Substance Abuse and Psychiatric Disorders, Exams of Advanced Education

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AODA Counselor Exam Certified Exams 2022

Reasons for drug use Correct Answer: Curiosity, peer pressure, help them fit in, rebellion, thrill seeking, attend to appear mature, escapism, entertainment, intoxication, anxiety reduction, social lubricant, relaxation, pain management. Behavioral changes in substance abuse Correct Answer: Change in routine, lying about use, decline in performance, change in activities, mood swings, personality changes, dealing, legal problems, change in peer group, change in way of dressing, conflictual family relationships, rebellion against societal norms Physical changes in substance abuse Correct Answer: Hangover, feeling on well, euphoria, cravings, appearance deteriorates, weight loss or gain, poor hygiene, memory deficits Dependency definition Correct Answer: Dependency occurs when the drug user experiences psychological or physical distress upon discontinuing the drug in question. Addiction definition Correct Answer: Addiction implies that the user is unable to control his intake of the drug and experiences psychological or physical distress during withdrawal. Psychiatric problems in substance abuse Correct Answer: Psychosis, paranoia, depression, mood swings, memory deficits, Seven symptoms to diagnose substance use disorder Correct Answer: 1. Tolerance,

2. withdrawal,
3. increase in amount of drug taken,
4. inability to control use,
5. significant time/effort devoted to obtaining the drug,
6. diminished interest in important activities,
7. continued use regardless of ill effects Five components of effective addiction treatment Correct Answer: 1. Assessment,
8. patient treatment matching,
9. comprehensive services,
10. relapse prevention,
11. accountability. A model treatment center for addiction will include the 17 components Correct Answer: 1. Assessment,
12. same-day intake
13. documenting findings
14. prevention and primary medical care,
15. testing for infectious diseases,
16. weekly random drug screening,
17. pharmacological interventions as indicated,
18. group counseling intervention as indicated,
19. basic substance abuse counseling,
20. practical life skills counseling,
21. general health education,

12.peer support groups,

13. liaison services to the community and court system,
14. social and athletic activities,
15. alternative housing assistance as needed,
16. relapse prevention, and
17. Outcome evaluation Nervous system Correct Answer: The nervous system is composed of the central nervous system (CNS) and the peripheral nervous system (PNS). The central nervous system is composed of the brain and the spinal cord. The peripheral nervous system has two parts, the somatic system (voluntary) and the autonomic system (involuntary) which are made up of the nerves which branch to the rest of the body from the central nervous system. Transmission of nerve impulses Correct Answer: An electrical impulse travels from the dendrite to the cell body to the axon to the synaptic knob, where electrical impulses cause the release of the neurotransmitter into the synaptic class. The neurotransmitter crosses the synaptic cleft, and joins with the receptor on the neighboring dendrite. where once again the electrical impulse is sent from these dendrite down the cell body to the axon. Neurotransmitter Correct Answer: Chemicals manufactured by the body to transmit nerve impulses between cell. Neurotransmitters are stored in vesicles in the synaptic knob. Neurotransmitters are released by cells called presynaptic neuron and received by post synaptic neurons. Neurotransmitters can be excitatory or inhibitory. Acetylcholine Correct Answer: Acetylcholine - excitatory transmitter involved in muscle movement Norepinephrine Correct Answer: Norepinephrine - excitatory transmitter involved with arousal mood and memory formation Dopamine Correct Answer: Dopamine - inhibitory and excitatory neurotransmitter involved in body movement, pleasure, and reward Serotonin Correct Answer: Serotonin - excitatory neurotransmitter involved with emotion, mood, sleep, and temperature regulation GABA - Gamma amino butyric acid Correct Answer: GABA - inhibitory neurotransmitter involved with motor behavior. Lack of GABA can lead to convulsion Glycine Correct Answer: Glycine - inhibitory transmitter involved with spinal reflexes and motor behavior Enkephalins and endorphins Correct Answer: Enkephalins and endorphins - inhibitory neurotransmitter involved with pain reduction and pleasure Neurotransmitters and drug interaction Correct Answer: Drug can interact with, and change the normal actions of neurotransmitters by affecting their:
18. synthesis,
19. storage,

3. release,
4. reuptake,
5. metabolism, and
6. binding at the receptor site Drug can interfere with the enzyme which is breaking down the neurotransmitters thereby causing a buildup in the synapse. Effects of alcohol - most abused drug in the United States Correct Answer: 1. Depression of the central nervous system from the outside inward beginning with the cerebral cortex interfering with higher processing and normal inhibition, altering emotional behavior, and interfering with muscle function culminating in a reduction of pulse and respiration.
7. Irritation of the cell tissue
8. Increase in production of hydrochloric acid with the potential to create ulcers
9. Initial increase in heart rate followed by decrease in heart rate
10. Increase in the release of insulin which depletes blood sugar and causes hypoglycemia, thereby interfering with pancreatic function
11. Reduction in sperm production and increased risk of impotence
12. Damage to fetus
13. Interference with sleep, prevention of REM sleep necessary for optimal health. Blood alcohol concentration (BAC) Correct Answer: 3 drinks .08 - .09% - motor function impairment, slowed reaction time, and poor concentration 5 drinks .14 - .15% - vision and hearing are distorted 7 drinks .20% - mental confusion difficulty moving without assistance. The ability to tolerate alcohol at this level is an indicator of alcoholism. 14 drinks .40% - loss of consciousness 16 drinks .60%, - death from respiratory failure Blackout Correct Answer: A period of amnesia that typically occurs with drinking or substance abuse that may last for seconds or hours, during which the person continues to function but will have no memory of what has occurred during the blackout. Hangover Correct Answer: Believed to be the result of one or more of the following:
14. The accumulation of acetyl aldehyde in the body, dehydration, alcohol poisoning, depletion of important enzymes, and the metabolism of congeners used in the fermentation and manufacturing process. Sedative hypnotic drugs Correct Answer: Sedatives and hypnotics calm emotions, reduce anxiety, induce drowsiness, and relax tense muscles. Some are used at anticonvulsants. Sedative hypnotic drugs - Barbiturates Correct Answer: Barbiturates are derivatives of barbituric acid with high dependence potential and significant withdrawal risks that can be life-threatening and detoxification must be medically managed. Although tolerant to barbiturates occurs and more is needed to achieve the desired effect over time, the amount needed to cause an overdose does not increase with usage. There are three types:

1. ultra-short acting for surgical anesthetic,

2. intermediate acting (onset of the fact 15 to 40 minutes, lasting for up to six hours) for anxiolytics and sleep,

