Drug Addiction Counseling

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. The 12-step approach to addiction treatment-its philosophy and procedures-applies to recovery from alcohol

a) alcohol
b) cocaine
c) narcotics
d) any mood-altering substance

2. The philosophy and beliefs of the 12-step approach incorporate all of the following principles except

a) Addiction is more closely akin to an illness over which one has little, if any, control.
b) Recovery involves a return to self-respect through honesty with oneself and others.
c) Addiction is a genetic trait over which one has little control.
d) Recovery requires addicts to recognize the existence of a higher power and to incorporate this belief in their own lives.
e) Spiritual aspect to recovery from chemical dependency; a healing of one's life that needs to take place, and abstinence from the drug is merely the first step rather than the terminal goal.

3. Individual drug counseling is similar and dissimilar to other approaches used in addiction counseling. Select the one that is dissimilar to individual drug counseling approach:

a) Minnesota Model (or Hezelden approach)
b) 12-step facilitation model
c) psychotherapy model

4. Addiction counseling differs from psychotherapy in many respects. One of the following is a correct element of addiction counseling:

a) It emphasizes long-term goals, e.g., continued abstinence, change in lifestyle, etc.
b) It encourages the patient, for instance, to work through issues stemming from his or her early abusive relationship with a parent.
c) It provides the patient with concrete, behavioral options to facilitate recovery, such as avoiding those things that trigger drug use.
d) Addiction counseling focuses on the present as well as the past issues that enabled the patient's drug use.

5. In the individual drug counseling model proposed to treat cocaine addiction, the optimal frequency for initial counseling sessions is _____ a week.

a) once
b) twice
c) 4 times
d) 6 times

6. The main assessment instrument that is used routinely with addiction counseling is the Addiction Severity Index (ASI). It measures all of the following addiction-related domains except

a) drug and alcohol use
b) psychiatric problems
c) legal problems
d) employment/support problems
e) success/failure of past treatments

7. For effective results, there are certain behaviors that the counselor should not indulge in. Which behavior is inconsistent with the goals of individual counseling?

a) The counselor should not be harshly judgmental of the patient's addictive behaviors.
b) The counselor should be respectful of the patient.
c) To gain patient's confidence and foster a therapeutic alliance, the counselor should "self-disclose" frequently.
d) The counselor should not project the counselor's own needs or experiences onto those of the patient's situation.
e) The counselor should be willing to accept feedback from the patient and possibly change the approach

8. The patient has tested positive for cocaine. During the session, when the counselor discusses the urinalysis result the patient denies any use. The best course of action for the counselor would be:

a) give the patient the benefit of the doubt and wait until next urinalysis;
b) use themes of shame or denial to bring the patient around to face his or her relapse;
c) confront the patient with the results and do not give ground until the patient has admitted the drug usage;
d) accept the patient's denial to help the patient save face.

9. During counseling sessions, counselor should deal with issues of denial and ambivalence. Which of the following statements indicates that the patient is ambivalent about making a commitment to treatment?

a) Refuses to believe that he or she is an addict.
b) The patient associates drug use with some positive emotional change.
c) Thinks that he or she can solve the problem by "cutting down" on cocaine use.
d) Believes that he or she is "not like other addicts who need help."

10. During the second (abstinence) stage of treatment for cocaine addiction, the counselor should address certain treatment issues. Select the incorrect approach:

a) Identify and avoid the people, places and things that will trigger or lead to a cocaine urge.
b) Help organize the patient's daily routine to encourage abstinence.
c) Insist on total abstinence from all drugs, including alcohol or marijuana, and if the patient resists or refuses to abstain from other drugs suspend the treatment until the patient cooperates.
d) Identify high-risk situations and develop strategies for avoiding these situations.
e) Emphasize the importance of participating in self-help groups, such as 12-step groups.

11. Craving is the strong desire an addict experiences for his or her drug of choice, such as cocaine. Craving, however strong, does not have to lead to drug use. One can just "sit the craving out," and it will pass.

a) True
b) False

12. Case: Sandy now has had 3 clean months. She works as a server in an upscale restaurant, is admired by her coworkers, and draws praise from her supervisors. Now that she has gotten her life back together, she works extra hours to earn overtime. But the add

a) yes
b) no

13. Addiction invariably produces feelings of shame and guilt that damage the addict's self-esteem. All of the following are appropriate ways for the counselor to help the patient deal with feelings of shame and guilt except

a) accept feelings of shame and guilt as part of addiction and recovery process make amends, or apologize to people one has wronged in one's addiction
b) make amends, or apologize to people one has wronged in one's addiction
c) take a personal inventory
d) encourage healthy, responsible living

