Chemical Dependency Counselor License Exam Screening and Assessment 5 — Questions and Answers
Question 1: The TWEAK screening tool is most commonly used to identify at-risk drinking in which specific population?
- Adolescent males in juvenile justice settings
- Older adults in geriatric care settings
- Pregnant women during prenatal visits (Correct answer)
- Veterans returning from combat deployment
Correct answer: Pregnant women during prenatal visits
TWEAK (Tolerance, Worried, Eye-opener, Amnesia, Cut down) was developed and validated specifically to identify at-risk alcohol use in pregnant women.
Question 2: During a substance use assessment, a client minimizes the extent of their alcohol use compared to records obtained from collateral sources. This discrepancy is BEST described as:
- Malingering, requiring immediate discharge
- Denial or minimization, a common feature of substance use disorders (Correct answer)
- Evidence of a factitious disorder
- A contraindication for further assessment
Correct answer: Denial or minimization, a common feature of substance use disorders
Minimization of use is a common defense mechanism in substance use disorders and should be explored therapeutically rather than treated as a barrier to treatment.
Question 3: Which of the following is a key component assessed in the SOCRATES (Stages of Change Readiness and Treatment Eagerness Scale)?
- Severity of physiological withdrawal symptoms
- Recognition of a drinking problem, ambivalence, and taking steps to change (Correct answer)
- Social support network strength and quality
- Duration and frequency of substance use history
Correct answer: Recognition of a drinking problem, ambivalence, and taking steps to change
SOCRATES assesses three factors: Recognition (acknowledgment of a problem), Ambivalence (uncertainty about change), and Taking Steps (current change efforts).
Question 4: A thorough substance use history collected during assessment should include which of the following elements?
- Only current substances used in the past 30 days
- Age of first use, substances used, frequency, amount, route of administration, and consequences (Correct answer)
- Current prescription medications only, verified by pharmacy records
- Lifetime legal charges related to substance use
Correct answer: Age of first use, substances used, frequency, amount, route of administration, and consequences
A comprehensive substance use history captures onset, progression, patterns of use, routes, consequences, prior treatment, and periods of abstinence across all substances.
Question 5: Which laboratory test result, when elevated, most directly supports a clinical impression of heavy chronic alcohol use discovered during assessment?
- Elevated serum creatinine
- Elevated gamma-glutamyl transferase (GGT) (Correct answer)
- Elevated fasting glucose
- Elevated thyroid-stimulating hormone (TSH)
Correct answer: Elevated gamma-glutamyl transferase (GGT)
GGT is a liver enzyme that is sensitive to heavy alcohol use and is commonly elevated in individuals with chronic alcohol use disorder.
Question 6: In the context of a substance use assessment, 'cross-addiction' or 'cross-dependence' refers to:
- A client using substances to manage withdrawal from a different substance in the same pharmacological class (Correct answer)
- Two family members in the same household both meeting criteria for substance use disorder
- A counselor experiencing vicarious trauma from working with clients who use substances
- Using one therapeutic modality to treat two different substance use disorders simultaneously
Correct answer: A client using substances to manage withdrawal from a different substance in the same pharmacological class
Cross-dependence occurs when tolerance and withdrawal from one substance (e.g., heroin) can be suppressed by another substance in the same class (e.g., methadone), which is clinically important during assessment.
Question 7: Which of the following assessment findings would MOST strongly support a diagnosis of Severe Alcohol Use Disorder under DSM-5 criteria?
- Client reports drinking socially 2–3 times per week without negative consequences
- Client meets 6 or more of the 11 DSM-5 criteria for alcohol use disorder (Correct answer)
- Client has a family history of alcohol use disorder but does not currently drink
- Client reports one episode of blacking out in the past year
Correct answer: Client meets 6 or more of the 11 DSM-5 criteria for alcohol use disorder
Under DSM-5, Severe Alcohol Use Disorder is diagnosed when a client meets 6 or more of the 11 diagnostic criteria within a 12-month period.
