. Treatment is court ordered. b. Family pressures a client to enter treatment. c. Job-based drug testing creates a clear need. d. A client accepts the need for treatment.

*35. D: A client accepts the need for treatment* External events and pressures may persuade or even compel a client to enter treatment, and treatment admission may follow. However, true readiness is when a client perceives and then accepts the need for treatment. This typically requires the client to possess at least some insight into his or her condition, the associated costs and consequences, and a recognition that self-induced efforts have been unsuccessful. Finally, readiness involves a meaningful desire to effect change. The use of assessment instruments, such as the use of circumstances, motivation, readiness, and suitability scales can be particularly helpful in judging readiness for change.

*36.* Guiding principles in treatment planning are identified by which acronym? a. MTSRA b. MATRS c. MSRTA d. MRAST

*36. B: MATRS* This acronym represents the following guiding treatment planning principles: *M = measurable.* Goals and objectives must be clearly measurable so that progress and other changes can be identified readily and documented. *A = attainable.* Goals and objectives, and interventions as well, must be achievable (attainable) during the active treatment phase. *T = time limited*. The active focus of treatment should be on short-term or time-limited goals and objectives. *R = realistic.* It must be realistic for a client to complete the identified objectives of each goal within the specified time period. *S = specific*. Objectives, and associated interventions, must be sufficiently specific and goal focused to ensure progress toward attainment. A key element is involving the client directly in the planning process to ensure that the goals, objectives, and action steps are mutually derived to ensure client buy-in and commitment.

*43.* What of the following is NOT a key component in a treatment plan? a. Problem statements from the intake assessment b. Goal statements derived from problem statements c. Objectives, which are what the client will do to meet treatment goals d. The theoretical approach to be operationalized via treatment.

*43. D: The theoretical approach to be operationalized via treatment* The key components of a treatment plan include: (1) problem statements, which are based on information obtained during the assessment; (2) goal statements, which are derived from the problem statements; (3) objectives, which consist of what the client will do to meet treatment goals; and (4) interventions, which are defined as what the staff will do to assist the client. Relevant client strengths are often a required component. It is often useful to draw problems from a master problem list. The list should include all identified problems, regardless of available program services, and whether they should be immediately addressed or deferred. Identification of problems is a shared client-counselor endeavor. Problem statements should be nonjudgmental, jargon-free, and written in complete sentences. Couch problem statements in behavioral specifics to ease writing goals, objectives, and interventions.

*27. Which of the following is the MOST common distinguishing characteristic of a psychedelic drug?* a. altered perception b. depression c. increased alertness d. sleepiness

*A: Altered perception* The most common distinguishing characteristic of a psychedelic drug is that users experience an alteration of their perception of reality. Psychedelic drugs are sometimes called hallucinogens because what users experience is similar to hallucinations.

*57.* How many sequential stages must outpatient clients work through, regardless of the level of care at which they enter treatment? a. Two stages b. Four stages c. Six stages d. Eight stages

*57. B: Four stages* Independent of the levels of care defined by the American Society of Addiction Medicine *(ASAM)*, outpatient clients must work through four sequential stages of treatment, regardless of the entry treatment level of care. The stages consist of: Stage 1—treatment engagement (establish a treatment contract including goals and client responsibilities; resolve acute crises; develop a therapeutic alliance; and prepare a treatment plan); Stage 2—early recovery (continue abstinence; sustain behavioral changes; terminate a drug-using lifestyle and develop drug-free alternatives; learn relapse triggers and prevention strategies; identify and resolve contributing personal problems; and begin a twelve-step or mutual-help program); Stage 3—maintenance (solidify abstinence; deepen relapse prevention skills; enhance emotional functioning; increase sober social networks; and address other problem areas); Stage 4—community support (sustain abstinence and a healthy lifestyle; establish treatment independence; extend social network and support group connections; pursue healthy community activities; and solidify important outlet activities and pursue new interests).

*58.* What is the usual recommended minimum duration of days for the intensive outpatient treatment (IOT) phase? a. Thirty days b. Sixty days c. Ninety days d. One hundred twenty days

*58. C: Ninety days* The most common recommended minimum duration of days in an intensive outpatient treatment (IOT) phase is ninety days. However, research reveals that longer duration of care is related to better treatment outcomes—specifically, less substance use and better social functioning in clients over time. Consequently, it may be both advantageous and cost-effective to plan lower-intensity outpatient treatment over a longer time period to enhance treatment outcomes. The ultimate duration should be adjusted to meet the client's rate of progress, psychiatric status, support system, clinical needs, and so on. IOT programming is commonly provided for nine or more hours over three to five days per week. The consensus panel recommends six to thirty hours, depending upon client needs. For some clients, more frequent, shorter visits may be of greater benefit than fewer, longer sessions. For other clients, more or longer sessions, approaching the intensity of partial hospitalization, may be needed.

*78.* Two clients in a treatment group begin dating. What would a proper response be? a. Address program policy preventing dating among group members. b. Initiate a group activity to acknowledge their new relationship. c. Terminate treatment for both of the members. d. Terminate treatment for one of the members.

*78. A: Address program policy preventing dating among group members.* Most treatment programs have policies that prevent clients from engaging in intimate relationships that might undermine treatment. This typically includes prohibiting clients and counselors from socializing outside the confines of the program. Some programs also discourage any contact between clients outside the program's structured activities. Virtually all programs discourage dating, sexual relationships, moving in together, and other forms of significant involvement. However, many programs do encourage clients to collaborate in mutual-help group attendance, and some even encourage mutual support in other meaningful aspects of their lives. Where boundary issues occur, options include assigning one of the clients to another group or providing individual counseling to one while waiting for the other to complete the program. Should mutual substance abuse occur, recommitment contracts and renewed abstinence contracts may be needed. Regardless, it is important for counselors to fully understand the boundaries within the treatment program and to consistently apply these guidelines.

Infectious Diseases *Hep C Rates*

*9O%* of those who inject drugs and share needles will eventually contract the hepatitis C virus For *15% to 25%, it is an acute illness* with full recovery, but for *75% to 85%* of those infected with the hepatitis C virus, it becomes a chronic, long-term infection

*1. Which of the following is the BEST description of a drug?* a. a substance taken for a desired effect (other than food, water, or air) b. any substance taken for effect c. a substance used to produce a high d. a substance that can have both positive and negative effects

*A: A substance taken for a desired effect (other than food, water, or air)* 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.*

*95.* When behaviorally assessing for a co-occurring disorder, what is the MOST important variable to consider? a. Alcohol or drug toxicity or withdrawal symptoms b. The client's denial of any psychiatric problem c. The client's family history of psychiatric disorders d. The client's immediate behavior

*A: Alcohol or drug toxicity or withdrawal symptoms* Client information, immediate behaviors, current medications, family history, and so on may well be indicative of a co-occurring disorder. However, they are not definitive criteria. The diagnosis must be proven or validated by the client's ongoing clinical presentation. Symptoms of withdrawal, as well as those of acute or chronic alcohol and drug toxicity, can readily present as a psychiatric disorder. They can also mask underlying psychiatric symptoms. True psychiatric symptoms often become apparent during the early stages of abstinence. Program staff should recognize that co-occurring disorders are common. Beyond the client's clinical presentation, additional attention should be given to: (1) the psychiatric history of the client and his or her family, especially documented diagnoses, prior treatment, and any psychiatric hospitalizations; (2) medications and medication compliance; and (3) ongoing symptoms and mental status changes over time. As the assessment proceeds, caution must be taken to ensure the client is properly treated for any serious medical withdrawal problems. Other safety issues, such as suicidality or homicidality and any inability to function, communicate, or care for oneself also should be responded to aggressively.

*73. What does a release of information form do?* a. allows the therapist to transfer confidential information to the party specified by the patient b. gives the therapist the right to transfer patient information to whomever the therapist feels should have it c. releases patient information only within the treating facility d. keeps information about the patient private

*A: Allows the therapist to transfer confidential information to the party specified by the patient* A release of information form is a written form that the patient signs and in which the patient specifies to whom the confidential information can be released.

Uses of barbiturates

-Anticonvulsants -Sedatives -Analgesics -Anasthetic

*114.* Sensitive interviewing and engagement techniques are important to optimize client responsiveness and investment. What does the ask-tell-ask technique refer to? a. Asking permission of the client to talk with them, telling them of any concerns you have, and then asking for their thoughts on what you shared b. Asking clients what they understand, telling them where they are wrong, and asking again if they understand c. Asking clients for their opinions, telling them where their opinions are valid and workable, and then asking them if they concur d. Asking clients to listen, telling them what they need to know, and asking if they will acquiesce to what is being asked of them

*A: Asking permission of the client to talk with them, telling them of any concerns you have, and then asking for their thoughts on what you shared* When making referrals, it is important to carefully inform clients of your concerns and reasons and then to engage them in ways that do not induce obstruction. The ask-tell-ask technique can assist in this. Further, providing ample information, background, and personal insights into referrals can also assist. To this end, it is important for case managers to be intimately familiar with their referrals, having completed site visits, meeting with provider staff, and in other ways becoming well prepared to put clients' concerns to rest. Finally, all substance abuse communications should be conducted away from clients' families and other staff, and any further sharing should take place only after receiving clients' express permission to that end.

*34.* Circumstances, Motivation, Readiness, and Suitability (CMRS) Scales are used for what purpose? a. Assessing client readiness for treatment b. Assessing various financial and family support domains c. Assessing client suitability for research participation d. Assessing clients for treatment level of care

*A: Assessing client readiness for treatment* CMRS scales, by G. De Leon, were developed to aid in determining client readiness for substance abuse treatment. The scales measure client perceptions in four interrelated domains: circumstances (the external pressures influencing substance abuse change), motivation (internal pressures driving change), readiness (perception and acceptance of the need for treatment), and suitability (the client's perception of the appropriateness of the treatment modality or setting) for community or residential treatment. CMRS scales consist of eighteen Likert-type (five-point, strongly disagree to strongly agree) response items. The scores are summed to derive a total score. Research on validity and reliability has offered strong support for the CMRS scales.

*49. When a counselor adopts a relaxed posture, good eye-contact, and a pleasant tone of voice, the counselor is...* a. attending. b. empathizing. c. focusing. d. trying to counsel.

*A: Attending* A basic counseling skill is attending. The counselor adopts a relaxed body posture, maintains eye contact with the patient, and speaks in an even, pleasant tone as a manner by which to communicate attentiveness to the patient. This helps facilitate a positive counseling relationship.

*148.* Clients with a history of abuse have a tendency to place themselves in situations in which further abuse is likely, particularly an unsafe relationship. If this occurs, what is the counselor's BEST response? a. Coach them to explore the situation, issues of risk, and self-endangerment. b. Point out to them the issues that are obvious to the counselor. c. Provide a lecture on issues of abuse recovery and important safety concerns. d. Contact the unsafe individual, and intervene on the client's behalf.

*A: Coach them to explore the situation, issues of risk, and self-endangerment.* Many survivors of significant abuse tend to put themselves in further high-risk situations. Their counter-transference issues with the counselor may draw the counselor into the role of rescuer as they seek the safety, nurturance, and security they deeply desire. If the counselor is not fully self-aware, he or she can be pulled into this dynamic in seeking to defend and support the client. In doing so, however, the client moves into dependency and fails to learn how to identify and set appropriate boundaries in his or her own life. Over time, the concerned counselor may over treat, lend funds, arrange child care, and otherwise inappropriately respond. The counselor may also attempt to intervene with others on the client's behalf and find him- or herself polarized from a client that is now angry with the counselor for intruding into important family or other relationships. While rescuing may temporarily relieve the counselor's concerns and frustrations, it will never provide long-term resolution of the problems.

*118.* In a client's efforts to maintain emotional and psychological balance, what does the term bookend refer to? a. Discussing a trigger event with someone trusted before and after it occurs b. Fully reading and applying reference literature provided in the program c. Remaining steadfast even in the face of temptation to abuse a substance d. Keeping a difficult issue on the shelf until it can be better dealt with

*A: Discussing a trigger event with someone trusted before and after it occurs* Trigger events are often crisis stressors or situations (e.g., notice of divorce, job loss, an impending holiday or anniversary, or visiting someone in an old neighborhood where past friends may again invite and encourage using, etc.). Clients are encouraged to anticipate such events and then bookend them—talking about them with a trusted friend (e.g., a twelve-step sponsor, close confidant, trusted friend, etc.) both before and after they occur. In this way, the client can prepare to remain strong and then debrief and decompress emotionally in order to continue strong in his or her abstinence commitments. A counselor can be of further assistance, addressing the client's specific strengths and weaknesses in order to shore up the client's resolve. In this way, the client can be assisted in avoiding a return to past familiar dysfunctional responses. Mometrix Test Preparation. Addiction Counselor Exam Practice Questions (First Set): Addiction Counselor Practice Tests & Review for the Addiction Counseling Exam (Kindle Locations 1410-1416). Mometrix Test Preparation. Kindle Edition.

*54.* Which of the following is NOT a primary learning style? a. Gustatory b. Kinesthetic c. Auditory d. Visual

*A: Gustatory* Gustatory refers to the sense of taste and is not a learning style. To learn, we utilize our senses to process information around us. When learning, most people use one of their senses more than the others. There are actually seven learning styles: (1) aural (auditory-musical): learning through sound; (2) visual (spatial): learning via images; (3) verbal (linguistic): learning through words; (4) physical (kinesthetic): learning via touch; (5) logical (mathematical): learning through logic; (6) social (interpersonal): learning best with others; (7) solitary (intrapersonal): learning through self-study. The three most common learning styles are visual, auditory, and kinesthetic. Consequently, programs should explore the use of videotapes, behavioral rehearsals or role plays, written materials, lectures, discussions, workbook assignments, and daily logs or journals. In this way, all primary learning modes can be met.

*138.* Accurate documentation and reports are necessary if effective treatment and recovery plans are to be developed and implemented. Which of the following is NOT fundamental assessment information at intake? a. Documentation regarding referrals and referral outcomes b. Psychoactive substance abuse history and patterns of use c. Psychological health and psychiatric treatment history d. Current physiological health and medical history

*A: Documentation regarding referrals and referral outcomes* It is very important to document all referrals made along with related outcomes. In this way, the full range of services a client is receiving and has received is known, and the effectiveness of any referral services can also be followed and measured over time. However, referrals are not part of the intake and evaluation process. Essential intake assessment information includes: (1) psychoactive substance abuse history and patterns of use; (2) psychological health and psychiatric treatment history; (3) current physiological health, nutrition, and medical history; (4) medications history and current medications; (5) basic demographic and social information; (6) legal history (arrests, sentences, probation or parole status, etc.); (7) educational history; (8) recreational activity history; (9) religious or spiritual history and current beliefs; (10) sexual orientation; (11) high-risk sexual and substance use practices, if any; and (12) family history and current support network.

*41.* All of the following are true of depression and substance abuse EXCEPT that a. drugs of abuse can successfully treat depression. b. depression can lead to self-medication with drugs of abuse. c. drugs of abuse can induce symptoms of depression. d. drugs of abuse can worsen symptoms of depression.

*A: Drugs of Abuse can successfully treat depression* Drugs of abuse are not able to successfully treat depression. While transient relief can be experienced, the subsequent withdrawal depression invariably serves to worsen the original symptoms. Among the most common assessment tools for depression is the twenty-one-item Beck Depression Inventory, now in its second revision (BDI-II). The BDI is designed for use with individuals between the ages of thirteen and eighty. It can be utilized as a self-report instrument, or administration may be provided by a verbally trained administrator. The new format is inclusive of a prior two-week period, and other items were revised to assess both increases and decreases in sleep and appetite, better allowing formulation of a DSM diagnosis.

*2. Psychoactive drugs are drugs that...* a. alter behavior or mood. b. alter only mood. c. alter only behavior. d. have little or no effect on mood or behavior.

*A: Drugs that alter behavior or mood* Many drugs have an effect upon the physiology of the user (such as birth control pills), *but do not alter behavior or mood—those types of drugs would not be termed psychoactive.*

*15. What do short-term effects of drug use refer to?* a. effects while the drug is still in the user's body b. psychological effects prior to drug ingestion c. physiological effects of drug use only d. only psychological effects of drug use after the drug enters the user's system

*A: Effects while the drug is still in the user's body* The short-term effects of drug use can be either physiological or psychological, and vary significantly from individual to individual.

*16.* At an initial meeting with a new client, what is the FIRST requirement? a. Establish rapport. b. Evaluate readiness for change. c. Review rules and expectations. d. Discuss confidentiality regulations.

*A: Establish rapport* Exploring readiness for change, rules and expectations, or issues of confidentiality may otherwise serve only to induce client anxiety, defensiveness, or rejection of potential treatment outright. The counselor must generate an authentic and safe environment that is conducive to trust and disclosure. This can be achieved, from a motivational perspective, by assuring the client that he or she will not be told what to do, but rather, help will be given in deciding what he or she is seeking to accomplish. A direct request about what has brought the client in can be helpful if they are ready to talk openly. Otherwise, asking about health, work, or family challenges may provide an oblique entry to asking about substance issues (e.g., "How is this affected by your substance abuse?"). As rapport grows, issues of confidentiality, program requirements (e.g., whether or not sessions can be held in spite of intoxication, etc.), session length, evaluation of change readiness, and so on, can then more naturally unfold.

*84. You find that recording therapy sessions works well for you. In relation to this practice, what should you do?* a. explain the purpose of the recording, and obtain the patient's permission b. do not inform the patient of the recording, as this can inhibit the patient's participation in therapy c. tell the patient about the recordings, but only after treatment is completed d. tell the patient that you will be recording therapy sessions

*A: Explain the purpose of the recording, and obtain the patient's permission* The therapist should inform the patient of the recording, but also gain permission to record. This is also the case when having students involved in treatment or when any other observation by third parties is allowed.

*20. Intellectual disability and growth retardation and physical deformities are common symptoms of...* a. Fetal Alcohol Syndrome. b. heroin post-birth addiction. c. all prenatal drug use. d. overuse of prenatal pain killers.

*A: Fetal Alcohol Syndrome* Women who habitually use alcohol while pregnant can cause permanent damage to their children, including mental, growth, and physical issues.

*21.* What does the acronym GATE stand for? a. Gather information; Access supervision; Take responsible action; Extend the action b. Gather resources; Access procedures; Take clinical notes; Extend the intervention c. Gather documentation; Access contacts; Take counsel; Extend positive outcomes d. Gather the team; Access records; Take consultation; Extend documentation

*A: Gather information; Access supervision; Take responsible action; Extend the action* GATE was established by a consensus panel addressing the evaluation of suicidal ideation and behaviors by substance abuse counselors working with at-risk clients. It consists of activities that are well within the practice scope of a substance abuse counselor. Gathering information involves (1) screening for suicidality and (2) observing for warning signs. Screening involves direct questions regarding current thoughts (plans, means, or preparations) and any past history of attempts. Accessing supervision or consultation (even if the counselor already has specialized training) ensures issues of risk are fully evaluated. Taking responsible action protects client well-being and safety. Extending the action involves securing follow-up and ongoing monitoring as needed. In this way, GATE fully assesses and addresses suicidality. The final step is thorough documentation to secure a medical and legal record of the care provided.

*76. The experience of substance abuse...* a. is unique to each individual. b. is pretty much the same from person to person. c. can always be treated with standard treatment plans. d. is the same from female to female, but differs in males.

*A: Is unique to each individual* The experience of substance abuse, although clinically similar in some respects among patients, is always unique to the individual. Every person has a unique situation, reaction to addiction, coping skills, etc.; therefore, treatment must be approached in a manner that is specific to each individual patient.

*12. Why do some users prefer the route of injection for drug administration?* a. It provides a fast and high-peak effect. b. It is easier to inject a drug than to take it other ways. c. Needles are safer to use than other routes. d. Injection has a lower chance of overdose.

*A: It provides a fast and high-peak effect* Some users prefer injection for two main reasons. Injection not only provides a fast means of getting the drug into the user's system, but it also allows for a higher peak intensity.

*134.* The number of older adults is rapidly increasing in the United States and worldwide. As a group, when receiving appropriate treatment for substance abuse, how are older adults likely to act? a. Less likely to continue to use alcohol or drugs b. About as likely to continue to use alcohol or drugs c. More likely to continue to use alcohol or drugs d. Insufficient data to make these comparisons

*A: Less likely to continue to use alcohol or drugs* Older adults are particularly receptive to treatment for drug and alcohol abuse. However, they are less likely to be identified as having a problem compared with the general population. The reasons for this include: (1) they are more likely to feel shame over the problem; (2) they are more likely to be covert about any substance abuse problems; (3) they are less likely to recognize they have a problem as much of the abuse may involve prescription medications, which they tend to justify; (4) they are unaware of interaction problems between alcohol and prescription drugs; (5) they often have physical conditions that may obscure their substance abuse, making it difficult to diagnose. Because of these factors, abuse among the elderly may more likely be spotted via screenings at wellness centers than by drug abuse outreach programs. Finally, this population has special needs, and age-appropriate treatment is essential for optimal outcomes.

*141.* Accurate records are the basis for the treatment plan and measuring client progress. If something is entered in a client record in error, what is the proper response? a. Line through the error, writing error and initialing and dating the change b. White-out or otherwise obscure the error to fully eliminate it from the chart c. Remove the erroneous page and recopy all correct information onto a new page d. Black out the error using a felt pen to ensure the error cannot be read

*A: Line through the error, writing error and initialing and dating the change* No information should be obliterated in a client record. It is only appropriate to line it out with a single line and indicate that the information was entered in error, when, and by whom. Generally, black ink should be used, every page should have a header with the client's name, and all notes should be concluded with the author's signature and any relevant acronym indicating a relevant degree, certification, or licensure. All notes should address interventions and client responses along with references to any related goals or objectives. No other clients should be named in another client's record, limiting references to others by the first name or initials only, if necessary, or by relationship status if adequately clear. Blank areas on a page should be avoided. If a blank space is left, it should be lined through with one or more diagonal lines. Charts should never leave a facility except for purposes of audit.

*31. Which of the following is a drug often used in treatment for narcotic addition?* a. methadone b. marijuana c. psilocybin d. nicotine

*A: Methadone* Methadone is often used in the treatment of those with narcotic addictions. It is a synthetic narcotic, the effects of which allow the user to feel and act in a more natural manner.

*133.* Although most individuals with cognitive and physical disabilities desire to work, many are unable to do so. In consequence, as related to substance abuse and the general population, how is this population likely to act? a. More likely to use alcohol or drugs b. About as likely to use alcohol or drugs c. Less likely to use alcohol or drugs d. Insufficient data to make these comparisons

*A: More likely to use alcohol or drugs* Given their disabilities, those who are cognitive or physically disabled are unable to find work and yet also spend a larger share of their income to meet the needs of their disabilities. Consequently, poverty, depression, unmedicated pain, functional limits, and vocational difficulties leave this group particularly vulnerable to drug and alcohol abuse. Further, because of these same cognitive or functional disabilities, coupled with limitations in networks and resources, members of this group are not only more likely to develop a substance abuse problem but less likely to receive treatment for the problems they do develop. In particular, learning disabilities are common among this population, and these learning obstacles also make what treatment they do receive less effective. In consequence, programs more carefully tailored to the needs of this population are very much needed.

*107. When older adults enter treatment, how do their rates of attendance and incidence of relapse, compare to their younger cohorts? a. Much higher attendance and much lower relapse rates b. Somewhat higher attendance and modestly lower relapse rates c. No real difference in attendance or relapse rates d. Much lower attendance and much higher relapse rates

*A: Much higher attendance and much lower relapse rates* When the many barriers to entering treatment are overcome, older adults tend to have substantially better attendance and a significantly lower rate of relapse that are found among younger adults in treatment. Research also indicates that these positive performance measures continue, even if older adults are brought into mixed-age treatment settings. However, the optimum outcomes are dependent upon seniors receiving age-appropriate, individualized treatment services. Seniors often do not envision themselves as abusers—particularly when over-the-counter or prescription drugs are at issue—and they often misunderstand problems arising from alcohol and drug interactions. Consequently, many will need to be reached through health promotion, wellness, social services, and other resources that work with older adults. To this end, program providers need to be involved actively with local aging networks, including home- and community-based short- and long-term care providers. These same external resources can often also assist with specialized cultural, ethnic, and language resources as needed.

*22.* To which of the following do assessment processes and instruments NOT need be sensitive? a. Political orientation b. Age and gender c. Race and ethnicity d. Disabilities

*A: Political Orientation* Political orientation is not typically a sensitive issue in the assessment process. Comprehensive assessment domains include: (1) complete substance abuse history (all substances past and recently used, modes of use, frequency and amounts, etc.); (2) full addiction treatment history (when, where, how long, etc.); (3) significant physical and mental health history (including medications and ongoing care needs, suicidality, etc.); (4) familial history and current issues (marital status, family supports, etc.); (5) educational history; (6) employment history (and current issues); (7) legal or criminal history (including any ongoing matters such as pending court, probation, parole, etc.); (8) emotional, psychological, and perceptual concerns (worldview issues); (9) spiritual or religious issues; (10) lifestyle concerns (sexual orientation, housing transience, etc.); (11) socioeconomic factors (finances, work benefits, insurance, etc.); (12) prior community resource use; (13) cognitive capacity and behavioral functioning; (14) readiness for treatment.

*34. To which of the following has long-term cocaine use sometimes been linked?* a. psychosis b. depression c. feelings of low self-worth d. schizophrenia

*A: Psychosis* Irritability is commonly seen with cocaine use that is heavy and long-term. This tendency has even been seen to proceed to psychosis.

*13.* Regarding substance abuse, what does Convergence Theory propose? a. Rates of substance abuse among women are converging with those of men. b. All individuals eventually narrow drug use to a drug of choice preference. c. Age is a key factor in eventual substance abuse abstinence. d. As individuals age, gender disparities in rates of abuse tend to converge.

*A: Rates of substance abuse among women are converging with those of men* 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.

*82. While your patient is seeing you for a substance abuse problem, you begin to see indications of bipolar disorder. What should you do?* a. refer to, or consult with, a clinician trained in bipolar disorder b. treat for the bipolar disorder as well as the substance abuse c. discontinue treatment d. continue to treat for the substance abuse problem only

*A: Refer to, or consult with, a clinician trained in bipolar disorder* A therapist should never treat a patient for something the therapist is not trained in. In this case, it would be best either to refer the patient to another therapist, or enter into co-therapy with a therapist trained in bipolar disorder.

*66. A post-session technique in group therapy does what?* a. reinforces insights b. helps patients ease back into their daily routines c. maintains order d. keeps patient accounting in order

*A: Reinforces insights* The post-session technique in group therapy allows for patients to stay after the group therapy session and discuss the insights gained that day in treatment. It is also a good way to minimize tensions or other miscellaneous issues that came up as a result of therapy.

*51. Paraphrasing involves...* a. repetition. b. paraprofessional phrasing techniques. c. using clinical phrases during the counseling session. d. only listening skills.

*A: Repetition* Paraphrasing is a useful counseling skill that involves repeating back to the patient what was said, only in a more concise manner and in the counselor's own words.

*77. Your patient tells you that he or she sometimes loses control and abuses the patient's 5-year-old daughter. What should you do?* a. report the abuse to the appropriate authorities b. maintain confidentiality and work with your patient on control issues c. contact a family member and urge that person to report the abuse d. tell your patient that if the abuse doesn't stop, you will report the patient to the authorities

*A: Report the abuse to the appropriate authorities* Although confidentiality is certainly to be protected, there are a few specific situations where it must be broken. The abuse of a minor is one such situation where it is permissible to break confidentiality.

*36. Janie has bipolar disorder and is struggling to hold a job. She excessively uses alcohol to help her sleep at night and now cannot fall asleep without it. Her issue with alcohol could be said to be...* a. secondary. b. primary. c. adjunctive. d. fundamental.

*A: Secondary* A secondary problem is one that exists in addition to what is causing the patient's difficulties

*38. Self-medication MOST closely refers to...* a. self-administering drugs with therapeutic intent.* b. heeding a professional's direction in regards to medication. c. self-administering drugs with direction from a professional. d. self-medicating with illegal drugs.

*A: Self-administering drugs with therapeutic intent* Self-medication refers to an individual deciding for himself or herself what medication is needed for a problem and taking the medication without direction. Although done with therapeutic intent, the therapeutic need for the medication is not confirmed by a health professional

*38.* How many problem domains are addressed in the Addiction Severity Index (ASI)? a. Six b. Eight c. Ten d. Twelve

*A: Six* The Addiction Severity Index (ASI) addresses six problem domains: (1) medical status, (2) employment and supports, (3) alcohol and drug use, (4) legal status, (5) family and social status, and (6) psychiatric status. At times, alcohol and drug abuse are separated, resulting in a total of seven domains. It is important, however, to emphasize that the ASI is not a comprehensive instrument. For example, it does not ask questions regarding pregnancy or homelessness, for example, even though either of these issues may be of crucial importance to the client. The ASI was designed to primarily explore issues of addiction and other common, closely related issues. The goal of the ASI is to produce a standardized baseline, ensuring that all counselors consistently ask the basic questions (an important construct of research reliability in data gathering). Additional questions may need to be asked to ensure that the client's needs are fully understood and incorporated into any forthcoming treatment plan.

*90.* What is the Matrix Model designed to treat? a. Stimulant abuse b. Alcohol abuse c. Barbiturate abuse d. Inhalant abuse

*A: Stimulant Abuse* The Matrix Model (also referred to as neurobehavioral treatment) was formulated during the 1980s' spike in cocaine and methamphetamine abuse. The model utilizes a complementary set of evidence-based practices coordinated and delivered as a program. Drawing upon cognitive-behavioral therapy, motivational interviewing, and findings from relapse prevention literature, combined with educational support and twelve-step program involvement, the model seeks to coordinate and optimize evidence-based treatments and support resources. Guiding principles include: (1) developing a positive therapeutic relationship; (2) applying a scheduled structure and expectations; (3) educating participants and families regarding brain chemistry, cravings, recovery, and relapse prevention; (4) incorporating cognitive-behavioral concepts for change; (5) reinforcing positive behavioral changes; (6) outlining the expected course of treatment and recovery; (7) promoting self-help (twelve-step) participation; and (8) using regular drug testing (urinalyses) to track progress.

*97. To be a truly proficient substance abuse counselor, you must...* a. have successfully completed your educational training. b. have had close relationships with substance abusers at some point in your life. c. have been a past substance abuser yourself. d. have natural ability as a therapist.

*A: Successfully completed your educational training* Some people believe that to be a competent substance abuse counselor, one must have been a substance abuser in the past. This is not true. A past abuser can be a good counselor, but having once abused is not a requirement of competency.

*93. John Smith was a patient of your residential program six years ago. You run into his brother at the grocery store, and he asks you if John has been in treatment. What should you do?* a. tell him nothing b. say you don't know c. say that John is no longer in treatment, but give no details d. tell him that John was in treatment years ago

*A: Tell him nothing* Confidentiality extends beyond the time that the patient is in treatment. In this example, even though John Smith is no longer in treatment, it is still not permissible to discuss any information about him—even with a family member.

*83. A young person meeting with you for the first time asks if treatment will be effective for him or her. What should you say?* a. tell the person that treatment is not always effective b. assure the person that treatment will work c. reassure the person that treatment will work if the person commits to it d. explain that treatment works to varying degrees for each individual patient

*A: Tell the person that treatment is not always effective* It is unethical to present therapy as always effective for every individual. A therapist should never misrepresent his or her ability or training, or the effectiveness of therapy.

*45. Which of the following is NOT related to concreteness in counseling?* a. theorizing about the patient's relationships b. focusing on the facts c. avoiding tangents d. keeping communications specific

*A: Theorizing about the patient's relationships* Concreteness in a counseling session is important because it keeps the conversation on-track and avoids wasting time on tangents and insignificant material. Staying concrete makes for a more efficient and effective counseling session.

*125.* Treatment for longer periods of time is closely associated with enhanced outcomes. What is the baseline duration for improved outcomes? a. Three months b. Six months c. Twelve months d. Eighteen months

*A: Three months* While longer is generally better, the positive effects of treatment duration typically begin to emerge at around three months. In planning treatment, the Institute of Medicine adds: (1) there is no one best treatment approach; (2) inpatient (residential) has not been proven superior to outpatient approaches; (3) outcomes improve if other related life problems are also treated; (4) outcomes are influenced by the treatment process, client-therapist characteristics, aftercare adjustment, and interactions among these variables; (5) many life areas improve with significant reductions in use or total abstinence. Finally, when comparing the management success of chronic ongoing-maintenance medical conditions (asthma, diabetes, and hypertension) with relapse rates for cocaine, nicotine, and opiates, the overall treatment response rates were similar, highlighting the similar compliance and behavioral change requirements involved and human nature in meeting these requirements.

*126.* There are numerous classification systems describing various stages of recovery. However, how many stages does the most common stage classification provide for? a. Three stages b. Four stages c. Six stages d. Eight stages

*A: Three stages* The three most common recovery stages are described as: early recovery, middle recovery, and late recovery or maintenance. Key features of early recovery include entering treatment, embarking on abstinence, and staying sober. Early recovery, however, is very fragile, and relapse vulnerability remains high. This stage of recovery typically lasts from one month to one year. Key features of middle recovery include: greater confidence in abstinence grows; cravings persist but are recognized and deflected successfully; lifestyle and personality trait changes are progressing; and although relapse vulnerability persists, it is becoming less significant. Middle recovery lasts at least a year but may continue indefinitely (failing to progress or serial relapsing). Key features of late recovery or the maintenance stage are: maintaining abstinence while also improving life in other related areas; addressing psychological or relationship issues that became apparent through abstinence; and continuing all relapse prevention behaviors and skills previously learned.

Depressants Alcohol *Late Stage Dependence*

*Anyone who must drink in order to function* This stage of alcohol dependence usually entails prolonged drinking binges, consuming alcohol to *intentionally delay withdrawal symptoms*, alcohol psychosis, nutritional diseases due to high alcohol intake, frequent intoxication, intoxicated behavior that is inconsistent with behavior when sober, and blackouts. Physical changes resulting from alcohol dependence are more obvious at this stage and thus, more easily documented.

*60. The intervention stage of treatment primarily focuses on...* a. termination b. problem-solving c. assessment d. easing out of the counseling relationship

*B: Problem-solving* During the intervention period of treatment, patient and counselor are focused on solving the patient's problems as set forth in the assessment stage of counseling. It is during this time when understanding and change are sought.

II. Eval, Assessment: Standard 6: RELEASE OF DATA TO QUALIFIED PROFESSIONALS

- info from assessments released to other pros ONLY WITH SIGNED RELEASE OF INFORMATION FORM, or such release from client's legal rep. - info released only to persons recognized as qualified to interpret the data.

*72.* What is the primary purpose of the Texas Christian University Drug Screen (TCUDS)? a. To identify those with versus those without issues of drug dependency b. To establish a roster of the kinds and severity of drugs used in the past c. To evaluate dangerousness and risk taking in drug use patterns d. To correlate drug use patterns with emerging health concerns

*A: To identify those with versus those without issues of drug dependency* The Texas Christian University Drug Screen *(TCUDS)* scale is able to distinguish between individuals with drug use disorders as opposed to those who misuse drugs but are not physically and psychologically dependent. The TCUDS instrument consists of twenty-five questions administered in less than five minutes. The TCUDS is frequently used in adult criminal justice settings. However, it is also appropriate for use in the general population. The TCU Drug Screen II (TCUDS II) is a standardized fifteen-item screening tool also designed to identify any current history of heavy drug use or dependency. Items on the TCUDS II are designed to meet the criteria found in the Diagnostic and Statistical Manual (DSM) and the NIMH Diagnostic Interview Schedule (NIMH DISC). The scale is divided into two parts, with the first assessing drug and alcohol use problems and the second addressing frequency of use and the individual's readiness for treatment. The TCUDS II can be used in an interview setting, or it can be self-administered.

*65. What is role reversal?* a. trading roles with another person in the group b. explaining why one feels the way one does c. sharing one's feelings about the other person d. stating the reasons behind the question being asked

*A: Trading roles with another person in the group* This technique can help group members understand why a particular member thinks, acts, and feels the way he or she does. It involves two members pretending to be the other, and sharing their viewpoints within that role.

*96.* How are substance abuse treatment programs for adolescents described? a. Very different from treatment programs for adults b. Somewhat different from treatment programs for adults c. Minimally different from treatment programs for adults d. Not at all different from treatment programs for adults

*A: Very different from treatment programs for adults* The physical, emotional, and cognitive changes of this developmental period make treatment more complex. Physical changes are marked by rapid growth, hormonal fluctuations, and the development of secondary sex characteristics. Cognitively, attention spans are shorter, projected awareness of the future is poor, abstract thinking skills are inconsistent, and impulsivity is high. Ideals, morals, and values are still developing, and intellectual interests are expanding. Not until late adolescence do youth become substantially aware of the consequences of their actions, thus allowing meaningful goal setting. The onset of substance abuse in this population is frequently associated with family dysfunction, parental substance use, peer influence, and troubled personal choices. Genetic background and cognitive dysfunction may also play a role. Other risk factors include: (1) a history of personality problems, poor parental or guardian relationships, academic failure, family disruption, and past victimization. An adolescent treatment provider must successfully cope with developmental, behavioral, psychiatric, family, and other treatment challenges. Most will only superficially resemble the challenges of adult clients.

*122.* Group work is utilized extensively in substance abuse treatment. How do group therapy and 12-step groups compare? a. Very different types of groups with very different purposes b. Somewhat different group types with modestly different purposes c. Inherently similar groups, though with some different purposes d. Different names for the same groups with the same purposes

*A: Very different types of groups with very different purposes* Just as individual therapy is a far more private, personal, and in-depth therapeutic modality, so is group therapy very different from twelve-step programming. Although both groups are complementary and important, a therapy group focuses on helping individuals to examine, understand, and interpret the intrapsychic and interpersonal influences and conflicts that motivate and perpetuate substance abuse. In contrast to this, twelve-step program practices are centered on drawing upon focuses such as affiliation, peer confrontation and support, and creating a culture of abstinence and the mutual accountability to sustain it. While both modalities can, for example, address denial, the twelve-step process confronts and breaks it down, while group therapy explores what produced it in the first place. Thus, group therapy is far more complex and requires highly specialized skills and experiences to effectively carry it out. Borrowing from twelve-step programming dilutes the group therapy venture and can lead to partial or complete failure of the group therapy process as the profound potential for psychological growth, emotional healing, and self-understanding remain neglected.

*66.* Adjunctive therapies refer to all EXCEPT which of the following? a. Vocational training b. Stress management c. Meditation d. Acupuncture

*A: Vocational Training* Education, vocational training, and employment issues are core support concerns but do not constitute adjunctive therapies. Adjunctive therapies are used to enhance the emotional and psychological functioning of clients laboring to overcome an addiction. Given the pressures of foregoing their substance of choice, individuals in recovery need alternative outlets for stress as well as better self-care skills. To this end, creative media groups (e.g., dance, drama, music, crafts, and arts) can be very therapeutic and helpful in the recovery process. Other alternative therapies include acupuncture and biofeedback therapy. Both of these can aid in reducing stress and in learning relaxation skills. Similarly, a variety of meditation techniques can be particularly helpful. Mediation techniques include approaches such as mindfulness (learning to appreciate the present), visualization (positive imagery), breath meditation (learning to focus and control thinking and the body), and transcendental meditation (deep awareness and consciousness). As an adjunct to substance abuse treatment, meditation is in harmony with the intent and philosophy of twelve-step and other mutual self-help groups.

*90. Your patient in a residential treatment program becomes agitated and is wildly striking out at everyone in the patient's path. May you physically restrain the patient?* a. yes b. no c. only if you have written instructions from the physician d. only if the patient consents

*A: Yes* In this situation, the patient is a possible threat to himself or herself and others. In this emergency situation, it would be permissible to restrain the patient. However, unless it is an emergency, a physician's written instructions are required to restrain a patient.

*55. Is a counselor a role model?* a. yes b. no c. no, but a few unstable patients will see it that way d. maybe

*A: Yes* Whether or not counselors like to see it that way, they are role models because they are commonly viewed as experts who know what is best to do in any given situation. For this reason, counselors should take steps to represent themselves well in their lives.

*84.* Staff familiarity with twelve-step program facilitation is important because of all of the following EXCEPT that a. clients feel more pressure to attend twelve-step programs by these staff. b. clients are more easily motivated into twelve-step programs by these staff. c. clients' concerns are more meaningfully resolved by these staff. d. clients generally remain abstinent longer with twelve-step involvement. involvement.

*A: clients feel more pressure to attend twelve-step programs by these staff.* Clients are less likely to feel pressure to attend twelve-step groups by staff very familiar with the twelve-step approach. Rather, they are more likely to feel they receive useful encouragement and support from these staff persons. To ensure adequate familiarity, staff (particularly those with no past experience receiving substance abuse treatment) are encouraged to: (1) read Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Cocaine Anonymous (CA), and other twelve-step program literature; (2) frequently attend open twelve-step meetings; (3) attend a diversity of twelve-step groups to better identify the unique milieu of those programs available (especially groups that are open to clients with co-occurring psychiatric disorders); and (4) study thoughtfully to ensure that they deeply understand the beliefs, values, and mores that undergird the twelve-step fellowships. In this way, staff can be particularly supportive and directive as clients explore the twelve-step approach to recovery and ongoing abstinence.

*63.* Topics addressed in psychoeducational groups are typically a. sequenced by concept for maximal effectiveness. b. presented as requested or needed by group participants. c. selected randomly by the group educator or presenter. d. determined by the group's prevailing drug of choice.

*A: sequenced by concept for maximal effectiveness.* Substance abuse and recovery topics addressed in psychoeducational groups are presented in a sequential, building order of concepts to ensure optimum learning. Core topics include: (1) understanding the relapse process; (2) relapse prevention tools; (3) creating a personal relapse plan; (4) managing euphoria and desires to test control; (5) stress management and coping skills; (6) anger management and relaxation techniques; (7) self-efficacy in relapse-risk situations; (8) managing slips and avoiding escalation; (9) recovery resources; (10) structuring leisure and recreation; (11) essentials of personal health; (12) regular personal inventory; inventory; (13) managing emotional triggers (shame, guilt, depression, and anxiety); (14) problem family dynamics (enabling and sabotaging); (15) restoring personal relationships; (16) healthy sexuality; (17) essential educational and vocational skills; (18) essential living skills (financial management, housing, and legal assistance); (19) finding meaning in life (spirituality); (20) grief and loss and substance use; (21) parenting essentials (children's needs, developmental stages, and tasks); (22) maintaining balance in life.

*17. What response to a drug has developed when increasing dosages of the drug are required over time to achieve the same effect as the original dosage?* a. tolerance b. magnitude effect c. causative tolerance d. clinical ambivalence

*A:Tolerance* When a user takes a drug over a long period of time, a tolerance can develop to the drug. This tolerance makes it necessary for the dosage of the drug to be increased in order to achieve the same effects as the previous dosage.

Definition *What is the difference between Alcohol Abuse and Alcohol Dependence?*

*Abuse* is the continuation of any drug use or compulsive behavior despite adverse consequences; the step before addiction occurs. (Inaba, 08/2014, p. 603) *Dependence* - Physiological adaptation to a psychoactive drug to the point where abstinence triggers withdrawal symptoms and readministration of the drug relieves those symptoms. - Psychological need for a psychoactive drug to induce desired effects or avoid negative emotions or feelings. - Reliance on a substance (or a compulsive behavior). (Inaba, 08/2014, p. 610)

Definitions *Difference between Drug Misuse and Abuse?*

*Abuse;* The continuation of any drug use or compulsive behavior despite adverse consequences; the step before addiction occurs. (Inaba, 08/2014, p. 603) *Misuse:* An unusual or illegal use of a prescription, usually for drug diversion purposes. Any nonmedical use of a drug or substance. (Inaba, 08/2014, p. 620)

Principles *Principle 1: Non-Discrimination*

*Access to services for all* *Counselor self awareness:* - an awareness of their limits in terms of knowledge and skills - an ability to consult comfortably with clients about ethnic issues - an openness to cultural differences - an ability to use cultural resources.

Minorities *Model of Acculturation*

*Acculturated* The acculturated client is one who identifies primarily with the *dominant culture* - Benefits from being in a white traditional treatment *Bi-Cultural* The bi-cultural client is one who has pride in his or her own ethnic group, as well as a degree of comfort operating in middle class, white America. - Benefits from multi-racial participants *Culturally Immersed* The culturally immersed client actively reflects a pro-African American, pro-Latino, pro-Asian or pro-Native American stance, for example, based on their dress, language and attitude. - Benefit from clinician and participant from the same ethnic group - influenced by friends and family *Traditional-Interpersonal* The traditional-interpersonal individual typically accepts his or her identity as it simply is - Benefit from clinician and participant from the same ethnic group - *not* influenced by friends and family

Rational-emotive;behavior Therapy (REBT) *Key Principal*

*Activating Events:* According to rational-emotive- behavior therapy, they are events that occur in an individual's life that lead to a reaction (belief) about that event, *Beliefs:* How a person feels or thinks about an activating event; a component of rational-emotive-behavior therapy. *Consequences:* How an individual behaves based on his or her beliefs concerning an activating event; a component of rational-emotive-behavior therapy

Step One

*Admitting Powerlessness* or from the exam *Powerlessness and Unmanageability* We admitted we were powerless over alcohol - that our lives had become unmanageable Many alcoholics have a hard time admitting that they can't control their alcohol use. Once they acknowledge that they are unable to stop on their own, the recovery process can begin. https://www.recovery.org/topics/alcoholics-anonymous-12-step/

Stages of Change *Contemplation*

*Ambivalent* about the condition and *vacillates* between possibly changing and remaining the same The client is casually considering change, but not immediately

*26. Narcotics are derived from...* a. distillation. b. plants. c. barbiturates. d. a chemical reaction of barbiturate and stimulant.

*B: Plants* Narcotics are derived from opium poppies. The poppy is a common ornamental plant that is also grown on a wide agricultural scale. It has many uses other than that of a narcotic.

*108.* Confidentiality requirements exist to protect client's and their personal lives and information. Without a client signed information release, what is information that can be disclosed? a. A client's enrollment in a treatment program only b. A report of child abuse suspected to be caused by the client c. A client's name, age, gender, and race or ethnicity d. A report of progress to an employer paying for treatment

*B: A report of child abuse suspected to be caused by the client* Only mandated reporting information, such as child abuse, can be disclosed without a client's written consent. This includes any information about whether or not a client is receiving treatment or what he or she may be receiving treatment for, even to an employer paying for the treatment. Further, non-court-ordered information cannot be released even to a law enforcement agency or to any other interested party without the client's written consent. A properly informed client is one who is aware of: (1) to whom or what entity the information is being released; (2) the full purpose for the release; (3) the specific information to be released; and (4) when the information release expires. Client confidentiality regarding substance abuse treatment is protected by the Substance Abuse Confidentiality Regulations 42 CFR (Code of Federal Regulations) Part 2 (codified as 42 U.S.C. [United States Code] §290dd-2 and 42 CFR Part 2 (Part 2) and the Health Insurance Portability and Accountability Act (HIPAA, codified as 42 U.S.C. §1320d et seq., 45 CFR Parts 160 and 164).

*112.* The term authentically connected referral network is used in conjunction with case management. How is it BEST defined? a. A resource directory of available community services to call as needed b. A set of defined relationships able to adapt and flexibly meet client needs c. A rolodex with key names and contacts for needed services d. An informal consortium of providers sharing information among each other

*B: A set of defined relationships able to adapt and flexibly meet client needs* The term authentically connected referral network refers to a carefully established set of service providers prepared to meet client needs as they evolve. Key elements to the network are: (1) established communication linkages to facilitate timely sharing of information with client consent; (2) a focus on community-wide outcomes, ensuring that best interests are being met and that community education ensures understandings about substance abuse; (3) a primary focus on meeting client needs through collaboration as opposed to exclusionary rules; (4) consistency and credibility in conduct to ensure both interagency and client confidence and trust. The goal is for all network agencies and providers to recognize their valued and essential roles in the addiction treatment process and for clients to recognize this and respond with similar trust and confidence.

*67. Which of the following stages of a family dealing with substance abuse includes denial, disorganization, and solution finding?* a. re-organization b. adjustment c. abandonment d. denial

*B: Adjustment* A family dealing with substance abuse often goes through stages of adjustment. These stages include denial, solution finding, disorganization, re-organization, and abandonment.

