Alcoholism, Substance Abuse and Dependency

Principles of Effective Treatment include the following, except:

Addresses all of the patient’s needs, not just his or her drug use Staying in treatment long enough Must be reviewed often and modified to fit the patient’s changing needs Medications are not an important part of treatment, especially when using behavioral therapies


can be used to manage withdrawal symptoms, prevent relapse, and treat co-occurring conditions can be used to manage withdrawal symptoms but should not be used to prevent relapse can be used to help re-establish normal brain function and decrease cravings both a. and c.

The following medications are used to treat opioid addiction, except:

Disulfiram Methadone Buprenorphine Naltrexone

Behavioral therapies help patients in the following ways, except:

Modify their attitudes and behaviors related to drug use Cause changes in brain chemistry that can quickly reverse symptoms (ECT) Increase healthy life skills Persist with other forms of treatment, such as medication

A common pattern for misusing steroids is taking multiple doses for a period of time, stopping for a time, and then restarting is called:

stacking cycling pyramiding plateauing

When a person tries to quit smoking tobacco, he or she may experience the typical withdrawal symptoms including the following, except:

irritability decreased appetite powerful cravings for tobacco problems paying attention

This drug is a powerfully addictive stimulant made from the leaves of a plant native to South America; is snorted through the nose, rubbed on the gums, or dissolved and injected; currently has no government-approved medicines to treat this addiction:

Molly/Ecstasy Heroin Cocaine Fentanyl

This drug is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent; is a preblockedion drug that is also made and used illegally; is commonly involved in drug overdose deaths.

Cocaine Fentanyl Molly/Ecstasy Kratom

This medicine can be used to reverse a fentanyl overdose.  Multiple doses might be necessary because of fentanyl’s potency.

Naloxone Chantix Zyban Antabuse

A diverse group of drugs that alter a person’s awareness of their surroundings as well as their own thoughts and feelings, commonly split into two categories, classic and dissociative.  They can be either natural or synthetic.

Stimulants Inhalants Hallucinogens Depressants

An opioid drug made from morphine, can be a white or brown powder or a black sticky substance; can be injected, sniffed, snorted or smoked; taken from the seed pods of various plants grown in Southeast and Southwest Asia, Mexico and Colombia.

Cocaine Molly/Ecstasy Ketamine Heroin

This class of substances are mostly used by young kids and teens and are the only class of substances used more by younger than by older teens.

Stimulants Depressants Inhalants Steroids

A tropical tree native to southeast Asia with leaves that can have psychotropic effects, not currently illegal and easy to access on the internet, has opioid and stimulant effects.

Kratom Molly/Ecstasy Ketamine Acid

Most commonly used psychotropic drug in the United States, after alcohol; widely used among young people; people use by smoking, eating, drinking or inhaling it;  the amount of THC in it has been increasing steadily in recent decades.

Cocaine Crack Molly/Ectasy Marijuana

Medical marijuana is all of the following, except:

recognized and approved by the FDA refers to treating symptoms of illness and other conditions with the whole, unprocessed marijuana plant or its basic extracts. legal is some states but not in others currently being tested for medical treatment

A synthetic drug that alters mood and perception; producing feelings of increased energy, pleasure, emotional warmth; initially popular in the nightclub scene and at all-night dance parties; usually taken as a capsule or tablet.

Kratom MDMA (Ecstasy/Molly) Ketamine Special K

A powerful, highly addictive stimulant that affects the central nervous system; may look like glass fragments or shiny, bluish-white rocks; people use by smoking, swallowing, snorting or injecting powder that has been dissolved. 

Cocaine Anabolic Steroids Methamphetamine Preblockedion CNS Stimulants

The following statements are all true about Methamphetamine, except:

The most effective treatments for methamphetamine addiction so far are behavioral therapies. There are currently no government-approved medications to treat methamphetamine addiction. Methamphetamine can be highly addictive. Methamphetamine decreases the amount of dopamine in the brain.

Over-the-counter medicine that can be sold directly to the public without a prescription that has the potential for misuse:

Benzonatate (TXS), a cough suppressant Dextomethorphan (DXM), a cough suppressant Guaifenesin (GSG), a cough suppressant Phenylephrine (PSX), a cough suppressant

The following statements are true about prescription CNS depressants, except:

They aremedicines that can slow brain activity to treat anxiety and sleep disorders. They act on the brain by increasing activity of GABA, a chemical that slows brain activity. They usually make people feel sleepy and uncoordinated at first. They cannot lead to substance use disorder if prescribed by a doctor.

