LPC Substance Abuse Counseling 1 — Questions and Answers
Question 1: The biopsychosocial model of substance use disorders proposes that addiction results from:
- A single genetic defect that predetermines substance dependence
- The interaction of biological, psychological, and social factors (Correct answer)
- Primarily moral weakness and lack of willpower
- Exposure to substances alone, regardless of individual factors
Correct answer: The interaction of biological, psychological, and social factors
The biopsychosocial model conceptualizes substance use disorders as resulting from the complex interaction of biological vulnerability, psychological factors, and social/environmental influences.
The biopsychosocial model replaced earlier moral and purely biomedical models of addiction. It recognizes: biological contributions (genetics, neurochemistry, neurodevelopment), psychological contributions (mental health comorbidities, trauma history, coping styles, beliefs about substances), and social contributions (family environment, peer influences, availability, socioeconomic factors, cultural norms). Effective treatment addresses all three dimensions.
Question 2: Motivational Interviewing (MI) was originally developed to address which population?
- Adolescents with conduct disorders
- People with alcohol use problems (Correct answer)
- Combat veterans with PTSD
- Individuals with schizophrenia
Correct answer: People with alcohol use problems
William Miller originally developed Motivational Interviewing to address ambivalence in clients with alcohol use problems, later expanding it across addictive behaviors and other clinical areas.
William Miller developed MI in the early 1980s while working with problem drinkers. He observed that directive confrontational approaches increased resistance while empathic, client-centered exploration elicited change talk. With Stephen Rollnick, he codified these observations into MI. MI has since been applied to tobacco cessation, illicit drug use, medication adherence, dietary change, and many other behavioral health areas.
Question 3: The transtheoretical model (Prochaska and DiClemente) stage of 'contemplation' is characterized by:
- Active engagement in changing the problem behavior
- Ambivalence — the person is considering change but not yet committed (Correct answer)
- No awareness or consideration of the problem
- Maintenance of the behavior change for 6+ months
Correct answer: Ambivalence — the person is considering change but not yet committed
In contemplation, individuals are aware of the problem and are considering change within the next 6 months, but have not yet made a commitment to act — ambivalence is its defining feature.
The Transtheoretical Model (TTM) stages are: Precontemplation (unaware or unwilling), Contemplation (considering change within 6 months, ambivalent), Preparation (planning to act within 30 days), Action (active behavior change for < 6 months), and Maintenance (sustaining change for 6+ months). Stage-matched interventions are more effective than stage-mismatched ones. For contemplators, MI and decisional balance exercises are well-suited.
Question 4: DSM-5 consolidates what were previously separate categories of substance abuse and substance dependence into a single diagnosis called:
- Substance-related and addictive disorders
- Substance use disorder with severity specifiers (Correct answer)
- Substance abuse spectrum disorder
- Compulsive substance use syndrome
Correct answer: Substance use disorder with severity specifiers
DSM-5 combined abuse and dependence into a single 'substance use disorder' with three severity levels: mild (2-3 criteria), moderate (4-5 criteria), and severe (6+ criteria).
DSM-IV distinguished substance abuse (less severe, pattern of harmful use) from substance dependence (more severe, including tolerance, withdrawal, loss of control). DSM-5 eliminated this distinction, creating a single substance use disorder diagnosis for each substance type. The 11 diagnostic criteria span impaired control, social impairment, risky use, and pharmacological criteria (tolerance and withdrawal). Severity is based on the number of criteria met.
Question 5: Which of the following is an evidence-based pharmacological treatment approved for alcohol use disorder?
- Methadone
- Buprenorphine
- Naltrexone (Correct answer)
- Naloxone
Correct answer: Naltrexone
Naltrexone is an opioid antagonist FDA-approved for alcohol use disorder; it reduces craving and the rewarding effects of alcohol.
Three FDA-approved medications for alcohol use disorder are: (1) Naltrexone — reduces craving and alcohol's reinforcing effects by blocking opioid receptors (available orally and as monthly injection Vivitrol); (2) Acamprosate — reduces protracted withdrawal symptoms and craving; (3) Disulfiram (Antabuse) — causes aversive reaction to alcohol (flushing, nausea). Methadone and buprenorphine are medications for opioid use disorder. Naloxone reverses opioid overdose emergently.
Question 6: The CAGE questionnaire is a brief screening tool used to identify:
- Severity of depression in primary care settings
- Problematic alcohol use requiring further assessment (Correct answer)
- Opioid misuse in chronic pain populations
- Cannabis use disorder in adolescents
Correct answer: Problematic alcohol use requiring further assessment
The CAGE is a 4-item screening tool (Cut down, Annoyed, Guilty, Eye-opener) designed to identify problematic alcohol use. Two or more positive responses indicate likely alcohol use disorder.
The CAGE questionnaire asks four yes/no questions: Have you ever felt you should Cut down on drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt Guilty about drinking? Have you ever had a drink first thing in the morning as an Eye-opener? Two or more affirmative responses indicate probable alcohol use disorder with high sensitivity and specificity. It is widely used in primary care and brief contact settings.
LPC Substance Abuse Counseling 1
The biopsychosocial model of substance use disorders proposes that addiction results from: