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Instructor’s Manual and Test Bank

For

Foundations of Addictions Counseling

Fourth Edition

David Capuzzi, Walden University, Professor Emeritus,

Portland State University

Mark D. Stauffer, Walden University

Prepared by

Melinda Haley, Walden University

Boston Columbus Indianapolis New York San Francisco Hoboken

Amsterdam Cape Town Dubai London Madrid Milan Munich Paris Montreal Toronto

Delhi Mexico City Sao Paolo Sydney Hong Kong Seoul Singapore Taipei Tokyo

NOTES TO INSTRUCTORS

The Instructors Manual to accompany Foundations of Addictions Counseling encourages journaling, group exercises, and class experiential exercises.

There is also a test bank for creating mid-term and final exams. These exercises and test items were generated from the context of each chapter. There are fifteen test items for each chapter. Please note that the answer keys for all chapters are on pages 72 to 81 of this booklet.

It is the intent and hope of the authors that these exercises and test items will be helpful to those utilizing this text. The authors appreciate the contributions made by the writers of individual chapters.

Table of Contents

PART 1 INTRODUCTION TO ADDICTIONS COUNSELING

Chapter 1 History and Etiological Models of Addiction1

Chapter 2 Substance Addictions5

Chapter 3 Process Addictions8

Chapter 4 Professional Issues in Addictions Counseling11

Chapter 5 Introduction to Assessment16

Chapter 6 Assessment and Diagnosis of Substance-Related and Addictive Disorders19

PART 2 THE TREATMENT OF ADDICTIONS

Chapter 7 Motivational Interviewing22

Chapter 8 Psychotherapeutic Approaches26

Chapter 9 Treatment of Comorbid Disorders31

Chapter 10 Group Counseling for Treatment of Addictions35

Chapter 11 Addiction Pharmacotherapy39

Chapter 12 12-Step Facilitation of Treatment42

Chapter 13 Maintenance and Relapse Prevention46

PART 3 ADDICTIONS AND FAMILY THERAPY, REHABILITATION, AND SCHOOL SETTINGS

Chapter 14 Substance Addiction and Families50

Chapter 15 Persons with Disabilities and Substance-Related and Addictive Disorders53

Chapter 16 Substance Addiction Prevention Programs Across the Lifespan56

PART 4 CROSS-CULTURAL COUNSELING IN ADDICTIONS

Chapter 17 Cross-Cultural Counseling: Engaging Ethnic Diversity59

Chapter 18 Gender, Sex, and Addictions62

Chapter 19 Lesbian, Gay, Bisexual, Transgender, and Queer Affirmative Addictions Treatment65

EPILOGUE SOME ADDITIONAL PERSPECTIVES

Chapter 20 Inpatient and Outpatient Addiction Treatment68

ANSWER KEYS

Chapters 1 & 272

Chapters 3 & 473

Chapters 5 & 674

Chapters 7 & 875

Chapters 9 & 1076

Chapters 11 & 1277

Chapters 13 & 1478

Chapters 15 & 1679

Chapters 17 & 1880

Chapters 19 & 2081

CHAPTER 1

History and Etiological Models of Addiction

Journaling Exercises:

1. As you read about the history of drugs in this country, you will note that attitudes about use changed as time passed and that attitudes and biases changed over the decades. Take some time to do a short life review and describe time periods in your life that impacted your attitudes about the use of illicit drugs. What was happening in your personal life that impacted how you felt?
2. Describe how attitudes in your family of origin have affected your current attitudes about the consumption of alcohol.
3. Is the philosophy of Alcoholics Anonymous congruent or incongruent with your values and beliefs? Why or why not?

Discussion Exercises:

1. Interview some professional counselors and ask them what they believe to be the causes of addictive behavior. Share your findings with members of the class.
2. Ask five or six individuals who are not members of this class or connected in any way with the profession of counseling what they think about the possibility of legalizing the use of marijuana. Report the results of your interviews with members of the class.
3. Do you think enough time, effort, and money is being spent on the prevention of addictive behavior? What are your best guesses about the most effective approaches to prevention?

Group Exercises:

1. Divide the class into several groups and assign each group one of the models used to explain the etiology of addiction. Ask each group to outline a tentative treatment plan that would be congruent with the model under consideration.
2. Divide the class into several groups and assign each group one or more of the web sites listed at the end of chapter one. Have each group explain to the rest of the class what they learned from exploration of each web site.
3. Organize a panel composed of students who represent different cultural, ethnic, and racial groups. Ask them to share their thoughts and feelings about the applica­bility of the models used to explain the etiology of addiction in cross and multi-cultural situations. Encourage class interaction with panelists as the presentations of panel members are made.

Quiz Items

True/False:

1. In 1926, the United States Congress passed the Purity in Food and Drug Act designed to control addiction by requiring labels on drugs contained in products including opium, morphine, and heroin.
   1. True
   2. False
2. A small minority of juvenile offenders (2 out of every 1000) will be offered Juvenile Drug Court (JDC) diversionary programs as an option to prison sentences.
   1. True
   2. False
3. Cognitive-behavioral models suggest a variety of motivations and reinforcers for taking drugs. One explanation suggests that people take drugs to experience variety.
   1. True
   2. False
4. The disease model of etiology, addiction is viewed as a primary disease rather than being secondary to another condition.
   1. True
   2. False
5. According to the moral model, addiction is incurable.
   1. True
   2. False

Multiple Choice:

1. Which U.S. Act required drugs to be classified according to their medical use, potential for abuse, and possibility of creating dependence:
   1. Anti-Drug Abuse Prevention Act.
   2. Harrison Act.
   3. Controlled Substance Act.
   4. None of the above.
2. Which etiological theory of addictions assumes that addicts are constitutionally predisposed to develop dependence on drugs:
   1. Disease theory.
   2. Family systems theory.
   3. Biophysiological theory.
   4. Supracultural theory.
3. Which etiology model explains addiction as a consequence of personal choice and, individuals, who are engaging in addictive behaviors, are viewed as being capable of making alternative choices:
   1. Learning theory model.
   2. Disease model.
   3. Cognitive behavioral model.
   4. None of the above.
4. According to this chapter, which of the following is NOT a psychological model of addiction etiology:
   1. Psychodynamic.
   2. Learning theory.
   3. Personality theory.
   4. Family Disease.
5. According to the syndrome model of Addictions, there are multiple and interacting antecedents of addiction that can be organized in at least three primary areas. Which of the following is NOT a primary area:
   1. Shared neuro-biological antecedents.
   2. Shared psychosocial antecedents.
   3. Shared spiritual antecedents.
   4. Shared experiences and consequences.

Matching:

1. _____Integral model

2. _____Learning model

3. _____Supracultural model

4. _____Disease model

5. _____Biological model

1. Influenced by B. F. Bales
2. Addiction is caused by genetics.
3. Influenced by E. M. Jellinek’s work.
4. Posits that children and adolescents may internalize the values and expectations of their parents.
5. A multi-causal model of addiction.

CHAPTER 2

SUBSTANCE ADDICTIONS

Journaling Exercises:

1. Spend some time reflecting on the information provided in this chapter. How did you respond to the descriptions of the effects of addictive substances? Were you surprised by anything you learned? Have your views of any of the substances changed?
2. Have you ever tried to stop consuming a substance (alcohol, other drugs, caffeine, sweets, etc)? What was your experience? Have you watched others try to stop? What sorts of thoughts and feelings did you notice in each case? What thoughts or feelings got in the way of your success reducing or abstaining from use, or made it difficult to support others in their efforts? What helped?
3. What role have drugs and alcohol played in your life? What is your experience with their effects on individuals, families, and society? What impact do you think your background will have on your ability to be an effective counselor to people with addictions?

Discussion Exercises:

1. Pay attention to portrayals of addiction and recovery in the media. What themes do you notice? How are different substances and types of users portrayed? How might these images and messages impact clients in recovery?
2. Do you think that psychological or physical dependence has more influence over addictive processes? Is one more or less important at various stages of the addictive or recovery process?
3. There are some very serious and disturbing long-term consequences of addictive behavior, for example the changes in the brain of many alcoholics. How would you address these consequences with your clients? What is your job to educate?

Group Exercises:

1. Ask groups of students to find personal stories about addiction and recovery and present short case studies to the class based on what they found. What factors shape the experiences? What issues are relevant to different people’s use and recovery?
2. Play a game with the class in which the students identify which drugs are associated with a range of effects and outcomes.
3. Invite a panel of people who are recovering from different forms of substance use disorder to speak to the class. How do their experiences compare? What is similar and what is different?

Quiz Items

True/False:

1. 20.1 million people age 12 or older struggle with an addiction.
   1. True
   2. False
2. Substances are classified into the following categories: depressants, stimulants, and opioids.
   1. True
   2. False
3. To better determine the potency of ethanol, the term proof is used to indicate the beverage’s strength or percentage of pure ethanol.
   1. True
   2. False
4. One cannot die from too much consumption of alcohol.
   1. True
   2. False
5. Benzodiazepines, even taken as prescribed by a physician, are toxic to the brain.
   1. True
   2. False

Multiple Choice:

1. According to your textbook, which one of the following is the most abused mood-altering substance?
   1. Cannabinoids
   2. Hallucinogens
   3. Alcohol
   4. Opioids
2. Which of the following is a true statement?
   1. 1 in 15 students reported recreational use of prescription drugs ranging from OxyContin to Adderall.
   2. There is strong correlation between substance use, mental health diagnoses, and childhood trauma.
   3. Tranquilizers, are frequently prescribed for a wide range of symptoms, including sleeplessness, anxiety, muscle strains, and seizures
   4. All of the above.
3. The center for disease control has declared overdose prevention for which of one of the substances below as one of its top five public health challenges for 2014?
   1. Alcohol
   2. Marijuana
   3. Methamphetamine
   4. Opioid
4. How many people die annually in the United States from tobacco use?
   1. 1 out of every 5
   2. 1 out of every 10
   3. 1 out of every 15
   4. 1 out of every 20
5. What part of the brain’s structure is home to the reward pathway?
   1. The Ventral Tegmental Area (VTA)
   2. Nucleus accumbens
   3. Prefrontal Cortex
   4. The Limbic System

Matching:

1. _____Ethanol

2. _____Benzodiazepines

3. _____Nicotine

4. _____Lysergic acid derivatives (LSD)

5. _____Marijuana

1. Sedative
2. Hallucinogen
3. Alcohol
4. Cannabinoids
5. Stimulant

CHAPTER 3

Process Addictions

Journaling Exercises:

1. What biases do find in yourself about process addictions? Are there some behaviors that you more readily accept or reject as being problematic or addictive?
2. What shapes your views of these processes? Are you more or less likely to call something an addiction if you are uncomfortable with the behavior or view it as undesirable or unhealthy?
3. Do you have any experience with concerning behaviors or process addictions in your family? How might these experiences – or lack of – shape your views of your clients’ problems?

Discussion Exercises:

1. What particular challenges do clients who may have more socially encouraged addictions present (e.g., workaholic), as compared with those who have addictive behaviors that are not supported? How might the processes of addiction and treatment look similar or differently for clients in each category?
2. How much room should there be in treatment for sub-cultural groups to shape their own definitions regarding taboos and addictions, for example about dieting, exercise, sex, or work behaviors? How might it be more challenging to address process addictions with clients who have markedly different backgrounds than you?
3. What other process addictions may emerge in the future? What do you think about problematic use of virtual reality and avatars such as in Second Life ©, Smeet ©, or InWorldz ©?

Group Exercises:

1. Ask small groups to interview several people about their views of a process addiction. Do people tend to accept or reject the idea of process addictions? What are their assumptions about the possible sources, severity, and impact of process addictions as compared to substance addictions? How might what the students find shape clients’ experience of problem and addictive behaviors?
2. Assign small groups a different process addiction and ask them to compile a packet of additional resources and information about that addiction, such as local support options for clients, Internet resources, research on the behavior, or stories from addicts. Ask them to share the information with the class.
3. Ask small groups to review the case of Gina, who began spending a great deal of money shopping through the television after her husband died. Is this behavior problematic or addictive? What factors shape the distinction? What are the implications of naming a behavior in one way or another? Does the distinction between problematic and addictive make any difference to treatment?

Quiz Items

True/False:

1. Workaholism can be supported and even rewarded in the workplace.
   1. True
   2. False
2. Researchers have not found evidence that pathological gambling is related to changes in neuroadaptation, tolerance and withdrawal symptoms.
   1. True
   2. False
3. Easy access to credit and media messages has no impact on compulsive buyers to purchase goods.
   1. True
   2. False
4. Three reasons given for the rising incidence of sexual addiction are increased affordability, easy access to sexual materials, and anonymity of the Internet.
   1. True
   2. False
5. Multiple addictions are termed comorbidities.
   1. True
   2. False

Multiple Choice:

1. Common characteristics of sexual addicts include all of the following except:
   1. Isolation
   2. Guilt
   3. Perfectionism
   4. Depression
2. The National Association of Anorexia Nervosa and Related Eating Disorders (ANAD) states that symptoms of anorexia nervosa also include weighing what percentage less than what is expected for age and height.
   1. 10 percent
   2. 12 percent
   3. 15 percent
   4. 20 percent
3. Which one of the following is a symptom of anorexia nervosa?
   1. Acts of binge eating.
   2. Acts of purging.
   3. Engaging in random fasting.
   4. Compulsive starvation.
4. People with eating disorders are preoccupied with
   1. Food and appearance
   2. Weight and control
   3. Assertiveness
   4. Both “a” and “b”
5. The three motivation types for internet gaming disorder identified by Yee (2006) were:
   1. Accelerated, Social, Immersion
   2. Achievement, Social, Immersion
   3. Achievement, Social, Interested
   4. Accelerated, Superior, Interested

Matching:

1. _____Gambling Addiction

2. _____Eating Disorder

3. _____Sexual Addiction

4. _____Compulsive Buying

5. _____Workaholism

1. Often exists with concurrent anxiety, personality disorders, relationship issues, and/or bipolar disorder.
2. Oniomania; cognitive behavioral treatment modalities are most often effective for this process addiction.
3. Not easily defined or recognized as an addiction.
4. Binge drinking or other drug use is often associated with this.
5. Low tolerance for change and new situations are often hallmarks of this type of process addiction.

CHAPTER 4

PROFESSIONAL ISSUES IN ADDICTIONS COUNSELING

Journaling Exercises:

1. Spend some time writing down your thoughts about what you need to do to become competent as an addictions counselor. What steps do you plan to take to develop the expertise you need to provide addictions counseling to clients seeking assistance with this issue?
2. Apply the stages of change model described in the chapter to a problem you once experienced and write about how you moved from one stage to the next as you grappled with the issue under consideration.
3. Read the section in this chapter about counselors in recovery and journal about your feelings connected with whether you think counselors who have never been addicted or counselors in recovery from an addictive past make the best addictions counselors.

Discussion Exercises:

1. Chapter four of our textbook contains an interesting subsection on credentialing for addictions counselors. What are some of the implications for the role and responsibilities of an addictions counselor?
2. Discuss some of the ethical concerns connected with managed care and treatment funding for addictions counseling.
3. What are some of the concerns connected with outcome research and studies of efficacy of treatment in both the prevention and remediation of addiction?

Group Exercises:

1. Divide the class into groups and have each group discuss one of the major subsections of this chapter. Have each group evaluate the importance of the issues contained in that segment of the chapter to the role of the addictions counselor. Reconvene the total group and ask each group to report to the total group and facilitate discussion of the questions and comments their report precipitates.
2. Divide the class into groups and ask each group to discuss which aspects of the chapter caused them to think about professional and ethical issues that they may not have thought about in the context of addictions counseling. Ask a representative from each group to briefly summarize the group’s discussion for the total group.
3. Divide the class into smaller groups and ask each member to interview one practicing addictions counselor or therapist and attempt to find answers to the following questions:
   • How do you determine when ethical issues are involved in your interactions with clients?
   • What advice do you have for a person just entering the profession regarding the role ethics will play in his/her work with clients?
4. After group members have had time to conduct the interviews, allow time for discussion within the smaller groups and with the class as a whole.

Quiz Items

True/False:

1. The revised Diagnostic Statistical Manual (5th ed., DSM-5) made significant changes to substance-related and addictive disorders, combining substance dependence and abuse into a singular category with subcategory distinguishers
   1. True
   2. False
2. The most common comorbid condition is the dual diagnosis of a substance use disorder and an organic or physical illness.
   1. True
   2. False
3. In terms of counselor competency, it is okay to treat adolescents if the counselor’s experience has been with adults because everything is essentially the same, just the age of the client is different.
   1. True
   2. False
4. One example of a boundary violation may be when the counselor brings his or her personal problems with addiction into the counseling relationship.
   1. True
   2. False
5. Regardless of the specific theory or setting of treatment, practitioners must recognize the value of the therapeutic relationship and prioritize client-centered approaches that focus on shared decision-making
   1. True
   2. False

Multiple Choice:

1. What ethnicity has the highest percentage of drug use?
   1. Native Americans
   2. African Americans
   3. Caucasians
   4. Hispanics
2. Which one of the following statements is true about managed care?
   1. The managed care system has been successful in lessening short-term costs for care.
   2. The managed care system has been created long-term consequences for clients and practitioners.
   3. The managed care system has had little effect on cost management.
   4. Both a and b
3. Which one of the following is an example of self-care?
   1. Exercise
   2. Traveling
   3. Debriefing or consulting with co-workers and supervisors
   4. All of the above
4. Which one of the following is the most rigorous form of professional regulation?
   1. Accreditation
   2. Certification
   3. Licensure
   4. National credentialing
5. In the field of addictions, there are a number of scientifically based treatment approaches available. All but ONE of the following is such an approach. Which one is NOT a noted scientifically based treatment approach as discussed in your textbook?
   1. Cognitive-behavioral therapy
   2. Community reinforcement approaches
   3. The twelve-step approach
   4. Abstinence based treatment approaches

Matching:

1. _____Accreditation
2. _____Continuing Education
3. _____Evidence-based practice
4. _____Postsecondary trauma
5. _____Managed care
6. Treatment practices supported by controlled research
7. Any type of intervention aimed at the financing of health care, with the intent focused on elimination of unnecessary and inappropriate care and reduction of costs.
8. Refers the specific counselor education program within colleges and universities that educate and train addictions counselors.
9. Refers to the stress and trauma that addictions counselors incur when working with AOD clients.
10. A method to keep counselors abreast of new developments and research that impact their understanding, competency, and treatment provision in addictions counseling.

CHAPTER 5

INTRODUCTION TO ASSESSMENT

Journaling Exercises:

1. The chapter says that successful counselors foster hope in their clients. What gives you hope? How have others encouraged your hopefulness? What will you do to monitor or foster your sense of hope as you work with clients? Can you encourage hope in others even when you do not feel it yourself?
2. Do you have an initial reaction to structures of assessment tools? Do you prefer one method over another? What would the challenges be for you of using certain methods, and how might you overcome those challenges?
3. What is your reaction to the diagnoses of the DSM? How do you view the strengths and weaknesses of the DSM’s approach?

Discussion Exercises:

1. What are benefits of a multidisciplinary approach? How does you decide who should be involved? How might you work to develop a client’s consent for such an approach if he or she does not want to involve others?
2. In an interview, how might a counselor know when information is relevant and deserves deeper attention, and when it is distracting the counselor and client from more important information?
3. Interview a therapist or reflect on a personal experience in which major information was missed in the initial assessment phase. Could anything have been done differently to gain more complete information? Or are such omissions part of the process? Share what you learn with the class.

Group Exercises:

1. The text states that skilled counselors recognize the physiological symptoms that are associated with use and addiction. Assign groups of students the topic of various drugs and ask them to create an illustration of how a person using that substance may appear, both while under the immediate influence, and after chronic use. Have each group explain their picture to the class.
2. Divide the class into groups. Ask each group to find two articles – one in support of the DSM process and criteria, and another challenging the methods or content of the DSM. Invite each group to share the information from each with the class. What is the range of arguments? Do the supporters and critics address similar issues, or do they hold very different lenses. How might people answer the critiques? Do students have any other views to share?
3. Divide the class into dyads. Give each group a mental status exam and several brief scenarios of clients. Ask the students to take turns role playing and evaluating one another.

Quiz Items

True/False:

1. In a typical MSE, observations are made of five basic areas: sensory and cognitive function, thinking, perception, feeling and behavior, and physical appearance.
   1. True
   2. False
2. The belief that addictions counselors draw on holistic, developmental, contextual, and multicultural approaches is an important guiding principle for the role of the addictions counselor.
   1. True
   2. False
3. Continuity of care refers to how a client is able to consistently actualize their health and wellness goals in recovery.
   1. True
   2. False
4. A screening instrument is a type of comprehensive assessment instrument.
   1. True
   2. False
5. “Level of care” refers to a protocol that the American Society of Addiction Medicine (ASAM) created to help place clients into an appropriate setting by determining their care needs.
   1. True
   2. False

Multiple Choice:

1. Which one of the following is NOT an objective of an addictions assessor?
   1. To plan appropriate interventions
   2. To involve appropriate family members or significant others, as needed, in the individual’s treatment.
   3. To evaluate the effectiveness of interventions implemented.
   4. To determine the which family members or significant others need counseling as well.
2. This is the first step in the assessment process:
   1. Crises intervention.
   2. Screening.
   3. Gaining contexual information.
   4. Treatment planning.
3. The process of screening leads to:
   1. Rule out addiction.
   2. Request a more comprehensive exam.
   3. Refer for treatment.
   4. All of the above.
4. Validity primarily relates to _______:
   1. Gaining approval of the assessment information.
   2. Obtaining the most essential assessment information.
   3. The consistency of the assessment.
   4. The correctness or accuracy of the assessment information.
5. According to the chapter, “affect” on a mental status exam may be described as:
   1. Flat, labile, blunted, restricted.
   2. Rumination, word salad, tangential, blocking.
   3. Calculation, abstraction, knowledge, construction.
   4. None of the above.

Matching:

1. _____Expectancy
2. _____Readiness for change
3. _____Hope
4. _____Orientation
5. _____Spirituality
6. May be adaptive or maladaptive
7. Useful in dealing with triggers
8. A client’s expectations or beliefs about the outcome of use
9. Person, place, and time
10. Hard to define and has many definitions

CHAPTER 6

Assessment and Diagnosis of Substance-related

and addictive disorders

Journaling Exercises:

1. After reading the following questions, do some thinking and writing about how you would respond:

• Do you feel you are a normal drinker? ("normal" - drink as much or less than most other people)
• Have you ever awakened the morning after some drinking the night before and found that you could not remember a part of the evening?
• Does any near relative or close friend ever worry or complain about your drinking?
• Can you stop drinking without difficulty after one or two drinks?
• Do you ever feel guilty about your drinking?

1. This chapter addresses the use of specific assessment instruments in the process of addictions counseling. What are your feelings about the use of instrumentation in the addictions counseling process?
2. Was there ever a time in your life when you were concerned about your own use of alcohol, another drug, or prescribed medication?

Discussion Exercises:

1. Given the large amount of information in this chapter about assessment instruments that may be used in the process of addictions counseling, what do you think is the best way for you to begin to master the information that has been presented?
2. What is your perception of the best way to use assessment instruments in the process of addictions counseling?
3. What kind of supervision do you think you need to acquire to become proficient in the use of assessment instruments in the process of addictions counseling?

Group Exercises:

1. Divide the class into smaller groups and select and assign one of the assessment instruments discussed in the chapter to each group. Ask each group to learn all they can about the use of the instrument in the process of addictions counseling. After the small groups have had time to assimilate the material, ask a spokesperson from each group to share information with the entire class.
2. This chapter has several case studies in it. Assign each group one of the case studies and ask each small group to discuss what a treatment plan for the person in their case study might look. What would the group recommend in terms of interventions?
3. As part of each small group’s discussion of the case studies, what cross cultural considerations may also need to be addressed with each of the individual depicted?

Quiz Items

True/False:

1. Counselors use their gut feelings when interpreting the results of standardized screening instruments.
   1. True
   2. False
2. As long as an instrument is reliable, it does not have be valid.
   1. True
   2. False
3. The SASSI has been used to screen for risky drinking in pregnant women.
   1. True
   2. False
4. If an assessment’s items are face valid, then clients can easily understand the exact trait or behavior the items are attempting to measure.
   1. True
   2. False
5. Gambling disorder is an established diagnosable medical condition.
   1. True
   2. False

Multiple Choice:

1. Which is the most frequently used gambling disorders screens?
   1. The National Opinion Research Center DSM Screen (NODS) for Gambling Problems
   2. The South Oaks Gambling Screen
   3. The Problem Gambling Severity Index
   4. The Gamblers Anonymous Twenty Questions
2. Which of the following instruments is specially designed to screen alcohol misuse in pregnant women?
   1. CAGE
   2. SMAST
   3. TWEAK
   4. AUDIT
3. Which of the following instruments has a version designed especially for adolescent substance abuse screening?
   1. SASSI-2A
   2. AUDIT
   3. T-ACE
   4. CAGE
4. Although the DSM does not provide diagnostic criteria for these conditions, for which of the follow sets of behaviors can counselors find screening instruments?
   1. Sex Addiction
   2. Internet Addiction
   3. Non-Suicidal Self Injury
   4. All of the above
5. Which of the following instruments is the most used substance use screening instrument?
   1. MAST
   2. T-ACE
   3. SASSI-4
   4. CAGE

Matching:

1. _____Specificity
2. _____Sensitivity
3. _____Reliability
4. _____Validity
5. _____Cost-efficiency
6. refers to the consistency of an instrument’s results.
7. is a measure of the ratio of persons correctly screened “positive” for having a substance use disorder to those who actually have the disorder.
8. refers to the proportion of people that a screen accurately identifies as not having a substance use disorder.
9. refers to direct costs associated with the purchase of an instrument and the costs related to the implications of a screen’s results.
10. is concerned with the degree to which a screen accurately represents the construct or criterion it was designed to measure

CHAPTER 7

MOTIVATIONAL INTERVIEWING

Journaling Exercises:

1. The first sidebar in this chapter emphasizes that the change process belongs to the client. The client decides what behavior he or she would like to change, when that change will occur, and how quickly that change will take place. What will you do if you find that you want to take charge of the client’s change process and prescribe what that change process should look like?
2. Your textbook author discusses the pillars that guide the philosophy of motivational interviewing. The fourth pillar is to support self-efficacy in the change process. Do some journaling about your own sense of self efficacy and how you have achieved it. How would you help a client develop it?
3. Clients are typically resistant to change because they either are not aware there is a problem (denial) or they do not have the confidence to make the change in their life (self-efficacy). Have you ever been resistant to making a change in your own life that needed to be made? What were the circumstances?

Discussion Exercises:

1. How do you plan to cope with the demands of your role as an addictions counselor or therapist in order to maintain a positive perspective?
2. How might the values and cultural biases of an addictions counselor influence his or her ability to make use of motivational interviewing techniques?
3. What do you see as the strengths and weaknesses of motivational interviewing?

Group Exercises:

1. Conduct a demonstration of a motivational interviewing session for the class. Select a volunteer from the class to serve as the client. Ask the client volunteer to construct a presenting problem. Conduct a 30-minute counseling session. Ask the class to observe and to pay special attention to the following:
   1. The presence or absence of core or basic conditions.
   2. The strategies used and their effectiveness.
   3. The stage(s) of change exemplified by the demonstration.
2. The importance of maintaining awareness of one's own values and the ability to articulate how the values of the counselor or therapist affect work with clients cannot be underestimated. Divide the class into triads and have each triad discuss the following:
   1. Am I completely cognizant of my own values?
   2. Do my values influence my preference for particular theoretical frameworks or methods and associated techniques and interventions?
   3. How will I resolve dilemmas that arise when my values and those of the client are oppositional?
   4. What is my belief about whether a professional can remain neutral and avoid communicating his or her value orientation?
   5. What is my role in helping clients more clearly delineate their values?

After giving triads an appropriate amount of time to engage in discussion focused upon the above questions, reconvene the group for discussion and debate relative to issues and questions that arose during discussions in the triads.

1. The instructor distributes a rock (or a shell or a basket of items) to each student in class. Tell each student that the rock is their client and ask them to take the next few minutes to spend time with their client. After about ten minutes, bring the class back together. What did people "do" with (to) their client? How was the experience for them? What was their first inclination when told the assignment? (e.g., some people generally want to "fix" what is wrong, some fidget with the rock and don't know what to do, others poke and explore the rock). How might this parallel the first experience with a "real" client. How did the “client” feel about the inquiry?

Quiz Items

True/False:

1. Contemplation is the earliest stage of the change process.
   1. True
   2. False
2. When a client determines that his behavior is causing enough problems to warrant a change, that client is in the Preparation stage.
   1. True
   2. False
3. Self-efficacy is a person’s belief about his or her ability to be efficient.
   1. True
   2. False
4. Sometimes a stage of change may be skipped altogether.
   1. True
   2. False
5. Counselors are encouraged to view resistance as a welcome signal that the therapeutic relationship is at a turning point.
   1. True
   2. False

Multiple Choice:

1. Which is NOT one of the six stages of change?
   1. Relapse
   2. Motivation
   3. Action
   4. Maintenance
2. Which of the following is NOT one of the four pillars that guide MI?
   1. Expressing Empathy
   2. Develop Alliance
   3. Rolling with Resistance
   4. Support Self-Efficacy
3. Which of the following is NOT one of the five early motivational methods?
   1. Challenging
   2. Affirming
   3. Summarizing
   4. Eliciting change talk
4. Transitional summaries are statements used to:
   1. End a counseling session
   2. Remind clients of transitional recovery needs
   3. Summarize accomplishments of a completed stage
   4. Shift from one therapeutic encounter to the next
5. Which of the following is NOT a form of resistance?
   1. Ignoring
   2. Interrupting
   3. Shifting focus
   4. Negating

Matching:

1. _____Advocacy talk
2. _____Working consonantly
3. _____Reduce resistance
4. _____Reflection responses
5. _____Shifting focus
6. When a counselor reinforces or enhances resistance talk
7. Maximizing change talk and reducing resistance talk
8. Simple, Amplified, Double-sided
9. Neither avoids nor deals with resistance head on
10. Allied toward common goals and ideals

CHAPTER 8

PSYCHOTHERAPEUTIC APPROACHES

Journaling Exercises:

1. You book chapter discusses the behavioral and cognitive- behavioral (CB) interventions represented among effective treatments for problematic alcohol use which include behavioral self-control training, community reinforcement, contingency management and behavior contracting, social skills training, and behavioral couples/family counseling. Research these approaches. Then pretend you have an addiction. Which of these approaches would be the best fit for you with your lifestyle and values? Make sure to provide a rationale for why you picked the approach that you did.
2. What is your reaction to varying psychotherapeutic approaches presented in this chapter? Which ones makes sense to you and which ones do you think might challenges you? Why?
3. What do you think about empirically validated approaches?

