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Might as Well Face It, There's Addiction Among Your Clients: Assessing for Substance Abuse - Test
by Cynthia Glidden-Tracey, Ph.D.

Course content © copyright 2007 by Cynthia Glidden-Tracey, Ph.D.. All rights reserved.

Please note that printing this page does not constitute proof of completion of the course. After successfully completing this test, you may purchase your Certificate of Completion and print it immediately or have it mailed to you.

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1. The course readings call for generalist mental health practitioners to be prepared to address substance use behavior occurring among their clients. All of the following are reasons except which one? Help
People with psychological disorders sometimes use drugs or alcohol to relieve their symptoms.
 Substance use disorders frequently occur simultaneously with other mental health problems.
 Psychotherapy is typically ineffective for helping people with substance use disorders.
 Substance use behaviors and related concerns are highly prevalent in both general and clinical populations.
2. In the initial phases of assessment and therapy to address substance use issues, which of the following is the usual reason the client is seeking professional services? Help
The client is voluntarily seeking help for negative consequences of drug or alcohol abuse that the client realizes is out of control or causing problems.
 The client has been strongly urged (and may feel coerced) by a concerned friend, family member, or personal associate to get professional help
 The client is facing trouble with legal or other formal consequences if the client does not comply with a mandate to obtain a substance use assessment.
 Any of the above may be presented as reasons why the client is attending a substance abuse assessment.
3. Which of the following is a plausible reason that a client who initially presented with mood or anxiety problems may wait until the middle or later stages of therapy to bring up concerns about personal substance use? Help
The practitioner has demonstrated that he or she is not trustworthy to confide such a personal issue.
 Over time, the client remains convinced that his/her problems are unrelated to his/her drinking or drug use.
 The client's substance use or mention of it increases to the point where it becomes a recognizable problem.
 The practitioner bypasses opportunities to inquire about client substance use in order to focus on more interesting or important concerns mentioned by the client.
4. In the course text, the term 'co-morbidity' is preferred over 'dual diagnosis' because substance abusers may have Help
Shared symptoms with a roommate
 A less troublesome secondary condition
 A primary care provider
 More than two diagnosable disorders or personal problems
5. While most anxiety disorders among alcoholics are alcohol-induced, research suggests which diagnosis tends to preceed alcohol use disorders? Help
Adjustment Disorder with Anxiety
 General Anxiety Disorder
 Agoraphobia
 Separation Anxiety Disorder
6. Engaging in interpersonal violence or behavior that violates social norms has been found to predict illegal drug use. Which of the following pairs of personality disorders exhibit these behaviors and co-occur frequently with substance use disorders? Help
Dependent/Narcissistic
 Narcissistic/Antisocial
 Borderline/Dependent
 Antisocial/Borderline
7. All of the following client factors except which one are discussed in the course text with potential to negatively affect therapy process and outcome with clients who abuse substances? Help
Lack of intrinsic motivation
 Withholding trust
 Ambivalence about substance abuse
 A competent, caring therapist
8. Mental health professionals in general practice and those therapists working specifically in the field of substance abuse have developed quite different perspectives on treatment. One underlying reason for this is that Help
Substance abuse counselors are usually in recovery themselves.
 The two client populations have mutually exclusive presenting issues.
 Generalist therapists are extensivelly trained in recognizing substance abuse.
 Stigmatizing attitudes contribute to emotional barriers between the fields.
9. The text discusses several barriers to integrating substance abuse treatment with other mental health therapies, but also considers reasons for optimism about the future potential of integrated assessment and treatment. Which of the following is one reason for optimism? Help
Research is elucidating the neural mechanisms of underlying addictive behavior as well as effective treatments for addictions and co-morbid disorders.
 Society provides mixed messages about the nature of substance use and appropriate responses to substance abuse.
 Clients who abuse drugs or alcohol tend to be unmotivated to change their behavior and ambivalent about their own substance use.
 Practitioners may be biased against working with the types of clients, issues, or employment conditions associated with addictions treatment.
10. At which of the following points in the therapy process is assessment for substance use most appropriate? Help
At the beginning of therapy, when the client first presents himself or herself seeking services.