*6. What does metabolism do?* a. maintains the composition of the drug b. alters the composition of the drug c. alters the drug so it cannot be eliminated from the body d. maintains the peak intensity of the drug

*B: Alters the composition of the drug* Metabolism is a process by which an ingested drug is changed into a form that can be removed from the user's body. The faster the drug moves through the user's system, the sooner the effects of the drug are diminished.

*69.* What is the sandwich technique? a. A method to increase health food intake b. An intake interviewing technique c. Client pairing for optimal treatment support d. Staff pairing for optimal treatment support

*B: An intake interviewing technique* Optimizing the intake process enhances the likelihood that the client will both disclose crucial intake information and accept treatment. Overly formal intake questioning is likely to be off-putting and may well inhibit self-disclosure and engagement. Both research and anecdotal evidence suggest that less-formal approaches can better build and support rapport between the counselor and client. One less formal approach is the sandwich technique. It involves sandwiching the standard screening and assessment questions between two less-formal discussions. For fifteen to thirty minutes, the counselor: (1) addresses perceptions of the problems that motivated the client to explore treatment; (2) elicits the client's expectations of treatment; (3) supports the commitment to change; (4) offers encouragement that change can be achieved; and (5) explores readiness to change. Next, the formal screening and assessment are conducted, followed by: (1) a less-formal summarizing of findings; (2) initial treatment planning appropriate to the client's change stage; and (3) addressing the individual's expectations for treatment.

*147.* Many substance-abusing clients suffer from high impulsivity. If a client begins to act out inappropriately, what is an IDEAL grounding technique? a. Verbal confrontation b. Anchoring exercises c. Walking out of the session d. Pointing out program rules

*B: Anchoring exercises* Many substance-abusing clients suffer from low self-esteem, poor self-control, deficient boundaries, and high impulsivity. Where this behavior is the result of poor emotional control, various interventions may help. Where the problem arises from underlying pathology (e.g., posttraumatic stress disorder [PTSD], bipolar disorder, psychosis, intoxication, etc.), rapid de-escalation and backup support may be immediately necessary. Where the behavior is simply developmental immaturity, grounding techniques are often beneficial. In anchoring, the counselor leads the client to relax, close his or her eyes, and focus on breathing and the immediate environment (the chair, the room, the quiet, etc.). Then, the counselor has the client recognize that, in spite of worries about the past or future, the immediate present is safe. The counselor must support this by avoiding sudden movements, pressured speech, and so on, so as to avoid any hypervigilant response from the client. In mirroring, the counselor has the client synchronize his or her breathing with the counselor's, leading to a calm rate (counselors avoid this technique if transference intimacy has been an issue). In timeout, the counselor allows the client to take a break from the topic, leaving the room if necessary, to relax before continuing..

*95. Substance abuse counselors should work only with...* a. ages 15 to 55. b. any ages. c. ages 10 up. d. ages 13 and up.

*B: Any ages* Substance abuse counselors can work with any population, depending upon their specific training. All ages, including young children and the elderly, can develop substance abuse issues.

Step Five

*Courage and Self-Disclosure* Admitted to God, to ourselves and to another human being the exact nature of our wrongs This step involves admitting to past poor behavior. Often, alcoholics will share what they wrote down during the previous step with their sponsor. https://www.recovery.org/topics/alcoholics-anonymous-12-step/

*127.* Beyond the five basic therapeutic group models (psychoeducational, cognitive-behavioral, interpersonal, and support), other unique group models include: culture specific, expressive, and relapse prevention. What does an expressive group therapy model involve? a. Communication skill-building education b. Art, dance, and psychodrama therapies c. Addressing distorted thinking and self-talk d. Confrontational dialectic therapy

*B: Art, dance, and psychodrama therapies* Other expressive therapies include writing (stories, poetry, etc.) and music. Expressive group therapy allows clients various ways of expressing themselves via alternative methods and allows greater exploration of their thoughts, bodies, and feelings. Through creative expression, clients can tap into their imaginations to better and more safely examine their bodies, feelings, emotions, and thought processes. Culturally specific groups provide opportunities to explore the role of culture in substance abuse and the strengths and handicaps it may produce during the change process. Relapse prevention groups offer clients the opportunity to focus intensely on developing the skills they need to identify, understand, and manage the situations, people, and thoughts that may trigger a return to substance abuse. Each of these groups can be used concurrently with client participation in other groups, augmenting and enhancing the learning and change processes.

*137.* Proper program and progress documentation is necessary for a great variety of reasons. Which of the following is NOT a particularly important reason? a. Ensuring treatment plan accuracy and continuity b. Avoiding client challenges of records and documentation c. Ensuring compliance and continued agency funding d. Avoiding loss or even retroactive return of funds

*B: Avoiding client challenges of records and documentation* Clients are not a party to documentation in records except in the rarest of circumstances. Rather, the need for accurate documentation is essential in determining a proper treatment plan and ensuring that the plan evolves appropriately as the client makes continued progress. Further, funding agencies require documentation to ensure that funds entrusted to the program are being utilized as agreed upon in the funding process. Overall, essential documentation competencies include: (1) recording of intake and screening; (2) client assessment; treatment plan formulation and goals; (3) clinical reports; (4) clinician progress notes; (5) a comprehensive discharge summary; and (6) any other client-related information or data necessary to ensure appropriate compliance, understanding, and treatment selection (e.g., consent forms, etc.). Client records should be safely maintained and stored in accordance with existing city, county, state, and federal regulations.

*22. Barbiturate drugs are derived from...* a. the cocoa bean. b. barbituric acid. c. turpentine. d. anaphylactic acid.

*B: Barbituric acid* Barbiturate drugs are derived from barbituric acid, and there are thousands of different types. They are a type of sedative-hypnotic drug and used more often by females than by males—possibly because women are more likely to seek medical attention than men are.

*61. In group therapy, members must...* a. all have different problems. b. be willing to share openly personal problems. c. remain quiet and orderly. d. all have the same problems.

*B: Be willing to share openly personal problems* In group therapy, the sharing of personal thoughts and feelings is critical if the group members are to be able to help each other through the counseling process.

*43. In relation to counseling, what is empathy?* a. the ability to feel what another person is feeling b. being able to understand what another person is experiencing c. the ability to reflect one's own choices onto the patient's d. helping the patient to change unproductive feelings

*B: Being able to understand what another person is experiencing* In counseling, one should not be feeling what the patient is feeling, but rather have the ability to understand those feelings and communicate that understanding in a clear manner to the patient.

*10.* Which of the following is NOT a basic chemical class of amphetamines? a. Amphetamine sulphate b. Benzedrine c. Dextroamphetamine d. Methamphetamine

*B: Benzedrine* Amphetamines consist of a group of synthetic stimulants chemically similar to the body's natural adrenaline—the hormone released when the body reacts in high-threat fight-fright-flight circumstances. The three main types are: amphetamine sulphate (commonly known as speed or by its trade name, Benzedrine), dextroamphetamine (trade name Dexedrine or colloquially as Dexy's midnight runners), and methamphetamine (Methedrine or meth, crank, speed, poor man's cocaine, etc.). Among the three classes, methamphetamine has the greatest abuse risk due to its extremely intense rush. While some drugs such as heroin may be unpleasant at first use, amphetamines are immediately pleasurable to most users. Consequently, meth is second only to marijuana as the nonalcoholic drug most abused worldwide.

*24*. Which one of the following alcohol abuse screening tests is designed specifically for use with adolescents? a. CAGE b. CRAFFT c. MAST d. AUDIT

*B: CRAFFT* This instrument was designed specifically for use with adolescents, drawing upon situations that are common to this age group. The instrument derives its name from the key word in each of the screening questions: driving a car while intoxicated; using alcohol or drugs to relax, feel better, or fit in; using alcohol or drug when alone; forgetting events that occurred while using alcohol or drugs; requests by family or friends to limit use; and, getting into trouble while using alcohol or drugs. The other instruments are: AUDIT (Alcohol Use Disorders Identification Test); the CAGE (also an acronym: needing to cut down drinking, feeling annoyed at drinking criticism, feeling guilty at drinking, and needing a morning eye-opener drink); and, the MAST (Michigan Alcoholism Screening Test).

*123.* There are five primary group models used in substance abuse treatment. Which is the model that views dependency as a learned behavior that can be modified? a. Psychoeducational group type b. Cognitive-behavioral group type c. Interpersonal process group type d. Support group type

*B: Cognitive-behavioral group type* The cognitive-behavioral group model views substance abuse as an issue of dependency and dependency as a learned behavior that can be modified. Modification is accomplished through a variety of interventions such as: (1) identifying the conditioned stimuli that trigger specific addictive behaviors; (2) producing ways to avoid conditioned stimuli; (3) creating contingency management strategies (relapse prevention strategies); and (4) desensitizing stimuli-response patterns. The cognitive-behavioral approach recognizes dependency as arising from the interplay of numerous contributing factors, including: (1) neurobehavioral, (2) biopsychosocial, and (3) genetic and physiological (i.e., the disease model). Cognitive-behavioral therapy groups change perceptions, beliefs, and thinking patterns to alter relapse behaviors and develop social networks to offer support for change.

*28.* Who should create a treatment plan? a. A multidisciplinary team of professionals b. Collaborative team with the client c. The primary treatment provider d. A professional boilerplate to ensure completeness

*B: Collaborative team with the client* Client collaboration in treatment planning is essential as client buy-in is essential to ultimate success. While various generic treatment plans may be useful in ensuring that all essential elements of planning have been addressed, boilerplate boilerplate plans should not be used to short-cut the planning process. The inclusion of the client's most important personal goals may well be crucial to the buy-in required. The outcome should be a written document that includes: (1) treatment goals, (2) action steps that are both measurable and time sensitive, (3) clearly defined expected outcomes, and (4) explicit verbal or even written agreement between the counselor and client.

*130.* Substance abuse affects not only the user but the family as well. What are intergenerational affects MOST commonly caused by? a. The legal system, with incarceration, unemployment, and family separation b. Compensating issues needed to cope with addictive dysfunction c. The counseling system, pushing families to encounter an addict's issues d. Society, rejecting the addict and all those associated with him or her

*B: Compensating issues needed to cope with addictive dysfunction* Families alter normal behaviors in many ways to cope with substance abuse and addiction. Children are likely to assume roles and responsibilities beyond those of their normal maturational development. They may miss out on their childhood, having to cope with insecurities and anxieties that are distorting and deforming of the normal developmental processes. Spouses and intimate others develop compensating behaviors such as denial and cover-up strategies to try and cope socially. Aging parents have to skip the normal launching phase that most young adults prepare for and achieve. Friends, neighbors, and coworkers have to adjust to their unreliability. Moreover, abusers often abandon or estrange themselves from their families, choosing reinforcing associations with other users in order to cope with their increasing antisocial and isolating needs. Children, in particular, are likely to telescope these issues intergenerationally as they grow up to become overprotective, overly controlling, dependent, or otherwise unbalanced in their own marriages (which may then fail) and in their parenting practices (which distort the experiences of the next generation, etc.).

*48.* How does the Center for Substance Abuse Treatment *(CSAT)* indicate that treatment or interventions provided following discharge from a formal inpatient or outpatient program be referred to? a. After care b. Continuing care c. Follow-up care d. Post-discharge care

*B: Continuing care* In keeping with the chronicity model of treatment (suggesting that substance abuse treatment requires a long-term treatment model, much like a chronic illness) as opposed to the acute treatment model, the Center for Substance Abuse Treatment (CSAT) recommends that treatments or other care provided following program discharge be referred to as continuing care. Thus, the terms aftercare and follow-up care are to be discouraged. In this way, care provider models can better perceive the need to realign themselves from an acute care model to a chronic care model. The result is expected to be better and more enduring care and support for those working to overcome issues of addiction and compulsion. Examples of continuing care include mutual-help groups (including twelve-step and other support groups) available in the community community and follow-up client appointments for episodic checkups, similar to typical medical checkups for other chronic diseases).

*29.* How must assessment information be handled to be the MOST effective? a. Carefully documented b. Converted into goals and objectives c. Available to all treatment providers d. Summarized with the client for feedback

*B: Converted into goals and objectives* Careful assessment documentation, information sharing, and summarizing with the client for feedback can help ensure that the assessment information is accurate and readily available. However, to be most effective, assessment information must be converted into clear goals, objectives, and action steps. Beyond this, the assessment must be recorded in a clinically useful, reliable, and valid manner. In this way, the information and data can be readily understood and replicated and applied in a uniform manner most relevant to treatment. Simplistic labels, unidimensional scores, and checklists will not alone achieve these ends. The record must include adequately organized narration and summation to be fully effective.

*72. The treatment plan should be...* a. kept secret from everyone except the therapist and facility. b. developed together with both therapist and patient. c. developed only by the therapist. d. denied to the patient, even upon request after treatment has been completed.

*B: Developed together with both therapist and patient* Treatment plans should be developed by the therapist and patient together, and the patient has a right to request a copy of the patient's personal records.

*30. Marijuana is eliminated from the body mainly via...* a. urine. b. feces. c. vomiting. d. sweating.

*B: Feces* Marijuana is absorbed through the bloodstream and produces a short peak effect (longer if taken orally rather than smoked). It is metabolized and eliminated mostly through the user's feces, *but also through the urine.*

*94.* How many categories does SAMHSA's Service Coordination Framework for Co-Occurring Disorders have? a. Two categories b. Four categories c. Six categories d. Eight categories

*B: Four categories* The Substance Abuse and Mental Health Services Administration (SAMHSA) has offered a Service Coordination Framework for Co-Occurring Disorders, which offers four categories by which to indicate the level of care a given client needs: Category I—mental disorders, less severe + substance use disorders, less severe; locus of care is a primary health care setting; Category II—mental disorders, more severe + substance use disorders, less severe; locus of care is a mental health system; category III—mental disorders, less severe + substance use disorders, more severe; locus of care is a substance use treatment system; and Category IV—mental disorders, more severe + substance use disorders, more severe; locus of care is state hospitals, jails or prisons, emergency rooms, and so on. In the first category (low severity mental health and substance use), the bias is for basic primary care. The middle two categories involve a bias for treatment in concert with the severity level of the primary diagnosis. The last category recognizes that, when both psychiatric disturbances and drug use are severe, clients tend to need highly integrated, even locked, care settings.

*37. Bob's addiction to heroin has caused him to behave in ways that have distanced him from friendships, and he has entered treatment because of relationship issues. His heroin addiction could be called...* a. secondary. b. primary. c. adjunctive. d. fundamental.

*B: Primary* A primary problem is one that, if addressed, will return the patient to normal functioning. It is the main focus of the patient's difficulties.

*31.* How many levels of treatment placement are recognized by the American Society of Addiction Medicine (ASAM)? a. Two levels of treatment placement b. Four levels of treatment placement c. Six levels of treatment placement d. Eight levels of treatment placement

*B: Four levels of treatment placement* The American Society of Addiction Medicine *(ASAM)* recognizes four levels of treatment placement and five specific levels of care. The lowest level (referred to as Level 0.5) is designated as early intervention, which refers to education and other services for individuals with at-risk behaviors but for whom a substance abuse diagnosis cannot be confirmed. Level I consists of basic nonresidential outpatient services, primarily education, counseling, and behavioral change. Level II offers Intensive outpatient or partial hospitalization (inpatient evenings or weekends, etc.). The focus is on comprehensive biopsychosocial assessments and individualized treatment plans. Level III consists of residential or inpatient treatment and offers a planned regimen of care in a twenty-four-hour live-in setting. Level IV is medically managed intensive inpatient treatment. Level IV provides twenty-four-hour medically directed evaluation and treatment of substance-related and mental disorders in an acute care setting.

*120.* In working with substance abuse clients, counselors must be aware specific guidelines found in the HIPAA statutes. What do these guidelines address? a. HIV counseling and practice guidelines b. Health privacy and confidentiality standards c. Health, addiction, and abuse practice guidelines d. Facility intake and admission policy standards

*B: Health privacy and confidentiality standards* The Health Insurance Portability and Accountability Act of 1996 (HIPAA) allows workers and families to retain their health insurance coverage when changing or between jobs. HIPAA also governs the management and release of Protected Health Information (PHI). The act ensures the right to privacy for all adults and minors ages twelve to eighteen. The act requires a signed disclosure before any health care information can be disclosed to any entity, agency, or individual, including parents of minors over the age of twelve. The more stringent guidelines, however, arise from the Code of Federal Regulations (CFR Title 42 Part 2). In 2000, the Department of Health and Human Services (DHHS) issued the Standards for Privacy of Individually Identifiable Health Information. The DHHS Privacy Rule imposed three additional privacy protection steps: (1) consent for information release must comply with 45 CFR §164.508; (2) clients must be given a copy of the signed form; and (3) a copy of each signed form must be kept for six years from its expiration date.

*7.* Which of the following conditions does alcohol NOT induce? a. Steatosis b. Nephrosis c. Hepatitis d. Cirrhosis

*B: Hepatitis* 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.

*44. Warmth...* a. tends to cause the client to be suspicious. b. is an essential component in counseling. c. can be detrimental in counseling sessions. d. is nice, but not necessary in counseling.

*B: Is an essential component in counseling* Things like warmth, respect, and acceptance are essential in a counselor's work because every patient has the right to be treated with respect and be given the opportunity to make his or her own decisions. Warmth also helps the patient to feel more comfortable with the counselor and therefore more productive in reaching the patient's goals.

*143.* If a client leaves a treatment program early or involuntarily, how is the written discharge summary affected? a. It is not needed altogether. b. It is produced as usual. c It is abbreviated or cursory. d. It is comprised only of the terminal facts.

*B: It is produced as usual.* A comprehensive discharge summary is always produced, regardless of how long or short the client's involvement was in the treatment program. Specifically required content includes: (1) whether the program was or was not completed successfully; (2) the reasons or rationale that resulted in client discharge; (3) whether the discharge was voluntary or involuntary; (4) any transfer or referrals involved in the discharge, with specific information about each, including transfer or referral rationale; (5) summary information on treatments offered and recovery level achieved; (6) the client's status in abstinence or continued substance use; (7) educational or vocational accomplishments; (8) legal status at the point of discharge; (9) relevant continuing medical issues, if any; and (10) any involved supports or services that are expected to be continued beyond discharge.

*54. If the counselor speaks English as a primary language, and the patient speaks English as a second language...* a. counseling will run smoothly. b. it might still be best to consider using another language in counseling. c. it can be assumed that there will be no problems communicating. d. it is always best to counsel only in English.

*B: It might still be best to consider using another language in counseling* Even when a patient's primary language is English, there might still be another language in which the patient is better able to express himself. Care must be given to assess not only the language used by the patient, but also use of slang, etc. that is important for the patient's ability to understand and communicate effectively.

*10. Which of the following routes of administration achieves the longest-lasting results for the user?* a. oral and nasal b. oral c. injection d. inhalation and nasal

*B: Oral* Many users prefer the oral route of administration because the effects of the drug tend to be experienced for a lengthier period of time. The effects of the drug might be less intense with this route, but the duration of the effects (and ease of administration) overrides that concern for many users

*46. Avoidance behaviors in a patient are common. Which of the following is NOT an avoidance behavior?* a. gossiping about a loved one b. perseverating on a specific situation c. rationalizing d. generalizing

*B: Perseverating on a specific situation* Although perseveration is not always a productive thing, in this case it is the best choice because it describes the attention to a specific topic. When a patient is avoiding a significant topic, the patient will rationalize, generalize, or in some other way avoid the relevant issue.

*16. A commonly seen physical effect of drug use is changes in...* a. hair growth. b. pupil size. c. personal ideation. d. delusions.

*B: Pupil size* There are several physical effects of drug use commonly seen in users. A few of the most common, and most obvious to the alert observer, are changes in pupil size, respiration, and heart rate. Delusions and personal ideation changes are psychological in nature, and hair growth is not a common effect.

*87. Your best friend has a drinking problem and approaches you for help overcoming his or her alcohol abuse problem. What should you do?* a. draw up a treatment plan with your friend and begin therapy b. refer your friend to a therapist you feel would be a good fit c. tell your friend you can't help because of your personal relationship d. do nothing

*B: Refer your friend to a therapist you feel would be a good fit* It is not desirable for a therapist to enter into a therapeutic relationship with someone with whom the therapist is personally involved. Such a relationship can make it difficult to maintain objectivity and present an uneven balance of power, among other possible issues.

*52. In counseling, reflection usually involves...* a. responding to the facts of the situation discussed. b. responding to feelings. c. a mirror. d. visual aids.

*B: Responding to feelings* In the counseling situation, reflection of feelings is a useful tool. By carefully listening to what a patient says, and determining which feelings are likely to be present, the counselor can verbally reflect back to the patient what the patient is feeling, thus bringing those feelings out in the open for attention.

*33.* The Stage Model of Change addresses how many client stages? a. Five stages b. Six stages c. Seven stages d. Eight stages

*B: Six stages* The first stage in the stages of change is precontemplation. This stage is characterized by: (1) giving no thought to change, (2) feeling resigned to substance abuse, (3) a sense of loss of control, (4) denial (there is no personal problem), and (5) minimization of consequences experienced. The second stage is contemplation. This stage is characterized by evaluation of the costs, benefits, and burdens associated with the substance abuse behavior as well as those involved in any proposed change. The third stage is preparation. This stage involves early experimentation with minor changes in use patterns to better evaluate the idea of change proposal. The fourth stage is action. This stage involves taking direct action in pursuit of change. The fifth stage is maintenance. This stage is characterized by efforts to maintain the change achieved. Finally, the sixth stage is relapse. This stage is initially demoralizing, though it is a normal part of change. Ideally, it culminates in a return to the contemplation or action stages.

*44.* What does the SOAP progress note acronym stand for? a. Subjective, Overview, Actions, and Plan b. Subjective, Objective, Assessment, and Plan c. Subjective, Observation, Assessment, and Plan d. Subjective, Overview, Attention, and Plan.

*B: Subjective, Objective, Assessment, and Plan* The SOAP note was first generated by Dr. Lawrence Weed, MD, in the 1970s to provide physicians with rigor, structure, and a way for practices to communicate with each other. Subjective provides a narrative summary of the client's current condition, usually including the presenting problem (why they came to be seen). Common elements include: (1) onset (if applicable); (2) chronology (improvements or worsening, variations in the problem, etc.); (3) symptom qualities (the nature of the symptoms, etc.); (4) severity (degrees of distress); (5) modifying factors (what helps or worsens the condition, etc.); (6) additional symptoms (whether related or unrelated to the presenting problem); and (7) treatments (prior treatments, if the client has previously been seen elsewhere). Objective captures key facts that are measurable, quantifiable, and repeatable aspects of the client's situation (physical symptoms, lab results, weight, etc.). Assessment refers to the clinician's early diagnostic impressions. Plan describes the clinician's next steps in response to the information obtained (further assessments, referrals, medications, interventions, etc.).

*42. Which of the following is NOT a common personality characteristic of counselors?* a. empathy b. superior intellect c. respect d. concreteness

*B: Superior intellect* Common personality characteristics of counselors are such things as empathy, respect for the patient, concreteness, warmth, genuineness, and acceptance. However, a superior intellect is not necessary for an individual to be a good counselor.

*80. Your patient does not seem to be meeting treatment goals after a substantial period of time in therapy. What should you do?* a. terminate therapy b. terminate therapy and refer the patient to another therapist c. continue therapy d. document that the patient is resistant and continue with the treatment plan

*B: Terminate therapy and refer the patient to another therapist* The therapist has an ethical responsibility to terminate therapy when treatment is not effective. When terminating, the therapist should also take steps to refer the patient to another clinician who might better be able to work with the patient.

*99.* Who is primarily responsible for ensuring that treatment is effective for culturally diverse clients? a. The client b. The provider c. The institution d. The family

*B: The provider* It is the provider who is primarily responsible to ensure that treatment is effective for clients of cultural diversity. Ensuring effective treatment requires two separate understandings: (1) how to properly communicate and interact with persons from differing cultures and (2) knowledge of the specific culture from of the person receiving service. In truth, every competent and caring clinician should always look past stereotypes, seek shared understandings, treat clients with respect, maintain an open mind, ask questions when needed (both of clients and other involved providers), and remain willing to learn. Thus, being culturally competent merely makes explicit this ongoing duty and obligation. Beyond this, however, providers should diligently endeavor to acquire a deeper and broader understanding of the major values, mores, standards, and expectations of those cultures he or she routinely serves—while still, however, allowing for idiosyncratic variations within that cultural paradigm. In this way, culturally diverse clients can receive effective, meaningful, and culturally acceptable services in a sensitive and kind way. Doing so ensures even greater treatment efficacy and more enduring positive outcomes.

*14. A user's expectation of how a drug will make the user feel...* a. is of little significance. 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. can enhance a drug's intensity, but not diminish it.

*C: Has a significant effect upon the user's experience of the drug* Studies have shown that one's expectation of what a drug will do has a significant effect upon how that drug is experienced by the user. For example, if the user expects the drug to have a relaxing effect, the user is likely to feel relaxed after ingesting the drug.

*91. At the beginning of therapy, which of the following does the patient NOT have the right to know?* a. behavioral expectations of the patient b. the thoughts and feelings of the therapist in relation to the patient c. purpose of the treatment plan d. fees associated with therapy

*B: The thoughts and feelings of the therapist in relation to the patient* At the start of therapy, the patient should be aware of issues regarding time (length, frequency, and duration of sessions), fees, behavioral expectations for both patient and therapist, and the purpose of therapy. The patient does not, however, have the right to know the personal feelings and thoughts of the therapist.

*69. Once a family leaves the substance abuser to build a new life...* a. there is no hope for the abuser's reentry into the family structure. b. there is a chance the substance abuser will seek help. c. the substance abuser will always further isolate himself/herself. d. the family will invariably regret the decision.

*B: There is a chance the substance abuser will seek help* When the family finally decides they can no longer sustain the presence of the substance abuser, the family will seek to build a new life without that family member. At this point there is still a chance of the abuser seeking help when faced with the loss of family.

*61.* What is the MOST common duration of counseling in an intensive outpatient treatment *(IOT)* program? a. Twenty to thirty minutes, one time each week b. Thirty to fifty minutes, one time each week c. Forty to sixty minutes, one time each week d. Thirty to fifty minutes, two times each week

*B: Thirty to fifty minutes, one time each week* Individual counseling is typically scheduled for thirty to fifty minutes at least weekly in the initial treatment stage. Sessions are held with a primary counselor to help facilitate a meaningful, collaborative therapeutic alliance. A common session format involves: (1) asking for reactions to recent group meetings; (2) reviewing outside activities since the last session; (3) asking about current feelings; (4) exploring any interim drug and alcohol use; and (5) inquiring about any urgent issues. Recent group topics, treatment plans, and coping strategies are reviewed. Fears and anxieties about change are explored, and drug testing feedback is provided. Sensitive issues not appropriate for the group are discussed. However, no effort is made to address any underlying conscious and subconscious issues contributing to substance use. Assistance with access to needed services outside the program's scope is given, and planning for transitions between levels of care or for discharge is completed. The session concludes with a review of the client's plans and treatment schedule. Clients with co-occurring disorders may require primarily individual counseling.

*11. How does a drug enter the user's bloodstream when snorted or sniffed?* a. by entering a blood vessel directly b. through the membrane lining of the nasal passages c. through the stomach wall d. by passing through the small intestine

*B: Through the membrane lining of the nasal passages* When a drug is snorted or sniffed, it collects directly upon the inner lining of the nose. These nasal passages have sensitive membranes that then absorb the drug and pass it into the user's system.

*89.* What is the MOST important reason that ordered and routine activities are built into the therapeutic community (TC) treatment process? a. To relieve boredom that may serve as a trigger for substance abuse b. To counter the typically disordered lives of substance-abusing clients c. To reduce the stress through focused programmed activities d. To distract from the negative thinking that may lead to substance abuse

*B: To counter the typically disordered lives of substance-abusing clients* A key feature of therapeutic communities (TCs) is structured programming. This involves scheduled activities and routines that help clients learn to avoid chaotic lifestyles and focus on daily activities that prevent the boredom and negative thinking that so often accompanies relapse behavior. TC treatment protocols consist of phases and stages that allow the tracking of client activities and measurement of progress. Treatment duration is dependent upon successful client progress. Staff and peer networks offer support, and other community-based services are integrated as needed to sustain recovery. The TC treatment approach is ideal for clients with past criminal issues, educational and employment deficits, relationship problems, and a history of failed treatment. Because of the focused, hierarchical, and often confrontational features of this treatment modality, it must be modified for those with co-occurring psychiatric disorders, antisocial personality traits, and various other dysfunctional behaviors. When used in an intensive outpatient program, a drug-free environment must be ensured.

*73.* What is physiological dependence on a drug determined by? a. The addictive properties of the drug b. Tolerance or symptoms of withdrawal c. A psychological need to again use the drug d. Frequency and amount of the drug taken

*B: Tolerance or symptoms of withdrawal* Physiological dependence exists if tolerance or withdrawal is in evidence. Tolerance is in evidence if there is a need for significantly more of the involved substance to achieve a desired effect or intoxication or if the effects of the substance are significantly diminished when the same amount of the substance is used. Withdrawal is in evidence if abstinence induces a withdrawal syndrome as expected for the substance or the same substance (or one closely related chemically) is used to relieve or ward off withdrawal symptoms. The DSM lists a set of eleven symptoms, 2 or more of which must have occurred at any time during the past 12 months for a diagnosis of substance use disorder. 1) Tolerance, defined as either the need for larger and larger amounts of the drug in question over time to achieve the desired result, or a decrease in the effect of the drug with continued use of the same amount; 2) Withdrawal, defined by either the known withdrawal symptoms for a particular drug, or by the fact that the drug, or a similar drug, is taken to avoid withdrawal symptoms; 3) An increase in the amount of the drug taken, or the continued use of the drug past the intended time; 4) An inability to control usage; 5) A large amount of time and effort devoted to obtaining the drug in question, using the drug in question, or recovering from its effects; 6) The giving up of important activities in order to obtain or use the drug in question, or recover from its effects; 7) The continued use of the drug in question regardless of the ill effects it has caused; 8) Craving; 9) Recurrent drug use which leads to inability to fulfill major role; 10) Recurrent drug use though it is physically harmful; 11) Recurrent drug use despite it leading to continued social problems

*47.* How does the Center for Substance Abuse Treatment (CSAT) recommend that substance abuse be considered and treated? a. A psychological disorder b. An acute disease c. A chronic treatable condition d. A degenerative treatable disorder

*C: A chronic treatable condition* The Center for Substance Abuse Treatment *(CSAT)*—part of the Substance Abuse and Mental Health Services Administration Administration within the U.S. Department of Health and Human Services—notes that substance abuse has been treated as an acute disorder for most of the twentieth century. This shaped treatment, which was typically short term and intensive, much like treating an acute infection. Detoxification occurred, information was shared, and the individual was discharged to manage independently. They now recommend that substance abuse be treated like a chronic condition, such as diabetes or hypertension. To this end, treatment needs to be realigned to allow for a gradual recovery with regular checkups to ensure that the condition remains in control.

*81.* In providing counseling treatment, what are counselors encouraged to do? a. Select a single counseling approach, and refine it fully. b. Use multiple counseling approaches to meet clients' needs. c. Avoid relying on any formal counseling technique. d. Recognize that all counseling techniques are equally effective.

*B: Use multiple counseling approaches to meet clients' needs.* Research is unable to confirm any optimal counseling approach as numerous factors, such as the substances used, degrees of dependency, treatment duration, irregular client characteristics, and so on, will inevitably shape research outcomes. Further, clients typically have complex psychosocial needs and unique personal and emotional factors that will require considerable creativity by involved providers. Consequently, counselors increasingly use a variety of approaches that are revised and tailored to meet each client's singular needs. This kind of theoretical accommodation and modification is a hallmark of effective treatment. However, when altering or combining approaches, counselors will need to recognize that theoretical conflicts may arise. In some cases, these conflicts could attenuate or even extinguish the success of the approach. Consequently, counselors must have a competent grasp of the approaches being utilized to ensure that ineffective or untoward outcomes are not unintentionally produced.

*19. Can drug use affect pregnant mothers?* a. no, because drugs are carried only through the user's bloodstream b. yes, because the mother's blood circulates to the unborn baby c. yes, but only when drugs are ingested orally d. yes, but only when drugs are used with a nasal route of administration

*B: Yes, the mother's blood circulates to the unborn baby* Drug use by pregnant women can affect the unborn baby, as the blood can be carried through the mother's bloodstream to the baby. The unborn baby can also become addicted to a substance, and once born (and the drug connection removed) suffer withdrawal symptoms.

Definitions *Competence*

*Being educated, trained and prepared to provide addiction-related services* Addiction professionals practice this virtue ethic when they pursue appropriate credentials, training, experience and supervision and operate within their scope of practice.

Step Two

*Belief in a Higher Power* From the class exam *Belief and Mental Stability* Came to believe that a Power greater than ourselves could restore us to sanity. AA believes that people with an alcohol addiction need to look to something greater than themselves to recover. Those working the steps are free to choose whatever higher power works for them. https://www.recovery.org/topics/alcoholics-anonymous-12-step/

Epinephrine/NE

*Body's natural stimulant *responsible for anxiety and fear, anger, hostility & violence *Instinctual fight or flight *predominant neurotransmitter in brain *affected by cocaine and amphetamines

Family Systems Counseling *Common Family Approaches*

*Bowenian Family Therapy* triangulation, genograms *Experiential/Humanistic Family Therapy* Focuses on the present, promoting choice, self-determination and actualization *Family Disease Model* Family disease *Structural Family Therapy* enmeshment - boundaries *Strategic Family Therapy* directives

*77.* What is an appropriate response to a substantial gift from a client? a. "You shouldn't have!" b. "Thank you so much!" c. "I can't accept that, but thank you!" d. "A gift like that is not appropriate."

*C: "I can't accept that, but thank you!"* A substantial gift may be loosely defined as one exceeding $20 in value. The giving of small gifts is not uncommon, and these gifts are usually acceptable—particularly if they can be shared by all staff or clients. At times, gifts may also be culturally significant, and extra care may be needed to ensure no offense occurs. These are often handmade items or items representative of a culture, ethnicity, or home country. Many will have unique meanings and background stories. Certain cultures view gift giving as a demonstration of respect and gratitude for a valuable service. Failure to accept could result in termination of treatment. Such gifts should be accepted whenever possible. They are not typically given with any ulterior motives. Inappropriate gifts (e.g., those that are too personal, too costly, or offered in exchange for favors, etc.) should be tactfully and politely refused. Citing program rules can help to explain and prevent problems. All gifts should be reported to supervising staff and entered into the case record.

*131.* HIV remains a profound problem in the United States. What approximate percentage of all HIV cases are found among females in this country? a. 5 percent b. 15 percent c. 25 percent d. 35 percent

*C: 25 %* Approximately 25% of all human immunodeficiency virus (HIV) cases are among adolescent and adult females in the United States. Although HIV continues to predominantly affect men who are sexually active with other men (homosexual or bisexual gay males), women are particularly susceptible to contracting the HIV virus. Due to many factors, African American and Hispanic or Latina women account for more than four-fifths of all HIV cases among women. At highest risk of new infection, however, are gay people who abuse substances as this group is also most likely to engage in risky sexual behavior. Other factors that contribute to issues of risk are: substance abuse, homelessness and poverty, psychiatric disorders, living in chaotic and high-crime areas, and so on. The incidence of substance abuse among those with HIV is higher than the national average, in part, no doubt, to issues of stress and depression that accompany the diagnosis. Although newer treatment options improve the overall outcome somewhat, obtaining treatment and maintaining the complex treatment regimen required is far more difficult among those who abuse alcohol and other substances.

*28. How long might the effects of a psychedelic drug last?* a. 1-3 hours b. 4-6 hours c. 8-10 hours d. 12-15 hours

*C: 8-10 hours* The duration of the effects of psychedelic drug use vary by type of drug, route of administration, and individual differences, but a reasonable average length of effect might be 8-10 hours.

*85. Your patient tells you about a particular situation the patient is having trouble with. You know what is best for your patient to do, so you...* a. do nothing. b. tell the patient what to do. c. facilitate discussion about the patient's options, guiding the patient to review his or her thoughts and feelings about the situation. d. steer the conversation in the direction of what you want the patient to do.

*C: Facilitate discussion about the patient's options, guiding the patient to review his or her thoughts and feelings about the situation* Ethically, the patient's thoughts and feelings must be respected. It is not the therapist's job to coerce the patient into doing what the therapist feels is best. Each patient must choose for himself or herself.

*124.* Matching clients with groups requires careful consideration. Where would a first-generation American Hispanic woman be BEST assigned? a. An all-women's group b. An all-Hispanic, Spanish-speaking group c. A group based on immediate needs d. A mixed new-immigrant group

*C: A group based on immediate needs* There is a myriad of factors to consider in assigning a client to any given group. These include: group availability, client stage in recovery, client preference, gender and culture issues, substance of abuse, and so on. Further, changes in group assignments may be needed episodically as clients progress, relapse, gain motivation, develop new insights needing address, and so on. Diversity issues include age, gender, race, ethnicity, education, language, sexual orientation, religion, and culture, among others. Cultural competence requires a counselor to recognize that: (1) a young Asian male may be unable to express himself openly among older Asians due to issues of respect; (2) many Hispanics or Latinos are adverse to rules and the authority figures that sustain them; (3) women may contend with the need to nurture and invest emotional energy in men; and so on. Adaptations, accommodations, and skillful group leadership will be required to optimize all participants' group opportunities.

*8.* What does formication refer to? a. The creation of freebase cocaine b. Sex between two unmarried individuals c. A sensation of bugs crawling under the skin d. Extrapyramidal symptoms of agitation

*C: A sensation of bugs crawling under the skin* 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.

*98.* How is the concept of culture BEST described? a. A shared set of beliefs, norms, and values among a racial group b. A shared set of beliefs, norms, and values among an ethnic group c. A shared set of beliefs, norms, and values among any given group d. A shared set of beliefs, norms, and values among a given nationality

*C: A shared set of beliefs, norms, and values among any given group* Culture is best understood broadly, referring to a shared set of values, norms, and beliefs common to any group of people, whether it is based on race, ethnicity, nationality, or any other shared identity or affiliation. According to 2010 Census Bureau figures cited by the Brookings Institute, approximately 12.9 percent of the current U.S. population is foreign born (of note, the figure exceeded 13 percent during every decade from 1860-1920). Beyond country of birth, however, there are many other variables that can shape a client's culture and worldview. Diverse client populations include: non-white Hispanics and Latinos; African Americans; Native Americans; Asian Americans and Pacific Islanders; persons with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS); lesbian, gay, bisexual, and transsexual (LGBT) populations; those with disabilities; rural populations; homeless populations; and older adults. Counselors must navigate between the prevailing culture, treatment culture, and the client's culture as coping styles, social supports, stigma, and a myriad of other factors can be profoundly influenced by a client's culture.

*135.* The likelihood of developing a substance abuse disorder fluctuates throughout the life course. What is the most likely period in life for a substance abuse problem to begin? a. Middle age b. Young adulthood c. Adolescence d. Childhood

*C: Adolescence* Substance abuse issues may develop at any time throughout the life course, especially during times of stress, divorce, family discord, unemployment, pain-inducing injury, depression, and other particularly vulnerable periods. Overall, however, the period of greatest risk is adolescence. This group is particularly vulnerable for numerous reasons, including: (1) the developing brain (during childhood and adolescence) is more susceptible to the changes induced by addiction; (2) the likelihood of exposure to substances of abuse increases at this time; (3) immaturity makes it more difficult to cope with peer pressure; (4) underdeveloped judgment (typically generating a sense of invulnerability) makes the desire for risk taking greater; (5) transitional stressors moving toward adulthood increase the need for alternative coping options, particularly those with little developmental demands; (6) the social demands of school and relationships become more acute; (7) hormonal and other developmental changes induce further instability. Programs sensitive to these needs are greatly needed in the substance abuse treatment field.

*109.* The CAGE questionnaire is a four-question screening tool. What is this screening instrument designed to screen for? a. Cocaine abuse b. Marijuana abuse c. Alcohol abuse d. Heroin abuse

*C: Alcohol abuse* The CAGE questionnaire effective and quickly screens for alcohol abuse by asking for a yes or no response to four questions: (1) Have you ever felt the need to cut down on your drinking; (2) do you feel annoyed by people complaining about your drinking; (3) do you ever feel guilty about your drinking; and (4) do you ever drink an eye-opener in the morning to relieve the shakes? Extensive studies reveal that two yes responses will accurately identify 75 percent of the alcoholics who honestly respond to it (and correctly rule out 96 percent of nonalcoholics). The CAGE has been modified to screen for drug abuse by simply replacing the word drinking with drug use in the initial three questions and then delivering the fourth question: Do you use one drug to change the effects of another drug, or do you ever use drugs first thing in the morning to take the edge off?

*21. Which of the following is the MOST commonly used sedative-hypnotic drug?* a. anti-anxiety drugs b. barbiturates c. alcohol d. muscle relaxants

*C: Alcohol* Alcohol, in all its forms, slows down the body's processes and is therefore known as a depressant. It is commonly used in one of three forms: beer, wine, or distilled spirits. One of the reasons for its widespread use is that it is legally obtainable.

*62. Group dynamics are...* a. always easy to manage. b. usually not a factor in successful treatment. c. always an issue in group therapy. d. a difficult issue in individual therapy.

*C: Always an issue in group therapy* Group dynamics are factors that affect the counseling process. These factors can be emotional, psychological, personality factors, or any other issues that affect the interaction of the group members.

*93.* What would be the MOST typical co-occurring disorder client? a. An alcohol-abusing man b. A drug-abusing man c. An alcohol-abusing woman d. A drug-abusing woman

*C: An alcohol-abusing woman* Individuals admitted for substance abuse treatment who also have a co-occurring psychiatric disorder are more likely to be female alcohol abusers than female drug users or male users of either alcohol or drugs. While most drug abusers are referred for treatment through the criminal justice system, female alcohol users are most typically referred through health care providers. Multiple studies reveal that the rates of co-occurring disorders are roughly that about 39 percent admitted for substance abuse treatment programs will meet Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for antisocial personality disorder; 11.7 percent are suffering with major depression, and 3.7 percent are struggling with a general anxiety disorder. Other challenges common among clients with dual-diagnoses (co-occurring disorders) include: chronic unemployment and homelessness, family conflict and disruption, incarceration and subsequent law enforcement involvement (probation or parole), and violent victimization. Further, complex problems such as suicidal ideation and attempts, medication noncompliance, high self-medication needs, emotional issues, significant medical problems, and a host of other challenges often complicate the treatment process.

*37.* In cases involving the criminal justice system, what is the minimum recommendation for frequency of updating treatment plans? a. Following sentencing b. Upon release to a community setting c. At all transition points d. Both A and B

*C: At all transition points* Treatment may be begun during incarceration, continued at transfer to minimum security, then to a halfway house, and finally out to home on probation or parole. At all transition points, treatment plans should be updated. This need is particularly acute because an offender's level of treatment needs, due to potential problems with motivation and environmental stressors, may significantly change at each of these junctures. Case management is typically required to ensure comprehensive services, and common participants include criminal justice staff, prerelease planners, halfway house staff, vocational or educational staff, health providers, and involved family. Because of the frequency of co-occurring disorders in this population, numerous professionals use the Integrated Screening, Assessment, and Treatment Planning model as it provides for evaluation of both substance abuse and mental health issues.

*79.* At a local dance club, a counselor spots a client drinking at the bar. What is the BEST response to this? a. Confront the client immediately, encouraging him or her to leave the club. b. Quietly find a moment to talk with the client privately at the club. c. Avoid contact with the client, and leave the club immediately. d. Avoid contact with the client, but remain at the club.

*C: Avoid contact with the client, and leave the club immediately.* No effort should be made to engage the client in such a public setting. Remaining at the club would likely precipitate some sort of contact. Therefore, leaving without contact would be best. Then, later, when the client returns to the program, a private conversation should be engaged. During this discussion, the client can be informed of the unexpected contact and what was witnessed. In this way, the client is able to privately disclose his or her issues regarding the lapse (or relapse, as the case may be) with regard to the return to using alcohol. This discussion can then build to include those issues, experiences, and triggers that may have contributed to the occurrence. In this way, the client can use the experience to build upon those skills needed to increase his or her abstinence goals and the steps needed to achieve them.

*55.* What is the influence of family on treatment outcomes? a. Treatment outcomes are improved with family support. b. Treatment outcomes are worse with family involvement. c. Both A and B d. Neither A nor B

*C: Both A and B* It has been noted that substance abuse treatment outcomes can be substantially improved when supportive family members are involved. However, it is also true that problematic family relationships can greatly hamper the treatment process and reduce the likelihood of enduring recovery. This is particularly true where family culture and traditions run counter to treatment and recovery processes. Ideally, family therapy will be available as an adjunct to the treatment process, as necessary. Where program resources lack this component of care, referrals to therapists or organizations that provide family therapy should be considered. Involved family members will also need to be educated regarding the addiction process as well as learning how to optimally support their loved one's recovery. Balance is important as attempts to exert too much control can drive their loved one away or even back into abuse. Conversely, where family involvement is too limited, the client may lack the support necessary to sustain themselves into recovery and beyond.

*52.* Which form of substance abuse is naltrexone used to treat? a. Alcohol dependence b. Opioid dependence c. Both A and B d. Neither A nor B

*C: Both A and B* Naltrexone is effective for some people with alcohol dependency. It has also been noted, however, that naltrexone may not be effective in treating men with chronic, severe alcohol dependence. In certain circumstances, naltrexone has also been effective in treating opioids addiction. Disulfiram (Antabuse) is another adjunctive medication used in the treatment of alcoholism. Naloxone (Narcan), a shorter-acting agent similar to naltrexone, is used primarily in situations of opioid overdose, though it is also used in the treatment of alcoholism to lower cravings. Buprenorphine and buprenorphine combined with naloxone are now also available for the treatment of opioid dependence and can be prescribed in programs that have medical personnel on staff.

*100.* What does the term culture-bound syndrome refer to? a. An illness (mental or physical) unique to a cultural group b. An illness presenting or interpreted distinctively, due to cultural influence c. Both A and B d. Neither A nor B

*C: Both A and B* The term culture-bound syndrome has been used in different ways. First, it can refer to an illness truly bound to a specific culture. For example, the mottled discoloration on the thighs caused by the heat of a laptop resting on the legs of an excessive techie computer user or the fatal brain disorder (kuru) caused by now-banned cannibalism among the South Foré people of the eastern New Guinea Highlands. Second, it can refer to otherwise common mental or physical illnesses that are subsequently construed as unusual because of the pathoplastic influence of culture. For example, interpreting the hallucinatory symptoms of schizophrenia as evidence of demonic possession or considering the apparently other worldly experience of grand mal seizures to be a sacred disease—as described by Hippocrates—and more recently by the animistic Hmong, who may then revere and elevate such persons to the station of shaman.

Middle Stage of ETOH dependence

-Loss of control over drinking bx -Impaired social relationships -Changes in drinking patterns -Temporary sobriety -Morning drinking -Neglect of dietary habits

*65.* Which of the following substances lack effective treatment medications? a. Cocaine b. Marijuana c. Both of the above d. Neither of the above

*C: Both of the above* There are effective medications for the treatment of alcohol and opioid addictions. The medications reduce cravings, inhibit the intoxicating effects, produce aversion, and lessen the desire to use the target substance. However, in spite of considerable laboratory research and extensive clinical trials, no effective medications for the treatment of dependence on stimulants such as cocaine, marijuana, inhalants, or hallucinogens has been discovered. There are medications to modestly mitigate the difficult withdrawal symptoms caused by these substances. For example, symptoms of stimulant withdrawal include insomnia, agitation, anxiety, and even delirium, psychosis, and hyperthermia in particularly acute cases. Neuroleptic medications can lessen the symptoms of psychosis and delirium, and benzodiazepines can reduce the symptoms of agitation and anxiety. Beyond symptom management, however, there are no target treatment drugs for these substances.

*91.* What are significant drawbacks to community reinforcement (CR) and contingency management (CM) approaches? a. CR and CM are only effective if used together. b. CR and CM are not enduringly effective. c. CR is labor intensive, and CM can be costly. d. CR requires others' support, and CM requires ongoing rewards.