Discussion Exercises:

1. The chapter states that adoption of empirically supported treatments for addiction has been slow, and that unproven programs are often used. Why might this be the case? Interview a practitioner about his or her knowledge and use of empirically supported treatments and report to the class on their experiences and views.
2. The chapter discusses coaching family members to respond differently to the intoxicated or addicted individual, setting boundaries and allowing the person to bear the natural consequences of his or her addiction. What are some likely barriers to family members doing this? How might you help them to overcome those challenges?
3. Review the types of therapeutic relationships discussed in the section on Solution-Focused therapy. How do these types of relationships relate to the stages of change discussed in chapter 7? How might each construct be useful?

Group Exercises:

1. Divide students up into groups. Have one member of the group volunteer to be the mock client who has an addiction. Have the student discuss something they might actually have an addiction to such as coffee, sugar, tobacco etc. Then have the remaining groups members work together to do a functional analysis on the mock client. What are the client’s triggers? What are the negative consequences associated of the use of the “substance?” What new alternatives can be used to help the mock client?
2. The chapter presents several cognitive-behavioral interventions for each of five categories (social, environmental, emotional, cognitive, and physical. Divide the class into groups and ask each group to find or create two additional possible interventions for each category. Ask each group to share these potential resources with the class as a whole.
3. Assign each of several small groups one of the treatment modalities (e.g., brief intervention, motivation enhancement, community reinforcement, self-change manual, behavioral self-control training, social skills training, behavioral marital therapy and family therapy, a variety of pharmacologic interventions (e.g., acamprosate, naltrexone), and cognitive therapy. Have the groups investigate the modality they were given. Then give all the groups the same case study and ask them to develop a treatment plan (or present their ideas for intervention) based on their treatment modality. Share and discuss the plans as a larger group.

Quiz Items

True/False:

1. Contingency management makes use of internal incentives that are contingent on the client meeting predetermined personal goals.
   1. True
   2. False
2. Perhaps the best known example for constructing future exceptions in Solution Focused Counseling (SFC) is the use of the “miracle question.”
   1. True
   2. False
3. Harm reduction promotes high-threshold access to services
   1. True
   2. False
4. Consistent with its origins as a brief or short-term therapy, Solution Focused Counseling (SFC) is known for its pragmatism.
   1. True
   2. False
5. Behavior contracting itself can be implemented with minimal or no cost to the counselor or agency.
   1. True
   2. False

Multiple Choice:

1. Functional analysis means:
   1. Understanding the limitations in the functioning of the individual due to prolonged substance use.
   2. Understanding the function or purpose of substance use behaviors for a specific individual.
   3. Assessing the antecedents (triggers) and consequences of substance use.
   4. Both a and c.
2. Which of the following is NOT one of the three key points made by this chapter about William and Hester’s “informed eclecticism?”
   1. There is no single superior approach to treatment
   2. Construct treatment with a variety of effective approaches
   3. Counselors gear an approach that fits their personality
   4. Different types of individuals respond best to different treatment approaches.
3. According to the W. R. Miller, Wilbourne, and Hettema (2003), which of the following is NOT one of 18 modalities determined to be efficacious:
   1. Family therapy
   2. Community reinforcement
   3. Drug abstinence management (dam)
   4. Motivation enhancement
4. In this type of relationship, a client believes there is not a problem and the counselor agrees, validates, or “goes along with” this perception, while also offering to help the client in ways the client can determine:
   1. Visitor-type relationship
   2. Complainant-type therapeutic relationship
   3. Customer-type relationship
   4. None of the above
5. Which of the following is an alternative to abstinence?
   1. Warm turkey approach
   2. Tapering down
   3. Trial moderation
   4. All of the above

Matching:

1. _____Environmental intervention
2. _____de Shazer
3. _____skillful inquirer
4. _____Marlatt
5. _____W.R. Miller and Page
6. Clients is advised to thoroughly clean their living space, one area or one room at a time, to reinforce their sense of control over their own personal or local environment.
7. “warm turkey” or sobriety sampling approach
8. Harm reduction
9. Solution focused counseling
10. Curious Columbo

CHAPTER 9

TREATMENT OF COMORBID DISORDERS

Journaling Exercises:

1. In thinking about a future role of a counselor, does the concept of comorbid disorders overwhelm you in any way? Why or why not?
2. The authors of this chapter stated: “New counselors working in the field of SUD treatment may wrongly assume that treating someone with an SUD is a straightforward process and that the identified disorder will be the sole focus of treatment. In practice, however, for a client to present with a single SUD, without a coexisting SUD(s) or without a coexisting psychiatric disorder(s), would be the exception rather than the rule.” What are your thoughts about working with clients with comorbid disorders?
3. The authors of this chapter state: “New counselors working in the field of SUD treatment may wrongly assume that treating someone with a SUD is a straightforward process and that the identified disorder will be the sole focus of treatment. In practice, however, for a client to present with a single SUD, without a coexisting SUD(s) or without a coexisting psychiatric disorder(s), would be the exception rather than the rule. How did you react when you first read this statement?

Discussion Exercises:

1. Interview an addictions counselor who works with clients who have comorbid disorders. During the interview, inquire as to what special knowledge or skills are needed to effectively deal with this client population. Discuss your findings with the class.
2. Review existing films or other audio-visual material that has application to counseling clients with comorbid disorders. Critique what you find and discuss your findings with the class.
3. Based upon the information presented in the chapter and in the class, design what you think would be an effective educational training program for counselors working with clients who have comorbid disorders. Discuss your findings to the class.

Group Exercises:

1. Before reading this chapter, ask students to write down their definition of comorbid disorders and their assumptions of what they think the counseling for such clients entails. Collect what they have written. After reading the chapter, ask students to complete the same exercise. Then compare answers written both before and after reading the chapter and note any changes. Compile the results on the blackboard for comparison and discussion amongst the group.
2. Organize a panel composed of students who represent different cultural, ethnic and racial groups. Ask them to share their thoughts and feelings about the applica­bility of ideas in this chapter in cross and multicultural situations. Encourage class interaction with panelists as the presentations of panel members are made.
3. Invite an addictions counselor to speak to the class. Ask her or him to address issues dealing with counseling clients with comorbid disorders. Allow time for a question and answer period.

Quiz Items

True/False:

1. A report generated by the National Survey of Substance Abuse Treatment Services (N-SSATS) indicated that (25%) of those seeking treatment for SUDs have been diagnosed as having a co-occurring mental disorder
   1. True
   2. False
2. There are high financial and social costs associated with co-occurring disorders. Such costs include increased health care and hospitalization costs, less satisfying family relationships, and poorer treatment outcomes.
   1. True
   2. False
3. According to SAMHSA, having an on-site prescribing psychiatrist is crucial to sustaining recovery and stable functioning for people with comorbid disorders and has been shown to improve treatment retention and decrease substance use
   1. True
   2. False
4. When treating SUDs, professionals need to pay attention to client predisposing factors such as a parental history of alcohol abuse, risk taking, and a diagnosis of ADHD.
   1. True
   2. False
5. The culture of the client is an important issue to address starting during the treatment phase.
   1. True
   2. False

Multiple Choice:

1. The APA (2018) has recognized the need for additional patient assessment measures to assist in treatment planning. Therefore, they have developed:
   1. Substance Abuse Subtle Screening Inventory (SASSI)
   2. Three Level 1 Cross-Cutting Symptom Measures
   3. Minnesota Multiphasic Personality Inventory-2 (MMPI-2)
   4. Addictions Severity Index (ASI)
2. Which of the following ethic group received a higher rate of comorbid diagnosis?
   1. European Americans
   2. African-Americans
   3. Latino/Hispanics
   4. Asian-Americans
3. For those counselors who work with addictive and SUDs clients within a Twelve Step model, they should be familiar with which of the following texts:
   1. Feeling Good Handbook
   2. Sponsor’s Guide
   3. Big Book
   4. Hazelton Dictionary
4. Which of the following are important activities for counselors who work with addictions and SUDs within a Twelve Step model to engage clients in?
   1. Doing step work
   2. Getting a temporary sponsor
   3. Getting sufficient exercise
   4. Both a and b
5. According to Von Steen., Vacc, and Strickland, approximately what percentage of alcoholics experience depression and anxiety?
   1. 10-15
   2. 25-30
   3. 40-45
   4. 55-60

Matching:

1. _____Formative
2. _____Level 1 Cross-Cutting Symptom Measures
3. _____Objectives
4. _____Alcoholics Anonymous
5. _____Comorbid
6. Big Book
7. Evaluation
8. Assessment
9. Treatment planning
10. A client with depression and heroin addiction

CHAPTER 10

GROUP COUNSELING FOR TREATMENT OF ADDICTIONS

Journaling Exercises:

1. What do you think about the effectiveness of groups for the treatment of addictions? Of all of the different types of group discussed in the chapter, which ones appeal to you as a potential counselor? Why? Which ones do not appeal to you. Why?
2. Make a list of values clients may expose which are opposing to the values of your own. Do you think it would be difficult for you to experience and express unconditional positive regard toward clients with certain values? Would it be impossible? Why or why not?
3. Individuals who participate in long-term substance use typically exhibit poor communication skills and the inability to perpetuate healthy interpersonal relationships. Research potential interventions or skill building exercises that you could employ with a client. Research and discuss five. Why did you pick those five? Why did they appeal to you?

Discussion Exercises:

1. Chapter 10 has an excellent discussion of ethical and legal issues with groups. Identify two or three issues explored in this discussion and identify how the discussion influenced your thinking about this aspect of using group therapy for the treatment of addictions.
2. How can gender play a role in the group therapy process?
3. Have students join a local self-help group to experience, first hand, what participation might be like for one of their clients? For rural students, reputable online self-help groups could be used. Then have students discuss what it was like to be in the group. Would the group have helped them if they had that issue? What did they learn about being a “client” that they could use with their own clients?

