ADDICTION COUNSELOR PRACTICE TEST WITH
RATIONALES
*1.* A wife refers her husband for substance abuse counseling. His drug of
choice is cocaine, which he has been using episodically with friends at a
poker game—biweekly to weekly—for some years. She is disturbed at the
illicit nature of the drug and the long-standing use. He states that though he
recreationally uses, he does not crave cocaine, does not seek it out but
rather uses with friends at the game who bring it, and he feels that other
than his wife being upset about him using, he has no other social or
occupational issues. Given the information provided, how is his use of
cocaine BEST described?
a. Substance abuse
b. Cocaine intoxication
c. Cocaine use disorder
d. None of the above - ANSWER-*D. None of the above*
The DSM lists a set of eleven symptoms, 2 or more of which must have
occurred at any time during the past 12 months for a diagnosis of substance
use disorder. 1) Tolerance, defined as either the need for larger and larger
amounts of the drug in question over time to achieve the desired result, or a
decrease in the effect of the drug with continued use of the same amount 2)
Withdrawal, defined by either the known withdrawal symptoms for a
particular drug, or by the fact that the drug, or a similar drug, is taken to
avoid withdrawal symptoms 3) An increase in the amount of the drug taken,
or the continued use of the drug past the intended time 4) An inability to
control usage 5) A large amount of time and effort devoted to obtaining the
drug in question, using the drug in question, or recovering from its effects 6)
The giving up of important activities in order to obtain or use the drug in
question, or recover from its effects 7) The continued use of the drug in
question regardless of the ill effects it has caused. 8) Craving 9) Recurrent
drug use which leads to inability to fulfil major role 10) Recurrent drug use
though it is physically harmful 11) Recurrent drug use despite it leading to
continued social problems. He does not meet the criteria for current
intoxication either. Recreational use commonly occurs biweekly or weekly,
,and the use is typically for reasons of sociality. Substance abuse counseling
is therefore not indicated. However, counseling regarding the potential for
life circumstances, stressors, or other unexpected losses or burdens to
precipitate a future substance abuse problem should be discussed.
*2.* What does the experienced effect of a drug depend upon?
a. The amount taken and past drug experiences
b. The modality of administration
c. Poly drug use, setting, and circumstance
d. All of the above - ANSWER-*D: All of the Above*
The amount of a drug ingested will typically affect the user's experience,
with higher doses often producing a greater effect (though potentially
diminishing over time as tolerance develops). The modality of administration
can greatly influence the rate of the drug's uptake into the system. Normally
the rate of effect, from greatest to least, is: inhalation (snorting or smoking),
injection (intravenous, intramuscular, or subcutaneous), and ingestion
(sublingual or swallowing with or without food). Generally, the faster the
systemic uptake, the shorter and more intense the high experienced.
Polydrug abuse greatly complicates the drug experience, particularly if the
drugs used are chemical antagonists (e.g., stimulants and depressants—such
as meth and alcohol), additive (producing a cumulative effect), synergistic
(more than cumulative), or potentiating (each enhancing each other). The
setting in which the substance use occurs is also often a significant
contributor to the experience. The feelings engendered by the surroundings,
the people with whom the experience is shared, the attitudes and reactions
of others involved, as well as personal past drug experiences and individual
biology all combine to produce a drug experience.
*3.* How is drug tolerance BEST described?
a. The inability to get intoxicated
b. The need for more of a drug to get intoxicated
c. Increased sensitivity to a drug over time
,d. Decreased sensitivity to a drug over time - ANSWER-*D: Decreased
sensitivity to a drug over time*
When a drug is used regularly, the body is gradually able to adapt to the
effects of the drug. Evidence of tolerance is twofold: (1) greater doses of the
drug are required to achieve previous effects, and (2) doses that would have
produced profound physiological compromise or even death are now readily
tolerated without untoward effects. In some cases, it has been noted that up
to ten times a lethal dosage, or even more, may be taken without any signs
of significant physiological compromise. Tolerance develops as the body
seeks homeostasis, or a functional state of equilibrium, in spite of the
presence of the drug.
*4.* Which of the following is NOT a "drug cue"?
a. A prior drug-use setting
b. Drug use paraphernalia
c. Seeing others use drugs
d. Drug avoidance strategies - ANSWER-*D: Drug avoidance strategies*
Intense drug euphoria produces extremely intense, emotionally imprinted
memory engrams, coupled with long-term changes in the amygdala area of
the brain, which operate outside of conscious control. Key euphoric
memories become integrally connected to sights, sounds, smells, people,
and places previously associated with drug use. The reappearance of any of
these past drug cues will often effectively trigger intense, amygdala-driven
cravings for a drug. Cravings are further intensified by lingering imbalances
in brain metabolism patterns, receptor availability, hormone levels, and other
hypothalamus and pituitary-mediated sensations of dysphoria and distress.
The cascading nature of these effects frequently induces a drug-use relapse.
*5.* What happens as tolerance for barbiturates develops?
a. The margin between intoxication and lethality increases.
b. The margin between intoxication and lethality decreases.
, c. The margin between intoxication and lethality stays the same.
d. Tolerance does not develop for barbiturates. - ANSWER-*C: The margin
between intoxication and lethality stays the same.*
While tolerance for barbiturates does develop, tolerance for an otherwise
lethal dose only marginally increases and never exceeds twofold. This means
that the likelihood of an unintentional fatal dose increases substantially over
time as the need for the intoxicating effect pushes that threshold ever closer
to a lethal dose. Given the impairments in memory and judgment that
typically accompany CNS depressant intoxication, simple forgetfulness can
lead to a fatal overdose. Finally, using barbiturates with any other CNS
depressant substance, such as alcohol, can result in an additive CNS
depression that can readily be fatal. Death most often occurs via respiratory
or cardiac suppression.
*6.* What is the MOST common symptom of Wernicke's encephalopathy?
a. New memory formation
b. Loss of older memories
c. Psychosis
d. Confusion - ANSWER-*D: Confusion*
Other symptoms of Wernicke's encephalopathy include poor muscle
coordination and oculomotor impairment (problems moving the eyes in a
controlled fashion). Wernicke's syndrome is a short-term condition resulting
from vitamin B1 (thiamine) deficiency, typically developing after years of
drinking and poor nutrition. Of those with Wernicke's syndrome, 80 to 90
percent will develop long-term psychosis and memory problems known as
Korsakoff syndrome. While poor coordination is a symptom, retrograde
amnesia (loss of old memories) and learning impairments are among the
more classic hallmarks of the condition. Because they are so often found
together, the two syndromes are often referred to concurrently as Wernicke-
Korsakoff syndrome.
RATIONALES
*1.* A wife refers her husband for substance abuse counseling. His drug of
choice is cocaine, which he has been using episodically with friends at a
poker game—biweekly to weekly—for some years. She is disturbed at the
illicit nature of the drug and the long-standing use. He states that though he
recreationally uses, he does not crave cocaine, does not seek it out but
rather uses with friends at the game who bring it, and he feels that other
than his wife being upset about him using, he has no other social or
occupational issues. Given the information provided, how is his use of
cocaine BEST described?
a. Substance abuse
b. Cocaine intoxication
c. Cocaine use disorder
d. None of the above - ANSWER-*D. None of the above*
The DSM lists a set of eleven symptoms, 2 or more of which must have
occurred at any time during the past 12 months for a diagnosis of substance
use disorder. 1) Tolerance, defined as either the need for larger and larger
amounts of the drug in question over time to achieve the desired result, or a
decrease in the effect of the drug with continued use of the same amount 2)
Withdrawal, defined by either the known withdrawal symptoms for a
particular drug, or by the fact that the drug, or a similar drug, is taken to
avoid withdrawal symptoms 3) An increase in the amount of the drug taken,
or the continued use of the drug past the intended time 4) An inability to
control usage 5) A large amount of time and effort devoted to obtaining the
drug in question, using the drug in question, or recovering from its effects 6)
The giving up of important activities in order to obtain or use the drug in
question, or recover from its effects 7) The continued use of the drug in
question regardless of the ill effects it has caused. 8) Craving 9) Recurrent
drug use which leads to inability to fulfil major role 10) Recurrent drug use
though it is physically harmful 11) Recurrent drug use despite it leading to
continued social problems. He does not meet the criteria for current
intoxication either. Recreational use commonly occurs biweekly or weekly,
,and the use is typically for reasons of sociality. Substance abuse counseling
is therefore not indicated. However, counseling regarding the potential for
life circumstances, stressors, or other unexpected losses or burdens to
precipitate a future substance abuse problem should be discussed.
