LCDC TX Exam Questions and Answers with Verified Solutions

LCDC TX Exam Questions and Answers with Verified Solutions A method of reinforcing therapeutic alliance & spirit of collaboration between the PT & counselor: ✔✔setting mutually-established goals A mental status exam ...

LCDC TX Exam Questions and Answers with Verified Solutions A method of reinforcing therapeutic alliance & spirit of collaboration between the PT & counselor: ✔✔setting mutually-established goals A mental status exam includes: ✔✔Appearance Speech Thought Process The provision of info concerning alcohol/drug abuse & the available srvcs & resources: ✔✔client education When should significant others should be involved in the treatment process? ✔✔From the clients first contact with the treatment center The NIDA-financed Drug Abuse reporting Program found that: (having to do with therapeutic communities) ✔✔Therapeutic communities do reduce drug use relative to untreated clients or those who are simply detoxified and released. A dually-diagnosed PT, stablized on meds for his psychatric D/O, wants to quit smoking. You should: ✔✔Consult with his physician regarding nicotine/medication interaction. A cognitive-based therapy, developed by Ellis, designed to confront a PT's irrational thinking ✔✔Rational-Emotive Therapy A "release of information" must include: name, address, DOB & _____? ✔✔The purpose of the release of information When a client discloses suicidal thougths, the counselor's first step is to: ✔✔Assess the degree of risk When conducting an assessment what is the counselor's primary focus? ✔✔Identifying the clients problems and needs, strengths and weaknessess. The BEST indicator if an individual is physically dependent upon alcohol or another drug is: ✔✔The presence of withdrawal symptoms. Guilt and ___ are painful emotions that are part of grieving. ✔✔Anger Despite vast personality differences, virtually all substance abusers experience: ✔✔remorse, self-hatred and shame You are having difficultiy with a client early on in the case. The BEST thing for you to do is: ✔✔Seek out supervision with a colleage or supervisor Self report screening instrument consists of 4 Y/N questions. Requires aprox 1 min to complete ✔✔CAGE questionnaire Drug Offender Profile Evaluation/Refferal Strategies ✔✔D.O.P.E.R.S. Michigan Alcoholism Screening Test ✔✔MAST Self Administered Alcoholism Screening Test ✔✔SAAST Short Michigan Alcoholism Screening Test ✔✔SMAST Substance Abuse Subtle Screening Inventory - Adult or Adolescent Version ✔✔SASSI Addiction Severity Index ✔✔ASI Diagnostic and Statistical Manual of Mental Disorders ✔✔DSM Adapted Short Michigan Alcoholism Screening Test for Fathers ✔✔F-SMAST Global Appraisal of Individual Needs ✔✔GAIN Minnesota Multiphasic Personality Inventory ✔✔MMPI Minnosota Substance Abuse Problems Scale ✔✔MSAPS Readiness To Change Questionnair ✔✔TRCQ Substance Abuse Subtle Screening Invnetory for Adolescents ✔✔SASSI-A Human Immunodeficiency Virus ✔✔HIV The Stages of Change : ✔✔1) pre-contemplation 2) contemplation 3) preparation 4) action 5) maintenance 6) relapse (SCM) Not yeat acknowledging that there is a problem behavoir that needs to be changed ✔✔Pre-Contemplation (SCM) Acknowledging that there is a problem but not yet ready or sure of wanting to make a change ✔✔Contemplation (SCM) Getting ready to change ✔✔Preparation (SCM) Changing behavior ✔✔Action SCM) Maintaining the behavior change ✔✔Maintenance (SCM) Returning to older behaviors and abandoning the new changes ✔✔relapse The Stages of Change Model was originally developed in the late 1970's and early 1980's by... ✔✔James Prochaska, Carlo DiClemente Bio-psychosocial perspective ✔✔This recognizes that there are biological, psychological and social causes of substance abuse and dependence. Biological factors ✔✔These include brain chemistry problems, which may be genetic, making some people particularly vulnerable to addiction to certain drugs once they try them. Psychological factors ✔✔These include cognitive styles, personality traits, and early developmental experiences that may contribute to a client's causes of substance abuse and dependence. Social factors ✔✔These include poverty, oppression, poorly developed social skills, and family dysfunction that may contribute to a client's causes of substance abuse and dependence. Motivational interviewing ✔✔This is a style of interacting with clents, used not only for assessment, but for all phases of treatment, that is particularly helpful for reducing defensiveness and encouraging therapeutic collaboration between the counselor and client. Uses the interpersonal process to enhance clients' motivation to change, and encourages clients to move on to the next stage of readiness for change. Assessment Instruments ✔✔These aid in the identification of, and treatment planning for substance related disorders. Reliability ✔✔This refers to the consistency with which an assessment instrument measures. Validity ✔✔This refers to what an assessment instrument measures and how it is used. Screening Instrument ✔✔This distinguishes individuals who do not have a disorder from those who might have one. ` ✔✔` CAGE ✔✔4 questions - Yes to 1 indicates possibility of alcohol dependence. Cut down? Annoyed by criticism of drinking behavior? Guilty about drinking? Eye-opener? DAST ✔✔Drug Abuse Screening Test (adapted from MAST) used to detect abuse or dependence on drugs other than alcohol. MAST ✔✔Michigan Alcoholism Screening Test - yes or no to 25 questions. RAPS-4 (Rapid Alcohol Problems Screen) ✔✔An answer of yes to one or more questions indcates the possibility of alcohol dependence during the past year. The questions have to do with remorse, amnesia, performance of life duties, and starting the day with alcohol. SASSI (Substance Abuse Subtle Screening Inventory) ✔✔This brief self-report is designed to identify individuals with a high probability of having a substance related disorder. SASSI-A2 ✔✔Substance Abuse Subtle Screening Inventory for Adolescents ages 12 to 18. TLFB (Time Line Follow Back Procedure) ✔✔This is a Comprehensive Measure of Drinking which makes connections between significant events in the client's life and alcohol/drug use patterns and intensity, for the past year. ADS (Alcohol Dependence Scale) ✔✔This diagnostic instrument is a 25-item instrument that provides a quantitative measure of the severity of alcohol dependence. DIS-IV (Diagnostic Interview Schedule - Alcohol Module) ✔✔This diagnostic instrument asks 28 questions that permit diagnosis of alcohol abuse or dependence. ICS (Impaired Control Scale) ✔✔This diagnostic instrument is a pencil and paper selfadministered insturment that measures clients' attempts to control drinking during the last 6 months and their perception of their ability to control it now. OCDS ✔✔Obsessive Compulsive Drinking Scale SADD ✔✔Short Alcohol Dependence Data SDSS ✔✔Substance Dependence Severity Scale ASI (Addiction Severity Index) ✔✔This is a semi-structured interview with seven subscales addressing problems in the areas of family/social status, medical status, employment and support, drug use, alcohol use, legal status, and psychiatric status. It is useful for treatment planning and outcome evaluation with adult clients. AUI (Alcohol Use Inventory) ✔✔This self-report inventory is in multiple-choice format, for ages 16 and up. It is based on the multiple condition theory, which takes into account individuals' different styles of drinking, perceptions of alcohol's benefits and consequences, and how they want to deal with drinking problems. CBI (Coping Behaviors Index) ✔✔This instrument measures factors related to relapse risk: positive thinking, negative thinking, avoidance/distraction, and seeking social supports. WAIS-III (Wechsler Adult Intelligence Scale) ✔✔This is a popular intelligence test. The Strong Interest Inventory ✔✔A vocational interest scale that compares clients' interests to those of people who are happy in different occupations. MMPI-2 ✔✔The Minnesorta Multiphasic Personality Inventory contaings several clinical scales that detect pathology including the MacAndrew Alcoholism Scale. The Mental Status Exam ✔✔A series of observations about a client's appearance, behavior, attention, mood, affect, perceptual and thought processes, judgement, and memory at a given point in time. Includes observations of a client's orientation to time, place and person. MBTI (The Myers-Briggs Type Indicator) ✔✔This is a personality inventory that looks at clients' preferred ways of being in the world and assigns them to 1 of 16 personality types. Frequently used in vocational and relationship counseling. The Beck Depression Inventory II ✔✔Used to track changing levels of depression over the course of treatment for clients age 13 and over. Individuals rate themselves on 21 groups of statements that tap the affective, behavioral, cognitive, and physiological symptoms of depression