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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 2007-2011 by Cynthia Glidden-Tracey, Ph.D.. All rights reserved.

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1. Mental health practitioners should 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 voluntarily seeks help for recognized negative consequences of drug or alcohol abuse.
 The client has been strongly urged by someone to get professional help
 The client is facing trouble with legal consequences if the client does not obtain a substance use assessment.
 Any of the above may be presented as reasons why the client is attending a substance abuse assessment.
3. Why might a client who initially presented with mood or anxiety problems wait until the later stages of therapy to bring up concerns about personal substance use? Help
The client remains convinced that his/her problems are unrelated to his/her drinking or drug use.
 The practitioner has not proved trustworthy for the client to confide such a personal issue.
 The client's mention of substance use increases to the point where it becomes a recognizable problem.
 The practitioner bypassed prior opportunities to inquire about client substance use to focus on more interesting client concerns.
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 precede alcohol use disorders? Help
Adjustment Disorder with Anxiety
 General Anxiety Disorder
 Agoraphobia
 Separation Anxiety Disorder
6. Two personality disorders involved engaging in interpersonal violence or behavior that violates social norms behaviors that have also been found to predict illegal drug use. These two personality disorders also co-occur frequently with substance use disorders. Which personality disorders are they? Help
Antisocial/Borderline
 Dependent/Narcissistic
 Narcissistic/Antisocial
 Borderline/Dependent
7. Several factors related to client abuse of psychoactive substances have potential to negatively affect therapy process and outcome. Which is NOT one of them? Help
Lack of intrinsic motivation
 Withholding trust
 Ambivalence about substance abuse
 A competent, caring therapist
8. Mental health professionals in general practice and substance abuse treatment specialists have developed quite different perspectives on treatment. One underlying reason for this is that Help
Substance abuse counselors must be in recovery themselves.
 The two client populations have mutually exclusive presenting issues.
 Generalist therapists are more extensively trained in recognizing substance abuse.
 Stigmatizing attitudes contribute to communication barriers between the fields.
9. Despite historical separation of substance abuse and mental health treatments, there are reasons for optimism about the future potential of integrated assessment and treatment. A major reason for optimism is that? 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. Substance use assessment is most useful and effective when: Help
A single baseline assessment is conducted early in treatment.
 The client gives retrospective report of the most severe episode of substance abuse ever experienced.
 Multiple assessments of factors interacting over time are taken into account
 History is minimized in order to concentrate on immediate symptoms and current substance use behaviors.
11. At which of the following points in the therapy process is in-depth 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.
12. Which of the following is NOT one of the questions a screener would ask a client 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?
13. A client's positive screening result indicates to the practitioner that: Help
The client definitely has a substance use disorder and needs specialized treatment.
 The client answered "no" to all the screening questions.
 A further, more 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.
14. 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 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.
15. 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
16. 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 also the client will during a one year period Help
Exhibit at least one form of recurrent problem related to substance use.
 Have intentionally consumed that psychoactive substance on at least two occasions.
 Demonstrate symptoms of withdrawal and/or tolerance for the particular substance that the client has been consuming.
 Report use of psychoactive substances only when NOT planning to drive or engage in other hazardous behavior.
17. 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 indicates repeating Substance Abuse.
 Substance Dependence involves more severe impairment or distress, compared to the less restrictive diagnostic criteria for Substance Abuse.
 A person who meets the criteria for Substance Dependence will never have met the criteria for Substance Abuse.
 Substance Dependence involves intentional drug or alcohol use while Substance Abuse is caused by accidental ingestion or poisoning.
18. The American Society of Addiction Medicine (ASAM) guidelines provide six dimensions of severity to be assessed so the practitioner can recommend a level of care appropriate to the level of severity of the client's substance use. Which one of the following is NOT one of the ASAM dimensions of 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
19. To build rapport and trust with the client, the substance use assessment template offered in this course 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.
20. The assessor gets the client's personal history of substance use by inquiring for each substance the client has acknowledged using about Help
The patterns of the client's use over time.
 The frequency of use of each substance in the past month.
 The date and amount of most recent use of each acknowledged substance.
 All of the above
21. 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.
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 assessed risk is high, take appropriate protective action in consultation with other professionals.
 Both 2 and 3 are correct.
23. Questioning clients' beliefs about whether they have a substance abuse problem can trigger resistance and thus limit further information and rapport. Therefore, 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 portion
 Near the end
 By someone other than the assessor
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.
 Focus treatment recommendations on threats to the client's safety, well-being, sobriety, or motivation.
 Confront the client's unrealistic expectations that the environment can be changed to reduce temptations.
 Decide whether the client is being honest about the 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 assessor's recommendations will be most effective if Help
The practitioner offers a short-term commitment of time to talk about the client's situation without labeling the client's substance use as a problem.
 The client is encouraged to explore personal ambivalence about substance use and weigh options for possible behavior change.
 The client has already taken initial steps toward changing problematic substance use.
 The practitioner offers therapy as a means of reinforcing the client's progress in reducing substance use 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 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 assessed for substance use may limit or distort the information they provide about their own substance use to the assessor. Awareness of 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 may suspect that the assessor could 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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