Drugs
Which of the following drugs would be present on a Urine Drug Screen (UDS) 5 days after use?
What is Marijuana
The active ingredient in marijuana, THC, is fat soluble whereas the other substances listed are water soluble. Fat cells are harder to burn, therefore can remain in a person's system longer.
Which option correctly represents the Stages of Change Model?
a. Pre-contemplation, contemplation, preparation, action and maintenance
b. Pre-contemplation, contemplation, action and relapse
c. Contemplation, preparation, action and maintenance
d. Contemplation, preparation, action, maintenance and relapse
What is Pre-contemplation, contemplation, preparation, action and maintenance
Treatment plans should be updated_________.
a. once per month
b. continuously
c. every 8 weeks
d. after a relapse
What is Continuously.
Treatment plans should be updated to reflect progress and regressions. Objectives and goals should be realistic and attainable.
Which of the following is not a consequence of glorifying drug use in a group session?
a. Triggering others
b. Continuing in an addictive behavior and thinking patterns for the person sharing
c. A distraction in the group from appropriate topics
d. Create group unity
Create group unity
Glorifying is talking about drinking and/or drug use in a manner that makes it sound exciting and positive. More times than not, this tends to have a negative impact on the group and can create some anger. Members often feel triggered by the topics and the person sharing continues to use their addictive thought processes. Should a person be glorifying in a group session, this should be addressed immediately before the negative impact intensifies.
True or False
It is ethical to hire a client for a job if there is no other reasonable option.
True
Which therapeutic approach is the most effective when working with a resistant client?
a. Cognitive Behavioral Therapy
b. Motivational Interviewing
c. Psychodynamic
d. EDMR
Motivational Interviewing
A common error that counselors make when conducting an assessment is:
a. processing the data collected from the client
b. asking too many questions and interrupting the client
c. moving too quickly from data collection to treatment planning
d. focusing on strengths and weaknesses rather than relationships
What is moving too quickly from data collection to treatment planning
Thomas is currently engaged in group and individual counseling with you and has a diagnosis of Alcohol Use Disorder, Severe and ADHD. Thomas has a positive Urine Drug Screen for stimulants and reported that he is currently prescribed stimulants for his ADHD by Dr. Smith.
Which of the following actions would not be appropriate for you to do?
a. Collaborate with Dr. Smith regularly.
b. Continue to have Urine Drugs screens to monitor medication compliance.
c. Encourage Thomas to stop using his medication due to risk for cross addiction.
d. Sign a consent of release for Dr. Smith.
What is Encourage Thomas to stop using his medication due to risk for cross addiction.
Medication regimen and recommendations is likely not in your professional scope, therefore is not appropriate for you to be changing. Through continued collaboration with his prescriber, you are able to verbalize any concerns you may have about cross addiction and misuse of the medication.
All of the following are indicators that a person would be appropriate for inpatient treatment except:
a. Continued use of marijuana
b. Use of alcohol to prevent withdrawal symptoms
c. Cocaine use that impairs functioning at work
d. Inability to engage in daily living skills
What is Continued use of marijuana.
A referral for inpatient treatment is appropriate when a person's use is having a significant impairment on their daily living skills, threatens their safety and/or safety of others around them and a risk of death. Answer a does not include a description of any impact on daily living skills.
It is considered unethical for a counselor to:
a. talk with a client any place other than the counseling office
b. treat client problems that are beyond his skill level
c. refuse treatment for certain clients
d. discuss some personal feelings
What is Treat client problems that are beyond his skill level.
You are facilitating a co-occurring mental health and substance abuse group. One of the group members, Sally, shares that she has been struggling with her depression symptoms and feels as though being sober is "too much". She noted that yesterday on her way home from work she was driving by a liquor store and stayed in the parking lot for approximately 35 minutes before calling her sponsor. Which approach are you least likely to use?
a. Allow her to discuss her challenges, support her in the group.
b. Have the group help her in identifying healthy behaviors when her depressive symptoms occur.
c. Change the topic to avoid triggering other group members.
d. Process her experience yesterday and support her for calling her sponsor.
Change the topic to avoid triggering other group members.
Sara is currently engaged in group and individual sessions with you. A current goal is to receive the Vivitrol injection to aid in her abstinence from opiate use. As her counselor, how can you best support her?
a. Trust that she is honest about her use with her prescriber.
b. Identify barriers to this goal and aide in developing skills to manage them.
c. Collaborate with her prescriber regarding compliance and treatment plan
d. Both b and c
What is Both b and c
Collaborating with her prescriber will provide a team approach which will aide in communication. For example, if Sara were to relapse days before the injection, receiving the Vivitrol injection would induce withdrawal symptoms. Identifying barriers and identifying skills would help Sara maintain sobriety until she is able to receive the injection.
