ADC./Exam./1
A./wife./refers./her./husband./for./substance./abuse./counseling../His./drug./of./ch
oice./is./cocaine,./which./he./has./been./using./episodically./with./friends./at./a./po
ker./game—biweekly./to./weekly—
for./some./years../She./is./disturbed./at./the./illicit./nature./of./the./drug./and./the./lo
ng-
standing./use../He./states./that./though./he./recreationally./uses,./he./doesn't./crav
e./cocaine,./doesn't./seek./it./out./but./rather./uses./with./friends./at./the./game./who.
/bring./it../He./feels./that./other./than./his./wife./being./upset,./he./has./no./other./soc
ial./or./occupational./issues../Given./the./information./provided,./how./is./his./use
./of./cocaine./BEST./described?
a../Substance./abuse
b../Cocaine./intoxication
c../Cocaine./use./disorder
d../None./of./the./above./-
./correct./answer./D:./None./of./the./above../The./DSM./lists./a./set./of./eleven./sym
ptoms,./2./or./more./of./which./must./have./occurred./at./any./time./during./the./pas
t./12./months./for./a./diagnosis./of./substance./use./disorder../1)./Tolerance,./defin
ed./as./either./the./need./for./larger./and./larger./amounts./of./the./drug./in./question.
/over./time./to./achieve./the./desired./result,./or./a./decrease./in./the./effect./of./the./d
rug./with./continued./use./of./the./same./amount./2)./Withdrawal,./defined./by./eit
her./the./known./withdrawal./symptoms./for./a./particular./drug,./or./by./the./fact./t
hat./the./drug,./or./a./similar./drug,./is./taken./to./avoid./withdrawal./symptoms./3)./
An./increase./in./the./amount./of./the./drug./taken,./or./the./continued./use./of./the./d
rug./past./the./intended./time./4)./An./inability./to./control./usage./5)./A./large./amo
unt./of./time./and./effort./devoted./to./obtaining./the./drug./in./question,./using./the.
,drug./in./question,./or./recovering./from./its./effects./6)./The./giving./up./of./impor
/
tant./activities./in./order./to./obtain./or./use./the./drug./in./question,./or./recover./fro
m./its./effects./7)./The./continued./use./of./the./drug./in./question./regardless./of./th
e./ill./effects./it./has./caused../8)./Craving./9)./Recurrent./drug./use./which./leads./t
o./inability./to./fulful./major./role./10)./Recurrent./drug./use./though./it./is./physica
lly./harmful./11)./Recurrent./drug./use./despite./it./leading./to./continued./social./
problems../He./does./not./meet./the./criteria./for./current./intoxication./either../Re
creational./use./commonly./occurs./biweekly./or./weekly,./and./the./use./is./typic
ally./for./reasons./of./sociality../Substance./abuse./counseling./is./therefore./not./i
ndicated../However,./counseling./regarding./the./potential./for./life./circumstan
ces,./stressors,./or./other./unexpected./losses./or./burdens./to./precipitate./a./futur
e./substance./abuse./problem./should./be./discussed.
What./does./the./experienced./effect./of./a./drug./depend./upon?
a../The./amount./taken./and./past./drug./experiences
b../The./modality./of./administration
c../Poly./drug./use,./setting,./and./circumstance
d../All./of./the./above./-
./correct./answer./D:./All./of./the./above../The./amount./of./a./drug./ingested./will./t
ypically./affect./the./user's./experience,./with./higher./doses./often./producing./a./
greater./effect./(though./potentially./diminishing./over./time./as./tolerance./deve
lops)../The./modality./of./administration./can./greatly./influence./the./rate./of./the
./drug's./uptake./into./the./system../Normally./the./rate./of./effect,./from./greatest./t
o./least,./is:./inhalation./(snorting./or./smoking),./injection./(intravenous,./intra
muscular,./or./subcutaneous),./and./ingestion./(sublingual./or./swallowing./wit
h./or./without./food)../Generally,./the./faster./the./systemic./uptake,./the./shorter./
and./more./intense./the./high./experienced../Polydrug./abuse./greatly./complicat
,es./the./drug./experience,./particularly./if./the./drugs./used./are./chemical./antago
nists./(e.g.,./stimulants./and./depressants—
such./as./meth./and./alcohol),./additive./(producing./a./cumulative./effect),./syne
rgistic./(more./than./cumulative),./or./potentiating./(each./enhancing./each./othe
r)../The./setting./in./which./the./substance./use./occurs./is./also./often./a./significan
t./contributor./to./the./experience../The./feelings./engendered./by./the./surroundi
ngs,./the./people./with./whom./the./experience./is./shared,./the./attitudes./and./rea
ctions./of./others./involved,./as./well./as./personal./past./drug./experiences./and./i
ndividual./biology./all./combine./to./produce./a./drug./experience.
