ADC Exam 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 doesn't crave 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 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 - CORRECT 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 fulful 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.
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 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.
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 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.
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 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.
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 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.
What is the MOST common symptom of Wernicke's encephalopathy?
a. New memory formation
b. Loss of older memories
c. Psychosis
d. Confusion - CORRECT 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.
Which of the following conditions does alcohol NOT induce?
a. Steatosis
b. Nephrosis
c. Hepatitis
d. Cirrhosis - CORRECT ANSWER-B: Nephrosis. Hepatitis refers to inflammation
of the liver. Alcohol is toxic to all body tissues. Because alcohol must be
metabolized by the liver, it is particularly susceptible to the toxic effects.
Consequently, many heavy drinkers suffer from alcoholic hepatitis, characterized
by abdominal pain, nausea, vomiting, and a swollen liver. In more extreme cases,
jaundice and bleeding can result. Jaundice (a yellowing of the skin and whites of
the eyes) is from bilirubin, a by-product of aging red blood cells broken down in
the liver, that should have been fully metabolized by the liver. Spontaneous
bleeding occurs because key clotting factors are made in the liver, but production
is inhibited by hepatitis. Steatosis consists of fatty deposits in the liver that, if
severe, can prove fatal. Cirrhosis refers to scarring of the liver from alcohol
damage, preventing its normal functioning. High blood toxins can also cause
hepatic encephalopathy—a reversible dementia—if the toxins are reduced.
What does formication refer to?
a. The creation of freebase cocaine
b. Sex between two unmarried individuals
c. A sensation of bugs crawling under the skin
d. Extrapyramidal symptoms of agitation - CORRECT ANSWER-C: A sensation
of bugs crawling under the skin. Chronic users of cocaine, crack cocaine,
methamphetamine, and other such stimulants develop a profoundly unpleasant
sensation of bugs crawling under their skin. They may even come to believe the
bugs are present and needing to be removed. In less severe cases, users may
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 doesn't crave 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 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 - CORRECT 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 fulful 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.
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 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.
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 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.
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 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.
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 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.
What is the MOST common symptom of Wernicke's encephalopathy?
a. New memory formation
b. Loss of older memories
c. Psychosis
d. Confusion - CORRECT 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.
Which of the following conditions does alcohol NOT induce?
a. Steatosis
b. Nephrosis
c. Hepatitis
d. Cirrhosis - CORRECT ANSWER-B: Nephrosis. Hepatitis refers to inflammation
of the liver. Alcohol is toxic to all body tissues. Because alcohol must be
metabolized by the liver, it is particularly susceptible to the toxic effects.
Consequently, many heavy drinkers suffer from alcoholic hepatitis, characterized
by abdominal pain, nausea, vomiting, and a swollen liver. In more extreme cases,
jaundice and bleeding can result. Jaundice (a yellowing of the skin and whites of
the eyes) is from bilirubin, a by-product of aging red blood cells broken down in
the liver, that should have been fully metabolized by the liver. Spontaneous
bleeding occurs because key clotting factors are made in the liver, but production
is inhibited by hepatitis. Steatosis consists of fatty deposits in the liver that, if
severe, can prove fatal. Cirrhosis refers to scarring of the liver from alcohol
damage, preventing its normal functioning. High blood toxins can also cause
hepatic encephalopathy—a reversible dementia—if the toxins are reduced.
What does formication refer to?
a. The creation of freebase cocaine
b. Sex between two unmarried individuals
c. A sensation of bugs crawling under the skin
d. Extrapyramidal symptoms of agitation - CORRECT ANSWER-C: A sensation
of bugs crawling under the skin. Chronic users of cocaine, crack cocaine,
methamphetamine, and other such stimulants develop a profoundly unpleasant
sensation of bugs crawling under their skin. They may even come to believe the
bugs are present and needing to be removed. In less severe cases, users may