for the 2 weeks prior to testing. Biomarkers ✔✔Measuring these physiological markers at intervals throughout treatment may provide early identification of relapse. EMIT ✔✔Enzyme Multiplied Immunoassay Test - this urine testing kit uses antibodies that react to the presence of a drug or its metabolites. GGT ✔✔Gamma-glutamyltransferase - indicates prolonged, rather than episodic drinking. ASAT ✔✔Aspartate aminotransferase - screens for heavy drinking. ALAT ✔✔Alanine aminotransferase - screens for heavy drinking. CDT ✔✔Carbohydrate Deficient Transferrin - sensitive enough to pick up moderate drinking over a peoiod of a few weeks. SOCRATES ✔✔A readiness-to-change scale that stands for Stages Of Change Readiness And Treatment Eagerness Scale. URICA ✔✔A readiness-to-change scale that stands for the University of Rhode Island Change Assessment. FTQ ✔✔Family Tree Questionnaire helps clients report information about the incidence of alcohol problems in their blood relatives. Genogram ✔✔A pictorial representation of family structure, using a least three generations and a standard set of symbols. DSM-IV-TR ✔✔Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (APA, 2000). Axis I ✔✔Contains 16 categories of clinical disorders, one of which is Substance Related Disorders. Substance Related Disorders ✔✔This category of clinical disorders in Axis I of the DSM IV-TR includes both Substance Use Disorders and Substance Induced Disorders. Substance Use Disorders ✔✔This sub-category of Substance Related Disorders includes both Substance Abuse and Substance Dependence. Substance Induced Disorders ✔✔These Axis I disorders are a sub-category of Substance Related Disorders and can include Substance Intoxication and Substance Withdrawal, Substance induced delirium, persisting dementia, persisting amnesic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction disorder, and sleep disorder. Axis II ✔✔This axis of the DSM IV- TR includes the personality disorders as well as mental retardation. Cluster A ✔✔Axis II disorders that feature odd, eccentric, isolative, or suspicious behavior. They include Paranoid, Schizoid, and Schizotypal personality disorders. Cluster B ✔✔Axis II disorders that often co-occur with substance abuse and dependence, and are characterized by dramatic, emotional, erratic, or impulsive behavior, or a reduced capacity for empathy. They include Antisocial Personality Disorder, BPD, Histrionic Personality Disorder and Narcissistic Personality Disorder. Antisocial Personality Disorder ✔✔This personality disorder features a pervasive pattern of disregard for and violation of the rights of others. Borderline Personality Disorder ✔✔This personality disorder features a pervasive pattern of instability in interpersonal relationships, self-image, affect, and control over inpulses. Features may include frantic attempts to avoid real or imagined abandonment, impulsivity in at least two areas that are self-damaging, chronic feelings of emptiness. Histrionic Personality Disorder ✔✔This personality disorder features a pervasive pattern of excessive emotionality and attention seeking, often with provocative dress. Narcissistic Personality Disorder ✔✔This personality disorder features a pervasive pattern of grandiosity, need for admiration, and lack of empathy. Cluster C ✔✔These Axis II personality disorders feature anxious, fearful, and perfectionistic behavior. They are the Avoidant, Dependent, and Obsessive-Compulsive personality disorders. ` ✔✔` Axis V ✔✔This axis of the DSM IV -TR is the Global Assessment of Functioning (GAF) scale, which assigns a number from 1 to 100 to the counselor's judgement of the client's overall level of psychological, social and occupational functioning. Substance Abuse ✔✔A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by at least one of the four following criteria occurring within a 12- month period: recurrent substance use resulting in a failure to fulfill major obligations at home, school or work, recurrent substance use in situations in which it is physically hazardous, recurrent substance use legal problems, and continued substance use despite having persistent or recurring problems caused or exacerbated by the effects of the substance. Substance Dependence ✔✔A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by 3 or more of the following 7 criteria: tolerance, withdrawal, increased dose or dosing for longer periods of time, attempts to cut down unsuccessfully, time spent obtaining, using, recovering from use, important social, occupational and recreational activities given up or reduced because of use, physical or psychological problems caused or exacerbated by continued use. Physiological Dependence ✔✔Indicated by whether tolerance and withdrawal are present. Withdrawal ✔✔Defined by either the characteristic withdrawal syndrome for the substance or the same or a closely related substance being taken to relieve or avoid withdrawal symptoms. Specifiers ✔✔Used for Substance Dependence Diagnosis, these 6 categories are: Early full remission, early partial remission, sustained full remission, sustained partial remission, on agonist therapy, in a controlled environment. Polysubstance Dependence ✔✔The proper diagnosis for a client who has repeatedly taken at least three groups of substances, and who meets creiteria for dependence for the substances as a group, but not for the substances individually. Dually-Diagnosed ✔✔This client has one or more other psychiatric disorders along with substance abuse or substance dependence. Also known as co-occurring disorders. All disorders should be treated concurrently and aggressively. Affect ✔✔The external expression of an internal emotional state. Mood ✔✔A sustained emotion. Changes less frequently than affect. Delusions ✔✔False beliefs that are maintained despite proof against their truth. Hallucinations ✔✔Perceiving something in the absence of a sensory input. May be auditory, visual, olfactory, gustatory or tactile. Illusions ✔✔Misperceptions of actual sensory input. Problem Statement ✔✔Component of a MTP that should be stated in client's words whenever possible. Answers the question, "Why are you here?" Include statement of problem and evidence for it. Goal Statement ✔✔Component of a MTP that should be acceptable to the client and answers the question, "What is necessary to remedy the problem?" Should be stated positively - eg. "Client will maintain abstinence," rather than, "Client will not drink." Objectives ✔✔Component of a MTP that states specific things the client will do to meet the goal. Stated in behavioral terms, and are observable, realistic, time specific, appropriate to the level of treatment and measurable. Strategies ✔✔Component of a MTP that states what the counselor will do to help meet the client's objectives. Includes the theoretical model to be used, (eg. reality therapy) and the specific techniques to be employed (eg. assertiveness training or refusal skills training). These are sometimes also called "Interventions". Axis I, IV and V ✔✔CASACs are responible for these three axes on the Written Assessment Summary. Other axes can be written up as "deferred" or list symptoms eg. deferred, reports frequent headaches. AUDIT ✔✔world health organization, over 8 suggests harmful consumption, looks at frequency ` ✔✔` DAST ✔✔drug dependence other than alc...lifetime severity RAPS4 ✔✔Remorse, amnesia, personal respon, start day with drink...alc dependence SASSI ✔✔allows diagnosis of cohabitating disorders...self report TWEAK ✔✔use/abuse during pregnancy CBI ✔✔coping behav inventory...relapse, social supports, attitude and avoidance WAIS ✔✔Weschler...intelligence tet MMPI ✔✔personality inventory...detects pathology MMPI ✔✔MacAndrews alc scale Myers Briggs ✔✔1-16 personality...no pathology EMT ✔✔urine tests, tests metabolites/drugs, heroin, marij, pcp, cocaine Beck depression ✔✔21 item...depression symptoms for 2 weeks...29-63 depression CDT ✔✔blood biomarker...detects long term drinking Induced disorder ✔✔brought on or worsened by substance sub abuse disorder ✔✔substance abuse and dependence Axis I ✔✔mood disorders Axis II ✔✔personality disorder Axis II Cluster A ✔✔odd...eccentric...suspicious Axis II Cluster B ✔✔dramatic...emotional..impulsive...lack empathy Axis III Cluster C ✔✔Fearful...anxious...perfectionist Axis III ✔✔medical Substance abuse ✔✔maladaptive patter of abuse...1 of 4 criteria..failure to meet life duties. cant quit, legal problems, continues regardless of danger Substance dependence ✔✔maladaptive pattern...3 of 7 criteria..cutting back, cont use despite prob, tolerance, gives up activities ` ✔✔` Mood ✔✔sustained emotion that colors the perception of the world Dellusions ✔✔continued belief of something even when proof against it....false belief based on faulty external reality Hallucinations ✔✔sensory perception of reality occuring without external stimuli Illusions ✔✔misperception about a real external