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

Course content © copyright 2007-2018 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 and behavioral treatments are 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 the practitioner, the client, or both recognize aloud its potential significance.
 The practitioner bypassed prior opportunities to inquire about client substance use to focus on more interesting or less complicated client concerns.
4. In the course text, the terms 'co-morbidity' or 'co-occurring disorders' are preferred over 'dual diagnosis' because substance users may have: Help
Shared symptoms with a roommate.
 A secondary condition in remission.
 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 involve engaging in interpersonal violence or in behaviors that violate 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. Virtually every mental health professional should be able to do all EXCEPT: Help
Detect themes of substance use when present in a client's narrative and screen for possible concerns about that use.
 Conduct brief intervention to get the client to consider reducing substance use if a problem or concern is indicated.
 Make good referrals as needed for further assessment and/or treatment.
 Provide specialized treatment for substance use disorders of all types.
8. A wise therapist examines one's own attitudes, feelings, and beliefs about drugs, alcohol, people who consume them, and related problems for individuals and communities. An effective therapist also cultivates: Help
Avoidant or condescending attitudes toward people who drink or take drugs.
 Personal experience using many drugs to become self-aware of effects that clients might also experience.
 Multicultural sensitivity about the socioeconomic and ethic factors and cultural significance of using particular substances and the impact of cultural differences on therapy processes.
 Worries about professional responsibility for clients' success and sobriety, especially reflecting countertransference with people in the therapist's personal life who take drugs or use alcohol.
9. Several factors related to client misuse of psychoactive substances have potential to negatively affect therapy process and outcome. Which is NOT one of them? Help
Lack of intrinsic motivation to change
 Withholding trust
 Ambivalence about substance use
 A competent, caring therapist
10. Mental health professionals in general practice and substance use treatment specialists have developed quite different perspectives on treatment. One underlying reason for this is that: Help
Substance use counselors must be in recovery themselves.
 The two client populations have mutually exclusive presenting issues.
 Generalist therapists are more extensively trained in recognizing substance use disorders.
 Stigmatizing attitudes contribute to communication barriers between the fields.
11. Despite historical separation of treatments for substance use disorders and for mental health problems, 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 psychological treatments for addictions and co-morbid disorders.
 Society provides mixed messages about the nature of, and appropriate responses to, substance abuse which gives therapists a chance to promote their own individual method of treatment.
 The clients that therapists see who misuse drugs or alcohol are the ones who are motivated for change and do not experience ambivalence.
 Practitioners may be biased against working with the types of clients and issues associated with addictions treatment, but they can refer to those therapists who themselves are in recovery.
12. 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 use 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.
13. 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
14. 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 use problems? 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?
15. The purpose of drug and alcohol screening is to: Help
Definitively diagnose the presence and severity of a clear substance use disorder.
 Detect or rule out concerns about a person's alcohol and/or drug use and to determine whether or not futher assessment and/or intervention is warranted.
 Eliminate any need for in-depth assessment of a client's substance use.
 Screen out clients whose problems may be more complicated than the practitioner wants to deal with.
16. The Alcohol Use Disorders Test (AUDIT) is a widely used measure to screen for risky drinking patterns. Developed by the World Health Organization, the 10 item AUDIT scored from zero to four on each item indicates hazardous drinking when: Help
Clients' total scores are 8 or more for women; 6 or more for men.
 Clients' total scores are 6 or more for women; 8 or more for men.
 A cutoff of 10 is exceeded, regardless of the sex or gender of the client.
 The client is in denial about the problems evident from her or his AUDIT score.
17. 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.
18. A good referral to another professional or specialist when the screener detects possible problems with psychoactive substance use: Help
Can connect clients with services and resources beyond what the screening professional can provide.
 Is enhanced when the referral included follow up to facilitate contact.
 Should be carefully documented in the client's record along with screening results.
 All of the above
19. When a screener has reason to suspect that a client may be misusing 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.
