CASAC - Credentialed Alcoholism and Substance Abuse Counselor Pharmacology and Co-Occurring Disorders 1

Question 1

Methadone, when used as medication-assisted treatment for opioid use disorder, differs from buprenorphine in a clinically significant way. Which of the following statements accurately describes a key distinction?

Accepted Answer

Methadone for OUD must be dispensed through a federally certified Opioid Treatment Program (OTP), while buprenorphine can be prescribed in office-based settings

Answer

Methadone for OUD is a Schedule II controlled substance that can only be dispensed through federally certified OTPs due to its high overdose potential and abuse liability. Buprenorphine, by contrast, can be prescribed by qualified physicians in office-based settings under the DATA 2000 waiver, significantly expanding access to MAT.

Question 2

A client with co-occurring generalized anxiety disorder and alcohol use disorder is being assessed for pharmacological treatment of their anxiety. Which of the following medications would generally be considered the most appropriate first-line choice, given the risk profile in this population?

Accepted Answer

An SSRI such as sertraline, because it is non-addictive and effective for anxiety with a co-occurring SUD

Answer

SSRIs are the preferred first-line pharmacological treatment for anxiety disorders in patients with co-occurring substance use disorders because they are non-habit-forming and have demonstrated efficacy without reinforcing addictive patterns. Benzodiazepines are generally avoided in this population due to their cross-tolerance with alcohol and high abuse potential.

Question 3

Acamprosate (Campral) is an FDA-approved medication for alcohol use disorder. Which of the following best describes its primary mechanism of action?

Accepted Answer

It modulates glutamate and GABA neurotransmission to reduce protracted withdrawal symptoms and cravings

Answer

Acamprosate works by stabilizing the glutamate/GABA imbalance that develops after prolonged alcohol use, thereby reducing the neurological hyperexcitability that drives protracted withdrawal symptoms such as anxiety, insomnia, and cravings. Unlike disulfiram, it does not cause an aversive reaction, and unlike naltrexone, it does not act on opioid receptors.

Question 4

A client with a history of psychotic disorder reports daily cannabis use and states it helps them feel relaxed. Which of the following represents the most clinically important concern the counselor should communicate to this client?

Accepted Answer

THC can exacerbate psychotic symptoms, trigger relapses in schizophrenia, and reduce the efficacy of antipsychotic medications

Answer

Research consistently shows that THC, the primary psychoactive compound in cannabis, can precipitate or worsen psychotic episodes and is associated with earlier onset and more severe course of schizophrenia. Regular cannabis use also interferes with antipsychotic treatment and significantly worsens long-term outcomes for individuals with psychotic disorders.

Question 5

A client with co-occurring ADHD and stimulant use disorder is being evaluated for ADHD pharmacotherapy. Which medication class would raise the greatest concern for misuse and diversion in this population?

Accepted Answer

Amphetamine salts (Adderall), a Schedule II stimulant with high abuse potential

Answer

Amphetamine-based medications such as Adderall are Schedule II controlled substances with significant abuse and diversion potential, making them particularly risky for individuals with a history of stimulant use disorder. Non-stimulant alternatives such as atomoxetine, bupropion, or guanfacine are generally preferred in this co-occurring population to avoid reinforcing the addiction cycle.

CASAC - Credentialed Alcoholism and Substance Abuse Counselor Practice Test

CASAC - Credentialed Alcoholism and Substance Abuse Counselor Practice Test

CASAC - Credentialed Alcoholism and Substance Abuse Counselor Pharmacology and Co-Occurring Disorders 1