stimuli...rustling leafs... Assesment ✔✔gathering info about pt in order to make informed diagnostic impression Empathy ✔✔ability to perceive pt emotions and see their world thru their eyes concreteness ✔✔relates vague aspect to concrete terms...helps with coping skills paraphrasing ✔✔picking out emotions and repeating them back with added clarity...builds trust and reduces resistance Reflection ✔✔restates content that produces emotions, counselor stays neutral simplifying ✔✔reflection, removes confusion, avoids convoluted explanations so they can solve problem in here and now Probing ✔✔open ended questions help clarify and move to new understanding Reframing ✔✔offers new perspective to situation exploring alternatives ✔✔examine various options to pt Person Centered Theory ✔✔Carl Rogers Person Centered ✔✔Here and now...people are resourceful and capable of solving own problems and are trustworthy Person Centered ✔✔3 characteristics; unconditional positve regard, genuiness and accurate empathy Person Centered ✔✔in addictions counseling; builds rapport and T.R to help pt recover Reality Therapy ✔✔William Glasser Reality Therapy ✔✔Help pt in here and now...frustrated with psychoanalysis Reality Therapy ✔✔humans have 2 basic needs; love and feel worthwhile Reality Therapy ✔✔accepts no excuses..holds pt accountable..allows for natural consequences...no enabling Reality Therapy techniques ✔✔challenge inappropriate beh, focus on strengths, discourages excses, help pt achieve goal, find constructive way to meet goals Reality therapy ✔✔rejects medical mode, emphasis on responsibility, no transference and encourages counselor to be himself Rational Emotive ✔✔Albert Ellis Rational Emotive ✔✔people born with both rational and irrational beliefs Rational Emotive ✔✔learn irrational thoughts as a child that can lead to self destructive behavior...disturbances come from faulty beliefs of everyone should love you Rational Emotive ✔✔Help pt confront irrational beliefs through gathering evidence...pt becomes aware of automatic thought process Rational Emotive - irrational thoughts ✔✔lead to self criticism, isolation, self abuse, not striving for potential and drug use Rational Emotive ✔✔A-B-C; activating event, belief about, and consequences Rational Emotive - techniques ✔✔detect irrational beliefs through words (ought, should, must and always)...when is that not true...homework given Cognitive behavior ✔✔Aaron Beck Cognitive behavior ✔✔focus on here and now, pt with emotional probls have faulty thinking or incorrect info Cognitive behavior ✔✔cognitive distortions - over generalization, minimization, personalizing events, polarized thinking Cognitive behavior - Techniques ✔✔challenge faulty thoughts, ask where did evidence come from, instill hope, Socratic Brief Therapy ✔✔time limited, structured, directed at specific goal Brief Therapy ✔✔uses motivation to change behavior, avoid getting ahead of pt, understands stages to help clinican Brief Therapy ✔✔reduces pt risk of harm from controlled substance use, specific goals for consumption pattern, key is to extract single behavior change process Brief Therapy ✔✔Five Stages Brief Therapy - Precontemplation ✔✔user not considering change, or acknowledge problem exists Brief Therapy - contemplation ✔✔acknowledges problem, ambivalent about change Brief Therapy - determination ✔✔begins once user decides to change - plan of action Brief Therapy - action ✔✔putting plan into action, uses new behav, not yet stable Brief Therapy - maintenance ✔✔establishes new behav on long term basis Constructivism ✔✔George Kelly Constructivism ✔✔people have system of constructs and symbols that reflect themselves in their world. Problem is discrepancy between people capacity and current demands of environment. Constructivism ✔✔focus current problem,then patterns...attention given to background and early attachment Constructivism ✔✔view people in positive optimistic terms, proactive, goal driven, operate according to the knowledge they posses Constructivism ✔✔clinican does not direct or pursuade, they use elaboration and metaphors to advance the process, serve as co-investigators helping pt construct rewarding way of being and coping. Feminist therapy ✔✔Helen Deutsch and Karen Horney Feminist therapy ✔✔Give women view of social position and sense of community with new power, possibilities and overriding binding stigmas Family Systems Theory ✔✔help addicts decrease anxiety by getting family members to focus on their own recovery, Families are systems of interconnected ad interdependent individuals, a system of interacting parts Human Validation process ✔✔Virginia Satir - assisting individuals in transforming family rules and messages (specifically abut individuation and communication) to be more acceptable and flexible, allowing for change, enhance and validate self-esteem; family rules; sculpting; nurturing triads; congruence & openness in communication; family mapping & chronologies Therapist is the role model, facilitator, resource person and investigator Structural famly therapy - present & past ✔✔Salvador Minuchin- modify the present, past changed by interventions. Three subsystems of nuclear family - parent subsystem, sibling, sibling/parent Structural famly therapy - Clear boundaries ✔✔Clear but firm boundaries Structural famly therapy - present & past ✔✔family supported but nurtured, balance between autonomy and connectedness; freedom to indivuate Structural famly therapy - Rigid boundaries ✔✔too much distance between family members, children fight for boundaries, negotiate for themselves without parental protection Structural famly therapy - diffuse boundaries ✔✔enmeshment, everyone in everyone elses business, distinctions not present between subsystems Intervention - organizer ✔✔witnessed the addiction firsthand and aware of consequences Intervention - choose team ✔✔choose team gather data, make list of incidents, describe incident, no anger or accusations Intervention - rehearse ✔✔go over each item on list, determine order to read list, allows you to find out team members individual emotions Intervention - steps ✔✔determine steps that will be taken if person does not seek help Intervention - treatment ✔✔find out about treatment, cost and info Therapeutic community ✔✔believes substance abuse is whole person; self help proess of incremental learning; changes in behavior, values and attitudes Social learning model ✔✔therp communities based on social learning model, goal is to learn to be different by participating in community that operates by different rules; commonly used for judicial treatment Components ✔✔members contribute, observe peers, model behavir, shared norms and values, structure, and relationships Case Mgt - Assessment ✔✔identify pt strength, weakness and needs Case Mgt - Planning ✔✔negotiate what pt wants, develop plan for achieving it Case Mgt - linking system ✔✔help pt obtain required services by referring to services for formal/informal care Case Mgt - advocacy ✔✔intercede on behalf of pt to obtain needed resources Case Mgt - monitoring ✔✔evaluate progress continuously and take action if needed Case Mgt - Brokerage- ✔✔id pt needs help access resources, no advocacy but when pt needs access to resources Case Mgt - Assertive community ✔✔frequent long term contact with pt in natural setting, focus on practical problems of daily living Case Mgt - strengths based ✔✔aggressive outreach, helps pt develop goal, advocates, and view community as resources not a barrier, this is an alternative to disease concept Level I Treatment ✔✔outpatient Level 2 treatment ✔✔intensive outpatient/partical hospitalization Level 3 ✔✔residential or inpatient Level 4 ✔✔medically managed intensive inpatient Aftercare ✔✔called continuing care, follows discharge, case mgr helps transition, and take responsibility for their lives Disengagement ✔✔takes place over time, discuss what has been learned in treatment Community resources ✔✔coordination variety of resources, counselor should be familiar with resources Advocacy coordination in case mgt ✔✔involves coordinating with family, community agencies, legal system and legislative bodies Culturally sensitive case mgt ✔✔pt should be linked to services whose values are consistent with their own Case mgt with women ✔✔reluctant to seek treatment without encouragement, medical, mental health and family counseling see more women case mgt with adolescents ✔✔encouraging family involvement, provide support, track relapse episodes, connect with school, work and community resources Evaluate case mgt effectiveness ✔✔track through interviews, professionals, self report, arrests.. Sociocultural view of substance disorders ✔✔stressful socioeconomic conditions, cultural differences in drinking patterns can enhane or reduce risk; social pressure, attitudes and cultural norms all influence behavioral view ✔✔influence both positive and negative reinforcement as casual factor