The following statements are true about prescription Opioids, except:

They are used mostly to treat moderate to severe pain, though some can be used to treat coughing and diarrhea. People misuse by taking the medicine in a way other than prescribed, taking someone else’s preblockedion, or taking the medicine to get high. Even when used as prescribed by a doctor can lead to a substance use disorder, which takes the form of addiction in severe cases. A large fraction, almost 2/3’s, of people who misuse opioid pain relievers switch to heroin.

The following statements are true about prescription Stimulants, except:

Prescription stimulants are medicines used to treat ADHD and narcolepsy. Most prescription stimulants come in tablet, capsule, or liquid form. Prescription stimulants decrease the activity of the brain chemicals dopamine and norepinephrine. Prescription stimulant misuse can lead to a substance us disorder, which takes the form of addiction in severe cases, even when used as prescribed by a doctor.

The following statements are true about Synthetic Cannabinoids, except:

They are human-made mind-altering chemicals that are sprayed on dried, shredded plant material or sold as liquids to be vaporized and inhaled. They are a safe, legal alternative to marijuana, synthetically created without the harmful chemicals in other marijuana products. They are sold in colorful foil packages and plastic bottles to attract consumers. Hundreds of brands now exist, including K2, Spice, Joker, Black Mamba, Kush and Kronic.

The following statements are true about Vaping, except:

Vaping is popular among teens. Vaping is less harmful than combustible cigarettes when people who regularly smoke switch to them as complete replacement. Vaping does not lead to nicotine addiction. Vaping exposes the lungs to a variety of chemicals, including those added to e-liquids, and other chemicals produced during the heating/vaporizing process.

The following statements are true about comorbidity, except:

Comorbidity describes two or more disorders or illnesses occurring in the same person. About half of people who experience a mental illness will also experience a substance use disorder sometime in their lives and vice versa. Comorbidity does not describe two or more disorders occurring one after the other. Comorbidity also implies interactions between illnesses that can worsen the course of both.

True or False?  Treatment for comorbid illnesses should focus on both mental illness and substance use disorders together, rather than one or the other.

True False

True or False?  Being infected with HIV automatically means that it will progress to AIDS?

True False

People can reduce their risk of getting or passing on viral infection by all of the following, except:

not using drugs, taking PREP if they are at high risk for infection getting the ceftriaxone vaccine, getting the flu shot if they’ve been exposed to HIV getting PEP if they’ve been exposed to HIV, getting tested for HIV and HCV consistently practicing safer sex, getting the HBV vaccine


is the return to drug use after an attempt to stop. Indicates the need for more or different treatment. is more likely when you have a daily schedule. is less likely if you are surrounded by other people who engage in addictive behaviors. is a sign of ultimate failure, of both the client and the therapist.

Prevention programs should do the following, except:

reverse or reduce risk factors address all forms of drug abuse, underage use of legal drugs, use of illegal drugs, inappropriate use of legally obtained substances, preblockedion medications or over-the-counter drugs. be tailored to address risks specific to population or audience characteristics, such as age, gender, and ethnicity. be designed to intervene as early as Kindergarten to address risk factors

True or False?  The National Academy of Sciences recently issued a scientific report stating that medications for opioid use disorder are effective, save lives and have better long-term outcomes than treatment that does not include medications.

True False

Addiction treatment must help the person do the following, except:

stop using drugs stay drug-free be productive in the family, at work, and in society become physically fit

Successful treatment…

has several steps: detoxification, behavioral counseling, medication (for opioid, tobacco, or alcohol addiction), evaluation and treatment for co-occurring mental health issues such as depression and anxiety, long-term follow-up to prevent relapse deals with one mental health issue at a time so that the patient does not feel overwhelmed does not use medications and/or devices to manage things the patient can do on their own is easily available to people in the criminal justice system because access to harmful or addicting drugs is limited in institutions where they are housed

Maintenance treatment..