3. long-lasting (onset within one hour lasting up to 16 hours) used as sedatives, hypnotics, and anticonvulsants Sedative hypnotic drugs - Benzodiazepines Correct Answer: Benzodiazepines were developed within the last 25 to 30 years with a high risk for dependence and significant withdrawal risks that can be life-threatening and detoxification must be medically managed. Combining these with alcohol can be fatal. Well-known names include: Valium/diazepam Ativan/Lorazepam Xanax/Alprazolam Sedative hypnotic drugs - others Correct Answer: Other drugs in this category include non- barb/benzo types such as Chloral Hydrate, Doriden/glutethimide, and Quaalude/methaqualone. These drugs create tolerance and physical dependence very quickly, side effects include dizziness, blurred vision, loss of motor coordination, reduced in vision, seizure, coma, and fatal overdose is not uncommon. Narcotics Correct Answer: Narcotics - clinically used as an analgesic, as sedative, and to treat diarrhea. Decreased the sensation of pain and the perception of pain depress the respiratory system nausea is not uncommon in new users and may include increased stomach acidity, constriction of the pupil, constipation. Highly addictive, rapid tolerance, psychological and physical dependence but without loss of motor coordination. Narcotics classifications Correct Answer: Three Classification:
4. Those that come from natural opiates include opium morphine and codeine to reduce pain, produce a euphoric state and induce sleepiness
5. Those that are semi-synthetic include heroine and Hydromorphine and are extremely fast acting and addictive.
6. Those that are completely synthesized include meperidine/Demerol, methadone/Dolophine, propoxyphene/Darvon. Narcotics withdrawal Correct Answer: Occurs in stages with increasingly severe but not life- threatening symptoms including abdominal cramps, increased heart rate, raised blood pressure, nausea, muscle spasm, achiness in the bone Narcotic analogues Correct Answer: Created in an attempt to find legal drugs which mimic the effect of narcotics but are now banned since 1986 as Schedule 1 controlled substances. AMF - analog of fentanyl, the dose which causes euphoria typically causes death. Fast acting and short-lived affects. Risk of overdose very high due to respiratory failure. Potential for damage to the central nervous system with symptoms similar to Parkinson's disease that is irreversible. MPPP - analog of meperidine created from a highly toxic called and PTP that causes destruction of nerve cells with symptoms similar to Parkinson's disease that is irreversible.

PPEAP - also created from highly toxic chemicals which lead to a disease with symptoms much like Huntington with progressive mental deterioration due to progressive brain damage, spasmodic facial and limb movements that are all irreversible. Inhalants Correct Answer: Three types: 1) Commercial solvents,2) aerosols, and 3)anesthetics that depress the central nervous system and produce excitability, delirium and at times hallucinations upon inhalation. Commonly abused by adolescence because they are easy to obtain, inexpensive and convenient to transport including liquid paper, nail polish remover, and commercial glues. Initial side effects include nausea, vomiting, and severe headache, continued use may lead to health problems including weight loss, bone marrow damage, visual deficit, memory deficits, paralysis, and cognitive disabilities that may be permanent, and physical and psychological dependence. Marijuana classification - Second most used drugs of abuse in the United States. Correct Answer: Marijuana is classified as a psychedelic and a CNS depressant producing euphoria as well as confusion, anxiety, visual and motor deficits, and slowed reflexes. Psychoactive ingredient THC, found in all parts of the plant except the root, highest concentrations in the buds of the female plants. Marijuana - withdraw and side effects Correct Answer: Is fat-soluble, and may take as many as six weeks to be metabolized to the system and is excreted through feces. Withdrawal symptoms include irritability, restlessness, and nausea. Side effects include a 50% increase in cancer-causing agents and tar compared to regular cigarettes, damage to white blood cells and the body's immune system, can prevent the body from changing estrogen to testosterone causing male users to develop breast and body and facial hair and adversely affect sperm production. In women it suppresses ovulation and menstruation. Both appear to be reversible with discontinuation. Marijuana "burnout" Correct Answer: Symptoms include dullness, apathy, loss of motivation, loss of ambition, decreased performance, inability to plan ahead Marijuana - possible health benefits Correct Answer: THC has been shown to be useful in treating glaucoma, asthmatic condition, muscle spasms, spasticity, may be a potential anticonvulsant, and reduction in nausea and vomiting brought on by chemotherapy. Hallucinogen/psychedelics Correct Answer: Hallucinogens and psychedelics excite and inhibit the central nervous system by changing the levels of neurotransmitters in the brain to distort perception, mood, cognition, sense of time, physical senses and emotions. These drugs have the potential to create psychological dependence but there is no evidence of physical dependence. Hallucinogens Correct Answer: These may include: psilbocybe mushroom, peyote, morning glory which contained Ergot alkaloids, members of the nightshade family, dimethyl tryptamine (DMT), Nutmeg, and Mace. Psychedelics Correct Answer: Lysergic acid diethyl amide (LSD) - most commonly known psychedelic drug manufactured from the ergot compounds found on the fungus that grows on rye as well as the acid in the morning glory seeds. Extremely powerful drug measured in micrograms. Route typically a dot on a piece of paper, tablet, capsule, or mixed with a beverage and ingested. Effects at low doses last 4 to 6 hours and include restlessness increased awareness feelings of affection toward others. A moderate dose last 8 to 12 hours and produces distortions in reality an

overlap of sensory input. The highest doses, lasting up to 20 hours, produce euphoria, hallucinations, self fragmentation with potential psychotic breaks affect. No physical dependence, psychological dependence is debatable. Phencyclidine (PCP) Correct Answer: PCP was developed to be an analgesic and marketed as Sernal but removed from the market due to serious side effects. It is used today as an animal tranquilizer. Popular for its psychedelic properties, referred to as Angel dust, it is an antidepressant, stimulant, analgesic, hallucinogenic, anesthetic, anticonvulsant. Multiple forms and routes. MDMA Correct Answer: A combination of amphetamine and mescaline. It is a depressant and a stimulant by interfering with the way neurons communicate. Potential to damage neurons containing serotonin and increased brain levels of norepinephrine. Lessor side effects include mental confusion, depression, anxiety, panic attack, and paranoia. Most severe side effects is the lack of temperature control with subsequent overheating and death. MDA Correct Answer: A synthetic similar to the composition of amphetamines and mescaline. Begins working within one hour and lasting eight hours making it popular to enhance sexual pleasure. DOM - STP Correct Answer: Another combination of amphetamine and mescaline referred to as serenity, tranquility, and peace. Flashbacks - substance induced Correct Answer: Psychedelic effects occur in about 25% of those who used psychedelics in the past. Flashbacks occur long after the drug has been metabolized and cleared the body and are unpredictable, vivid, frightening, with the potential to cause psychological harm. Caffeine Correct Answer: A central nervous system stimulate that increases metabolism slightly, found in coffee tea cocoa chocolate and cola drinks. It is the most commonly ingested source of caffeine in the United States as much as 227 mg per day on average Synthetic caffeine - PPA Correct Answer: PTA - phenylpropanolamine, similar in chemical composition to an amphetamine and has been linked to hemorrhagic stroke. Nicotine Correct Answer: Central nervous system stimulant found in tobacco and reaching the brain in seven seconds. Highly addictive. Betel nuts and Yohimbe Correct Answer: Central nervous system stimulants cause euphoria and excitation. If muscarine, found in betel nuts is consumed in large quantities can cause psychological dependence, death, illness, mouth sores, and cancer. Yohimbe, aphrodisiac from the African yohimbe tree that increases levels of acetylcholine and is toxic in large quantities. Ephedra Correct Answer: Central nervous system stimulant obtained from the ephedra bush used medically to treat low blood pressure narcolepsy asthma and allergy and a dietary aid. Large doses can be toxic resulting in heart palpitations, nausea, vomiting, hypertension, psychosis, convulsion and coma. Khat Correct Answer: Khat leaves are chewed, made into tea, or a paste. The active ingredient cathinone with psychological effects that include euphoria increased energy, hyperactivity, insomnia, anorexia, hypertension, irregular heartbeat, exhaustion, hallucination, violent behavior, and death

