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ADDICTION COUNSELOR PRACTICE TEST BOOK
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ADDICTION COUNSELOR PRACTICE TEST BOOK
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ADDICTION COUNSELOR PRACTICE TEST BOOK1.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 - Answers -*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 - Answers -*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 - Answers -*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 - Answers -*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. - Answers -*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.
*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. - Answers -*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 - Answers -*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 - Answers -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 - Answers -*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.
*6.* What is the MOST common symptom of Wernicke's encephalopathy?
a. New memory formation
b. Loss of older memories
c. Psychosis
d. Confusion - Answers -*D: Confusion*
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