Mid-Term

Question 1

1. Know 5-6 of the 17 ethical principles of the NAADAC (2016) especially those that are different from the ACA.

Answer 1

ii. NAADAC(2016) recommends
a. Autonomy
b. Obedience
c. Conscientious refusal
d. Beneficence
e. Gratitude
f. Competence
g. Justice
h. Stewardship
i. Honesty and candor (i.e. veracity)
j. Fidelity
k. Loyalty
l. Diligence
m. Discretion
n. Self-improvement
o. Non-malfeasance
p. Restitution
q. Self-interest

Question 2

Neurotransmitters and their functions

Answer 2

1. ach-learning, memory, muscle movement
2. Dopamine- arousal, mood cognition, movement
3. Serotonin- sleep eating, emotional self regulation, mood
4. Norepinephrine-mood, attention, sleep
5. Endorphins-endogenous opioids, pleasures, stress and pain relief
6. GABA- main inhibitory neurotransmitter, decreases activity if nervous system
7. Glutamate-main excitatory neurotransmitter, increases nervous system activity, learning, memory, formation and repair of neural networks.

Question 3

Agonist

Answer 3

Drugs/poisons that increase the activity of one orore neurotransmitters

Question 4

Antagonists

Answer 4

Drugs/poisons that decrease the activity of one of more neurotransmitters

Question 5

Antagonists

Answer 5

Drugs/poisons that decrease the activity of one of more neurotransmitters

Question 6

Half life

Answer 6

The time it takes for the concentration of a drug to be reduced 50%

Question 7

Dosage

Answer 7

Prescribed administration of a specific amount, number and frequency of doses over a specific time.

Question 8

Dose

Answer 8

Specific amount of medicine/drug taken at a time

Question 9

The neuroscientific process

Answer 9

1. Electrical impulse travels down axon go axon terminals
2. When electrical impulse reaches axon terminal it causes vesicles go open and neurotransmitter molecules to be released into the synaptic gap and enter receptor sites on dendrites of receiving neurons.
3. After carrying message, neurotransmitters return to the synaptic gap; some undergo reputake into sending neurons

Question 10

Function of SSRI’S

Answer 10

Block the reputake of serotonin

Question 11

Functions of the prefrontal cortex

Answer 11

1. Empathy
2. Insight
3. Response flexibility
4. Emotion regulation
5. Body regulation
6. Morality
7. Intuition
8. Attuned communication
9. Fear modulation

Question 12

Incentive Sensitization Theory if Addiction Factors for Addiction Susceptibility

Answer 12

1. Genetics
2. Gender and presence of sex hormones
3. Major stress order before taking drugs
4. Situational factors such as, duration of drug use, increase in dose, speed of action (i.e. inhalation vs intravenous use)

Question 13

Four classes of Drugs

Answer 13

1. Sedatives/ depressants
2. Stimulants
3. Narcotics/opioids
4. Psychedelics and hallucinogens

Question 14

Tenets of Strength-Based Counseling

Answer 14

1. Choice-respects individuals rights to control their destinies and take response for their actions
2. Options-levels of recovery;not abstinence only
3. Readiness to change-client guides pace

Question 15

Strategies of Prevention

Answer 15

1. Information dissemination
2. Education
3. Alternatives
4. Problem id and referral-targeting at risk populations
5. Community based processes-mobilizing community to provide prevention services
6. Environmental approaches- changing written and unwritten laws, norms, codes , and attitudes that affect development of addictions

Question 16

Alderson’s risk factors

Answer 16

1. Individual Characteristics ( mental illness, antisocial behavior)
2. Attitude ( distrust of authority, anger towards parents)
3. Psychosocial ( low self esteem poor social skills)
4. Family characteristics ( family history with drugs)
5. Being a member of an indigenous community

Question 17

Alderson’s Preventive Factors

Answer 17

1. Resilience
2. Strong family support
3. Identifying with one’s culture and ethnicity
4. Religion and spirituality

Question 18

Unhealthy Families

Answer 18

1. Closed communication
2. Low parental self esteem
   3 family members expected to think, feel, and act the same
3. Controlling parents
4. Coercion and threats
5. Anxious and tense
6. Coalitions and triangles
7. Disengagement and enmeshment
8. Rigidity of chaos due to insufficient rules

Question 19

Characteristics of differentiation ( Steinke)

Answer 19

1. Defining self and staying in touch with others
2. Being responsible for self and responsive to others
3. Maintaining integrity and well being without intruding in that of others
4. Having and “I” and entering into relationship with another “ I” without losing self or diminishing the self of the other.