*2.* What does the experienced effect of a drug depend upon?
a. The amount taken and past drug experiences
b. The modality of administration
c. Poly drug use, setting, and circumstance
d. All of the above - ANSWER-*D: All of the Above*
The amount of a drug ingested will typically affect the user's experience,
with higher doses often producing a greater effect (though potentially
diminishing over time as tolerance develops). The modality of administration
can greatly influence the rate of the drug's uptake into the system. Normally
the rate of effect, from greatest to least, is: inhalation (snorting or smoking),
injection (intravenous, intramuscular, or subcutaneous), and ingestion
(sublingual or swallowing with or without food). Generally, the faster the
systemic uptake, the shorter and more intense the high experienced.
Polydrug abuse greatly complicates the drug experience, particularly if the
drugs used are chemical antagonists (e.g., stimulants and depressants—such
as meth and alcohol), additive (producing a cumulative effect), synergistic
(more than cumulative), or potentiating (each enhancing each other). The
setting in which the substance use occurs is also often a significant
contributor to the experience. The feelings engendered by the surroundings,
the people with whom the experience is shared, the attitudes and reactions
of others involved, as well as personal past drug experiences and individual
biology all combine to produce a drug experience.
*3.* How is drug tolerance BEST described?
a. The inability to get intoxicated
b. The need for more of a drug to get intoxicated
c. Increased sensitivity to a drug over time
,d. Decreased sensitivity to a drug over time - ANSWER-*D: Decreased
sensitivity to a drug over time*
When a drug is used regularly, the body is gradually able to adapt to the
effects of the drug. Evidence of tolerance is twofold: (1) greater doses of the
drug are required to achieve previous effects, and (2) doses that would have
produced profound physiological compromise or even death are now readily
tolerated without untoward effects. In some cases, it has been noted that up
to ten times a lethal dosage, or even more, may be taken without any signs
of significant physiological compromise. Tolerance develops as the body
seeks homeostasis, or a functional state of equilibrium, in spite of the
presence of the drug.
*4.* Which of the following is NOT a "drug cue"?
a. A prior drug-use setting
b. Drug use paraphernalia
c. Seeing others use drugs
d. Drug avoidance strategies - ANSWER-*D: Drug avoidance strategies*
Intense drug euphoria produces extremely intense, emotionally imprinted
memory engrams, coupled with long-term changes in the amygdala area of
the brain, which operate outside of conscious control. Key euphoric
memories become integrally connected to sights, sounds, smells, people,
and places previously associated with drug use. The reappearance of any of
these past drug cues will often effectively trigger intense, amygdala-driven
cravings for a drug. Cravings are further intensified by lingering imbalances
in brain metabolism patterns, receptor availability, hormone levels, and other
hypothalamus and pituitary-mediated sensations of dysphoria and distress.
The cascading nature of these effects frequently induces a drug-use relapse.
*5.* What happens as tolerance for barbiturates develops?
a. The margin between intoxication and lethality increases.
b. The margin between intoxication and lethality decreases.
, c. The margin between intoxication and lethality stays the same.
d. Tolerance does not develop for barbiturates. - ANSWER-*C: The margin
between intoxication and lethality stays the same.*
While tolerance for barbiturates does develop, tolerance for an otherwise
lethal dose only marginally increases and never exceeds twofold. This means
that the likelihood of an unintentional fatal dose increases substantially over
time as the need for the intoxicating effect pushes that threshold ever closer
to a lethal dose. Given the impairments in memory and judgment that
typically accompany CNS depressant intoxication, simple forgetfulness can
lead to a fatal overdose. Finally, using barbiturates with any other CNS
depressant substance, such as alcohol, can result in an additive CNS
depression that can readily be fatal. Death most often occurs via respiratory
or cardiac suppression.
*6.* What is the MOST common symptom of Wernicke's encephalopathy?
a. New memory formation
b. Loss of older memories
c. Psychosis
d. Confusion - ANSWER-*D: Confusion*
Other symptoms of Wernicke's encephalopathy include poor muscle
coordination and oculomotor impairment (problems moving the eyes in a
controlled fashion). Wernicke's syndrome is a short-term condition resulting
from vitamin B1 (thiamine) deficiency, typically developing after years of
drinking and poor nutrition. Of those with Wernicke's syndrome, 80 to 90
percent will develop long-term psychosis and memory problems known as
Korsakoff syndrome. While poor coordination is a symptom, retrograde
amnesia (loss of old memories) and learning impairments are among the
more classic hallmarks of the condition. Because they are so often found
together, the two syndromes are often referred to concurrently as Wernicke-
Korsakoff syndrome.