*C: CR is labor intensive, and CM can be costly* Considerable research has demonstrated that *community reinforcement (CR)* and *contingency management (CM)* are both independent-effect treatment interventions. Further research, however, does support that CR and CM are most effective when used in conjunction with each other. Because a return to baseline drug use can follow the termination of CM, in particular, more long-term supports (such as twelve-step program involvement) may be needed for more enduring success. Maximum benefits accrue with larger rewards that increase in value to maintain CM motivation. By contrast, CR typically involves rewards from more-enduring sources (family, job, pleasurable activities, etc.) that can more naturally persist after treatment completion. Even so, education in relationship enhancement, goal setting and attainment, balanced lifestyle, and so on, can more fully ensure long-term treatment benefits. Finally, rewards and other reinforcements must be consistently applied and must only be provided in response to measurable successes (e.g., extended negative-result urine screens, etc.).

*70. The family effect upon treatment...* a. is always positive. b. is always negative. c. can be both positive and negative. d. should be minimized as a part of the treatment plan.

*C: Can be both positive and negative. Family can provide a great deal of support to the substance abuser* However, the negative effects of the abuser's behavior on the family can also present some unique stresses to be dealt with in treatment. A sound treatment plan takes both the positive and negative into account.

*119.* In working with substance-abusing clients, counselors must be aware of the applicable guidelines in CFR Title 42 Part 2. What do the guidelines deal with? a. Substance abuse treatment program accreditation and standards b. Issues involving the illicit manufacture and sale of drugs of abuse c. Confidentiality in areas of alcohol and substance abuse d. Mandated client treatment under a court directive or order

*C: Confidentiality in areas of alcohol and substance abuse* The Code of Federal Regulations (CFR) Title 42 Part 2 deals with issues of confidentiality when working with clients coping with drug or alcohol use and abuse. The confidentiality restrictions apply: (1) to records, which may not be disclosed even in administrative, civil, criminal, or legislative proceedings by any governmental authority; (2) to communications, even if the person seeking information already has it, could otherwise obtain it, is an official or law officer, has a subpoena, or otherwise claims the right of information release not permitted in the CFR; and (3) to acknowledgements, such as regarding the presence of a client (unless he or she is in a facility or facility area not dedicated solely to alcohol or drug abuse treatment, and no mention of drug or alcohol treatment is made), whether past, current, or anticipated in the future without the client's written consent. A subpoena will be valid for information release only if a court of competent jurisdiction also explicitly enters an order authorizing information release specific to these regulations.

*101.* Beyond the culture of the client, what is another key cultural issue? a. Client's number of generations in the United States b. Clients living in cultural enclaves c. Culture of the counselor d. Client's primary language

*C: Culture of the counselor* Not only do clients bring their culture to the treatment experience, but counselors do as well. A group of professionals also has a culture that consists of shared values, norms, and beliefs. Complicating the clinician's culture further is the language (jargon) used, an emphasis on books, the professional mind-set (way of looking at things), and so on. Health institutions and training facilities are grounded in Western medicine, launched in ancient Greece, emphasizing the central role the human body in disease. Further, objectivity and scientific and empirical methods are the only trusted source of knowledge about diseases and treatment. By 1900, Western medicine began to recognize social contributions to disease, widening the view to issues of diet, lifestyle, employment and income, and family structure, which led to the field of public health. These cultural views make it harder for counselors to recognize symptoms couched in non-Western medical language or to understand a client's concerns and needs. Finally, different assumptions about the clinician-client role model, the etiology of illness, and acceptable treatments offer further relational barriers.

*35. Heroin overdoses MOST often involve...* a. a rise in blood pressure. b. damaged nasal membranes. c. depressed respiration. d. a heart attack.

*C: Depressed respiration* With a heroin overdose the user's body slows down; respiration is depressed, which eventually can lead to death.

*53.* Which of the following is NOT a core treatment and recovery skill? a. Stress management b. Substance refusal training c. Exercise and health training d. Relaxation training

*C: Exercise and Health Training* Although exercise can be an important stress reducer, and health improvement is also meaningful, these are not core treatment and recovery skills. Substance refusal training is crucial as development of this skill helps clients to practice and become comfortable with refusing addictive substances. Outside of the program, it is inevitable that clients will at times be offered illicit substances, and they need the skills to reflexively but politely refuse without returning to substance abuse. Stress management and relaxation training are both important as unmanaged stress is a significant trigger for relapse. Assertiveness training teaches individuals how to get their needs met proactively (but not aggressively) and to avoid allowing others to take advantage of them. Unmet needs can be a powerful trigger to relapse, thus this is an important skill.

*20.* Which of the following functions is NOT what a Certified Alcohol and Drug Abuse Counselor can usually perform? a. Client screening b. Substance abuse assessment c. Diagnose mental disorders d. Formulate a treatment plan

*C: Diagnose mental disorders* Certified Alcohol and Drug Abuse Counselors, absent additional mental health training and licensure, do not have the credentials and training necessary to diagnose mental disorders. They do have the training and certification necessary to diagnose substance abuse disorders and are well within their scope of practice to screen, assess, and otherwise evaluate clients for substance abuse issues and to formulate and carry out substance abuse treatment plans. Because of the frequency with which co-occurring mental illnesses exist within the substance abusing community, Certified Alcohol and Drug Abuse Counselors can become very familiar and proficient with numerous commonly occurring mental disorders. It can therefore seem natural to broaden the scope of practice as experience grows. However, legal scope-of-practice parameters do not provide for Certified Alcohol and Drug Abuse Counselors to diagnose mental illness, and it is essential that they collaborate with other professionals whenever non-substance abuse mental health issues arise.

*94. Jane Doe was a patient of yours three years ago and has since died. You run into the man you know was her husband at the local park, and he asks about his wife's treatment plan. What should you do?* a. don't give him any information b. deny remembering who he is, or knowing his wife c. discuss her case with him d. tell him he'll need to provide a release of information for you to discuss his wife's case with him

*C: Discuss her case with him.* Confidentiality extends beyond the grave, with the deceased patient's legal representative given the responsibility of providing the release of information after the patient's death. Although laws can vary from state-to-state, it is often permissible to give confidential information to a surviving spouse, who is likely seen as the patient's legal representative after the patient's death.

*86. If there is a conflict between yourself and a colleague over treatment of a patient, you should...* a. ignore it. b. try to resolve it amicably with the other therapist. c. do primarily whatever is in the best interest of the patient. d. report the conflict to a superior.

*C: Do primarily whatever is in the best interest of the patient* Although it is certainly true that an amicable resolution to the conflict would be beneficial, the primary focus should always be on what is in the best interest of the patient.

*71.* What is the SDSS designed to measure? a. Substance-induced depression over time b. Variations in polysubstance use over time c. Drug use disorder severity over time d. Severity and duration of intoxication symptoms

*C: Drug use disorder severity over time* The Substance Dependence Severity Scale (SDSS) is a structured interview that provides current (last thirty days) DSM and ICD-10 substance use disorders and harmful use diagnoses. The instrument measures the quantity and frequency of recent drug use, which directly translates into variations in clients' clinical status. Following the usual two to three days of training (for those with a preexisting clinical assessment and diagnosis background), the SDSS can be administered in thirty to forty-five minutes. Past research indicates that the SDSS dependence scales are reliable and valid measures of DSM diagnostic severity. More recent investigations into test-retest reliabilities for the ICD-10 dependence scales yielded good to excellent results for alcohol, cannabis, cocaine, and heroin. Test-retest reliabilities for the ICD-10 harmful use scales fell in the good range for alcohol, cocaine, and heroin but were poor to fair for cannabis. Concurrent validity, diagnostic concordance, and internal consistency results were similar to the test-retest findings. These findings support the use of the SDSS in assessing DSM and ICD-10 dependence and harmful use diagnoses.

*74.* According the DSM-5 criteria, a client that has previously met the criteria for stimulant use disorder but now has not met the criteria for stimulant use in 10 months (except for craving) would be termed to be in ______ remission. a. Full b. Partial c. Early d. Sustained

*C: Early* Early remission is no stimulant use criteria being met (except for craving) for at least 3 but less than 12 months. Sustained remission is no stimulant use criteria being met (except for cravings) for 12 months or longer. The terms full and partial are no longer used to describe remission.

*64.* What was the original CIWA-Ar scale designed for? a. Evaluation of opioid withdrawal risk b. Evaluation of amphetamine withdrawal risk c. Evaluation of alcohol withdrawal risk d. Evaluation of benzodiazepine withdrawal risk

*C: Evaluation of alcohol withdrawal risk* The Clinical Institute Withdrawal Assessment-Alcohol, Revised (CIWA-Ar) scale assists in identifying which alcohol-dependent clients can receive ambulatory detoxification versus inpatient care. The CIWA-Ar can be administered in minutes by staff with a minimum of three hours training. There is some disagreement about cutoff points on the scale. Numerous physicians concur that scores of twenty or higher should be treated in a medical inpatient setting. Other specialists suggest that clients with scores into the low twenties can be safely managed in an outpatient setting, providing there is proper monitoring, medications supervision, and so on. Consequently, medical staff must rely on their best judgment or program policy and procedures. The CIWA-Ar also guides the administration of medications at thirty- to sixty-minute intervals. Doses are only given in response to observed withdrawal signs at a specified intensity. The CIWA-Ar has reduced both client numbers receiving medications and the amounts of medications given. Revisions of the instrument have enabled the monitoring of both benzodiazepine and opioid withdrawal symptoms.

*139.* Treatment and recovery plans must remain current and effective for optimal client progress and well-being. Consequently, how often are treatment plans typically updated? a. Every fourteen to twenty-one days or as changes or progress indicate a need b. Every twenty-one to thirty-six days or as changes or progress indicate a need c. Every thirty to ninety days or as changes or progress indicate a need d. Every sixty to one hundred twenty days or as changes or progress indicate a need

*C: Every thirty to ninety days or as changes or progress indicate a need* Relevant changes might arise if a client tests positive for an addictive substance, if mandatory meetings are missed, if an ancillary support program terminates services, or where substantial progress is noted. While formats may vary, the flow of information in a treatment or recovery plan remains consistent: (1) alcohol or drug-related problems are listed, including social, vocational, family, and medical problems; (2) current short- and long-term objectives; (3) action plans that will meet short-term goals; (4) client progress measures toward identified goals; and (5) updates to the discharge summary or continuing care plan as ongoing changes warrant. In this way, the treatment and recovery plan remains actively applicable, and client progress can be carefully monitored and followed.

*97.* What is the MOST effective treatment approach for adolescents, in terms of less drug use at treatment completion? a. Parent education b. Peer group therapy c. Family therapy d. Multifamily interventions

*C: Family Therapy* Family therapy posits that conditions leading to adolescent drug use began in the home, and thus, the family can help with recovery. Family-based therapeutic approaches include multidimensional family therapy and multisystemic therapy. These approaches extend classic family therapy models to promote change in four areas: (1) the adolescent, (2) family members, (3) family interaction patterns, and (4) outside (nonfamily) influences. The family cognitive-behavioral therapy approach combines family systems theory with cognitive-behavioral therapy. The premise is that family cues and contingencies reinforce the conditioned behavior of adolescent substance abuse. Adolescent community reinforcement focuses on altering environmental influences that perpetuate substance use while also teaching enhanced coping skills for better self-management. The family support network develops a support group for parents, augmented with group and home therapy sessions. The family intervention program focuses on the family and other systems that affect the family (e.g., schools and the community). It partners a family therapist with a community resource specialist to address key family issues that arise when an adolescent uses substances.

*56.* How many main levels exist in the substance abuse continuum of care, according to the American Society of Addiction Medicine (ASAM)? a. Three levels of care b. Four levels of care c. Five levels of care d. Six levels of care

*C: Five levels of care* The five main levels in the substance abuse continuum of care, as identified by the American Society of Addiction Medicine *(ASAM)* are: Level 0.5: early intervention services (subclinical or pretreatment, exploring risks and addressing problems or risk factors that appear to be related to substance use); Level I: outpatient services (nonresidential, less than nine hours per week); Level II: intensive outpatient or partial hospitalization services— nonresidential, a minimum of nine hours per week (Level II is subdivided into levels II.1 and II.5); Level III: residential or inpatient services—minimum of twenty-five hours per week (Level III is subdivided into levels III.1, III.3, III.5, and III.7); and Level IV: medically managed intensive inpatient services (subacute, with daily physician supervision). These levels are not discrete but rather points on a treatment continuum.

*128.* In 1965, Bruce Tuckman proposed a model of group development that included five phases. What is the one phase that is NOT part of Tuckman's model? a. Performing b. Storming c. Framing d. Norming

*C: Framing* All groups pass through five phases to accomplish their purposes: forming, storming, norming, performing, and adjourning (last phase added in 1977). Forming involves engaging, exchanging information, and creating bonds. The key characteristics are tentative overtures, polite exchanges, and worries about fitting in. Storming involves dissatisfaction, disagreement, competition, and conflict. Key characteristics are criticizing ideas, interrupting, hostility, and attendance issues. Norming involves forming group structure, establishing roles and relationships, developing cohesion, and creating harmony. Key characteristics are seeking consensus, reaching agreements, creating support, and achieving a sense of we in endeavors. Performing involves task focus, emphasizing productivity, and identifying achievements. Key characteristics are cooperation, problem solving, and decision making. Adjourning involves completing tasks, ending duties, and dropping dependency. Key characteristics are feeling regrets, managing emotions, and disbanding.

*105.* What is the difference between AIDS and HIV? a. HIV can be fatal; AIDS is a nonfatal chronic condition. b. HIV is a common viral illness, while AIDS is a lethal infection. c. HIV is the virus that causes the AIDS syndrome. d. HIV is sexually transmitted, while AIDS is acquired in other ways.

*C: HIV is the virus that causes the AIDS syndrome.* Human immunodeficiency virus HIV is the virus that causes the acquired immunodeficiency syndrome (AIDS) syndrome. HIV is the viral agent that causes AIDS, which is the final stage in the HIV disease process. The Centers for Disease Control and Prevention reports that more than 918,000 people have AIDS at any given time (2004). The disease continues to be most prevalent among men who have sex with men and intravenous drug users, with these groups collectively accounting for almost four-fifths of all cases of HIV/AIDS. The disease disproportionately affects minorities. While13 percent of the U.S. population is African American, they represented 50 percent of all new HIV infections in 2004. HIV is also spreading rapidly among women and adolescents, with nearly half of new HIV cases reported among females age thirteen to twenty-four, and more than 60 percent among females age thirteen to nineteen. Gay substance abusers are at high risk because they more frequently engage in high-risk sexual behaviors when intoxicated. Although new medications have significantly extended life for many with HIV/AIDS, the treatment protocols are burdensome and expensive. HIV also contributes to poverty, homelessness, and other medical problems.

*87.* Why do therapeutic communities (TCs) often focus on habilitation instead of rehabilitation? a. Many clients cannot successfully be rehabilitated. b. Rehabilitation is not as effective as habilitation. c. Habilitation helps clients learn new skills they never had. d. Rehabilitation focuses only narrowly on detoxification.

*C: Habilitation helps clients learn new skills they never had.* Rehabilitation refers to the recovery of skills and abilities that have been lost. Due to extended and severe drug use, criminal behavior, or co-occurring disorders, many therapeutic community (TC) clients need to develop skills and abilities they never previously properly possessed. The TC model views substance abuse as a holistic (whole person) disorder rather than as an isolated disorder. Consequently, TC clients are assessed across an interrelated continuum of psychological and social deficits (e.g., dishonesty, poor impulse control, anger issues, etc.), along with their substance abuse patterns. The key beliefs and values necessary for recovery include: (1) complete honesty; (2) reality orientation to the here and now; (3) personal accountability for all behavior; (4) empathy and concern for others; (5) a strong work ethic and realization that rewards must be earned; (6) proper differentiation between external behavior and the inner self; (7) understanding that change is always occurring; (8) understanding that learning has value; (9) developing economic self-sufficiency; (10) community involvement is important; and (11) quality citizenship matters.

*89. Which of the following is the primary focus of a code of ethics?* a. keeping the therapist out of legal trouble b. defining basic concepts for working with other professionals c. helping guide the professional in the right thing to do d. providing guidelines for dealing with legal issues

*C: Helping guide the professional in the right thing to do* The code of ethics can help keep a professional out of legal trouble and assist in working with colleagues and legal situations. However, it is primarily a guide in aiding professionals to know the right thing to do.

*4. The magnitude of a drug's effect is...* a. the dosage of the drug. b. the rate of absorption of the drug into the user's system. c. how intensely the user feels the drug's effects. d. the level of quality of the drug.

*C: How intensely the user feels the drug's effects* The intensity of the drug, or how much the user feels its effects, depends upon several factors. Generally, however, the greater the dosage, the greater the intensity of the response. The peak effect is the highest intensity level at a given dosage of the drug.

*25.* Which of the following is the MOST important introductory statement or question to ask in a suicidality evaluation? a. Have you ever tried to take your own life? b. Do you have thoughts about killing yourself? c. I need to ask you a few questions about suicide. d. Have you ever attempted suicide?

*C: I need to ask you a few questions about suicide.* It is important to introduce the topic rather than simply launching into questions. In this way, the client can understand for the questions that follow. This introduction should be followed by very clear questions. Screen for thoughts: "Have you had thoughts about deliberately ending your life?" Screen for past attempts: "Have you ever tried to end your life?" A past history of attempts greatly increases the likelihood of future attempts. Any affirmative response to thoughts should lead to questions such as: "Have you had these thoughts for long?" "What have you been thinking of doing?" "Have you made firm plans about this?" "Do you have (the pills, etc.) that you've been thinking of using?" Where a client has begun to formulate clear plans and realistic means, and so on, immediate intervention is essential.

*75. When can confidentiality be breached?* a. when the family demands it b. if the patient's employer requests information in writing c. if the patient threatens the welfare of another person d. when a spouse asks for it

*C: If the patient threatens the welfare of another person* There are several times when confidentiality can be breached without the consent of the patient. One such situation is when another's life is at risk.

*18. The reliability of a drug refers to...* a. a drug producing the expected effects when ingested by the user. b. the drug's ability to produce consistently the desired effects. c. the drug being what the user intended to purchase. d. the consistency of the cost per dosage.

*C: It being what the user intended to purchase* There are many look-alike drugs and disreputable dealers in the drug trade. Therefore, it can be difficult to be assured of the quality of drugs purchased on the street. The reliability of a drug refers to the drug meeting the expectations of the buyer.

*48. Which of the following BEST describes what a counselor does in a facilitative relationship?* a. solves the patient's problems b. teaches the patient coping skills c. keeps the patient talking d. soothes the patient's hurt feelings

*C: Keeps the patient talking* The most basic component of a facilitative relationship is to keep the patient talking. Learning how to do this is an initial step in having positive communication and a productive therapeutic experience

*99. You become ill and are unable to continue treating your patients. What should you do?* a. escalate treatment and terminate early b. terminate treatment c. make arrangements depending upon the patients' needs rather than just your own d. refer your patient to another therapist

*C: Make arrangements depending upon the patients' needs rather than just your own* Whether you are ill or simply going on vacation, the needs of your patients must be kept primary, and the arrangements made for your absence should reflect those concerns.

*132.* Members of the lesbian, gay, bisexual, and transgender (LGBT) community face many challenges, including issues of discrimination. Regarding substance abuse as compared with the general population, how is the LGBT community likely to act? a. Less likely to use alcohol or drugs b. About as likely to use alcohol or drugs c. More likely to use alcohol or drugs d. Insufficient data to make these comparisons

*C: More likely to use alcohol or drugs* On all measures of alcohol and drug use and abuse, the incidence of occurrence is higher. The lesbian, gay, bisexual, and transgender (LGBT) community has a greater likelihood of alcohol and drug use generally, are more likely to abuse these substances, are less likely to maintain abstinence, and continue alcohol use longer into their later years. Research reveals that as high as 30 percent of the lesbian community may have a drinking problem. In addition, LGBT substance abusers tend to use more frequently and more kinds of drugs. In particular, judgment-altering drugs are also more common (e.g., amyl nitrite, gamma hydroxybutyrate, ketamine, and ecstasy). The more frequent use of judge-altering drugs such as those at raves and parties appears to be correlated with the higher rates of human immunodeficiency virus (HIV) infection due to a greater frequency of higher-risk sexual behaviors. Unquestionably, this community would benefit from greater education, services, and specially oriented groups and services.

*42.* How does motivation for participating in treatment differ from motivation to change problem behaviors? a. There is no difference between treatment and behavior change motivation. b. Motivation for behavioral change precedes motivation for treatment. c. Motivation for change is internal; treatment may be pushed on a client. d. Motivation for treatment precedes motivation for behavioral change.

*C: Motivation for change is internal; treatment may be pushed on a client* Clients may enter treatment by court order or family pressure. Motivation for behavioral change is a personal and internal matter, with a greater likelihood of ultimate success. Assessing motivation may be pursued via the Stages of Change Readiness and Treatment Eagerness Scale *(SOCRATES)*. It is a nineteen-item self-report instrument comprised of three main scales—recognition, ambivalence, and taking Steps—requiring approximately three minutes to complete. SOCRATES identifies client states on a continuum between not prepared to change and already changing. Those in the pre-contemplation stage typically deny the problem. Clients in the preparation and action stages typically admit that they have a problem. Optimal treatment planning requires an understanding of where a client is in the change readiness process, which also promotes more effective exploration of the current barriers to further change. There are two versions of SOCRATES. One version is used to assess alcohol issues and the other addresses personal drug use.

Addiction Counselor Qualities *Listening and Attending*

*Clarification* The purpose is to ensure accuracy and understanding *Paraphrasing or Restating* The purpose of paraphrasing or restating is listening for content and affect *Reflection* The purpose of reflection is to identify the feelings of a client and repeat them back to him or her. Similar to paraphrasing but adds an emotional tone or quality *Summarization* Tie together multiple elements or themes in the client's various messages.

*50.* According to the American Society of Addiction Medicine *(ASAM)*, what is the minimum of treatment time the intensive outpatient treatment *(IOT)* must provide? a. Three hours of treatment per week b. Six hours of treatment per week c. Nine hours of treatment per week d. Twelve hours of treatment per week

*C: Nine hours of treatment per week* Intensive outpatient treatment (IOT) has traditionally consisted of a minimum of nine hours of weekly treatment provided in three three-hour sessions. However, some programs provide more contact hours and others as few as six contact hours per week. Even so, according to the American Society of Addiction Medicine (ASAM)'s Patient Placement Criteria, IOT programs must provide nine or more structured contact hours each week and treatment at six or more hours per day during a partial hospitalization program. The Center for Substance Abuse Treatment (CSAT) consensus panel agreed that IOT key features include: (1) six to thirty contact hours each week; (2) step-up and step-down care with varying intensity; (3) a minimum of ninety days continuing care following discharge; and (4) various additional core features and services.

*50. How does one NOT convey an open invitation to talk in a counseling session?* a. by listening to the patient b. taking steps to eliminate interruptions c. offer lengthy responses to what the patient says d. avoid judgmental comments

*C: Offer lengthy responses to what the patient says* One of the best ways to facilitate conversation during a counseling session is for the counselor to keep his or her comments to a minimum and encourage opportunities for the patient to talk as much as possible.

*57. Which of the following is a critical component of individual counseling?* a. maintaining an authoritative counselor/patient relationship b. that the counseling session addresses only one main focal point c. that only two people are present during the counseling session d. that counseling is done by one therapist

*C: Only two people are present* Individual counseling involves two people, the counselor and the patient. Unlike family or group counseling, the sessions involve only two people and are conducted in a private setting.

*3. Which of the following is a psychoactive drug?* a. aspirin b. birth control pills c. opium d. malathion

*C: Opium* Opium is a psychoactive drug because it has an *effect upon the behavior and mood of the user.* Aspirin and birth control pills have only a physiological impact upon the individual, and malathion is an insecticide.

*39. Which of the following is NOT a common problem of those with a substance abuse issue that would likely be addressed in treatment?* a. relationship issues b. legal problems c. optical difficulties d. coping skills

*C: Optical difficulties* Although patients with substance abuse difficulties might also have vision problems, it is not a common problem addressed in treatment.

*102.* What are the two key mental health treatment paradigms of Western medicine? a. Objectivity and the scientific method b. Theoretical and applied practice c. Pharmacological therapy and psychotherapy d. Biological and environmental perspectives

*C: Pharmacological therapy and psychotherapy* Biological psychiatry is focused on the biological causes and treatments of psychiatric disorders. The first forms of biological psychiatry appeared in the mid-nineteenth century and paved the way for pharmacological therapy for mental illness. The practice of psychotherapy (or talk therapy) emerged near the end of the nineteenth century with the establishment of psychotherapy (originally psychoanalysis) by Sigmund Freud. Although numerous disparate forms of psychotherapy now exist, all emphasize verbal communication as the basis for treatment. Most modern approaches now combine pharmacological therapy and psychotherapy, referred to as multimodal therapy. However, the emphasis on verbal communication retains the potential for miscommunication and more especially so when counselor and client come from different cultures. Misunderstandings can result in misdiagnoses, treatment conflicts, and noncompliance. Thus, the importance of effective cross-cultural communication continues to assume greater significance.

*79. Your patient is doing well in therapy and offers you a free weekend on the patient's yacht. What should you do?* a. accept, but only if the patient accompanies you b. accept, but go only after treatment is completed c. politely decline the offer d. accept the gift in the spirit in which it is given and have a good time

*C: Politely decline the offer* Accepting gifts, especially extravagant ones, from a patient is considered unethical. Patients are vulnerable and easily exploited, but such a situation also can detract from the respectful relationship of equals that should exist in the professional relationship.

*113.* In providing case management services, beyond providing seamless care and being client focused, what is the primary aim? a. Provide referrals to needed services in as timely a way as possible b. Determine how to integrate needed referrals in a coordinated fashion c. Produce the least-restrictive level of care possible in meeting the client's needs d. Promote client self-determination in identifying and selecting needed services

*C: Produce the least-restrictive level of care possible in meeting the client's needs* Although it is important to provide timely and well-coordinated referrals and to encourage client self-determination in this process, it is most important to secure the least-restrictive level of care. In this way, client self-determination is also ensured. To achieve this, clients and case managers must collaborate in selecting among available options. Self-determination is most fully ensured when clients are allowed to take the lead in identifying their needs and in choosing from among resource options that most fully meet their personal goals and lifestyle. Flexibility is important, as is adaptability, to ensure that referral providers and agencies are adequately responsive. Clients should be assessed for their ability to apply for, access, and follow through with selected referrals, with the case manager providing assistance where needed. Informing, educating, and guiding clients through this process can help to ensure an overall least-restrictive level of care.

*68. In which stage do family members take on the responsibilities of the substance abuser?* a. denial b. solution finding c. re-organization d. abandonment

*C: Re-organization* In a need for stability, the family of a substance abuser might begin to re-organize the family structure. Various members might take on the roles and responsibilities of the substance abuser to return order to the family.

Gestalt

*Client gains awareness of their bx and learns how to accept personal responsibility for those bx *Based on existentialism- focus on present day and personal responsibility for ones own destiny *Contact is the procvess of interacting with nature & with other people without losing one's sense of individuality. * Uses empty chair method By acknowledging the under dog and top dog they can work through the problems

*149.* A counselor finds herself treating a perpetrator of incest abuse. A survivor of past abuse herself, the counselor finds this deeply disturbing. What would be her BEST response? a. Ignore her personal feelings, and focus on the client's issues and needs. b. Confront the client about his past, and press for growth in this area. c. Refer the client to a counselor more comfortable with the client. d. Find a therapist to help her better cope with a client such as this.

*C: Refer the client to a counselor more comfortable with the client.* Counselors must recognize that they are also entitled to limits. While working with difficult clients is a part of the job, it does not require working in situations that are personally deeply disturbing or troubling. It can also lead to substandard service for the client, who is entitled to receive counseling from a professional who is not compromised by his or her past history. In situations such as this, it may be helpful to seek supervisory consultation to better determine what is occurring and the degree of the associated problem. The client should be notified in advance of the need (but not the direct reason) for a transfer to avoid generating issues of rejection or abandonment. He or she should be informed that another clinician better suited to meeting his or her needs is available. Any subsequent issues about the transfer should also be addressed in the new therapeutic relationship.

*56. You ask your patient about a particular painful experience when the patient struck his or her domestic partner. The patient speaks of the experience in a fact-based, rational tone. What is the patient likely doing?* a. justifying b. cutting short c. resistance d. changing the focus

*C: Resistance* Patients will often resist the counseling process, and do so in several ways. In this case, the patient is avoiding his or her feelings by rationalizing or analyzing the experience the patient is describing.

*129.* A productive group therapeutic engages deep issues in many individuals with remedial or neglected issues. This may at times induce regression. How is regression defined? a. Feelings of regret and guilt that accompany past failures b. A sense of emotional closure when painful issues are recalled c. Reverting to a prior developmental level (i.e., juvenile or infantile) d. Strong feelings of anger projected inward toward oneself

*C: Reverting to a prior developmental level (i.e., juvenile or infantile)* Productive groups not infrequently elicit strong responses. The group experience is enhanced by: (1) self-disclosure that is genuine rather than contrived, honestly reflecting feelings, attitudes, and struggles; (2) authentic behavior that reflects the real self as opposed to the socially presented self, or the front used to avoid criticism and rejection; (3) personal risk taking, usually initiated by a leader, leading to the openness and candor that allows for actual growth and progress; (4) personal privacy, secured by group consensus and commitment to such a degree that self-disclosure, authentic behavior, and risk taking are possible. It should be noted that the key contributions already noted are to be exercised in balance and moderation. All expressions should be self-oriented, revealing oneself rather than pushing through into the private space of others. In this way, negative exchanges among group members can be avoided. Group leaders, while modeling, should be careful not to over-disclose to avoid damaging confidence and trust.

*64. In group treatment, direct communication refers to...* a. trading roles with another person in the group. b. explaining why one feels the way one does about the other person. c. sharing one's feelings about the other person, and using the pronoun you when speaking. d. stating the reasons behind the question being asked

*C: Sharing one's feelings about the other person, and using the pronoun 'you' when speaking* Direct communication involves speaking directly to the other person, rather than about him or her. The answer in d refers to the principle of question analysis, b is about advice analysis, and answer a refers to role reversal.

*32.* How many Assessment Dimensions are recognized by the American Society of Addiction Medicine (ASAM)? a. Two assessment dimensions b. Four assessment dimensions c. Six assessment dimensions d. Eight assessment dimensions

*C: Six assessment dimensions* In assessing clients, the American Society of Addiction Medicine *(ASAM)* encourages evaluations using six interactive dimensions: (1) acute intoxication or withdrawal potential (the level of intoxication or risk of severe withdrawal symptoms or seizures and exploring inpatient or ambulatory detoxification); (2) biomedical conditions and complications (other illnesses that may create risk or complicate treatment); (3) emotional, behavioral or cognitive conditions and complications (diagnosable mental disorders or mild, undiagnosable mental problems that complicate treatment); (4) readiness to change (open or resisting treatment, acknowledging or denying addiction, high or low motivations, etc.); (5) relapse, continued use or continued problem potential (immediate or low risk of substance use; good or poor coping or relapse prevention skills; severity of collateral problems such as suicidal behavior; etc.); (6) recovery environment (influence or proximity of people, resources, and situations that may help or pose a threat to safety or continued treatment).

*67.* Dealing with smoking cessation during a substance abuse treatment program is a. something too overwhelming for the majority of individuals. b. something that should not be brought up by anyone but the client. c. something to be seriously considered if the client desires it. d. something that should be required during any treatment program.

*C: Something to be seriously considered if the client desires it.* The majority of drug- or alcohol-dependent individuals are also smokers. And, more in this group die from smoking-related conditions than from their substance abuse. Treating staff believe that smoking cessation may complicate drug or alcohol abstinence. However, clients may feel otherwise—believing the best time to quit would be during treatment for their drug or alcohol use. Fewer than 10 percent of clients would object to a clinic's smoking ban if nicotine replacement therapy was available. Smoking cessation success is highest when coupled with behavioral therapy and nicotine replacement therapy. Thus, treatment programs are ideal settings for smoking cessation. Finally, there are strong associations between reduced smoking and reductions in substance abuse. Numerous forms of nicotine replacement are available, and clients are encouraged to try various products before deciding what works best for them. The antidepressant medications bupropion and nortriptyline help to reduce nicotine cravings, probably because they help reduce depression—which is a major cause of relapse.

*25. Nicotine, amphetamines, and cocaine are types of...* a. depressant-hypnotic drugs. b. barbiturates. c. stimulants. d. alcohol.

*C: Stimulants* Nicotine, amphetamines, and cocaine are all types of stimulants. Stimulants generally increase mental and/or physical function and come in a variety of forms. They tend to be absorbed quickly into the bloodstream.

*23.* What are serious mental health symptoms that resolve with abstinence in thirty days or less MOST likely due to? a. A resolution of transient situational stressors at home, school, or work b. A serious underlying mental disorder that temporarily improved c. Substance abuse-induced disorders that require continued abstinence d. Malingering to manipulate circumstances for underlying goals

*C: Substance abuse-induced disorders that require continued abstinence* Serious mental health issues, such as persistent suicidality, delusions, or hallucinations that precipitously resolve with abstinence are most likely substance abuse-induced disorders that will not reoccur without a return to the former substance abuse. In like manner, serious mental health issues that do not resolve in an abstinence period of thirty days or longer are likely due to an underlying mental disorder that must be evaluated and properly treated. In certain circumstances, an underlying mental disorder becomes exacerbated by substance abuse. In these situations, some measure of improvement will be noted, but it will fall substantially short of total resolution. This reflects the persistence of the underlying disorder; they will still need appropriate treatment for meaningful resolution of the condition.

*29. Which of the following is the psychoactive ingredient in marijuana?* a. the opium poppy b. methadone c. tetrahydrocannabinol d. psilocybin

*C: Tetrahydrocannabinol* Tetrahydrocannabinol (or THC) is the psychoactive ingredient in marijuana. THC is a chemical found in the cannabis plant; the chemical binds with receptors in the user's brain to produce several drug-induced effects.

*39.* The Addiction Severity Index has been formally adopted by which organization? a. The Substance Abuse and Mental Health Services Administration *(SAMHSA)* b. The Center on Drug and Alcohol Research *(CDAR)* c. The National Institute on Drug Abuse *(NIDA)* d. The Institute for Governmental Service and Research *(IGSR)*

*C: The National Institute on Drug Abuse (NIDA)* The Addiction Severity Index (ASI) was first released in 1977 and formally adopted for use by the National Institute on Drug Abuse in 1980. The ASI was developed by the Drug Evaluation Network Systems, which was sponsored in this endeavor by the White House Office of National Drug Control Policy (ONDCP) and the Center for Substance Abuse Treatment (CSAT). Since that time, the ASI has become the most widely used assessment instrument in the field of addictions. It is recommend as a baseline instrument for addiction assessment by a great many governmental and private substance abuse treatment organizations, and due to its standardized questions, it is particularly useful for research. A teen version (T-ASI) and a shortened version (ASI-Lite) are also available. Currently in its fifth iteration, version six is in development.

*70.* Which of the following was NOT identified as being among the three MOST effective screening tools for substance use disorders? a. The *CSAT* Simple Screening Instrument b. The Alcohol Dependence Scale (ADS) and the Addiction Severity Index *(ASI)*-Drug Use Subscale combined c. The Substance Abuse Screening Instrument d. The Texas Christian University Drug Screen

*C: The Substance Abuse Screening Instrument* Researchers have compared eight commonly used screening instruments for efficacy in determining the presence of substance use disorders. Only three possessed optimal accuracy, positive predictive value, diagnostic sensitivity. These three instruments are: (1) the Center for Substance Abuse Treatment (CSAT) Simple Screening Instrument; (2) the combined Alcohol Dependence Scale (ADS) and the Addiction Severity Index (ASI)-Drug Use Subscale; and (3) the Texas Christian University Drug Screen. Other popular brief screening instruments include the Substance Abuse Screening Instrument, the CAGE Questionnaire, and the Offender Profile Index. Each of these instruments is in the public domain and thus may be reproduced and used freely.

*5.* What happens as tolerance for barbiturates develops? a. The margin between intoxication and lethality increases. b. The margin between intoxication and lethality decreases. c. The margin between intoxication and lethality stays the same. d. Tolerance does not develop for barbiturates.

*C: The margin between intoxication and lethality stays the same.* 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.

*9. When a drug is ingested orally, which of the following BEST describes how the drug enters the bloodstream?* a. through the lungs b. directly via a blood vessel c. through the stomach or small intestines d. via nasal membranes

*C: Through the stomach or small intestines* When a drug is taken orally, it is dissolved within the stomach and then passes through the stomach lining or small intestine to enter the bloodstream.

*7. How are drugs MOST often removed from the body?* a. by vomiting b. through exhalation c. through the user's urine d. by pumping the stomach contents

*C: Through the user's urine* Drugs most often leave the body after metabolization through the user's urine. Depending upon the level of efficiency, the liver and kidneys work together to break the drug down and excrete it out of the body through the user's urine.

*142.* Clients actively in a treatment program need regular chart entries. Typically, state requirements mandate an updating entry no less often than a. daily. b. semi-weekly. c. weekly. d. monthly.

*C: weekly.* Whether the client's treatment includes group or individual session counseling, most states require an updating entry at least weekly. Entries should include session dates and attendance status as well as client progress in terms of recovery phase and movement toward (or away from) recovery or treatment goals and objectives. Entries should clearly indicate whether the progress (or lack of progress) leaves the client on or off track in regards to achieving necessary progress, especially if an associated increase in relapse risk has been identified. Issues of client responsiveness to program staff, involved family, referral services, as well as attendance compliance should be noted in an ongoing fashion. Finally, planned or expected interventions and recommendations should also be included in the weekly update or summary entry.

Level of Psychoactive Substance Use *Second Level*

*Circumstantial Use* Think use in specific situations i.e. war/depressent and truck driving/stimulant

Interdisciplinary Approach

A training process based on using more than one approach to direct or change behavior.

*85.* When outcomes from cognitive-behavioral coping skills therapy and motivational enhancement therapy are compared with outcomes from twelve-step facilitation, how do clients fare BEST? a. cognitive-behavioral coping skills therapy b. motivational enhancement therapy c. Twelve-step facilitation d. All the above

*C: Twelve-step facilitation* The three approaches all produced positive outcomes in improving drinking from admission baseline to one year in follow-up. However, twelve-step facilitation showed a measurable advantage when clients were followed for three years post treatment. Other studies have comparatively investigated the outcomes of aftercare by way of structured relapse prevention and twelve-step facilitation. Of importance, the twelve-step facilitation approach has provided more positive overall outcomes for the greater share of people who abuse substances. The findings were particularly positive for: (1) clients who were experiencing high levels of psychological distress; (2) substance users who were women; and (3) clients who reported the use of multiple substances at the outset of treatment. Specifically, these three groups clearly remained abstinent for more extensive periods following treatment with twelve-step facilitation, as compared to structured relapse prevention. In point of fact, both approaches have contributions to make to the recovery process. However, where limitations in resources, time, and other obstacles exist, it is particularly important to ensure that members of these three groups are meaningfully encouraged to participate in available twelve-step programs.

*83.* Which of the following is NOT a strength of twelve-step programs? a. Twelve-step meetings are free, widely available, and offer ongoing support. b. The twelve-step approach easily accommodates client diversity. c. Twelve-step programs offer easy monitoring of assigned step tasks. d. The twelve-step approach offers recovery in cognitive, health, and spiritual areas.

*C: Twelve-step programs offer easy monitoring of assigned step tasks.* Twelve-step programs offer easy monitoring of assigned step tasks. Among the many benefits of twelve-step program participation are: (1) cost—meetings are a free, available virtually worldwide, and they provide a source of continuous support; (2) many larger cities offer specialized meetings for those with unique needs (e.g., youth, women, specific sexual orientations, treatment beginners, foreign language speakers, etc.); (3) the twelve-step approach addresses recovery in varied domains, such as cognitive health, spiritual health, and physical health realms, accommodating a focus of almost any potential participant; (4) the twelve-step approach easily accommodates clients from diverse ethnic, cultural, and other backgrounds. These benefits make the twelve-step approach uniquely beneficial as an important adjunct to comprehensive treatment. Primary drawbacks include: (1) it is difficult to accurately monitor client compliance with step tasks or even meeting attendance; (2) the emphasis on a higher power may be problematic for some clients; (3) smaller communities may not be able to sustain ongoing twelve-step meetings, issue-specific groups, or meetings well suited to dual-diagnosed (psychiatric disordered) clients.

*146.* Clients with an extensive substance abuse history often struggle with impulse control and anger. If a client becomes verbally agitated, angry, and elevated with a counselor, what is the BEST response? a. Threaten to call law enforcement unless he or she calms down. b. Cite the right to expel him or her from treatment if he or she misbehaves. c. Validate his or her affect but not expression (if threatening) d. Ignore the behavior so as not to further escalate his or her emotions

*C: Validate his or her affect but not expression (if threatening)* Substance abuse clients, especially those with a history of abuse themselves, can struggle with impulse control and emotions, especially anger. Acting out anger cannot be tolerated. Usually, however, there are signs of agitation, elevation, and anger well before physical acting out occurs. At this earlier juncture, it can be helpful for the counselor to validate their affect without validating any given verbal expression ("I can see this is something difficult for you . . ." or "This brings up a lot of emotion for you, doesn't it?"). In this way, the counselor moves to constructive address of the client's emotions, defusing the need to act out physically. Prevention is particularly valuable—ground rules for conduct in group, with staff and on site, should be provided at the point of intake. Language, breach of confidentiality, threats, and physical aggression cannot be tolerated. Law enforcement may need to be called if safety becomes an issue. Clients should know in advance that serious threats are taken seriously and will be reported.

*59. Defining patient goals takes place during which point in counseling?* a. when counselor and patient have become comfortable with each other b. during the treatment process c. within the assessment stage d. at the close of each counseling session

*C: Within the assessment stage* Defining patient goals should take place during the initial stage of counseling, when a treatment plan is determined and set in place.

*98. Substance abuse counselors tend to...* a. work only with those in the mental health professions. b. work only with other substance abuse counselors. c. work closely with other health disciplines. d. work completely independently.

*C: Work closely with other health disciplines* Because of the nature of substance abuse counseling, counselors often tend to work closely with other health professionals (such as social workers and professionals within the court system).

*100. You are asked to fill in with a patient while another counselor is away. Should you accept this request?* a. no, never b. yes, always c. yes, depending on the circumstances d. only if paid at a higher rate than usual

*C: Yes, depending upon the circumstances* It is not uncommon for a counselor to be asked to take the place of another counselor during a time of illness or even due to vacation schedules. Whether or not it is appropriate to conduct treatment with another counselor's patient, however, depends upon the needs of the patient and ability of the counselor to meet those needs during the time needed.

*92. If your patient is mentally impaired or otherwise considered incompetent, can you give treatment information to family members?* a. yes, if they are blood relatives b. no, not without a release of information from the patient c. yes, if the family member is the patient's legal guardian d. no

*C: Yes, if the family member is the patient's legal guardian* If a patient is considered significantly impaired or incompetent, then it is advisable for there to be a legal guardian who is responsible for the patient. In this case, the therapist may discuss the patient's treatment, without written consent from the patient, with the legal guardian.

Level of Psychoactive Substance Use *Fourth or Final Level*

*Compulsive Use* Daily or almost daily of high doses to achieve a desired physical and/or psychological effect

*1.* A wife refers her husband for substance abuse counseling. His drug of choice is cocaine, which he has been using episodically with friends at a poker game—biweekly to weekly—for some years. She is disturbed at the illicit nature of the drug and the long-standing use. He states that though he recreationally uses, he does not crave cocaine, does not seek it out but rather uses with friends at the game who bring it, and he feels that other than his wife being upset about him using, he has no other social or occupational issues. Given the information provided, how is his use of cocaine BEST described? a. Substance abuse b. Cocaine intoxication c. Cocaine use disorder d. None of the above

*D. None of the above* The DSM lists a set of eleven symptoms, 2 or more of which must have occurred at any time during the past 12 months for a diagnosis of substance use disorder. 1) Tolerance, defined as either the need for larger and larger amounts of the drug in question over time to achieve the desired result, or a decrease in the effect of the drug with continued use of the same amount 2) Withdrawal, defined by either the known withdrawal symptoms for a particular drug, or by the fact that the drug, or a similar drug, is taken to avoid withdrawal symptoms 3) An increase in the amount of the drug taken, or the continued use of the drug past the intended time 4) An inability to control usage 5) A large amount of time and effort devoted to obtaining the drug in question, using the drug in question, or recovering from its effects 6) The giving up of important activities in order to obtain or use the drug in question, or recover from its effects 7) The continued use of the drug in question regardless of the ill effects it has caused. 8) Craving 9) Recurrent drug use which leads to inability to fulfil major role 10) Recurrent drug use though it is physically harmful 11) Recurrent drug use despite it leading to continued social problems. He does not meet the criteria for current intoxication either. Recreational use commonly occurs biweekly or weekly, and the use is typically for reasons of sociality. 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.

*59.* How is the MOST effective relapse-prevention training provided? a. Group therapy is more effective. b. Individual therapy is more effective. c. Structured classes are more effective. d. A and B are roughly equal in effectiveness

*D: A and B are roughly equal in effectiveness* Research reveals that the effectiveness of group therapy is on a par with that of individual therapy. In addition, group therapy allows for a more effective balance of costly individual counseling services. Intensive outpatient treatment (IOT, Level II care) is typically delivered in sequential stages, with greater service intensity and structure gradually reduced as clients progress. This allows for increasing personal responsibility even as structure and staff supervision is reduced. However, it is important to be able to return to more intensive services if changing client circumstances require it. The sequenced nature of IOT can motivate clients toward recovery milestones and stage completion criteria. Celebrating or otherwise marking the transition between IOT stages can provide further motivation. Finally, complex information can be better delivered via sequenced stages as this allows for conceptual units that are more easily understood and that can be revised to meet the unique cognitive, psychological, and transition readiness of each client.

*88.* In what setting is the therapeutic community (TC) treatment model MOST effective? a. A formal full-time residential setting b. An intensive day treatment setting c. Neither A nor B, but in a support group setting d. A and B equally

*D: A and B equally* Researchers investigating therapeutic community (TC) treatment have found that residential and day-only TC treatment program outcomes are not significantly different. Consequently, trends toward intensive outpatient treatment (IOT) using the TC treatment model should be effective. Studies funded by the National Institute on Drug Abuse (NIDA) have revealed that participation in TC treatment is correlated with measurably positive outcomes. For example, treatment outcome data from the longitudinal Drug Abuse Treatment Outcome Study found that completing TC treatment was associated with reduced use of alcohol, cocaine, and heroin, as well as reductions in depression, criminal behavior, and unemployment, as compared against levels experienced prior to treatment. Further, a study of inmates transitioned from an institutional TC program to a TC-oriented outpatient work-release program experienced lower rates of recidivism (re-incarceration) and drug use than those receiving institutional TC treatment alone. Thus, TC treatment appears to be an effective approach to reducing substance abuse, criminal activity, depression, and unemployment among individuals with positive criminal and drug use histories.

*86.* Traditionally, what has the term therapeutic community (TC) referred to? a. An informal group organized for mutual support b. A court-ordered treatment environment c. A formal mutual-help or twelve-step support group d. A drug-free residential treatment environment

*D: A drug-free residential treatment environment* From the first therapeutic community (Synanon, founded in 1958 in California by Chuck Dederich), treatment communities (TCs) were organized as controlled, drug-free residential treatment settings providing intensive and comprehensive treatment. The central goal is to produce a holistically healthy lifestyle, engaging emotional, psychological, and social issues that may lead to substance use. Residents learn from each other, staff members, and other authority figures. This has come to be referred to as community-as-method perspective, which sees the whole community (clients, staff, social structure, and daily activities) as the active therapeutic agent. Many early TCs utilized punitive contracts, privilege losses, and extreme peer pressure to produce change. The more harsh aspects have since been significantly modified, though peer pressure remains a key motivator. The TC model has been expanded to include additional services, such as mental health and medical services, educational and vocational services, and family education and therapy. Today, many TC programs are carried out in intensive outpatient treatment (IOT) programs, serving clients transitioning out of residential or incarceration settings or bypassing residential treatment altogether.