A 67 year old female, Mary, attends an intake assessment with you on Monday. You diagnosis her with Alcohol Use Disorder, Severe and Bipolar I. You gave her a treatment schedule to engage her in group sessions along with a referral for a doctor on staff to assess for medications. Mary lives alone and has limited mobility due to severe arthritis. Mary misses her group session on Wednesday. As her primary clinician, you call her to follow up regarding her absence. While on the phone, it becomes apparent that she is inebriated and she reported falling down stairs and is struggling to get up. You encourage her to call 911, however she refuses.
Which would be the best course of action to present to your supervisor?
a. Call her son so he can go check on her.
b. Talk to her about the incident when she comes in for group and discuss the danger she put herself in.
c. Document the call; process the call if she brings is up with you.
d. Call 911 for a wellness check.
What is Call 911 for a wellness check.
The best option to discuss with your supervisor would be to call for a Wellness Check. Her apparent intoxication, limited mobility, living alone and her self-report of falling with a difficulty of getting up poses a concern for her safety. Therefore, you have an ethical responsibility to break confidentiality to ensure her safety. Consulting with your supervisor or colleague allows you the opportunity to receive feedback regarding your plan of action.
Steven is a 15 year old male who was referred to treatment by his school counselor after he was observed impaired at school. Steven has been abusing Xanax and acknowledges use at school. He currently lives with his mother who has a legal prescription for Xanax which she does not keep in a locked location. Steven's mother is aware that this is her son's drug of choice and has decided to not keep her prescription in a secure location. Knowing that your client's drug of choice is not securely locked in the house, what would be the best course of action to discuss with your supervisor?
a. Do nothing
b. Involve CPS
c. Document that you told his mom to secure her medication.
d. Have a family session to create a safe space for an open discussion regarding boundaries.
Involve CPS
When meeting with your supervisor, it would be best to discuss making a CPS report. Steven's mother is aware of his use of Xanax and has continued to leave her prescription in an unsecured location. The use of Xanax does cause concern for his safety and would warrant a mandated report.
What is transference?
a. Having romantic feelings for a client.
b. When your feelings about one person is transferred to another
c. When a client goes from an active status in treatment to non-active.
d. Transferring a client from your case load to a colleague.
When your feelings about one person is transferred to another.
What organ is most most damaged by cocaine use?
A. Heart
B. Lungs
C. Kidneys
D. Liver
What is the Heart
You work in an outpatient program with a team of addiction counselors, social workers, a nurse and a physician. You facilitate an intensive outpatient group in the mornings from 9am-12. Around 9:30 am you notice that Scott appears to be nodding off in the group. You also observe that group members have noticed him as well and appear uncomfortable. You are aware that Scott uses opiates and has been struggling to abstain from use. What is your best course of action?
a. Continue facilitating the group as normal.
b. Ask Scott to come into the hall with you, explain what you observed and that you would like him to be assessed by the nurse and/or physician.
c. Call on Scott in the group to engage in discussion
d. Ask Scott to come into the hall with you, explain what you observed and ask him to go home.
Ask Scott to come into the hall with you, explain what you observed and that you would like him to be assessed by the nurse and/or physician.
Scott may be inebriated, or he may be tired. Either way, the appearance of nodding off is often triggering for other group members which means that he is not appropriate for the group at this time. Since your concern is that he may be inebriated, he should be assessed by a medical professional before going home to ensure safety. Once you return to the group after Scott leaves, it may be necessary to process how group members were impacted after seeing Scott's presentation in group. If this is the case, keep the discussion off of Scott and on how others felt when seeing someone appear inebriated (ie. Triggered, sad, anxious, angry, etc.).
Joseph comes into your office for an intake assessment required by his Probation Officer. Joseph is reluctant to discuss his opiate use. However, he is compliant because he knows that the results of the intake would be reported to his PO. He shared that he is on probation as a result of being arrested for stealing. Joseph explained that he was stealing to support his heroin use and has continued to use since his arrest. Joseph began using Oxycodone recreationally at age 17 which progressed to daily use soon after. Joseph began using heroin approximately 8 months later due to the cost difference. Joseph has used to avoid withdrawal symptoms. He recently began to share needles and noted that he is aware of the health risk that this behavior poses. Joseph's family began distancing themselves from him when he continued using heroin after being arrested.
With the information provided, how would you diagnose Joseph?
a. Opiate Use Disorder, Severe
b. Opiate Use Disorder, Mild
c. Opiate Use Disorder, Moderate
d. Opiate Use Disorder
What is Opiate Use Disorder, Moderate
The summary above falls into the moderate level of the DSM-V for Opiate Use Disorder. The severity rating scale is as follows:
Mild: 2-3 Symptoms
Moderate: 4-5 Symptoms
Severe: 6 or more Symptoms
Symptoms identified in the summary were as follows. Joseph had continued use despite persistent social and interpersonal issues (discord with family). Joseph continued to use in physically dangerous situations (sharing needles). Joseph has developed a tolerance which led to him using larger amounts over time. Lastly, he has experienced withdrawal and uses to avoid symptoms.