Group Exercises:

1. Divide the class into groups. Assign each group a substance of addiction: opioid, marijuana, alcohol, cocaine etc. Have each group develop a 5-session psychoeducational group. Each group of students should design their content based on working with clients with an addiction to that particular substance. Then have each group share their ideas for their psychoeducational group with the class.
2. Ask each of the small groups to review existing films or other audio-visual material that has application to using group therapy as an approach to addictions counseling. Have them critique what they find and provide for class time to present their findings.
3. Based upon the information presented in the chapter and or in the class, ask each small group to design what they think would be an effective educational training program for counselors and therapists interested in using groups in addictions counseling. Provide for time to present each group’s findings.

Quiz Items

True/False:

1. The ACA Code of Ethics states that counselors may only practice within areas in which they have received the necessary education, training, experience, and supervision.
   1. True
   2. False
2. Group counselors must guarantee that there will be no breaches of confidentiality.
   1. True
   2. False
3. An understanding of gender from a developmental and cultural perspective, as well as an awareness of the implications inherent in that perspective is a critical attribute of the group counselor working with addictions.
   1. True
   2. False
4. Family members of addicts should be provided an opportunity to come together to share their experiences, discuss problems, provide encouragement, and learn to cope more effectively with various concerns.
   1. True
   2. False
5. Rationalization is the chronic use of excuses to support both addiction and the feelings of inadequacy that lead to destructive acting and behaving.
   1. True
   2. False

Multiple Choice:

1. A type of counseling group that commonly includes planned interventions that focus on specific issues is commonly referred to as:
   1. Psychotherapeutic group
   2. Self help group
   3. Psychoeducational group
   4. None of the above
2. Typically led by a volunteer, this type of counseling group helps members cope with problems while providing support to one another.
   1. Self help group
   2. Psychoeducational group
   3. Psychotherapeutic group
   4. All of the above
3. A visual representation of a person’s family tree created with lines, words, and geometric figures that may reveal patterns of addiction, codependence, or other problem behaviors in the client’s family system is called
   1. Genogram
   2. A timeline
   3. Person, house, tree
   4. None of the above
4. Typically facilitated by mental health professionals, psychologists, social workers, or certified alcohol and drug counselors, these counseling groups typically improve psychological functioning and the adjustment of the members.
   1. Psychotherapeutic group
   2. Psychoeducational group
   3. Self help groups
   4. None of the above
5. ASGW recommends which of the following specific training as minimum requirements to leading psychoeducational or psychotherapeutic groups:
   1. One graduate course in Group Counseling
   2. Ten or more hours of group experience
   3. 45- 60 hours of supervised experience
   4. a and b

Matching:

1. _______ Denial
2. _______ Al-Anon
3. _______ Informed Consent
4. _______ Involuntary
5. _______ Drug Abuse Resistance Education
6. A self help support group for family members of alcoholics.
7. Clients involved in treatment due to court orders or commitment process.
8. The emotional refusal to acknowledge a person, situation, condition, or event the way it actually is.
9. Communicates basic rights and responsibilities of the group members.
10. Teaches children about the harmful effects of alcohol and drugs while helping them build self esteem.

CHAPTER 11

ADDICTION PHARMACOTHERAPY

Journaling Exercises:

1. Spend some time writing about your thoughts and feelings about the material presented in chapter eleven. Was the material easy for you to assimilate? Why or why not?
2. Is pharmacotherapy a topic you ever thought about prior to reading this chapter? If “yes,” what led you to think about this ahead of time? If “no,” what do you suppose blocked your awareness of the relevance of this topic?
3. If someone asked you to explain what is meant by addictions pharmacotherapy, what would you say?

Discussion Exercises:

1. How might the values and cultural biases of a counselor influence his or her view of the material presented in this chapter?
2. The author of chapter 11 states, “As a professional counselor, you are under an ethical obligation to provide your clients treatment based not upon bias but rather upon scientific evidence of effectiveness. Thus, attention to addiction pharmacotherapy is an ethical mandate no matter what prejudices you encounter at your worksite.” What kinds of prejudices do you think you might encounter at your worksite? How would you respond?
3. The discussion of diversity and pharmacotherapy is an interesting component of this chapter. What did you learn from reading this subsection of the chapter? What else do you think you need to know more about?

Group Exercises:

1. After getting students in small groups, ask them to talk about American society’s views of addiction. Ask them to look at the way our culture and society approaches individuals with addiction issues and how those approaches might affect treatment. Then have them report back to the class on their main points of discussion.
2. Divide the class into two groups, ask one group to represent those who support the use of pharmacotherapy in the treatment of addictions and the other group to represent the opposite point of view. Debate the usefulness of each argument.
3. Invite an addictions counselor who supports the use of addictions pharmacotherapy to make a presentation to the class. Ask the two small groups (above) to ask questions based on the point of view they discussed in the previous exercise. Let the invited speaker know, in advance, that there will be discussion and questions connected with both points of view.

Quiz Items

True/False:

1. There exists no scientific evidence that one can “treat a drug with a drug.”
   1. True
   2. False
2. Acetylcholine is a neurotransmitter.
   1. True
   2. False
3. Anxiolytics are the class of medication used to treat depression.
   1. True
   2. False
4. There are no known considerable cross-ethnic variations in drug effects.
   1. True
   2. False
5. A first line agent is a proven medication that is typically given first to a patient.
   1. True
   2. False

Multiple Choice:

1. The term endogenous means:

a. Produced from outside the body.

b. Manufactured outside the US.

c. Produced by the body.

d. Blocks a ligand.

1. The term pharmacodynamics means:

a. A drug’s impact on the body.

b. The body’s impact upon a drug.

c. The economic context of a drug.

d. The political context of a drug.

1. Which of the following is not one of the four pharmacokinetic processes?

a. Absorption.

b. Distribution.

c. Biotransformation.

d. Reuptake.

4. The obsessive disinhibition form of craving is the result of dysfunction in the ______ neurotransmitter system.

a. DA.

b. 5HT.

c. OP.

d. GABA.

5. The correct definition of polytherapy is:

a. The use of one medication in treatment.

b. The use of more than one medication in treatment.

c. The use of drug antibodies to prevent drugs of abuse from entering the central nervous system.

d. Both b and c

Matching:

1. _____Dopamine
2. _____Norepinephrine
3. _____Opioid
4. _____Serotonin
5. _____γ-aminobutyric acid
6. GABA
7. OP
8. 5HT
9. NA
10. DA

CHAPTER 12

12-STEP FACILITATION OF tREATMENT

Journaling Exercises:

1. In examining your values, preferences, and biases, what do you like about support groups in general? Please incorporate your personal and professional experiences into your answer.
2. Attend a support group and journal about your experience and reactions.
3. How does 12-step facilitation of treatment relate to your personal theory of life and your counseling theoretical orientation?

Discussion Exercises:

1. Attend a support group prior to class. Discuss your experience, perceptions, and reactions.
2. Find one or two individuals who are not members of this class, nor connected in any way with the profession of counseling but who do attend regular 12 meetings, then ask them about their experience. What do they see as the pros and cons of going to groups. Report the results of your interviews with members of the class.
3. Find a current research article related to the effects of 12 step groups, bring these to group for discussion.

Group Exercises:

1. As a group come up with a list of rules from scratch that might be helpful for running a support group.
2. Divide the class into several groups and assign each group one or more of the web sites connected with a 12-step support group. Have each group explain to the rest of the class what they learned from exploration of each web site.
3. Assign each class member to a different support group (e.g., AA, NA). Each member then searches for local meetings and creates an electronic list including place and time. This list is then shared with the entire group.

Quiz Items

True/False:

1. Alcoholics Anonymous (AA) is one of the most widely recognized twelve-step groups today and has been an instrumental force in the establishment of groups founded afterward.
   1. True
   2. False
2. Twelve-step/self-help groups are not generally compatible with individual counseling services and treatment plans.
   1. True
   2. False
3. Both Rational Recovery (RR) and Alcoholics Anonymous (AA) promote abstinence.
   1. True
   2. False
4. Moderation Management (MM) holds that individuals are most successful at attaining their goals with alcohol when these goals are chosen by the group as a whole.
   1. True
   2. False
5. Because all groups guarantee confidentiality of members, the counselor can assure the client that information shared in the group will be protected beyond the group context.
   1. True
   2. False

Multiple Choice:

1. Which is NOT one of the primary responsibilities of the addictions counselor?
   1. Having resources and lists of and information on all self-help groups in the client’s community.
   2. Collaborating with the client to determine if the group is an appropriate match.
   3. Having familiarity with groups, the process, the aims and goals, and membership composition.
   4. Collaborating with group leaders to ensure the client’s progress in the group.
2. Which one of the following is a true statement about Alateen?
   1. It was founded in 1986 by Jack Trimpey, a California licensed clinical social worker.
   2. Members pay monthly dues to support the program.
   3. There are approximately 1,200 Alateen groups in the United States, and it is active in more than 40 countries.
   4. Alateen was established after modifications to Al-Anon.
3. In Alcoholics Anonymous (AA), the role of the sponsor is:
   1. To recruit addicted persons into religious sects to aid in recovery.
   2. To encourage a gradual transition from primary dependence on the sponsor to a focus on “moderation”.
   3. To serve as a guide and facilitator of the recovery process.
   4. b and c
4. To the members of _____, it is not the specific chemical that is the problem, but the common disease of addiction.
   1. Narcotics Anonymous (NA)
   2. Alcoholics Anonymous (AA)
   3. CoDependents Anonymous (CoDA)
   4. Al-Anon
5. There are six noted types of twelve-step meetings. In _____ meetings, one recovering person speaks to the group about his/her addiction and recovery story.
   1. Closed
   2. Open
   3. Speaker
   4. Step

Matching:

1. _____Moderation Management (MM)
2. _____Alcoholics Anonymous (AA)
3. _____Al-Anon
4. _____Secular Organization of Sobriety
5. _____Rational Recovery (RR)
6. Closely follows the cognitive-behavioral school of counseling, and views alcoholism as reflecting negative, self-defeating thought patterns.
7. Founded by Shirley Kishline.
8. Developed by the wives of men attending AA.
9. Also called “Save Our Selves.”
10. Focuses on the disease of addiction by member sharing of life stories and by public confessions of distortions, self-deceptions, and denial which supports the addicts’ chemical use.

