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LCDC REVIEW-IN PROGRESS
8 Domains - correct answer 1. Clinical Evaluation
- Treatment Planning
- Referral
- Service Coordination
- Counseling
- Client, Family, and Community Education
- Documentation
- Professional and Ethical Responsibilities Domain 1: Clinical Evaluation - correct answer Includes: Screening and Assessment Definition: The systematic approach to screening and assessment of individuals thought to have a substance use disorder, being considered for admission to addiction-related services, or presenting in a crisis situation. Domain 2: Treatment Planning - correct answer Definition: A collaborative process in which professionals and the client develop a written document that identifies important treatment goals; describes measurable, time-sensitive action steps toward achieving those goals with expected outcomes; and reflects a verbal agreement between a counselor and a client. At a minimum an individualized treatment plan addresses the identified bustance use disorder(s), as well as issues related to treatment progress, including relationships with family and significant others, potential mental conditions, employment, education, spirituality, health concerns, and social and legal needs. Domain 3: Referral - correct answer Definition: The process of facilitating the client's use of available support systems and community resources to meet needs identified in clinical evaluation or treatment planning. Domain 4: Service Coordination - correct answer Includes: Implementing the Treatment Plan, Consulting, and Continuing Assessment and Treatment Planning
Definition: The administrative, clinical, and evaluative activities that bring the client, treatment services, community agencies, and other resources together to focus on issues and needs identified in the treatment plan. Service coordination, which includes case management and client advocacy, establishes a framework of action to enable the client to achieve specified goals. It involves collaboration with the client and significant others, coordination of treatment and referral services, liaison activities with community resources and managed care systems, client advocacy, and ongoing evaluation of treatment progress and client needs. Domain 5: Counseling - correct answer Includes: Individual Counseling, Group Counseling, Counseling Families, Couples, and Significant Others Definition: A collaborative process that facilitates the client's progress toward mutually determined treatment goals and objectives. Counseling includes methods that are sensitive to individual client characteristics and to the influence of significant others, as well as the client's cultural and social context. Competence in counseling is built on an understand of, appreciation of, and ability to appropriately use the contributions of various addiction counseling models as they apply to modalities of care for individuals, groups, families, couples, and significant others. Domain 6: Client, Family, and Community Education - correct answer Definition: The process of providing clients, families, significant others, and community groups with information on risks related to psychoactive substance use, as well as available prevention, treatment, and recovery resources. Domain 7: Documentation - correct answer Definition: The recording of the screening and intake process, assessment, treatment plan, clinical reports, clinical progress notes, discharge summaries, and other client-related data. Domain 8: Professional and Ethical Responsibilities - correct answer Definition: The obligations of an addiction counselor to adhere to accepted ethical and behavioral standards of conduct and continuing professional development. 12 Core Functions - correct answer 1. Screening
- Intake
- Orientation
- Assessment
- Treatment Planning
Core Function 7: Case Management - correct answer Activities which bring services, agencies, resource, or people together within a planned framework of action toward the achievement of established goals. It may involve liaison activities and collateral contacts. Core Function 8: Crisis Intervention - correct answer Those services which respond to an alcohol and/or other drug abuser's needs during acute emotional and/or physical distress. Core Function 9: Client Education - correct answer Provision of information to individuals and groups concerning alcohol and other drug abuse and the available services and resources. Core Function 10: Referral - correct answer Identifying the needs of a client that cannot be met by the counselor or agency and assisting the client to utilize the support systems and community resources available. Core Function 11: Report and Record Keeping - correct answer Charting the results of the assessment and treatment plan, writing reports, progress notes, discharge summaries and other client-related data. Core Function 12: Consultation with Other Professionals in Regard to Client Treatment/Services - correct answer Relating with in-house staff or outside professionals to assure comprehensive, quality care for the client. Keys of Assessment - correct answer 1. ongoing process
