NCMHCE Addictions Counseling and Substance Use Disorders — Questions and Answers
Question 1: In the Transtheoretical Model (Stages of Change), a client who states 'I know my drinking is causing problems, but I'm not ready to do anything about it yet' is MOST likely in which stage?
- Precontemplation
- Contemplation (Correct answer)
- Preparation
- Action
Correct answer: Contemplation
Contemplation is characterized by ambivalence — the client acknowledges the problem and its consequences but has not yet committed to change. Precontemplation involves no awareness or desire to change; preparation involves a commitment and initial steps; action involves active behavior change.
Question 2: The CAGE questionnaire screens for problematic alcohol use. The acronym stands for:
- Cravings, Anger, Guilt, Early morning drinking
- Cut down, Annoyed, Guilty, Eye-opener (Correct answer)
- Compulsive use, Abuse, Guilt, Elimination
- Control loss, Avoidance, Grief, Excessive use
Correct answer: Cut down, Annoyed, Guilty, Eye-opener
CAGE asks four questions: Have you felt you should Cut down? Have people Annoyed you by criticizing your drinking? Have you felt Guilty about drinking? Have you had a drink as an Eye-opener in the morning? Two or more 'yes' responses suggest a probable alcohol use disorder and warrant further assessment.
Question 3: According to the DSM-5, the severity of a Substance Use Disorder is determined by:
- The type and potency of the substance being used
- The number of diagnostic criteria met: 2–3 = mild, 4–5 = moderate, 6+ = severe (Correct answer)
- The length of time the client has been using the substance
- The degree of social and occupational impairment alone
Correct answer: The number of diagnostic criteria met: 2–3 = mild, 4–5 = moderate, 6+ = severe
The DSM-5 replaced DSM-IV's separate 'abuse' and 'dependence' categories with a single Substance Use Disorder diagnosis rated on a dimensional severity scale based on how many of 11 criteria are met. This eliminates the artificial categorical split and better reflects the continuum of substance-related problems.
Question 4: Harm reduction as a treatment philosophy for substance use disorders is BEST described as:
- Requiring immediate abstinence before any treatment services are provided
- A disease-model approach emphasizing lifelong recovery through 12-step programs
- Reducing drug-related negative consequences without mandating abstinence as a prerequisite (Correct answer)
- A behavioral approach using aversion therapy to decrease substance cravings
Correct answer: Reducing drug-related negative consequences without mandating abstinence as a prerequisite
Harm reduction accepts that not all clients are ready or able to achieve immediate abstinence and focuses on pragmatic strategies (e.g., needle exchanges, safer use education, controlled use goals) to reduce morbidity and mortality. It is client-centered and non-coercive, meeting clients where they are.
Question 5: Medication-Assisted Treatment (MAT) for opioid use disorder using buprenorphine works primarily by:
- Producing euphoria that substitutes for heroin, making recovery easier
- Acting as a partial opioid agonist to reduce cravings and withdrawal while having a ceiling effect that limits overdose risk (Correct answer)
- Blocking dopamine receptors to eliminate the rewarding effects of all substances
- Inducing an aversive reaction to opioids to create a conditioned avoidance response
Correct answer: Acting as a partial opioid agonist to reduce cravings and withdrawal while having a ceiling effect that limits overdose risk
Buprenorphine is a partial mu-opioid agonist — it activates opioid receptors enough to relieve craving and prevent withdrawal but has a ceiling effect that greatly reduces overdose risk compared to full agonists. SAMHSA and APA recognize MAT as an evidence-based treatment that reduces illicit opioid use, overdose deaths, and disease transmission.
Question 6: A counselor using Motivational Interviewing (MI) with a client ambivalent about sobriety reflects 'change talk' by responding most therapeutically to which client statement?
- 'I don't think I have a drinking problem.'
- 'My wife probably worries too much.'
- 'Sometimes I wonder what my life would look like sober.' (Correct answer)
- 'I've tried quitting before and it never works.'
Correct answer: 'Sometimes I wonder what my life would look like sober.'
Change talk consists of client statements favoring change: Desire, Ability, Reasons, Need, and Commitment (DARNC). 'I wonder what my life would look like sober' is change talk expressing desire/reasons. MI counselors selectively reflect and reinforce change talk while using double-sided reflections or reframes for sustain talk.
NCMHCE Addictions Counseling and Substance Use Disorders
In the Transtheoretical Model (Stages of Change), a client who states 'I know my drinking is causing problems, but I'm not ready to do anything about it yet' is MOST likely in which stage?