Question 20

Risk Factors for substance addictions (Perkinson)

Answer 20

Substance/behavior readily available

2. Substance/behavior is cheap
3. Chemicals reach the brain quickly
4. Addiction is a pain reliever
5. Addiction more common in certain jobs (i.e. Bartender)
6. Addiction is prevalent in peer group
7. Addiction is preferred in deviant subcultures
8. Social instability
9. Genetic predisposition
10. Dysfunctional family
11. Comorbid psychiatric disorders are present

Question 21

Six Dimensions of Multidimensional Assessment

Answer 21

1. Acute intoxication and/or withdrawal potential -past and current experiences of use and withdrawal
2. Biomedical conditions and complications-health history and current physical condition
3. Emotional, behavioral, cognitive conditions and complications- thoughts, emotions, and mental health issues
4. readiness to change
5. Relapse and continued use/problem potential- past relapses, continued use or problems
6. Recovery and Living Environment- living situation-people, places and and things that could serve as potential triggers

Question 22

NIDA Prevention Principles

Answer 22

Prevention Programs Should…

1. Enhance protective factors and reverse/reduce risk factors
2. Address all forms of drug abuse
3. Address the type of drug abuse problem in local community, Target modifiable risk factors
4. Be tailored to address risks specific to population or audience
5. Enhance family bonding/ relationships and include parenting skills, developing, discussing and enforcing family policies on substance abuse, drug education a dm information
6. Early intervention

Question 23

Diagnosing Addictions: DSM IV vs. DSM V

Answer 23

Definitions of abuse and dependence have been merged into a single disorder ( SUD) with graded severity. There is no longer a distinction between abuse and dependence under the DSM V.

SUD severity:
Mild 2-3 symptoms
Moderate 4-5 symptoms
Severe 6+ symptoms

Question 24

Allostasis

Answer 24

The body’s ability to adjust it’s set points to maintain homeostasis. For example, the body’s withdrawal reaction to a stimulant is to produce physiological depression to bring itself back in balance; the opposition is true if withdrawing from a depressant. The idea behind allostasis is that chronic drug use may create a new and long-standing set point ( i.e. tolerance) which leads to a need for more of a drug to produce the same affect as before.

Question 25

Maturing out

Answer 25

Recovery that happens without professional treatment. The tem maturing out was coined by Winick (1962) when he discovered that the average duration of an addiction is 8.6 years. In 2016, Earleywine found that 2/3 of individuals with a SUD no longer meet criterion after 3 years (despite most never receiving formal treatment). Breidebahj and Take ( 2016) contribute the process of maturing out to an awakening experience which leads to insight about addictive behaviors that consequently leads to a cessation of use.

Question 26

SUD Criteria

Answer 26

1. Taking substance in larger doses or for longer than supposed to
2. Wanting to reduce use or stop but not managing to do so
3. Spending a lot of time getting, using it recovering from substance use
4. cravings/ urges to use
5. substance use disrupting work, school, and home life
6. Continuing to use, even when it disturbs relationships
7. Giving up important social, occupational or recreation activities because of substance abuse
8. Using substances again and again event when it puts one in danger
9. Continuing to use even in the presence of a known physical or psychological problem caused or exacerbated by substance use
10. Tolerance
11. Withdrawal

Question 27

Criteria for Residential vs. Inpatient Treatment

Answer 27

inpatient treatment

Criteria for Outpatient Treatment (Adults) (Perkinson, 2017):
Individual meets DSM diagnostic criteria
Individual is not acutely intoxicated/minimal risk for severe withdrawal
Medical conditions are stable
Anxiety, guilt, and/or depression, if present, appear to be substance related
If emotional, cognitive, or behavioral problems other than those caused by substance use exist, they are being treated by an appropriate mental health professional
Client understands the program or the treatment process & willingness to cooperate
Client is not at risk for harming himself or herself or others
Client may admit that he or she has a problem with alcohol or drugs, but requires monitoring and motivating strategies
Client can remain abstinent with support (Can do so between appointments)
Environment is sufficiently supportive to make outpatient treatment feasible
Family or significant others are supportive of recovery & client is willing to obtain such support
Significant others are supportive, but professional interventions needed

Criteria for Inpatient Treatment (Adults):
Individual meets DSM diagnostic criteria
Presents a severe withdrawal risk
Past failures entering treatment after detox
Emotional, cognitive, or behavioral problems interfere with abstinence and stability to the degree that there is a need for a structured 24-hour environment
Moderate risk of behaviors endangering self or others
Client is manifesting stress behaviors related to losses or anticipated losses that significantly impair daily living
History or presence of violent or disruptive behavior during intoxication with imminent danger to self or others
Concomitant personality disorders are of such severity that the accompanying dysfunctional behaviors require continuous boundary-setting interventions
Despite consequences, client does not accept the severity of the problem and needs intensive motivating strategies available in a 24-hour structured setting
Despite active participation at a less intensive level of care or in a self-help fellowship, client is experiencing an acute crisis with an intensification of addiction symptoms
Client cannot control his or her use so long as alcohol or drugs are present in the environment
Treatments necessary for the client require this level of care
Client lives in an environment where treatment is unlikely to succeed
Treatment accessibility prevents participation in a less intensive level of care
There is a danger of physical, sexual, or emotional abuse in the current environment
Client is engaged in an occupation where continued use constitutes a substantial imminent risk to personal or public safety

Question 28

Incentive Sensitization Theory of Addiction

Answer 28

f. The mesolimbic pathway is the reward circuit and it is responsible for rewarding/reinforcing effects of abused drugs. It is the pathway between the VTA and the Nucleus accumbens. Along this pathway, the VTA propels dopamine to the nucleus accumbens, when activated by a substance. Repeated drug use leads to a decline in the reward experience so that the liking (actual pleasure component) effect is not as strong as it initially was, but the wanting (expectation, anticipation, desire) effect continues to increase as the user tries to recreate that initial or early experience brought on by first/early drug use. This change in the levels of liking and wanting over time is caused by OFC( orbitofrontal cortex) coding, which creates neural pathways in the brain of the user that teach the user selective satiety, or to always have a desire, or “wanting” for a certain substance, when triggered by certain cues, even when the user knows using will not be an enjoyable experience.

Question 29

Stages of Change Model

Answer 29

defensive and resistant to suggestion of problems related with use
-uncommitted or passive
-consciously/subconsciously avoiding steps to change
Interventions:
-build rapport and develop a good excellent therapeutic relationship
-critical task is to generate concerns, interest and hope
-roll with resistance: validate and active listening and agreeing with a twist and emphasizing personal choice and control
-wait until client expresses acknowledgement of problem and negative consequences then client is ready to move to next stage

2. Contemplation – aware a problem exists but with no commitment to action
   -seeking to evaluate and understand their behavior
   -distress and desire to gain some control and mastery
   -have not begun taking action; not prepared yet to do so
   -frequently made attempts to change
   Intervention:
   -the critical task is to resolve ambivalence
   -consciousness raising (decision making chart; pros and cons)
   -foster self and environmental re-evaluation
   -wait for decision to acts and some preliminary action, to move to the next stage

3.Preparation – intent on taking action to address the problem
- intending to change their behavior
-Ready to change in terms of both attitude and behavior
-On the verge of taking action
-Engage in the change process
Intervention:
-increase commitment or self-lib
-Wait until client sets goals and priorities to achieve change