- counselor and client collaborates
- tools include observations, clinical interviews, lab tests, and other instruments like self-report inventories
- must include appropriate documentation of client consent before soliciting information from outside sources
- should be culturally relevant by taking into account the client's social context
- should be explained to clients so that they can ask questions about the procedure
- should be spoken about in non-technical terms
- should have results offered tentatively so the client can have an opportunity to ask questions and indicate their level of agreement with the assessment results
Biopsychosocial Perspective - correct answer recognizes that there are biological, psychological, and social causes of substance abuse and dependence Biological Factors of Dependence Include... - correct answer brain chemistry problems, which may be genetic; genetics influence biochemistry, and biochemistry makes some people particularly vulnerable to addiction to certain drugs once they try them Psychological Factors of Dependence Include... - correct answer 1. cognitive styles
- personality traits
- early developmental experiences Social Factors of Dependence Include... - correct answer 1. poverty
- oppression
- poorly developed social skills
- family dysfunction Counselors' assessments emphasize _____ and _____ factors. - correct answer 1. psychological
- social If a counselor asks a client only about alcohol or drug use, it is not possible to... - correct answer formulate a comprehensive diagnostic impression or treatment plan What should be made when the counselor's assessment identifies potential problems outside of their scope of practice? - correct answer referral Immediate medical evaluation should be sought for clients who present with/who... - correct answer 1. hallucinations
- severe tremors
- tachycardia
- confusion or delerium
Alcohol Use Disorders Identification Test (AUDIT) - correct answer The 10 items on this instrument developed by the World Health Organization 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 Questionnaire - correct answer An answer of yes to one or more questions indicates the possibility of alcohol dependence. The four questions are "Have you ever felt you should cut down on your drinking?" "Have people ever annoyed you by criticizing your drinking?" "Have you ever felt bad or guilty about your drinking?" or "Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye opener) Drug Abuse Screening Test (DAST) - correct answer 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. Michigan Alcoholism Screening Test (MAST) - correct answer 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). Rapid Alcohol Problems Screen (RAPS4) - correct answer An answer of yes to one or more questions indicates 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. Substance Abuse Subtle Screening Inventory (SASSI) 3 - correct answer This brief self report is designed to identify individuals with a high probability of having a substance related disorder. A version designed for adolescents, the SASSI-A2 is for clients ages 12 to 18.
TWEAK - correct answer 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. Time Line Follow Back (TLFB) Procedure - correct answer A comprehensive measure of drinking; this instrument makes connections between significant events in the client's life and alcohol/drug use patterns and intensity, for the past year. It includes a calendar and a standard drink conversion chart to aid memory. It may be particularly useful in working with elderly clients. Other measures of drinking that go beyond screening for abuse or dependence include... - correct answer the Cognitive Lifetime Drinking History (CLDH), Drinking Self Monitoring Log (DSML), and Form 90 Alcohol Dependence Scale (ADS) - correct answer a diagnostic instrument; this 25- item instrument provides a quantitative measure of the severity of alcohol dependence. Diagnostic Interview Schedule (DIS-IV) Alcohol Module - correct answer a diagnostic instrument; the 28 questions permit diagnosis of alcohol abuse or dependence. Impaired Control Scale (ICS) - correct answer a diagnostic instrument; this pencil and paper self-administered instrument measures clients' attempts to control their drinking during the last 6 months and their perception of their ability to control it now.
