LPC Substance Abuse Counseling 2 — Questions and Answers
Question 1: Harm reduction approaches to substance use counseling prioritize which of the following?
- Immediate and complete abstinence from all substances
- Reducing the negative consequences of substance use without requiring abstinence (Correct answer)
- Confrontational techniques to break through client denial
- Medication-only treatment without counseling support
Correct answer: Reducing the negative consequences of substance use without requiring abstinence
Harm reduction meets clients where they are, prioritizing reduction of substance-related harms (overdose, disease, legal consequences) without requiring abstinence as a prerequisite for engagement.
Harm reduction encompasses a range of strategies — needle/syringe programs, naloxone distribution, safe injection sites, supervised consumption services, medication-assisted treatment without abstinence requirements — designed to reduce the negative consequences of drug use for individuals who are not yet ready to stop. It is non-judgmental, pragmatic, and evidence-based. Harm reduction treats clients with dignity and recognizes that reducing harm is valuable even when abstinence is not the immediate goal.
Question 2: The disease model of addiction views substance use disorders as:
- A moral failure reflecting a lack of willpower
- A chronic brain disorder with genetic, neurobiological, and environmental components (Correct answer)
- An existential crisis requiring meaning-making therapy
- A learned behavior fully reversible through behavioral conditioning
Correct answer: A chronic brain disorder with genetic, neurobiological, and environmental components
The disease model, endorsed by ASAM, NIDA, and mainstream medicine, views addiction as a chronic brain disorder characterized by compulsive drug seeking despite negative consequences.
The American Society of Addiction Medicine (ASAM) defines addiction as a primary, chronic disease of brain reward, motivation, memory, and related circuitry. The disease model is supported by neuroimaging research showing changes in prefrontal cortex, striatum, and limbic structures in addiction. It reduces stigma by framing addiction as a health condition rather than a moral failure. Critics note it may minimize agency; the biopsychosocial model incorporates the disease model while also emphasizing social and psychological factors.
Question 3: In substance abuse counseling, 'relapse prevention' as developed by Marlatt and Gordon focuses on:
- Identifying and managing high-risk situations and coping deficits that lead to relapse (Correct answer)
- Eliminating all environmental exposure to substances through geographic relocation
- Using aversive conditioning to associate substances with negative outcomes
- Total abstinence as the only acceptable treatment goal
Correct answer: Identifying and managing high-risk situations and coping deficits that lead to relapse
Marlatt and Gordon's Relapse Prevention model identifies high-risk situations, abstinence violation effects, and coping skill deficits as targets for intervention to prevent relapse.
Marlatt and Gordon's Cognitive-Behavioral Relapse Prevention model identifies: (1) high-risk situations (negative emotions, interpersonal conflict, social pressure); (2) coping skills deficits; (3) outcome expectancies; and (4) the abstinence violation effect (AVE) — the catastrophic thinking and guilt following a slip that can escalate a lapse into a full relapse. Interventions include coping skills training, cognitive restructuring of AVE, and lifestyle balance. This model informs most modern CBT-based addiction treatments.
Question 4: Medication-Assisted Treatment (MAT) for opioid use disorder may include which of the following FDA-approved medications?
- Disulfiram, acamprosate, and naltrexone
- Methadone, buprenorphine, and naltrexone (Correct answer)
- Clonidine, diazepam, and phenobarbital
- Sertraline, venlafaxine, and lithium
Correct answer: Methadone, buprenorphine, and naltrexone
FDA-approved MAT for opioid use disorder includes methadone (opioid agonist), buprenorphine/naloxone (partial agonist), and naltrexone/Vivitrol (opioid antagonist).
Medication-Assisted Treatment (MAT) for Opioid Use Disorder: Methadone is a full opioid agonist dispensed through federally regulated opioid treatment programs (OTPs). Buprenorphine (often combined with naloxone as Suboxone) is a partial agonist that can be prescribed in office-based settings. Naltrexone (extended-release injectable Vivitrol) is an opioid antagonist requiring prior detox. SAMHSA and major medical organizations recommend MAT as first-line treatment for OUD.
Question 5: Co-occurring disorders (dual diagnosis) in substance abuse counseling refers to:
- Using two different substances simultaneously
- The presence of both a substance use disorder and a mental health disorder in the same individual (Correct answer)
- Two different substance use disorders with different substances
- Co-occurring substance use in a family system
Correct answer: The presence of both a substance use disorder and a mental health disorder in the same individual
Co-occurring disorders (dual diagnosis) refers to the simultaneous presence of a substance use disorder and a mental health disorder in the same individual.
The prevalence of co-occurring disorders is high: roughly 50% of individuals with severe mental disorders have co-occurring substance use disorders, and vice versa. The self-medication hypothesis, common neurobiological vulnerability, and shared risk factors help explain this comorbidity. Integrated treatment — addressing both disorders simultaneously rather than sequentially — is the gold standard, as treating one disorder in isolation typically produces poorer outcomes for both conditions.
Question 6: The AUDIT (Alcohol Use Disorders Identification Test) was developed by the WHO to screen for:
- Alcohol withdrawal severity requiring medical management
- Hazardous and harmful alcohol use in primary care and general population settings (Correct answer)
- Alcohol-related cognitive impairment
- Fetal alcohol spectrum disorder in children
Correct answer: Hazardous and harmful alcohol use in primary care and general population settings
The AUDIT is a 10-item WHO screener designed to identify hazardous and harmful alcohol use and alcohol dependence across diverse populations.
The AUDIT (Alcohol Use Disorders Identification Test) was developed by the WHO as a cross-nationally validated screening instrument. Its 10 items assess quantity/frequency of alcohol use, dependence symptoms, and alcohol-related harms. Scores guide clinical action: 0-7 (low risk, education), 8-15 (hazardous use, brief intervention), 16-19 (harmful use, brief counseling), 20+ (probable dependence, referral for specialized assessment). The AUDIT-C is a shorter 3-item version used in busy clinical settings.
LPC Substance Abuse Counseling 2
Harm reduction approaches to substance use counseling prioritize which of the following?