*76.* What does a dual relationship refer to? a. Dyads assigned in addiction-recovery groups for added support b. The sponsor-sponsee relationship in twelve-step groups such as A.A. c. The mentor relationship with those newly entering addiction treatments d. A working relationship with a client outside the professional domain

*D: A working relationship with a client outside the professional domain* Dual relationships are unethical during and immediately following the course of any counselor-counselee relationship. More broadly, dual relationships arise when multiple roles are created outside the therapeutic-fiduciary relationship. Examples include: (1) allowing a client to provide automobile repair work for a therapist, whether it is paid or not; (2) hiring a client to paint a therapist's home; (3) allowing a client to provide volunteer clerical work in the program office; and so on. Multiple roles such as these compromise the integrity of the therapeutic process, making it more difficult to provide client services that are untainted by the ancillary roles. Working through difficult issues becomes highly problematic—is it really about the issue at hand or the quality or willingness with which the ancillary role is carried out? Termination, closure, referrals, and so on all become laden and troublesome.

*110.* The MAST screening test is a twenty-five-question instrument that is used to explore the degree and severity of a client's problem with which type of abuse? a. Cocaine abuse b. Mescaline abuse c. Methamphetamine abuse d. Alcohol abuse

*D: Alcohol abuse* The Michigan Alcoholism Screening Test (MAST) is used in more in-depth interviews as well as in confinement or brief holding scenarios. It is administered to explore a number of important treatment issues: (1) the severity of the alcohol abuse problem; (2) a client's maturity and readiness for treatment; (3) the potential existence of a co-occurring psychiatric disorder; (4) the intervention technique needed to address the presenting problem; (5) the extent of potential support resources (including family, social, educational, and employment resources, along with individual motivation for change); and (6) facilitation of the engagement process leading to treatment. MAST is among the oldest and most accurate alcohol screening instruments and is able to identify dependent drinkers with as much as 98 percent accuracy. Its two drawbacks are (1) it is longer than many other screening tools, and (2) MAST questions explore drinking over a client's lifetime (not just currently), which makes the test less likely to detect early-stage drinking problems. Several variations of the MAST have been developed, including the brief MAST, the short MAST, and the self-administered MAST.

*2.* What does the experienced effect of a drug depend upon? a. The amount taken and past drug experiences b. The modality of administration c. Poly drug use, setting, and circumstance d. All of the above

*D: All of the Above* The amount of a drug ingested will typically affect the user's experience, with higher doses often producing a greater effect (though potentially diminishing over time as tolerance develops). The modality of administration can greatly influence the rate of the drug's uptake into the system. Normally the rate of effect, from greatest to least, is: inhalation (snorting or smoking), injection (intravenous, intramuscular, or subcutaneous), and ingestion (sublingual or swallowing with or without food). Generally, the faster the systemic uptake, the shorter and more intense the high experienced. Polydrug abuse greatly complicates the drug experience, particularly if the drugs used are chemical antagonists (e.g., stimulants and depressants—such as meth and alcohol), additive (producing a cumulative effect), synergistic (more than cumulative), or potentiating (each enhancing each other). The setting in which the substance use occurs is also often a significant contributor to the experience. The feelings engendered by the surroundings, the people with whom the experience is shared, the attitudes and reactions of others involved, as well as personal past drug experiences and individual biology all combine to produce a drug experience.

*117.* Education regarding substance abuse includes topics such as triggers, patterns of abuse, and relapse prevention. What should treatment MOSTLY be focused on? a. Substance abuse issues and recovery only b. Substance abuse issues and health issues c. Substance abuse issues and co-occurring disorders d. All of the above

*D: All of the above* Clients need positive education and skills in substance abuse triggers, patterns of use, and relapse prevention. However, failures in other key areas of clients' lives can also trigger substance abuse relapses. Consequently, holistic treatment planning and interventions are essential to the recovery process. Establishing routine schedules early on can help clients to better organize their lives and sustain abstinence following program completion. Efforts directed toward improvement in the development of life skills can be especially important. Examples include counseling and education in areas such as self-esteem and assertiveness training, communication and anger management skills, relationship training, counseling for co-occurring disorders and personal psychological issues, vocational-educational training and interviewing skills, as well as home maintenance, budgeting and personal hygiene instruction—all are important contributors to clients' abilities to maintain clean and sober lifestyles.

*19.* What factors can affect screening instrument validity? a. The screening setting and privacy b. The levels of rapport and trust c. How instructions are given and clarified d. All of the above

*D: All of the above* Experienced counselors and researchers are aware that the setting in which screening occurs (home, office, clinic, or voluntary vs. involuntary facility) can significantly affect the results of any screening tool used. How instructions are given can substantially influence the findings as poorly chosen words and presenting attitudes can unquestionably taint client thinking, presumptions, and willingness to disclose. The presence or absence of privacy can also be a significant factor, as distractions, fears of disclosures or being overheard, and other such elements can bias and the screening and intake process. Further, the levels of rapport and trust between the client and the intake counselor may also alter client perceptions and, consequently, client responses during any screening interview or when completing any screening instrument. New counselors must, therefore, be alert to these factors and quickly learn to overcome any deleterious influences.

*111.* The relapse and remitting model addresses cycles of relapse and recovery common to addiction. What else can it be usefully applied to? a. Medication management b. Unemployment c. Issues of anger and violence d. All of the above

*D: All of the above* The relapse and remitting model of addiction has been successfully applied to a great many other situations, such as unemployment, poor medication compliance, anger management, and so on. Indeed, virtually any situation that tends to return (relapse) can benefit from this model. The relapse and remitting model recognizes that some issues tend to return cyclically over time. Recognizing this can help both the counselor and the client make advance contingency plans to avoid having a brief lapse return to a full relapse in negative circumstances or behaviors. This is particularly important in addiction management as lapses or relapses in any area of life tend to draw clients back into addiction relapses as well. Therefore, careful recognition and following of relapse-prone issues can result in quality advance planning, prompt responses, and minimization or outright prevention of further concurrent addiction relapse problems as well.

*5. 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. vein scarring d. damage to the nasal membrane lining

*D: Damage to the nasal membrane lining* Snorting or sniffing a drug refers to ingesting the drug through the nose. This route of administration tends to lead to irritation of the nasal membrane, and long-term damage as well. *The other three possible answers (infection, overdose, and scarring) are more common with administration of a drug through injection.*

Van Hoose and Paradise consider an ethical addiction professional to be one who:

- maintains personal and professional honesty; - focuses on the best interests of the client; - uses no malice nor receives personal gain; and - justifies his or her actions based on the current standards of practice.

*116.* Given a client's history, referrals for co-occurring disorders as well as medical, educational, and psychological needs should be ongoing as discovered. When should planning for aftercare be engaged? a. During the last few sessions, addressing specific, continuing needs b. When a client is roughly halfway through a program c. After measurable progress has been demonstrated d. At the point of the initial counselor-client contact

*D: At the point of the initial counselor-client contact* The initial contact provides the counselor with the opportunity to gather both positive and negative client history, which should not only be used in treatment plan development and ongoing modification over time but which will be relevant in the aftercare planning process as well. Family members should be drawn into aftercare planning and education early on to ensure ongoing understanding and support. Aftercare planning should also include education regarding health maintenance and prevention against sexually transmitted infections (STIs) - especially human immunodeficiency virus (HIV), tuberculosis, and hepatitis C, among others. Screening for STIs and tuberculosis should be an important part of programming as substance abuse clients may well not recall high-risk behaviors and thus may have encountered diseases of which they are not aware.

*121.* Confidentiality is particularly stringent in situations of alcohol abuse, drug abuse, and HIV infection. When are limited confidentiality breaches permitted? a. In situations where an individual is at real risk of harming him- or herself or others b. In situations of suspected child abuse and (in some states) in situations of suspected elder abuse c. Neither A nor B d. Both A and B

*D: Both A and B* Every state and all federal regulations allow the limited breach of confidentiality in situations of credible suicidality and threats of serious harm to others. Credible suicidality is a plan for self-harm and the means to carry out the plan. Dangerousness to others typically involves voiced threats regarding a third party and the real intention of harm (possibly including intentional human immunodeficiency virus [HIV] exposures). Tarasoff regulations require a counselor to notify the intended victim or someone reasonably able to notify the intended victim as well as law enforcement. Mandated reporting of child abuse typically involves physical or sexual abuse, though other conditions may apply. Many states have similar laws governing reporting abuse of the elderly or dependent adults. Finally, conditions of grave disability may also require that confidentiality be breached to keep an individual and others safe. Grave disability tends to be defined as compromise from a mental disorder to the extent an individual is not able to pursue basic personal needs (food, clothing, or shelter) or otherwise sustain health and personal safety.

*68.* Disulfiram (Antabuse) is contraindicated for clients whose alcohol abuse is combined with which of the following circumstances? a. Cocaine use b. Methadone use c. Both cocaine and methadone use d. None of the above

*D: Both cocaine and methadone use* Disulfiram (Antabuse) is indicated even with cocaine use or methadone maintenance. Disulfiram interferes with acetaldehyde metabolism, which produces a profound physical reaction if drinking occurs within twelve hours to seven days, depending on dose. The reaction involves facial flushing, followed by a throbbing headache, tachycardia, tachypnea, and sweating. Some thirty to sixty minutes later, nausea and vomiting occur, often accompanied by hypotension, dizziness, fainting, and collapse. The full cycle takes one to three hours. Careful blood alcohol monitoring is needed to ensure that no alcohol is present before administering disulfiram. Low doses (125 mg) can be given as quickly as the blood alcohol reaches zero. An initial dose of 250 to 500 mg may be used, though lower doses may be better for small women, the elderly, and those with liver impairment. Clients have taken the drug as long as sixteen years. Episodic use is effective to guard against drinking in high-risk situations (e.g., special events or celebrations, etc.). Food that contains alcohol usually does not cause a problem if it has been evaporated during the cooking process.

*40. Which of the following is a significant difference between casefinding and ongoing services?* a. Ongoing treatment is rarely used for alcoholism. b. Casefinding involves only alcoholism. c. Ongoing services do not always include treatment, and casefinding does. d. Casefinding does not always include treatment, and ongoing services do.

*D: Case finding doesn't always include treatment, and ongoing services do* Casefinding refers to finding individuals who require treatment and encouraging them to enter into a treatment process. The individual might or might not actually enter into treatment. Ongoing services refers to those who are in treatment

*41. Which of the following is the primary goal of the helping relationship between patient and counselor?* a. elimination of the substance the patient is abusing b. education of the patient c. the emotional support of the patient d. changing the patient's behavior

*D: Changing the patient's behavior* The primary goal of the helping relationship is to help the patient to change the behavior that is causing the difficulties in the patient's life.

*6.* What is the MOST common symptom of Wernicke's encephalopathy? a. New memory formation b. Loss of older memories c. Psychosis d. Confusion

*D: Confusion* Other symptoms of Wernicke's encephalopathy include poor muscle coordination and oculomotor impairment (problems moving the eyes in a controlled fashion). Wernicke's syndrome is a short-term condition resulting from vitamin B1 (thiamine) deficiency, typically developing after years of drinking and poor nutrition. Of those with Wernicke's syndrome, 80 to 90 percent will develop long-term psychosis and memory problems known as Korsakoff syndrome. While poor coordination is a symptom, retrograde amnesia (loss of old memories) and learning impairments are among the more classic hallmarks of the condition. Because they are so often found together, the two syndromes are often referred to concurrently as Wernicke-Korsakoff syndrome.

*81. Your patient is of a spiritual faith that is counter to your own. You should...* a. avoid spiritual discussions. b. discuss the spiritual differences and continue with treatment. c. terminate treatment. d. continue with treatment, being respectful of the patient's beliefs.

*D: Continue with treatment, being respectful of the patient's beliefs* A patient's belief system should be respected, and a competent professional should be able to work with a patient regardless of that belief system. If this is not possible, then the patient should be referred to another practitioner.

*13. How does the route of inhalation pass the drug into the user's bloodstream?* a. by the stomach lining b. through a nasal membrane c. directly via a blood vessel d. through the lungs

*D: Through the lungs* When the user inhales a drug, it enters the bloodstream through the user's lungs. There can be a rapid peak effect with this method of administration, but it is far more difficult to use unnoticed.

*45.* What does the DAP progress note acronym stand for? a. Description, Assessment, and Progress b. Details, Assessment, and Progress c. Documentation, Actions, and Pending d. Data, Assessment, and Plan

*D: Data, Assessment, and Plan* DAP notes assist clinicians record clear and organized notes to better understand client thinking, select appropriate goals, and track client progress. The data section includes facts such as client statements, observations regarding mood and behavior, past assignment reviews, and so on. This section is typically the longest portion of a DAP note. The assessment section includes client current status and evaluation of treatment progress. It may also include tentative or working diagnoses, potential treatment requirements, requirements, and information regarding a client's motivation or ability to proceed. The plan section includes session scheduling and the expected focus for upcoming treatment sessions. In this area, updates or alterations in treatment are recorded, along with comments regarding homework assignments. DAP notes allow others to understand events during each therapy session and evolutions in treatment and can aid in tracking long-term progress and program and intervention effectiveness in a consistent manner.

*47. In counseling, to what does immediacy refer?* a. getting the patient into counseling as soon as possible b. discussing the most critical issues first c. getting to the sessions on time d. dealing with feelings in the here and now

*D: Dealing with feelings in the here and now* Immediacy deals with the counselor and patient working through feelings in the counseling relationship.

*80.* As a substance abuse counselor, you work in a treatment program and also personally attend a twelve-step program in the community. A treatment program client asks you to become his or her twelve-step sponsor. What is the proper, thoughtful response? a. Accept, knowing that it may benefit the therapeutic alliance. b. Accept, knowing how much this client needs help. c. Decline, concerned that the client could be difficult to support. d. Decline, recognizing the potential conflicts in multiple roles.

*D: Decline, recognizing the potential conflicts in multiple roles.* Many substance abuse counselors have a past history of substance use and thus also hold membership in mutual-help programs. Where a client from a treatment program is encountered in a mutual-help setting, it is essential for a counselor to maintain appropriate boundaries between these separate roles (professional vs. consumer). To this end, it would not be proper for a counselor to become a client's sponsor. To minimize potential conflicts, counselors should not attend meetings where current or former clients attend. Where this cannot be avoided, the counselor should not share his or her personal issues at that meeting. If a counselor needs to talk, he or she should share with other non-clients privately after a meeting or contact his or her sponsor. To prevent such dilemmas, some cities host counselor-only meetings. These are typically not listed in the general mutual-help directories. To locate a mutual-help program of this composition, a counselor should contact the intergroup office or consult with other counselors in the area.

*3.* How is drug tolerance BEST described? a. The inability to get intoxicated b. The need for more of a drug to get intoxicated c. Increased sensitivity to a drug over time d. Decreased sensitivity to a drug over time

*D: Decreased sensitivity to a drug over time* When a drug is used regularly, the body is gradually able to adapt to the effects of the drug. Evidence of tolerance is twofold: (1) greater doses of the drug are required to achieve previous effects, and (2) doses that would have produced profound physiological compromise or even death are now readily tolerated without untoward effects. In some cases, it has been noted that up to ten times a lethal dosage, or even more, may be taken without any signs of significant physiological compromise. Tolerance develops as the body seeks homeostasis, or a functional state of equilibrium, in spite of the presence of the drug.

*4.* Which of the following is NOT a "drug cue"? a. A prior drug-use setting b. Drug use paraphernalia c. Seeing others use drugs d. Drug avoidance strategies

*D: Drug avoidance strategies* Intense drug euphoria produces extremely intense, emotionally imprinted memory engrams, coupled with long-term changes in the amygdala area of the brain, which operate outside of conscious control. Key euphoric memories become integrally connected to sights, sounds, smells, people, and places previously associated with drug use. The reappearance of any of these past drug cues will often effectively trigger intense, amygdala-driven cravings for a drug. Cravings are further intensified by lingering imbalances in brain metabolism patterns, receptor availability, hormone levels, and other hypothalamus and pituitary-mediated sensations of dysphoria and distress. The cascading nature of these effects frequently induces a drug-use relapse.

*53. Why must every patient be treated differently?* a. Patients with substance abuse are usually demanding. b. Every patient will have an underlying psychiatric diagnosis. c. Addictions cause changes to the patient's personality. d. Each patient is different.

*D: Each patient is different* Every patient must be treated differently because every patient is different. Even if two patients have a very similar set of circumstances and addiction, each will still show differences in how they react to their situation, the therapeutic situation, the conflicts in their lives, etc. Counseling techniques must be adjusted to meet the needs of each individual patient best.

*15.* Which of the following subcategories of alcohol use disorder onset is NOT found in the elderly? a. Late-onset alcoholism b. Delayed-onset alcoholism c. Late-onset exacerbation drinking d. Early-onset alcoholism

*D: Early-onset alcoholism* Early-onset alcoholism refers to an onset of alcohol abuse in adolescence or young adult life. This represents about two-thirds of all individuals with an alcohol use disorder. Late-onset exacerbation drinking refers to individuals with an intermittent history of alcohol abuse that only became chronic in late adulthood. Late-onset alcoholism refers to individuals with no prior life history of alcohol abuse who developed an alcohol problem solely in later life. This category of alcoholism may be more amenable to treatment than the earlier-onset forms. Detoxification can be protracted in the elderly, requiring a longer treatment stay, due to the metabolic changes of aging. Group treatment can be complicated by the group milieu, where younger participants may leave the elderly feeling estranged and out of sync with the other participants. Careful efforts at inclusion or an alternate group composed of older participants may be required.

*63. In group therapy, which of the following is the BEST choice for characteristics of counselors and patients?* a. punctuality and responsibility b. genuineness and a sense of humor c. respect and familiarity d. empathy and concreteness

*D: Empathy and concreteness* The four best choices of personality characteristics (of both patients and counselors) are empathy, concreteness, genuineness, and respect. Although there are many other useful characteristics as well, these four are key.

*82.* What does the Twelve-Step Facilitation Approach refer to? a. Program counselors also serving as twelve-step group facilitators b. Twelve-step program facilitators working within a treatment program c. Teaching twelve-step principles during treatment program work d. Encouraging clients to enter a community twelve-step program

*D: Encouraging clients to enter a community twelve-step program* Using a modified Minnesota Model of treatment (i.e., first used at Hazelden Foundation and Willmar State Hospital in Minnesota in the late 1940s), twelve-step facilitation, involves a thorough introduction to twelve-step principles, education about the disease of alcoholism (or other drugs), and strong encouragement toward participation in twelve-step groups. Twelve-step fellowships, such as Alcoholics Anonymous (AA), are guided by the philosophy that alcoholism (or other addiction) is a progressive disease with psychological, biological, and spiritual aspects. The twelve-step approach gradually evolved for use with drug addictions and various compulsive disorders (e.g., eating disorders). Treatment programs that use twelve-step facilitation teach twelve-step principles, begin working the twelve steps, achieve abstinence, and move clients to community-based twelve-Step groups (e.g., AA, Cocaine Anonymous [CA] or Narcotics Anonymous [NA]). In these programs, educational efforts present alcoholism as a disease marked by denial and loss of control. Outside work includes reading twelve-step materials, journal writing, and other personal recovery-oriented tasks.

*30.* Which of these key elements does NOT bolster a client's desire to complete the program? a. Knowledge of the benefits of treatment b. Understanding of the treatment process c. Fully assuming the patient role d. Frequent interdisciplinary consultations

*D: Frequent interdisciplinary consultations* Clients are largely unaware of the consultations that treatment team members engage in throughout the treatment process. However, an awareness of the benefits of treatment—not only for the issue of substance abuse or alcohol but for other related life concerns—can substantially increase a client's commitment to a treatment program. In like manner, the client needs to fully understand the treatment process. In this way, the purpose and goals of interventions can be clear, and motivation to adhere to treatment consequently increases. Finally, fully assuming the patient role is important because, in this way, the client resolves to put him- or herself completely into the hands of treatment provides. A relinquishment of this nature removes attitude and behavioral barriers and results in more effective treatment functioning.

*32. Narcotics withdrawal symptoms are sometimes described as being like....* a. a head cold. b. experiencing food poisoning. c. feeling fatigued. d. having the flu.

*D: Having the flu* The severity of withdrawal from a narcotic addiction depends upon how much of the drug has been used and for how long, as well as how often it has been administered. However, many people describe the withdrawal symptoms from narcotics as being similar to having the flu.

*24. Alcohol causes...* a. decreased urination. b. decreased size of blood vessels near the skin. c. decreased blood flow to the skin. d. increased breathing at low levels.

*D: Increased breathing at low levels* Alcohol can cause increased breathing at low levels of ingestion, and depressed breathing at higher levels. Blood flow to the skin and blood vessels near the skin is increased, as is urination due to its effect upon the kidneys and the increased fluid levels.

*104.* What is the trend for cultural diversity in the United States? a. Decreasing slowly but steadily b. Remaining approximately unchanged c. Increasing slowly but steadily d. Increasing rapidly and steadily

*D: Increasing rapidly and steadily* As recently as 1990, about 23 percent of adults were from ethnic and racial minority groups. By 2025, it is estimated that 40 percent of adults (and 48 percent of children) will be from these same groups. Even among the four most representative ethnic and racial minority groups, great diversity exists. For example, Asians and Pacific Islanders consist of at least forty-three distinct subgroups speaking more than one hundred different languages. Hispanics may be further divided into Central and South Americans, Cubans, Mexican, and Puerto Ricans, among many others. More than five hundred tribes fall under the heading of American Indian or Alaskan Natives, each with different ancestry, cultures, and languages. African Americans are also an increasingly diverse group as immigrants continue to arrive from Africa, the Caribbean, and South America. Degrees of acculturation and mainstream assimilation vary widely. Higher birth and immigration rates have resulted in a 56 percent increase in Hispanics—the fastest-growing minority group in the United States. Mometrix Test Preparation. Addiction Counselor Exam Practice Questions (First Set): Addiction Counselor Practice Tests & Review for the Addiction Counseling Exam (Kindle Locations 1315-1322). Mometrix Test Preparation. Kindle Edition.

*145.*The Code of Federal Regulations, Title 42, Part 2, Subpart E, addresses situations where law enforcement or courts can breach client confidentiality. What is a subpoena signed by a judge? a. Sufficient for release of information, provided it is delivered by a law officer b. Sufficient for information release, if signed by a federal court judge c. Insufficient for information release, unless signed by two qualified judges d. Insufficient, unless a qualified hearing is first held in court

*D: Insufficient, unless a qualified hearing is first held in court* The Code of Federal Regulations, Part 2, Subpart E, requires that information, even about the mere presence of a client in treatment, is not to be released under any circumstances unless a qualified court hearing has first been held wherein the issue of confidentiality and client needs have first been addressed. Following this, a special authorizing order must be issued. At a hearing, the court must determine: (1) if the alleged crime is sufficiently serious to warrant breaching confidentiality in this sensitive area (e.g., homicide, rape, assault with a deadly weapon, etc.); (2) if the records disclosure will be of sufficient value in the investigation; (3) if other reasonably effective options exist; (4) if the potential for damage to the client, to the client-provider relationship, and to the program's ability to continue providing services outweighs the release of this very sensitive information; and (5) if the applicant is acting in a true law enforcement function and if adequate counsel has been obtained by the records holder or agency.

*23. Why can an overdose of a barbiturate cause death?* a. It targets the impulse-control centers of the brain. b. It causes a fast-acting negative effect on the kidneys. c. It quickly damages the liver. d. It can depress critical physiological functions, such as breathing.

*D: It can depress critical physiological functions, such as breathing* Barbiturates pass into the brain through the bloodstream and can depress physiological functions such as breathing. If too much of a barbiturate is taken, the depressive effect can be enough to stop breathing and other functions entirely.

*106.* As compared with current older adults, what is the upcoming baby boomer generation (born between 1946 and 1964) expected to have? a. Much lower treatment needs b. Somewhat lower treatment needs c. Somewhat higher treatment needs d. Much higher treatment needs

*D: Much higher treatment needs* It has been estimated that, not only will there be a 50 percent increase in the number of seniors needing substance abuse treatment, but there will also be a 70 percent rate of increase in the treatment needed by these older adults. In part, this may be because baby boomers have had a higher baseline of use throughout their lives than the generations that preceded them. In addition, the baby boomer generation and beyond is more racially and ethnically diverse, with all the unique needs this entails. Barriers to treatment among older adults include: (1) high levels of shame; (2) relatives who either rationalize the problem away or are ashamed to acknowledge it on behalf of their loved one; (3) diagnosis and treatment is more difficult because of collateral mental and physical health problems; (4) transportation is more limited; (5) social networks are dwindling; and (6) financial constraints are tighter.

*96. As regards ongoing education of counselors, substance abuse counselors...* a. should take one educational class every five years. b. can choose whether or not to continue their education. c. do not require ongoing education. d. need ongoing education just like other health professionals.

*D: Need ongoing education just like other health professionals* A counselor should ethically maintain the counselor's standard of expertise and stay current within his or her field. What is required to do so will differ from counselor to counselor, but it should be a serious professional consideration.

*78. You and your patient are attracted to each other. When can you ethically enter into a romantic relationship?* a. only after treatment has progressed to a certain point b. once treatment is completed c. at any time d. never

*D: Never. It is not considered ethical to enter into a romantic relationship with current or former patients* Patients are vulnerable and that should be kept in mind when considering any personal involvement outside the professional relationship.

*11.* In terms of difficulty quitting (dependence), which of the following four drugs ranks the highest? a. Alcohol b. Cocaine c. Heroin d. Nicotine

*D: Nicotine* 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.

*144.* The Code of Federal Regulations, Title 42, Part 2, addresses client confidentiality. Other than through a written information release, when do exceptions to confidentiality exist? a. When program funding requires it b. When a police officer demands it c. When a subpoena requests it d. None of the above

*D: None of the above* In general, the language in 42 CFR Part 2 prevents all information releases (as well as client-identifying information), even to other uninvolved staff. Key exceptions do, however, exist: (1) written information releases—if properly completed—oral consent, however, is not permitted; (2) emergency medical situations—limited essential information may be given to treating medical personnel but not to law enforcement directly; (3) other agencies working with a client—if a Qualified Service Organization Agreement (QSOA) that guarantees confidentiality at the same level has been signed; (4) mandated reports—notifying authorities of child abuse, and (sometimes) dependent adult and elder abuse, releasing only limited essential information; (5) qualified researchers under limited conditions; (6) crime on site or against staff—limited release to law enforcement; and (7) court order or subpoena, search warrant, or arrest warrant—only if it also meets 42 CFR Part 2 criteria. Language in 42 CFR Part 2 also applies to all staff and volunteers as well as past, current, and even potential (applicant) clients, living or deceased.

*74. Confidentiality rules do NOT include...* a. the number of times a patient has attended therapy sessions. b. the patient's diagnosis. c. the patient's treatment plan. d. none of the above—confidentiality applies to all patient information.

*D: None of the above—confidentiality applies to all patient information* Any and all information about the patient is held to be confidential and must be protected.

*71. Your patient has been in treatment for two weeks when the patient refuses further treatment. What should you do?* a. contact family members to encourage a return to treatment b. continue to contact the patient in an attempt to return the patient to therapy c. contact the legal authorities d. note the patient's refusal and respect the patient's decision

*D: Note the patient's refusal and respect the patient's decision* A patient has a right to refuse treatment unless there are extenuating circumstances (such as a legal court order). In such a case, the therapist should make the appropriate documentation and respect the patient's decision.

*62. How are pharmacotherapy and medication management in substance abuse treatment described? a. Of little importance outside a hospitalization program b. Of some but limited value but without a central role c. Of moderate value in treatment but not crucial d. Of considerable, albeit limited, value in treatment

*D: Of considerable, albeit limited, value in treatment* Pharmacotherapy and medication management are of critical importance in effective substance abuse treatment. They must not be overlooked or isolated from other therapies and interventions. Even so, medications cannot alter lifestyles or recover the functional damage that results from drug abuse. Due to the three- to five-day weekly schedules of most intensive outpatient treatment (IOT) programs, they are an ideal setting for identifying medication needs and then initiating and monitoring the necessary medications. IOT program-based pharmacotherapy and medication management can facilitate: (1) ambulatory detoxification; (2) withdrawal symptom relief; (3) craving reduction; (4) blocking the reinforcing effects of drugs; (5) reducing the health risks that accompany the use or injection of illicit drugs; (6) mitigation of certain underlying psychopathologies that may predispose substance abuse or relapse; (7) the monitoring and treatment of numerous potential medical conditions that may result from acute or long-standing substance abuse.

Principles *Principle 3: Client Relationship* *Can you use clients in a Educational Projects?*

*Not without their informed consent*

*46.* The mnemonic DIG-FAST evaluates which psychological state? a. Depression b. Anxiety c. Paranoia d. Mania

*D: Paranoia* The acronym DIG-FAST is a tool prompting the full evaluation of the symptoms of mania. Each letter addresses one of the key potential features of mania: distractibility (easily distracted as evidenced by an inability to concentrate), indiscretion (excessive pleasure activities), grandiosity (larger-than-life feelings of superiority, wealth, power, etc., often experienced during manic, hypomanic or mixed episodes), flights of ideas (mind is racing, seemingly unable to control or slow down thoughts), activity (markedly increased activity, with weight loss and increased libido), sleep deficit (unable to sleep for extended periods well below normal sleep needs but not drug induced), talkativeness (pressured speech: rapid, virtually nonstop, often loud and emphatic, seemingly driven, and usually hard to interrupt).

*49.* What is the BEST distinction between substance abuse treatment programs and mutual-help groups, such as a twelve-step support groups? a. Programs offer help, and groups offer support. b. Programs are expensive, and groups are free. c. Programs are run by professionals, and groups are run by laypersons. d. Programs offer treatment, and groups offer support.

*D: Programs offer treatment, and groups offer support.* The policy of the American Medical Association (AMA) is that clients coping with substance abuse disorders should receive formal treatment from qualified professionals. Mutual-help groups may provide adjunctive services and may be a part of a successful treatment plan. The American Psychiatric Association (APA), the American Academy of Addiction Psychiatry (AAAP), and the American Society of Addiction Medicine (ASAM) have concurred, asserting in a joint policy statement that treatment involves at least: (1) a qualified professional providing services; (2) a thorough evaluation to determine the severity and stage of the illness and to screen for other mental and medical disorders; (3) a properly developed treatment plan; (4) that the treating professional or program remains accountable for the treatment and additional service referrals as necessary; (5) that the treatment professional or program remains in contact with the client until the recovery process is complete. While mutual-help groups are important, they cannot substitute for professional treatment.

*51.* Which of the following is NOT a core feature or service that the Center for Substance Abuse Treatment *(CSAT)* consensus panel agreed upon? a. Biopsychosocial assessment b. Individualized treatment planning c. Case management d. Recreational therapy

*D: Recreational Therapy* Recreational therapy was not one of the core features and services referenced by the Center for Substance Abuse Treatment (CSAT). The CAST consensus panel agreed that intensive outpatient treatment (IOT) core features and services must include the following: intake and orientation; full biopsychosocial assessment; individualized treatment planning; individual, family, and group counseling; psycho-educational programming; case management; linkages with mutual-help and community-based support groups; twenty-four-hour crisis support; medical treatment; formal drug screening and monitoring (urine or breath tests); educational and vocational services; psychiatric evaluation and psychotherapy; medication management; and discharge planning and transition (discharge) services. They further defined potential enhanced services to include: adult education; recreational activities; housing and food resources, smoking cessation treatment; transportation referrals; child care; and parenting skills education.

*88. You learn that your patient has been convicted of sexual assault in the past. As an assault survivor yourself, this is the one area in which you have difficulty being objective. What should you do?* a. inform the patient of your situation, but continue with therapy b. terminate therapy c. continue with therapy, doing the best you can in the situation d. refer your patient to another therapist

*D: Refer your patient to another therapist* Professional conduct and objectivity are critically important in therapy. The therapist must be able to remain objective and keep his or her personal feelings out of the counseling relationship. If the therapist cannot do this, then the patient should be referred to a therapist who can.

*75.* What is a client's family of choice used to describe? a. Step-parents and step-and half-siblings b. Common-law relationships only c. Planned pregnancies as opposed to those unplanned d. Relationships created by marriage, friendship, and other associations

*D: Relationships created by marriage, friendship, and other associations* The family of origin refers to blood relationships (parents, siblings, cousins, grandparents, etc.). The relationships in both family types are important in substance abuse treatment. Either group may bring factors and influences that contribute to substance abuse (e.g., alcoholism, culture or traditions supportive of drug experimentation, etc.). Where outright drug or alcohol use was not condoned, families may have interactive patterns that predispose substance abuse. Troubled families often have too few or too rigid rules, difficulties with intimacy, and ineffective problem solving. Such families often perpetuate a don't-trust-don't feel-don't-talk paradigm that allows isolation, damaging alliances, enmeshment, or other dysfunctions to persist. It is essential for counselors to learn about both the positive and negative resources in a client's family. Referrals for family counseling may be essential to this end. When the family becomes ready to change negative behaviors and adopt new, healthier ones, they become supporters in the treatment process.

*58. The issues of time, purpose, and confidentiality are parts of what?* a. maintaining order in therapy b. addressing addiction-related psychosis c. dealing with addiction issues d. structuring the counseling relationship

*D: Structuring the counseling relationship* Time, purpose, expectations and behavior, confidentiality, and fees are all parts of establishing the counseling relationship. This is important in order that both patient and counselor begin therapy with a common understanding.

*17.* What does motivational interviewing primarily involve? a. Focused confrontation b. Behavioral accountability c. Reality testing d. Supportive persuasion

*D: Supportive persuasion* The goal of motivational interviewing is to help the client discover his or her own desire to change. Thus, confrontation, stern accountability, overt reality testing, and other coercive or argument-inducing approaches are avoided. Five fundamental principles to guide the motivational interviewing process are: (1) reflective and empathetic listening, (2) identification of variances between behavior and personal goals, (3) deflection of confrontation or argument to more positive, goal-oriented dialogue, (4) redirection of client resistance to desires and goals rather than opposing it outright, and (5) nurturing optimism and a sense of self-efficacy when confronted with obstacles, challenges, and negative expressions.

LSD

-Lysergic acid diethylamide -Comes from mold of rye bread -Most popular hallucinogen in the US -Most potent hallucinogen -Small dose size -Schedule I

*12.* Which of the statements below is MOST correct? a. THC content in all marijuana is about the same. b. THC content in hashish is lower than in a joint. c. THC content in marijuana is predictable. d. THC content in marijuana varies widely.

*D: THC content in marijuana varies widely.* . Historically, the level of delta9-tetrahydrocannabinol (THC) in domestic U.S. marijuana was less than 0.5 percent. Recent cultivation and cross-breeding practices, however, have changed this, and some domestic marijuana has substantially higher levels. The THC in Mexican marijuana can range as high as 4 percent, and sinsemilla can reach concentrations as high as 8 percent. The potency of hashish (cannabis plant resin) can be as great as 10 percent, and hashish oil may contain as much as 20 percent THC. Street marijuana products may be diluted or cut with other adulterants (oregano, catnip, etc.) and may also be laced with other undisclosed psychoactive ingredients such as opium or LSD. Unexpectedly high doses of THC or the addition of other psychoactive substances can greatly affect the unsuspecting user in potentially troubling ways. Thus, caution is in order.

*136.* Research reveals that science-validated community and school prevention programs do work. Which of the following is NOT a category of youth prevention substance abuse programs? a. Universal programs b. Selective programs c. Indicated programs d. Targeted programs

*D: Targeted programs* A great many science-informed, effective prevention programs have been designed to target youth of varying ages in a variety of settings. There are three types of youth substance abuse prevention programs: (1) universal programs—designed to address both risk and protective factors in the general community or in school settings; (2) selective programs—oriented to engage youth that possess specifically identified risk factors that increase their likelihood of developing a substance abuse disorder; and (3) indicated programs—designed to address issues relevant to youth who have already allowed substance abuse into their lives. When programs such as these are properly applied to age-appropriate target audiences, research reveals that abuse of drugs, alcohol, and tobacco are all reduced. Central to all these programs is education regarding the harms caused by substance abuse as such education has proven to reduce experimentation and lower the rates of continued substance abuse in youth.

*9.* What is/are the organ(s) most damaged by cocaine abuse? a. The brain b. The lungs c. The kidneys d. The heart

*D: The Heart* Considerable medical research demonstrates that cocaine not only causes arterial constriction secondary to the drug's stimulant effects, but it also causes a cumulative effect, with more cocaine causing increased arterial narrowing. Atherosclerosis (artery hardening and plaque buildup) greatly magnifies this deleterious process. The result is that permanent disability or death due to sudden cardiac arrest or hemorrhagic cerebral stroke is an increasingly real possibility the longer the drug is abused. Finally, cocaine-induced damage to the prefrontal lobes (where behaviors are modified and controlled) often results in impaired judgment, disinhibition, loss of foresight, decisional incapacity, and chronic unpredictability and irritability.

*40.* What does it mean if an assessment instrument is valid? a. The instrument is licensed for use by professionals. b. The instrument consistently provides accurate information. c. The instrument has been approved by the government for use. d. The instrument assesses what it purports to assess.

*D: The instrument assesses what it purports to assess* Reliability addresses how well an instrument consistently gives accurate information. Accuracy is of little value if the aspects or issues being measured are not those the instrument was intended to measure. In like manner, an instrument that accurately addresses the intended aspects or issues is still of little value if the measurements taken by it are inaccurate. Thus, to be truly useful and effective, assessment instruments and tools must be both reliable and valid. In multiple studies, the Addiction Severity Index has been proven both reliable and valid.

*8. What is a route of administration?* a. the directions to a drug supplier b. a way to process a drug user's recovery program c. the way a drug acts upon the user's body d. the manner in which a drug enters the user's body

*D: The manner in which a drug enters the user's body* A route of administration is the means by which a drug is taken into the user's body. This ingestion can be accomplished in a number of ways. The most common ways to bring a drug into the bloodstream are oral, injection, and inhalation and nasal.

*140.* What is the key difference between a current treatment plan and a current progress note? a. The treatment plan evaluates client achievements, while a progress note ensures action steps are taken to meet objectives. b. The treatment plan assesses client needs, while a progress note coordinates service providers' interventions. c. The treatment plan records events and activities, while a progress note captures the client's current clinical presentation. d. The treatment plan provides an action blueprint, while the progress note captures what did or did not occur.

*D: The treatment plan provides an action blueprint, while the progress note captures what did or did not occur* Properly written progress notes chart the trajectory of the client's progress toward the goals, objectives, and action steps that make up the treatment plan. Progress notes are used to explain and inform any changes to the treatment plan in the context of what is actually happening in the client's daily lived experiences, behaviors, and level of functioning. In order to maintain a current and effective treatment plan, progress notes must be recorded within fourteen days or less of counseling sessions and fully reviewed at the time of a treatment plan update. These updates occur at regularly scheduled intervals or whenever it becomes apparent that changes in client functioning, behavior, motivation, or intent warrant the update. In this way, the treatment plan remains informative, effective, and transformational.

*14.* Among psychiatric disorders in the elderly, where does alcohol abuse rank? a. twenty-fifth b. fifteenth c. fifth d. third

*D: Third* Alcohol use disorders rank third among psychiatric disorders of the elderly. Some 2 to 4 percent of the elderly have a substance use disorder (including alcohol, drugs, or both). Approximately 15 percent of the elderly with an alcohol disorder will also have a concurrent drug abuse problem. Due to physical changes of age, researchers recommend only one drink per day as the upper limit. Detecting alcohol and drug abuse in the elderly can be difficult as the symptoms are often very similar to other health problems associated with age. Isolation, poor health, pain, or depression often motivates substance abuse in the elderly. Many are ashamed of the abuse and further avoid family and others to hide the problem. Suicide rates climb as people grow elderly, and 25 to 50 percent of all attempts by the elderly involve alcohol. Some 10 percent of the elderly misuse their prescription medication, intentionally or accidentally. Substance abuse may greatly complicate a potentially tenuous status for many on complex medication regimens.

*150.* In providing services, an agency needs to maintain a vision of purpose and important objectives. Of the following, what is the MOST significant mission? a. To ensure the survival and funding of the agency to continue offering services b. To ensure that staff have jobs so that they may continue offering services c. To earn a reputation of stability and consistency in offering services d. To break the cycle of abuse and neglect and its negative impact on others

*D: To break the cycle of abuse and neglect and its negative impact on others* While an agency must continue to receiving funding, provide employment, and maintain a consistent reputation in order to continue offering services, its most important purpose and function is to break the cycle of abuse and relieve the individual, involved families, and society as a whole from the suffering involved. To accomplish this, staff must receive appropriate support. This involves proper supervision and training, avoiding over-scheduling caseloads, allowing time for colleague consultations and support, facilitating quality outside support and consultation as needed, providing policies and procedures that ensure a safe, effective, and positive work environment, and so on. In this way, staff can be supported, quality services will be provided, agency longevity will be maintained, and turnover and burnout will be kept to a minimum. Administrators must recognize that counselors can only be expected to perform optimally if agency leadership provides adequate support.

*26.* What is the purpose of screening? a. To prepare the client for program admission b. To determine client readiness for change c. To establish client diagnoses and treatment needs d. To determine the need for placement or referral

*D: To determine the need for placement or referral* The purpose of screening is to methodically review a client's presenting circumstances by which to determine the appropriateness (or lack thereof) for placement or referral for further assessment and evaluation. Screening tools are also used to identify the presence or absence of co-occurring disorders, particularly those that might contribute to substance abuse. Screening tools do not attempt to diagnose a presenting co-occurring disorder but rather to establish the likelihood that one may be present. Where a client presents as potentially having a significant co-occurring disorder, the client is then referred to the proper clinician (psychologist, psychiatric social worker, psychiatrist, etc.) for further evaluation and diagnosis. Once a diagnosis is obtained, a treatment plan can be formulated that addresses the co-occurring disorder as well.

*27.* What is the primary purpose of substance abuse assessment? a. To determine the current level of health deterioration b. To identify a substance abuser's drug of choice c. To provide co-occurring disorder( s) diagnosis d. To determine the severity of the substance problem

*D: To determine the severity of the substance problem* The primary purpose of substance abuse assessment is to develop a full understanding of the severity and extent of a substance user's drug or alcohol abuse problem. However, the assessment process should also identify and explore other closely related issues such as co-occurring disorders (both mental and physical), significant others, employment and education, finances, and other social and legal concerns. The overarching goal of assessment is to gather sufficient information to establish (1) a working diagnosis of current substance abuse, (2) significant co-occurring disorders, (3) the quality and availability of important supports, (4) readiness for change, and (5) all other necessary information sufficient to establish a meaningful and successful treatment plan.

*33. A common side effect of long-term alcohol abuse that requires an increase in dosage is...* a. dilated pupils. b. olfactory retardation. c. stomach discomfort. d. tolerance.

*D: Tolerance* When alcohol is used over a long period of time, the user can develop a tolerance of the drug. This tolerance requires that the user increase the dosage in order to feel the same effects.

*60.* Which of the following is NOT a type of intensive outpatient treatment *(IOT)* group? a. Psychoeducational groups b. Skills development groups c. Interpersonal process groups d. Transitional care groups

*D: Transitional care groups* Psycho-educational groups teach key concepts regarding substance use disorder and its consequences. Time-limited, these groups are ideal for education at the outset of treatment. The low-key educational nature (as opposed to emotionally intense therapy groups) allows more objective examination of dysfunctional beliefs, problem thinking patterns, along with relapse prevention and skills training. Skills-development groups focus on refusal training, relapse prevention, assertiveness training, and stress management. Support groups address immediate issues along with ways to change negative thinking, emotions, and behavior, learning new ways of relating, managing conflict without violence or relapse, and evaluating how actions affect others. Interpersonal process groups include single-interest groups (focused on specialized issues, usually later in treatment) and family or relationship, and to the program's ability to continue providing services outweighs the release of this very sensitive information; and (5) if the applicant is acting in a true law enforcement function and if adequate counsel has been obtained by the records holder or agency.

*92.* With regard to co-occurring disorders, what does the term integrated treatment refer to? a. Meeting both medical and substance abuse treatment needs b. Using an eclectic treatment paradigm in the treatment process c. Incorporating sociocultural issues in the treatment process d. Treating both psychiatric and substance abuse issues concurrently

*D: Treating both psychiatric and substance abuse issues concurrently* The old view that one disorder should be stabilized before another can be treated has been found to be flawed. It is important to coordinate the treatment of co-occurring disorders as treatment may otherwise be counterproductive and otherwise ineffective. For example, many substance abuse treatments are confrontational, tightly scheduled, and semi-authoritarian in nature—particularly those programs for court-ordered clients. However, clients with psychiatric disorders may do very poorly in such treatment paradigms. Many suffer from depression, anxiety, paranoia, self-abuse (cutting, etc.), suicidal ideation, or personality disorders, among other possible symptomatology. Others struggle with fears about psychotropic medications to treat their co-occurring conditions and may also resist pharmacological treatment of their substance abuse. Clients struggling with such issues are far less likely to cope well with common substance abuse treatment approaches. Consequently, program adaptation and specialized staff training may be required.

Definitions *Obedience*

*Observing laws and regulations which govern individuals and the profession* Addiction professionals apply this principle ethic by following licensure and certification regulations, agency policies and legal mandates.

*115.* After referrals are made, it is important to track the associated outcomes for measures of referral success. What are the three MOST important evaluative aspects? a. How, where, and when b. Why, what, and where c. Where, when, and who d. Who, what, and how

*D: Who, What, and How* Referrals are of limited value if they do not contribute measurably to important goals and needed outcomes. These measures of success are evaluated by tracking the results of the referral—ideally, by means of a referral form. The who portion of the form identifies the client and the involved counselor. It may also include demographic information as well as information on the substances the client uses, any legal issues, and family concerns. The what section addresses the issues that generated the need for the referral—substance issues (and symptomatology), work issues, family issues, goals and commitments, and so on. The form's how section should address how the client was engaged and dealt with. In this way, the referrals made for any given client in the how section can be evaluated for interventions provided and outcomes realized.

*103.* Racism may jeopardize the mental health of minorities in all of the following ways EXCEPT that a. negative racial images and stereotypes adversely affect social and psychological function. b. racism and discrimination result in diminished socioeconomic status, where poverty, crime, and violence affect mental health. c. racism and discrimination lead to physiological changes and psychological distress that affect mental health. d. discrimination and racism limit recreational and leisure opportunities to improve mental health.

*D: discrimination and racism limit recreational and leisure opportunities to improve mental health.* Discrimination and racism limit recreational and leisure opportunities to improve mental health. While leisure and recreational activities are important to mental health, racism and other forms of discrimination are not typical sources of limiting these resources and opportunities. The terms racism and discrimination refer to attitudes, beliefs, and practices that prejudge and denigrate individuals or groups solely based on disparate phenotypic characteristics (e.g., skin color, hair texture, facial features, etc.) or ethnic minority group affiliation. Despite some improvements, racial discrimination continues and has been documented in the area of health care. Examples include fewer medical diagnostic and treatment procedures for African Americans as compared with whites, demeaning and belittling expressions, and less time and attention given to eliciting and addressing other health care needs. Racism and discrimination can be intentional or unintentional and can be perpetrated by individuals, groups, and institutions. Because racism and discrimination can be insidious and go unrecognized, it is crucial that it be continuously evaluated, especially in cross-cultural situations.

Depressants Alcohol *Withdrawal Stage 4*

*Delirium Tremens* *Profound confusion, delusions, vivid hallucinations*, tremors, severe agitation, sleeplessness, reduction in psychomotor activity, dilated pupils, fever, tachycardia and profuse perspiration Usually occurs three to five days after last drink. Most cases are mild and end abruptly. Severe cases are a medical emergency, with a 15% fatality rate. A single episode lasts 72 hours or less in 80% of the cases.