Drug - correct answer any substance that, after entering the boy, can change either the structure or function of the body Medicine - correct answer includes drugs that are used to prevent, treat, or diagnose illness and/or relieve pain Misuse of Drugs - correct answer the unintentional or inappropriate use of a drug for other than what or how it was intended Abuse of Drugs - correct answer the intentional use of a drug for other than what or how it was intended, or for the sole purpose of achieving an altered state of consciousness, or leads to any degree of mental, physical, emotional, or social impairment of the person using, the user's family, or society Intoxication - correct answer a temporary change caused by a significant amount of drug entering the body affecting one's emotional, cognitive, and/pr psychomotor functioning Dependence to Drugs - correct answer a condition that, after using drugs, an individual finds it difficult or impossible to control use; dependence or addiction usually involves a physical and/or psychological need for the drug in order to function normally, and it usually involves tolerance and withdrawal Physical Dependence - correct answer a state of functional adaptation to a drug in which the presence of a foreign chemical becomes normal and necessary, and the absence of the drug would present an abnormal state Psychological Dependence - correct answer when the individual has a strong desure to continue to use the drug for emotional reasons and is related to the rewarding effects of the drugs; there are no physical withdrawal symptoms with the discontinuation of use Cross-Dependence - correct answer when a person who is physically dependent to one drug can lessen or prevent withdrawal symptoms by using other drugs from the same or similar classification
Tolerance - correct answer an altered physiological state that develops after repeated drug use when the body becomes accustomed and adapts to the presence of the drug and functions normally; evidence of tolerance is when the drug has less of an effect when using the same dose, or when a larger dose must be used to get the desired effect Pharmacodynamic Tolerance - correct answer when the nerve cells become less sensitive to the effects of the drug over time and repeated use Metabolic Tolerance - correct answer when the liver adapts to the presence of a drug over time and may produce more of the enzyme needed to break down the drug Behavioral Tolerance - correct answer when, after a period of time and repeated drug use, the users are able to modify their behavior in hopes that others will not notice they are intoxicated Cross-Tolerance - correct answer when the tolerance to a drug develops--the individual may also show an increased tolerance to the effects of another drug in the same class Reverse Tolerance (Kindling Effect) - correct answer when the individual can become more sentitive to the drugs effects rather than less sensitive Withdrawal - correct answer consists of negative symptoms that result from the abrupt discontinuation of the drug; the presence of withdrawal symptoms reveals physical dependence; the withdrawal symptoms of a particular drug usually involve the opposite reaction on the body than the drug's affects; for instance, the withdrawal symptoms of a depressant drug would result from the hyperactivity or hyper-arousal state of the CNS Dose - correct answer the amount of a drug that is taken at any particular time Half-Life - correct answer the length of time a drug remains in the body and continues to affect the user
Subcutaneous Injection - correct answer (i.e., "skin popping") using a needle and syringe to inject the substance into the fatty layer just under the extern skin layer Intramuscular Injection - correct answer using a needle and syringe to inject the substance into the large muscles Intravenous Injection - correct answer using a needle and syringe to inject the substance directly into the vein Inhalation - correct answer substances can be inhaled into the lungs by smoking or huffing Snorting - correct answer drugs can be ihaled into the nose and absorbed through the mucous membranes Transdermal Administration - correct answer the drug is absorbed through the skin from a patch Buccal Administration - correct answer the drug is absorbed throught the mucous membranes in the mouth Rectal Administration - correct answer drugs are administered by inserting them into the body through the rectum and are absorbed through the intestinal lining The faster the absorption... - correct answer 1. the more intense the high
- the shorter the duration of action The effects of drugs administered through inhalation are felt.... - correct answer 1. almost immediately-within a few seconds
- have a short duration
The effects of drugs administered through intravenous injection are felt.... - correct answer 1. quickly-a few seconds to a few minutes
- are short in duration The effects of drugs administered through orallly are felt.... - correct answer 1. within at least 15 minutes
- will have a longer duration of effect as compared to inhaled or injected drugs Classification of Drugs - correct answer Drugs of abuse can be classified in several ways (e.g., legal or illegal). Although such classifications do not necessarily reflect the drugs' effects or potential for abuse, classifications might provide an indication of the drugs' availability, how they are categorized on the controlled substances list, and/or their primary pharmacological effects. Title 21 of the United States Code (USC) Controlled Substances Act - correct answer the statute establishing federal U.S. drug policy under which the manufacture, importation, possession, use, and distribution of certain substances is regulated Drug Enforcement Agency (DEA) Drug Scheduling - correct answer Drugs, substances, and certain chemicals used to make drugs are classified into five (5) distinct categories or schedules depending upon the drug's acceptable medical use and the drug's abuse or dependency potential. The abuse rate is a determinate factor in the scheduling of the drug; for example, Schedule I drugs have a high potential for abuse and the potential to create severe psychological and/or physical dependence. Schedule 1 - correct answer Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse; heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4- methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote Schedule II - correct answer Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous; combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid),