CHAPTER 13

MAINTENANCE AND RELAPSE PREVENTION

Journaling Exercises:

1. One of your best coping strategies is your ability to self-regulate. But can your self-regulation “muscle” get tired? If you have been under a lot of stress, resulting in overuse of self-control resources, your self-regulation “muscle” may become exhausted. This fatigue leads to using more ineffective coping strategies”. Has this ever happened to you and what were the circumstances?
2. Read sidebar about Fluctuations in Motivation and write about an experience in your life that was similar. Does this happen to you often? Think of one thing you were trying to quit or cut back on. What were your triggers that made you lapse or relapse?
3. Think of something you wanted to quit or change, like a bad habit or quitting smoking. Did you ever have a relapse when working on that issue? Why type of relapse was it: emotional, mental, physical, or a combination? What was that experience like for you? What tools did you use to cope with the relapse? Did you ever resume working on that issue again? If so, what helped you get “back on the wagon” so to speak?

Discussion Exercises:

1. After reading about the components of relapse prevention described in chapter 13, discuss the implications you think it has for the design of a treatment program.
2. What do you think is the best way to help clients identify and avoid or cope with high risk situations connected to their addictive behavior?
3. We have all heard the comment “she or he will have to make new friends after completing addictions counseling or the problematic behavior will reoccur.” How do you think you could help a client make the required life style changes to accomplish such a change? What would you recommend?

Group Exercises:

1. Workings in small groups (three or four members) have students review current professional journals and periodicals for information pertaining to maintenance and relapse prevention. Have each group prepare an annotated bibliography of the group’s findings with copies distributed to each student in the class. Allow time in the class for groups to discuss their findings. Follow each discussion with a question and answer period.
2. Show a video of an addictions counselor working with a client around issues of maintenance and relapse prevention. You can use any video you choose but here is a YouTube video if you’d like to use it: https://www.youtube.com/watch?v=wuzjPZPZtJs. Ask the class to critique the work of the counselor and ask any questions that may have arisen while viewing the session.
3. Ask students to keep a journal of their thoughts or reactions to this course. Have students write an entry for each chapter and outline a few personal reactions to learning about these concepts. At the end of the term, divide the class into smaller groups and ask members to identify areas of growth during the time the course has been meeting. Ask: What thoughts and feelings did you notice you had early in the term? How did they change or evolve? What do you think is your personal reason for that evolvement?

Quiz Items

True/False:

1. There is no treatment for addictive disorders that results in 100% improvement for all clients.
   1. True
   2. False
2. The definition of relapse is dependent upon the therapeutic treatment being used.
   1. True
   2. False
3. A lapse is more severe than a relapse.
   1. True
   2. False
4. Identifying High Risk Situations is one of the primary strategies in relapse prevention therapy.
   1. True
   2. False
5. A positive outcome expectancy for substance use is associated with increased relapse rates.
   1. True
   2. False

Multiple Choice:

1. The abstinence violation effect refers to
   1. The physiological urge to return to the addictive behavior after a relapse.
   2. The belief that a lapse is a sign of failure and there is no longer any use in continuing to try.
   3. Small violations that do not lead to major violations.
   4. A greater belief in one’s ability to prevent relapse.
2. A major difference in principles between AA and other treatment programs centers around the belief that
   1. The individual is powerless.
   2. A support system is essential.
   3. There is a need to abstain from all mind-altering drugs.
   4. Lifestyle change is necessary.
3. The likelihood of relapse is
   1. Minimal and of minor importance in treatment.
   2. Certain.
   3. Forty percent during the first year of abstinence.
   4. An important topic of discussion throughout treatment.
4. Which strategy listed below is NOT an effective method of gaining self-efficacy?
   1. Identifying personal strengths and resources in the environment
   2. Developing a hierarchy of high-risk situations
   3. Placing self in high risk situations during high stress times
   4. Rehearsing alternative responses in problematic situations
5. The benefits for peer support include all of the following EXCEPT
   1. Increased self-esteem and confidence.
   2. Raised empowerment scores.
   3. Increased engagement in self-care and wellness.
   4. Decreased levels of shame following a relapse.

Matching:

1. _____Lapse
2. _____Relapse
3. _____HRS
4. _____Intrapersonal triggers
5. _____Mindfulness
6. Identified situations with heightened potential for return to use
7. A powerful adjunct to CBT and is based on models of human suffering.
8. Thought patterns and related emotions
9. A single return to use
10. A return to repeated use after a commitment to abstinence

CHAPTER 14

SUBSTANCE ADDICTION AND FAMILIES

Journaling Exercises:

1. Spend some time journaling about your family and whether there were any family members with addiction issues. What impact do you think this had on your early development?
2. If someone were to ask you why it might be important to help a client see the relationship between his or her addiction issues and those of other family members, what would you say?
3. Read the section in chapter 14 that addresses boundary issues. How can you connect this discussion with the dynamics of your family of origin? What were your family’s boundaries, roles, and rules?

Discussion Exercises:

1. After reading about co-dependence do you know any one who exhibits those traits? Which of the functions and characteristics do you recognize? Do any of those traits apply to you? Why or why not?
2. Look at table 14.1 in your chapter. Pick any two characteristics and discuss how you could help a client overcome the characteristics you have selected.
3. Read the case of Betty and Leo that follows the COA table (14.1). Discuss how you would help this couple with their distortions of reality.

Group Exercises:

1. Communication in alcoholic families is often very limited. Break the class up into small groups of four or five students each. In these groups, compile a list of communication problems that can occur in families. Also, list those traits that describe positive family communication. Have each small group share its lists with the larger group. Which traits were mentioned most often?
2. Before students read chapter14, divide students into small groups and ask students to write down their definition of alcoholic families and their assumptions of what they think the family would be like. Collect what they have written. After reading the chapter, have students will complete the same exercise. Then compare answers written both before and after reading the chapter and note and discuss any changes
3. Divide the class into groups of 4-5 asking each group to select five words, terms, or concepts mentioned in the chapter that seem unfamiliar. Each group will then list the terms and, from the explanation in the chapter, define the words or terms in his or her own words to assist with proper meaning. Each group will have a spokesperson chosen by the group members, who will report two to four of the terms to the class, so that most of the new words and terms in the chapter become clear through discussion.

Quiz Items

True/False:

1. Healthy generational interactions demonstrate clear hierarchy, flexible roles, and open communication.
   1. True
   2. False
2. In an addicted family system, the three major rules are don’t talk, don’t trust, and don’t feel.
   1. True
   2. False
3. The non-abusing parent can buffer the negative effects of addiction.
   1. True
   2. False
4. Once the family stops attempting to return the system to homeostasis, other family members adapt to the substance use behavior in an effort to return balance to the family.
   1. True
   2. False
5. Alcohol and marijuana also appear to play a major role in interpersonal violence.
   1. True
   2. False

Multiple Choice:

1. Family counseling is more effective in treating addictions than:
   1. Individual counseling
   2. Group counseling
   3. 12-step support groups
   4. All of the above
2. Homeostasis within the family does which of the following?
   1. Makes family members similar to one another.
   2. Balances family dynamics in response to change.
   3. Freezes family dynamics so they remain the same.
   4. Does not refer to families at all.
3. Addiction plays a role in:
   1. Physical violence
   2. Sexual violence
   3. Sexual functioning
   4. All of the above
4. The outcomes for children of alcoholics:
   1. Are always negative
   2. Are always positive
   3. Depend on the combination of personality traits and stressful events
   4. Depend on whether they receive counseling
5. A structured clinical interview can be helpful for which of the following:
   1. Help development a solid therapeutic alliance
   2. Provide a counselor with an observance of the family’s nonverbal interactions
   3. Help with 3^rd party payer reimbursements
   4. Both a and b

Matching:

1. _______Boundary
2. _______Family Roles
3. _______Family Rules
4. _______Healthy Structure
5. _______Generational Interactions
6. Determines how to act and how others react to them
7. The ways in which communication occurs between the various subsystems (e.g., parental, sibling, partner).
8. Communication between subsystems
9. A set of rules determining how people interact
10. family hero, scapegoat, lost child, mascot

CHAPTER 15

PERSONS WITH DISABILITIES AND SUBSTANCE-RELATED

AND ADDICTIVE DISORDERS

Journaling Exercises:

1. Do you know anyone in your life who has a disability? Read the risk factors for people with disabilities. Does this person have any of these risk factors? As a counselor, how might you help this person reduce these risk factors?
2. Would you be willing to take the time and the training needed to learn and use sign language so you could work most effectively with the deaf? Why or why not?
3. How would you react if you were suddenly confronted with a disability you had not anticipated? Do you think you would continue with your interest in becoming an addictions counselor or would you switch specializations, or perhaps, professions?

Discussion Exercises:

1. The authors of this chapter state “A significant number of the people currently seeking treatment for substance use disorders also have a physical, cognitive, sensory, or affective disability. Many people with disabilities are unable to access treatment they desperately need because of the double stigma of having a substance use disorder and a coexisting disability.” What are your thoughts about interventions that are needed in our communities to increase access to individuals with disabilities?
2. One of the major issues in diagnosis of substance use disorders for persons with disabilities is that addiction are frequently either seen as occurring secondary to another disability, and thus receiving limited clinical attention, or else they are not recognized at all. What are your ideas of contributing to social change in this area as a future addictions counselor? What interventions can you think of that you could employ to help change this situation?
3. There are many risk factors for people with disabilities. Choose three know risk factors then discuss what you could do as a counselor to help a client with each risk factor.

Group Exercises:

1. Divide the class into smaller groups and have each group make a list of risk factors for persons with disabilities prior to reading chapter 15. Have each group compare their list to the risk factors discussed in the chapter and consider whether their list included factors that could have been mentioned in the textbook. Have the small groups share with the class as a whole.
2. In these same small groups, have group members brainstorm about possible protective factors for persons with disabilities. Have each small group share with the class as a whole.
3. Ask each small group to discuss and report on what aspects of the chapter surprised or interested them the most.