Definitions *Loyalty*

*Demonstrating allegiance to the client* Addiction professionals apply this virtue ethic when they advocate for and actively support clients' needs

Group Counseling *Two Stage Model*

*Developing:* - Acquaintance Stage - being introduced to strangers - Ground Work Stage - Characterized by conflict *Potency:* - Working Stage - Works through conflict to resolve it - Closing Stage - End stage, if the group makes it to here

Suicide Intervention *Do's and Don'ts*

*Do* always take suicide threat seriously *Do* always document all interactions where suicide is discussed or assessed *Do* access the immediate situation *Do* explain SI and SA mandatory reporting obigations *Don't* Interrupt the client *Don't* downplay *Don't* try to cheer up *Don't* ever ignore signs or SI verbiage

Definitions *Nonmaleficence*

*Doing no harm* Addiction professionals promote this principle ethic by avoiding any behavior that can cause harm or has the potential to harm an individual

Definitions *Fidelity*

*Exercising honesty and trust* Addiction professionals promote this principle ethic by being trustworthy with clients and the general public, as well as following through with commitments to clients and others.

Gestalt Therapy *Other Key Tenets*

*Existentialism* focuses on present day and stresses personal responsibility for one's own destiny *Unfinished Business* Unexpressed feelings from childhood that now interfere with healthy functioning *Contact* process of interacting with nature and with other people without losing one's sense of individuality

Addiction Counselor Qualities *Non-Verbal Responses*

*Eyes* *Head* *General Facial Expression* *Paralinguistics:* *Eye Brows* *Mouth* *Hands and Arms* *Legs and Feet*

Addressing Relapse *True or False: Relapse is only using a psychoactive substance*

*False* Relapse can also be the manipulative or destructive use of people, places or things people, places or things

Addressing Relapse *True or False: Relapse is unpredictable*

*False* Relapse is usually preceded by clearly defined signs

Addressing Relapse *True or False: Relapse is a failure*

*False* Relapse should be viewed as a learning experience and not as a failure

NAADAC Ethical Model *What does Reflect on the outcome of the course of action mean?*

*First*, it allows the addiction professional to evaluate the effectiveness of the course of action, as well as the effectiveness of the decision making process. *Second*, it may identify training needs in ethics or changes to agency policies and procedures that could be helpful in preventing similar ethical problems in the future. *Finally*, additional ethical or legal concerns may arise that were not apparent prior to the implementation of the plan.

Depressants Alcohol *Neurotransmitters*

*GABA* Met-enkephalin Serotonin

Co-Occurring Disorder *What is the rate of people with Co-Occuring Disorders?*

*One half to two-thirds of all clients* who have a psychoactive substance use disorders also have another diagnosable mental health disorder.

Dependendence *Physical versus Psychological*

*Physical Withdrawal Symptoms* i.e. nausea, shaking, headaches, etc. *Psychological* i.e. mental cravings

Infectious Diseases *At Risk Populations*

*Gay Men* - ripping of the tissue inside the anus *Minorities* - Six times higher among African-Americans - Three times higher among Latinos than for Caucasians - Primarily due to lack of education and public health care resources *Hetrosexual Women* Women having unprotected sex with a man - eight times easier for a male to infect a woman with HIV than vice versa - This population is growing faster than any other, especially among African-American women who have sex with intravenous drug abusing men - adolescents aged 15 to 24 represent the majority of new cases

Gestalt Therapy *Key Aspects*

*Genuineness* must occur between the client and the therapist *Projective Therapy* Think empty chair approach

Step Three

*Give oneself over to their higher power* or from the exam *Surrender and Willingness* Made a decision to turn our will and our lives over to the care of God as we understood Him. For this step, the alcoholic consciously decides to turn themselves over to whatever or whomever they believe their higher power to be. With this release often comes recovery. https://www.recovery.org/topics/alcoholics-anonymous-12-step/

Depressants Alcohol *Withdrawal Stage 3*

*Grand Mai (full body) type seizures* generally occur in bursts of two to six or more in the majority of cases. *Ninety percent of these seizures occur between seven to 48 hours after the last drink.* The *peak incidence is from 13 to 24 hours after the last drink* One third of the clients with seizures will go on to develop delirium tremens (DTs).

Group Counseling *Differences between Group and Self-Help*

*Groups* are screened and not open membership *Groups* require anxiety for change *Groups* focus on group conflict *Groups* are lead by a facilitator *Groups* work off transference

Depressants Alcohol *Withdrawal Stage 2*

*Hallucinations* Symptoms of distorted perception occur in about *25% of the clients*. Symptoms vary in intensity from misinterpreted shadows and movements to full-scale auditory or visual hallucinations. Auditory hallucinations may occur despite an otherwise clear sensorium and seem intensely real. An alcohol dependent suffering from this stage of withdrawal will appear distracted, frightened and disoriented.

Special Populations *Homophobia versus Hetrosexualism*

*Homophobia:* The irrational fear of and hatred towards homosexuality and homosexuals *Heterosexism:* A general distaste for homosexuality and the feeling that heterosexuality is superior

Person Centered Therapy *Main Principals*

*Humanism:* A philosophical movement that focuses on the innate nature within all humans to achieve our potential and find meaning in our lives *Congruence:* This is the most important of the three attitudes. lt is a condition where the counselor is consistently *genuine or real*, the counselor is able to match his or her external behavior with inner thoughts and feelings *Unconditional Positive Regard:* A component of person- centered therapy where a counselor shows the client constant acceptance and caring. *Accurate Empathic Understanding:* The ability to identify with and understand the subjective world of a client; also a component of person-centered therapy

Addiction Counselor Qualities *Five Key Traits*

*Immediacy* *Personal Ability* *Genuineness* *Warmth* *Positive Regard and Respect*

Adlerian Psychology

*Individual Psychology. Goal directed. *Everyone is striving to toward superiority and perfection. *Must learn how to handle inferiority. *Fictional Functioning imagined central goal that gives a client purpose or guides behavior *Lifestyle- clients chosen method on moving through life *phenomenolgy- viewing the world from the client's perspective *private logic- subjective reality as we view it *Social Interest- an awareness of being part of the human community and how one interacts with the social world *The goal is to further develop the client's social interest and help them connect with the social world in a more meaningful way.

Level of Psychoactive Substance Use *Third Level*

*Intensified Use* Taken daily or almost daily is low to moderate doses. To achieve relief from a condition i.e. depression

Central Nervous System Depressants *Note*

*Major tranquilizer* - antipsychotic - not addictive *Minor tranquilizer* - anti anxiety - addictive

Step Eight

*Make a List of Those We Hurt* Made a list of all persons we had harmed, and became willing to make amends to them all. Alcoholics write down all of the people they have wronged through their alcoholism. The wrongs could range from large to small - from stealing from them to buy more alcohol to talking negatively behind their backs. https://www.recovery.org/topics/alcoholics-anonymous-12-step/

Step Nine

*Making Amends* Made direct amends to such people wherever possible, except when to do so would injure them or others. Many alcoholics work with their sponsor to figure out the best way to complete this step. Making amends could include writing a letter to a person or sitting down face to face with them. https://www.recovery.org/topics/alcoholics-anonymous-12-step/

Glutamate

*Memory *Duck tape of the brain... regenerates and mimics other neurotransmitters to fill the gaps for the ones that have been damaged *Anti Convulsant

Acetylcholine

*Memory, Movement, Motivation, New Learning (learning in general) *Depletion results in alzheimers symptoms *Affected by THC

Dialectical Behavior Therapy (DBT) *Main Principal*

*Mindfulness* - Essential and core skill *Interpersonal Effectiveness* - Similar to assertiveness training *Distress Tolerance* - This involves accepting, finding meaning for, and tolerating distress *Emotional Regulation* - Learning to regulate emotions

GABA

*Natural anti-anxiety, anti-convulsant. *Helps cope with stressful situations *affected by etoh, benzo, barbs

Client - Counselor Relationship *Self-Disclosure - Negatives*

*Negatives* - It can be seen as threatening. - It can blur the relationship boundaries. - Disclosing too little can add to therapeutic distance. - Disclosing too much can lead to the addiction counselor or other helping professional being perceived as lacking discretion, being untrustworthy, self-preoccupied and/or needing therapy him or herself. - Premature feedback about a client's attitude or behavior can contribute to feelings of inferiority or rejection in that client. - Too much disclosure does not allow the client to talk.

Dopamine

*Pleasure (located in the pleasure pathway) *every drug mimics or releases dopamine *cocaine and other stimulates actually block the re-uptake of dopamine so that it increases the dopamine response *etoh & opiates enhance dopamine release that would otherwise block/inhibit dopamine secreting neurons. *Schizophrenia is noted to be too much dopamine in the brain *too few dopamines mimic parkinsons *Affected by all drugs but mostly meth.

Client - Counselor Relationship *Self-Disclosure - Positives*

*Positives* - lt can reduce feelings from the client that he or she is alone in a certain situation. - lt can promote feelings of empathy by the addiction counselor or other helping professional. - lt can increase the level of trustworthiness of the addiction counselor or other helping professional - lt can increase the client's expression of feelings and self-exploration. - lt can increase self-disclosure from the client. - It can elicit new perceptions from the client. It can be used for role modeling.

SAP *Drug testing - when?*

*Pre-employment* before actually performing safety-sensitive functions for the first time *Post-accident* whose performance could have contributed to the accident *Reasonable cause* observes behavior or appearance that is characteristic of alcohol or drug use. *Random* any time *Return-to-duty* Seeking to return to work *Follow-up* Random on individuals who have previously tested positive

Principles *Principle 2: Client Welfare*

*Privacy and Confidentiality* - The general rule for confidentiality is do not disclose any information concerning a client to anyone. Self-Determination

Adlerian Psychology (Therapy) *Private Logic*

*Private logic* is reality as we perceive it; it is subjective, and the behavior that results from it can change if the client's perceptions change. Addiction counselors and other helping professionals must recognize the client's perspective and work to create change within it.

Addiction Counselor Qualities *Action Responses*

*Probing or Questioning* Asking a question to further explore *Interpretation* A type of action response when the addiction counselor or other helping professional provides a client with another explanation for his or her thoughts, attitudes and or behaviors,

SAP *Intent*

*Protect the public* - protect American citizens from possible harm caused by psychoactive substances that can put them and others at risk for accidents and accident-related injuries or death. Employers share this burden

Definitions *Justice*

*Providing equal and fair treatment* Addiction professionals practice this principle ethic when they provide the same quality of treatment to all clients without discrimination.

Definitions *Prudence*

*Prudence* is a habit of mind and will that inclines a person to act with integrity, even in ethically ambiguous situations.

Level of Psychoactive Substance Use *First Level*

*Recreational Use* Occurs in a social setting - infrequent and often in small to moderate amounts

Addiction Counseling Practices *Individualized Treatment Plan*

*Reflects the salient points of the assessment and outlines the next steps for the client.* lt is important for the *client to be involved* in this process as it fosters a sense of ownership and, internal motivation to pursue the agreed upon goals,

Step Four

*Self-Examination* Made a searching and fearless moral inventory of ourselves. This step requires self-examination that can be uncomfortable, but honesty is essential in this process. The key is to identify any areas of past regret, embarrassment, guilt or anger. https://www.recovery.org/topics/alcoholics-anonymous-12-step/

Medication Assisted Treatment *Types*

*Sensitizers* Overly sensitizes Antabuse *Antagonists* Block the effects Naltrexone *Opioid Inverse Agonist* both opioid-like properties and can also be a blocker of opioids Buprenorphine *Psychotropics* dual diagnosis anti-depressants

Special Populations *LGBTQ*

*Sexual Identity Acceptance Level or how comfortable one is with his or her sexual identity* *Identity Confusion* confusion or denial about his or her sexual or gender identity thoughts *Identity Comparison* beginning to entertain the possibility that he or she might be gay *Identity Tolerance* begins to refer to him or herself as gay, lesbian, bisexual or transgender. *Identity Acceptance* accepted he or she is gay and begins to interact socially with other homosexuals *Identity Pride* aware of the difference between the pride he or she feels about homosexuality and society's rejection of it and Psychoactive substance use can increase at this stage *Identity Synthesis* deemphasizes the importance of homosexuality in his or her life and most likely not abusing psychoactive substances

Family Systems Counseling *Six Basic Family Roles*

*Substance Abuser* *Enabler* *Hero* *Scapegoat* *Lost Child* *Mascot* - Most likely to commit suicide

Reality Therapy/Control Theory *Key Principal"

*Success Identity:* A component of reality therapy/control theory where a person feels he or she has seltworth, is powerful, and is able to love and be

Definitions *Autonomy*

*Supporting clients' independence, freedom and self-determination* Addiction professionals practice this principle ethic by respecting clients' values, facilitating clients' independence and supporting clients' rights to make choices about their own life.

Definitions *Beneficence*

*The obligation to do good* Addiction professionals apply this principle ethic through their commitment to helping others and by promoting what is in the best interest of the client.

Behavior Therapy *What is classical conditioning?*

*Think Pavlov's dog*, where a particular response to a stimuli can be elicited over time by association with another related stimuli, like ringing of the bell when food is given to the dog.

Depressants Alcohol *Withdrawal Stage 1*

*Tremors* May occur approximately *eight hours* after a heavy bout of drinking. The *peak intensity is usually 24 to 36 hours after the last drink. * Common symptoms include *tremors or jitters*, slurred speech, irritability, nausea, vomiting, easily startled, face flushed, diuretic effects, sweating, rapid heart rate, increased blood pressure and temperature, loss of appetite, unsteady gait, insomnia, inattention, poor coordination, mild disorientation, poor recent memory and uneasiness. *Ninety percent of alcohol dependent clients experience these symptoms.*

Psychoanalytical Theory *Key Principles*

*Unconscious Mind:* A part of the human psyche that functions outside of the awareness of the individual *Analysis of Resistance:* A component of psychoanalytical therapy where a client surfaces repressed material from the unconscious mind up to the conscious mind, *ld:* A component of psychoanalytical therapy that is the source of unconscious aggressive and sexual urges *Ego:* A component of psychoanalytical therapy that is the mediator between the id and superego *Super Ego:* A component of psychoanalytical therapy that is the source of moral urges *Defense Mechanism:* A technique employed by the ego when a conflict between the superego and id causes anxiety, according to psychoanalytical therapy

Definition *Drug Misuse*

*Use a drug for purposes it is not intended for.* Using Vicodin for a headache, Xanax for nausea, or any other example of people believing a drug can make them 'feel better.' Misuse involves not following medical instructions, *but the person may not necessarily be looking to 'get high' from their use.* For example, if a person isn't able to fall asleep after taking a single sleeping pill, he or she may take another pill an hour later, thinking, "That will do the job." *Signs of Drug Misuse* - Taking a dose at the wrong time - Forgetting to take a dose - Stopping a medication too soon - Accepting prescription medication from a friend - Taking drugs for reasons other than what they were prescribed for https://newlifehouse.com/drug-abuse-vs-misuse/

Solution-Focused Therapy *Key Principle*

*Utilization:* A component sf solution- focused therapy where the counselor helps the client utilize previous successes to motivate change

Definitions *Discretion*

*Valuing the right to privacy* Addiction professionals promote this virtue ethic by following confidentiality guidelines and privileged communication laws relating to their clients.

NAADAC Ethical Model *What does Decide on a course of action mean?*

*When making this decision, consider the following questions:* - If acting only for the welfare of the client, which course of action is most appropriate? - If acting only for the welfare of the addiction professional, which course of action is most appropriate? - If acting only for the welfare of the treatment service provider, which course of action is most appropriate? - Who would disagree with this chosen course of action and why?

Endorphins

*body's natural pain killer *brain does not distinguish between physical, emotional & spiritual pain. In all instances endorphins are released *More pain receptor sites than pleasure receptor sites. * We remember painful events more vividly our our brains are designed to avoid these situations. *Increase in endorphins vis exercise, laughter, meditations, sleep, food, healthy relationships/sex & music *Affected by opiates, soma & etoh

Motivational Enhancement therapy (MET)

*method of counseling where the client's internal motivation is the driving force for changing problem bx *FRAMES (feedback, emphasis on personal responsibility, clear advice to change, a menu of alternative, therapist empathy, facilitation of client self efficacy) *Goes hand in hand with the stages of change Used in arenas where sessions are infrequent

Reality Therapy/Control Theory

*method that focuses on how the client perceives the external world & behaviors he exhibits fit those perceptions and needs *it isn't important how the world really exists, only the client's perception of how it exists. * basic principles- dev a therapeutic relationship, focus on current bx, ask client to eval that bx, develop a plan for change, get commitment from client, accept 0 excuses, no punishment, never give up on client. *there are 4 components that guide our functioning (doing, thinking, feeling and physiology) *Success Identity- the place in therapy where the client has self worth is able to love and be loved

Methods of Administration

*orally (inhale or ingested) *nasally (longest acting) *IM *IV (most instense) *subcutaneously *topically *sublingually *rectally

Serotonin

*responsible for calmness and sleep, appetite, some memories *responsible for some types of depression *offsets the effects of E/NE *affected by cocaine and amphetimines

PIP (phenylimide Indoleamine Pyrimidine)

*responsible for feeling of true care/love *affects various parts of the brain at one time *decreases after about 3 years bc the brain cannot sustain the same level of intensity. The passion sorta burns out. *PIP changes to endorphins after decades in a relationship

Benzo

*tolerance develops QUICKLY, within 1-3 weeks, but does not develop to the anti-anxiety effects. Dependence is likely if used over 4 months, 80-85% who take over 2 years. *medical detox due to risk of seizures

I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION =

- Client has fundamental human right to self-determination & making decisions in their own best interest - Counselor must provide clear information about probable effectiveness & costs of care to allow informed decision. - Must be specially mindful in "fiduciary" relationships where special trust is given the pro due to client's inability to judge competence.

V. Working in a Culturally Diverse World: OVERVIEW

- ethnicity & culture places significant role in individual's perceptions & how he lives in world - Pro shall remain aware of disabilities that may/may not be obvious - Intake will include assessment of additional factors that must be considered when working with clients

I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #11 of 11: Disclosure of confidentiality

- Clients must be provided statement of full disclosure re: confidentiality if/when working with person in training (supervisee). Consent to treat will outline boundaries of client-supervisee relationship, supervisee's training status and confidentiality issues. - clients can opt to refuse services by training as determined by agency policies. - disclosure forms will provide info about grievance procedures.

Principles *Principal 2 - Client Welfare* *When to use Fax Machines*

- Find out if the receiving fax machine is located in a private area - Find out who has access to the fax machine - Send a test sheet prior to sending the confidential information to verify the fax number - When using a modem, verify that the recipient of the information is the one authorized to have the client's record - Include a cover sheet with the fax warning that confidential information is being sent and who is authorized to receive it - Call the receiving party after the fax was sent to ensure that the authorized person received the information - Inform clients of the addiction professional's procedures for transmitting confidential information by fax - *Allow for clients to choose not to have their records sent by fax*

IV. Prof Responsibility: Standard 2: Legal & Ethical Standards: 4. IMPAIRMENT ON THE JOB: SUPPORTING TX & PEER PROGRAMS

- Imapirment impacts prof performance - Addiction Pros will seek appropriate TX for himself or colleagues, when needed - Pros will support work of peer assistance programs to assist in recovery of self and colleagues

Principles *Principal 2 - Client Welfare* *What must be on an ROI per 42 CFR?*

- Name of the Client - Name of the program or individual making the disclosure - What specific information will be disclosed - Name of the program or individual receiving the disclosure the purpose for the disclosure - When the information will be released - *Date of expiration that must be within 90 days* - *Statement of revocation* - Signature of the client - Date of signature

What is buprenorphine?

- Opiod "partial" agonist -Binds to opiod receptors, causing partial activation, but not enough to experience "high" or euphoria -Also acts indirectly as an opiod antagonist, blocking effects of other opiods

II. Eval, Assessment: Standard 2: INFORMED CONSENT:

- Prior to assessments, Pro gets informed consent documents & verification of confidentiality from client and interpreter (if used).

I. Counseling relationship: Standard #5: PREVENTING HARM: #7 of 7: Research compensation

- Pro is careful to not make compensation too great/attractive to subjects in research so as to distort clients ability to make free decisions about participation

IV. Prof Responsibility: Standard 1: Counselor Attributes: 10. USE OF PSYCHOACTIVE CHEMICALS:

- Pro is cognizant of ways use of psychoactive chemicals in public or private might adversely affect opinion in community, among Addiction Pros, or vulnerable individuals seeking TX for substance use. -Pros who profess to be in recovery will avoid impairment - If impairment occurs, Pro will immediately report impairment, & take immediate action to discontinue prof practice & take steps to address impairment through professional assistance See: IV, Standard 2, Item 4.

III. Confidentiality: 4. Use of electronic records

- Pro must explain impact of electronic records & use of electronic devises in transmitting info via fax, email or other - Pro must use most secure way of transmitting confidential info.

1. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #10 of 11: Informed Consent

- Pro understands client right to be informed re: TX - must be in clear, understandable language to client/guardian - must present purpose of services, risks related to service, limits of services due to 3rd party payer, relevant costs, reasonable alternatives, client's right to refuse services - if services via telephone/web: limits and risks must be disclosed

I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #9 of 11: foster self-sufficiency

- Pro will foster self-sufficiency in clients, students, employees and supervisors, to manifest mature, independent functioning

I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #6 of 11: Requests outside treatment

- Pro will not request any action that doesn't pertain to treatment (e.g.: giving testimonials or participating in interviews)

I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #8 of 11: when client's needs are beyond Pro's scope of practice

- Pro will refer client to appropriate resource for TX of mental, spiritual, physical, or chemical impairment.

IV. Prof Responsibility: Standard 1: Counselor Attributes: 7. POTENTIALLY VIOLENT CLIENTS

- Pro will take adequate safeguards to protect clients and staff from harm

I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #4 of 11: avoid abandonment

- Pro will take reasonable steps to avoid abandoning clients who need services. - Referrals will be made after considering how to minimize adverse effects.

II. Eval, Assessment: Standard 2: INFORMED CONSENT: Client's right to know results

- Pro's respect client's right to know results of assessments, & basis for conclusions & recommendations. - These are provided to client / guardian, unless it is deemed that disclosure will harm client

IV. Prof Responsibility: Standard 2: Legal & Ethical Standards: 2. HONESTY REPRESENTING SERVICES

- Pros shall identify, & accurately describe all services, with no unsubstantiated claims - Pros will describe terms of information that has been verified by scientific inquiry

VII: Supervision & Consultation: OVERVIEW

- Supervisors accept the obligation to facilitate develop of supervisees by providing accurate & current info, timely evaluations, & constructive consultation - Supervisors take precautions to maintain ethical standards re: the power differential with supervisees - Supervisors seek to develop full creative potential & mature independent functioning of students, employees, & supervisees

I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #5 of 11: When services are not effective for specific client....

- There may be clients with whom pro cannot work effectively. - In such cases, make arrangements for consultation, co-therapy, or referral.

VI. Workplace Standards WORKING ENVIRONMENT: OVERVIEW

- Will maintain working environment that is safe, in good condition through maintenance, meeting sanitation needs and addressing structural defects

Continuous Quality Improvement *What it covers*

- client care monitoring - utilization review - staff performance - performance of clinical programs - performance of professional services - administration support of clinical programming - integration of programs and administration in meeting facility goals

II. Eval, Assessment: Standard 11: CULTURAL SENSITIVITY DIAGNOSIS

- cultural background, socioeconomic status impact how client issues/needs are defined - these are considered in making clinical diagnosis -assessments chosen for specific populations + will consider cultural background, socioeconomic status in making recommendations

IV. Prof Responsibility: Standard 3: Records and Data: 1. DOCUMENTS WILL INCLUDE:

- date, time, place of client contact -services provided -referrals made -disclosures of confidential information - consultation re: client -notation of supervision meetings -outcome of every service provided.

IV. Prof Responsibility: Standard 1: Counselor Attributes: 3. AS CLIENT ADVOCATE...

- pro has obligation to support legislation & public policy that recognizes treatment as first intervention of choice for non-violent subst-related offenses

II. Eval, Assessment: Standard 12: SOCIAL PREJUDICE

- social prejudices in a diagnosis of subst use disorders can have long-term impact. Pro's will refrain from making and/or reporting a diagnosis if they think it would cause harm to client/others.

Ethics =

- standards that govern the conduct of the person. - "human reflecting self-consciously on the act of being a moral being."

I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #6 of 11: termination for non-payment

- termination possible for nonpayment IF contractual arrangements have been made clear to client & if client does not pose imminent danger to self/others - Pro will document discussion of consequences of non-payment with client

III. Confidentiality: 1. When disclosure is appropriate

- to prevent/minimize harm to another person, group - to prevent abuse of protected persons - when legal court order is presented - for purpose of research, audit, internal agency communication or in a medical emergency

I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #7 of 11: When client has inability to pay

- when Pro must refuse service due to inability to pay, must attempt to identify other care options.

IV. Prof Responsibility: Standard 1: Counselor Attributes: 9. DIFFERING PERSPECTIVES

- when differences between professionals arise from training or experience, common ground is sought, rather than striving for ascendant of one opinion over another

Dosage of LSD

-20-30 micrograms today -150-300 micrograms in the 1960s

Mechanism of action for LSD

-Absorbed through GI tract -Physical effects begin first (20-60min) -Psychological effects follow at 2-3 hours (peak)

PCP mech. Of action

-Activates glutamate, an excitatory neurotransmitter -Absorbed by fatty tissue, and release into bloodstream in "waves" -Fat solubility prolongs effects

Mechanism of action of nicotine

-Acts as a stimulant, and later as a depressant -Increase in NE and Epi, and mimics effects of acetylcholine -Later, Nicotine blocks nicotinic-cholinergic receptors, resulting in CNS depression, resulting in "calming" effect -Nicotine can paralyze skeletal muscles, resulting in possibly respiratory paralysis if taken at high doses

Lifestyle

-Adlerian Psychology: Refers to client's chosen method of moving through life

LAAM

-Alternative to methadone treatment, which requires only 3 administrations a week. -Has fallen out of favor d/t side effects

Dangers of PCP use

-Anesthetic effects result in self-injurious bx

II. Eval, Assessment: Standard 4: BASIS FOR ASSESSMENT

-Assessment tools give insight in forming appropriate TX plan. -Assessment instruments used with goal of gaining understanding of extent of person's issues / needs, extent of addictive behaviors

THC mech of action

-Binds to cannabinoid receptors meant for anandamide and 2-AG -Instead of alleviating pain (done by anandamide and 2-AG), and produces psychoactive effects

Mech. of Action of Methylphenidate (Ritalin)

-Block dopamine reuptake -Increase serotonin release *Reduces "background noise" for subject

Selective tolerance to effects of opiates

-Body and mind build tolerance to analgesic and euphoric effects of opiates -Body does NOT build tolerance to sedating, respiratory depressing, and constipation effects of opiates

Dangers of using MDMA

-Can cause neurological damage, even after first use -Destroys dopamine, NE, and serotonin releasing axons, and results in receptor downregulation -Over-hydration, dehydration, seizures, hyperthermia, and MI are all risks of MDMA use

Cautions for Benzos

-Can cause physical dependence, even at low doses of use -Indicated for short-term, and specific conditions

VI. Workplace Standards Working Environment: 2. CLERICAL STAFF

-Clerical staff members must be competent, & educated in confidentiality standards, and must be respectful of clients seeking services

Cocaine vs. Amphetamines

-Cocaine has more "intense", but shorter lasting high -Cocaine is more expensive -Amphetamines last longer -Cocaine is plant-based, while amphetamines are synthetic

Marinol

-Delta-8-THC -Pharmaceutical pill form of THC

Tricyclics

-Developed in attempt to reduce side-effects of MAOI's -Generation of antidepressants that blocks reuptake of serotonin and catecholamines -Side effects include drowsiness, lethargy, dry mouth, urine retention, acid reflux, and changes to HR

Early stage of alcohol dependence

-Escaping social situations to drink -Sneaking to drink -Feelings of guilt -Difficulty stopping once drinking has begun -Preoccupation w/ drinking, and events that involve consumption

Mechanism of action for ETOH

-Ethanol is both water and fat soluble, and thus crosses barriers rapidly -Metabolized by the enzyme "Alcohol dehyrdogenase" in the LIVER -Turns into acetaldehyde, which is poisonous is large amounts -Acetaldehyde turns into acetic acid, which can be used as energy

Symptoms after amphetamine user wakes from "crash"

-Extreme hunger -Lethargy -Irritability -Problems with memory, recall, attention, and cognition -Muscle twitching

How are benzos different from barbs?

-Faster onset of effects -Less potential for abuse -Less CNS depression -Effects last longer -Higher toxicity threshold, with more needed to O.D.

Hashish

-Form of cannabis used in Europe and Middle East -Sticky resin made from passing female cannabis flowers through sieves, and melting the product -Higher THC content than regular pot (5%-20%)

Barbiturates traits

-High abuse potential -Use peaked in 1970s -Depressant

Sensemilla

-Highly potent MJ made of un-pollinated female cannabis plant

Volatile solvents

-Hydrocarbons -Found in industrial solutions and aerosols -Abused by youngest crowd (10-20 year olds) -Ex: rubber cement, hair spray, glue, paint

Mechanism of action for caffeine

-Increase NE -Blocks effects of adenosine (adenosine produces calming effects by dilating blood vessels in the brain)->Adenosine inhibits dopamine and acetylcholine -Increase in dopamine and adenosine

Mech. Of Action for MDMA

-Increase release of dopamine -Increase release of NE -HUGE increase in Serotonin release and blocked reuptake (downregulates serotonin receptors, causing depression-like effects)

Schedule IV

-May lead to limited dependence -Low potential for abuse -Has accepted medical uses -Can be dispensed by prescription by authorized prescriber

Schedule V

-May lead to limited dependence -Very low potential for abuse -Has accepted medical uses -Can be dispensed by prescription by authorized prescriber

Schedule III

-May lead to moderate or low physical dependence, or high psychological dependence -Moderate potential for abuse -Has accepted medical uses -Can be dispensed by prescription authorized prescriber

Schedule II

-May lead to severe dependence -High potential for abuse -Has some accepted medical uses with severe restrictions -Can be dispensed by prescription by authorized prescriber

Schedule I

-May lead to severe physical or psychological dependence -High potential for abuse -No accepted medical uses -Cannot be dispensed by authorized prescriber

Methadone discontinuation considerations

-Methadone is slow onset, and slow resolution of withdrawal -It is twice as long as heroine's, making it hard to discontinue "cold-turkey"

MAOI's

-Monamine Oxidase Inhibitors -Oldest antidepressant -Very effective, but requires dietary restrictions, which makes it less attractive -Prevents breakdown of serotonin, dopamine, and NE

How does cocaine compare to other CNS stimulants?

-Most potent, but short-acting -Most abused

Late stage of ETOH dependence

-Must drink in order to function -Prolonged drinking binges -ETOH psychosis -Nutritional disease -Incongruence between bx when drunk and bx & values when sober -Blackouts

Detox protocol for PCP

-No antipsychotics (makes psychosis worse) -Place in quiet room with little stimulation

Dependence and withdrawal

-No dependence outside of PCP -No withdrawal noted, even with high use

Withdrawal, detox, and dependence to inhalants/solvents

-No physical dependence -No withdrawal symptoms -Dependence is largely psychological

MDMA withdrawal

-No physical withdrawal, but high risk for depression and mood changes even after little use -MDMA can "fry" the brain

Cocaine overdose

-No set level -Unique to each individual -Death is usually quick

Facts about Zolipdem (Ambien)

-Often mistaken for Benzo, but is not -Similar effects to a benzo, so often gets grouped together

MDMA and other drugs

-Often used with fluoxetine (prozac) and sertaline to extend effects -> Higher risk for hyperthermia with this combo -Used with heroin -Mushrooms (psilocybin)

THC dependence & withdrawal

-Physical dependence rare and low -Psychological dependence more pronounced -Few experience withdrawal, but even then it is discomfort, rather than danger

Dependence to benzos

-Physical dependence takes 4 months of use -Little psychological dependence for neurotypicals -Alcohol abusers report feeling of euphoria when taking benzos, explaining why they are often abused by same people

I. Counseling relationship: Standard #5: PREVENTING HARM: #5 of 7: Obligation to protect...

-Pro is obligated to protect individuals, institutions and profession from harm by others. - Pro assumes ethical obligation to report harmful activities of others to competent authorities

IV. Prof Responsibility: Standard 1: Counselor Attributes: 5. INTELLECTUAL PROPERTY...

-Pro recognizes that much of the "property" in the profession involves Intellectual property - Pro will give appropriate credit for ideas, concepts, publications of others whens peaking or writing as prof or as an individual.

VIII: Resolving Ethical Issues OVERVIEW

-Pro will attempt to resolve ethical dilemmas w/ direct & open communication with all parties involved. - Pro will seek supervision and/or consultation as appropriate

I. Counseling relationship: Standard #5: PREVENTING HARM: #6 of 7: Use of Review Boards in case of research projects

-Pro will defer to Review Board to ensure research protocol is free of coercion, that informed consent process is followed - confidentiality, deceptive practices are avoided except when essential to research protocol & approved by Review Board

III. Confidentiality: 6. informing client when recording...

-Pro will inform client, get their agreement when activity might affect client's participation, e.g.: when recording interview, use of interview material for training purposes, or being observed by another person.

I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #3 of 11: Do not engage in dual relationships

-Pro will not form pro relationships w/ family members, friends, close associations or others whose welfare might be jeopardized by dual relationship

What are the approved pharmacotherapies for treating nicotine addiction?

-Varenicline (Chantix) -> Blocks nicotine's pleasurable effects -Bupropion (Wellbutrin)-> Antidepressant used to curb craving

I. Counseling relationship: Standard #5: PREVENTING HARM: #3 of 7: Requests of client

-Pro will not make requests of client outside of agreed TX plan. -At beginning of each session, client informed of intent of session - Collaboration btn client/ Pro maintained as much as possible

VI. Workplace Standards Working Environment: 1. MAINTAINING WORKPLACE STANDARDS

-Pro will seek appropriate supervision/ consultation to ensure conformance with workplace standards

III. Confidentiality, Privileged Communication and Privacy: OVERVIEW

-Pro's shall inform clients re: confidentiality and any reasons for releasing info - Will provide written document and review it on limits and exceptions to confidentiality to each person they work with -once private info has been obtained, standards of confidentiality apply.

Fermentation

-Process of ETOH production, typically from fruits and grains, resulting in wines and beers -About 12% ETOH by volume is max -Oldest method

Distillation

-Process of producing ETOH where spirits are distilled using vats and evaporation, typically used to produce liquors and whiskeys -Up to 95% ETOH by volume

II. Eval, Assessment: Standard 5: RELEASE OF ASSESSMENT RESULTS

-Pros will consider examinee's welfare in determine when/ where to report assessment results. - Info shall include accurate, appropriate interpretations when individual / group assessment results are reported to another entity

Treatment application for Anabolic Steroids

-Psychological addiction is more pronounced -Depression often accompanies coming off of drug

Neurochemistry of cocaine use

-Releases Epi, NE, serotonin and dopamine (Just like amphetamines) -Blocks reuptake of NE, serotonin, and dopamine -Does NOT neutralize enzyme activity in synaptic cleft, resulting in rapid metabolism of ntms, which explains rapid "crash"

MDMA

-Schedule I hallucinogen -Feels like mix of meth and LSD -Knows as Ecstacy

Marijuana

-Schedule I substance -Lower abuse liability than other schedule Is, but still illegal -Must be taken in high doses to take effect (grams vs. milligrams)

Mescaline

-Schedule I, but can be used by Native Americans in religious ceremonies -2000 less potent than LSD -Consumed as "buttons" of mature peyote plant

Phencyclidine (PCP)

-Schedule II -Was historically used as anesthetic -Unique in that it does not cause respiratory and cardiovascular depression -Caused psychosis among patients, so it got DC'ed -Used in veterinary med, but rarely stocked (and mostly illegal)d/t risk of robbery -Take primarily for stimulant effects, but causes AVH in 40% of subjects

Anabolic Steroids

-Schedule III -Combination of synthetic and natural androgens, such as testosterone -Being used more by females

Medical uses of Benzos

-Short-term anxiolytic -Control anxiety and cause amnesia in surgical procedures -Treat sleep problems -Control muscle spasms -Elevate seizure threshold (help control seizures) -Treat acute ETOH withdrawal effects

IX. Communication and Published Works 1. REPORTING RESEARCH BASIS OF INFORMATION

-Statements of fact based on empirically validated study can be presented as fact. -Other opinions, speculations and conjectures related to the addictive process shall be represented as less scientifically validated

Toxicity and danger of using solvents/inhalants

-Sudden respiratory asphyxia -Heart arrhythmia

Drug testing for THC

-THC gets stored in fat -Up to 20% of dosage from 5 days ago can be stored -Can take up to 30 days to clear from system

Hashish Oil

-THC oil extracted directly from cannabis plant -30% THC concentrations

What drugs, other than caffeine, are found in the xanthine family?

-Theophylline (Tea) -Theobromine (Chocolate)

Tolerance and dependence

-Tolerance develops quickly -No physical dependence, but possible psychological dependence

Tolerance and dependence of LSD

-Tolerance is quickly developed, but resets quickly after discontinuation -Moderate to high-risk of psychological tolerance d/t euphoria caused by drug

Important facts about Benzo tolerance

-Tolerance to sedative effects is built up over 1-3 weeks -No tolerance build to anxiolytic effects *Tolerance to barbs develops quickly, making them unsuitable for long-term use

Potency of MJ

-Typically between 0.5% and 11% THC -Sensemilla can be as high as 24%-27% THC -Street grade MJ tends to average 3% THC

Amphetamine withdrawal and detox

-Uncomfortable, but not life threatening -Individuals often "crash" and sleep for 1-3 days after a binge, or "run" -Acute withdrawal usually last 2-3 days, but effects can be present for a week or more for chronic users

II. Eval, Assessment: Standard 8: UNSUPERVISED ASSESSMENTS:

-Unless assessment is designed for self-administration, Pro must administer tests and score them following recommended methods.

Volatile nitrites

-Used as sexual performance enhancers -Drastically harder to obtain -Called "poppers" -Abused more by high school and college students

Mech. of Action for Benzos

-Work by activating GABA -Selectively inhibits function of limbic system, reticular activating system, and motor cortex -Length of action is unique, as metabolites have their own psychoactive effects, making drug last longer

Legal limit of alcohol in 21+ in most states

.08

Toxic alcohol levels

.4

Toxicity (lethal) level of ETOH BAC

0.4, according to study guide

Reality Therapy/Control Theory *Eight Basic Principles*

1) develop a therapeutic relationship 2) focus on the client's current behavior 3) ask the client to evaluate the behavior 4) develop plans for change; 5) get a commitment from the client 6) do not accept any excuses 7) do not use punishment 8) never give up on the client

Cocaine Overdose

1) vomit, headache, cold sweats, muscle twitches 2) convulsions, rapid gasping breaths, decreased blood pressure 3) dilated pupils, paralyzed, unable to breath, cardiac arrest and death *no medicinal treatment to counter the overdose

Treatment stages

1)Detoxification 2)rehabilitation 3)continuing care 4)support

Methods of administration for solvents/inhalants

1. "Huffing"= With a rag 2. "Sniffing"=Sniffing directly from container 3. "Bagging"= Creating a seal and breathing in from a bag *Bagging is most dangerous

3 steps of MDMA high

1. "Weird period" (30-60min after consumption) Disoriented, anxious, tachycardic, and jaw-clenching 2. "Rush period" (Last 20-30min) Wave of tingling sensation with muscle jerking 3. "High period" (Last a few hours) Euphoria, sense of well-being, emotional insight, empathy for others

Group Counseling *Traditional Stages of Group Development*

1. *Forming:* The group comes together, initially, and gets to know one another and form as a group 2. *Storming:* A chaotic vying for leadership and experiencing group processes through "trial and error" 3. *Norming:* The group agrees on norms with regards to how the group operates 4. *Performing:* The group practices its craft and becomes effective in meeting its objectives 5. *Adjourning:* The process of "unforming" the group, that is, letting go of the group structure and moving on. *Tuckman added this stage 1O years after he proposed the first four stages*

Types of neurotransmitters (8)

1. Acetylcholine 2. Norepinephrine 3. Epinephrine 4. Dopamine 5. Serotonin 6. Gamma-amino-butyric acid (GABA) 7. Glutamate 8. Endogenous Opioids

CNS Depressants

1. Alcohol (ETOH) 2. Barbiturates 3. Benzodiazepines *4. Opiates (but considered a "narcotic" in CAC II study materials)

Most widely used Benzos

1. Alprazolam (Xanax) 2. Lorazepam (Ativan) 3. Diazepam (Valium) 4. Clonazepam (Klonopin) 5. Temazepam (Restoril)

Categories of stimulants (4)

1. Amphetamines 2. Cocaine 3. Nicotine 4. Caffeine and Xanthines

3 main pharmacotherapies for alcohol use disorders

1. Antabuse (Disulfiram) 2. ReVia, Vivitrol (Naltrexone) 3. Campral (Acamprosate)

Two categories of psychotropics that are most important for an addictions counselor to know about

1. Antidepressants 2. Antipsychotics

What are the three most common types of "bad trips"?

1. Anxiety and panic attacks 2. Extreme depression 3. Extreme fear, with symptoms similar to schizophrenia

Name the underlying principle & virtue ethics in NAADAC Code of Ethics:

1. Autonomy. 2. Obedience. 3. conscientious refusal. 4. beneficence. 5. gratitude. 6. competence. 7. Justice. 8. Stewardship. 9. Honesty and candor. 10. Fidelity. 11. Loyalty. 12. Diligence. 13. Discretion. 14. Self-improvement. 15. Non-malfeasance. 16. Restitution. 17. Self-interest.

Considerations in making ethical decisions (17):

1. Autonomy. 2. Obedience. 3. conscientious refusal. 4. beneficience. 5. gratitude. 6. competence. 7. Justice. 8. Stewardship. 9. Honesty and candor. 10. Fidelity. 11. Loyalty. 12. Diligence. 13. Discretion. 14. Self-improvement. 15. Non-malfeasance. 16. Restitution. 17. Self-interest.

I. Counseling relationship: 5 STANDARDS =

1. CLIENT WELFARE 2. CLIENT SELF-DETERMINATION 3. DUAL RELATIONSHIPS 4. GROUP STANDARDS 5. PREVENTING HARM

Potency of stimulants

1. Cocaine 2 Meth 3 Dexedrine 4 amphetamine 5 ritalin 6 caffeine 7 nicotine

Name the nine principles in the 2016 NAADAC Code of Ethics:

1. Counseling relationship 2. Confidentiality/privileged communication, privacy 3. Professional responsibility & Workplace standards 4. Working in culturally diverse world 5. Assessment, Evaluation, and Interpretation 6. E-Therapy, E-Supervision & Social Media 7. Supervision & consultation 8. Resolving Ethical issues 9. Research & Publication

Code of Ethics: Covers what 10 topics:

1. Counseling relationship 2. Evaluation, assessment & interpretation of client data 3. Confidentiality/privileged communication, privacy 4. Professional responsibility 5. Working in culturally diverse world 6. Workplace standards 7. Supervision & consultation 8. Resolving Ethical issues 9. Communication & published works 10. Policy and political involvement

Two most abused Benzos

1. Diazepam (Valium) 2. Alprazolam (Xanax)

Stages of Alcohol Dependence

1. Early 2. Middle 3. Late

Types of Alcohol

1. Ethyl Alcohol (Ethanol) Ex: Beer, wine, liquor 2. Methyl alcohol (Methanol) Ex: Wood alcohol 3. Isopropyl (Isopropanol) Ex: Rubbing alcohol

Two narcotics that have caused major public health concern

1. Fentanyl 2. Demerol

What are the two ways of producing alcohol?

1. Fermentation 2. Distillation

Neurochemical effects of amphetamines

1. Forces release of catecholamines (Epi. NE, and Dompamine) from nerve terminals into synaptic cleft 2. Blocks catecholamine reuptake 3. Blocks metabolism in synaptic cleft, causing overstimulation *The third neurochemical effects is what makes meth last so long compared to cocaine

III. Confidentiality: 5. notification when disclosure made

Clients must be notified when disclosure made -- to whom, and for what purpose.

What are the 4 neurchemical changes that occur as a result of opiod overuse and dependence?

1. Hyperalgesia 2. Hyperapathia 3. Allodynia 4. Hyperkatifeia

Routes of amphetamine administration

1. IV injectiom 2. Snorting 3. Orally (rare, because it's bitter) 4. Smoking

Methods of heroin administration

1. Injection 2. Subcutaneously (skin popping) 3. Intramuscularly 4. Smoking 5. Snorting

Stronger narcotics

1. Morphine 2. Dihydromorphine (Dilaudid) 3. Oxycodone (OxyContin) 4. Meperidine (Demerol)

Common narcotic and opiod antagonists

1. Naloxone (Narcan) 2. Naltrexone (Depade, ReVia, and Vivitrol)

What are the 4 natural narcotic drugs?

1. Opium 2. Morphine 3. Codeine 4. Heroin

Fast acting barbs

1. Secunol 2. Nembutal 3. Tuinal *High abuse liability

Subdivisions of motor pathways of PNS

1. Somatic (voluntary) 2. ANS (2 pathways)

Subdivisions of ANS

1. Sympathetic 2. Parasympathetic

Name the subsections for What is NAADAC Code of Ethics - Principle 5. Assessment, Evaluation, and Interpretation

5.1 assessment 5.2 & 5.3 validity 5.4 explanation 5.5 administration 5.6 cultural influences 5.7 diagnosing 5.8 results 5.9 misusing results 5.10 not normed 5.11 referral 5.12 security 5.13 - 5.15 forensic

3 legal uses for amphetamines

1. Treat severe obesity 2. Narcolepsy 3. Treat ADHD and hyperactivity

Names of ETOH withdrawal stages

1. Tremors 2. Hallucinations 3. Withdrawal seizures 4. Delirium Tremens

3 forms of inhalants and solvents that are commonly abused

1. Volatile solvents 2. Volatile nitrates 3. Anesthetics

Signs of Cocaine overdose

1. Vomit, headache, cold sweats, and muscle twitching 2. Convulsions, rapid shallow breaths, and decreased BP 3. Dilated pupils, paralysis, and unable to breathe, resulting in cardiac arrest

Sources of White heroin, Brown Heroin, and Black Tar Heroin

1. White Heroin: Colombia, Afghanistan, and Golden Triangle 2. Brown Heroin: Anywhere, but mostly Mexico 3. Black Tar: Only Mexico

Cocaine Withdrawal phases

1. crash- depression, anxiety, exhaustion, cravings 2. hypersomnia, decreased att span, poor recall, increased appetite, muscle twitching 3. intense cravings marked by reduction to enjoy life and pleasure *meds that help; Provigil, symmetrel, parlodel, tofranil, norpramin

Name the subsections for What is NAADAC Code of Ethics - Principle 1: Counseling Relationship

1.1 Client welfare 1.2 & 1.3 Informed Consent 1.4 Limits of Confidentiality 1.5 Diversity 1.6 Discrimination 1.7 Legal Competency 1.8 Mandates Clients 1.9 Multiple Therapists 1.10 Boundaries 1.11 Multiple/Dual Relationships 1.12 Prior Relationships 1.13 Previous Client 1.14 Group 1.15 Financial Disclosure 1.16 Communication 1.17 Treatment Planning 1.18 Level of care 1.19 Documentation 1.20 Advocacy 1.21 Referrals 1.22 Exploitation 1.23 Sexual Relationships 1.24 Termination 1.25 Coverage 1.26 Abandonment 1.27 Fees 1.28 Self-Referrals 1.29 Commissions 1.30 Enterprises 1.31 Withholding records 1.32 Withholding reports 1.33 Disclosures re: payment 1.34 Regardless of Compensation 1.35 Billing for actual services 1.36 Financial records 1.37 Suspension 1.38 Unpaid balance 1.39 Bartering 1.40 Gifts 1.41 Uninvited solicitation 1.42 virtual

Anabolic Steroids

100% of users experience withdrawal symptoms after discontinuing use

Self Help Meetings

12 step, celebrate recovery, rational recovery, etc

*18.* What percentage of individuals with a dual diagnosis (co-occurring disorders [COD]—i.e., substance abuse disorder and an existing mental illness) received treatment for only their mental illness? a. 32.9 percent b. 27.6 percent c. 12.4 percent d. 8.8 percent

18. A: According to the 2009 National Survey on Drug Use and Health, when individuals have co-occurring disorders (dual diagnoses) consisting of substance abuse and mental illness, only 7.4 percent will receive treatment for both disorders, 32.9 percent will receive only mental health treatment, and 3.8 percent will receive only substance abuse treatment. Where mental illness is severe, the existence of a substance abuse problem is particularly likely (25.7 percent). And among individuals with a substance use disorder in the past year, 17.6 percent will have a concurrent mental illness disorder. Thus, where either a substance abuse disorder or a mental illness disorder is known to exist, treatment professionals should be particularly careful to screen further and ensure that any coexisting disorder is identified, if one exists.