4. Action – active modification of behavior
   -client has decided to make changes and has attempted changes in the past
   -Client has verbalized or otherwise demonstrated a firm commitment to making change
   -demonstrated efforts to mod behavior
   Client present a motivation and effort to achieve behavioral change
   -client is committed to making change and is involved in the change process
   -client is willing to follow suggested strategies and activities to change
   Intervention:
   -utilize methods of overt behavior change
   -wait for client to apply behavior change methods for an average of 6 months and increase self-efficacy to perform the behavior change, in order to move to the next stage
5. Maintenance – sustained change; new behavior replaces old
   -considerable attention is focused on avoiding lapses or relapses
   -client is working to sustain changes achieved to date
   -may describe anxiety regarding relapse and facing a high risk for future relapse situations

Intervention:

• behavioral treatment methods continue
• focus on modifying and updating the client’s relapse prevention plan

6. Relapse – fall back into old patterns of behavior
   * Upward spiral allows for learning and growth from each relapse

Question 30

Theories of Addiction: Biological and Disease Theories

Answer 30

a. Mostly focuses today on neuroscience and genetic research
b. About 50% of an individual likelihood of developing a substance addiction is related to genetic factors (Smith, 2015) Epigenetics research has also gained in popularity
c. The primary belief underlying these theories is that addiction is “primary, progressive, and chronic” and it is viewed and treated as a brain disease and often fatal
d. The research base underlying the biological/disease theories is massive, and it continues growing daily
e. It remains the prevailing theory behind AA

Question 31

Theories of Addiction: ACE Study

Answer 31

a. Kaiser and CDC-led study
b. ACE’s can lead to a 20 year difference in life expectancy
c. 17,500 adults surveyed about their ACE’s
d. Sexual abuse, neglect, parental mental illness, parental substance abuse, parental incarceration, parental separation/divorce, domestic violence
e. The higher your ACE score, the worse your health outcomes
f. 4 or more ACE’s predicts 4-12 fold increased risk for alcoholism, drug abuse, and depression and suicide attempts.
i. Exposure to early adversity affects the nucleus accumbens (pleasure/reward center implicated in SUDS), inhibits the prefrontal cortex (impulse control), amygdala (fear response center).
g. 2-4 fold increased risk for >50 sexual intercourse partners, and STDS

Question 32

Theories of Addiction: Biopsychosocial Model

Answer 32

a. Occurred following criticisms of the ever-popular biomedical theories
b. Research does not support the medical model of addiction (the biopsychosocial model better fits the data)
c. None of the available theories explain why some people develop addictions and others do not
d. Three overarching categories: biological, psychological, and social models, which form the biopsychosocial model

Question 33

Theories of Addiction: Sociocultural Theories

Answer 33

• Example: Despite the many similarities between French and Italian cultures, there are stark differences in their use of alcohol: “The French drink wine and spirits at home and elsewhere, they do not strongly oppose public drunkenness, …Italians, on the other hand, usual l y drink wine and mostly at family meal s…[ and] strongly disfavor drunkenness.” Results: The rate of Alcohol Use Disorder (AUO) in France for males is nearly seven times higher compared with Italy, whereas, for females, it is about three times higher
• The Irish have high percentages of both abstainers and problem drinkers, whereas Jews have low rates of both ( The Irish are more accepting of drunkenness, whereas Jews condemn it)
• Bales’ (1946) hypothesis: Cultures that condone alcohol use (but also suppress aggression and sexuality) induce guilt, are likelier to have higher rates of alcoholism compared with more libertarian societies
• Bales also suggested that individuals in societies that favor abstinence, ritual use for religious practices, and/or drinking within an amiable social situation are less likely to develop alcohol problems
• Individuals living in communities that are disorganized demonstrate higher rates of substance use (e.g. , inner-city drug use is more common than in the suburbs) + Subcultures

Question 34

Theories of Addiction: Family Systems Theory

Answer 34

Systems theory suggests that a change in one aspect of a system will affect the other aspects of the system

• If children are raised in dysfunctional families, they are likely to become vulnerable to addictions
• In the behavioral family model, one or more members reinforce the addictive behavior of the client (some family members might actually prefer that our clients are involved in their addictive behavior)
• In the family systems model, the belief is that clients become the scapegoat or exemplar of problems within the family (the “identified” client is merely the person who most expresses the family dysfunction = addiction