14. Taking one's personal inventory is a pivotal aspect of the recovery process, allowing the recovering addict to recognize what he or she has been through and how he or she wants his or her life to be from this point forward. This process involves

a) recognizing "character defects" that are obstacles to recovery;
b) recognizing positive qualities within oneself;
c) both of the above

15. Addicts recovering from chemical addiction often become compulsively involved in other activities. The counselor should warn the patient against transferring addictive behaviors. However, there is one important exception to discouraging compulsive behav

a) spending excessive amount of time on the job ("workaholism")
b) attending several self-help group meetings a day (such as AA, NA or CA)
c) overexercise
d) overeating

16. Which of the following is an example of codependent behavior?

a) the addict's spouse or family members feel that their lives are controlled by the addict's addictive behavior
b) when another person helps or encourages the addict to continue using drugs

17. One of the important triggers causing a relapse to cocaine use for an addict in recovery is too much free time with little gainful activity. Therefore, the counselor should encourage the addict to seek employment during the very early stages of counseling

a) True
b) False

18. In the time-limited model for individual drug counseling to treat cocaine addiction, counseling is concluding at the point when the patient is entering advanced recovery. In the final treatment session, the counselor should discuss with the patient all of

a) patient's thoughts and feelings about ending treatment
b) patient's overall experience of the treatment process
c) if the patient would like to extend the length of treatment.
d) the areas still needing work and how the patients will continue to work on them independently
e) patient's personal commitment to contine in his or her own recovery process

19. Individual drug counseling approach allows

a) to extend the length of the treatment to suit the individual's needs;
b) for treatment booster sessions following completion of the active treatment phase to reinforce the issues learned;
c) both of the above.

20. What is the best way to deal with a patient's lateness or nonattendance for the treatment session?

a) confront the patient about it in the session
b) excuse such behavior as a sign of drug addiction
c) extend the session or schedule a makeup session to compensate for lateness or nonattendance
d) promptly terminate the treatmen

21. What is the most appropriate way to deal with a relapse?

a) Terminate the treatment and dismiss the patient from the program since the patient is not committed to his or her recovery.
b) Overlook the relapse, if it is only a slip, and hope that the patient will not use again.
c) Identify where the patient deviated from his or her recovery plan and help the patient to recommit to the recovery program.
d) Change the counselor; prescribe different treatment modality, such as group counseling.

22. Protocol in individual drug counseling requires that the counselor terminate the treatment if the patient fails to show up for

a) one treatment session
b) three consecutive sessions
c) 30 consecutive sessions

23. An ideal addiction counselor should have certain personal characteristics. Since patients look up to counselors as role models, a counselor in recovery himself or herself should not be hired for the job.

a) True
b) False

24. Generally speaking, a drug counselor should not be hired unless he or she has a degree in clinical psychology.

a) True
b) False

25. The adherence scale designed in the individual drug counseling model has the following purpose:

a) training and supervision
b) determine compensation of counselors
c) justify and obtain funding for the program
d) community relations
e) all of the above

26. Which of the following features define cognitive-behavioral therapy?

a) long duration, focuses on long-term problems
b) uses right format for effectiveness
c) short-term, comparatively brief approach
d) focuses on the immediate problems faced by the cocaine abuser
e) c and d

27. Select the approach that is the hallmark of CBT?

a) spiritual approach
b) emphasis is on learning healthier skills and habits
c) employs rewards-and-punishment system
d) uses holistic approach addressing physical, emotional, spiritual and interpersonal needs

28. CBT treatment is usually delivered on an outpatient basis.

a) True
b) False

29. Cognitive-behavioral therapy is based on three treatment principles. Select the one that's not part of CBT:

a) recognize
b) confront
c) avoid
d) cope

30. Cognitive-behavioral coping skills treatment (CBT) has several features that make it promising as a treatment for cocaine abuse and dependence. Select the correct statement from the following:

a) CBT is designed to deliver treatment to substance users in a group format.
b) For positive outcome, CBT is offered over a long term, typically 12 months.
c) Treatment is usually delivered on an inpatient basis.
d) CBT is generally not appropriate for those who have psychotic or bipolar disorders and are not stabilized on medication.
e) For cocaine abusers with no stable living arrangements, CBT has delivered excellent results.