Quiz Items

True/False:

1. People with disabilities are disproportionately represented among those with substance use disorders.
   1. True
   2. False
2. One of the major issues in diagnosis of substance abuse and addiction in persons with disabilities is that abuse and addiction are frequently either seen as occurring secondary to another disability.
   1. True
   2. False
3. Both spinal cord injury and traumatic brain injury have a lower post-injury versus pre-injury drug use.
   1. True
   2. False
4. Disabilities such as arthritis, bipolar disorder, and cystic fibrosis seldom place a person at risk for problems related to medication use.
   1. True
   2. False
5. People with disabilities may be vulnerable for alcohol and other drug abuse through peer pressure due to a lack of social experience or a need for acceptance.
   1. True
   2. False

Multiple Choice:

1. Which of the following is not how people with disabilities are classified?
   1. By category
   2. Need for assistance
   3. Severity of disability
   4. Financial need
2. Which group has the lowest rates of polydrug use?
   1. Hispanics Americans
   2. African American
   3. White Americans
   4. Asian Americans
3. Persons with disabilities abuse substances for which of the following reasons?
   1. Isolation
   2. Depression
   3. Financial
   4. All of the above
4. What are the risk categories for substance use disorders for people with disabilities?
   1. Medical, cultural, regional, access
   2. Health, religion, access, social
   3. Medical, psychological, economic, employment
   4. Employment, social, regional, cultural
5. Treatment programs for people with disabilities should be which of the following?
   1. Segregated and exclusive
   2. Integrated and inclusive
   3. Individualized and segregated
   4. Exclusive and integrated

Matching:

1. _____Risk factors
2. _____Psychological risk factors
3. _____Health and medical risk factors
4. _____Psychological risk factor
5. _____Reduced levels of social support
6. Issues that can contribute to the person engaging in alcohol and other drug use and abuse
7. Includes enabling behavior, increased stress on family life, and the stress associated with adjustment to disability.
8. Enabling behavior
9. Interpersonal and social risk factor
10. Multiple concurrently prescribed medications.

CHAPTER 16

SUBSTANCE ADDICTION PREVENTION PROGRAMS across

the lifespan

Journaling Exercises:

1. What were your attitudes toward use of substances when you were a child and adolescent? What was your personal and peer group experience of substance use? How are your views different now? What might it feel like to work with clients making different choices, or to encourage choices that you did not make?
2. How would you reply if a youth asked you about your own personal experience of drugs and alcohol use?
3. Who advised you about drugs and alcohol, and when? What was your response? What encouraged or discouraged you use in the approaches you encountered? What do you hope to emulate or discard from your models?

Discussion Exercises:

1. Pay attention to local messages about drug and alcohol use. What messages might youth in your community be getting about drugs and alcohol? Bring examples to share with the class.
2. Discuss what issues might come up for parents as they work to prevent their children’s substance use or encounter their children’s substance use problems.
3. Can a parent be too concerned about a child’s use? What about a counselor?

Group Exercises:

1. Some parents downplay the negative impact of drugs or alcohol on youth because they used substances when they were younger to no ill effect. Ask students to research how substances and (perceived) risks associated with substance use have changed over the past several generations, so they can appreciate the changing climate of use of which parents may not be aware. Invite students to share what they found with the class.
2. Invite a panel of youth in recovery to discuss their experiences and answer questions from the class. If possible, include the youth’s parents or counselors as well.
3. Ask small groups of students to research and visit local resources for parents and youth and to report back about their experiences. Include prevention resources and treatment options.

Quiz Items

True/False:

1. In 2017, 28.6 million people age 12 or older used an illegal substance within the past 30 days.
   1. True
   2. False
2. According to the public health model of disease prevention programs fall into three general categories.
   1. True
   2. False
3. DARE is the most effective adolescent drug abuse prevention program in the United States.
   1. True
   2. False
4. It is not a cultural expectation that some young adults drink to intoxication on their 21st birthdays.
   1. True
   2. False
5. The “soldier’s disease” that leads to veteran substance use disorders is posttraumatic stress disorder (PTSD)
   1. True
   2. False

Multiple Choice:

1. Approximately ____ % of people over 12 years old have substance abuse problems.
   1. 13
   2. 24
   3. 11
   4. 4
2. The abuse of _____ by students has increased by over 300%.
   1. Pain Killers
   2. Crack
   3. LSD
   4. Alcohol
3. According to the reading, when people have co-occurring disorders of addiction with some other mental disorder, usually _____.
   1. The disorders have equal severity
   2. Mental disorder occurred first.
   3. The substance abuse is exacerbated by the mental disorder.
   4. Both b & c.
4. Harm reduction programs seek to reduce the problems associated with substance use by:
   1. Forbidding the use of drugs.
   2. Use of scare tactics to prevent the use of drugs.
   3. Strict enforcement of underage drinking laws.
   4. Teaching young people to drink responsibly.
5. _______ % of juveniles in detention were using drugs when they committed their crime.
   1. 45
   2. 95
   3. 20
   4. 80

Matching:

1. _____Evidence-based, multimodal, multisensory, holistic program to combat opioid use.
2. _____Pertains to the interest, commitment, and resources within and outside of the community.
3. _____Marijuana, opioids, prescription pain relivers, and heroin.
4. _____When a needs assessment is conducted to measure levels of risk.
5. _____This type of drug rehabilitation program is used in place of serving a jail term.
6. Diversionary program
7. The most abused substances.
8. Operation Prevention
9. Part of what is done for an evidenced-based program
10. Capacity

CHAPTER 17

CROSS-CULTURAL COUNSELING: ENGAGING ETHNIC

DIVERSITY

Journaling Exercises:

1. How do you define your culture and cultural influences? What are some of your foundational beliefs and attitudes? What other self-definitions matter to you?
2. What in your cultural heritage supports your ability to experience and show respect for differences? What attitudes or beliefs get in your way?
3. What does an ongoing process of challenging your own views and beliefs look like? What resources, supports, or skills does you need to stay aware of, and shift, subtle internal beliefs and attitudes that may impact your value and support of difference? How will you find these resources?

Discussion Exercises:

1. How might cross-cultural client-counselor relationships complicate the counselor’s ability to assess and treat denial? What should counselors consider when clients from a different background claim that their use or behavior is accepted in their communities?
2. How can a community of counselors support one another in their continued development of cultural or ethnic identities as discussed in the chapter? What has helped you to see and work with your own strengths, assumptions, and biases? What has gotten in your way?
3. Discuss the complexities of balancing knowledge of cultural patterns with respect for individual difference within groups. Why does it matter what a group may be like if the emphasis is on the individual?

Group Exercises:

1. Form the students into small groups assign each group one of the case studies: James, Sebastian, Aiyana, Bojing, or Christine. Then using the MSJCC model, ask them how they would approach counseling with their client. Ask each group to share their ideas with the class.
2. Ask small groups to research websites and other resources that address substance use and addiction in specific cultural groups. Have groups report back to the class on their findings.
3. Invite three counselors who work with multicultural clients to discuss with the class how they approach their work, what challenges they encounter, and how they continue to evolve in their efforts to provide competent and respectful services.

Quiz Items

True/False:

1. The history and experience of various cultural, racial, and ethnic groups suggests that substance use and abuse patterns tend to be similar.
   1. True
   2. False
2. Today most Native Americans live in traditional native communities known as reservations, with difficult living conditions.
   1. True
   2. False
3. Alcohol consumption patterns among Asian/Pacific Islanders may be impacted by physiological factors related to metabolic difficulties.
   1. True
   2. False
4. Cultural competency in substance use disorder treatment involves the need to focus attention on the client’s ethnic, racial, and cultural history as part of a good assessment.
   1. True
   2. False
5. Twelve step approaches to substance use have historically embraced notions of cultural competency.
   1. True
   2. False

Multiple Choice:

1. Health disparities research focuses on:
   1. Understanding differences in use, and treatment across racial and ethnic groups.
   2. Racial, ethnic, and cultural differences which cause substance use and substance use disorders.
   3. The negative effect that poor health has on various racial and ethnic groups.
   4. Understanding how many persons in each cultural and racial group uses substances.
2. What industry has typically targeted African Americans urban communities via targeted advertising?
   1. Alcohol
   2. Tobacco
   3. Pharmaceutical
   4. Both a and b.
3. Latino youth who abuse substances are often negatively impacted by:
   1. Psychological issues of guilt and shame regarding drug use.
   2. Economic and educational stressors.
   3. Difficulties accessing treatment sources.
   4. Family pressures to conform to similar substance use patterns.
4. The use of culturally specific substance use disorder treatment:
   1. Has rarely been implemented.
   2. Has been implemented but lacks a strong empirical foundation.
   3. Has been argued for consistently in recent decades.
   4. none of the above.
5. Counselors need to understand their own cultural heritage in order to:
   1. Relate more comfortably with their clients
   2. Utilize appropriate boundaries in work with their clients.
   3. Identify cultural groups from which they derived attitudes, beliefs, and values.
   4. Recognize their limitations in establishing rapport with clients.

Matching:

1. _____African American
2. _____Latino
3. _____Native American
4. _____Asian/Pacific Islander
5. _____People of color
6. In counseling, it may be important to integrate traditional healing practices.
7. This culture puts a strong emphasis on emotional resistance and the avoidance of shame.
8. “Life skills” training is particularly important to women of this ethnicity.
9. Counselors should not underestimate the importance and influence of the family system.
10. Development of racial identity involves a transformative process for this group.

CHAPTER 18

GENDER, sex, AND ADDICTIONS

Journaling Exercises:

1. What is your reaction to reading about the differences in addiction related to sex and gender? Are you surprised in any way? If so, what surprised you?
2. The chapter addressed the way that a client’s gender can shape societal perceptions of his or her substance use. What assumptions and biases do you find in yourself about men and women and addiction? Do you judge one group differently than another? How might this affect your counseling?
3. Choose from one of the case studies in your chapter. What cultural variables of the client you chose stand out to you? How would the context of cultural, gender, and sex factor into your considerations when working with this client?

Discussion Exercises:

1. Under what circumstances might it be helpful to address gender in counseling with men? How about with women?
2. Discuss the complexity of working with clients who are using and also pregnant. How would a pregnancy change your approach to treatment? What issues might come up for you as a counselor? How might you talk about the risks with the client?
3. Research has shown better treatment results when groups are divided by gender. When this is not possible, what should the counselor keep in mind to facilitate effective work in a mixed gender group?

Group Exercises:

1. Invite men and women who have experienced addiction to come talk to the class about their experiences.
2. Divide students into groups and have each group make a chart of the differences and similarities between men and women as it relates to addiction process, treatment, and related issues. When students have finished, have them share their charts. How similar or different were they?
3. Divide the class into two groups, and give them identical case studies, but with the gender of the client different in each case. Ask each group to prepare a treatment plan for the client. Compare the plans as a class and discuss how gender changed the counselors’ approaches.

