Addiction Counselor Practice Test Book, All Questions with accurate answers. 100% Verified.

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Addiction Counselor Practice Test Book, All Questions with accurate answers. 100% Verified. *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. *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. *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. *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. *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. *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. *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. *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. *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. *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. *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. *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 twentyfirst 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. *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. *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. *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. *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. *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. *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. *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 nonsubstance abuse mental health issues arise. *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. *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. *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. *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). *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. *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 cooccurring 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. *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. *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. *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. *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. *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). *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. *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. *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. *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. *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 exam [Show More]

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