for cont drug use; positve reinforcement reinforces the cont use because of pleasure pathway, reinforcement pleasure thru effects on GABA neurotransmitters Negative reinforcement ✔✔provides escape from neg feelings, also called tension reduction, self medication; avoiding unpleasant w/d symptoms Biological view of addiction ✔✔biogenetic factors cause behavioral and psychological change; internal, not environmental causes Mesolimbic dopamine sys ✔✔A central group of structures is common to the actions of all drugs / pleasure pathway in the brain Aldehyde dehydrogenase ✔✔an enzyme that is involved in metabolizing alcohol Primary prevention ✔✔intended for young with no experience, promotes abstinence, develops refusal skills, promote viable alternatives Secondary prevention ✔✔seeks to stop experimental, incorporates intervention, education, skills to avoid future use, instead of jail use treatment Tertiary prevention ✔✔focus on stopping progressive damage of drug use, incorporates group intervention to get people into treatment, residential ther communities, promotes healthire life style Treatment recovery continuum ✔✔nonuse, moderate and non problematic use, heavy and non problematic use, heavey use with moderal life, heavy use with seirous life prob, depen/addiction with life and health prob Identification ✔✔can be self id, court order, probation ` ✔✔` Stabilization ✔✔includes need for detox at a medical facility Rehab/tx program ✔✔can range from providing duc, intensive outpatient, inpatient residential prog Relapse prevention ✔✔recovery and relapse are ongoing, not one event, should id individual triggers and plan to confront as they occur, should be part of pt aftercare AVE ✔✔abstinence violation effect - tendency for some to use substances problematically when they believe abstinence is too difficult, happens when person attempts to abstain and then faces conflict and guilt Denial ✔✔early when occasional excessive drinking are explained as isolated event Attempts to eliminate ✔✔users partner realizes usage not normal and pressures him to quit/cut back Disorganization/chaos ✔✔family operations have broken down, partner has to deal with critical situations Reorganization in spite of prob ✔✔partner takes charge redirecting main focus from user to maintain life Family reorganization ✔✔seperation occurs and family without user Physical signs of alcohol dependence ✔✔weakened overall appearance, hyper pigmented, jaundice skin, ataxia, unstady gate Internal signs of alc ✔✔irritation causes inflammation, abdominal pain, bleeding esophagus and stomach Chronic use ✔✔acute pancreatitis, inflammation of panreas, blocking of duct causing digestive juices to produce fat and then injury through attempts to digest Moderate alc ✔✔decrease risk of gallstones, harms liver, acute fatty liver is fat deposits, build up in liver cells, is reversable if stopped Alcoholic hepatitis ✔✔heavy or extnded bout of alco, inflammation of liver, metablilism is disrupted, jaundice, may be reversible with medical intervention Cirrhosis ✔✔permanent, widespread destruction of liver cells, progress can slow with cessation Anemia ✔✔insufficeient function of red blood cells, affects nutrient levels, buildup of toxins reduces red blood cells production, those that are produced are defective and can cause bleeding from ulcers White blood cells ✔✔chronic alc use reduces white blood cells, negatively affects immune sys, increases chances of infection AHMD ✔✔alco heart muscle disease - serious condition where heart does not pump amt of blood needed for demands of body Seasonal alcohol arrhythmias ✔✔healy alcohol consumption assoc with holidays, subsides in few days ADH ✔✔antidireutic hormone - can inhibit production and output of ADH by pituitary region of brain, causing kidneys to reasbsorb less water, and produce more urine Respiratory sys decrease ✔✔increases respirations when low to moderate doses are used, larger or toxic amts Pulmonary defense ✔✔contrubtue to chronic obsturction in airflow, bronchospasm, affects asthma lung cancer high long term drinkers, smokers and increases risk of TB Endocrine system ✔✔affect pituitary gland, liver damage, production of, reception of and metabolizing of hormones may be affected by alco Skin ✔✔dilates vessels of skin, jaundice, itching, changes in hair distribution, skin infections because liver dysfunciton Substance abuse effects on musculoskeletal system ✔✔arthritis, gouty arthiritis CNS ✔✔CNS - Body's coordinating center for mechanical and chemical actions, brain and spinal cord Black out ✔✔amnesia like state, appear to be functioning normally but have no memory of what went on Step 1 ✔✔admit powerlessness and lives unmanageble Step 2 ✔✔a power greater than ourselves can restor sanity..indiv recognizes insanity of and moves toward higher power Step 3 ✔✔made decision to turn lives over to God, enables indiv to go to life preserver, begins search for own direction Step 4 ✔✔Made a searching and fearless moral inventory of self, provokes indiv to look closer at basic errors in perceptin, begains teaching about responsibility Step 5 ✔✔Admit to God, ourselves and others the nature of our wrongs, allows the release of neg behav and wrong doings Step 6 ✔✔we entirely ready to have God remove all defects of character, this step let go Step 7 ✔✔Humbly ask him to remove short comings, admits to fear of repeated unhealthy behav Step 8 ✔✔made list of person harmed and make amends Step 9 ✔✔made direct aments, concerded effort to clean up situations and wrong doings Step 10 ✔✔Cont to take personal inventory and when we were wrong promptly admit it...promote support of sobriey and continue chane, helps recognize dont have to slip back into old habits Step 11 ✔✔sought through prayer and meditation to improve our conscious contact with God Step 12 ✔✔having had spiritual awakening as result of steps, this step vital to maintain sobriety, sharing steps with others Rational recovery ✔✔self help based on RET, self reliance, non-spiritual, AVRT addictive coice recognition technique Moderate mgt ✔✔not intended for alcoholic, but prblem drinkers, abstinence is not primary goals but guidelines and limits for moderate drinking, promotes early self recognition of risky drinking behav Secular org for sobriety SOS ✔✔promotes one day at a time toward sobriety, non religious, sobriety being the priority in addict life Drug ✔✔any substance, after enters body changes either the structure or function of body Medicine ✔✔includes drugs used to prevent, treatment, diagnose illness/relieve pain Misuse ✔✔unintentional or inappropriate use of drug for what other than intended Abuse ✔✔intentional use of drug other than intended, to achiee altered state of consciousness, leads to mental, phyusical, emotional or social impariment of using, family or society Intoxication ✔✔temporary change caused by significant amt of drug affecting emotional, cognitive or psychomotor functioning Dependence ✔✔after using drugs, indiv finds difficult or impossible to control use, dependenc or addiction usually involves tolerance or W/D Physical dep ✔✔state of functional adaptation to drug in which presence of foreigh chemical becomes normal and absence of drug would present abnormal state Cross dependence ✔✔a person who is physically dep to one drug, lessens or prevents W/D symptoms by using other drugs with similar classification Tolerance ✔✔altered physiolocal state develops after repeated drug use and body becomes accustomed and adapts to presence of drug, evidenced by drug having less of an effect in same dose Pharmacodynamic tolerance ✔✔nerve cells become less sensitive to effects of drug over time Metabolic tolerance ✔✔liver adapts to presence of drug over time and produces mre enzyme to break down drug Behavioral tolerance ✔✔when, after peiro of time repeated drug use the user is able to modify their behav in hopes that others wont notice intoxication a form of diminishing effect that takes place because the user becomes accustomed to the effects of a given drug and how to act under its influence Cross tolerance ✔✔increased tolerance to effects of another drug in same class Reverse tolerance ✔✔kindling efect - indiv can become more senstive to drugs rather than less sensitive Dose ✔✔amt of drug taken at any particular time Half life ✔✔length of time drug remains in body and continues to affect user Threshold dose ✔✔minimal dose - smallest amt of drug to produce detectable response Max effect ✔✔greatest response from drug no matter the dose given or taken Effective dose ✔✔amt of drug necessary to get desired effect in about 50% of those who use Lethal dose ✔✔dose of drug results in death Therapeutic index ✔✔dose determined to be safe for use and desired effect of drug, determined by dividing the lethal dose by effective dose Potency ✔✔amt of drug needed to produce desired effect Additive Effect ✔✔when two or more drugs used same time result are