community-based, culturally sensitive, pragmatic, and client-driven. It is anticipatory in that it prepares clients for the next stage of treatment. Case management strives for interventions that intrude on the client's life as little as possible while being effective (Bois & Graham, 1997, p. 63). Note that case management activities should focus on fitting services to the client rather than the client to services. It is possible that some clients do not need every aspect of a particular program. 4 Models of Case Management - correct answer 1. Brokerage/Generalist
- Strengths Based
- Clinical/rehabilitation
- Assertive Community Treatment Brokerage/generalist model - correct answer In this model, the case manager identifies clients' needs and helps them access the necessary resources. Ongoing monitoring is not 53 emphasized, nor is advocacy. The brokerage/generalist model is most useful when there is a problem with access, not availability, of resources. Strengths-based model - correct answer In this model, the case manager supports clients in their search for resources. It encourages the use of informal helping networks as opposed to institutional ones. It involves aggressive outreach to clients, helps clients develop their own goals, and emphasizes the role of advocacy. Some of the principles of the strengths perspective are encouraging client control over the search for those resources they perceive as needed and viewing the community as a resource and not a barrier (Siegal, Rapp, Kelliher, Fisher, Wagner & Cole,
Part of the value of traditional substance abuse treatment based on the disease concept is that it gives straightforward structure to a life that may have lacked adequate rules and structure. The strengths-based approach is an alternative to the disease concept approach, which some assert may actually intensify problems for some clients (Siegal, et al., 1995). Clinical/rehabilitation model - correct answer In this model, the case manager is also the client's counselor. So the counselor provides both the clinical help (therapy) and the resource acquisition help (case management). Assertive community treatment model - correct answer In this model the case manager has frequent, long-term contact with clients in their natural settings (e.g., home), focusing on the practical problems of daily living. Advocacy is emphasized. The Treatment Continuum - correct answer Case management supports the client through all phases of his/her substance abuse/dependence treatment. The phases are case finding and pretreatment, primary treatment, aftercare, and disengagement Case finding and pretreatment - correct answer Case finding refers to how treatment programs get clients Primary treatment - correct answer At this phase, the case manager orients the client to the program and may help the client resolve immediate problems that would keep him/her from focusing on treatment. The case manager makes a plan for resource acquisition to meet the client's short-term needs. The case manager also organizes
receiving information from another agency, and communicating with other agencies in planning aftercare Culturally Sensitive Case Management - correct answer Counselors should be as culturally sensitive in their case management responsibilities as they are in their other duties. Clients should be linked to service providers whose values are consistent with their own and who will provide culturally sensitive care. Case Management with Women - correct answer Culturally sensitive case management is particularly important when working with women for several reasons. One is that some case finding methods, such as drunk driver programs, drug courts, and employee assistance programs, may not find women as often as men. Outreach efforts may find more women in medical, mental health, and family counseling service settings. Outreach to women is crucial because women may be reluctant to present for treatment without encouragement. Women tend to respond favorably to attempts to encourage and support steps toward change, using internal strengths and natural network of support. Counselors who have not been encouraged to take an active role in case management may see doing so as enabling, rather than as appropriate assistance that increase the likelihood of a positive outcome Case Management with Adolescents - correct answer Counselors provide case management services for adolescent clients by encouraging family involvement; providing support; tracking substance abuse relapse episodes following treatment; connecting the youth with school, work, and community resources; and helping youth fulfill legal obligations
Documentation of Case Management Activities - correct answer All case management activities should be documented as part of the client's record. Notes regarding case management activities will appear throughout the client's record, since they occur at all phases of treatment. A guiding question for deciding what to include in the client's record is "What do others need to know to respond therapeutically?" Entries should indicate what the counselor coordinated, with whom, when, and why. Note also that counselor records, including electronic files, are legal documents. Evaluating Case Management Effectiveness - correct answer Counselors are expected to monitor the effectiveness of case management activities for individual clients. Treatment programs should track effectiveness for groups of clients. Information about effectiveness can be gathered through interviews with clients, collateral interviews, and interviews with professionals who worked with the client.