How./is./drug./tolerance./BEST./described?
a../The./inability./to./get./intoxicated
b../The./need./for./more./of./a./drug./to./get./intoxicated
c../Increased./sensitivity./to./a./drug./over./time
d../Decreased./sensitivity./to./a./drug./over./time./-
./correct./answer./D:./Decreased./sensitivity./to./a./drug./over./time../When./a./dru
g./is./used./regularly,./the./body./is./gradually./able./to./adapt./to./the./effects./of./th
e./drug../Evidence./of./tolerance./is./twofold:./(1)./greater./doses./of./the./drug./are.
/required./to./achieve./previous./effects,./and./(2)./doses./that./would./have./produ
ced./profound./physiological./compromise./or./even./death./are./now./readily./to
lerated./without./untoward./effects../In./some./cases,./it./has./been./noted./that./up.
/to./ten./times./a./lethal./dosage,./or./even./more,./ may./be./taken./without./any./sign
s./of./significant./physiological./compromise../Tolerance./develops./as./the./bod
y./seeks./homeostasis,./or./a./functional./state./of./equilibrium,./in./spite./of./the./p
resence./of./the./drug.
, Which./of./the./following./is./NOT./a./"drug./cue"?
a../A./prior./drug-use./setting
b../Drug./use./paraphernalia
c../Seeing./others./use./drugs
d../Drug./avoidance./strategies./-
./correct./answer./D:./Drug./avoidance./strategies../Intense./drug./euphoria./prod
uces./extremely./intense,./emotionally./imprinted./memory./engrams,./couple
d./with./long-
term./changes./in./the./amygdala./area./of./the./brain,./which./operate./outside./of./
conscious./control../Key./euphoric./memories./become./integrally./connected./
to./sights,./sounds,./smells,./people,./and./places./previously./associated./with./d
rug./use../The./reappearance./of./any./of./these./past./drug./cues./will./often./effect
ively./trigger./intense,./amygdala-
driven./cravings./for./a./drug../Cravings./are./further./intensified./by./lingering./i
mbalances./in./brain./metabolism./patterns,./receptor./availability,./hormone./l
evels,./and./other./hypothalamus./and./pituitary-
mediated./sensations./of./dysphoria./and./distress../The./cascading./nature./of./th
ese./effects./frequently./induces./a./drug-use./relapse.
What./happens./as./tolerance./for./barbiturates./develops?
a../The./margin./between./intoxication./and./lethality./increases.
b../The./margin./between./intoxication./and./lethality./decreases.
c../The./margin./between./intoxication./and./lethality./stays./the./same.
d../Tolerance./does./not./develop./for./barbiturates../-
./correct./answer./C:./The./margin./between./intoxication./and./lethality./stays./th
e./same../While./tolerance./for./barbiturates./does./develop,./tolerance./for./an./ot
A./wife./refers./her./husband./for./substance./abuse./counseling../His./drug./of./ch
oice./is./cocaine,./which./he./has./been./using./episodically./with./friends./at./a./po
ker./game—biweekly./to./weekly—
for./some./years../She./is./disturbed./at./the./illicit./nature./of./the./drug./and./the./lo
ng-
standing./use../He./states./that./though./he./recreationally./uses,./he./doesn't./crav
e./cocaine,./doesn't./seek./it./out./but./rather./uses./with./friends./at./the./game./who.
/bring./it../He./feels./that./other./than./his./wife./being./upset,./he./has./no./other./soc
ial./or./occupational./issues../Given./the./information./provided,./how./is./his./use
./of./cocaine./BEST./described?
a../Substance./abuse
b../Cocaine./intoxication
c../Cocaine./use./disorder
d../None./of./the./above./-
./correct./answer./D:./None./of./the./above../The./DSM./lists./a./set./of./eleven./sym
ptoms,./2./or./more./of./which./must./have./occurred./at./any./time./during./the./pas
t./12./months./for./a./diagnosis./of./substance./use./disorder../1)./Tolerance,./defin
ed./as./either./the./need./for./larger./and./larger./amounts./of./the./drug./in./question.
/over./time./to./achieve./the./desired./result,./or./a./decrease./in./the./effect./of./the./d
rug./with./continued./use./of./the./same./amount./2)./Withdrawal,./defined./by./eit
her./the./known./withdrawal./symptoms./for./a./particular./drug,./or./by./the./fact./t
hat./the./drug,./or./a./similar./drug,./is./taken./to./avoid./withdrawal./symptoms./3)./
An./increase./in./the./amount./of./the./drug./taken,./or./the./continued./use./of./the./d
rug./past./the./intended./time./4)./An./inability./to./control./usage./5)./A./large./amo
unt./of./time./and./effort./devoted./to./obtaining./the./drug./in./question,./using./the.
,drug./in./question,./or./recovering./from./its./effects./6)./The./giving./up./of./impor
/
tant./activities./in./order./to./obtain./or./use./the./drug./in./question,./or./recover./fro
m./its./effects./7)./The./continued./use./of./the./drug./in./question./regardless./of./th
e./ill./effects./it./has./caused../8)./Craving./9)./Recurrent./drug./use./which./leads./t
o./inability./to./fulful./major./role./10)./Recurrent./drug./use./though./it./is./physica
lly./harmful./11)./Recurrent./drug./use./despite./it./leading./to./continued./social./
problems../He./does./not./meet./the./criteria./for./current./intoxication./either../Re
creational./use./commonly./occurs./biweekly./or./weekly,./and./the./use./is./typic
ally./for./reasons./of./sociality../Substance./abuse./counseling./is./therefore./not./i
ndicated../However,./counseling./regarding./the./potential./for./life./circumstan
ces,./stressors,./or./other./unexpected./losses./or./burdens./to./precipitate./a./futur
e./substance./abuse./problem./should./be./discussed.