equal to the sum of the actions of the drugs used Synergistic interactions ✔✔occur two or more drugs used same time, results are greater than the sum of the actions of the drugs used Antagonistic interactions ✔✔occur when two or more drugs used same time, results are less than the sum of the acitons of the drug or they cancel the effects of each other Oral ✔✔mouth or swallowed - 15 min Injected ✔✔IV - few seconds to minutes Inhalation ✔✔inhaled into lungs, immediately or few sec Snorted ✔✔inhaled into nose absorbed through mucus membrances Neurotransmitters ✔✔chemical messengers Gaba ✔✔relates to inhibitory factors and slows communication Norepinephrine ✔✔A neurotransmitter involved in arousal, as well as in learning and mood regulation Dopamine ✔✔neurotransmitter associated with movement, attention and learning and the brain's pleasure and reward system. Serotonin ✔✔anxiety, depression and aggressiveness Affects mood, hunger, sleep, and arousal Acetylcholine ✔✔arousal reactions or inhibitory factors VTA ✔✔bentral tegmental area and nucleus accumbens of brain make up leasure center, responsible for reward sys for all drugs Abuse potential ✔✔speed of action and how long lasts/ and social factors Schedule I ✔✔high level of abuse/dep, no accepted medical, heroin, lsd, marijuana Schedule II ✔✔some medical use, restrictions of manufaucturing, prescriptions not refillable Schedule III ✔✔moderate to low physical dep, high psychological dep, medical uses; steriords, barbituates, ketamine Schedule IV ✔✔low physical dep, moderate psychologcal dep, xanax, barbitatues, chloral hydrate Schedule V ✔✔low risk for either; medical mixture of opium or codeine Depressants ✔✔slow CNS, decreases alertness and judgment, binds to GABA inhibitor receptors Alcohol W/D ✔✔anxiety, hyper arousal, elevated vitals, sweating, shakes, altered perceptin, visual/tactile hallucinations and illusions/swizures, possible death if combined with alco or barbituate Cocaine ✔✔snorting - 20 to 30 min, remains brain 2/3 days, affects dopamine, norepinephrine and serotonin; blocks reuptake of dopamine increasing amt and prolonging the dopamine effect Amphetamine ✔✔direct the release of dopamine and norepinephrine and blocks reuptake creating euphoric effect Meth ✔✔smoke, immediate intense rush lasts few min Stimulants produce ✔✔alertness, well being, euphoria, increased engry,anxiety, medical prob, cardiac, cns, respiratory and potential death Stimulants ✔✔tolerance and dependence, snxiety, confusion, social w/d, weight loss, psychosis, potential death, ireversable prob with CNS Stimulant W/D ✔✔depression with suicidal thoughts, excessive need for sleep, fatigue, increased appetite, drug craving, not life threathening but suicide potential high Hallucinogens ✔✔change sensory perceptino and alter reality; hallicunations naturally occuring and synthetically prepared drugs LSD side effects ✔✔panic attacks, increased blood pressure, heart palpitations, tremors, nausea, muscle weakness, increased temp, LSD ✔✔structured like serotonin and binds to receptors MDMA ✔✔nausea, clenching of jaw, blurred vision, painic attacks, confusion, depression, paranoid psychosis, increased temp, cardiac arrest PCP ✔✔psychotic reactions, bizarre behavior, ourbursts of hostility and violence, impending death Ketamine ✔✔can be snorted or injected, frightening experience of complete sensory detachment, paranoia, boredom, explained near death experiences Cannabinoids ✔✔mari, hashish, thc, well being, relaxed, euphoria, etachment, altered level of consciuonsess, altered sense of time Effects ✔✔slowed reaction time, altered perception, panic, anxiety, dizziness, increased respiration, heart rate and body temp, red eyes, mild dilation of pupils, tremors, decreased coordination, anxiety, probl with memory and possible hallucinations Client files should be readily accessible to? ✔✔only those persons directly involved in providing clinical services. The first barbiturate produced in 1903 was called ✔✔barbital Dr. Sigmund Frued unsuccessfully used cocaine to ✔✔reduce the severity of withdrawal symptoms of morphine addicts. Heroin, a chemically altered form of morphine, was originally introduced as ✔✔a cure for morphine addiction. THC can produce ✔✔hallucinations and analgesia The "businessman's lunch" is a term used for ✔✔DMT Regarding a "seropositive" result, the person has? ✔✔AIDS The Interpersonal style in which a member of a minority group has pride in his/her racial identity; it's history and cultural traditions and yet is comfortable in operating in the world is known as: ✔✔The Bi-cltural Interpersonal Style Prohibtion caused _________________to occur. ✔✔Decreased number of deaths associated with alcoholism Several experts believe that burn-out occurs in stages. The first stage is______________. ✔✔enthusiasm Pattern of drinking accurately associated with the term "alcoholism" ✔✔Inability to control the amount one drinks Metalbolic process that changes alcohol to the compound acetaldehyde ✔✔detoxification Frequent mistake that begining counselors make with clients ✔✔Failure to openly discuss each others expectations Metabolic process that leads to the formation of water and carbon dioxide by process of chemically heating acetic acid ✔✔oxidation Part of the brain that controls heart rate, hunger, body weight and arterial blood pressure ✔✔hypothalamus Style of counseling in which a counselor is aware of his/her fears and dislikes for a minority culture but hides those fears beneath the surface of counseling ✔✔Covert (Hidden) Prejudice Neurotransmitter associated with arousal and mood ✔✔norepinephrine Functional and structural unit of the nervous system ✔✔neuron If an anti-ulcer medicine tends to increase blood alcohol levels and thus makes drinkers more intoxicated, this type of drug interaction would be best described as _____________. ✔✔potentiating Five Critical Components of Effective Treatment ✔✔Assessment, Patient-treatment matching, Comprehensive services, Relapse prevention and Accountability of the treatment program The medical view of addiction understands that addicted persons have a ________________. ✔✔treatable disease Addiction is a __________ disorder that is prone to relapse, even after significant periods of recovery. ✔✔chronic Which two basic categories have treatment approaches evolved? ✔✔pharmacological and behavioral modalities Criminal view of addiction defines drug use as a ___________. ✔✔criminal behavior. The nervous system is comprised of the specialized structures that control and coordinate all body activities through the process of _______________ and ____________. ✔✔stimulus; response Three stages of the process of stimulus and response ✔✔sensory reception, interconnection and motor response Three major structures of the nervous system ✔✔Brain, spinal cord and peripheral nerves Two major parts of the nervous system ✔✔Central and peripheral nervous systems Two subdivisions of the peripheral nervous system ✔✔somatic and autonomic systems Somatic system ✔✔Comprised of the cranial and spinal nerves which connect the CNS to the skin and the skeletal muscles Autonomic System ✔✔Nerves connect the CNS to the various body organs; including heart, stomach, intestines and various glands If one drug, such as a barbiturate tends to reduce the effectiveness of an oral contraceptive, the drug interaction would be most accurately described as _________. ✔✔antagonistic An irresistible impulse ✔✔compulsion Barbiturates can be sub-classified into group by__________. ✔✔the speed of the onset and duration of the effects Heroin is an example of a ___________. ✔✔semi-synthetic narcotic The ___________is the basic unit of the nervous system. ✔✔neuron When an electrical impulse reaches the end of an axon; tiny saclike structures known as synaptic knobs manufacture chemicals called ___________. ✔✔Neurotransmitter Excitatory neurotransmitter released by axons ✔✔Acetylcholine Neurotransmitter found in the brain associated with movement and pleasure ✔✔Dopamine Neurotransmitter associated with regulation of sensory perception, sleep and body temp and its alterations in functioning have been found to be related to mental illness and certain drug hallucinations ✔✔serotonin NIDA- financed drug abuse reporting program found ( having to do with therapeutic communities) ✔✔therapeutic communities do reduce drug use relative to untreated clients or those who are simply detoxified and released when should significant others be involved in the treatment process ✔✔From first contact with treatment center Provision of information concerning alcohol and other drug abuse and the available services and resources ✔✔Client Education Mental status exam does not assess: a) education level b) appearance c)speech d) thought process ✔✔education level Major method of reinforcing the therapeutic alliance and spirit of collaboration between the client and the counselor ✔✔setting mutually-established goals All of the following are benzodiazepines except: a)valium b)halcion c)trazodone d)xanax ✔✔trazodone Tendency of the family to try and maintain balance ✔✔homeostasis Primary purpose of professional standards of practice ✔✔Provide recognition of demonstrated competency in addictions counseling Primary purpose of a professional code of ethics ✔✔Serve as a guideline helping clients while behaving in a fair way to colleagues One of the best safeguards against differential power ✔✔Be alert to and understand the power relationship Common error counselors make when conducting an assessment? ✔✔Moving too quickly from data collection to treatment planning You are having difficulty with a client early in the case ✔✔Seek out supervision/consultation CAGE questionaire ✔✔Self report screening instrument consisting of 4 yes or no questions. Requires approx. 