Amphetamines - Third most used stimulant drug in the United States. Correct Answer: Central nervous system stimulant used pharmacologically to increase alertness, energy, and endurance. High risk of psychological and physical dependence with rapid development of tolerance. Nicknames include uppers, speed, crystal and crank and if injected they cause a rush comparable to orgasm. Unwanted side effects include suspiciousness, anxiety, paranoia, delusions, psychosis, and auditory hallucinations. Physical effects include dilated pupil, increased blood pressure, and tremors in the hands. Heavy use can cause brain liver and kidney damage weight loss, malnutrition, the calcification leading to bone loss and dental decay. Chronic users often display acne, rashes, and self-inflicted sores. Withdrawal symptoms include rapid pulse, abdominal cramping, anxiety, nausea, tremors, and convulsions lasting as long as 21 days after discontinued use. Ice Correct Answer: Crystallized methamphetamine that is extremely potent producing euphoria, increase alertness, energy, and a sense of well-being by increasing the amount of dopamine in the brain and damaging neurons that contain serotonin and dopamine. Negative side effects include panic attack, aggression, paranoia, and psychosis. Acute effects include tremors, dizziness, stomach cramps, nausea, insomnia, and heart palpitations. Long-term effects include depression, paranoia, anxiety, malnutrition, and heart problems. Cocaine - powder Correct Answer: Central nervous system stimulant that acts by inhibiting the reuptake of dopamine and serotonin. Derived from Erythrozylon coca plant synthesized into a white crystalline powder that can be snorted, or heated until it becomes a liquid and injected or smoked. The powder is also mixed with additives and sold in bulk. Effects are short-lived, potential for tolerance, potential to cause impotence. Cocaine - crack Correct Answer: Manufactured by mixing cocaine, baking soda, and water. More potent than other forms of cocaine and far more addicting. Short-lived effect and resulting depression may lead to binge behavior. Psychological side effects of chronic use include paranoid psychosis, insomnia, anxiety, excessive excitability, loss of interest in sex, and social withdrawal. Physical effects include convulsions, significant weight loss, high blood pressure, permanent damage to hard and long, sexual dysfunction, and the potential for permanent damage to dopamine producing neurons. Models of addiction Correct Answer: 1. Biopsychosocialspiritual - holistic and all-encompassing, assume genetic, chemical, psychological, social, and spiritual factors play a part in addiction and involve a multidisciplinary approach to treatment.

2. Medical model - addiction is seen as a disease, initial use voluntary, addictive use is not, believed to be brought on by altered brain chemistry as well as genetic. Abstinence viewed as necessary for recovery, pharmacological approaches including methadone are used.
3. Clinical model - assume two categories of drug abusers. Category one are those that use to gain positive reinforcement and social reward while trying to avoid negative consequences such as physical and emotional pain and will need help finding legitimate socially acceptable rewards. The second group are those who use to escape life problems and sense of personal inadequacies and will need help with self-esteem.

4. Social causes model - addiction is a learned behavior supported by rewards such as social acceptance and avoidance of dramatic influences from environmental settings where treatment would include removing the user from the situation and the people that encouraged use. Detoxification Correct Answer: Withdraw from substance use that may require medical intervention to manage withdrawal symptoms including those which may be life-threatening, and in such cases are managed with the use of benzodiazepines. 4 Classes of Pharmacotherapeutic treatment Correct Answer: 1. Agonists - drugs which mimic the effect of the drug of abuse
5. Antagonists - drugs which block the effects of the drugs of abuse
6. Antidipsotropics - drugs which cause adverse reactions to the consumption of a substance
7. Psychotropics - drugs which control the symptoms associated with both the use of and withdraw from drugs of abuse including anxiolytic, antipsychotic, and antidepressants 5 Types of Treatment program Correct Answer: 1. Residential programs providing stable environment close monitoring and structure
8. Inpatient hospital treatment offering residential hospital setting with medication administration and medical monitoring
9. Therapeutic community residential, highly structured environment, emphasizing self-help, those with long-term recovery are employed as peer counselors
10. Outpatient non-methadone treatment programs include private clinics mental health centers and private practice
11. Combine settings of in an outpatient treatment modalities Treatment techniques Correct Answer: 1. Mutual aide programs
12. Individual counseling
13. Group therapy
14. Family therapy
15. Behavior modification 8 Practice Dimensions (PD) of Addiction Counseling Correct Answer: I. Clinical evaluation: screening and assessment II. Treatment planning III. Referral IV. Service coordination: Implement plan, consult, continued assessment and plan review and update V. Counseling VI. Psychoeducation VII. Documentation VIII. Professional and ethical responsibilities PD I Clinical Evaluation: Screening and Assessment Correct Answer: While screening is a procedure used to determine IF an individual may have a problem, the role of assessment is to determine the nature and extent OF that problem and investigate whether or not there are other problems related to substance abuse including social, occupational, educational, legal, and socioeconomic concerns. PD I Clinical Evaluation