What./does./the./experienced./effect./of./a./drug./depend./upon?
a../The./amount./taken./and./past./drug./experiences
b../The./modality./of./administration
c../Poly./drug./use,./setting,./and./circumstance
d../All./of./the./above./-
./correct./answer./D:./All./of./the./above../The./amount./of./a./drug./ingested./will./t
ypically./affect./the./user's./experience,./with./higher./doses./often./producing./a./
greater./effect./(though./potentially./diminishing./over./time./as./tolerance./deve
lops)../The./modality./of./administration./can./greatly./influence./the./rate./of./the
./drug's./uptake./into./the./system../Normally./the./rate./of./effect,./from./greatest./t
o./least,./is:./inhalation./(snorting./or./smoking),./injection./(intravenous,./intra
muscular,./or./subcutaneous),./and./ingestion./(sublingual./or./swallowing./wit
h./or./without./food)../Generally,./the./faster./the./systemic./uptake,./the./shorter./
and./more./intense./the./high./experienced../Polydrug./abuse./greatly./complicat
,es./the./drug./experience,./particularly./if./the./drugs./used./are./chemical./antago
nists./(e.g.,./stimulants./and./depressants—
such./as./meth./and./alcohol),./additive./(producing./a./cumulative./effect),./syne
rgistic./(more./than./cumulative),./or./potentiating./(each./enhancing./each./othe
r)../The./setting./in./which./the./substance./use./occurs./is./also./often./a./significan
t./contributor./to./the./experience../The./feelings./engendered./by./the./surroundi
ngs,./the./people./with./whom./the./experience./is./shared,./the./attitudes./and./rea
ctions./of./others./involved,./as./well./as./personal./past./drug./experiences./and./i
ndividual./biology./all./combine./to./produce./a./drug./experience.
How./is./drug./tolerance./BEST./described?
a../The./inability./to./get./intoxicated
b../The./need./for./more./of./a./drug./to./get./intoxicated
c../Increased./sensitivity./to./a./drug./over./time
d../Decreased./sensitivity./to./a./drug./over./time./-
./correct./answer./D:./Decreased./sensitivity./to./a./drug./over./time../When./a./dru
g./is./used./regularly,./the./body./is./gradually./able./to./adapt./to./the./effects./of./th
e./drug../Evidence./of./tolerance./is./twofold:./(1)./greater./doses./of./the./drug./are.
/required./to./achieve./previous./effects,./and./(2)./doses./that./would./have./produ
ced./profound./physiological./compromise./or./even./death./are./now./readily./to
lerated./without./untoward./effects../In./some./cases,./it./has./been./noted./that./up.
/to./ten./times./a./lethal./dosage,./or./even./more,./ may./be./taken./without./any./sign
s./of./significant./physiological./compromise../Tolerance./develops./as./the./bod
y./seeks./homeostasis,./or./a./functional./state./of./equilibrium,./in./spite./of./the./p
resence./of./the./drug.
, Which./of./the./following./is./NOT./a./"drug./cue"?
a../A./prior./drug-use./setting
b../Drug./use./paraphernalia
c../Seeing./others./use./drugs
d../Drug./avoidance./strategies./-
./correct./answer./D:./Drug./avoidance./strategies../Intense./drug./euphoria./prod
uces./extremely./intense,./emotionally./imprinted./memory./engrams,./couple
d./with./long-
term./changes./in./the./amygdala./area./of./the./brain,./which./operate./outside./of./
conscious./control../Key./euphoric./memories./become./integrally./connected./
to./sights,./sounds,./smells,./people,./and./places./previously./associated./with./d
rug./use../The./reappearance./of./any./of./these./past./drug./cues./will./often./effect
ively./trigger./intense,./amygdala-
driven./cravings./for./a./drug../Cravings./are./further./intensified./by./lingering./i
mbalances./in./brain./metabolism./patterns,./receptor./availability,./hormone./l
evels,./and./other./hypothalamus./and./pituitary-
mediated./sensations./of./dysphoria./and./distress../The./cascading./nature./of./th
ese./effects./frequently./induces./a./drug-use./relapse.
What./happens./as./tolerance./for./barbiturates./develops?
a../The./margin./between./intoxication./and./lethality./increases.
b../The./margin./between./intoxication./and./lethality./decreases.
c../The./margin./between./intoxication./and./lethality./stays./the./same.
d../Tolerance./does./not./develop./for./barbiturates../-
./correct./answer./C:./The./margin./between./intoxication./and./lethality./stays./th
e./same../While./tolerance./for./barbiturates./does./develop,./tolerance./for./an./ot