1 min to complete Stages of Change ✔✔Pre-contemplation, Contemplation, Preparation, Action, Maintenance, Relapse Not yet acknowledging that there is a problem behavior that needs to be changed. ✔✔Precontemplation Acknowledging that there is a problem but not yet ready or sure of wanting to make a change ✔✔Contemplation Getting ready to change ✔✔Preparation Changing behavior ✔✔Action Stress inoculation ✔✔Focuses primarily on increasing coping skills Special study of where and how drugs act in the human body ✔✔Pharmacodynamic " primum non nocere" ✔✔Do no Harm Potential pitfall for new counselors ✔✔Over-identification with clients 2nd or transition stage of group development involves ✔✔Control issues After absorption and distribution of a drug, it is metabolized by the ___________. ✔✔liver Positive reinforcement ✔✔Something specifically designed to increase the occurrence of a particular behavior What should occur after a PT is considered appropriate and eligible for treatment? ✔✔Counselor should provide the PT with an overview describing the goals, objectives, rules and obligations of the program Personality Disorders ✔✔Maladaptive ways of perceiving, thinking and relating While the overall national suicide rate has increased slightly but consistently in recent years, disproportionate increase have occurred among ✔✔females and the young Seconal taken with what drug will lead to a "potentiation"effect ✔✔Alcohol To assist them in handling termination issues, effective counselors use appropriate levels ✔✔self- disclosure T or F: Alcohol accounts for one half of the ten leading causes of death in the Native American population ✔✔True During a session you notice that the client is getting progressively more agitated. You suspect potential violence unless something is done immediately. Best course of action: ✔✔Call for assistance After a counselor has made a summary statement, the most important thing the counselor should do is ______________. ✔✔Remain quiet for a time to allow the client to consider the summarized material Bi-polar mood disorder is distinguished from major depression ✔✔By at least one episode of mania Must always be considered when consulting with out-of -agency professionals ✔✔Confidentiality Process of termination should be discussed ✔✔At the onset of treatment Chronis and relapsing nature ✔✔Disorder of addiction The metabolic effects of alcohol and other drugs alter the individual's chemistry because psychoactive drugs mimic, displace, block or deplete_________________. ✔✔specific chemical messengers between nerve cells in the brain Process of Addiction: Stage One ✔✔Experimental and Social Use of Drugs and Alcohol Process of Addiction: Stage Two ✔✔Problem Use or Abuse Process of Addiction: Stage Three ✔✔Dependency/Addiction Frequent client reaction during the termination phase of counseling ✔✔Acting out behavior Goal of an effective aftercare program ✔✔Support gains made in treatment T or F: According to the American Society of Addiction Medicine(ASAM), detoxification services are one of the five categories of primary treatment. ✔✔False 3 Stages of effective treatment ✔✔medical/physical interventions, psychosocial rehabilitation and aftercare Most important criteria for client inclusion in group counseling ✔✔Motivation Tor F: Counselors should visit facilities to which they frequently make referrals. ✔✔True Progress Notes ✔✔Must include interpretations of progress with reference to directly observed behaviors T or F: Hallucinogens are associated with physical withdrawal. ✔✔False A counselor best communicates a non judgmental attitude by ______________ ✔✔non-verbal behavior Codiene, morphine and opium fall under what drug classification ✔✔narcotics Drug misuse ✔✔Combining alcohol with other depressant drugs PT discloses suicidal thoughts, counselor's first step? ✔✔Assess the degree of risk " Release of Information" form must include client's name, address, date of birth and ________________. ✔✔purpose for release Your dually-diagnosed client, stabilized on medication for his psychiatric disorder, decides he wants to quit smoking. You should: ✔✔Consult with his physician regarding nicotine/medication interaction Trazadone is an ______________. ✔✔antidpressant Valium, Halcion and Xanax are _________________. ✔✔bezodiazepines In a crisis interview with a client, you are most concerned with ✔✔focusing questions about the present situation and the clients means of coping with the stress. While taking an alcohol drug history, a good clue to alcohol dependence is _________________. ✔✔increased tolerance and withdrawal symptoms when abstinence is attempted You have assessed your client and determined that he is a problem drinker. He insists that the reason he drinks is because of his wife's behavior. You intial objective is to help him? ✔✔take responsibility for his behavior The intake process involves________________. ✔✔screening When alcohol and barbiturates are taken together, what pharmacological affect are they likely to have? ✔✔synergistic Despite Vast personality differences, virtually all substance abusers experience ✔✔remorse, selfhatred and shame T or F: Guilt and anger are painful emotions that are part of grieving ✔✔True The best indicator if an individual is physically dependent upon alcohol or another drug is ✔✔the presence of withdrawal symptoms When conducting an assessment, what is the counselor's primary focus? ✔✔Identifying the clients problems, needs, strengths and weaknesses The primary purpose of the screening process is to ✔✔determine one's appropriateness and eligibility for admission During the screening process, a critical task that the counselor has to do is to ✔✔establish rapport with the client. Therapeutic communities differ from Synanon because ✔✔these communities try to return clients to society. What popular street drug that includes the main ingredient Cathonine? ✔✔KHAT The following naturally occurring substance is not classified as a stimulant ✔✔Ergot DOM, MDA and MDMA are ? ✔✔hallucinogen amphetamines Double-Consciousness for a minority client means ✔✔"How I see myself" and " How I see whites" A relatively mild psychedelic substance which is chemically similar to LSD is ✔✔found in morning glory seeds. Amphetamines were first used clinically to treat? ✔✔narcolepsy Pointing out parallels between a client's interpersonal relationships and client/counselor interaction serves to focus awareness on ✔✔the "here and now". Which cultural group has traditionally been the subject of a matriarchal family structure? ✔✔Blacks The identification and ranking of problems needing resolution is ✔✔treatment planning. According to the most recent National Survey on Drug Abuse and Health the specific drugs that had the highest levels of past years dependence or abuse in 2009 were ✔✔marijuana, pain relievers and cocaine Benzodiazepines include the ability to_? ✔✔produce severe, even fatal, withdrawal. T or F: Betel Nut has effects similar to that of cocaine. ✔✔False Comprehensive client documentation ✔✔facilitates communication and enhances accountability The goal of AL-ANON is ✔✔to provide a fellowship and support for individuals in relationships with Alcoholics. The focus of intervention in the criminal justice system is first to ✔✔protect the health, safety and welfare of the public. The description of the Clients Rights typically occurs during the ✔✔orientation. Relapse prevention efforts are aimed at ✔✔identifying high risk situations and learning alternative coping skills. The initial stage of crisis intervention involves ✔✔determining the problem. A counselor can avoid professional burnout by ✔✔attending to health through adequate sleep, an exercise program and proper diet. Maintenance ✔✔Maintaining the behavior change Relapse ✔✔returning to older behaviors and abandoning the new changes The Stages of Change Model was originally developed in the late 1970's and early 1980's by ________and __________ at the University of Rhode Island when they were studying how smokers were able to give up their habits or addiction. ✔✔James Prochaska; Carlo DiClemente 6 Stages of Counseling ✔✔Evaluation, Feedback, Counseling, Agreement, Changing Behavior and Termination 3 Stages of Drug/Alcohol Counseling ✔✔Medical, Psychosocial and Aftercare Adolescent Drinking Index ✔✔24 item paper and pencil self report rating scale intended to measure the severity of drinking. 