Screening: Definition Correct Answer: The process by which the counselor, the client, and available significant others review the current situation, symptom, and other available information to determine the most appropriate initial course of action given the clients needs and characteristics, and the available resources within the community. Establishing rapport begins at this initial stage of contact and includes crisis management and possible consultation with other professionals. PD I Clinical Evaluation Screening: Skills Correct Answer: skills - eliciting, intervening, assessing, preventing and managing crisis. PD I Clinical Evaluation Assessment: Definition Correct Answer: Assessment is an ongoing process through which the counselor collaborates with the client and others to gather and interpret information necessary for planning treatment and evaluating client progress PD I Clinical Evaluation Assessment: Skills Correct Answer: skills - obtaining, interpreting and incorporating data and communicating to clients and providers PD II Treatment planning: Definition Correct Answer: A collaborative process in which professional and the client develop a written document that identifies important treatment goals; describe measurable, time sensitive actions that toward achieving those goals with expected outcome; identifies all necessary resources and personnel required, and reflects a verbal agreement between the counselor and the client PD II Treatment planning: Skills Correct Answer: skills - establishing trust, and eliciting, summarizing, synthesizing, and translating information and communicating with the client in a culturally sensitive manner PD II Treatment planning: Components Correct Answer: At the minimum, the PCP addresses the identified substance use disorder(s), as well as issues related to treatment progress, including relationship with family and significant others, potential mental heath conditions, employment, education, spirituality, health concern, and social and legal needs. PD III Referral: Definition Correct Answer: Referral - the process of facilitating the client use of available support systems and community resources to meet needs identified in clinical evaluation and/or treatment planning PD III Referral: Skills Correct Answer: skills: networking, public relations, advocating, communicating PD IV

Service Coordination: Definition Correct Answer: 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. PD IV Service Coordination: Skills Correct Answer: Skills - use of technology, consultation, communication, attention to detail, ability to prioritize, ability to collaborate with client and other professionals PD IV Service Coordination: components Correct Answer: Includes case management and client advocacy, establishes a framework of action to enable the client to achieve specified goal. It involves collaboration with the client and significant other, coordination of treatment and referral services, liaison activities with community resources managed care system, client advocacy, and ongoing evaluation of treatment progress and client needs. PD V Counseling: Definition Correct Answer: A collaborative process that facilitates the clients progress toward mutually determined treatment goals and objectives PD V Counseling: Skills Correct Answer: skills - attending, concreteness, distinguishing, probing, accurate empathy, genuineness, respect. Alos: strength based, rapport and relationship building, active listening, empathy, appropriate use of authority, cultural competence, motivational interviewing, ongoing assessment, coaching, mentoring, teaching, knowledge of behavioral and cognitive interventions, healthy boundaries, ethics, supervision PD V Counseling: Attending Correct Answer: 1. Listening and observing

2. Ensuring that the client knows that he is being heard Being able to establish a trusting relationship with the client by: Physical attending - recognizing personal a relaxed posture and eye contact. Psychological attending - observing the clients physical characteristics and noting the clients affect word choice and themes of conversation. Self attending - aware of the client's impression and countertransference. Responding - to demonstrate active listening and Concreteness - stating problems and issues specifically and identifying feelings and behaviors precisely and not abstractly in order to distinguish between what is implied and what is actually expressed through body language, tone of voice, and manner of speaking and posture. PD V Counseling: Concreteness Correct Answer: Identifying variables relevant to the problem. PD V Counseling: Distinguishing Correct Answer: Distinguishing content from feelings, between what the client says and what the client feels. This may include the use of interpreting whereby the clinician suggests ideas to the client for problem solving to introduce a new perspective. The three components of interpreting our
3. ascertaining the client ideas and restating them

2. adding the counselor's ideas to the client ideas,
3. going over these ideas with the client PD V Counseling: Probing Correct Answer: Knowing how to conduct the session without leading the client so as not to take away the opportunity for the client to gain insight into his/her own behavior and feelings. Probing with open-ended questions emphasizes the responsibility of the client to begin helping himself by exploring his thoughts, feelings and behaviors at a deeper level. PD V Counseling: Accurate Empathy Correct Answer: Feeling what the client is feeling PD V Counseling: Genuiness Correct Answer: Remaining true to yourself PD V Counseling: Respect Correct Answer: Treating the client as a worthy individual PD V Counseling: Components Correct Answer: Includes and not limited to: individual and group therapy, drug and alcohol psychoeducation, psychodynamic therapy life skills, general health psychoeducation, peer counseling, and relapse prevention PD V Counseling: 6 Stages Correct Answer: 1. Information gathering
4. Evaluation
5. Feedback
6. Counseling agreement
7. Changing behavior
8. Termination PD VI Client, Family and Community Education: Definition Correct Answer: The process of providing client, family, and others, and community groups with information on the risks related to psychoactive substance use, as well as available prevention, treatment, and recovery resources PD VI Client, Family and Community Education: Skills Correct Answer: Presentation skills, communication, cultural sensitivity, need awareness, breadth of knowledge PD VII Documentation - Definition Correct Answer: The recording of the screening and intake process, assessment, treatment plan, clinical report, clinical progress notes, discharge summaries, and other client related data. PD VII Documentation - Skills Correct Answer: Use of technology, attention to detail, ability to be concise, analysis, summarizing, synthesizing, presentation, time management, administrative skills, knowledge of coding and billing, accuracy

PD VIII

Professional and Ethical Responsibility: Definition Correct Answer: The obligation of an addiction counselor to adhere to excepted ethical and behavioral standards of conduct and continuing professional development PD VIII Professional and Ethical Responsibility: Skills Correct Answer: Awareness, respect, personal ethics, self-awareness, cultural competence, ability to adapt, scope of knowledge, motivation, goal directed, application of ethical, legal and professional standards, ongoing self-assessment, eliciting and applying feedback, effective use of supervision Confidentiality Correct Answer: According to state and federal laws of patient confidentiality information can only be disclosed under one of these conditions:

1. Client gives written permission
2. Medical emergency
3. Client threatens or harms program property of personnel
4. Program evaluation
5. Court order is presented Orientation: Definition Correct Answer: A process by which the nature of the program, it rules, and goal are explained to the client along with client rights and responsibilities in written form with all necessary signatures. Diagnostics Correct Answer: Interviews must take into account the patient's level of cognitive functioning, language skills, culture, gender, and other psychosocial factors. Process Evaluation Correct Answer: Assesses whether or not the procedures were appropriate, confirm if those services were indeed available. and whether or not the patient took advantage of those services. Outcome Evaluation Correct Answer: Examines whether or not the client was accurately assessed, and whether or not he/she benefited from the treatment plan. Self-disclosure Correct Answer: May include personal values, thoughts, attitudes, and life experiences but only to allow for a deeper sense of rapport and trust to develop between the client and therapist. Pitfalls of self-disclosure must also be anticipated. Confrontation Correct Answer: Used to question discrepancy between statements made by the client and the client's actions, to challenge the client's view of himself, to force the client to talk about difficult issues necessary for wellness, and done with immediacy allowed for the discussion of what is happening between the client and the therapist in the moment to help resolve possible issues. Three stages of treatment in Drug and Alcohol Counseling Correct Answer: 1. Medical/physical intervention
6. Psychosocial rehabilitation
7. After care