Short and long term treatment drug abuse programs

6 months for short term and 12 months for long term

Severe use disorder:

6 or more criteria positive

Name the subsections for What is NAADAC Code of Ethics - Principle 6. E-Therapy, E-Supervision & Social Media

6.1 definition 6.2 competency 6.3 & 6.4 informed consent 6.5 verification 6.6 licensing laws 6.7 state & federal laws 6.8 non-secured 6.9 & 6.10 access 6.11 multidisciplinary care 6.12 local resources 6.13 boundaries 6.14 capability 6.15 missing cues 6.16 & 6.17 records 6.18 links 6.19 friends 6.20 social media

Awareness of the addiction professional's own cultural values, biases, and assumptions

1st component of Sue's necessary components of an ethical multicultural practice

Mild use disorder:

2-3 criteria positive

Name the subsections for What is NAADAC Code of Ethics - Principle 2: Confidentiality and Privileged Communication

2.1 Confidentiality 2.2 Documentation 2.3 Access 2.4 Sharing 2.5 Disclosure 2.6 Privacy 2.7 Limits of Confidentiality 2.8 Imminent Danger 2.9 Courts 2.10 Essential only 2.11 & 2.24 Multidisciplinary care 2.12 Locations 2.13 Payers 2.14 Encryption 2.15 Deceased 2.16 All parties 2.17 Minors and others 2.18 & 2.26 Storage and disposal 2.19 Video recording 2.20 Recording e-therapy 2.21 Federal regulations stamp 2.22 Transfer records 2.23 Written permission 2.25 Diseases 2.27 Temporary Assistance 2.28 Termination 2.29 Consultation

Methadone lasts

24 to 36 hours

Awareness of the cultural values, biases, and assumptions of the diverse group of clients with which they work

2nd component of Sue's necessary components of an ethical multicultural practice

Name the subsections for What is NAADAC Code of Ethics - Principle 3. Professional responsibility & Workplace standards?

3.1 Responsibility 3.2 Integrity 3.3 Discrimination 3.4 Nondiscriminatory 3.5 Fraud 3.6 Violation 3.7 Harassment 3.8 Membership 3.9 & 3.10 Credentials 3.11 Accuracy of Representation 3.12 Misrepresentation 3.13 Scope of Practice 3.14 Boundaries of competence 3.15 proficiency 3.16 educational achievement 3.17 continuing education 3.18 self-monitoring 3.19 scientific 3.20 innovation 3.21 multicultural competency 3.22 & 3.25 multidisciplinary care 3.23 medical professional 3.24 & 3.27 collaborative care 3.26 collegial 3.28 qualified 3.29 - 3.32 Advocacy 3.33 present knowledge 3.34 organizational v private 3.35 public comments naadac 3.36 public comments suds 3.37 public comments legislative 3.38 development 3.39 policy 3.40 parity 3.41 & 3.42 impairment 3.43 referrals 3.44 termination 3.45 representation 3.46 promotion 3.47 testimonials 3.48 reports 3.49 advice 3.50 dual relationships 3.51 illegal practices 3.52 & 3.53 supervision 3.54 credit

Once a final order is published, interested parties have how many days to appeal to the US Court of Appeals?

30 days

Post-tramatic stress disorder

30 to 60% of drug abusers show symptoms, A disorder caused by exposure to a terrifying event.

Hashish

30%THC or more. European/Middle Eastern cannabis

Development of culturally appropriate individual and systemic interventions to assist these cients

3rd component of Sue's necessary components of an ethical multicultural practice

How many stages of withdrawal?

4

Moderate use disorder:

4-5 criteria positive

Name the subsections for What is NAADAC Code of Ethics - Principle 4. Working in culturally diverse world

4.1 knowledge 4.2 cultural humility 4.3 meanings 4.4 personal beliefs 4.5 heritage 4.6 credibility 4.7 roles 4.8 methodologies 4.9 advocacy 4.10 recruitment 4.11 linguistic diversity 4.12 needs driven

What is the toxicity level for nicotine?

40-60 miligrams

Currently the number of chemicals the DEA monitors

41

Number of DEA "Drug schedules"

5

Name the subsections for What is NAADAC Code of Ethics - Principle 7. Supervision & consultation

7.1 responsibility 7.2 training 7.3 code of ethics 7.4 - 7.6 informed consent 7.7 policies 7.8 & 7.9 multiculturalism 7.10 & 7.11 diversity 7.12 & 7.13 boundaries 7.14 confidentiality 7.15 monitor 7.16 treatment 7.17 impairment 7.18 clients 7.19 disclosures 7.20 observations 7.21 gatekeepers 7.22 & 7.23 education 7.24 current 7.25 evaluation 7.26 & 7.27 dual relationships 7.28 e-supervision 7.29 harassment 7.30 distance 7.31 termination 7.32 counseling 7.33 endorsement

How long might the effects of a psychedelic drug last

8 to 10 hours

How long mihgt the effects of a psychedelic drug last

8-10 hours

Name the subsections for What is NAADAC Code of Ethics - Principle 8. Resolving Ethical issues

8.1 code of ethics 8.2 understanding 8.3 decision making model 8.4 jurisdiction 8.5 investigations 8.6 participation 8.7 cooperation 8.8 agency conflict 8.9 crossroads 8.10 violations without harm 8.11 violations with harm 8.12 non-respondent 8.13 consultation 8.14 retaliation

Name the subsections for What is NAADAC Code of Ethics - Principle 9. Research & Publication

9.1 research 9.2 participation 9.3 consistent 9.4 confidentiality 9.5 independent 9.6 protect 9.7 welfare 9.8 informed consent 9.9 accurate 9.10 students 9.11 clients 9.12 consents 9.13 explanation 9.14 outcomes 9.15 transfer plan 9.16 diversity 9.17 verification 9.18 data availability 9.19 errors 9.20 publication 9.21 theft 9.22 e-publishing 9.23 advertising 9.24 credit 9.25 student material 9.26 submissions 9.27 proprietary

I. Counseling relationship: Standard 1: CLIENT WELFARE: #3 of 4: PERSONALIZED TX:

= Prof will take action to relieve the unique suffering, and actions will be uniquely suited to the individual, not by universal prescription

I. Counseling relationship: Standard 1: CLIENT WELFARE: #4 of 4: Equal service regardless of pay:

= Services will be provided equally regardless of clients paying reduced fee, full fee or waived fees.

I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #2 OF 11: Conflict of interest & gifts

= avoids situations that could be interpreted as conflict of interest. No gifts from clients, unless it causes irreparable harm to others. Gifts over $25 are never permitted

I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #1 OF 11: Maintain non-exploitative relationships:

= due to power differential, pro will not exploit relationships for personal gain, including social or business relationships

I. Counseling relationship: Standard 1: CLIENT WELFARE: #2 of 4: CLIENT AUTONOMY:

= professional support clients in doing what they can for themselves. Will not insist on pursuing goals w/o incorporating what clients perceives as good, necessary

I. Counseling relationship: Standard 1: CLIENT WELFARE: # 1 of 4: LIFE IMPROVEMENT:

= professional supports actions that assist client in better quality of life, greater freedom & independence

I. Counseling relationship

= safeguarding integrity of counseling relationship to ensure services that are most beneficial by providing services or referral. - specific legal obligations may supersede loyalty to clients.

Psychoanalytical Theory *Basis*

A *deterministic method* of counseling where the mental dysfunction results from a client's internal conflicts, processes and memories.

What is amphetamine

A Stimulant type of prescription drug used in the treatment of ADD and ADHD. Stimulants speed up activity in the brain and cause an increase in heart rate, blood pressure and metabolism. It also causes a decrease in blood flow and oxygen to the heart.

Psychoactive substance

A chemical that can change consciousness, mood and thoughts.

Choreoathetosis

A combination of chorea and Athetosis movements (involuntary jerking movements and writing movements)

Adlerian Psychology (Therapy) *What is Fictional Finalism?*

A component of Adlerian therapy is an imagined central goal that gives a client purpose and guides his or her behavior.

Adlerian Psychology (Therapy) *Social Interest*

A component of Adlerian therapy that is an awareness of being a part 0f the human community and how one interacts with the social world.

Adlerian Psychology (Therapy) *Lifestyle*

A component of Adlerian therapy that refers to the client's chosen method of moving through life.

Extrapyramidal syndrome

A constellation of involuntary movements that are primarily associate with the real reactions to proper dosing up there electric medications. Examples are dyskinesia dystonia Athetosis Bradyphrenic tremor: and all our tardive

Stages of Change *Maintenance*

A continued commitment to sustain the new, healthy behavior

DSM Axis 1

Clinical Disorders, Other Conditions That May Be a Focus of Clinical Attention

Crisis *Definition*

A crisis is generally considered to be a state of *disorganization in which the client faces frustration and profound disruption* of his or her life. lf not handled appropriately by an addiction counselor or other helping professional, a crisis can produce long-term negative consequences. Typically temporary

Postural hypotension

A decrease in blood pressure but I'm by positional changes

MDMA

A designer psychoactive substance that can cause symptoms of Parkinsons disease, is not a narcotic

Oculogyric crisis

A dystonic reaction evidenced by fixation of the eyeballs in one position usually upward off to the side affect of a neuroleptic drug

Classical Conditioning

A model of behavioral therapy developed by Ivan Petrovich Pavlov where a particular response to a stimuli can be elicited overtime by association with a related stimulus

Acetylcholine

A major nutrients that are responsible for the transmission of nerve impulses in the body including those responsible for muscle movement

Quality Assurance (Q.A.)

A means of evaluating the quality of treatment services by a facility. A written plan and documentation that problems are addressed after they are identified.

Rational-emotive;behavior Therapy (REBT) *Basis*

A method of counseling that focuses on changing the problematic beliefs ol an individual as a result of the events in his or her life

Reality Therapy/Control Theory *Basis*

A method of counseling that focuses on how a client perceives the external world and the behaviors he or she exhibits to fit those perceptions and needs.

Adlerian Psychology (Therapy) *What is the method of counseling?*

A method of counseling, which is also called individual Psychology, where all behavior is believed to be purposive and goal directed

Gestalt Therapy *Basis*

A method of counsering where a client gains awareness of his or her behavior and learns how to accept personal responsibility for those behaviors

Behavior Therapy *What is the basis?*

A method of therapy that focuses on modifying the client's learned behaviors that are negatively affecting their lives.

Operant Conditioning

A model of behavioral therapy developed by B.F. Skinner where behavior is reinforced and learned based on the consequences of the behavior

Psychological or behavioral dependence

A person taking a chemical to satisfy a feeling or an emotional need. Psychoactive chemical addicts use drugs to get pleasurable and desirable psychological effects.

Substance Abuse Disorder

A problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 or more criteria, occurring within a 12-month period

What is a hallucinogen?

A psychoactive substance that alters perceptions, thoughts, and feelings

Antagonist

A receptor antagonist is a type of receptor ligand or drug that blocks or dampens agonist-mediated responses rather than provoking a biological response itself upon binding to a receptor.

Stages of Change *Relapse*

A return to the condition and behavior

Which of the following is the best description of a drug

A substance taken for a desired effect[other than food, water, or air].

Addiction Counseling Practices *Evaluation*

A systematic and ongoing process in which a relationship is initially formed with the evaluating counselor in the initiation of a two-phase process: *Screening* and *Assessment*

Continuous Quality Improvement *Defined*

A systematic approach to monitoring the effectiveness of a treatment facility and its programs. proactive, instead of reactive

Arrhythmia

A typical heart rhythm

NAADAC's ethical decision making model

A viable ethical decision-making model shall include but is not limited to: (a) supervision and/or consultation regarding the concern; (b) consideration of relevant ethical standards, principles, and laws; (c) generation of potential courses of action; (d) deliberation of risks and benefits of each potential course of action; (e) selection of an objective decision based on the circumstances and welfare of all involved; and (f) reflection, and re-direction if necessary, after implementing the decision.

Definitions *Ethical Absolutism*

A viewpoint of ethics where ethical decisions are based on *fixed moral rules* that exist regardless of whether one believes in them. By contrast, an addiction professional practicing *ethical absolutism* would apply the NAADAC Code of Ethics literally, with little accommodation to other factors

Definitions *Ethical Relativism*

A viewpoint of ethics where ethical decisions are based on the *context or consequences* An addiction professional practicing *ethical relativism* would use the NAADAC Code of Ethics as a guide and apply it based on the client, the situation, the potential outcome and input from other professionals

Termination and Continuing Care *Continuing Care Plan*

A written, individualized outline of how the client will continue to receive the support and services necessary to maintain recovery,

Inhibitory Neurotransmitters

Dopamine, serotonin, GABA

Cognitive Behavior Therapy *What is the basis?*

An method of counseling that focuses on simultaneously learning new behaviors and restructuring automatic thoughts,.

Rational-emotive;behavior Therapy (REBT) *The A-B-C Theory*

ABC Model of REBT *A* = Activating Event *B* = Beliefs *C* = Emotional and Behavioral Consequences ln therapy, the therapist also introduces *D (disputing intervention)*, *E (the effect of D)*, and *F (the new feeling that results from E)*.

Hyperapathia

Abnormal increase in pain as a result of a repetitive and damaging stimulus. Can persist after nociceptive pain stimulus has been removed. Basically, pain without source of pain being there anymore...

How long can you pick up meth in UA?

About 48hrs

Principles *Principle 4: Trustworthiness* *What is Fidelity?*

Accurate Representation The integrity of the addiction profession relies heavily on its members' ability to be truthful and trustworthy. There is no greater breach of this principle than an addiction professional who misrepresents his or her credentials, qualifications or experience.

Laws and regulations regarding reports and record keeping

Accurate reports and record keeping is the responsibility of counselors. Federal, State and licensing require that appropriate records are kept by healthcare professionals

Anticholinergic

Acetylcholine blocker in CNS and PNS

Inhibitory and Excitatory Neurotransmitters

Acetylcoline, norepinephrine

Definitions *Situational Ethics*

Acknowledging the uniqueness of a situation and the need to apply ethical principles accordingly

Principles *Principal 2 - Client Welfare* *Should you do whatever possible to relieve suffering of another?*

Actions taken to relieve the suffering must be actions uniquely suited to the suffering individual and not simply some universal treatment. Therefore, the addiction professional must be careful to do what is both necessary and welcome for the client. Finally, in clinical practice the addiction professional should refrain from using any dependency producing practices.

NAADAC Ethical Model *What does Consult with a supervisor and/or colleagues really mean?*

Addiction professionals who are under supervision are hopefully already discussing ethical concerns with their supervisor

Which of the following persons has been called the Father of Individual Psychology?

Adler

Korsacoff Wenicke Syndrome

After prolonged alcohol abuse, the person is unable to walk steadily (like walking in sand), eyes twitch back and forth

What is the strongest correlative indicator of later nicotine addiction?

Age of first use. The younger the individual, the higher the chance of becoming a smoker or user.

Barriers that prevent treatment for elderly with substance abuse problems

Ageism, lack of awareness, behavior of clinicians and services professionals, existence of both medical and psychiatric conditions.

Antiemetic

Aids and prevention of nausea and vomiting

What is the most commonly use sedative hyponotic drug

Alcohol

Central Nervous System Depressants *List*

Alcohol - not scheduled Barbiturates - schedule II to IV Benzodiazepines - schedule IV

NAADAC regarding the addiction of alcohol to the National Drug Control Strategy

Alcohol is a drug even though it is legal. Alcoholisim is the primary chronic disease among many groups of U.S. Citizens.

ETOH route of administration

Alcohol is only available in liquid form, thus is typically taken orally, but some have consumed it rectally.

Central Nervous System Depressants

Alcohol, Barbiturates, Benzodiazepines, Klonopin,

CNS Depressants

Alcohol, Barbiturates, Benzodiazepines, Xanax,Klonopin

CNS depressants

Alcohol, barbituates, benzos

Family Structure

Alcoholic marries an enabler, the first child is the Hero... they are usually perfect "see we are good" The second child is the scapegoat and can do no right. Then is the lost child. If they have another that child is the mascot.

IV. Prof Responsibility: Standard 3: Records and Data: 4. DOCUMENTS IN LOCKED CABINETS

All records shall be kept in locked cabinets or rooms that is not easily accessed by professional other than those performing essential services for clients or operation of agency

Enabling

Allowing and or making it easier for problematic behavior to occur

Psychoactive drugs are drugs that do, what?

Alter behavior or mood.

What does metabolism do?

Alters the composition of a drug.

amotivational syndrome

Amotivational syndrome is a chronic psychiatric disorder characterized by a variety of changes in personality, emotions and cognitive functions such as lack of activity, inward-turning, avolition, apathy, incoherence, blunted affect, inability to concentrate and memory disturbance. The syndrome was first described among those patients with a history of longtime cannabis use in the 1960's. Since then, there have been several reports describing similar psychiatric disorders to amotivational syndrome among patients with the history of some other psychoactive substances use including solvents, methamphetamine and OTC cough syrups. Therefore, the syndrome has been recognized as one of the common psychiatric conditions that might develop in patients with a history of any psychoactive substance use. Recently, more attention has been paid to the biological basis of amotivational syndrome. Several studies using MRI, SPECT or neuropsychological measures have revealed white matter changes, hypoperfusion in the frontal cortex of the brain and impairment of frontal lobe function. Those findings suggest that amotivational syndrome might be related to "hypofrontality" of the brain. Although no specific treatments have been reported to be definitely effective for patients with amotivational syndrome, some neuroleptics with activating properties or antidepressants can be given appropriately to treat the chief symptoms of the patients.

agonist

An agonist is a chemical that binds to a receptor and activates the receptor to produce a biological response

Agonist

An agonist is a chemical that binds to a receptor and activates the receptor to produce a biological response.

Ethnically sensitive addiction professional suggestions by Carter, Liu, and Cross /1

An awareness of their limits in terms of knowledge and skills

Short and long term effects of amphetamine use

An increase in blood sugar, inability to sleep, alertness and tremors are possible. Long term Elevated blood pressure, skin rashes, irregular heart beat, Eating disorder etc.

Ethnically sensitive addiction professional suggestions by Carter, Liu, and Cross /3

An openness to cultural differences

Naltrexone

An opiate blocker, has been found to be effective in treatment of heroin addicts.

Buprenorphine

An opioid replacemtn therapy that has both agonist and antagonist effect

Examples of Schedule III substances include

Anabolic steriods, codeine and hydrocodone products with aspirin or Tylenol, some barbiturates

What is PCP's common street name?

Angel dust, because it is often "dusted" onto tobacco, MJ, or parsley. *Users are often called "dusters"

Definitions *psychoactive substance*

Any drug that affects the central nervous system and alters consciousness and/or perceptions

Controlled substance

Any drug that has an abuse liability and is placed on restricted use by the DEA.

Psychotropic drug

Any drug that is capable of affecting the mind influencing behavior

Vasoconstrictor

Anything that induces blood vessels to constrict

Which of the following is a common symptom of the later stages of burnout?

Apathy

Method of Administration *Topical*

Applying the psychoactive substance onto the top layer of the skin (e.g. LSD blotter paper or duragesic patches). This method provides a systemic effect if it is able to penetrate the skin tissues and be absorbed into the blood stream, especially if heat is applied.

Methamphetamines

Are chemically made stimulants/ Speed, Chalk , Ice, crystal, glass.

Anabolic-Androgenic Steroids

Are drugs related to male hormones.

Protracted or secondary withdrawal refers to withdrawal

Arising when a drug has been used for a considerable period of time.

II. Evaluation, Assessment & Interpretation of Client Data =

Assessment instruments used to: - gather info on client's personal, cultural background - form basis of recommendations, reports on approved evaluation instruments and procedures - Instruments used are those verified by research

When a counselor adopts a relaxed posture, good eye contact and a pleasant tone of voice, the counselor is ...

Attending, This help facilitate a positive counseling relationship.

Principle and Virtue Ethics

Autonomy- support client independence Benefiecence- obligation to do good, best interest of client Justice- equal and fair treatment Obedience- observing law and regulations Competence- being educated trained and prepared fidelity- exercising honesty and trust deiscretion- valuing the right to privacy nonmaleficence- do no harm

II. Eval, Assessment: Standard 10: OUTDATED ASSESSMENT RESULTS

Avoid reliance on obsolete assessment instruments. -seek training / education on administering, scoring, reporting data through assessments. - Data collected should be used in planning TX level & TX reviews, approved by authorized mental health professional or Addiction Pro with training on assessment & testing

Toxicity level of ETOH

BAL of 0.40. Person is probably in a coma at this point, and chance of death is high

barbiturates

Barbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, hypnotics, and anticonvulsants.

Barbiturates drugs are derived from....

Barbituric acid.

Behavioral Modification Theroy

Based on the idea that all behavior is learned and what is learned can be unlearned. Classical Conditioning, Operant Conditioning and Modeling

Gestalt Therapy

Based on the idea that people must accept responsibility for what happens to them and find their own way in life. Help the patient be what he wants to be rather than try to be something that he is not.

Why are Benzos (BZs) preferred over Barbs?

Because they have many of the same anxiolytic effects as Barbs, but less of the typical side-effects associated with barbs.

NAADAC Ethical Model *What does identify all courses of action and their consequences mean?*

Before deciding on a course of action, all options available to the addiction professional and their corresponding consequences need to be considered

Stages of intoxication: subclinical

Behavior nearly normal by ordinary observation

Suicide Assessment [three components]

Behavioral indications, Historical patterns, Present situation, and Degree of lethality.

In relations to counseling, what is empathy

Being able to understand what another person is experiencing.

Rational Emotive Behavioral Theory

Belief that it is not an actual event disturbs a person and how he sees that event.

Adlerian Individual Therapy

Believed that social urges were what influenced people. Based on people are always striving to do better. Therapist try to see the world from the viewpoint of the patient.

Method of Administration *Subcutaneous (SC)*

Beneath the skin

Groups of drugs known as tranquilizers

Benzodiazepines and sedatives

Edema

Body tissue swelling from fluid accumulation

Client and Counselor relationship

Both parties are responsible for its creation.

Central Nervous System is made up of three parts.

Brain & Spinal Cord, pheripheral nervous system, and The Autonomic nervous system.

Central Nervous System (CNS)

Brain & spine

Neurotransmitters *Amino Acids* *GABA*

Brain's main inhibitory neurotransmitter and is involved in 25% to 40% of all synapses in the brain. It controls impulses, muscle relaxation, and arousal and generally slows down the brain *Alcohol has a strong effect on GABA*

Pharmacology

Branch of science that examines how psychoactive substances taken to alter bodily functions or enhance bodily functions interact with the brain and body

Gynecomastia

Breast enlargement in males

Addiction Treatment Modalities *Brief Therapy*

Brief therapy does not point to any specific therapy or theoretical approach but rather is a relative set of therapies that includes a shorter time period and fewer sessions than "traditional" therapy.

partial antagonist

Buprenorphine is a partial agonist meaning, it activates the opioid receptors in the brain, but to a much lesser degree than a full agonist.

Miseducation of Lauryn Hill

But deep in my heart, the answer it was in me And I made up my mind to define my own destiny

How is heroin produced from morphine?

By attaching 2 acetyl groups to the morphine molecule. Hence, its chemical name, diacetylmorphine.

How do opiods cause euphoria and relieve emotional pain?

By binding to opiod receptors within the limbic system, effecting mood.

NAADAC Ethical Model *What does Review the NAADAC Code of Ethics to determine which principles are applicable really mean?*

By reviewing the NAADAC Code of Ethics, addiction professionals can further clarify if there is an ethical concern.

Chemical Diversion and Trafficking Act of 1988

CDTA

Central Nervous System abbr. form

CNS

Major class of psychoactive chemicals

CNS Depressants,CNS Stimulants, Narcotics, Hallucinogens, Cannabis, Solvents/Inhalants,Steroids, Psychotropics.

Downers

CNS Depressants: alcohol, benzos, barbituates, opiates, sedative- hypnotics, muscle relaxants, antihistamines

What is the most probable classification for a substance that causes a client to experience an instant euphoric flash when using?

CNS Stimulant

Uppers

CNS Stimulants: cocaine, amphetamines & meth, caffeine, nicotine

Gamma Hydroxybutrate (GHB)

CNS depressant known as the date rape drug

Sedative-hypnotics

CNS depressant psychoactive substances used to reduce anxiety and induce sleep

Eight groups of psychoactive substances

CNS depressants, CNS stimulants, narcotics, hallucinogens, cannabis, solvents/inhalants, anabolic steroids, and psychotropics.

amphetamine

CNS stimulant

Temporary or Emergency Scheduling

CSA was by the Comprehensive Crime Control Act of 1984 to include

Which Xanthine is strongest CNS stimulant?

Caffeine (on CNS and skeletal muscles) *But weakest on cardiovascular system

Action Response

Can be probes or questions, confrontations or interpretation: Should be open ended and non-judgmental.

Bad Trip

Can include anxiety attacks, depressive episodes, and psychotic breaks that resemble schizophrenia. Can last for days especially with PCP

What is the age limit for substance abuse counselor to counsel people.

Can work with any age group depending upon their training. Young children and elderly can develop substance abuse addictions.

Person Centered Therapy

Carl Rogers Approach to counseling where the client directs the treatment process bc she is capable of invoking change within herself. Based on humanism- the movement that focuses on the innate nature of all humans to achieve our potential and find meaning in our lives 3 characteristics- congruence (match external bx with internal feelings / thoughts. Unconditional positive regard (counselor shows the client constant acceptance and caring) empathy (identify with & understand the subjective world of the client. Decreases defensiveness and encourage openness. Explore inner secrets and issues

Which of the following is a significant difference between case finding and ongoing services.

Case finding does not always include treatment, but ongoing services do

Gonadotrophs

Cells in the anterior pituitary gland that secrete gonadotrophins - that stimulate gonads in males and females that are essential for production

Principles of person centered therapy.

Centered around the idea that it is the patient's responsibility to find ways to deal with reality. Three principles/ Positive regard, Empathy, Congruence, demonstrate being real and genuine.

Limbic System is made of

Cerebral Cortex: voluntary motor skills, sensory input Hypothalamus: Liaison between CNS & PNS

Special Populations *Older Adults*

Changes in body Lack of Reporting All about support systems

Intervention Models *The Johnson Model*

Characterized by confrontation from family and friends. Note chaotic but systematic Maintains that confrontation is the only effective way to break through a client's denial. Criticized that it is not effective because it does not evoke change within the client i.e. MI. Primary goal is not to get the client into treatment but to do so in a manner where they would stay in treatment.

Depressants Alcohol *Early Stage Dependence*

Characterized by escaping from social situations and sneaking to drink, feelings of guilt, difficulty stopping once drinking has begun and preoccupation with drinking. At this stage of alcohol dependency, the individual will often try to set goals for him

Psychotropic,Mood Stabilizer and Antipsychotic family

Chlorpromazine, Triflupromazine Resperidone, resperadol, Clozapine,

Listening Responses

Clarification, paraphrasing, reflection, summarization

IV. Prof Responsibility: Standard 3: Records and Data: 3. SEPARATE RECORD KEEPING

Client interactions (group & individual counseling) will be maintained on SEPARATE DOCUMENTS than financial data (client billing, payments, third party payments, gifts, donations)

clonidine

Clonidine is a type of drug known as a centrally acting alpha-agonist hypotensive agent. It is commonly used in the treatment of high blood pressure (hypertension). It does this by reducing the heart rate and relaxing blood vessels. Clonidine is also a type of drug known as a sympatholytic - this means that it inhibits Postganglionic nerve fibers which in turn alter the functioning of the sympathetic nervous system. It comes in tablet form.

What does mixing cocaine and alcohol produce?

Cocaethylne -Dramatically increases HR and BP

Shares the same penalty for Heroin (schedule I) offences

Cocaine (schedule II) 5 kgs or more; LSD (Schedule I) 10 gms or more; Meth (Schedule II) 50 gms or more pure or 500 gms or more mixture

Shares the same penalty for Heroin 100 to 999 gms (first and second offences)

Cocaine (schedule II) 500-999 gms; LSD (Schedule I) 1 - 9 gms; Meth (Schedule II) 4- 49 gms pure or 50 - 499 gms mixture

Cocaine HCL vs "Crack" cocaine

Cocaine HCL: -Cocaine HCL is the powdered form of coke -Cocaine HCL is often snorted or injected -Cocaine HCL burns at too high of a temp to be able to smoke effectively without destroying the psychoactive compounds Crack cocaine: -"Crack" is made by chemically separating the cocaine from the HCL salt, forming a "free base" -Freebasing=Smoking crack cocaine -Typically smoked, and results in a faster rush than snorting, which can take 3-10min to kick in

Narcotics

Codeine, Morphine, Opium, Vicodin, Hycodan, Hydrocodone, Dilaudid, Oxycodone,Percodan, Percocet, Tylox.

Aaron Beck

Cognitive Behavior Therapy [CBT]

BAC 0.35 to 0.50

Coma

CMEA

Combat Methamphetamine Epidemic Act of 2005

Stages of alcohol dependence

Early: escaping from social situations, sneaking to drink, feelings of guilt, difficulty stopping & preoccupation Middle: Loss of control, impaired social relationships, changes in drinking patterns, temp sobriety, morning drinking, neglect of health needs. Late: drink in order to function, binges, withdrawal sx, blackouts, etc

Speed Balling

Combining Heroin with a stimulant like cocaine. Very dangerous. Causes heart to give out.

Infectious Diseases *Hep C Facts*

Commonly transmitted through the sharing of needles Chronic hepatitis C is much more serious than hepatitis B and can result in long-term health problems, even death. Chronic hepatitis C typically progresses slowly and, for some, no symptoms are apparent for 20 to 3O years after infection.

Principles *Principal 2 - Client Welfare* *What is compassion?*

Compassion is the habit of understanding of the mind that inclines a person toward the intelligent understanding of the suffering of another and the desire to alleviate that suffering.

Stages of intoxication: Coma

Complete unconsciousness Depressed or abolished reflexes Subnormal body temperature Incontinence Impairment of circulation and respiratory Possible death

MCA

Comprehensive Methamphetamine Control Act of 1996

III. Confidentiality: 3. In writing

Confidentiality rights must be given in writing, including any areas likely to affect the client's confidentiality

NAADAC Decision Making Model step four

Consider any potential legal concerns and identify if consultation with an attorney is neeeded

Step Ten

Continued to take personal inventory and when we were wrong promptly admitted it. This step involves a commitment to monitor yourself for any behaviors that may be detrimental to yourself or others and to admit when you are wrong. https://www.recovery.org/topics/alcoholics-anonymous-12-step/

Continuous Quality Improvement *How often should it be reviewed?*

Continuous quality improvement program be reviewed at least annually

Photosensitivity

Easily sunburned, induced by some drugs

Phenylethylamine psychedelics schedule I examples

Ecstacy, STP-LSD combo, peyote cactus

Incentive sensitization

Effective brain adaption to early drug use maximize its affects quickly producing a strong stimuli and reward linkage; drug use moves from liking to a driving one teen called incentive salience ensuring continued to abuse

What does short term effects of drugs refer to?

Effects while the drugs are still in the users body.

Indicator that a drug or other substance (OS) has a potential for abuse

Evidence that individuals are taking the drug or OS in amounts sufficient to create a hazard to their health or community

Examples of Schedule V substances include

Cough medicines

Agonist / antagonist

Counteracts or inhibits Neurotransmitter effects on the postsynaptic cell

? to use a specific substance.

Craving or a strong desire or urge

Indole psychedelics schedule I examples

DMT, LSD, Mushrooms, Yage, ibodga plant

SAP *What does it cover?*

DOT expanded the testing mandate to include all commercial vehicles entering the U.S. from both Canada and Mexico

propoxyphene

Darvon

In counseling what does immediacy refer to?

Dealing with feelings in the here and now. Deals with the counselor and patient working through feelings in a counseling relationship.

BAC 0.45 +

Death

Stages of intoxication: Death

Death from respiratory arrest

NAADAC Decision Making Model step six

Decide on a course of action

Stages of Change *Preparation*

Decides he or she would *like to change* The client makes the decision to change and attempts to begin the process

Acute intox sx of depressants (general)

Decreased: heart rate, blood pressure, breathing, digestion, basic psychological functions such as motor coordination and mental awareness, restricted pupils

THC

Delta-9-Tetrahyrdocannabinol

meperidine

Demerol

Addiction Counseling Qualities

Demonstrate warmth, genuineness, immediacy, personal ability, and positive regard/respect

Only mental health issue really affected by caffeine

Exacerbation of Generalized Anxiety Disorder (GAD) through stimulation of the CNS

Defense Mechanisms:

Denial- refusing to accept reality Displacement- transferring a feeling about an unpleasant situation onto another individual (grading wasn't' fair) Projection- attributing unacceptable thoughts or feelings to another ind or object (she only has friends bc of $) Rationalization- hiding the true reason behind a bx or feeling but doing so in a self serving way with incorrect explanations (I didn't run for president bc I didn't want to upset you win I won) Repression- blocking unpleasant experiences or thoughts from the conscious mind (I don't remember that night...) Sublimation- redirecting maladaptive bx into a socially accepted bx (I am sad so I will go to lunch w a friend)

Chemicals found in PSYCHOTROPIC DRUGS, ANTIDEPRESSANTS

Dibenzoxazepine, Selective Serotonin, Prozac, Zoloft, Luvox, Selective Norepinephine, Effexor, Tetracyclic and Trazodone.

Dysphagia

Difficulty swallowing

dihydromorphine

Dilaudid

Dissociative Drugs

Disconnect from reality, convulsions, coma, high fever, death

Method of Administration *Sublingually*

Dissolving under the tongue

Depressants Alcohol *Middle Stage Dependence*

Distinguished by loss of control over drinking behavior, impaired social relationships, changes in drinking patterns, temporary sobriety, morning drinking and *neglect of dietary and health needs.*

Pharmacotherapies available for alcohol use disorder are

Disuliram and Naltrexone. Also groups for coping skills, relapse prevention, and the use of other support groups.

Non-maleficence

Do no harm

what is NON-MALFEASANCE?

Do no harm addiction professionals promote this principle ethic by avoiding any behavior that can cause harm or has the potential to harm an individual

Considerations in making ethical decisions: NON-MALFEASANCE

Do no harm to the interests of the client

A counselor is conducting a suicide risk assessment on a new patient. Which of the following would be considered inappropriate?

Do you know how you will kill yourself?

Reality Therapy/Control Theory *Total Behavior*

Doing Thinking Feeling Physiology

Principles *Principle 4: Trustworthiness* *What is Non-maleficence?*

Doing *no* harm

DCDCA

Domestic Chemical Diversion Control Act of 1993

To be in a powerful position as a counselor and to be carrying cultural biases, without self-awareness, is dangerour

Dr. Kenneth Hardy quote

Campral

Drug treatment for alcohol abuse and inhibits GABA and glutamate pathways to reduce reinforcement and minimize drug cravings

I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #9 of 11: handling referrals from criminal justice system

Due to increased role of criminal justice system making referrals: pro will strive to REMOVE COERCIVE ELEMENTS from such referrals ASAP to encourage TX and recovery process

Tardive dyskinesia

Dyskinesia symptoms presented after extended neuroleptic medication treatment usually seen as movements including chewing her sucking motions Lip smacking

Tardive dystonia

Dystonia symptoms present after extended of neuroleptic medication treatment. Include twisting movements of the body

II. Eval, Assessment: Standard 2: INFORMED CONSENT: Use of interpreters

Interpreter AND client must provide informed consent documents & verific of confidentiality before services.

ECG

Electrocardiogram

ECT

Electroconvulsive therapy

EEG

Electroencephalogram

IV. Prof Responsibility: Standard 3: Records and Data: 5. ELECTRONIC RECORDS

Electronic records shall be maintained in ways to assure consistent service & confidentiality to clients

There are how many possible criteria used in diagnosing a substance abuse disorder

Eleven

Stages of intoxication: Excitement

Emotional instability; loss of critical judgment Impairment of perception, memory and comprehension Decreased sensatory response; increased reaction time Reduced visual acuity; peripheral vision and glare recovery Sensory-motor incoordination; impaired balance Drowsiness

Definitions *Humanistic Ethics*

Emphasizing human needs, such as self-actualization and freedom, as the basis for ethical decisions

The shadow is an archtype that

Encompasses everything a person refuses to acknowledge

MDMA

Energizing effect, distortion in perception and time, chills, muscle cramping, teeth clenching, reduction in mental abilities

Confusion

Exaggerated emotional states Disturbances of vision and of perception of color, form, motion and dimensions Increased pain threshold Increased muscular incoordination; staggered gait; slurred speech Apathy, lethargy

Definitions *Principle Ethics*

Ethics that answer the question *"What should 1 do?"*

Definitions *Virtue Ethics*

Ethics that answer the question *"Who should 1 be?"*

Chemical metabolism process for ethanol

Ethyl alcohol->(alcohol dehydrogenase)->acetaldehyde ->(acetaldehyde dehydrogenase)->acetic acid

Semi synthetic narcotic

Etorphrine, heroin, Hydromorphone, meperidine, oxycodone

BAC 0.03 to 0.12

Euphoria

Principles *Principal 2 - Client Welfare* *Can a CDP/T refuse services for lack of payment?*

Even though an addiction professional does not receive any public subsidy for services, *he or she may discriminate among potential clients based on their ability to pay for services.* Such discrimination, however, does not apply to clients whose needs are emergent or who are at risk of substantial harm if treatment intervention is not initiated immediately. However, when an addiction professional refuses to accept the client because of inability to pay for services, *he or she still has an obligation to assist that individual in finding care.* The addiction professional *must provide the individual with the names and contact telephone numbers of other providers* who are highly likely to accept clients without reference to their ability to pay. Finally, an addiction professional *may not enter into a contractual agreement with third party payers who consistently provide payment for less than adequate treatment service*

X. Policy and Political Involvement Standard 1: Societal Obligations: 2. UNJUST LAW OR REGULATION

Exception to laws and regulations existing for the good ordering of society, is when a law or regulation is clearly unjust, where compliance leads to greater harm than breaking the law.

BAC 0.09 t0 0.25

Excitement

Existential Therapy

Existential therapy uses a positive approach that applauds human capacities and aspirations while simultaneously acknowledging human limitations.

Crisis *Three Categories*

External Factors Internal Distress Transitional State

Exogenous depression

Externally induced, reactive, depression such as depressing events or circumstances

Orthostatic hypotension

Faintness brought on by sudden drop in blood pressure from standing

Considerations in making ethical decisions: JUSTICE

Fair and equal treatment, to treat others in a just manner.

what is JUSTICE?

Fair and equal treatment, to treat others in a just manner; addiction professionals practice this principle ethic when they provide the same quality of treatment to all clients without discrimination.

Time of onset: intravenous cocaine

Fast (20 seconds) and and short lived 30 minutes

Time of onset: smoking cocaine

Fast - 15 seconds and brief 10 to 15 minutes

Time of onset: smoking heroin

Fast - 20 seconds and short lived 1 to 2 hours

Time of onset: Intravenous heroin

Fast 1 to 2 minutes and short lived 1 to 2 hours

Are most psychoactive substances water or fat soluble?

Fat-soluble, which is why they cross the blood brain barrier

Mental growth and retardation and physical deformities are common symptoms of what ?

Fetal Alcohol Syndrome

Principles *Principle 4: Trustworthiness* *What is this principal based on?*

Fidelity, Obedience and Non-maleficence

Neurotransmitters *Monoamines (e.g., catecholamines)* *Dopamine*

Fine motor muscular activity, emotional stability, satiation, and the addiction pathway. *Dopamine is the most crucial neurotransmitter involved in both substance and process addictions.* It is often called the "reward chemical

Stages of group growth

First Stage, is Acquaintance and ground work Second stage is Working and closing

Discuss guideline for intervention preparation

First in preparation is the development of a list by each team member, next a action plan should be designed and offer help to the patient/ person.

Depressants Alcohol *How long does alcohol detox take?*

Five days or less

Intervention Models *Systemic Family Intervention*

Focused on family, not the individual, no identified patient Not planned in secrectacy or deceit *Not Confrontational* Goal is to create a healthy family system again and all family members appropriate care in the recovery

Solution focused therapy

Focused on things that work rather than the problem. The successes of a patient should be dealt with rather than his disabilities or deficits.

Cognitive Behavior Therapy *Where it does not work well*

For the client who is unwilling to be engaged in therapy and do the homework.

Dynorphin

Form of endorphin that is released at childbirth. 700x stronger than morphine. Helps offset fatigue, forget the intensity of the pain, bonds mother and child.

Volatile

Form of psychoactive substance that can be inhaled

Neurotransmitters *Opioid Peptides* *Substance P (tachykinin)*

Found in sensory neurons, was first discovered in 1931. *It conveys pain impulses from the peripheral nervous system back to the central nervous system.* *Enkephalins block the release of substance P, thereby subduing pain.*

Hyperuris

Frequent urination

Psychoanalytical Therapy

Freud- A deterministic method of counseling where the mental dysfunction results from internal conflict and memory. Human bx is largely influenced by internal drives. We all have an unconscious mind that functions outside of our awareness. It is brought to the conscious mind via the analysis of resistance. 3 components: Id (unconscious aggression and sex, the animal) Superego ( the conscience) and Ego ( mediates for the other 2) Defense Mechanisms stem from this theory. Good with those who chronically relapse or have deep seeded personality issues.

Neurotransmitters *Misc* *Adenosine*

Functions as an autoregulatory local hormone. Has an inhibitory effect on the CNS. Caffeine's stimulatory effects are due partially to its ability to inhibit adenosine, which results in enhanced dopamine and glutamate effects in the brain

Goal of Adlerian Therapy

Further develop the client's social interest and help him or her connect with the social world in a more meaningful way

Neurotransmitter most affected by ETOH

GABA

Which neurotransmitter is most effected by Benzos?

GABA (most inhibitory neurotransmitter)

Which neurotransmitters does ETOH affect?

GABA, dopamine, glutamate, and serotonin

Inhalants

Gases that are administered to body via breathing

Alcohol health disorders

Gastrointestinal disorder, Cardiovascular disorder,Skin disorder, Neurologic and psychiatric disorders

DSM Axis 3

General Medical Conditions

Stages of intoxication: Stupor

General inertia; approaching loss of motor functions Markedly decreased response to stimuli Marked muscular incoordination; inability to stand/walk Vomiting; incontinence Impaired consciousness; sleep

Listening responses

Good eye contact, Clarifying what client said, Restating or paraphrasing, and reflection.

Which of these are Avoidance behaviors in a patient's behavior.

Gossiping about loved ones, rationalizing, generalizing.

Myalgia

Generalized muscle pain

Addiction Counseling Practices *Intake*

Generally the business end of services that must be finalized before treatment can begin i.e. ROIs, Consent for services, clarification of fees, etc

Motivational Enhancement Therapy

Getting the patient to motivate himself for change. Help him see the connection between his behavior and his goals.

Publication Credit -Ethical Principles

Give every one credit who contributes to published material

DSM Axis 5

Global Assessment Functioning

Neurotransmitters *Amino Acids* *Glycine*

Glycine, an inhibitory neurotransmitter, is primarily found in the spinal cord and the brainstem. It is also prominent in protein synthesis and *slows down the brain.*

Infectious Diseases *Hep C versus HIV/AIDS*

HCV is highly contagious and those who inject drugs are *more likely to contract hepatitis C than HlV*

Schedule review step four

HHS recommends a schedule based on the scientific evidence.

Schedule review step three

HHS, through the FDA, evaluates the drug and its schedule through an analysis based on eight factors. Among the factors: a drug's potential for abuse, the scientific evidence for a drug's pharmacological effects, and the scientific evidence for a drug's medical use.

Infectious Diseases *HIV versus AIDs*

HIV is a precursor to AIDs Incurable but controllable with medical care and Antiretroviral (ART) treatment.

Diseases associated with heroin

HIV/AIDS, tuberculous, and hepatitis B or C

Hallucinogens

Hallucinations, several emotions, dilated pupils, increase in body temperature, increase in heart rate, sweating, loss of appetite, sleeplessness, dry mouth, tremors

Definitions *Potentiation*

Happens when substances taken together have a synergistic effect

Schedule II

High potential for abuse and has some medical uses with seveeere restrictions

Physiological dependence

Has to do with the body's adaptation to the presence of a chemical. When the chemical is not present the body acts in a negative manner, called withdrawal.

Step Twelve

Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs. This step encourages members to help others in their recovery. Many members become sponsors once they have completed the 12 steps. https://www.recovery.org/topics/alcoholics-anonymous-12-step/

NAADAC Peer assistance committee

Help other professional that have relapsed or are using illicit drugs or are impaired and cannot perform their counseling duties.

Protracted Abstinence Syndrome

Heroin residual withdrawal

What is a heroin "needle freak"?

Heroin users who are not physically dependent, but must inject due to psychological dependence, to regain feelings of normalcy

Examples of Schedule 1 substances include

Heroin, LSD, marijuana

Acute Alcohol withdrawal Sx

High Risk: tremors, slurred speech, nausea and/or vomiting, flushed face, dehydration, sweating, rapid heart rate, insomnia, poor coordination, poor memory, halluninations, grand mal seizures, delirium tremens (DT's)

Easy availability and low price

High abuse potential of ocaine and the tendency for occasional users to quickly turn into psychoactive substance dependents is accounted for by its:

Hypertension

High blood oressure

Schedule *Schedule II*

High potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. Some examples of Schedule II drugs are: Combination products with less than 15 milligrams of hydrocodone per dosage unit *(Vicodin)* *cocaine* methamphetamine *methadone* hydromorphone (Dilaudid) meperidine (Demerol) *oxycodone (OxyContin)* *fentanyl* Dexedrine Adderall, and Ritalin

Schedule II

High potential for abuse; currently accepted medical use in treatment in the US or use with severe restrictions; use may lead to severe psychological or physical dependence

Schedule I

High potential for abuse; no currently accepted medical use in treatment in the US; lack of accepted safety for use under medical supervision

Special Populations *Adolescents*

Highly Influenced by Peers Mutual Support Groups are Effective

Principles *Principle 3: Client Relationship* *What is Informed Consent*

Honest and open discussion with the client concerning all the specifics involved in the services to be delivered including all the associated costs.

The magnitude of a drug's effect is, What?

How intensely the user feels the drug's effects.

Definitions *Method of Administration*

How the psychoactive substance physically enters the individual's body and bloodstream.

inhalants/solvents

Huffing is a method of administration most commonly used with

Infectious Diseases *How it is not transmitted*

Hugging Shaking Hands Sitting next to each other Touching the same items Only direct exchange of bodily fluids

Principles of Freudian or Psychonalytical

Human being are influenced by powerful inner and unconscious drives. id, ego, superego. People go through 5 stages of life. oral, anal, phallic, latency, and genital.

Step Seven

Humbly asked Him to remove our shortcomings. Every person has character defects, whether they come in the form of impatience, anger, apathy, criticism or negativity. The recovering alcoholic is not strong enough to eliminate these defects on their own, so they ask their higher power to do so. https://www.recovery.org/topics/alcoholics-anonymous-12-step/

Hyperkatifeia

Hypersensitivity to emotional distress, as a result of opiod misuse in the context of pain management.

Non-Discrimination Principle 1

I shall affirm diversity among colleagues or clients, regardless of age, gender, sexual orientation, ethnic/racial background, religious/spiritual beliefs, marital status, political beliefs, mental/physical disability or veteranstatus.

Non-discrimination principle 1b

I shall avoid bringing personal and professional issues into the counseling relationship. Through an awareness of the impact of stereotyping and discrimination, I shall guard the individual rights and personal dignity of my clients.

Non-discrimination principle 1c

I shall relate to all clients with empathy and understanding no matter their diagnosis or personal history

Non-Discrimination Principle 1a

I shall strive to treat all individuals with impartiality and objectivity relating to all based solely on their personal merits and mindful of the dignity of all human persons. As such, I shall not impose my personal values on my clients.

NAADAC Decision Making Model step five

Identify all courses of action and their consequences

NAADAC Decision Making Model step one

Identify and define the problem

Dyskinesia

Impaired or feeling voluntary muscle control evidenced by grimacing twitching etc.