 At the end of therapy, to assess whether the client is actually ready for termination.
 At any point in therapy during which concerns are raised about the client's use of psychoactive substances.
 None of the above.
11. Which of the following is NOT one of the questions a screener would ask using the CAGE acronym to screen for possible alcohol abuse? Help
Have you ever felt the need to cut down on your drinking?
 Have people annoyed you by criticizing your alcohol use?
 Have you ever felt guilty about your drinking behaviors or episodes?
 Has your drinking led to eye-opening experiences of personal insight?
12. A client's positive screening result indicates to the practitioner that: Help
the client positively has a substance use disorder and needs specialized treatment.
 no further substance use assessment is needed at present for this client.
 a detailed assessment should be conducted to determine if the client's substance use is problematic.
 the client is lying about the extent of personal substance use.
13. When a screener has reason to suspect that a client may be abusing drugs or alcohol despite the client's negative responses to the screening questions, the screener should: Help
share respect for the client's position as well as any contradictory evidence and invite further discussion.
 confront the client about her/his denial to break through the resistance and deception.
 let the topic go, knowing that clients will bring it up if and when they are ready.
 avoid requests for blood or urine tests since the client is likely to become hostile.
14. A Substance Dependence diagnosis requires that the person being assessed has in a 12 month time period exhibited at least________ out of seven possible criteria indicating distress or impairment due to the person's substance use. The seven possible criteria include: withdrawal symptoms, tolerance, use of larger amounts or for longer period than intended, failed attempts to control substance use, excessive time spent using/obtaining/processing substances, neglect of important activities in favor of continuing substance use, and continuing substance use despite known problems linked to the person's substance use. Help
1
 3
 5
 7
15. To qualify for a DSM-IV Substance Abuse diagnosis for a particular substance, the client will never have met the criteria for Dependence for that substance, and the client will also during a one year period Help
exhibit at least one form of recurrent problem related to substance use, such as failure to fulfill obligations, use in hazardous situations, legal problems, or continuing interpersonal difficulties.
 have intentionally consumed any form of psychoactive substance, including cigarettes or alcohol, on at least two occasions over the year.
 demonstrate symptoms of withdrawal and/or tolerance for the particular substance that the client has been consuming, indicating the need for prompt medical attention.
report that s/he only uses psychoactive substances when s/he knows s/he will not be driving or engaging in other hazardous behavior while under the influence of the substance.
16. A primary difference between the diagnoses of Substance Abuse and Substance Dependence is that Help
Any use of drugs or alcohol qualifies as Abuse, while Dependence is a repeating form of disordered substance use.
 Substance Dependence involves more severe impairment or distress, compared to the less restrictive diagnostic criteria for Substance Abuse.
 A person who meets the diagnostic criteria for Substance Dependence will never have met the recurrent problems criterion for Abuse of psychoactive substances.
 Substance Dependence involves intentional drug or alcohol use while Substance Abuse is caused by accidental ingestion or poisoning.
17. Which of the following is NOT one of the dimensions of severity assessed using the American Society of Addiction Medicine (ASAM) guidelines to recommend a level of care appropriate to the client's substance abuse severity? Help
Acute Intoxication/ Withdrawal Potential
 Emotional, Behavioral, or Cognitive Conditions or Complications
 Treatment Acceptance/Resistance/Readiness to Change
 Biological Screening Results from urine or blood samples
18. To build rapport and trust with the client, the interview template offered in this course for assessing a client's substance use begins with questions about Help
the client's motivation for changing problematic substance use behaviors
 the client's history of alcohol use.
 the client's reasons for participating in the assessment.
 the client's risk of endangering self or others.
19. When assessing a client's personal history of substance use, the practitioner gets most useful information by inquiring (for each substance the client has acknowledged using) about Help
the circumstances and patterns of the client's use over time.
 the frequency of use of each substance in the past thirty days.
 the date and amount of most recent use of each acknowledged substance.
 all of the above
20. Mental health practitioners ask clients about physical consequences of their substance use in order to Help
prescribe appropriate medications
 determine the need for medical attention and refer clients as needed.