Five necessary goals for Drug and Alcohol Counseling Correct Answer: 1. The client must accept that he or she has a problem

2. It must be determined if medical intervention is needed
3. The client needs to accept that he or she must stop using the drug in question entirely
4. The client must accept responsibility for the effect of the substance in question on his/her life and
5. learn to reorganize life without the substance Communication techniques Correct Answer: 1. Active listening
6. Minimal encouragers
7. Parroting for clarification of content
8. Paraphrasing for clarification of meaning
9. Reflection the affective content to provide the speaker with feedback
10. Confrontation to identify and address discrepancies between the client's true self and his view of himself. Stages of group development Correct Answer: 1. Forming - superficial, lack of intimacy, need for acceptance
11. Storming - struggles for dominance, control, and power
12. Norming - the above dynamic should ultimately result in group cohesiveness
13. Performing - working stage, trust has developed members are openly sharing with honesty and authenticity and less guidance from the group leader accept to generalized learning to the bigger picture of recovery and to maintain group norms.
14. Termination - group members transition out of the group once his/her particular goals have been met Three Components of the Group Process Correct Answer: 1. Compliance - client must decide to cooperate in the group
15. Identification - client must come to see how the group concerns apply to him/her
16. Internalization client must take what he/she has learned and apply the information to his or her own life. The counselor's role is to help each group member moves through the three processes and see how their behavior impact the behavior of others as well as himself/herself Five types of clients Correct Answer: 1. Silent client who chooses not to participate and does not make gains either out of fear or a desire for manipulation.
17. Boring client who is scared and inhibited and should be encouraged and rewarded for spontaneity
18. Monopolizing client demands constant attention with self centered focus. Counselor may throw the problem back on the group asking why they allow the behavior. Counselor should point out that listening is an important aspect of therapy.
19. Self righteous client behavior may stem from a sense of failure and inferiority or a mental health diagnoses and client and group education regarding such behavior can be beneficial
20. Hostile client behaviors may be a cover for fear and can be helped as the counselor addresses and the fear with the client to reduce hostility and find healthier ways to express emotion. Blocking Correct Answer: A process by which the client interferes with the functioning of the group. Client may only be about other group members problems, may be detached from his/her own feelings and prefer to express knowledge rather than application. Sometimes it can be passive aggressive and attempt to usurp authority from the counselor. In all cases the counselor must identify this behavior and address the problem to avoid group manipulation. Intoxicated clients should be asked to

leave the group, be assessed by medical staff, and outreach and follow-up by the counselor will be necessary. Family therapy for addiction Correct Answer: Sharon Wegscheider's family roles in addiction include:

1. The enabler who makes it possible for the client to continue their views
2. The hero, usually the eldest child and family success story striving for perfectionism, likely to develop substance use and abuse
3. Scapegoat - often the second oldest in the family who takes the blame for all the family problem by getting in trouble. Scapegoats are at a high risk for becoming substance abusers.
4. Lost child typically the youngest child ignored by the others and often this person creates an idealized fantasy world and fails to develop interpersonal effectiveness skills.
5. Mascot generally the third or middle child who knows that something is wrong but is continually told that everything is all right and therefore maintain childlike behaviors to get attention and is rarely taken seriously and so suffers from low self-esteem. Often they are misdiagnosed with hyperactivity, schizophrenia, or paranoia and must come to terms with family problems in order to grow up. Crisis: definition Correct Answer: A state of cognitive and/or emotional confusion precipitated by a perceived threat. Crises can be triggered by a traumatic experience that may be situational, developmental, intrapsychic, or existential in nature. Goals and process of crisis intervention Correct Answer: To prevent further psychological or physical damage to the individual and resolve the issues that cause the crisis by:
6. Establishing rapport quickly
7. Gather information
8. Determine appropriate action
9. Help the client see the problem is solvable and discussed options he/she can take for resolution
10. Arrange for and conduct follow-up Suicide risk factors Correct Answer: 1. Women are more likely to attempt suicide
11. Men more likely to commit suicide
12. Teenage boys
13. Men in midlife crisis
14. Older people in general
15. Those suffering recent loss or serious illness
16. Those without a support system in unstable relationship
17. Impulsive individuals
18. Those suffering emotional burnout Suicide indicators Correct Answer: 1. Client has expressed a hopelessness, helplessness
19. Client has expressed a desire to end life as a possible solution to problem
20. Client has a plan and means
21. Client is depressed (OR - client reports no longer depressed but no change in factors that caused that depression)
22. History of past suicide attempts Psychodynamic theory: Sigmund Freud Correct Answer: Also referred to as psychoanalysis, developed by Freud. Personality is formed by age 5 and unresolved conflicts must be addressed at each stage of development to psychoanalysis for the individual will be stuck in that stage of development.

Divisions of the mind include the id, ego, and superego which all have their own purpose. The id deals with unconscious instincts and basic drive without care for consequence seeking immediate gratification. The ego is more conscious, rational, logical and mediates the constant battle between the id and the superego, often employing defense mechanisms to keep unacceptable thoughts from reaching awareness. The superego is the conscience and the source of moral behavior and rules of society. Psychodynamic theory: seven defense mechanisms Correct Answer: 1. Repression force unacceptable thoughts from the conscious mind into the unconscious but still able to affect behavior.

2. Projection unacceptable thoughts are attributed to someone else
3. Displacement by redirecting feelings from a perceived threat toward a target who to be safe.
4. Reaction formation replacing an unacceptable feeling with an acceptable one
5. Regression - returning to an earlier and more immature behavior pattern most likely in response to stress.
6. Rationalization - justifying and unacceptable
7. Intellectualization - having understanding of the situation but blocking any feelings about the situation. Rogerian Client Centered Therapy Correct Answer: Assume people are basically good and capable of our life full of meaning and fulfillment. Identity is constantly changing by interaction with one's environment. Given the appropriate environment, the individual is capable of psychological self- healing to reorganize him or herself into a healthier happier version through self exploration and self acceptance. It is the clinician role to create that science environment and encourage congruence and authenticity through empathy, unconditional regard, and nonjudgmental behavior. The clinician does not interpret but simply reflects back to the client to facilitate understanding. Gestalt therapy Correct Answer: Founded by Fritz Perls and developed from psychoanalytic theory that a person is shaped by experience. To be healthy one must live in the present, accept responsibility for his/her actions, thoughts and emotions. The therapist leads the client to discover using techniques that promote greater awareness and experience. Rational emotive therapy Correct Answer: Developed by Robert Alice and others on the premise that thoughts and emotions are linked and that behavior is a result of thoughts and feelings about an event and not the event itself. The client must learn how to correct a faulty belief system with the help of the clinician who points out the distortions and help the client replace them with rational judgment. Reality therapy Correct Answer: Founded by William Glasser on the premise that a sense of responsibility leads to psychological health and is based upon a moral code established in childhood. The role of the therapist is to help the client make choices in line with accepted morality. Transactional analysis Correct Answer: Established by Eric Berne based on three ego states: parent, adult, and child. Human interaction is based on the transaction of the ego state of one individual with the ego state of another with four possible view: I'm not okay - you're okay; I'm not okay - you're not okay; I'm okay - you're not okay; I'm okay - you're okay the therapist helped the client to function from the adult position. Adlerian Therapy Correct Answer: Founded by Alfred Adler, holding a positive view of human nature, that they are goal driven and self-controlled with a personal style fully developed in childhood. The