NAADAC Decision Making Model step seven

Implement the course of action and document it appropreately

Definitions *Clinical Pragmatism*

Implementing the values of the dominant social system as the basis for ethical decisions

Neurotransmitters *Amino Acids* *Glutamic Acid*

Important excitatory neurotransmitter, is present in 80% of neurons in the brain. It is one of the major amino acids and plays a role in cognition as well as motor and sensory function. Glutamate enhances the prominence of dopamine's effects when it is released in response to psychoactive drugs. It is also important in memory reinforcement and is a precursor for GABA.

In a Controlled Environment

In a Controlled Environment

IX. Communication and Published Works: 3. COOPERATIVE WORKS

In documents and presentations that are generated cooperatively, all contributors are recognized.

I. Counseling relationship: Standard #4: GROUP STANDARDS: #1 of 2: confidentiality in groups

In each group, Pro and clients will establish confidentiality guidelines.

Which of the following is an example of a treatment plan goal for a client?

Incorporating healthy activities into everyday life

Neurotransmitter effected by barbs

Increase in GABA activity

Cocaine

Increase in energy, decrease in appetite, disturbance in heart rhythm, nausea, respiratory failure, strokes and seizures

Operant Conditioning

Increase or decrease of certain behaviors through the use of reinforcement. Negative reinforcement can decrease a behavior.

Suicide Intervention *Phases of Suicide*

Increased Suicidal Thoughts Devising a Plan Actions are being taken to carry out Plan

Mech. of Action for Antabuse

Inhibits the enzyme acetaldehyde dehydrogenase (ALDH) , which results in buildup of the ETOH's metabolic intermediate Acetaldehyde, resulting in feelings of a "hangover" near immediately after consumption

Continuum of drug use

Initiation, intoxication, substance use disorder, withdrawal, craving, relapse, and recovery

Method of Administration *Intramuscularly (IM)*

Injected into the muscle

Method of Administration *Intravenously (IV)*

Injecting the psychoactive substance into a vein, which is often called "shooting," and is the most intense, rapid and efficient method of administration. Most individuals prefer this method above others due to the increased perceived intensity of the euphoria. However, along with this pleasure comes an increased risk of HIV/AIDS, tuberculosis, and hepatitis B and C and other infectious diseases when *individuals share dirty needles.*

Endogenous depression

Internally induced depression such as hormonal balance

Petechiae

Intradermal hemorrhage resulting in very small red or purple spots

Infectious Diseases *Contraction of HIV/AIDs*

Intravenous Drug Use - sharing dirty needles Sexual Intercourse - unprotected Mother to Child - In womb or from breast milk Blood Transfusion - *rare* Not through casual contact

Chorea

Involuntary brief unexpected jerky movements that flow from one body part to another

Dystonia

Involuntary muscle contractions and spasms that result repetitive twisting body movements and awkward postures

Encopresis

Involuntary pooping

Autonomic

Involuntary portion of nervous system

Athetosis

Involuntary writing movements

Neurotransmitters *Opioid Peptides* *Endorphins, Enkephalins, Dynorphins, and Opioid Peptides*

Involved in the regulation of pain, the mitigation of stress (emotional and physical), the immune response, stomach functions, and a number of other physiological functions. *They are also intimately involved with the addiction pathway.*

Benzo detox

Involves "weaning off", rather than abruptly cutting off

Medical malpractice and negligence

Involves a law suit and the other is breach of duty of care.

Drug testing

Is a means of getting help for someone and not a form of punishment.

Person-centered therapy

Is an approach to counseling and psychotherapy that places much of the responsibility for the treatment process on the client, with the therapist taking a nondirective role

Detoxification Modalities

Is identified as crisis intervention and serves as a beginning for further treatment.

Professional Ethical decision making

Is it based off of what I believe, or professional codes of conduct? Which principle of ethical conduct is involved. Is the conflict based on intellect, emotion, or needs?

Oxycodone

OxyContin

Most commonly abused prescription opiod

Oxycodone (oxycodone)

Informing of educating the client, family and community about risks of substance abuse.

Is very important because it effects the family, client and community and they all will have some understanding of how to deal with client substance abuse.

Why can an overdose of a barbiturate cause death?

It can depress critical physiological functions, such as breathing

Motivational Enhancement Therapy - (MET)

It is Motivational Psychology. Belief that the patient has the capability as well as the responsibility to change. 5 Stages of change.

Adlerian Psychology (Therapy) *What is the basis?*

It is holistic in nature and we are all striving towards superiority and perfection, must learn how to deal with feelings of inferiority.

Rational Emotive Behavioral Theory.

It is not the actual event that disturbs a person but how he sees the event. Negative life events, negative beliefs, and negative consequences. ABC model.

NAADAC Ethical Model *What does Implement the course of action and document it appropriately mean?*

It is recommended that addiction professionals briefly document the steps taken in response to an ethical problem and include a written description of the course of action. *In situations directly related to a client, the documentation should be in the client's file.*

Relapse-prone Style of recovery Relapse Grid

It takes the road of denial and evasion.

Cannabis

Marijuana (Schedule I) Hashish (Sched I) Marinol (Sched III) Effects last 8-12 hours

Factors to determine which schedule a drug or OS should be placed or decontrolled or rescheduled /4

Its history and current pattern of abuse

Interventions

Johnson Model Motivational Interviewing Systematic Family Intervention ARISE intervention-

Arthralgia

Joint pain

Confidentiality -Ethical Principles

Keep client confidentiality the first obligation.

Referral, consultation and client welfare

Knowing the responsibility of counseling as well as client, Competence, legal and moral standards, client welfare, confidentiality, consult with other professionals.

Transportation services provided by DOT.

Known as SAP services SAP is to provide a drug free work place. Professional services for substance abuse is set up by DOT.

Special Populations *LGBTQ Considerations*

LGBT people may also be victims of antigay violence and hate crimes. limited in social outlets and have traditionally socialized in gay bars, private homes, or clubs where alcohol and drugs often play a prominent role.

Hallucinogens

LSA, Phencyclidine, MDMA

Hallucinogens

LSD, MDMA, Shrooms, PCP, peyote, etc

DOT Drug testing policy

Marijuana, cocaine, opiates, narcotics, amphetamines, PCP and Alcohol are required to be apart of a drug screen.

State Dependent Learning

Learn when high on THC, does not remember when sober, does remember when under the influence of THC later.

0.40

Lethal alcohol toxicity, also known as alcohol poisoning can occur when an individuals blood alcohol concentration is this or higher

LAAM

Levacetylmethadol is a longer acting drug, similar to methadone, that typically only needs to be taken 3 times a week (vs 7 for methadone). It has fallen out of medical favor due to the possibly dangerous side-effects associated with its use.

Federal Trafficking Penalties of Heroin (schedule I) 1K or more (2 or more priors)

Life imprisonment

Schedule IV

Limited physical or psychological dependence. Low abuse potential. accepted medical use.

Solvent

Liquid used to dissolve another substance

Victor Frankl is known for

Logotherapy

Alcohol

Loss of coordination; impaired reasoning, balance, speech and judgement; slow reaction time

Ataxia

Lots of muscle coordination, especially voluntary muscles

Hypotension

Low blood pressure

Schedule *Schedule IV*

Low potential for abuse and low risk of dependence. Some examples of Schedule IV drugs are: *Xanax* Soma Darvon Darvocet Valium Ativan Talwin Ambien Tramadol

Schedule IV and V

Low potential for abuse relative to other scheduled substances; currently accepted medical use in treatment in the US; use may lead to limited psychological or physical dependence

Amotivational syndrome

Marked by: -lack of motivation -Poor short term memory -Lethargy -Apathy towards future *Strictly anecdotal, no sig research to support

Only hallucinogen that causes physical dependence

PCP

Other psychedelics scheduled III

PCP

Schedule *Schedule V*

Lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes. Some examples of Schedule V drugs are: cough preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC) Lomotil Motofen Lyrica Parepectolin

Cannabis long term effects

Lung damage just as cigarettes, slow mental process

What synthetic narcotic "froze" addicts?

MPTP, a designer drug attempting to mirror Fentanyl and Demerol

II. Eval, Assessment: Standard 9: ASSESSMENT SECURITY

Maintain integrity, security of tests & assessments consistent w/ legal, contractual obligations

Ethical addiction professional based on Van Hoose and Paradise

Maintains personal and professional honesty; focuses on the best interests of the client; uses no malice nor receives personal gain; and justifies their actions based on the current standards of practice.

Client Relationship Principle of Ethical standards

Make sure the client has access to effective treatment, and that the integrity of the treatment relationship is safeguarded. Do not use the Client/Counselor relationship for personal gain or sexual behavior etc.

Documentation

Make sure to complete progress notes on each visit. These should include the personal account of the visit, and where the person is on the clinical course and treatment plan goal Progress Notes: DAP- data assessment plan or SOAP- subjective, objective assessment plan

Androgens

Male sex hormones

Crisis Counseling

Manage crisis- get caller name, address, phone number, family friends, assess if they are at risk

SAP *Who is a SAP?*

Mandated by DOT *evaluating the employee* and *recommending the most appropriate treatment *options to reestablish the employee's ability to work in a safety-sensitive position *SAP will then make a referral* to the appropriate treatment provider for the employee. Upon completion of treatment services, the SAP will be responsible for reviewing the employee's level of rehabilitation and make recommendations to the employer regarding the ability of the employee to return to the workplace and perform in a psychoactive-free manner. Works with the Medical Review Officer (MRO)

HIV infection and AIDs for chemically dependent individuals

Many people have fear of HIV and AIDS: Therefore counselors must learn ways to deal with this fear.

SAP *SAP Restrictions*

May not provide treatment or referral to an agency where the SAP has a ownership or financial compensation Unless the referral would have an undue hardship

Dual Disorders

Means the presence of two medical disorders that are independent but interactive. Treatment is characterized by treating one disorder followed by the second. Could involve two treatment programs.

Pharmacotherapies in treatment of substance abuse

Means using prescription drugs along with some form of therapy to treat substance abuse. Benzodiazepines and anti-seizure medicines are aids for this, and methadone for treatment of heroin.

Psychotropics

Medications designed to treat mental illness

Augmentor

Medications prescribed increased efficacy of a primary medication

Group Counseling *Typical - Common Growth Pattern*

Member Orientation Conflict Openness Closing Note: Not fixed but dynamic

Ethical principles of interpersonal relationships, remuneration, and societal obligations.

Members should be treated with courtesy, respect, fairness and good faith. Never counsel someone who already has a counselor. Co-operation with other professionals ethics committees is require unless confidentiality will be broken.

Dependent delusional system is a way a person protects the inner person from the realization of his dependency on drugs.

Memory and recall are one part, Denial is the second part of the system.

II. Eval, Assessment: Standard 7: DIAGNOSIS OF MENTAL HEALTH DISORDERS

Mental Health diagnoses will be performed only by those authorized: - by license or certification to conduct mental health assessments, - or by licensed/ certified addictions counselor w/ graduate level specific education on diagnosis of mental health disorder.

Methamphetamine

Mental alertness, increase in energy and body temperature, convulsions, violent behavior, anxiety, insomnia, paranoia, delusions and dependency

Synthetic narcotics

Methadone, Fentanyl, LAAM, Demerol to MPPP to MPTP

MAPA

Methamphetamine Anti-Proliferation Act of 2000

Stages of intoxication: Euphoria

Mild sociability; talkativeness Increased self-confidence; decreased inhibitions Diminution of attention, judgment and control Beginning of sensory-motor impairment Loss of efficiency in finer performance tests

Schedule III

Moderate or low physical dependence OR high psychological dependence. Moderate potential for abuse Has accepted medical uses and can be dispensed by authorized prescriber

Schedule *Schedule III*

Moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV. Some examples of Schedule III drugs are: Products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine) ketamine *anabolic steroids* testosterone

Time of onset: Snorting cocaine

Moderate within 10 minutes and short lived 45 minutes

Time of onset: snorting heroin

Moderate within 15 minutes and short lived 1 to 2 hours

Dialectical Behavior Therapy (DBT) *History and Original Intent*

Modified form of CBT originally designed to treat suicide patients who meet the diagnosis for *borderline personality disorder*.

MAOI's

Mono amine oxidase inhibitor's when taking must avoid meets, aged cheese, wine, chocolate etc. because it results in hypertensive crisis

Special Populations *Women*

More *sensitive* to ETOH than men For example, up to *7O%* of women with a substance use disorder have been physically or sexually abused during their lifetime Women treated in women-only treatment programs were *two times* more likely to complete treatment than women in mixed gender groups. Maintain a gender-responsive treatment environment across settings.

Opiate Narcotics Are usually thought of as pain killing drugs or analgesics.

Morphine and codeine are of a natural group, they come from the poppy plant. Heroin is chemically made from morphine. Talwin and Methadone are synthetic group.

Are barbs usually short or long acting?

Most are longer acting

Depressants Alcohol *Facts*

Most commonly used psychoactive substance in the world Effects every organ in the body except the ear Has dramatic effects and withdrawal

Lost Child

Most likely to commit suicide

Hydromorphone (Dilaudid)

Narcotic

Meperidine (Demerol)

Narcotic

Morphine

Narcotic

What are the two subdivisions of narcotics?

Natural and synthetic

Endogenous Opioids

Natural peptides that combat pain and stress

Endorphins and Enkephalins

Natural peptides throughout human body that combat pain and stress. Body's endogenous opiods.

Three forms of Narcotics

Naturally occurring, Semisynthetic and synthetic.

Addiction Counseling Practices *Treatment Plan Key Elements*

Need Goal Statement Measurable Objective Strategies and Interventions

Peripheral neuropathy

Nerve damage the Peripheral nerves

Mechanism of action for antidepressants

Neurotransmitters affected: -Serotonin -Dopamine -Epi -NE

What is the most common substance addiction?

Nicotine

What is nicotine's naturally occurring state?

Nicotine is a poisonous, oily liquid from the tobacco plant.

No Apparent Category for Individuals with Co-Occurring Mental Illness and Substance Abuse

No Apparent Category for Individuals with Co-Occurring Mental Illness and Substance Abuse

On Maintenance Therapy

On Maintenance Therapy

Reticular activating system

Part of CNS responsible for arousal (sleep/wake)

Basal ganglia

Part of CNS responsible for involuntary and fine motor skils

Limbic system

Part of CNS that regulates emotion

Hypothalamus

Part of brain that serves as the liaison between the ANS and the CNS

Cerebral cortex

Part of limbic system

Hypothalamus

Part of the limbic system: liaison between CNS & ANS

Syncope

Partial or complete loss of consciousness due to precipitous drop in blood pressure

Behavioral Therapy

Pavlov- Classical Conditioning (UCS = UCR, CS=CR) Skinner- Operant Conditioning behavior is reinforced and learned by the consequences of the bx Bandura- Social Learning. Bx is learned by observing the consequences of other's behavior Human behavior is learned and can be unlearned Applications: Contingency Management: rewards are given for period of abstinence (chips) Community Reinforcement: social circle reinforces healthy behavior Assertion Training: Ct learns skill to resist negative influences and bx in life Cue Exposure training: constantly exposed to triggers and cues covert sensitization: client imagines himself using and immediately visualized worst possible outcome. aversion therapy: use is paired with unpleasant feeling such as electric shock or nausea

Marijuana

Peaceful and euphoric sensation, slow reaction time, impairs memory and attention span, affects coordination and balance

DSM Axis 2

Personality Disorders

What drug is used by Native Americans in their religious rituals

Peyote, a cactus that contains the hallucinogenic substance mescaline, has been used for centuries in Indian religious ceremonies.

Safest barbiturate

Phenobarbital, due to its long-acting properties (12-24hrs). Often used to detox pts off other sedatives and barbs, since it is so long acting, and very tough to abuse.

Barbiturate Depressant -taken oral, Intravenous, or smoke.

Phentobarbital, short term effects are induced sleep, relax muscles,and calm anxiety. Long term, vomiting, constipation, high blood pressure, insomnia, confusion.

Therapeutic doses

Physical dependence on Benzodiazepines can occur with

Characteristics of physical, mental and personality, Social development of young adulthood and late adulthood

Physical health issues, Mental health issues, personality and social disorders.

X. Policy and Political Involvement Standard 1: Societal Obligations: 1. PURPOSE OF LAWS & REGULATIONS

Pro knows that Laws and regs exist for good ordering of society, and restraining harm, while reserving right to commit civil disobedience

Treatment planning process of client evaluation

Plan needs to reflect the most important points discovered in the assessment. Problem statement, goal statement, list of measurable objectives, should be realistic for the client.

What are "rebound effects"?

Polar opposite of effects of a psychoactive drug. Seen during withdrawal of many substances

Youth

Population most likely to us inhalants/sovents

Definitions *Short-Term Psychological Effects*

Possible signs and symptoms exhibited by the individual's perceptions and senses shortly after the psychoactive substance is consumed

PAWS

Post-acute withdrawal Syndrome can occur as far as 8-12 months after last use.

Most common long-term side-effect of LSD use

Post-hallucinogenic perceptual disorder -Subject had disturbances and flashbacks that last a few seconds -Can occur years after last LSD use

Effect of taking Intravenous cocaine and heroin

Potent and strong

Effect: smoking cocaine and heroin

Potent/strong

Serotonin syndrome

Potentially life-threatening drug reaction that most often occurs when two serotonin influencing drugs are taken together causing too much serotonin to be released or remain in the brain

Addiction Counseling Practices *Global Assessment of Functioning (GAF)*

Pre DSM5 for accessing for Axis V

I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #2 of 11: info re: TX effectiveness

Pro must provide accurate info on efficacy of TX, and referral options available

I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #1 of 11: Complete disclosure

Pro must provide complete, accurate info re: extent of relationship, including Code of Ethics, & documentation re: professional loyalties & responsibilitoies

Stages of Change

Precontemplation, Contemplation, Preparation, Action, Maintenance, Relapse not considering treatment- casually considering treatment- makes decision to change- begins change- continued commitment- return to problem behavior

pharmacotherapies is based on.

Prescription drugs can be used to detox, stabilize and maintain people with substance abuse addictions.

Phases of Recovery

Pretreatment, Initial Stabilization, Early Phase I, Early Phase II, Middle Phase, Advanced Phase

Ct Family and Community Ed

Prevention & Education

Co-Occurring Disorder Primary versus Secondary Diagnosis

Primary diag is the disorder the appeared first in a client's life, secondary appeared second.

VI. Workplace Standards Working Environment: 3. MAINTENANCE OF WORK AREAS

Private work areas that ensure confidentiality must be maintained.

IV. Prof Responsibility: Standard 2: Legal & Ethical Standards: OVERVIEW

Pro - will uphold legal & ethical standards of profession - will be fully cognizant of fall federal laws and state laws that govern practice of substance abuse counseling - will uphold letter of law and Code + espouse aspirational ethical standards such as autonomy, beneficence, non-malfeasance, justice, fidelity and veracity

IV. Prof Responsibility: Standard 3: Records and Data: 1. RECORDS MANAGEMENT

Pro creates, maintains, disseminates, stores, retains & disposes of records related to research, practice, payments and other work in accordance to legal standards and in ways that satisfies ethical standards established

I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #10 of 11: client self-sufficiency

Pro encourages self-sufficiency of clients in making daily choices related to recovery & self-care

IV. Prof Responsibility: Standard 1: Counselor Attributes: 8. LIFE-LONG LEARNING

Pro have a life-long commitment to seek out new, effective approaches to enhance prof abilities & expand skills ot better serve clients

X. Policy and Political Involvement Standard 2: Public participation OVERVIEW

Pro is strongly encouraged to actively participate in community activities designed to shape policies & institutions that impact on substance use disorders. - Pros will provide appropriate services in public emergencies to greatest extent possible

X. Policy and Political Involvement Standard 1: Societal Obligations: OVERVIEW

Pro is strongly encouraged to engage in legislative processes, education institutions and general public to change public policy & legislation to make possible opportunities & choice of service for everyone of any ethnic or social background whose lives are impaired by alcoholism & drug abuse.

X. Policy and Political Involvement Standard 3: Social and Political Action OVERVIEW

Pro is strongly encouraged to understand that commitments and relationships create network of rights & corresponding duties. -Pro will work to safeguard the natural and consensual rights of each individual in their community. - Pro will not impose their social or political views on individuals with whom they work professionally.

VI. Workplace Standards 1. LIMITS OF COMPETENCY & SERVICE

Pro knows his/her limits of competencies & doesn't offer services outside her own prof competency

VI. Workplace Standards 2. IMPACT OF IMPAIRMENT

Pro knows impact of impairment on performance, and will seek appropriate TX for oneself & colleague as appropriate

IV. Prof Responsibility: Standard 1: Counselor Attributes: 4. ACCURATE PRACTICES...

Pro practices honesty & congruency in accurate: - billing for services - accounting of expenses - faithful, accurate reporting of interactions w/ clients - reporting of prof activities.

IX. Communication and Published Works 2. CREDITING OTHERS' CONTRIBUTION

Pro recognizes contributions of other persons to their written documents

IV. Prof Responsibility: Standard 4: Interprofessional Relationships: 2. Cooperation with ethics committees

Pro shall cooperate with duly constituted professional ethics committees and provide necessary info except when constrained by confidentiality requirements

IV. Prof Responsibility: Standard 4: Interprofessional Relationships: 1. Clients seeing multiple counselors

Pro shall refrain from offering prof services to client in counseling with another professional, except with knowledge of the other professional OR after termination of service with other Pro

IV. Prof Responsibility: Standard 2: Legal & Ethical Standards: 3. STRIVING FOR BEST INFO

Pro strives for better understanding of substance use disorders, refusing to accept supposition & prejudice as if it were the truth

IX. Communication and Published Works -ADHERENCE TO COPYRIGHT

Pro submitting works for publication or in handouts, must be aware of and adhere to copyright laws.

X. Policy and Political Involvement Standard 1: Societal Obligations: 3. DETERMINING AN UNJUST LAW

Pro understands that determining that a law or regulation is unjust requires rational investigation, deliberation and dispute, and being willing to accept a penalty for justified civil disobedience.

II. Eval, Assessment: Standard 1: SCOPE OF COMPETENCY

Pro uses assessment instruments for which they are adequately trained to administer & interpret

IX. Communication and Published Works 4. CONFIDENTIALITY & PROPRIETARY RIGHTS

Pro who reviews material submitted for publication, research or scholarly purposes must respect confidentiality and proprietary rights of authors

I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #11 of 11: Respecting clients Personal beliefs

Pro will avoid action that imposes on other's acceptance of their religious/spiritual, political and other personal beliefs, while encouraging participation in recovery support groups

IV. Prof Responsibility: Standard 2: Legal & Ethical Standards: 5. SERVICES MUST MEET ETHICAL STANDARDS

Pro will ensure that services and products provided to clients meet the ethical standards of this code

III. Confidentiality: 7. limits of confidentiality

Pro will inform client of limits of confidentiality PRIOR to recording an interview, or prior to using info from session for training purposes

IV. Prof Responsibility: Standard 2: Legal & Ethical Standards: 7. INSURANCE

Pro will maintain appropriate property, life and malpractice insurance policies to serve to protect personal and agency assets

IV. Prof Responsibility: Standard 1: Counselor Attributes: 1. RESPECT INSTITUTIONAL POLICIES

Pro will maintain respect for institutional policies & management functions in their agencies - Will take initiative to improve policies when it serves interests of clients

IV. Prof Responsibility: Standard 2: Legal & Ethical Standards: 6. PERSONAL SUPPORT

Pro will maintain support system outside of work to ensure well-being and personal growth, as well as continued development in professional setting

I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #5 of 11: Past romantic involvements

Pro will not accept client with whom they've engaged in romantic or sexual relationships.

I. Counseling relationship: Standard #5: PREVENTING HARM: #1 of 7: Coersive methods

Pro will refrain from methods considered coercive, e.g.: threats, negative labeling, attempts to provoke shame or humiliation

IV. Prof Responsibility: Standard 3: Records and Data: 6. CONFIDENTIALITY OF ELECTRONICALLY SHARED DATA

Pro will take steps to ensure confidentiality of electronic data and transmission of data to other entities

I. Counseling relationship: Standard #5: PREVENTING HARM: #4 of 7: When client not benefiting...

Pro will terminate counseling relationship when its reasonably clear that client isn't benefiting from exchange

I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #3 of 11: termination of service

Pro will terminate services when no longer required or in client's best interest

IV. Prof Responsibility: Standard 4: Interprofessional Relationships: OVERVIEW

Pro will treat colleagues with respect, courtesy, fairness, and good faith

IV. Prof Responsibility: Standard 1: Counselor Attributes: 6. CONFLICTS OF PRIORITIES

Pro will try to maintain balance btn prof and personal priorities, when conflicts arise. - Pro will communicate appropriately and take action to balance priorities such that professional duties are able to continue to flow effectively.

Action Responses

Probing/Questioning, Confrontation, interpretation

Reverse Tolerance

Process by which eventual liver damage from chronic ETOH consumption result in decreased ability to metabolize ETOH, resulting in severe intoxication from even small doses of the substance

Detoxification

Process of eliminating all psychoactive substances from the body

Self referral process

Provides help for the professional to get help for addictive behavior.

Controlled Substance

Psychoactive substance with abuse liability that are placed under restricted use by DEA

What is a Narcotic?

Psychoactive substances derived from the opium poppy, or synthetically derived as opiod agonist

Psychoanalytic Therapy

Psychoanalysis was founded by Sigmund Freud (1856-1939). Freud believed that people could be cured by making conscious their unconscious thoughts and motivations, thus gaining "insight"

Sigmund Freud

Psychoanalytic Therapy

Transference is a key concept in What?

Psychoanalytic therapy

Which of the following problems does long term cocaine users sometimes experience.

Psychosis

DSM Axis 4

Psychosocial and Environmental Problems

detox

Quiet room with little to no stimulation

Albert Ellis

Rational Emotive Behavior Therapy. [REBT]

William Glasser

Reality Therapy

Federal Controlled Substance Act

Record keeping for Programs. Documentation monitoring, All mandatory information on forms, Dosage. Maintain records for two years and kept confidential.

Levels of Psychoactive Substance Use

Recreational- Circumstantial-Intensified Use- cCompulsive Use

NAADAC Decision Making Model step eight

Reflect on the outcome of the course of action

SAP *What happens if individual refuses?*

Refusal is considered the same as a positive

Principles *Principle 3: Client Relationship* *What happens if the client is highly intoxicated during intake?*

Regardless if they are in crisis or intoxicated, if they are not able to function at normal mental capacity, the informed consent process should be reviewed again when they are back at baseline.

Steps in regulations by the CSA

Registration, Record keeping and Reporting, and Distribution

A post session technique in group therapy does what?

Reinforces insights

Eight referral elements used.

Relationship, re-evaluation, client self referral, Meet client needs, have an clear explanation for referral, referral information exchange from other agency, Confidentiality, effectiveness of the referral.

GHB & Rohypnol

Relaxing effect, muscle growth, seizures, loss of consciousness, death, coma

Paraphrasing involves what?

Repetition, involves repeating back to the patient what was said, in a more concise manner and in the counselor words.

Elderly and alcohol use

Research states that between 2 and 10% of persons 65 or older are addicted to alcohol. And 1 out of 5 are treated for medical or psychiatric problems also have alcohol problems.

In counseling reflection usually involves.....

Responding to feelings, by carefully listening to what a patient says and determining what feelings are likely present and then giving feedback on those feelings.

Akathisia

Restlessness-for mild anxiety to difficult lying or sitting still to insomnia: often an extrapyraMidal side effects produced by neuroleptic drugs

MOA for Campral

Restores chemical balance caused by withdrawal, and has been shown to reduce incidence of relapse and cravings if subject is abstinent prior to treatment

CNS is made of

Reticular Activating System: Awake/Asleep Limbic System: feelings Basal Ganglia: fine motor skills

NAADAC Decision Making Model step two

Review the NAADAC Code of Ethics to determine which principles are applicable

Which of the following is NOT one of the basic principles of ethics?

Right to Privacy

Hypnotic

Soporific or sleep inducing

Principles *Principle 4: Trustworthiness* *What is Obedience?*

Role Modeling Inherent in the role of assisting others in living a more responsible life, an addiction professional must acknowledge his or her ethical responsibility of living a life that is more than ordinarily responsible

Heroin

Rush of pleasure, severe drowsiness, nausea, vomiting, severe itching

Infectious Diseases *Hep B - Important note*

SInce Hep B impacts the liver, drinking makes it worse Hep B is treatable and curable

Family Systems Counseling

SUD person has an enabler (provides responsibility), a hero (provides self worth), scapegoat (provides focus), lost child (provides relief) and a mascot (provides distraction)

What is the highest (most restricted) drug schedule?

Schedule I

What drug schedule is cocaine on?

Schedule II

Difference in Schedule IV and V

Schedule IV has lower risks of abuse than Schedule I to III and Schedule V has even less risk than IV

What is the lowest drug schedule?

Schedule V

What can PCP high resemble?

Schizophrenia or Alzheimer's

Factors to determine which schedule a drug or OS should be placed or decontrolled or rescheduled /2

Scientific evidence of the drug's pharmacological effect, if known

II. Eval, Assessment: Standard 3: SCREENING:

Screening = - formal process of identifying individuals w/ particular issues / needs or those at risk for developing problems in certain areas, - used to determine if further assessment is warranted

Screening v Assessments

Screening tools are brief and determine basic information, assessment goes further into the meat of things.

Withdrawal peak for short acting barbs

Second or third day

Withdrawal peak for long-acting barbs

Second or third week!

Parasymphathetic Nervous System

Secondary within the ANS- when activated decreases breathing, heart rate, etc.

Neurotransmitters *Monoamines (e.g., catecholamines)* *Serotonin*

Serotonin helps control mood stability, including depression and anxiety, appetite, sleep, and sexual activity MDMA (ecstasy) forces the release of this neurotransmitter. Many antidepressant drugs, including fluoxetine (Prozac®) and paroxetine (Paxil®), are *aimed at increasing the amount of serotonin in the synaptic gaps by blocking their reabsorption, thus elevating mood.*

SNRI's

Serotonin norepinephrine reuptake inhibitor's; block of sourcing of norepinephrine and serotonin to relieve depression; has fewer side effects then TCAs and more withdrawal symptoms then SSRIs

What does PCP resemble in small doses?

Sedative intoxication

Greatest risk associated with CNS detox and withdrawal

Seizures

Adolescent egocentrism

Self -centeredness based on the concern about what others think

Self medication most closely refers to?

Self administering drugs with therapeutic intent

Counselor/ Client relationship

Self disclosure, transference (when client projects onto the professional their thoughts on others), countertransference (when the counselor projects onto the client their own feelings and attitudes )

SDAT

Senile dementia Alzheimer's type

Components of peripheral nervous system

Sensory pathways and motor pathways

Confidentiality laws and regulations

Signed Consent forms must be completed before any information can be shared.

Cross Dependence

Similar drugs substituting for each other within the body and preventing withdrawal or two drugs preserving the state of physical dependence.

Anandamide

Similar to aceylcholine. *Memory, New Learning specific, calmness, controlling movement *Affected by THC

Somnambulism

Sleepwalking

Bradycardia

Slow heartbeat

Bradyphrenia

Slowness of thought

Depressants Alcohol *What does consuming water with alcohol do?*

Slows down absorption

Where is ETOH absorbed the most?

Small intestine (duodenum)

Step Eleven

Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out. requires you to commit to some kind of spiritual practice. That practice could be anything from prayer, to meditation, to reading scripture. https://www.recovery.org/topics/alcoholics-anonymous-12-step/

Hyperkinesia

Spastic movement and hyperactivity

Depressants Alcohol *What does consuming carbonated drinks with alcohol do?*

Speed absorption

Styles of steroid use

Stacking: Taking multiple types of steroids at once Cycling: Taking one type at a time, in sequence, over a set period of time

Alcohol Withdrawal

Stage 1: Tremors 24-36 hr after last drink, irritability, nausea, vomiting, slurred speech, jitters, tremors. 90% of alcohol dependent people experience Stage 2: Hallucinations distorted perceptions occur in 25% Stage 3: Wdrawal Seizures Grand Mal, 7-48hr after last drink, peak is 13-24 hr. 1/3 of clients experience Stage 4: DT Confusion, delusions, hallucinations, severe agitation, tachycardia, dilated pupil, fever, 3-5 days after drinking, 15% fatality rate. Lasts 72 hours or less in 80%

Definitions *Ethics*

Standards that govern the conduct of a person to decide the difference between right and wrong

Intervention Models *Arise Intervention Model*

Stands for *A* *R*elational *S*equence for *E*ngagement Three stages - Invitational Intervention Uses a Transitional Family Therapy approach Again, family focused for healing ARISE interventions begin with the least demanding option, increasing the effort only if the individual is not engaged at that lesser level.

Consider the potential consequence of all options and choose a course of action

Step five of Forester-Miller and Davis model for ethical decision making

Generate potential courses of action

Step four of Forester-Miller and Davis model for ethical decision making

Evaluate the long-term effects of your choices on your client

Step four of McGuire model for ethical decision making

Identify the problem

Step one of Forester-Miller and Davis model for ethical decision making

Review your code of ethics and legal mandates

Step one of McGuire model for ethical decision making

Whose interests are involved and who can be harmed?

Step one of White model for ethical decision making

Implement the course of action

Step seven of Forester-Miller and Davis model for ethical decision making

Evaluate the selected action

Step six of Forester-Miller and Davis model for ethical decision making

Determine the nature of the dilemma

Step three of Forester-Miller and Davis model for ethical decision making

Determine the values and motives involved

Step three of McGuire model for ethical decision making

What standards of law or professional propriety apply to this situation?

Step three of White model for ethical decision making

Apply the appropriate code of ethics

Step two of Forester-Miller and Davis model for ethical decision making

Seek input from a second party

Step two of McGuire model for ethical decision making

How could the application of various universal values shed light on the appropriate action to be taken in the situation?

Step two of White model for ethical decision making

Nicotine

Stimulant or sedative, addiction

Nicotine, amphetamines, and cocaine are types of what drug?

Stimulants

Relationship between stress and substance abuse

Stress is a natural occurrence in life for all people, it can cause relapse for substance abuse users.

VII: Supervision & Consultation: 2. REQUIRED EDUCATION

Supervisors must complete required education & training specific to clinical and/or administrative supervision. - Pros who supervise counselors in training shall ensure that counselors-in-training adhere to policies regarding client care

VII: Supervision & Consultation: 8. ACCESSIBILITY TO SUPERVISEES

Supervisors shall establish, communicate ways supervisees can contact them, or in their absence provide alternative on-call supervisors

BAC 0.18 to 0.40

Stupor

What 3 drugs have buprenorphine as their base?

Suboxone, Buprenex, and Subutex

Illicit psychoactive substance

Substance that is illegally obtained

Licit psychoactive substance

Substance that is legally obtained

designer psychoactive substances

Substances specifically invented with a different molecular formula to evade law inforcement

Designer drugs

Substances with a slightly altered chemical makeup, designed in a laboratory, with the intent or circumventing the law

Classical conditioning

Substituting a stimulus which brings about the same result

Suicide Intervention *Facts*

Suicide is 20x higher for SUD clients

Which of these are not a common personality characteristic of counseling?

Superior intellect

VII: Supervision & Consultation: 6. SUPERVISION MEETINGS

Supervision meetings are conducted at regular intervals and documentation is maintained for each meeting

VII: Supervision & Consultation: 5. SUPERVISION OF FRIENDS/ RELATIVES

Supervision of relatives, romantic partners or friends is prohibited

VII: Supervision & Consultation: 4. PERSONAL RELATIONSHIPS PERMITTED

Supervisors are prohibited in having sexual, romantic or personal relationships with current supervisees

VII: Supervision & Consultation: 3. DEFINING PRO RELATIONSHIPS

Supervisors will define & maintain ethical, professional, personal and social relationships with supervisees. -If other prof roles are assumed, standards must be established to minimize potential conflicts

VII: Supervision & Consultation: 9. TRANSFERENCE & COUNTER-TRANSFERENCE

Supervisors will help identify counter-transference and transference issues - referrals will be provided when supervisee needs to address issues related to prof work or personal challenges.

Infectious Diseases *Hep B*

Symptoms last a few weeks, rarely fatal lt has been estimated that complications of cirrhosis and liver cancer will result in the death of 15 to 25% of those with chronic hepatitis B. Many do not show symptoms, but may develop cirrhosis and liver cancer

Narcotic Therapeutic Communities

Synanon and Narcotics Anonymous

Potentiation

Synergistic effect of two or more psychoactive substances taken together, where the net effect is greater than the sum of its pharmacological parts. Especially potent with CNS depressants

CNS Stimulant chemical and trade name

Synthetic Amphetamines, Cocaine, Nicotine

Opiods

Synthetic Opiates: Fentanyl, Lorcet,Lortab, Talwin, Dolophine, Pentazocine, Darvon,

Schedule drugs

System from 1970 controlled substances act which classifies drugs at the five categories by their potential for abuse in which requires very levels of documentation for their prescription

Neurotransmitters *Misc* *Anandamide and Endocannabinoid*

THC in marijuana has an affinity for anandamide receptor sites These endocannabinoids activate two receptor sites in the body—CB1 and CB2— which are found in a wide variety of locations within and outside the central nervous system. In the CNS the receptors are in the limbic system and in the areas responsible for the integration of sensory experiences with emotions (often associated with a sense of novelty) as well as those controlling learning, motor coordination, and memory. Endocannabinoids can act as an analgesic or a pain reliever. There are many more cannabinoid receptors in the brain than there are opioid receptors.

Family System

THe unique interaction and relationship of each family member to one another

I. Counseling relationship: Standard #5: PREVENTING HARM: #2 of 7: Treatment planning

TX Plan is developed through negotiation with client, with client's input re: identified issues/ need, goals of treatment, means of reaching TX goals

THC stands for

Tetrahydrocannabinol

Factors to determine which schedule a drug or OS should be placed or decontrolled or rescheduled /7

Th drugs psychic or physiological dependence liability

What are the 2 main divisions of nervous system?

The CNS and PNS

Schedule review step five

The DEA conducts its own review, with the HHS's determination in mind, and sets the final schedule.

Schedule review step two

The DEA requests HHS to review the medical and scientific evidence regarding a drug's schedule.

Schedule review step one

The DEA, US Department of Health and Human Services, or public petition initiate a review.

Stages of withdrawals from CNS depressants

The Shakes, Hallucinations, Seizures, Delirium Tremens [DT]

What drug family is caffeine a part of?

The Xanthines

Deductive reasoning

The ability to solve problems by working from a given situation to a conclusion.

Inductive reasoning

The ability to solve problems by working from a specific experience to a conclusion.

Half- Life

The amount of time it takes to eliminate 1/2 of the original dosage from the body

Competence principle of ethical standards

The counselor need to continue their education so that they can provide the very best professional competency. Counselor should be able to treat several types of disorders.

Potentiation

The danger f adding one central nervous system depressan to another is that the toxic effects are magnified by the process of

What does the reliability of a drug means to a user?

The drug being what the user intended it to be upon purchase.

Indicator that a drug or other substance (OS) has a potential for abuse

The drug is a new drug related in its action to a drug or OS already listed as having a potential for abuse

Factors to determine which schedule a drug or OS should be placed or decontrolled or rescheduled /1

The drug's actual or relative potential for abuse.

What is the only organ not affected by alcohol?

The ear

Neurotransmitters *Misc* *Acetylcholine*

The first neurotransmitter discovered (in 1914), is mostly active at nerve/muscle junctions (e.g., cardiac inhibition and vasodilation). Helps induce REM sleep and modulate mental acuity, memory, and learning.

Addiction Counseling Practices *Screening*

The first phase of evaluation where the potential client is briefly interviewed to determine if he or she is appropriate for that specific facility

NAADAC Ethical Model *What is identify and define the problem mean?*

The first step in a decision making model is to clearly identify and define the problem at hand. It is important to distinguish whether or not there is an ethical concern.

Where is nicotine metabolized?

The liver

Behavior Modification Theory

The idea that all behavior is learned, and what is learned can be unlearned.

Abuse liability

The level of risk associated with a psychoactive substance that potentially leads to repeated use and/or dependence

Group Counseling *Main Purpose*

The main purpose of group counseling is to use the resources and experiences of a group to learn new behaviors and recognize, confront, correctly label, appropriately express and deal with a client's denial and unpleasant feelings about his or her addiction

Principles *Principle 3: Client Relationship* *What is professional loyalty?*

The maintaining of the client/counselor therapeutic relationship by the counselor Since the client/counselor therapeutic relationship exists only for the purpose of providing treatment, it is the ethical responsibility of the counselor to communicate to the client the nature of the professional relationship and any conflicts of interests that might interfere with treatment.

Interested Parties

The manufacturer of a drug, medical society or association, pharmacy association, public interest group concerned with drug abuse, state or local government agency, or individual citizens.

In a normal curve

The mean, median, and mode are at the same point

NAADAC Ethical Model *What does Consider any potential legal concerns and identify if consultation with an attorney is needed mean?*

The need for legal counsel will most often arise in situations where the client is involved in the legal system and subpoenas or court orders have been issued

Definitions *Short-Term Physiological Effects*

The possible signs and symptoms exhibited by the individual's body shortly after the psychoactive substance is consumed.

Screening process

The primary goal is to determine if the client is right for the program and services that it provide.

Definitions *Mechanism of Action*

The process and interactions that take place inside the individual's body and brain to create the desired effects or resulting side effects of the psychoactive substance.

Relapse Prevention

The process of knowing the signs and developing a plan to prevent the return to drug use after a period of abstinence.

Depressants Alcohol *How is it eliminated from the body?*

The remaining 90% to 98% of alcohol is neutralized through metabolism (mainly oxidation) by the liver and then by *excretion through the kidneys and the lungs.* (Inaba, 08/2014, p. 229) Inaba, D. S., Cohen, W. E. (08/2014). Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs, 8th Edition [VitalSource Bookshelf version]. Retrieved from https://bookshelf.vitalsource.com/books/9780926544406

In which stage does family members take on the responsibility of the substance abuse user?

The reorganization stage

Considerations in making ethical decisions: LOYALTY

The responsibility to not abandon those with whom you work.

Considerations in making ethical decisions: OBEDIENCE:

The responsibility to observe and obey legal and ethical directives

What is OBEDIENCE?

The responsibility to observe and obey legal and ethical directives which govern individuals and the profession; addiction professionals apply this principle ethic by following licensure and certification regulations, agency policies and legal mandates.

Considerations in making ethical decisions: CONSCIENTIOUS REFUSAL

The responsibility to refuse to carry out directives that are illegal and/or unethical

What is CONSCIENTIOUS REFUSAL?

The responsibility to refuse to carry out directives that are illegal and/or unethical

Relapse

The return to the use of the substance *usually preceded by clear signs *begins much earlier than actual use *Usually due to lack of skills *Often a reflexive and unconscious matter *opportunity to learn from mistakes and alter the plan Identify triggers!!!

Factors to determine which schedule a drug or OS should be placed or decontrolled or rescheduled /5

The scope, duration, and significance of abuse

Addiction Counseling Practices *Assessment*

The second phase of evaluation where the client is interviewed extensively to determine the most effective treatment plan after he or she is admitted into the treatment program. *Assessment of the client's history, experiences and mental status*

Factors to determine which schedule a drug or OS should be placed or decontrolled or rescheduled /3

The state of current scientific knowledge regarding the substance

id, ego, and Super Ego

The unconscious drives, The internalized outside world and, Takes the forces of conflict results in creating a defense mechanisms such as denial.

Medication Assisted Treatment *Basis*

The use of prescriptions to assist and support a client's ongoing counseling and recovery

Principles of the Behavioral Modification theory

There are three principles, Causes, Maintenance and change of behavior. Classical conditioning, Operant conditioning, Modeling is the most effective.

Principles *Principle 4: Trustworthiness* *When can Copyright Materials be used?*

There is an exception under copyright law that allow for copying such material for educational purposes only and in limited quantities. However, materials can never be reproduced for profit, regardless of the educational purpose.

Indicator that a drug or other substance (OS) has a potential for abuse

There is significant diversion of the drug or OS from legitimate drug channels

Important points about central nervous system depressants

They are used as sedative-hypnotics. Are used for psychoactive chemicals in medicine. Withdrawal symptoms are anxiety, shaking, agitation restlessness, and sweating.

Behavior Therapy *Operant Conditioning*

Think BF Skinner and his little girl, where behavior is reinforced and learned based on the consequences of the behavior.

Behavior Therapy *Social Learning Approach*

Think the post toasties cereal joke - A method of behavior therapy developed by Albert Bandura where *behavior is learned by observing the consequences of someone else's experience.*

Sustained Partial Remission

This specifier is used if full criteria for Dependence have not been met for a period of 12 months or longer; however, one or more criteria for Dependence or Abuse have been met.

Sustained Full Remission

This specifier is used if none of the criteria for Dependence or Abuse have been met at any time during a period of 12 months or longer.

Early Partial Remission:

This specifier is used if, for at least 1 month, but less than 12 months, one or more criteria for Dependence or Abuse have been met (but the full criteria for Dependence have not been met)

Method of Administration *Orally*

Through the mouth and per the old study module one on page 17, this could include smoking

Method of Administration *Nasally*

Through the nose and is typically longer acting

Method of Administration *Rectally*

Through the rectum

When a drug is ingested orally how does it enter the bloodstream?

Through the stomach or small intestines

Depressants Alcohol *What is typically used for Alcohol detox?*

To alleviate some of the discomfort and possibly prevent development of severe withdrawal, medical personnel can sedate the client using medication, such as *benzodiazepines* Clonidine and beta-blocking medications may help decrease symptoms of tremor, fast heart rate and hypertension.

Considerations in making ethical decisions: AUTONOMY =

To allow others the freedom to choose their own destiny

What is AUTONOMY?

To allow others the freedom/independence to choose their own destiny; self-determination; addiction professionals practice this principle ethic by respecting clients' values, facilitating clients' independence and supporting clients' rights to make choices about their own life.

Considerations in making ethical decisions: FIDELITY

To be true to your word, keeping promises and commitments

what is FIDELITY?

To be true to your word, keeping promises and commitments, honest; addiction professionals promote this principle ethic by being trustworthy with clients and the general public, as well as following through with commitments to clients and others.

I. Counseling relationship: Standard #4: GROUP STANDARDS: #2 of 2: Matching client to group

To degree possible, Pro will match clients to group to meet similar needs/goals.

Considerations in making ethical decisions: BENEFICENCE:

To help others

what is BENEFICENCE?

To help others; the obligation to do good; addiction professionals apply this principle ethic through their commitment to helping others and by promoting what is in the best interest of the client

Considerations in making ethical decisions: GRATITUDE:

To pass along the good that we receive to others

what is GRATITUDE?

To pass along the good that we receive to others

Considerations in making ethical decisions: COMPETENCE:

To possess the necessary skills and knowledge to treat the clientele in a chosen discipline and to remain current with the treatment modalities, theories and techniques.

what is COMPETENCE?

To possess the necessary skills and knowledge to treat the clientele in a chosen discipline and to remain current with the treatment modalities, theories and techniques. addiction professionals practice this virtue ethic when they pursue appropriate credentials, training, experience and supervision and operate within their scope of practice

Considerations in making ethical decisions: SELF-INTEREST:

To protect yourself and your personal interests

what is SELF-INTEREST?

To protect yourself and your personal interests

Adlerian Psychology (Therapy) *Phenomenology*.

To use Adlerian therapy effectively, an addiction counselor or other helping professional must attempt to view the world from the perspective of the client through a process called *phenomenology.* ln other words, the client can only be understood in terms of his or her family, social and cultural contexts, perceptions and private loqic.

What is barbiturates

Tranquillizers that are types of prescription drugs that are used for anxiety and sleep problems. It decreases in brain activity, which causes feelings of drowsiness and calmness. It also results in a decrease in heart rate and blood pressure.

Lithium is use primarily to

Treat bipolar disorder

Multimodality

Treatment that is a combination of several methods

When withdrawing from short-acting barbiturates, which withdrawal symptoms are observable at both 8-12 hours and 2-3 days of abstinence?

Tremulousness and insomnia

Proof

Twice the percentage of alcohol by concentration

How is it used medically?