Quiz Items

True/False:

1. Addiction research results that use all-male samples can be generalized to women, as there is no difference in the ways women and men experience addiction.
2. True
3. False
4. Most treatment methods currently used by addictions counseling centers currently include gender-sensitive practices.
5. True
6. False
7. Women experience “telescoping” effects of drugs and alcohol in that they suffer more severe physical consequences after a shorter duration of use than men.
8. True
9. False
10. Alcoholic women who attempt suicide are as likely to die as alcoholic men who attempt suicide.
11. True
12. False
13. One of the biggest barriers to men seeking addictions counseling is lack of adequate childcare.
14. True
15. False

Multiple Choice:

1. Which of the following is NOT usually a primary concern of men seeking addictions counseling?
   1. Anger management training
   2. Whether free childcare is available during treatment
   3. Addressing unemployment issues
   4. Fear about expressing deep feelings in treatment
2. Which of the following is NOT usually a primary concern of women seeking addictions treatment?
   1. Whether free childcare is available during treatment
   2. Anger management training
   3. HIV/AIDS information
   4. Treatment for depression or anxiety
3. Addicted men are more likely than women to be diagnosed with which of the following?
   1. Sociopathology
   2. Depression
   3. Anxiety
   4. None of the above
4. Women are more likely than men to become addicted to which of the following drugs:
   1. Heroin
   2. Marijuana
   3. Alcohol
   4. Prescription medication
5. Which of the following is NOT a component of gender-sensitive addictions counseling?
   1. Considering a client’s problems within a social context
   2. Encouraging client’s freedom to make choices about treatment
   3. Creating a hierarchical counseling relationship for the client’s interpersonal safety
   4. Openly discussing gender issues as a part of treatment

Matching:

1. _____Colonial times
2. _____1830’s
3. _____1950’s
4. _____1970’s -1980’s
5. _____Today
6. Harriet Martineau describes four reasons a woman might drink: none of them include “for social reasons”.
7. Barbiturates are commonly prescribed as a sleep medication for women.
8. Alcohol used by men, women, and children as an accepted part of daily life
9. Men experience alcohol dependence at twice the rate that women do.
10. Interest in women’s alcohol use reaches its peak in the research literature

CHAPTER 19

LESBIAN, GAY, BISEXUAL, TRANSGENDER, queer AFFIRMATIVE ADDICTIONS TREATMENT

Journaling Exercises:

1. In this and previous chapters, the subject of advocacy and work to end bias has arisen. What does it mean to you to advocate for clients and challenge bias? How do you feel about taking on that role? Is that a role you expected to take on as a counselor? Are there some groups for whom it would be harder or easier for you to advocate? What does that tell you about yourself?
2. Review and reflect on your use of inclusive language socially, and in paperwork, and assessment. Do you inadvertently express assumptions about people’s sexual orientation or gender? What would it be like to try to change this language?
3. What did you learn about LGBTQ people growing up? How has that shaped your personal experience and your experience with LGBTQ people and communities? What is your current comfort level with LGBTQ people and their concerns? Where are your areas for growth?

Discussion Exercises:

1. The chapter states, “if a counselor is uncomfortable working with LGBTQ clients, they should acknowledge this lack of competence and refer to counselors who are LGBTQ-friendly.” How could a counselor do this in a manner that felt respectful and empowering to the client? How would a counselor know that they should refer?
2. Discuss the questions associated with each case study presented in the chapter.
3. What are the implications of displaying a safe zone sticker? What reactions might you get from a range of clients? How would you address these responses? How do you know that you are safe enough for LGBTQ clients to put forth such a sign?

Group Exercises:

1. Assign small groups several websites to explore related to resources that can be used to counsel members of the LGBTQ community and ask the groups to report back on what resources they found that were helpful.
2. The text states that sometimes myths are held by members of both the straight and queer communities. Divide the students into several groups, and have each group develop lists of myths and facts about LGBTQ people. As a whole group, play a game in which you review the lists, and challenge one another to distinguish the myth from fact.
3. Ask small groups to locate local resources for LGBTQ clients for socializing, recovery, or mental health help. Are these services likely to meet the needs of LGBTQ people, or would one group be better or less well served?

Quiz Items

True/False:

1. LGBT individuals all have the same rates of abuse of drugs and alcohol.
   1. True
   2. False
2. Counselors should always encourage LGBT clients to come out to their family and friends.
   1. True
   2. False
3. The coming out process is different for people depending on their race/ethnicity, disability status, socioeconomic status, and religious/spiritual affiliation.
   1. True
   2. False
4. Sexual minority clients may need counselors to help them get connected with LGBT-friendly recovery communities.
   1. True
   2. False
5. Transgender and queer youth of color have the lowest risk for violence.
   1. True
   2. False

Multiple Choice:

1. One way addiction counselors can advocate for LGBTQ clients is:
   1. Include LGBTQ magazines in the reception area.
   2. Post a list of LGBTQ-friendly 12-step meetings in the local, regional, and national area.
   3. Ensure that all paperwork is LGBTQ-inclusive and free of heterosexist language.
   4. All of the above.
2. When working with a LGBT client who is early in his or her sexual identity and recovery, the counselor should:
   1. Force the client to speak about their sexual identity each time the counselor meets with the client.
   2. Ask their family and friends if the person is really “gay.”
   3. Create a safe and welcoming environment to discuss LGBT issues.
   4. None of the above.
3. Transgender people face discrimination, prejudice, and misunderstanding in society. Transgender individuals in recovery face unique challenges in the form of:
   1. Job and career loss.
   2. Hate crimes.
   3. Family estrangement.
   4. All of the above.
4. Myths about bisexual people are that they are:
   1. confused.
   2. over-sexed
   3. Both a and b.
   4. none of the above.
5. A thorough psychosocial history when working with a LGBT client includes:
   1. talking to his or her family.
   2. assessing the client’s degree of outness.
   3. asking personal questions about his or her sex life.
   4. trying to convert them to be straight.

Matching:

1. _____Queer
2. _____Conversion Therapy
3. _____Transprejudice
4. _____Heterosexism
5. _____Bisexual
6. Hatred and fear of individuals who have nontraditional gender expression
7. An ideological system that assumes that all individuals are heterosexual and that heterosexuality is a “normal” model of sexual identity
8. A term that is being reclaimed by the LGBT community to refer to people who challenge the restrictive system of heterosexuality and traditional gender norms.
9. Have attractions to both men and women.
10. Unethical practice where a counselor attempts to convert LGB people to be heterosexual.

CHAPTER 20

INPATIENT AND OUTPATIENT ADDICTION TREATMENT

Journaling Exercises:

1. Review the history related to the “War on Drugs.” Do you agree with these policies? Why or why not? How would you change the current policies we have in place?
2. According to SAMHSA, most referrals for treatment come through the criminal justice system. Do you agree or disagree with this policy? Why or why not?
3. What are your thoughts about the treatment of comorbid clients (e.g., those with SUDs and a mental health condition)? If you had to choose to treat only one of the conditions, which would you deem most important for the welfare of the client? Why?

Discussion Exercises:

1. Review the history of how the United States (US) has dealt with its substance use problem in this country. What has been positive about the US policies and procedures? Why? What has been negative? Why?
2. What role should the family of an individual who is in treatment for substance use play? Support your position with peer-reviewed literature.
3. Review the case study of Jane in your chapter. You are on the treatment team helping to write the individualized treatment plan (ITP). What's in the plan?

Group Exercises:

1. If your group were to design a treatment program for individuals using a substance, what would be your top three most important criteria you’d want to have in your program? Why?
2. Funding problems have challenged substance use treatment for years, relegating care to individuals who were limited in licensure or training. If your group were tasked to solve this funding issue, what would be your recommendations? Why?
3. Divide the class into small groups. Ask each group to review case of Jane in the chapter. Ask each group if they were the treatment team what their recommendations would be? Then have each group share their recommendations and why they chose them? Process with the class the similarities and differences in the recommendations.

Quiz Items

True/False:

1. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), now requires health insurance providers to cover both mental and physical health equally.
2. True
3. False
4. Levels of care are organized in a stair step manner, patients start at level one and move through each level, one step at a time.
5. True
6. False
7. Each year from 2002 to 2012, over 80% of those incarcerated for drug related offenses were incarcerated for intent to distribute or manufacture and not for use.
8. True
9. False
10. Drug court is free.
11. True
12. False
13. During the 1970s and the initial stages of the “War on Drugs,” it was estimated that 3 to 5 percent of the population had a substance use disorder. Since the initiation of the “War on Drugs,” substance abuse in the United States has increased.
14. True
15. False

Multiple Choice:

1. Which one of the following is not part of what is considered in determining the level of treatment and care for an individual?
2. Diagnosis
3. Screening
4. Insurance reimbursement limitations
5. Patient problem areas
6. Which of the following definitions best defines a “Continuum of care?”
7. A treatment system in which clients enter treatment at a level appropriate to their needs and then step up to a more intense treatment or down to less intense treatment as needed.
8. A range of inpatient and outpatient services that are available to a patient, but not necessarily utilized.
9. An element of care providing consistency and flexibility in the spectrum, intensity and duration of addiction treatment.
10. An outdated system of care that has been replaced by a triadic level of care.
11. Ambulatory Detoxification with Extended On Site Monitoring is a Level II-D classification, which means which one of the following?
12. There is no such thing as Ambulatory Detoxification with Extended On Site Monitoring
13. The client is not at this moment in need of inpatient services, is only experiencing moderate discomforts from detoxification, and is able to go home to family and social support.
14. The client can be served in an outpatient setting with on call support from an addictions specialist.
15. All of the above
16. Which one of the following best describes a typical inpatient program length of stay?
17. 15 days
18. 28 days
19. 30 days
20. 90 days
21. Historically, relapse rates for drug and alcohol abuse can range as high as:
22. 10%
23. 30%
24. 50%
25. 80%

Matching:

1. Stages of change
2. Drug court
3. Early intervention
4. SBIRT
5. Federal of Bureau of Prisons
6. An alternative to incarceration for nonviolent substance abuse offenders and reduce rates of recidivism
7. Bernstein and D’onofrio
8. Precontemplation, contemplation, preparation, action, and maintenance
9. Asam’s level 0.5 level of care
10. Offers many treatment programs for inmates who have substance-related issues.