client is encouraged to develop socially appropriate goals aimed at changing flawed motivations to the use of therapeutic contract between the therapist and the counselee to develop trust and respect. Classic conditioning and behaviorism Correct Answer: Concerned only with observable behavior, the effect of thoughts and emotions are not of interest. Classic conditioning is Pavlovian involving a stimulus response reaction. Operant conditioning associated with BF Skinner involved reinforcement that may be positive, negative, punishment/consequences, or extinction in the absence of positive reinforcement. The goal is to train new responses to all stimuli to modification, contracting, systemic desensitization, and modeling. Behavior therapy Correct Answer: Dysfunctional individuals differ from normal functioning individual because they have failed to acquire skills needed to cope with life, have learned faulty behaviors have been reinforced, or both. Therapists identify maladaptive behaviors which must be modified by behavioral techniques such as reward and punishment to shape behavior. Negatively reinforced behavior such as that which is sustained by anxiety, is harder to extinguish than positively reinforced behavior and often requires desensitization. Aversion therapy uses punishment to change behavior. Modeling involves observing the behavior and copying at. Reinforcement is used to cause and maintain certain behaviors using token, response shaping, and contracting. Assertiveness therapy Correct Answer: Involve the appropriate expression of ideas and feelings while respecting the rights and needs of others through use of new interpersonal skills. Biofeedback treatment Correct Answer: Immediate feedback is provided so client can attempt to control physiological reaction linked to an undesired emotional state. Acculturation Correct Answer: 1. Acculturated to the values of the dominant society and rules with little interest or knowledge of traditional ways.

2. Bicculturated with a balance of traditional values and interests with those of the dominant society.
3. Acculturated with no interest in becoming acculturated, but integrated some aspects of main society into their lives.
4. Unacculturated keeping themselves apart from the dominant society and holding strictly to traditional value Tardive dyskinesia Correct Answer: Cause by the use of antipsychotics, includes lolling movement of the time and mouth and jerky movements of the limbs, more often seen in women, may be irreversible, risk increases with age and length of time on drug. Neuroleptic malignant syndrome Correct Answer: Most commonly occurs with the antipsychotics Haldol and Trifluperazine, symptoms include confusion, breathing difficulties, hypothermia, sweating, muscle rigidity, rapid heart rate, and unstable blood pressure. Risk increases as the dose increases and is life-threatening. Diabetes mellitus Correct Answer: Can be associated with the use of atypical neuroleptic/antipsychotics and symptoms include excessive thirst, headaches, slow healing, tiredness, and frequent urination Psychoactive drugs: definition Correct Answer: Drugs that cause a change in mood, thought, or behavior through changes in the central nervous system brought on by stimulation, sedation, or euphoria and can be used for prescribed or illicit substances.

HIV and AIDS - general facts Correct Answer: 1. IV users account for one half of all new AIDS cases in US. Incubation period for a 7 to 8 years after exposure.

2. ARC - AIDS-related complex, and people who have tested positive for HIV but not a and may experience swollen lymph glands, fever, extreme weight loss, fatigue, and diarrhea - most often advances to AIDS
3. Retrovirus enters T cells and replicate, destroys T cells, damages immune system allowing for opportunistic infections that can be fatal, attaches to microphages, if carried to the brain, destroys glial cells, and intellectual functioning is affected.
4. Opportunistic infections include fungal, bacterial, protozoal, and viral diseases along with some types of cancer. Kaposi's sarcoma affects the blood vessels causing purple lesions. Pneumocystis Carinii pneumonia (PCP) is a protozoal infection.
5. Transmission by bodily fluids including semen, vaginal secretions, blood, feces may carry a high enough viral load as well, and breast milk.
6. 30 to 50% of all people who test positive for HIV go on to develop AIDS. Negative test results may be the person has not been exposed, or have been exposed that the antibodies have not had time to develop and this may take up to one year. Professional ethics: definition Correct Answer: The principles of conduct by which an individual professional or group of professionals operates including way the counselor views the world and counselor's values, as well as the legal ethics that govern what services a clinician is licensed to provide. The client needs must come first and clinicians must be aware of their own limitations and not impose their values, ethics or morals on the client. Guidelines for ethical decisions Correct Answer: 1. Identify problem
7. Identify ethical dilemma and liabilities
8. Request feedback from peers and supervisors
9. List all possible solutions and subsequent consequences
10. Take appropriate action National Association of alcoholism and drug abuse counselors (NAADAC) code of ethics Correct Answer: 1) nondiscrimination, 2) responsibility, 3) competent, 4) legal and moral standards, 5) public standards, 6) publication credit, 7) client welfare, 8) confidentiality, 9) client relationships, 10) interprofessional relationships, 11) remuneration, and12) societal obligations Privilege: definition Correct Answer: Privilege refers to the right of an individual not have confidential information disclosed in legal proceedings. Privilege is the property of the client, and the therapist cannot divulge confidential information during a legal proceeding unless the client waive privilege either by agreement, disclosing to a third-party, and under certain legal conditions. Not all states recognize information disclosed to a addiction counselor by a client as privileged. Court ordered disclosure Correct Answer: A court order may be issued under certain circumstances, strict procedures must be followed, client and program must be informed of the application and have the right to file an answer. An order is issued if the good of the public outweighs the interest of the client and program and only information pertinent to the investigation or prosecution may be released. Court ordered disclosure - five criteria Correct Answer: 1. There must be a crime serious in nature, threat to life, threat to serious bodily harm
11. Information must be germane to the investigation or prosecution of a crime
12. If the information cannot be obtained by any other reasonable methods