5 min. completion time. Need 5th grade reading level. Rational Recovery ✔✔Organization founded as an alternative to programs with spiritual overtones, whose publications called" The Small Book". PT is unhappy with the way treatment is progressing, counselor should __? ✔✔discuss these concerns with the client and make necessary changes in treatment goals. The essential first step in determining the possible causes of addiction for the person and the most appropriate modality for his needs. ✔✔Assessment Erickson's developmental theory- ____ should be accomplished in adulthood is ✔✔Intimacy vs. Isolation The following AIDS associated illness that may be less recognized in substance abusers is ✔✔Dementia The intake process is usually an extension of the ✔✔screening. Marijuana is a unique compound which contains over 200 chemicals, one particular chemical is the main psychoactive chemical that makes marijuana "go". The name of the psychoactive compound is ✔✔cannabinol The primary factor in the development of young people's attitude toward drugs is ✔✔parental role models Destructive & rigid family rules which contribute to the low self-esteem of CoA's. -Claudia Black ✔✔Don't Talk, Don't Trust, Don't Feel. The following is the best indicator if an individual is physically dependent upon alcohol or another drug. ✔✔Presence of withdrawal symptoms Hallucinogens work on the brain by interfering with various neurotransmitters, causing an overlap of the senses to occur. ✔✔synesthesia A person wants to accept a party invitation because he is very social but is concerned because there will be a lot of drinking and he is a member od AA. He is experiencing ✔✔approachavoidance conflict The measurement of progress toward treatment goals id best assessed by ✔✔reviewing documentation in progress notes. Before therapy or counseling begins, clients may be given information about the treatment they will receive, as will as possible risks involved. this process is called ✔✔obtaining informed consent for treatment. Effective communication occurs in group when ✔✔message senders use "I" messages. One of the counselor's task is to guide the client in relating and communicating in specific terms, rather than in general or abstract terms. This characteristic or ability is called ✔✔concreteness. One of the earliest models for case management services in the criminal justice system was created in 1972, when the White House launched a demonstration program known as ✔✔Treatment Alternatives to Street Crimes (TASC) ___ withdrawal - pupils dilated, gooseflesh, lacrimation, muscle jerks, flu syndrome, vomiting, diarrhea, nervousness, yawning, severe anxiety ✔✔Opiod Alcohol decreases resistance to HIV infection by ✔✔compromising T-cell functions Effective case management for persons in need of multiple services requires ✔✔monitoring, feedback and evaluation of services. The method by which disulfiram (antibuse) act to deter the consumption of alcohol is ✔✔by decreasing the body's ability to break down poisonous metabolites of alcohol. potentiation ✔✔enhancement of one agent by another so that the combined effect is greater than the sum of the effects of each one alone 12 Core Functions ✔✔1. Screening 2. Intake 3. Orientation 4. Assessment 5. Treatment Planning 6. Counseling 7. Case Management 8. Crisis Intervention 9. Client Education 10. Referral 11. Reports & Record Keeping 12. Consultation Screening ✔✔The process by which a client is determined appropriate and eligible for admission to a particular program. Intake ✔✔Administrative and initial assessment procedures for admission to a program. Orientation ✔✔Describing to the client the general nature and goals of the program; the rules governing client conduct and infractions that can lead to disciplinary action or discharge from the program, the hours during which services are available; the treatment costs that are to be borne by the client, if any; and the client's rights. Assessment ✔✔Ongoing process by which a counselor/program identifies and evaluates an individual's strengths, weaknesses, problems and needs for the development of the treatment plan. Treatment Planning ✔✔The process in which the counselor and the client identify and rank problems needing resolution, establish agreed upon immediate and long-term goals, and decide on the treatment methods and resources to be used. Counseling ✔✔The utilization of special skills to assist individuals, families, or groups in achieving objectives through exploration of a problem and its ramifications; examination of attitudes and feelings; consideration of alternative solutions; and decision making. Case Management ✔✔Activities intended to bring services, agencies, resources, or people together within a planned framework of action toward the achievement of established goals. It may involve liaison activities and collateral contacts. Crisis Intervention ✔✔Those services which respond to an alcohol and/or other drug abuser's needs during acute emotional and/or physical distress. Client Education ✔✔Provision of information to individuals and groups concerning alcohol and other drug abuse and the available services and resources. Referral ✔✔Identification of client's needs that cannot be met by the counselor or agency and assisting the client to use the support systems and community resources available. Reports and Record Keeping ✔✔Charting the results of the assessment and treatment plan; writing reports, progress notes, discharge summaries, and other client-related data. Consultation ✔✔Relating with counselors and other professionals in regard to client treatment (services) to assure comprehensive quality care for the client. Psychosocial Stage: Infancy (Birth to 18 months) ✔✔Trust vs Mistrust: Psychosocial Stage: Early Childhood (2 to 3 years) ✔✔Autonomy vs Shame and Doubt Psychosocial Stage: Preschool (3 to 5 years) ✔✔Initiative vs Guilt Psychosocial Stage: School Age (6 to 11 years) ✔✔Industry vs Inferiority Psychosocial Stage: Adolescence (12 to 18 years) ✔✔Indentity vs Role Confusion Psychosocial Stage: Young Adulthood (19 to 40 years) ✔✔Intimacy vs Isolation Psychosocial Stage: Middle Adulthood (40 to 65) ✔✔Generativity vs Stagnation Psychosocial Stage: Maturity (65 to death) ✔✔Ego Integrity vs Despair Assimilation ✔✔Adaptation to a new culture by taking on a new identity and abandoning the old cultural identity. Acculturation ✔✔Accommodation to rules & expectations of the majority culture without entirely giving up cultural identity. Bicultural/Multicultural ✔✔Individuals that are proud of their cultures and can function in, fulfill their needs through, and be proud of the dominant culture. Their emotional, educational, economic, and spiritual needs are usually fulfilled in a diverse, integrated living environment that honors two (or more) cultures. Culturally Immersed ✔✔Individuals have rejected mainstream culture, and their emotional and spiritual needs are met exclusively in their ethnic community or in the gay community. Traditional ✔✔Individuals are defined as carriers of the community ethos. They neither overtly accept nor reject their ethnic identity. Traditional persons have most of their emotional, spiritual, and, to some degree, educational needs met through their ethnic community and have limited contact with the dominant culture or any outside communities. Trust vs Mistrust ✔✔Children develop a sense of trust when caregivers provide reliability, care, and affection. A lack of this will lead to mistrust. Difference between, Autonomy vs Shame and Doubt ✔✔Success lead to feelings of autonomy, failure results in feelings of shame and doubt. Initiative vs Guilt ✔✔Children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt. Industry vs Inferiority ✔✔Children need to cope with new social and academic demands. Success leads to a sense of competence, while a failure results in feelings of inferiority. Identity vs Role Confusion ✔✔Teens need to develop a sense of self and personal identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self. Intimacy vs Isolation ✔✔Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships, while failure results in loneliness and isolation. Generativity vs Stagnation ✔✔Adults need to create or nurture things that will outlast them, often by having children or creating a positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world. Ego Integrity vs Despair ✔✔Older adults need to look back on life and feel a sense of fulfillment. Success at this stage leads to feelings of wisdom, while failure results in regret, bitterness, and despair. Maslows Hierarchy of