Question 35

Theories of Addiction: Psychodynamic Theories

Answer 35

a. Capuzzo and Stauffer (2012) linked psychodynamic explanations of addiction with ego deficiency, inadequate parenting, attachment disorders, hostility, homosexuality, and masturbation.
b. Other psychodynamic theorists have viewed alcoholics, as orally fixated, narcissistic, and self-destructive
c. Addicted individuals have difficulty with regulating their emotions and possess disturbed object relations (Klein, Fairbairn, Winnicott) inadequate parenting + maladaptive attachment =future negative close/intimate relationships
d. Trauma, abuse, and or neglect (including insecure attachments are risk factors for mental health disorders and addictions (ample research indicates that many addicted individuals have experienced trauma, abuse and or neglect during childhood)

Question 36

1. Problem List (Perkinson, 2017)

Answer 36

1. Problem List:
   ¨ Brief clinical statement of a condition that needs treatment
   ¤ No longer than one sentence
   ¤ Describes only one problem
   ¨ Problem statements are abstract concepts
   ¤ You cannot see the problem (ex: low self-esteem)
   ¤ Problems are evidenced by signs and symptoms
   ¨ Problem on treatment plan is followed by specific physical, emotional, and behavioral evidence

Example of a Problem List
Problem 1: Inability to maintain sobriety outside of structured facility
As evidenced by: Blood alcohol level of .23
As evidenced by: Client’s family reports daily drinking
As evidenced by: Alcohol withdrawal symptoms
As evidenced by: Third DWI
As evidenced by: History of third treatment for addiction

Question 37

3. Objectives (Perkinson, 2017)

Answer 37

3. Objectives:
   ¨ An objective is a specific skill client must acquire to achieve a goal
   ¤ What you set out to accomplish in treatment
   ¤ A concrete behavior you can see, hear, smell, taste, or feel
   ¤ Objective is stated clearly so almost anyone would recognize it if they saw it
   ¨ Example goal and corresponding objective
   ¤ Goal: Client will gain self-esteem
   ¤ Objective: Client will express 10 positive things about his/herself

¨ All goals and objectives help the client change
¨ Each goal should have one or more objectives
¨ State goal with the words “as evidenced by”
¨ Complete goal sentence by describing specific objectives that will tell you when goal is reached
¤ Objectives must be measurable
You must be able to count objectives

Goal and Objectives Example:
¨ Goal A: The client will develop a program of recovery congruent with a sober lifestyle, as evidenced by the following (objectives):
¤ The client will share in recovery skills group three times when he or she tried to stop drinking but was unable to stay sober
¤ The client will make a list of the essential skills necessary for recovery

19. Know and explain the three basic tenets of strength-based counseling.

ACA’s definition: A professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.
Three Basic Tenets:
• Choice- respecting the rights of individuals to manager their destinies and to take responsibility for their actions
• Options- if the program is based solely on abstinence, clients are not provided options
• Readiness to Change- attention is given to readiness to change, allowing client to guide pace

Question 38

2. Treatment Goals (Perkinson, 2017)

Answer 38

2. Treatment Goals:
   ¨ Brief clinical statement of the condition you expect in client or family:
   n State what you intend to accomplish in general terms
   n Specify condition of the client that will result from treatment
   n All goals have a set of behaviors that you want to create
   ¨ Goals are more than elimination of pathology
   ¤ Directed toward client learning new, more functional ways of coping

Examples of a Goal:

¨ Instead of: The client will stop drinking.
¤ Use: The client will develop a program of recovery congruent with a sober lifestyle. (The client is learning something different. It often helps to put the goals in the client’s own words.) Client statement: “I need learn how to stay sober”
¤ Use: The client will learn to cope with stress in an adaptive manner. Client statement: “I need to learn how to cope with my stress”
¤ The client will learn the skills necessary to maintain a sober lifestyle
¤ The client will learn to express negative feelings to his or her spouse
¤ The client will develop a positive commitment to sobriety
¤ The client will develop a healthy diet and begin to gain weight
¤ The client will learn how to tolerate uncomfortable feelings without using chemicals