31. Which of the following interventions is not part of CBT?

a) problem solving and planning for emergencies
b) training in recognizing and coping with craving
c) requiring the patient to attend self-help groups
d) providing feedback on urinalysis results

32. While CBT is dissimilar to 12-step, or disease-model approaches in a number of ways, it shares some concepts with them too. Select from the following the similarity between the two therapies:

a) concept of alcoholism as a spiritual and medical disease
b) addiction as a disease that can be controlled but never cured
c) the concept of higher power
d) substance abuse is a learned behavior that can be modified
e) people, places and things

33. Which of the following concepts characterizes cognitive-behavioral therapy approach?

a) reduce substance use by changing the way the patient thinks
b) change what the patient does and thinks
c) contingency management component that provides vouchers for staying in treatment
d) employ motivational strategies to mobilize the client's own change resources

34. Which of the following statements correctly describes the basic principles of cognitive-behavioral therapy approach?

a) In cognitive-behavioral therapy, the counselor assumes a dominant role and defines treatment goals and formulates strategies for the patient to follow.
b) The treatment uses three spiritual principles of honesty, open-mindedness and willing- ness as ladders for recovery.
c) CBT relies heavily on psychosocial interventions and eschews pharmacotherapy.
d) Individuals "learn" to use and abuse substances, and the CBT treatment can help them "unlearn" the substance abuse.
e) CBT is essentially a self-help program where the patient is rewarded for abstinence.

35. Being lonely or bored elicits an intense craving to use cocaine in this patient. This is an example of modeling

a) modeling
b) operant conditioning
c) classical conditioning

36. CBT uses three principles-modeling, operant conditioning, and classical conditioning-to help the patient stop abusing cocaine. Therapist attempts to understand why a patient is more likely to use in a given situation and to understand the role that cocain

a) modeling
b) operant conditioning
c) classical conditioning

37. CBT uses the "20/20/20 Rule" for the flow of a typical 60-minute CBT session. When should the discussion of urine tests take place?

a) first third of session
b) second third of session
c) third third of session

38. The cognitive-behavioral approach to treating cocaine addiction is not compatible with pharmacotherapy.

a) True
b) False

39. The treatment goal in cognitive-behavioral therapy for cocaine addiction is:

a) cut down the drug use to a point where the negative consequences are eliminated
b) satisfy the court-imposed or probation-related legal conditions
c) reduce the cocaine dependency to a level where the patient is able to return to somewhat normal life, avoid criminal behavior, resume family life
d) abstinence

40. Following are some of the statements that explain craving and ways of coping with it. Select the incorrect statement.

a) Experiencing some craving is normal and quite common.
b) When the patient craves for cocaine, it means the patient really wants to resume drug use.
c) Craving does not mean something is wrong with the patient.
d) Craving is time-limited; in other words the feeling of craving would go away if the patient does not give in to it.
e) Leaving the situation and going somewhere safe is one of the most effective ways of dealing with craving when it occurs.

41. The variety of strategies for coping with craving include

a) focusing on craving until it goes away
b) giving in to the craving
c) recalling the negative consequences of cocaine abuse
d) doing nothing

42. If a patient states that his goal is to reduce cocaine use to "controlled" levels, it would be wise for the therapist, particularly in the early weeks of treatment, to not directly challenge the patient until a therapeutic alliance is established.

a) True
b) False

43. Which of the following strategies is likely to be most effective when a person is offered cocaine by a friend, coworker or family member?

a) Look away from the person, avoiding eye contact.
b) Say "Not now."
c) Change the subject.
d) Respond with a clear and firm "no."

44. All of the following are examples of Seemingly Irrelevant Decisions except

a) keeping alcohol in the house
b) not having any free time
c) not destroying cocaine or crack paraphernalia
d) getting overtired or stressed

45. What is the first-step in the problem-solving process?

a) What is the problem?
b) Write down as many solutions as possible.
c) Is there a problem?
d) Consider both the positive and negative consequences of all solutions.

46. In cognitive-behavioral approach therapists are encouraged to actively address patient's psychosocial problems that present a barrier to treatment.

a) True
b) False

47. The risk of HIV infection to cocaine abusers generally comes from

a) unsafe needle practices
b) unsafe sexual practices

48. In selecting significant others to attend a CBT session, only the individuals who are close to the patient (spouses, partner, parents, siblings) and who are not substance abusers themselves should be invited.

a) True
b) False

49. Therapists may allow patients to invite a close family member or friend to attend the CBT sessions. The purpose of their attendance is all of the following except

a) offer significant others the opportunity to learn about the treatment in which patients are involved;
b) explore strategies through which they can help patients become and remain abstinent;
c) provide marital or family therapy;
d) answer questions from the significant others about the treatment.