Needs ✔✔Bottom to Top: Physiological (breathing, food, water, sex, sleep, homeostasis, excretion) Safety (security of body, employment, resources, morality, the family, health, property) Love/Belonging (Friendship, family, sexual intimacy) Esteem (self- esteem, confidence, achievement, respect of others, respect by others) Self-Actualization (morality, creativity, spontaneity, problem solving, lack of prejudice, acceptance of facts). AUDIT ✔✔Alcohol Use Disorders Identification Test. The 10 items on this instrument developed by the WHO ask about frequency of drinking, alcohol dependence, and problems caused by alcohol. Scores range from 0 to 40 with a score of 8 or higher indicating the likelihood of harmful alcohol consumption CAGE ✔✔An answer of yes to one or more questions indicates the possibility of alcohol dependence. DAST ✔✔Drug Abuse Screening Test, adapted from the MAST, this self-report instrument is used to detect abuse of or dependence on drugs other than alcohol. It provides a measure of lifetime problem severity. MAST ✔✔Michigan Alcoholism Screening Test. This instrument requires yes/no answers to 25 questions. Scores indicate the absence of alcohol dependence (0 to 3), possible substance dependence (4), or likely alcohol dependence (5 or higher). A brief MAST (10 items) and a 13- item Short MAST (SMAST) are available, as is a Geriatric MAST (MAST-G) RAPS4 ✔✔Rapid Alcohol Problems Screen. An answer of yes to one or more questions indicated the possibility of alcohol dependence during the past year. The questions have to do with remorse, amnesia, performance of life duties, and starting the day with alcohol. SASSI ✔✔Substance Abuse Subtle Screening Inventory. This brief self report is designed to identify individuals with a high probability of having a substance related disorder. A version is designed for adolescent, the SASSI-A2 is for clients 12 to 18. TWEAK ✔✔This five-item instrument was designed to screen for harmful drinking in pregnant women. The items have to do with tolerance, worry of close friends and relatives, using alcohol as an eye opener, amnesia (blackouts), and felt need to cut down on drinking. Tuckman's 5 Stages of Group Therapy ✔✔Forming, Storming, Norming, Performing, Adjourning Transtheoretical model of Change ✔✔Precontemplation (Not ready) , Contemplation (Getting Ready), Preparation (Ready), Action, Maintenance Active listening ✔✔Attending to verbal/nonverbal aspects of communication, counselor remains neutral. Encourages trust and self-disclosure. Restating ✔✔Paraphrasing what has said to clarify. Don't just repeat word for word what the client is saying. Clarifying ✔✔Grasps the message at both feeling and thinking levels; helping members sort out conflicting and confused feelings and thoughts. Summarizing ✔✔Tying together of the main points, themes, and issues presented by clients during part or all of a session. Empathy ✔✔The ability to perceive another person's experience and communicate that perception back to the person. Concreteness ✔✔Process by which the counselor relates the vague aspects of the client in direct expression of feelings and experiences in specific concrete terms to assist the client to develop more functional coping skills. Paraphrasing ✔✔Includes therapeutic qualities of empathy and warmth. Paraphrasing refers to a counselor's verbal response that rephrases the essence of the client's message. It allows the client to hear what he or she has just said, either in parroted form or with added clarity. The interactive process can increase trust and can reduce resistance. Reflecting ✔✔Occurs when the counselor restates content that had generated emotion from the client--it is a reflection of feeling. Reflection of feeling captures and expresses to the client the core of what he or she is feeling. It allows the client to be aware of his or her own expressed emotions and how the counselor understood his or her emotional message. The counselor should be careful not to interpret the client's feelings. The counselor remains neutral and nonjudgmental by not offering opinions, judgments, or advice. Simplifying ✔✔Involves the reflection and restatement of what the client said. It removes confusion, avoids intellectualizations, and convoluted explanations, and can help the client stay focused on concerns, feelings, and problems in the here and now. Attending ✔✔Refers to ways in which the clinician demonstrates that she/he is listening to the client through the use of cues Probing ✔✔Involves asking open-ended questions to clarify information and to help the client toward a new understand. Re-framing ✔✔Consists of offering a different perspective on a situation the client is facing. Exploring Alternatives ✔✔Working with the client to examine various options Self-disclosure ✔✔When the clinician shares something about him/herself for the benefit of the client. Confrontation ✔✔Involves the use of a statement or question to raise some discrepancy within the client Immediacy ✔✔Consists of dealing openly with issues that are present in the clinical relationship. Name the Routes of Administration for Substances ✔✔Oral, Injection, Inhalation, Transdermal, Buccal Administration (mucous membranes in the mouth), Rectum The Controlled Substances Act created how many Schedules of drugs? ✔✔5 Schedules (I through V) Schedule I Drugs ✔✔Any drug included here has a high level of abuse/dependence. Also, there is no accepted medical use. (Examples: Heroin, LSD and Marijuana) Schedule II Drugs ✔✔These drugs are essentially similar to those in Schedule I. There is evidence of the potential for abuse/dependence. The distinguishing feature in Schedule II is that there is accepted medical use. There are restrictions on manufacture and distribution via production quotas and import/export controls. Prescriptions are non-refillable. (Examples: Methadone, Morphine, Methamphetamine, Ritalin, Adderall and Cocaine) Schedule III Drugs ✔✔Drugs in this category are considered to be at moderate risk or low risk for physical dependence but at high risk for psychological dependence. There are currently reasons for medical use. (Examples: Anabolic steroids, most barbiturates, and ketamine) Schedule IV Drugs ✔✔Drugs in this category are considered to be at low risk for physical dependence but moderate risk for psychological dependence. There are currently accepted indications for medical use. (Examples: Xanax, Ambien, Brabital, and Chloral hydrate) Schedule V Drugs ✔✔Drugs in this category are considered to be at low risk for either physical dependence or psychological dependence. Again, there are currently accepted indications for medical use. (Examples: Medical mixtures using small amounts of opium or codeine) Duty to Warn ✔✔If a client threatens to harm another person who is reasonably identifiable, the counselor has a duty to warn the appropriate authorities of that threat. Texas counselors do not have a duty to warn the intended victim, but the authorities. Axis II of the DSM-IV-TR? ✔✔Contains personality disorders as well as mental retardation. Axis III of the DSM-IV-TR? ✔✔Contains 16 general medical conditions that are potentially relevant to the understanding or management of the client's diagnosed disorder. Axis IV ✔✔Contains nine psychosocial and environmental problems that may affect the client's diagnosis, treatment, and prognosis. (Examples: Homeless, Money problems, Access to healthcare, Transportation) substance abuse ✔✔A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by at least one of the four following criteria occurring within a 12 month period: There is recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home; there is recurrent substance use in situations in which it is physically hazardous; there are recurrent substance-related legal problems; and/or there is continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance. Additionally, if symptoms have ever met the criteria for substance dependence, substance abuse cannot be diagnosed for that class or substance. What are the 4 main components to a treatment plan? ✔✔Problems, Goals, Objectives, Strategies Fundamental Ethical Principles ✔✔Autonomy: Respect the client's independence and selfdetermination. Nonmaleficence: Do not harm the client Beneficence: Provide benefit for the client Justice: Be fair to the client Fidelity: Be faithful to the client Veracity: Be truthful with the client What does SOAP mean in reference to note taking? ✔✔Subjective, Objective, Assessment, Plan Agonist ✔✔Mimic the action of the endogenous (naturally occurring) neurotransmitters, same or a stronger affinity than the neurotransmitter itself (Ex Methadone) Antagonist ✔✔Blocks the receptor and prevents activation by neurotransmitters or other drugs (Ex Naltrexone) Antidipsotropic ✔✔Intended therapeutic effect is to reduce or prevent alcoholic drinking. Psychotropic Medications ✔✔Psychiatric medications that treat mental disorders.