 assess the client's recovery environment as indicated on ASAM Dimension 6.
 detect whether the client is intoxicated at the time of assessment.
21. The history-taking phase of the assessment process provides opportunities for: Help
Client education about the nature and biological impact of drugs being used
 Therapist education about current street names of drugs and impetus for taking drugs
 Diagnostic impressions that will guide treatment planning
 All of the above
22. If during a substance use assessment the client reports suicidal or homicidal ideation, the assessor should Help
come back to this topic later, after completing the entire substance use assessment interview.
 immediately assess whether the client has a plan, as well as means and intent to carry out a plan.
 if risk is assessed to be high, take appropriate protective action in consultation with other professionals.
 Both 2 and 3 are correct.
23. Because questions about clients' beliefs that they have a substance abuse problem can trigger resistance and thus limit further information and rapport, it is recommended that the client's motivations for behavior change be assessed ________________ of the assessment interview. Help
at the beginning
right after the substance use history component
 near the end
 by someone other than the conductor
24. Which of the following factors indicates to the assessor that a client has a high potential to relapse or continue substance abuse? Help
successful past treatment efforts
 lower frequency of recent use
 presence of tolerance and/or withdrawal symptoms
 high motivation to reduce substance use
25. Assessment of a substance abusing client's recovery environment allows the assessor to Help
determine the risk of biomedical conditions complicating the client's recovery from substance abuse and related problems.
 identify potential threats to the client's safety, well-being, sobriety, or motivation so these can be a focus of treatment recommendations.
 confront the client's unrealistic expectations that the environment can be changed to reduce temptations to use substances.
decide whether the client is being honest about the nature and extent of personal substance use.
26. Under which of the following conditions would you refer a client you are assessing for prompt medical attention? Help
The client admits to having a beer with lunch just prior to the therapy session.
 The client's health problems are outside of the assessor's area of expertise.
 Severity is rated high on ASAM Dimension 2, Presence of Biomedical Conditions or Complications
 Answers 2) and 3) both indicate conditions for referral.
27. When a client is in the Precontemplation stage of changing substance use behavior, the recommendations the assessor offers will likely be most effective if Help
the practitioner offers a short-term commitment of time to talk about the client's situation including the role of alcohol or other drugs without labeling the client's substance abuse as a problem.
 the client is encouraged to explore his/her ambivalence about personal substance use and weigh options for possible changes in behavior.
 the client has already taken initial steps toward action to promote change in his/her own problematic substance use.
 the practitioner offers therapy as a means of validating and reinforcing the client's progress in reducing problematic substance abuse and keeping on track with the client's goals
28. A client in the _________ stage of change will agree that s/he has a problem with alcohol or other drugs and needs to change behavior, but may deny either intention or ability to change. This suggests the need for different treatment recommendations following assessment in contrast to a client in the _________ stage of change, who reports intentions to change but may still be working up confidence to take action. Help
Precontemplation; Contemplation
 Contemplation; Preparation
 Preparation; Action
 Action; Maintenence
29. Clients participating in a substance use assessment may at times limit or distort the information they provide about their own substance use to the assessor. This alerts the assessor that Help
clients who abuse alcohol or other drugs cannot be trusted to tell the truth.
 additional sources of information must be obtained to prove that the client is lying.
 it may be necessary to breach confidentiality to break through the client's resistance.
the client suspects that the assessor might try to control, report, or shame the client.
30. To enhance trust between the assessor and the client in a substance use assessment, a recommended strategy would be for the assessor Help
to inform the client that confidentiality cannot be guaranteed if the client reveals information about illegal substance use.
to tell the client up front that substance use assessors assume that clients are not honest about their substance use and related behaviors.
to let the client know that the assessor takes the client's words at face value while also keeping open to discussion of additional information that becomes available.
to require the client's consent for the assessor to talk to friends, family members, and social service or law enforcement personnel as needed regarding the client's substance use.

 

 

  
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