50. The minimum acceptable level of ongoing supervision for an experienced therapist is

a) once a week
b) once a month
c) once every three months
d) whenever therapist requests it

51. If a patient presents with a range of complex and severe comorbid problems, a therapist is well-advised to abandon the manual and adopt a less structured approach.

a) True
b) False

52. After reviewing clinical research supporting CBT, select the most correct statement from the following:

a) CBT is better than no treatment or minimal treatment.
b) CBT is more effective than other widely used treatments.
c) both of the above
d) none of the above

53. Several clinical trials have been conducted to examine the efficacy of CRA+Vouchers approach. The results clearly established that CRA+Vouchers was superior to

a) standard drug counseling
b) CRA alone
c) both of the above
d) none of the above

54. CRA+Vouchers approach requires flexibility in appointment scheduling and goal setting. Toward this, the counselor should

a) tolerate tardiness
b) be willing to meet patients any time of day
c) set up meetings out of the office if necessary
d) compromise on total abstinence
e) all of the above

55. Patient comes to a treatment session in the CRA+Vouchers program with a housing problem which is clearly unrelated to the immediate issues of drugs addiction. How should the counselor handle this crisis?

a) Explain to the patient that the issue is not part of the treatment plan.
b) Provide referrals to other resources.
c) Reserve 10-20 minutes at the end of the session to discuss the patient's concerns.
d) Solve the problem for the patient.

56. CRA+Vouchers is an incentive-based program designed to obtain long periods of continuous abstinence from patients. Which of the following statements correctly reflects the voucher/ incentive plan?

a) Cash is given to patients who provide five consecutive cocaine-negative urine specimens.
b) Patients can use vouchers to buy whatever item they want.
c) Vouchers are discontinued whenever cocaine use occurs.
d) Vouchers are used to purchase retail items in the community by a staff member.

57. Once an applicant contacts the clinic to request treatment, the maximum time that should elapse before the intake interview takes place is

a) 3 hours
b) 24 hours
c) 2 days
d) 1 week

58. For CRA+Vouchers program the patient should meet all of the following criteria except

a) cocaine abuser
b) 18 years or older
c) residing within a reasonable distance of the clinic
d) have supporting family or friends

59. One of the important steps while introducing the voucher program to patients is called priming. Which of the following is an example of priming?

a) collecting a urine sample from the patient
b) scheduling the next session
c) determining if the patient abuses alcohol as well
d) describing the abstinence contract
e) providing the patient movie tickets or passes to some community recreational facility

60. There are four components of the functional analysis, some occurring before the cocaine use, some after. Which of the following components occurs considerably after the patient has used cocaine?

a) triggers
b) behavior
c) positive consequences
d) negative consequences

61. Therapy recommends three basic ways of handling triggers to reduce the risk of cocaine use. Which of the following is not recommended?

a) meet the trigger situation head-on asking the patient to exercise his or her will power
b) avoid the trigger (e.g., take a different route home)
c) rearrange the environment (e.g., don't keep cocaine in the house)
d) develop new coping method (e.g., engage in a different activity)

62. As many as one-third of substance abusers relapse as a direct result of social pressure from friends to use. Counselors should train patients in effective drug refusal techniques. Which is the best refusal response?

a) Maybe later.
b) I'm on medication.
c) No, thank you.
d) My counselor will find out.
e) I have to get home, my wife is waiting for me.

63. As part of the relationship counseling, patients are asked to complete Relationship Happiness Scale form. This exercise is used to

a) recount to each other what it was like when they first met
b) assess how happy couples are currently with various areas of their lives
c) remind patients and their partners to be nice to each other
d) list areas in which each of them would like to see some changes from the partner

64. CRA+Vouchers recommends but does not require cessation of all abuse substances as a condition of treatment.

a) True
b) False

65. Alcohol is the substance most commonly used or abused in combination with cocaine. In the CRA+Vouchers program, the recommended strategy for dealing with alcohol use is:

a) Make monitored disulfiram therapy a condition of the treatment.
b) Encourage the patient to reduce drinking and restrict it to safe circumstances.
c) Terminate the therapy if the patient refuses to cease or reduce alcohol use.
d) The issue is irrelevant since alcohol use does not interfere with cocaine abstinence.

66. Some individuals can use marijuana regularly without adversely affecting cocaine abstinence.

a) True
b) False

67. In 90 percent of cocaine-dependent patients, depressive symptoms continue to be a significant problem despite abstinence which requires psychiatric and behavioral interventions.

a) True
b) False

68. A common symptom that occurs following discontinuation of cocaine use is insomnia.

a) True
b) False