Gives the client time to change the people, places and things connected with their drug use and to do so more safely. Minimizes cravings and withdrawal symptoms. Is an approach with the understanding that the best results occur when a patient receives medication for as long as it provides a benefit. All of the above

Distinguishing OUD From Physical Dependence on Opioid Medications.  According to DSM-5 OUD falls under the general category of SUDs and is marked by all of the following except:

Compulsion and craving Loss of control and withdrawal when use stops Intolerance Continued opioid use despite adverse consequences

Case management helps establish the stability necessary for SUD remission.  It helps some people in SUD treatment get or sustain access to services and necessities, such as the following except:

Food and shelter Income support and legal aid Cable and internet services Transportation and vocational services

Recovery occurs via 

getting the client off of being physically dependent on any drug(s) using medicines only at the beginning of treatment waiting until after the client has been tapered off all OUD medication many pathways. OUD medication may play a role in the beginning, middle, or entire continuum of care.

Which of the followingsupports clients in making their own informed decisions about treatment…

Counselors don’t need to agree with client’s decisions but must respect them. Counselors have the education and knowledge to know what is best for the client. Counselors and clients need to be ‘on the same page’ regarding the benefits of longer-term medication Counselors need to remind clients that addiction is not a chronic disease but a matter of choice

Providers provide person-centered care by doing the following except:

Clients control the amount, duration, and scope of services they receive. Selecting the professionals clients will work with. Providing care that is holistic; it respects and responds to clients’ cultural, linguistic, and socioenvironmental-mental needs. Implement services that recognize patients as equal partners in planning, developing, and monitoring care to ensure that it meets each patient’s unique needs.

Which of the following is not a tenet of providing trauma-informed care:

Understanding how trauma can affect clients, families, and communities Applying knowledge of trauma extensively and consistently in both practice and policy Knowing ways to promote recovery from trauma Interventions that may retraumatize or harm clients or staff

Self-determination theory (SDT) suggests that people inherently want to engage in activities that meet their need for the following except:

Autonomy Competency (i.e., self-efficacy) Relatedness (i.e., having close personal relationships) Subjugation

Motivational interviewing (MI) is a counseling approach that is consistent with SDT and

Emphasizes enhancing internal motivation to change Works to investigate the interaction between the conscious and unconscious elements of the mind Emphasizes the complete cessation of drug or alcohol use Uses a system of positive and negative consequences to shape behavior

Motivation helps people resolve their ambivalence about making difficult lifestyle changes, is multidimensional and all of the following, except:

Is influenced by social interactions Cannot be enhanced Is influenced by the counselor’s style Is dynamic and fluctuates

As a therapist, social worker or counselor, your role is to do all of the following except:

help clients recognize when a substance use behavior is inconsistent with their values or stated goals help clients by teaching, instructing and giving unsolicited advice help clients feel competent to change help clients regard positive change to be in their best interest

Approaches in motivational interviewing include all of the following, except:

Focus on client strengths Individualized and person-centered treatment Labeling clients as “addicts” or “alcoholics” Use of empathy, not authority and power

In this stage in the ‘Stages of Change (SOC)’ an individual perceives that the envisioned advantages of change and adverse consequences of substance use outweigh the benefits of maintaining the status quo, the decisional balance tip in favor of change.

Precontemplation Contemplation Preparation Action

In this stage in the ‘Stages of Change (SOC)’ an individual chooses a strategy for change and begins to pursue it.  Clients are actively engaged in changing substance use behaviors.

Contemplation Preparation Action Maintenance

In the SOC model, relapse is the following, except:

A common part of the process as people cycle through the different stages Most often discussed as a setback during the Maintenance stage Is viewed as pathological and a failure Is viewed as a learning opportunity

The MI treatment approach…

Encourages clients to progress at their own pace toward deciding about, planning, making, and sustaining positive behavioral change Sees motivation for change is seen as a dynamic state that therapists can help the client enhance Is client centered and focused on client strengths All of the above

In motivational counseling, FRAMES, Feedback is the following, except:

A time to give personalized feedback to clients about their substance use Usually compares a client’s scores or ratings on standard screening or assessment instruments with normative data from a general population or treatment group Should address cultural differences and norms related to substance misuse Should be direct, forceful and aggressive

Strategies for emphasizing client responsibility include the following ,except:

Ask clients’ permission to talk about their substance use; invite them to consider the information you are presenting. If clients have choices, they feel less need to oppose or dismiss your ideas State clearly that you will not ask clients to do anything they are unwilling to do. Let them know that it is up to them to make choices about behavior change Determine a common agenda for each session State the treatment goals that you have determined for the client

Clients are more likely to adhere to a specific change strategy if they can choose from a menu of options.  Strategies for offering a menu of options include the following, except:

Provide options that are consistent with supporting client autonomy and responsibility Provide information on each option with the option you prefer shown in the best light and skew potential implications for choosing a different option in a negative light Elicit from clients which options they think would work or what has worked for them in the past Brainstorm alternative options if none offered are acceptable to clients

Counselors who show high levels of empathy do all of the following, except:

Focus clients to elaborate only on just the content of their story Are curious Spend time exploring clients’ ideas about their substance use Show an active interest in what clients are saying

In assessing the client’s readiness for change, do the following, except:

Urge the client to go faster through the SOC Realize some clients will cycle back and forth numerous times between stages Know where the client has been and where they are now to facilitate the change process at the right pace Realize some clients need time to resolve their ambivalence about current substance use

All of the following are examples of how to tailor motivation support to the client’s stage in the SOC, except:

In Precontemplation consider change by increasing awareness of behavior change In Preparation resolve ambivalence by helping him or her choose positive change over the current situation In Action carry out and follow through with the change strategies In Maintenance develop new skills to maintain recovery and a lifestyle without substance misuse

Part of being culturally responsive is all of the following, except:

Getting familiar with the populations with whom one is expecting to establish treatment relationships Be open to listening to and learning from clients about their cultures and their own theories of change Treating all clients equally, as if they were variants of the same individual Adapting motivational counseling approaches in consideration of specific cultural norms

The impetus to expand the use of Brief Intervention (BI) is a response to the following, except:

The growing number of people covered under some type of health insurance The need for broader base of treatment and prevention components to serve all segments of the population that have minimal to severe use and misuse patterns The need for cost-effective interventions that satisfy cost-containment policies in an era of managed health care A growing body of research findings that consistently demonstrate the efficacy of BI relative to no intervention

MI is a counseling style based on the following assumptions, except:

Ambivalence about substance use and change is normal and is an important motivational barrier to substance use behavior change Ambivalence cannot be resolved by exploring the client’s intrinsic motivations and values The therapist’s alliance with the client is a collaborative partnership to which both bring important expertise An empathic, supportive counseling style provides conditions under which change can occur.

In the MI model, “Acceptance” refers to the following, except:

Absolute worth: prizing the inherent worth and potential of the client Accurate empathy: an active interest in, and an effort to understand, the client’s internal perspective reflected by your genuine curiosity and reflective listening Arbitrary goals: based on or determined by the more educated and informed one Autonomy support: honoring and respecting a client’s right to and capacity for self-direction

A key concept in MI is ambivalence.  Frequently, client ambivalence…

Is a roadblock to change, not a lack of knowledge or skills about how to change Is denial or resistance Does not create tension or conflict Is not a normal experience in the change process

The following statements are true, except:

Sustain talk consists of client statements that support not changing a health-risk behavior, like substance misuse Change talk consists of client statements that favor change Sustain talk and change talk are expressions of both sides of ambivalence about change In MI, your main goal is to evoke sustain talk and minimize evoking or reinforcing change talk in counseling sessions

To make best use of clients’ change talk and sustain talk that arise in sessions, remember the following, except:

Recognize client expressions of change talk but don’t worry about differentiating various kinds of change talk during a counseling session Use reflective listening to reinforce and help clients elaborate on change talk Recognize sustain talk and use MI strategies to lessen the impact of sustain talk on clients’ readiness to change Be aware that either exclusively change talk or exclusively sustain talk will be present in your conversations with clients

The ‘A’ in the core skills of MI:  OARS, stands for asking open questions and inviting clients to tell their story rather than closed questions, which merely elicit brief information.  The following are all open questions, except:      

“Do you agree that it would be a good idea for you to go through detoxification?” “What is it that brings you here today?” “Tell me about your marijuana use on a typical day.” “In what ways are you concerned about your use of amphetamines?”