4. The need to protect the public is greater than the harm that may be done to the client, the treatment program, or the counselor patient relationship
5. And the program is given a chance to retain independent legal counsel. Subpoenas Correct Answer: 1. Should not be ignored but should not be automatically obeyed
6. A lawyer issuing the subpoena should be contacted
7. After consulting with a lawyer if the client record is not germane, subpoena should be destroyed
8. A court order involving a hearing must be issued before the release of information, a subpoena is not enough in and of itself
9. The therapist and/or program should refuse to comply if possible
10. The client and his/her lawyer should be contacted, releases must be obtained if the client chooses to release information Duty to warn: definition Correct Answer: Refers to the legal duty of a therapist to warn the police and potential victim when a client threatened violence to that individual and only applies when a specific individual has been threatened and the risk is imminent. If a client is thought to be dangerous but does not express a threat to any particular individual, it is still generally considered justifiable, on an ethical basis, to warn the proper authorities. Counselors and programs are required by law to report child and elder abuse that comes to their attention. It is the therapist right, not duty, to disclose information in order to prevent a client from committing suicide while protecting client privacy is much as possible. The counselor may choose to take the least intrusive action possible to prevent the danger, and if police are contacted, they should be given only the necessary information. If the client makes a threat to the program, to staff, to the property, or the premises of the program police assistance may be thought and the client's name address and whereabouts and status may be disclosed. Third-party does not have the right to access to confidential information or to influence the course of treatment, however third-party billing makes it difficult to keep the patient's identity and diagnosis confidential. Termination Correct Answer: Counseling lefty terminated when clients are no longer benefiting from the process and counselors must know their limitations and assist with referral as appropriate. Dual relationship Correct Answer: Shipping of sexual contact with the client, this constitutes unethical behavior, the counselor is in a leveraged position over the client, and there should be no exceptions to the rule. Clinicians should not treat friends, relatives, trainees, and fellow workers which can jeopardize the integrity of the program. Social relationships with clients are problematic and discouraged. A counselor should never be a sponsor for a client. Systems of payment Correct Answer: The three most common systems are state and federal funded Medicaid, Medicare funded by Social Security for those over age 64 and those with disabilities, and the HMO. 12 step programs Correct Answer: If programs have not been empirically tested. The steps were written in 1938 and were later adapted for use by drug and food of users as well as others. The 12 steps Correct Answer: 1. Admission by the individual that they are powerless
11. Acceptance of and faith in a greater power

3. A decision to turn their life over to God (of their understanding)
4. Moral inventory
5. Admitting wrongdoing
6. Readiness to ask God to remove character flaws
7. Readiness to ask God to cure shortcomings
8. Listing of long individuals
9. Making a man to wrong the individuals
10. Taking of a personal inventory
11. Seeking of God through prayer
12. Passing on of a spiritual awakening to others AA meetings Correct Answer: Closed meeting - only members of the local group or fellowship are allowed to attend open meeting - any interested party is allowed to attend and asked to maintain the tradition of confidentiality two types of meeting: discussion meeting and speaker meeting where the speaker talks about his/her recovery and speak for about a half hour. A spiritual awakening involve the individual developing a belief that he/she can change in 10 men his/her life to the development of a new outlook, a new hope, as a result of gaining access to a new source of strength, whatever that may be. Rational recovery Correct Answer: An educational company that publishes addictive voice recognition technique (AVR T) 287 abusers in self recovery to a set of educational materials based on the self- help premise Women for sobriety Correct Answer: Dedicated to helping female alcoholics with a 13 positive statements to encourage. Highly successful program. Moderate management (MM) Correct Answer: Provide support for individuals who wish to cut back on their use to the point where it no longer causes problems. Research suggests that this is a possible goal for those who do not use too much, who are not dependent SMART recovery Correct Answer: Self Management And Recovery Training - addiction is not viewed as a disease, but rather a maladaptive behavior pattern and treatment encourages the individual to take responsibility for their actions according to the following four points
13. Develop and maintain motivation to abstain
14. Deal with cravings
15. Rational problem-solving
16. Creating a balanced lifestyle Motivational interviewing Correct Answer: Interviewing techniques designed to elicit self motivational statements from the client by addressing ambivalence to the following five principles
17. Show empathy by reflective listening
18. Expose inconsistency between stated goal, morals, and action
19. Role was resistance and avoid confrontation
20. Challenge inconsistency with flexibility rather than challenging the client
21. Indications of self motivation and hopefulness on the part of the client should be validated strongly Motivational interviewing

The 4 Types of Self motivational statements Correct Answer: 1. A conscious acknowledgment of the issue

2. An emotional expression of concern about the problem
3. A statement of intention to change behavior, and
4. An expression of optimism about the possibility of change Motivational interviewing signs of resistance Correct Answer: 1. Interrupting
5. Arguing
6. Denying
7. Ignoring Motivational interviewing rolling with resistance Correct Answer: 1. Simple reflection in a nonjudgmental manner
8. Amplified reflection in exaggerated form
9. Double-sided reflection using current statement and past statement to develop discrepancy
10. Shifting focus away from the problem area
11. Agreements with a twist by agreeing with the statement and redirecting the conversation
12. Reframing by restating a negative comment in a positive way
13. Siding with the negative by agreeing with the negative statement made by the client as a way to induce change of direction on the part of the client Promoting self-efficacy Correct Answer: For change to occur, the client must believe that he/she is capable of change and that there is hope for his/her situation. Counselor must also believe in client capacity for change and draw upon strength and provides psychoeducation. Routes of administration Correct Answer: 1. Oral - take effect in 20 to 30 minutes
14. Inhalation - through the lungs to the blood to the heart to the brain, take effect in about 7 seconds
15. Intravenous - through the blood to the lungs to the heart to the brain, take effect in about 14 seconds
16. Intranasal/insufflation - nasal mucosal membranes to the heart, lungs, brain
17. Installation (transdermal) through the skin, take up to 60 minutes to have effect Threshold dose Correct Answer: The smallest quantity of a particular drug which will produce an effect that can be detected Median effective dose Correct Answer: The dose of any given drug which will produce unknown response in 50% of the individuals tested Lethal dose Correct Answer: That which result in death for any user Lethal dose 50%, LD - 50 Correct Answer: Measure of the toxicity of a drug, legal for 50% of the individual who take the drug that amount Half-life of a drug Correct Answer: Indication of how long the drug takes to leave the body, measured the time needed for one half of the dose contained in the body to leave the system Four types of drug effects Correct Answer: 1. Independent effect - each individual drug is not affected by the action of the other when taken in combination
18. Antagonistic affect - the actions of one drug block, or diminish the action of the other in the system