20. A DSM-5 Substance Use Disorder diagnosis requires that the person being assessed has in a 12 month time period exhibited at least ________ out of eleven possible criteria indicating distress or impairment due to the person's use of a psychoactive substance. The possible criteria include: withdrawal symptoms, tolerance, cravings, 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 role obligations in favor of continuing substance use, giving up important activities to use substances, using in hazardous situations, and continuing substance use despite known problems linked to the person's substance use. Help
1
 2
 3
 5
21. The severity of a Substance Use disorder diagnosed using the DSM-5 depends on how many symptoms the client reports or exhibits for any particular substance the client uses. The presence of 2-3 symptoms indicates a mild disorder. Moderate disorder is diagnosed with ___________ symptom(s); while __________suggest(s) a severe level of disorder. Help
The presence of 1-2; 4 or more symptoms
 Withdrawal; Intoxication
 The presence of 4-5; 6 or more symptoms
 Substance Dependence; Substance Abuse
22. The diagnosis of a Substance Use Disorder is based on pathological patterns of behaviors related to a person's psychoactive chemical use. The DSM-5 specifies four types of criterion groupings that reflect characteristic difficulties with excessive use of drugs including alcohol. These groupings include impaired control of continuing use, social impairment due to substance misuse, risky use, and: Help
Intoxication.
 Substance Dependence.
 Substance-Induced Disorders.
 Pharmacological criteria including tolerance and withdrawal.
23. When conducting a substance use assessment, it is sometimes important for the assessor to define or explain diagnostic criteria or symptoms to clients. If the client is not sure what a question about drug "tolerance" is asking, the assessor could say: Help
"Do you ever need more and more of a drug to get the same feeling of being intoxicated or high?"
 "Do you ever find it hard to put up with the effects drugs or alcohol have on you?"
 "Do you have uncomfortable symptoms like hangovers after an episode of substance use ends?"
 Both 1 and 2 would be accurate.
24. The American Society of Addiction Medicine (ASAM) Criteria provide six dimensions of severity of substance-related problems to be assessed so the practitioner can recommend and plan 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 and/or Withdrawal Potential
 Emotional, Behavioral, or Cognitive Conditions or Complications
 Readiness to Change
 Biological Screening Results from urine or blood samples
25. To build rapport and trust with the client, the substance use assessment template offered in this course begins with questions about the client's: Help
Motivation for changing problematic substance use behaviors
 History of alcohol use.
 Reasons for participating in the assessment.
 Risk of endangering self or others.
26. The assessor gets the client's personal history of substance use by inquiring for each substance the client has acknowledged using about the: Help
Patterns of the client's use over time.
 Frequency of use of each substance in the past month.
 Date and amount of most recent use of each acknowledged substance.
 All of the above
27. Consistent with ASAM assessment dimensions 1 and 2, 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.
28. 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 and empathically 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.
29. 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 when rapport and information are likely to be greater. Help
At the beginning
 Right after the substance use history portion
 Near the end
 By someone other than the assessor
30. Which of the following factors indicates to the assessor that a client has a high potential to relapse or continue substance use, as reflected in ASAM Dimension 5? Help
Successful past treatment efforts
 Lower frequency of recent use
 Presence of tolerance and/or withdrawal symptoms
 High motivation to reduce substance use
31. Assessment of a substance using client's recovery living environment (ASAM Dimension 6) 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.
32. 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 your 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.
33. When a client is in the Precontemplation stage of changing substance use behavior, the assessor's recommendations will be most effective if the: Help
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.
 Client is encouraged to explore personal ambivalence about substance use and weigh options for possible behavior change.
 Client has already taken initial steps toward changing problematic substance use.
 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.
34. 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
35. 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 use 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.
36. To enhance trust between the assessor and the client in a substance use assessment, a recommended strategy would be for the assessor to: Help
Inform the client that confidentiality cannot be guaranteed if the client reveals information about illegal substance use.
 Tell the client up front that substance use assessors assume that clients are not honest about their substance use and related behaviors.
 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.
 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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