While working in an outpatient clinic, you recognize the name of a person you are supposed to conduct an intake assessment with at 2pm in the afternoon. You recognize the name because this person is friends with your brother. What is the best course of action?
a. Conduct the assessment as scheduled.
b. Conduct the assessment and work with them individually since you know them.
c. Have a colleague do the assessment and ensure they are not your client.
d. Have a colleague conduct the assessment and have them placed in your morning group.
Have a colleague do the assessment and ensure they are not your client.
Conducting the assessment, having this person in your group and/or working with them individually would all create a dual relationship which would blur the professional lines of this relationship. This could be explained to the person if they wonder why they do not work with you. Remembering the limits of confidentiality would be important as well to maintain this person's privacy.
Mary is an 18 year old female who is currently engaged in outpatient treatment with you. She has been actively using cocaine and has reported continued discord with her mother. Mary has not signed a consent for her mother at this time. While in your office, you receive a phone call from her mother insisting to know the results from Mary's recent drug screens. Mary's mother stated that she believes her daughter is using cocaine based on her current behaviors and "attitude".
What is the most appropriate response?
a. You should ignore the phone call since there's no consent.
b. "Let me call her and make sure she is OK with me sharing her results with you"
c. "At this time I do not have her permission to share information with you."
d. "I cannot confirm or deny that your daughter is a client. However, I am happy to listen to concerns you may have about your daughters use."
You should ignore the phone call since there's no consent.
Since you do not have a consent signed, you are not able to disclose that she is a client of yours. As a counselor, you are able to listen to concerns that anyone has regarding a person in active addiction. After the phone call, you should clearly document what you said as well as inform Mary of her mother's phone call.
When clients ask directly for advice, it is usually helpful for counselors to:
a. avoid offering advice, since it negatively effects communication with the client
b. encourage the client to explore various alternatives
c. discuss with the client his/her request for advice
d. give advice since it encourages independence in the counseling relationship
encourage the client to explore various alternatives
Mary just completed her intake session with you. Her use of alcohol has had a significant negative impact on her life. Consequences of her use were discord with her husband, missing her children's soccer games, daily use of alcohol and decreased productivity at work. Which consequence should be addressed first?
a. Attain and maintain sobriety.
b. Attend her children's soccer game this week.
c. Improve communication with her husband.
d. Improve her performance at work.
Attain and maintain sobriety.
Attaining sobriety should be the first goal. Once that is accomplished, other consequences can be addressed appropriately.
You facilitate an after care group for clients who have successfully completed your inpatient program. This group is on an outpatient basis and occurs once per week. You are notified that a person who was engaged in the inpatient treatment at the same time as some of your aftercare patients has overdosed and died. How should you proceed?
a. Do not mention the death, re-direct if brought up in group.
b. Start your next group session by processing this loss and how the group members feel.
c. Process the death only if brought up by a group member.
d. Attend the funeral services to pay your respects.
Process the death only if brought up by a group member.
The best way to protect the confidentiality of the person who passed is to not bring up the conversation yourself. Group members may not be in contact with this person and/or remember being in treatment with them. Confidentiality continues in death. It may be necessary for some members to process the death in which case it is best to keep the conversation on how they are impacted by the loss and not to focus on the person who passed.
Sally and Joe have been married for 16 years and have a pattern of verbal and physical abuse when drinking. Both persons are engaged in treatment within your facility. You work with Joe and your colleague works with Sally individually. Joe informs you that he and Sally have been drinking every night to the point of blacking out. He explains that they often wake up in the living room and do not remember several hours of the evening before. You are aware that they have 2 children, ages 7 and 4 who live with them. You feel as though you need to do something regarding the children's safety.
Which of the following is the best option to discuss with your supervisor?
a. Engage in a family session with your colleague to provide psychoeducation about responsible parenting behaviors.
b. Provide psychoeducation to your client regarding responsible parenting behaviors.
c. Encourage joe to abstain from alcohol use.
d. Involve CPS.
Involve CPS.
This scenario would warrant a mandated report as the children living with Joe are minors and unable to care for themselves. Joe reported drinking every night to the point of blacking out which means that he and his wife are no longer able to properly care for their children. Psychoeducation about parenting would be appropriate, however the children's safety is a priority.
Sleeping with an agency client is
A. Allowed after 5 years.
B. Permitted once the client is no longer your client and no harm will come to the client
C. Not in a million years.
D. Only if approved by your supervisor.
NOT IN A MILLION YEARS