Typically used by ear, nose, and throat specialists (ENT), as well as in ophthalmology and urology, due to its anesthetic and vasoconstrictive properties. -Anesthetizing -Vasoconstrictive -Limits blood flow to surgical areas

Unique characteristics of amphetamine metabolism

Unlike most other drugs, amphetamines are not metabolized by the liver, but rather are excreted in urine unchanged, and can have a half-life of more than ten hours.

Pathological Intoxication

Unusual reaction to depressants. The person becomes agitated and belligerent after only small doses

Enuresis

Urine incontinence

Considerations in making ethical decisions: DISCRETION:

Use of good judgement, honoring confidentiality and the privacy of others

what is DISCRETION?

Use of good judgement, honoring confidentiality valuing the right to privacy; addiction professionals promote this virtue ethic by following confidentiality guidelines and privileged communication laws relating to their clients.

How is PCP used?

Used in "runs", similar to meth

Intensified drug use

Using everyday but in low amounts to help alleviate some problems or to boost levels of performance.

Definitions *Religious Ethics*

Using religious beliefs, such as the belief in divine love or the will of God, as the basis of ethical decisions

Alcohol and cocaine are often combined

VERY dangerous. Produces cocaethylene

Ballosmus

Violent flinging movement of one or more limbs or body parts

Photophobia

Visual hypersensitivity to light

Emesis

Vomiting

Infectious Diseases *Hep B - How to prevent it*

Wash hands after restroom use and before making meals Use a condom Not sharing needles, razors and toothbrushes

Ethics

a major branch of philosophy, encompassing right conduct and good life

Most attractive medical use of amphetamines for clients

Weight loss

Step Six

Were entirely ready to have God remove all these defects of character. The alcoholic admits that they are ready to have their higher power remove the wrongs they listed in Step 4. https://www.recovery.org/topics/alcoholics-anonymous-12-step/

Solution-Focused Therapy *Basis*

What is possible in developing solutions, rather than attempting to understand the problem.

Factors to determine which schedule a drug or OS should be placed or decontrolled or rescheduled /6

What, if any, risk there is to the public health

VIII: Resolving Ethical Issues 2. KNOWLEDGE OF PRO ACTING UNETHICALLY

When Pro has knowledge of another counselor acting in unethical manner, they are OBLIGED TO TAKE ACTION based on this code of ethics, their state ethics committee and National Certification Commission.

Family Systems and addiction counseling

When a person uses drugs the whole family is affected.

Professional issues and Self Referral Process

When a professional is using substances, use the process to get help for their behavior.

Plateauing

When anabolic steroid users develop tolerance to effects of steroids

I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #7 of 11: when Dual Relationships are inevitable

When dual relationships are inevitable (e.g.: in rural areas), pro will take steps to distinguish counseling relationship with other interactions.

VIII: Resolving Ethical Issues 3. INFORMAL VS FORMAL RESOLUTION

When ethical dilemma involving person not following ethical standards cannot be resolved INFORMALLY, the matter shall be referred to state ethics committee and National Certification Commission

VIII: Resolving Ethical Issues 1. CONFLICT BTN LAW & ETHICAL RESPONSIBILITIES

When ethical responsibilities conflict with law or regulations, Pro shall take steps to resolve issues through consultation & supervision

Poly-chemical abuse

When more than one psychoactive chemical is used at a time.

Considerations in making ethical decisions: RESTITUTION

When necessary, make amends to those who have been harmed or injured

what is RESTITUTION?

When necessary, make amends to those who have been harmed or injured

V. Working in a Culturally Diverse World: MAKING ACCOMMODATIONS:

When needed, accommodations will be made for clients with challenges including physical, mental, educational, or those experience emotional difficulties, or language differences

I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #8 of 11: When Pro is working in other capacity

When pro works for dept of corrections, military, an HMO, or client's employer: obligations to external organizations/ individuals will be disclosed prior to delivering service

VII: Supervision & Consultation: 1. ADEQUATE MATERIALS & LANGUAGE

When providing consulting, Pros will provide appropriate resources to others, and use clear understandable language to all parties to clarify the purpose and expectations of the consultation

Which of the best routes of administration of drugs gives the longest lasting effects?

When taken orally.

Interesting aspect of amphetamine dependence and withdrawal

Withdrawal symptoms are not a good indicator of dependency, as they can occur, even after a single use of the drug

Limbic system

Within the CNS, Controls Emotions

Reticular Activating System

Within the CNS, responsible for the state of arousal

Basal Ganglia

Within the CNS: responsible for involuntary and fine motor skills

Defining patient goal takes place during which point in counseling?

Within the assessment stage.

Factors to determine which schedule a drug or OS should be placed or decontrolled or rescheduled /8

Whether the substance is on immediate precursor of a substance already controlled

Drug Enforcement Administration (DEA), Department of Health and Human Services (HHS), or by petition from any interested party

Who has the ability to initiate proceedings to add, delete, or change the schedule of a drug or other substances

What are the approved medical uses for hallucinogens?

With the exception of PCP, hallucinogens have no approved use in general medicine.

Does more death occur from barb O.D. or withdrawal?

Withdrawal results in most deaths

Men and women differ in relapse

Women do not have relapse frequently as men do. Women are more prone to take group therapy. Women are more willing to seek treatment.

Benzodiazepine depressants

Xanax, Clonazepam, Diazepam, Short term effects include anti-anxiety and sedative effects.

Caffiene

Xanthines: naturally occurring stimulants. includes caffeine, theophylline (tea) and theobromine (chocolate)

In the event that a patient is a wildly striking people in the facility, are you allowed to physically restrain him?

Yes he is a danger to himself and others.

You are ask to fill in with a patient while another counselor is away. Should you accept this request?

Yes, depending on the circumstances.

Are solvents and inhalants legal?

Yes, nearly all are, except for butyl nitrite.

How does LSD leave the system?

You shit it out

Prudence

a habit of mind and will that inclines a person to act with integrity

Abandonment during the referral process occurs when

a counselor does not make suitable arrangements for client.

injection route provides

a fast and high peak effect

multidisciplinary team

a group of professionals that are all working on the client. example would be the probation officer, dcs, dhs, and mental health provider

Rational Emotive Behavioral Therapy (REBT)

a method that focuses on changing the problematic beliefs of an individual as a result of the events of his life Events do not disturb people, their view of it does. ABC Model- Activating Event - negative event in ones life Belief- how a person thinks or feels about an activating event Consequences- how an ind behaved based on the beliefs concerning the activating event Counselor should dispute and correct illogical beliefs Targets thought distortions often associated with SUD

morphine

a natural substance found in the opium poppy that is used to produce heroin

tolerance

a need for markedly increased amounts of the substance to achieve intoxication or desired effect

Difference between medical malpractice and negligence.

a patient filing a law suit for compensation, and a breach of duty.

hallucinogen

a psychoactive substance that alters perceptions, thoughts, and feelings

consumed cannabis

a single dose should be eliminated from your body in 5 days

An example of a selective intervention is:

a skills-based program for youth from military families who have experienced many transitions.

What is the best description of a drug

a substance taken for a desired effect

Methadone

a synthetic narcotic mainly used as a replacement therapy for opioid dependents

ethical absolutism

a viewpoint of ethic where ethical decisions are based on fixed moral rules that exist regardless of whether one believes in them

ethical relativism

a viewpoint of ethics where ethical decisions are based on the context or consequences

Code of ethics

a written system of stands of ethical conduct

Neurotransmitters most affected by AOD

acetylcholine, norepinephrine, epinephrine, dopamine, serotonin, GABA, glutamate, endogenous opioids

*SkoreUp Question* 36. It is true that morning drinking reduces anxiety that affects the alcoholic's ability to start the day. a. Investigation b. Self-Disclosure c. Role-Playing d. Counter-transference

a. Investigation *b. Self-Disclosure* c. Role-Playing d. Counter-transference Have no clue in the world to where this came from and could only find it on some other user generated quizzes. https://quizlet.com/TrayJewell https://www.proprofs.com/quiz-school/story.php?title=casac-practice-quiz https://quizlet.com/174122044/casac-general-review-1-flash-cards/

*SkoreUp Question* 42. Which of the following refers to the branch of knowledge concerned with medicinal drugs obtained from pans and other natural sources? a. Pharmacodynamics b. Pharmacogenomics c. Pharmaceutical chemistry d. Pharmacognosy

a. Pharmacodynamics b. Pharmacogenomics c. Pharmaceutical chemistry *d. Pharmacognosy* a. Pharmaco*dynamics* - the branch of pharmacology concerned with the effects of drugs and the *mechanism* of their action b. Pharmaco*geno*mics - the study of how *genes* affect a person's response to drugs c. Pharmaceutical *chemistry* - the study of drugs, and it involves *drug development* d. Pharma*cognosy* - the branch of *knowledge* concerned with medicinal drugs obtained from plants or other natural sources. https://en.wikipedia.org/wiki/Pharmacognosy

the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms unless

an individual is taking medications under medical supervision such as analgesics, antidepressants, anti-anxiety medications or beta- blockers.

*SkoreUp Question* 46. Sandra, a tranquilizer and alcohol abusing client, is assessed to have the capability to delay impulses and is self-destructive when frustrated. What is is the most appropriate assessment battery for Sandra? a. The MMPI, the MAST test and the Stanford-Binet b. The Beck Depression Scale, The MAST test and the MMPI c. The Strong-Campbell, the Stanford-Binet and the MMPI d. The Beck Depression Scale, The Strong-Campbell, and the the Stanford-Binet

a. The MMPI, the MAST test and the Stanford-Binet *b.* The Beck Depression Scale, The MAST test and the MMPI c. The Strong-Campbell, the Stanford-Binet and the MMPI d. The Beck Depression Scale, The Strong-Campbell, and the the Stanford-Binet *MMPI* - The Minnesota Multiphasic Personality Inventory (MMPI) is a psychological test that assesses personality traits and psychopathology. It is primarily intended to test people who are suspected of having mental health or other clinical issues. Although it was not originally designed to be administered to non-clinical populations, it has found. *MAST* - The Michigan Alcoholism Screening Test (MAST) screening tool was developed in 1971 and is one of the oldest alcoholism screening tests in identifying dependent drinkers https://en.wikipedia.org/wiki/Michigan_Alcoholism_Screening_Test *Stanford-Binet* - is an individually administered intelligence test. https://en.wikipedia.org/wiki/Stanford%E2%80%93Binet_Intelligence_Scales *Beck Depression Scale* - most widely used psychometric tests for measuring the severity of depression https://en.wikipedia.org/wiki/Beck_Depression_Inventory *Strong-Campbell* - is an interest inventory used in career assessment. https://en.wikipedia.org/wiki/Strong_Interest_Inventory

Steroids

anabolic- memic natural steroids androgen- natural male hormones

*SkoreUp Question* It was observed that the overall national suicide has increased slightly. However in the recent years, disproportionate rate has increased. Disproportionate condition usually occurs, in which of the following group of people? a.Among men and the elderly b. Among women and the elderly c. Among men and the young d. Among women and the young

a.Among men and the elderly b. Among women and the elderly c. Among men and the young *d. Among women and the young*

situational ethics

acknowledging the uniqueness of a situation and the need to apply ethical principles accordingly

tolerance

after repeated admin. a given dose of a substance produces a decreased effect or conversely with increased/larger doses must be administered to get the effect observed with the original dose

tolerance

after repeated administration, a given dose of a psychoactive substance produces a decrease effect or, conversely, when increasingly larger dose must be administered to obtain the effect observed with the original dose

Dependence

aka Addiction: behavioral pattern of complusive substance use; consistent involvement with the use of substances, high tendency to relapse after withdrawal

PNS

all neurons outside the CNS

Examples of Schedule IV substances include

alprozolam, clonszepam, and diazepam

dependence

also known as addiction; a behavioral pattern of compulsive psychoactive substance use, characterized by consistent involvement with the use of a psychoactive substance, the securing of its supply and a high tendency to relapse after withdrawal.

What is projection

also known as blame shifting, is a theory in psychology in which humans defend themselves against unpleasant impulses by denying their existence in themselves, while attributing them to others.

Neurotransmitters *Monoamines (e.g., catecholamines)* *Norepinephrine / Epinephrine*

also known as noradrenaline and adrenaline, respectively Norepinephrine has a greater effect on confidence and feelings of well- being epinephrine has a greater effect on energy

Psychoactive drugs

alter behavior or mood

psychological effects

alterations in perception and/or judgement caused by a psychoactive substance

psychological effects

alterations in perception or judgment caused by substance.

what does metabolism do

alters the composition of the drug

Other psychedelics not scheduled

amanita mushrooms, kava root, nutmeg & mace

Stimulants include

amphetamines, cocaine, caffeine, nicotine

Ethnically sensitive addiction professional suggestions by Carter, Liu, and Cross /2

an ability to consult comfortably with clients about ethnic issues

Ethnically sensitive addiction professional suggestions by Carter, Liu, and Cross /4

an ability to use cultural resources

Psychoactive Substance

any drug that affects the CNS and alters consciousness and or perceptions

psychoactive substance

any drug that affects the CNS and alters consciousness and/or perceptions

Naroctics

any psychoactive substance that derives from the opium poppy or manufactured to mimic the poppy

One of the four general principles that underlies Motivational Interviewing is

asking open questions

The first step in developing community prevention strategies is:

assessment.

Heroin withdrawal

begins six to eight hours after the last dose and peaks between 12 to 48 hours after last use. lasts four to five days.

in relation to counseling, what is empathy

being able to understand wht another person is experiencing

Competence

being educated, trained, and prepared to provide addiction-related services

Cocaine

blocks reuptake of dopamine, norepinephrine and serotonin. dopamine in the nucleus accumbens produces the euphoric effect. High risk of overdose though the dosage is unique to each individual. No medical treatment to reverse effects

Some short-term physiological narcotic effects

bobbing head, flushing skin, constricting pupils, decreased blood pressure, slurred speech, nausea, itching, elimination of pain, cough suppression

metabolism

body getting rid of the substance. elimination

CNS

brain and spinal cord

Addiction is a

brain disease most characterized by an individual's inability to control their thoughts of and intake of psychoactive substances.

standard drink of 1.5 oz

brandy or 80-proof spirits

barbiturate drugs are derived from

brbituric acid

metabolites

by-product of the liver breaking substances down that can be eliminated

Alcohol withdrawal

can be life threatening

PCP

can be physically dependent. All others are psychological only. Many claim this is the most dangerous drug ever to be abused.

common symptoms of fetal alcohol syndrome

causes mental and growth retardation and physicaaal deformities

Fentanyl and Demerol

causing major public health concern

primary goal of the helping relationship between patient and counselor

changing the patients behavior

implementing the values of the dominant social system as the basis for ethical decisions;

clinical pragmatism

Implementing Ethics

clinical pragmatism- implementing values of the dominant

Substance abuse counselors tend to work

closely with other health disciplines.

lowest potencies of opium derivatives

codeine, Paregoric, and propoxyphene

One important component of integrated co-occurring treatment that has been supported by several studies is:

cognitive-behavioral counseling.

Coordination of care

collaboration between the client and the multidisciplinary team

speedballing

combination between cocaine and heroin

Drug Interactions

combination of specific psychoactive substance that can have dangerous and/or lethal effects

Sterotypy

common with stimulants: repeating the same behavior over and over again

A child has trouble understanding that the amount of juice she sees being poured is the same amount when it is in her sippy cup and when it is in her baby brother's bottle. She believes the narrower bottle has more juice. She is in the developmental stage labeled by Piaget as

concrete operations

Amotivation Syndrome

condition characterized by regular users of cannabis being lethargic, lacking drive, being apathetic, etc

NAADAC Decision Making Model step three

consult with a supervisor and/or colleague

Caffeinism

consuming 550 or more mg a day

Physiological dependence

continued use of the substance is needed in order to prevent withdrawal symtoms

Medical uses for narcotics

cough suppression, pain, reducing anxiety and/or depression

Tobacco withdrawl

coughing, lack of concentration, dizziness, fatigue, nervousness, stomach issues, throat problems, sleep disturbance, skin issues, mood alterations.

Group Counseling

counseling with group members who have similar situations and experiences. The effectiveness depends greatly on the effectiveness of the leader. Qualities of a good leader- courage, stamina, self-awareness, openness, sense of humor, belief in the process, caring/goodwill, abilty to be a role model, aware of cultural perspectives and bias, maintain power posture, willingness to seek new experience, commitment Have an informed consent. Stress confidentiality

Interpretation

counselor provides the ct with another explanation of their behavior attitude or thoughts.

CDTA

created in 1989 a broad chemical control program that regulated 12 precursor chemicals, eight essential chemicals, tableting machines, and encapsulating machines

Methadone is administered

daily

Immediacy

dealing with feelings in the here and now

Loyalty

demonstrating allegiance to the client

what is LOYALTY?

demonstrating allegiance to the client, not abandoning those with whom you work. addiction professionals apply this virtue ethic when they advocate for and actively support clients' needs

heroin overdoses most often involve

depressed respiration

Withdrawal from Stimulants

depression, increased appetite, irritability, weakness and energy loss. Increased need for sleep and loss of concertration

Methadone

detox is harder than that of the actual opiate. daily basis.

Tolerance of narcotics

develops rapidly and requires higher doses

Benzodiazepines

disadvantage is the development of physical dependence after 4 months use, any of a class of heterocyclic organic compounds used as tranquilizers, such as Librium and Valium.

methadone

drug often used in treatment for narcotic addition

two or more drugs take at the same time that have antagonistic effects means

drugs cancel each other out

continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

e.g., arguments with spouse about consequences of intoxication, physical fights

recurrent substance use in situations in which it is physically hazardous

e.g., driving an automobile or operating a machine when impaired by substance use

recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home

e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household

Specifics of alcohol

effects every organ in the body, impacts GABA, dopamine, glutimate and serotonin; electrolite imbalances can lead to life threating seizures

what do short term effects of drug use refer to

effects while the drug is still in the users body

Have cultural competency.

elderly, young folks, all races, cultures, etc. LGBTQI, women, HIV+ , inmates

detoxification

eliminating the substance from your body *The first step in sobriety and treatment

humanistic ethics

emphasizing human needs such as self-actualization and freedom, as the basis for ethical decisions

Adlerian Therapy

encourages to acquire a more positive and productive way of life by developing new insights, skills, and behaviors.

Heroin activates

endorphins

Clarification

ensure accuracy in understanding- "are you saying" "Could you clarify that"

a viewpoint of ethics where ethical decisions are based on fixed moral rules that exist regardless of whether one believes in them

ethical absolutism

a viewpoint of ethics where ethical decisions are based on the context or consequences

ethical relativism

Principle Ethics

ethics that answer "what should I do"

Virtue ethics

ethics that answer "who should I be"

Principle ethics

ethics that answer the question "what should I do?"

virtue ethics

ethics that answer the question, "who should I be?"

You can withdraw from Amphetamines after the first use

even without dependence. Tx includes some antidepressants

Barbituates paired with etoh

exacerbated effects due to potentiation

Fidelity

exercising honesty and trust

Nonverbal Responses

eyes, facial expression, eyebrows, mouth, legs and feet, hands and arms, paralinguistics, head

Culturally skilled counselors can demonstrate their awareness of a client's world view by being:

familiarize their self with relevant research and the latest findings regarding mental health/mental disorders of various ethnic and racial groups.

marijuana is eliminated from the body mainly via

feces

Most narcotic withdrawal mimiac

flu symptoms

Solutions focused therapy

focus on the solution and not the problem.

standard drink of 3 to 4 oz

fortified wine

Inhalants

gases that are administered via breathing through mouth or nose within 10 seconds they relax the muscles around the heart and brain. Lipid soluble - can damage the brain quickly. Solvents, Nitrites and Anesthetics have similar effects. Can result in death due to respiratory asphyxia or heart arythmia

important social, occupational, or recreational activities are ? because of substance use

given up or reduced

Excitatory Neurotransmitters

glutamate, epinephrine

a users expectation of how a drug will make the user feel

has a significant effect upon the users experience of the drug

narcotics withdrawal symptom are sometimes described as being like

having the flu

Indole psychedelics schedule III examples

hawaiian woodrose and morning glory seeds

Schedule I

high potential for abuse and has no accepted medical uses

Crisis *Internal Distress*

hopelessness despair depression suicidal impulses PTSD unpleasant psychoactive substance use reaction

Magnitude of a drugs effect

how intensely the user feels the drug's effects

Method of Administration

how the psychoactive substance physically enters the individual's body and bloodstream

emphasizing human needs, such as self-actualization and freedom, as the basis for ethical decisions

humanistic ethics

Reflection

identify feelings of the client and repeat them- "it is clear that you are angry" "it seems like you are feeling..."

"Addicted" label is given typically

if a person exhibits signs and symptoms of dependence and tolerance

Free basing cocaine or smoking crack result in

immediate and powerful psychoactive substance effects

Confidentiality exceptions by Law.

imminent harm or danger, Legal attorney consultations.

Short term effects of depressants

impaired coordination, slurred speech, staggered gait, drowsiness, muscle relaxation, slowing of breath, slowing of HR, dizziness, sedation, loss of memory, euphoria, impaired judgement, decreased inhibition, decreased fear, confusion, irritability, paranoia,

clinical pragmatism

implementing the values of the dominant social system as the basis for ethical decisions

Adverse Effects of substances are usually seen

in those with ADHD or Bipolar w

Amphetamines

increase release and prevent reuptake of norepinephrine, dopamine, adrenaline and serotonin. Not metabolized in the liver but excreted in urine unchanged, can have a half-life of more than 10 hours. High risk of overdose which can lead to cardiac arrest, stroke, brain hemorrage (and other concerns associated with increased blood pressure)

alcohol causes

increased breathing at low levels

Heroin Long Term effects

increased risk of infection, pneumonia, irregular levels of sex hormones, asthma & bronchial infections, liver disease, collapsed veins, abnormal cortisol levels, chronic constipation, etc

short term effect of Anabolic steroids

increased urination

Heroin detox

individuals enter a drug-free rehabilitation program. May include methadone or buprenorphine

nasally

inhailed

Neurotransmitters are either

inhibitory or excitatory

intramuscularyly

injected into the muscle

itravenously

injected into the vein

Ways to consume heroin

intravenously, subcutaneoulsy, or intramuscularly, smoked or snorted

Designer psychoactive substances

invented by cheists with a different molecular chemical formula of similar controlled substance to evade law enforcement

Xanthine

is a purine base found in most human body tissues and fluids and in other organisms. A number of stimulants are derived from xanthine, including caffeine and theobromine.

Reality Therapy

is a therapeutic approach that focuses on problem-solving and making better choices in order to achieve specific goals.

Behavioral Therapy

is a treatment that helps change potentially self-destructing behaviors. It is also called behavioral modification or cognitive behavioral therapy. Medical professionals use this type of therapy to replace bad habits with good ones.

Vivitrol

is administered once a month

warmth

is an essential component in counseling

Principle of CT/RT. Control Theory/ Reality Therapy

is based on the principle that four elements guide human functions: Doing, Thinking, Feeling, and Physiology. People choose negative reactions to events, Is responsible for one's own life. Cant change how the body feels or functions but can control how he reacts and thinks.

Reasonable cause

is conducted when a supervisor suspects that an employee is engaging in alcohol or drug misuse.

Early Full Remission:

is defined as at least 3 but less than 12 months without substance use disorder criteria (except craving)

OVERDOSE ON HEROIN

is imminent- especially with the way it is being cut with fentanyl

LSD

is not approved for medical use in the united states. Also has no withdrawal symptoms

Pharmacotherapies such as disulfiram, naltrexone, methadone and acamprosate to aid in addiction treatment

is only a temporary measure and should never be considered part of a long term intervention

Glutamate

is the major excitatory neurotransmitter in the brain

Marinol

is used for severe vomiting

Temporary Scheduling

issues for one year with a possible six month extension if formal scheduling procedures have been initiated.

Why can an overdose of barbiturate cause death

it can depress critical physiological functins such as breathing

Concreteness

keeps a counseling conversation on track and avoids wasting time on tangents and insignificant material. Concreteness makes a more efficient and effective counseling session.

what does the counselor do in a facilitative relationship

keeps the patient talking

dependence

known as addictions, a behavioral pattern of compulsive substance use characterized by consistent involvement with the use of a substance, securing of its supply and a high tendency to relapse after withdrawal.

the substance is often taken in ? or over a longer period than was intended

larger amounts

stimulant withdrawel

lasts 2 - 3 days, occasionally a week or more

LAAM replacement therapy

lasts up to 72 hours

Effect of taking methadone orally

less euphoric and used for treatment

Effect of snorting cocaine and heroin

less potent

Schedule III

less potential for abuse than other scheduled substances; currently accepted medical use in treatment in the US or use with severe restrictions; use may lead to severe psychological or physical dependence

some short-term psychological effects

lethargy, euphoria, mental clouding, impaired judgement

Schedule V

limited dependence, very low potential for abuse, medcial use

Standard drink of 2 to 3 oz

liqueur, cordial, or aperitif

Reality Therapy/Control Theory *Central Question of Reality Therapy*

ls what you are choosing to do getting you what you want?

standard drink of 8 to 9 oz

malt liquor

The BEST management technique to use in order to maintain effective programming and to ensure a maximum level of client care is:

matching clients to appropriate staff and level of care.

Heroin residual withdrawal

may be present for eight to 12 months

Two or more drugs taken at the same time and have a potentiative effect (synergistic effect)

may up the dose of one making it really 1+1=3

treatment applications

method of detox, stabilization & maintenance

Meth withdrawal

mimics parkinsons

psychological effects

mind altering

Effect of taking cocaine orally

minor

Autonomic Nervous System (ANS)

montiors unconscious bodily functions such as heart rate, breathing, and digenstion

Heroin is made from

morphine

Examples of Schedule II substances include

morphine, cocaine, methadone, oxycodone, hydrocodone, methamphetamine, Dronabinol, nabilone

altered perception

most common distinguishing characteristic of a psychedlic drug

Ritalin

most commonly prescribed to treat ADHD

alcohol

most commonly used sedative-hypnotic drug

Methamphetimine high

most resembles schizophrenia

Narcan

naloxone

Depade/ReVia/Vivitrol

naltrexone

common narcotic antagonists

naltrexone and naloxone

Hydrocodone (vicodin)

narcotic

Methadone

narcotic

Oxycodone (Percocet or Oxycontin

narcotic

Heroin

narcotic, is not a CNS stimulant, causes constricteed pinpoint pupils

Anticoholingergics

natural belladonna alkaloids (atropine, belladonna, hyoscyamine, and scopolamine) and related products.

Cortisol

natural hormone that is released during times of stress, resulting in elevated blood sugar and enhanced metabolism

Endorphins

natural peptides throughout the human body that combat pain and stress

Counselors, continued assessment and treatment planning for patient.

need to continue to play an active role after admission of a client.

Addiction Treatment Modalities *Motivational Interviewing*

non-directive approach to counseling that uses the internal motivation of a client to evoke and sustain rapid change, instead of counselor interpretation and discovery

When presented with conflicting messages, communicators are most likely to rely on the:

non-verbal message

Obedience

observing laws and regulations which govern individuals and the profession

psychological dependence

occurs when a individual repeatedly consumes a psychoactive substance3 to obtain a subjective experience described as satisfying a huner or need

Amphetamines use outside of adhd

often for weight loss

LAAM

old school treatment of opiate addiction. Not used now due to the abuse ability. every 3 or so days.

Naltrexone and Naloxone can only be used

once a heroin dependent is clean

blood-brain barrier

once drugs are in the blood stream, they must pass through X to get into the brain tissue.

Opiates

opium, morphine, codeine

which route of administration achieves the longest lasting results for the user

oral

Methods of administration

oral- mouth via swallowing or smoking; Nasally- snorting or inhaling; IM- injection into a muscle; IV- Injecting into a vein; Subcutanious- injecting beneith the skin; Topical- applyed on top of the skin; Sublingually- dissolving under the touge; rectally- inserted into the anus; Vagionally- inserted into the vagional opening

Least potent way to consume cocaine

orally

administration of opium derivatives

orally, injected, intravenously, subcutaneously, or smoked

Caffienism

over 650mg of caffeine- 5 cups of coffee

Controlled Substance Act (CSA)

places all substances which were in some manner regulated under existing federal low into one of five schedules.

narcotic are derived from

plants

needle freaks

people psychologically dependent on heroin, not physiological

Psychological dependence

percetion that the effects produced by a substance, or the associated condtions of use, are needed to maintain optimal well- being.

Emergency Scheduling

permits the scheduling of a substance which is not currently controlled and has no medical use

there is a ? to cut down or control substance use

persistent desire or unsuccessful efforts

varencline

pharmacotherapy used for nicotine dependence that works by blocking the pleasurable effects experienced by smoking

physiological effects

physical effects

physiological effects

physical signs

physiological effects

physical signs and symptoms of a psychoactive substance

chemical interaction

physiological and psychological effects of 2 or more substances administered at the same time

chemical interaction

physiological and psychological effects of two or more psychoactive substances that are administered simultaneously

sublingually

placed in the mouth or under the tongue

Confrontation

point out discrepencies and mixed messages Experimental Confrontation- focus on client discrepencies Didactic- counselor attempts to clarify misinformation or lack of information Strength confrontation- focus on clients' resources and past successes Weakness Confrontation- draw attention to the client's perceived failings flaws and short comings to encourage them to take action

Long-Term Psychological Effects

possible mental illness and dysfunction resulting from chronic, continued use of the psychoactive substance.

Long-Term Physiological Effects

possible physical illness, disease or dysfunction resulting from chronic, continued use of the psychoactive substance.

Short-Term Physiological Effects

possible signs and symptoms exhibited by the individual's body shortly after the psychoactive substance is consumed.

Short-Term Psychological Effects

possible signs and symptoms exhibited by the individual's perceptions and senses shortly after the psychoactive substance is consumed.

Marijuana

potency ranges from .5 to 11%, street grade is about 3%.

Two ways AOD's impact reuptake

prevent reuptake OR prevent the metabolizing process that would remove the substance- both result in continued stimulation of the neuron

Solution Based Therapy

primarily focuses on the problem, not the person., Utilization- where counselor uses previous successes to motivate change Positive and self affirming, gets good results

IV. Prof Responsibility: Standard 1: Counselor Attributes: 2. AS EDUCATOR...

primary obligation to help others acquire knowledge & skills in treating substance use disorders

type of ethics that answers the question "What should I do?"

principle ethics

the intervention stage of treatment focuses on

problem solving

Code of ethics provides

protection for the public as well as a means of accountability for professionals actions with clients and colleagues

Justice

providing equal and fair treatment (do not discriminate)

Safety Sensitive

refers to an employee's job description.

Standard drink of 12 oz

regular beer

a post session technique in group therapy:

reinfores insights

Extrapyramidal

relating to or denoting nerves concerned with motor activity that descend from the cortex to the spine and are not part of the pyramidal system.

using religious beliefs, such as the belief in divine love or the will of God, as the basis of ethical decisions

religious ethics

Crisis *Transitional States*

relocation new family member job change retirement illness family conflict divorce absentee family member

Sterotypy

repeating the same behavior over and over again

habituation

repetition of behaviors until hey are a habit.

Habituation

repitition of behaivors until they are established into daily life

in counseling, reflection usually involves

responding to feelings

Paraphrasing

restatement- "I sense that.." "Sounds like..."

nucleus accumbens

reward center of the brain

Abuse Liability

risk potential associated with a substance becoming repeatedly used and/or dependence inducing

Meth is

schedule II

Sympathetic Nervous System

secondary within the ANS- when activated increases breathing, heart rate, etc.

types of antidepressants having the fewest side effects

selective morepinephrie/serotonin reuptake inhibitors

Blood Brain Barrier

series of cells that prevent certain chemicals from reaching the brain

in group treatmet direct communications refers to

sharing ones feelings about the other person, and using the pronoun you when speaking

intravenously

shooting up

psychoactive substance shortly after consumption

short term psychological effects

intramuscularly

shots directly into the muscle

withdrawal

signs and symptoms that occur when an indiv that is physically dependent on a substance discontinues its use.

withdrawl

signs and symptoms that occur when an individual who is physically dependent upon a psychoactive substance discontinues its use

subcutaneously

situated or applied under the skin

acknowledging the uniqueness of a situation and the need to apply ethical principles accordingly

situational ethics

subcutaneously

skin popping

Time of onset: taking cocaine orally

slow within 30 minutes and lasts 2 to 4 hours

Time of onset: taking methadone orally

slow withing 30 to 60 minutes and lasts 24 hours

Raw opium ingested by

smoking or eaten

Detoxification Issues

special consideration that are unique to each psychoactive substance must be taken into account before an individual abruptly discontinues use

narcotic withdrawal

speed of onset and duration of symptoms are most highly related to the duation of the effect of the narcotic

adjustment

stages of a family dealing with substance abuse including denial, disorganization and solution finding

Heroin tolerance

starts immediately

LSD

starts in gastrointestinal tract Lasts up to 12 hours can cause permanent damage to the brain flashbacks can be permanent

MDMA

starts with a weird period that lasts about 30-60 min, then a rush period for 20-30 min and the high period that last several hours. Can be fatal due to dehydration, increased heart rate and decreased blood pressure paired with high body temps

Cocaine

stimulent

Cross- Tolerance

the ability of pharmacologically similar substances to substiture for the other in relation to tolerance and to prevent withdrawal

cross tolerance

the ability of pharmacologically similar substances to substitute for one another in relation to tolerance and prevention of withdrawal (ie using hydrocodone when heroin isn't available)

Toxicity Level and Risk of Overdose

the amount of a specific psychoactive substance necessary to cause death and the likelihood of that occurring

patient goals takes place during which point in counseling

the assesment stage

Central nervous system CNS

the brain and spinal cord comprise this

Pharmacology

the branch of science that examines how psychoactive substances taken to alter bodily functions or enhance bodily functions interact with the brain and body

withdrawal, as manifested by

the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)

the route of inhalation pass the drug into the users bloodstream through

the lungs

"Use" of illicit drugs fines cannot be used if

the drug offender has been previously convicted of a federal or state offence or if they have already been fined twice

Addiction counseling incorporates

the findings of the field of pharmacology with a prescribed method of treatment or treatment applications.

Dependence

the level of risk associated with an individual developing physical and psychological dependence on a specific psychoactive substance.

Tolerance

the level of risk associated with an individual requiring more and more of the psychoactive substance over time to achieve the same desire psychoactive effects

Beneficence

the obligation to do good (advocate and support clients)

Withdrawal Sx

the oppopsite of intoxication sx

Mechanism of Action

the process and interactions that take place inside the individual's body and brain to create the desired effects or resulting side effects of the psychoactive substance.

detoxification

the process of eliminating all psychoactive substances from the individual's body

Referral

the proves of seeking assistance for an issues that is beyond the scope of your practice. Can be for additional services or to replace you if there is a reason you are ineffective

Withdrawal

the signs and symptoms an individual might experience when discontinuing use of a psychoactive substance, which varies among individuals, depending on duration of continued use, amount usually consumed and individual brain chemistry.

Once a family leaves the substance abuser to build a new life

there is a chance the substance abuser will seek help

Develop an individualized treatment plan

this is based on the assessment toole should have a problem statement, goal statement, measurable objectives, and include strategies

Narcotic antagonists need to be administered

three times/week

Summarization

tie together multiple elements

a great deal of time is spent in activities necessary

to obtain the substance, use the substance, or recover from its effects

The anticholinergics and antispasmodics are used

to relieve cramps or spasms of the stomach, intestines, and bladder.

Alcohol must be detoxed

under medical supervision due to risk of seizures. Often given Librium.

religious ethics

using religious beliefs, such as the belief in divine love or the will of God as the basis of ethical decisions

Discretion

valuing the right to privacy

characerisstic of a psychoactive substance easy to pass through the blood brain barrier

water soluble

Reverse Tolerence

when a psychoactive substance produces an enhanced response to a smaller dose than the original. Seen in amphetamines

Re-organization

when the family membeers take on the responsibilities of the substance abuser

Cerebral Cortex

within the CNS: part of the limbic system that controls voluntary motor skills and sensory input

resistance

you ask yor patient about a particular painful experience when the patient struck his or her domestic partner. The patient speaks of the experience in a fact-based, rational tone. What is the patient likely doing

Naltrexone

An opiate Blocker, has been found to be effective in the treatment of heroin addicts. Totally blocks any of the effects of heroin.

Methamphetamines

Are chemically made stimulants. It is related to amphetamines but the effect are much greater. Made in illegal home labs.

Compulsive drug use

Using on the daily basis and using in large amounts to get the desired effect.

Pharmacotherapies in treatment of substance abuse

Using prescriptions drugs along with some form of therapy to treat substance abuse.

Alcohol Detoxification

Usually in a hospital and does not last more than five days. Provide patient with nutrition, fluids , electrolytes and medications

Inhalants

Vapors that are inhaled in order to produce mind altering effects.

Professional ethical decision making

What is the decision based on? Will anyone be hurt by my decision, is it base on what I believe personally or, professional codes of ethics

CHEMICAL INTERACTIONS

When more than one chemical is given at the same time.

Aversion Therapy

Where psychoactive substance use is paired with a very unpleasant feeling, such as an electric shock or nausea, in hopes that the client will associate the unpleasant feeling with the psychoactive substance use

Covert Sensitization

Where the client imagines him or herself abusing a psychoactive substance, then immediately visualized a horrible consequence because of use

Cue Exposure treatment

Where the client is constantly Exposed to the triggers and cues that are known to result in psychoactive substance use

Assertion training

Where the client learns the skills necessary to resist negative influences and behaviors in his or her life

Community Reinforcement

Where the client's vocation, social ties, recreational activities and family play a role in reinforcing healthy behavior

Contingency Management

Where tokens or rewards are given for periods of abstinence

Adolescent egocentrism

Self centeredness based on the concerns of what others think

Main Principles of DBT: Mindfulness

-"What" skills- Observe, describe, and participate -"How" skills- be non-judgemental, one-mindful, and effective

Social Interest

-A component of Adlerian therapy that is an awareness of being a part of the human community and how one interacts with the social world

Main Principles of DBT: Distress tolerance

-Accepting, finding meaning for, and tolerating distress -Bear pain skillfully -Tolerating and surviving crises and accepting one's situation in the moment

Fictional Finalism

-Adlerian Psychology: All behavior is purposeful and self-determined and works to accomplish the central goal of an individual's life -Each individual is in control of their own fate and not a victim of it

Social Learning Approach

-Also known as modeling -People learn behavior by watching what happens to someone else in a given situation -If the individual finds consequences to be favorable, they are likely to mirror behavior

Behavioral Therapy

-Also referred to as behavioral modification therapy -General approach to counseling where a client modifies his or her learned behaviors that are negatively affecting his or her life

Phenomenology

-An addiction counselor or other helping professional attempts to view the world from the same frame of reference as the client to better understand the behavior of the client

Brief therapy

-An approach to therapy that includes a shorter time period and fewer sessions than "traditional therapy" -Founded by Freud

Bowenian Family Therapy

-Based on the idea that there is a multi-generational transmission of problems that need to be addressed as a family unit in the present -Goal of differentiation: where an individual is able to achieve seaaration of intellect and emotion while remaining independent of other family members -Undifferentiated individuals have diffivulty separating from other members and become fused with emotional patters of the family

Pharmacotherapy: Antagonists

-Block the effects of certain drugs to either prevent overdose from finalizing or as a treatment approach to maintain sobriety -Naltrexone (ReVIa, Depade, Vivitrol): Opiod and alcohol dependence -Naloxone (Narcan): Antidote for opioid overdose -Flumazenil(Mazicon): Antidote for benzo overdose

Strategic Family Therapy

-Built on theories and approaches of Milton Erikson -Developed by Jay Haley and Cloe Madanes -Deal with change by use of strategic techniques providing directives toward change

Pharmacotherapy: Sensitizers

-Cause very unpleasant effects if certain psychoactive substances are taken in conjunction with them -Disulfiram (Antabuse)

Cognitive Behavioral Therapy

-Developed by Aaron Beck -A method of counseling that focuses on simultaneously learning new behaviors and restructuring automatic thoughts.

History of Gestalt

-Developed by Fritz Perls -German for "meaningful whole"

Dialectical Behavioral Therapy

-Developed by Marsha Linehan -A modified form of cognitive behavior therapy that combines standard CBT techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from Buddhist meditative practice. -Developed to treat suicidal individuals who also meet the diagnosis for borderline personality disorder -Also effective in treating other disorders including substance dependence, depression, PTSD, and eating disorders

Crises Survival Strategies

-Distracting, self-soothing, improving the moment, thinking of pros and cons

Main Principles of DBT: Interpersonal effectiveness

-Effective strategies of asking for what one needs, saying no and coping with interpersonal conflict -Make a change or resist changes someone else is trying to impose

Gestalt Practices in Addiction Counseling

-Empty chair technique -Contact: The process of interacting wih nature and with other people without losing one's sense of individuality

Scapegoat

-Feeling: anger, hurt, rejection, fear -Expressing: strong peer needs, chemically dependent, sullen, acts out, withdrawn, defiant -Provides focus

Lost Child

-Feeling: fear, rage, confusion, hurt -Expressing: withdrawn, quiet, distant, overweight, rejection, super independent -Provides Relief

Enabler

-Feeling: guild, anger, pain, fear -Expressing: powerless, serious, self-blaming, fragile, self-pity, manipulation, super-responsible -Provides responsibility

Mascot

-Feeling: insecurity, fear, confusion -Expressing: humor, fragile, attention, clown, being cute -Provides distraction

Chemically Dependent Person

-Feeling: shame, pain, guilt -Expressing: anger, charm, rigid, aggression, compulsive, gradiosity -Trap of self delusion

Hero

-Feeling:inadequacy, guilt, hurt -Expressing: success, super responsible, special, denial, needs approval, all together -Provides self-worth

Main Principles of Gestalt

-Focuses on understanding how one behaves and not on explaining why -People are in control of their own lives -Once behavior is accepted, the client can think clearly and make better choices -Bring concerns from the past and experience them head on (Unfinished business) -Left unexpressed feelings can manifest as unhealthy behavior

Main Principles of DBT: Emotional regulation

-Identify and label emotionsl -Identify obstacles to changing emotions -Reducing vulnerability to "emotion mind" (When ones thinking and behavior is controlled by their emotion) -Increasing positive emotional events -Increasing mindfulness to current emotions -Taking opposite action -Applying distress tolerance techniques

Adlerian Psychology

-Individual Psychology -Holistic in Nature -Humans are moving towards goals -Often self-defeating as a result of discouragement and inferiority feelings

Principles of Brief Therapy

-Induction phase: client makes decision to seek therapy, counselor assesses whether the client is willing to change -Alliance: The counselor forms an alliance with the client Refocus/Change: Working phase Termination/Homework: Assists with relapse prevetion. Long-term goals are set, along with long-term homework assignments and planning Continuation/Follow-up: Check in or follow-up appointments should be scheduled for as long as homework is planned

Main Principles of Adlerian Psychology

-Maintains that everyone is striving toward superiority and perfection and must learn how to cope with inevitable inferiority feelings -Individuals remember times they were dissatisfied with themselves and try to rise above those times to reach a higher level of functioning

Gestalt Therapy

-Method of counseling where the clinet gains "awareness" of what he or she is currently experiencing and learns personal responsibility for what and how he or she is feeling, thinking, and doing. -Empowers that client to regain control of his or her life and change unhealthy behavior -Growth occurs within an interactive relationship between the client and the therapist

Other pharmacotherapies

-Norpramin, tofranil, parlodel, symmetrel, subutex, suboxone are used to alleviate the effects of withdrawal from a psychoactive substance

History of Behavioral Therapy

-Pavlov's classical conditioning -Skinners operant conditioning -Bandura's social learning approach

Family Systems Counseling

-Proposed by Sharon Wegsheider-Cruse -Expanded by WIlson

Acceptance skills

-Radical acceptance, turning the mind toward acceptance, and willingness vs. mindfulness

Structural Family Therapy

-Salvador Minuchin -Core of a healthy family is setting appropriate boundaries and providing each member with a feeling of attachment -Enmeshed families are characterized by an absence of clear boundaries and attachment -Disengaged families have rigid boundaries and personal distance -Individual symptoms are best understood by exploring the interactional patters within the family

vbnm xxxx logic

-The subjective reality as we perceive it

Main Principals of Behavioral Therapy

-What is learned can be unlearned -Certain laws or processes govern the initiation, maintenance, and cessation of behavior

Family systems and addiction counseling

Based on the premise that when a person abuses drugs the whole family is affected.

Two stages of Alcohol withdrawal syndrome

Blood pressure, Temperature, Anxiety,Shakes, Speech Slurred unsteady balance. And, Hallucinations, Seizures, DT's, confusion, incontinence.

Human Central Nervous System

Brain & Spinal Cord, and the automatic nervous system which checks all body functions to make sure it is functioning properly.

DSM-5 Defines substance use disorder

Caused by abusing a drug, by medication side effect or by exposure to a toxin. It will vary depending on the type of substances being used. 2 or more drugs used at anytime during the past 12 months for a diagnosis of substance abuse disorder.

Recreational drug use

Chemical use in a social setting with a group of friends who are using drugs.

Schedules one Drugs (I)

Chemicals that have no medical use and a high abuse liability

Schedule Two drugs (II)

Contain chemicals that are valuable for their medical use but can only be prescribed by a doctor.

Schedule Five Drugs (V)

Contains the least abuse liability

Pharmacotherapies for Alcohol disorder

Naltrexone, Reduces the craving for alcohol, and Disulfiram, [Antabuse] make you sick if you use alcohol while using it.

Adlerian Psychology: Therapeutic Task

Encourage clients to identify and utilize their strengths, develop social interest and a new, more satisfying life style

Short and long term effects of Cannabis use

Relaxation and lowered inhibition, Damage to lungs as with cigarettes, difficulty completing simple task, slow mental responses.

Short term effects of alcohol

Feeling of euphoria, drowsiness, dizziness and flushing complexion: vision and speech imbalance.

Circumstantial drug use

For a specific reason, such as using to stay awake or to be active.

Stimulants on the central nervous system

Increase heart rate, blood pressure, irritable, anxious and dilated pupils, dry mouth.

The dependent delusional system

Is the way a person protects the inner person from the realization of his dependency on drugs. Memory recall, Blackout, Euphoric Recall, Denial, Rationalization, Blaming and Intellectualizing.

Ways to accomplish Adlerian Therapy Goal

Look for patterns and themes in a client's life and identify what behaviors are leading to repetition. Re-educate the client with healthy assumptions of the world and fictional finalism

Codependency

Maladaptive behaviors learned and exercised by a person in order to survive in a family which is experiencing emotional stress

Withdrawal effects from Barbiturates

Most dangerous occurrence is of blood pressure and breathing problems. Must be treated immediately or it can become life threatening. Nausea, vomiting,increased heart rate, sweating abdominal cramping and shakes.

Treatment Applications for Barbiturates

Must take place in a hospital under medical care because of life threatening episodes.

Difference between Benzodiazepines and Seditives

One are know as tranquilizers, it reduces anxiety rather than being a general depressant and is less drowsiness than sedatives. Safer than the other one even when taking large amounts of the drug does not produce fatal results.

Gestalt Therapy

People must accept responsibility for what happens to them and find their own way in life.

PHYSIOLOGICAL EFFECTS

Physical and bio-chemical behaviors of short and long term drug use.

WITHDRAWAL SYNDROME

Physical and psychological rebound effects of psychoactive chemicals.

TERMINOLOGY

Psychoactive chemical name, brand name, and street name

Disease model of addiction

Psychological primacy-the need to have the drug is the most important in life, Self doubt-can't function without the drug. Relationship to the drug, inability to abstain, inability to control the amount you use. Personality changes and conflicted behavior

TREATMENT APPLICATION

Refers to the purpose of detoxification, stabilization & maintenance

NAADAC regarding addiction of alcohol to the national drug control strategy

Should be addressed by the National Drug Control Strategy because it is a drug even though it is legal

Detoxification for cocaine users

Side effects are increased appetite, depression, weakness, irritability, excessive sleepiness, lack of concentration and paranoid ideations and craving for the drug.

Structural family therapy

The counselor tries to change the dysfunctional structure of the family

PSYCHOLOGICAL EFFECTS

The effects on perception and judgement by psychoactive chemicals

Stages of withdrawal from CNS depressants

The shakes 90% of the time, Hallucinations 25%, Seizures 7 to 48 hours after last drink, Delirium Tremens 3 to 5 days after last drink.