3. Additive effect - both drugs taken have similar action, the action of the first drug is added to that of the other drug resulting in a doubling effect
4. Potentiation or just take a fact - potentially highly dangerous effect, the actions of two drugs together are greater than the action of one drug added to the action of the other. Drug schedules Correct Answer: Based upon the potential for a drug to the abuse, whether it has legitimate medical use, and its potential for psychological and physical dependence. Divided into five groups. Schedule I - no legitimate medical use in the US, extremely high potential for abuse, and considered to be unsafe. Schedule II - extremely high potential to be abused, these drugs have legitimate, severely restricted medical uses in the US with risk for psychological and/or physical dependence Schedule III - less likely to be used as drugs of abuse than I and II, have legitimate uses and medical treatment, low to moderate physical dependence but high level of psychological dependence Schedule IV - lower potential for being used for abuse, legitimate medical uses in the US, lower level of physical or psychological, examples include tannic and Valium Schedule V - have accepted medical use in the US, produce low level of physical or psychological dependence, examples include cough syrup with codeine Drug Correct Answer: Any substance which once taken into the human body can change it biological function or structure, maybe non-synthetic or synthetic may be taken for medicinal or recreational purposes Psychoactive drug Correct Answer: Organic or synthetic substance which affects the brain function, potential to change cognitive functioning, emotional functioning, perceptions and behavior, include depressants, narcotics, stimulants, hallucinogens, and inhalants, taken for medicinal purposes and recreationally Depressant drugs Correct Answer: Drugs which decrease the activity of the central nervous system and cause relaxation or sedation Narcotic drugs Correct Answer: Extremely strong analgesics, produce euphoria and other pleasurable effects, reduce tension and anxiety, encourage sleep or stupor Stimulant drugs Correct Answer: Substances which enhance the activity of the central nervous system and sympathetic nervous system causing excitability and increased alertness Hallucinogen drugs Correct Answer: Mostly naturally occurring, causing distortion in perception and reality by exciting the central nervous system Inhalant drugs Correct Answer: Substances that have a psychoactive affect when inhaled, often household products, affect similar to anesthetics Drug use: definition Correct Answer: A term used to describe the consumption of the drug in a socially acceptable manner or in a ritualistic manner to include taking wine at a meal or religious rights such as communion, taking a prescription under the supervision of a physician Drug misuse: definition Correct Answer: Involve the inappropriate or unintentional use of a prescription or nonprescription drug resulting in physical, cognitive, emotional, or social impairment of

the individual, including drinking alcohol while taking antidepressants, taking unfinished prescription medicine from previous treatment. Drug abuse: definition Correct Answer: Conscious use of legal or illegal substances for purposes not related to its normal medical indication which result in impairment in cognitive, physical, emotional, or social functioning on the part of the user.Examples include drug abuse of any illegal substance and under age use of alcohol, and taking any prescription medication in quantities greater than prescribed. Drug dependence: definition Correct Answer: A continuing psychological and/or physical desire for a drug which is demonstrated by compulsive use, tolerance, and physical dependence Physical dependence: definition Correct Answer: The presence of withdrawal symptoms on discontinuance of drugs in question. Also described as producing dependence if its effect reinforce use Tolerance: definition Correct Answer: Diminishing sensitivity to the effects of the drug such that the use occurs in increased amounts to achieve the same psychological and physical results Physical dependence Correct Answer: Use of a drug is needed for normal functioning, because the body had come to view the presence of the drug as the normal state Withdrawal: definition Correct Answer: Also called abstinence syndrome, the body craves the drug when not present, symptoms disappear when the drug is present, physical and psychological withdrawal symptoms occur when the drug is discontinued or when the amount is reduced. Symptoms include sleeplessness, muscle tremors, upset stomach, vomiting, cramps, increased heart rate, increased blood pressure, seizures, anxiety, and depression Addiction/Dependence Correct Answer: Compulsive use of the drug in spite of the ill effects on physical, psychological, or social functioning and progresses on a continuum of disordered use. The term addiction and dependence are often used interchangeably Alcoholism Correct Answer: Considered a chronic disease that may be affected by genetic, environmental, psychological, and social factors Abstinence Correct Answer: Avoidance of the use of drugs or alcohol Relapse Correct Answer: The renewed use of a drug after an interval of abstinence. physiological dependence Correct Answer: related to the body's adaptation to the presence of a chemical so that when the chemical is not present, the body experiences withdrawal symptoms - first acute (1-7 days), then prolonged or post acute (weeks or months) psychological dependence Correct Answer: behavioral dependence - taking a chemical to satisfy a feeling or emotional need or get pleasure, called having a craving. A client must be have both physiological and psychological dependence to be classified as psychoactive chemical dependent. Four stages of CNS withdrawal from depression Correct Answer: Stage I shakes, irritability, loss of appetite

Stage II short-term memory loss, insomnia, perception disturbances, hallucinations, in about 25% of clients. Stage III seizures typically between seven and 48 hours after the last drink stage IV delirium tremens, agitation, hallucination, fever, dilated pupils, delusions, extreme confusion, profuse sweating, tachycardia, sleep disorders, 3 to 5 days after the last drink. Alcohol withdrawal syndrome Correct Answer: Life-threatening stage I: high blood pressure, rapid Paul, increased temperature, anxiety, sleeplessness, nausea, vomiting, shakes, unsteady gait, frequent urination, slurred speech stage II: hallucination, disorientation, seizure, DTs treatment: increase sedation, monitor fluid and electrolytes, provide quiet well lit room to cut down on shadows. Alcohol pharmacotherapies Correct Answer: Disulfiram/Antabuse antagonist making someone sick if they drink. Can be taken with methadone. Naltrexone/ReVia - reduce cravings Telangiectasia Correct Answer: Broken capillaries on the skin surface caused by chronic dilation of the vessels brought on by alcohol consumption Rhinophyma Correct Answer: Abnormal enlargement of the nose due to alcohol consumption Barbiturate withdrawal syndrome Correct Answer: Symptoms include the possibility of blood pressure and breathing problems as well as seizures, uncontrolled heartbeat, delirium, and death. Detoxification must take place under medical supervision. Recreational use Correct Answer: Use of chemicals in social settings to get the effect of the drug, infrequent and small amounts Circumstantial use Correct Answer: Use tied to a particular situation, such as truck drivers using stimulants to stay awake Compulsive use Correct Answer: Use on a daily basis, large amount, to produce a desired effect, typically classified as addiction Intensified use Correct Answer: Typically small amounts used on a daily basis typically to alleviate the problem or to boost levels of performance Abuse liability Correct Answer: The chance of a drug causing addiction Controlled substance Correct Answer: Any drug that has an abuse liability and is placed on restricted used by the DEA Poly chemical abuse Correct Answer: When more than one psychoactive chemical is used at a time Stage theory of addiction model Correct Answer: 1) Treatment initiation

2. early abstinence
3. maintenance of abstinence
4. advanced recovery

SOAP notes Correct Answer: The SOAP note (an acronym for subjective, objective, assessment, and plan) is a method of documentation employed by health care providers to write out notes in a patient's chart, along with other common formats, such as the admission note.