Affirming clients…

Is a way to express your genuine appreciation and positive regard for clients Supports and promotes self-efficacy Can boost clients’ confidence about taking action All of the above

Reflective listening does the following, except:

Communicates respect for and acceptance of clients Establishes trust and invites clients to explore their own perceptions, values, and feelings Allows you to be supportive because you agree with all of the client’s statements Encourages a nonjudgmental, collaborative relationship

Summarizing is a form of reflective listening that does all of the following, except:

Distills the essence of several client statements and reflects them back to him or her Reinforces key statements of movement toward change Are intentionally selected statements that may have particular meaning for the client Does not encourage self-reflection

You can fall into this __________________ when you focus on an agenda for change before the client is ready—for example, jumping into solving problems before developing a strong working alliance.  When you focus on an issue that is important to you (e.g., admission to an inpatient treatment program) but not to the client, discord will occur.  This trap is referred to as the _____________.

The Premature Focus Trap The Expert Trap The Question-and-Answer Trap The Labeling Trap

Once you have engaged the client, the next step in MI is to find a direction for the conversation and the counseling process as a whole.   This is called ______ in MI.

SOC Focusing TTM Prioritizing

When clients bring multiple problems to the table or are confused or uncertain about the direction of the conversation, you can engage in _______ , which is a process consistent with MI that helps you and clients decide on the counseling focus.

Free association Agenda mapping Hypnosis Breath awareness meditation

All of the following are true about MI Evoking, except:

Is the core of MI and differentiates it from other counseling methods Elicits client motivations for change Can be used before identifying a target behavior Shapes conversations in ways that encourage clients, not counselors, to argue for change

The following are examples of open questions that elicit change talk in preparation for taking steps to change, except:

“How do you want your life to be different a year from now?” “If you decide to quit drinking, how could you do it?” “What needs to happen?” “Do you want to keep drinking or using?”

To help a client perceive discrepancy, you can use what is sometimes termed the “Columbo approach.”  The “Columbo approach” does the following, except:

The counselor expresses understanding and continuously seeks clarification of the client’s problem and appears to have the right answer The counselor plays the role of a detective who is trying to solve a mystery but is having a difficult time because the clues don’t add up The counselor expresses confusion, which allows the client to take over and explain how these conflicting desires fit together Forces the client, rather than the counselor, to grapple with discrepancies and attempt to resolve them.

Signs of readiness to change include the following, except:

Increased change talk Increased sustain talk Resolve Envisioning

Developing a change plan. Begin with the change goal identified by the client; then, explore specific steps the client can take to achieve it.  Some strategies for helping clients develop change plans include the following, except:

Confirm the change goal, once set do not deviate until the goal is reached Elicit the client’s ideas about how to change, strategies and options Summarize the change plan and the specific steps or pathways the client has identified Explore obstacles, try to anticipate potential obstacles and how the client might respond

In the Precontemplation stage…

Counselors should be nonjudgmental about clients’ low motivation to change and instead focus on building a strong working alliance Counselors should jump into the planning process and develop a plan that is acceptable, accessible, and appropriate Counselors should remember that all clients need a structured method to develop a change plan Counselors should provide information as an expert and teach the client as a calm and patient recipient

Consistent with person-centered counseling principles and the spirit of MI, asking the client for permission to address the topic of changing substance use behaviors…

Is unnecessary, the fact that their behavior needs to change is obvious Shows respect for the client’s autonomy Shows a lack of respect for the therapists’ knowledge and position Sets up unnecessary boundaries for the rest of treatment

“So, drinking helps you relax.  Yet, you say you sometimes resent all the money you are spending, and it’s hard for you to get to work on time, especially Monday mornings.” Is an example of…

Simple reflections Double-sided reflections Agreements with a twist Amplified reflections

Including people with whom the client has a close relationship can make treatment more effective.  Before involving a Significant Other (SO) in the client’s treatment do the following, except:

Ask the client for permission to contact the SO Review confidentiality concerns If the client agrees, obtain the necessary written releases Because of spousal privilege, invite the spouse to surprise the client in treatment

True or False.  Clients mandated to treatment have similar treatment outcomes as those who attend treatment voluntarily.

True False

Along with MI techniques, use the following strategies to identify and strengthen intrinsic motivation, except:

Show genuine curiosity about clients Wait for clients to talk spontaneously about their substance use Reframe clients’ negative statements about external pressure to get treatment Emphasize they can freely choose to change because doing so makes good sense and is desirable, not because negative consequences will happen if they choose not to change.