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Which of the following is NOT one of the components of a collaborative treatment plan, as described in the course text? [Help]

A A clear rationale for generating a plan

B Goals both parties can agree are worth attempting

C Objectives identifying meaningful steps toward the goal(s)

D Methods dictated by the therapist

From a Motivational Interviewing perspective, a person is more likely to change a problem behavior when that person: [Help]

A Resists participating in the development of the client's own treatment plan.

B Voices in an interpersonal context a commitment to plan and implement change.

C Relies on a therapist to give expert opinions that override the client's low motivation.

D Follows instinct and spontaneous decisions without imposing structure or rationale.

Why should a therapist offer a client a rationale before launching into treatment planning? [Help]

A Because it is required by most agencies for record keeping

B To satisfy third party payers for reimbursement

C To let the client know what to expect and how to participate

D To inform clients of the therapist's authority to decide the course of treatment

The treatment planning process can be an intervention that contributes to progress in therapy in which of the following ways? [Help]

A Collaborative planning invites the client's participation.

B Treatment planning helps identify a focus of concern(s).

C Treatment plans specify therapeutic goals and objectives.

D All of the above

If a client resists formulation of a written treatment plan, the therapist should: [Help]

A Insist that no further work can be done until the client is willing to discuss and sign a plan.

B Listen carefully and develop a tentative plan that can be presented to the client at the next session.

C Forego planning and talk about whatever the client wants to discuss.

D Terminate the client and close the case file.

Which of the following therapists is most likely to effectively engage clients in collaborative treatment planning to address problematic or disordered substance use? [Help]

A Those who are careful not to assert a format and decline to offer suggestions or interrupt a client

B Those who offer numerous goals, objectives, and methods that have worked with other clients without unnecessary input or feedback from the current client

C Those who develop self-knowledge and utilize professional consultation as needed to employ flexible structure in planning with clients

D All of the above are likely to be equally effective strategies.

When the treatment goal is to increase a client's self-efficacy for changing alcohol or other drug use, the four objectives listed below can help improve the client's efficacy expectations. According to Bandura's social cognitive theory, which objective will have the strongest impact on clients' abilities to better regulate their own behaviors? [Help]

A Choosing tasks with strong chances of client success

B Learning to manage negative affect associated with treatment efforts

C Learning from vicarious experiences, such as therapy or self-help groups

D Persuading clients that they can and should change

Clients exhibiting substance use disorders often benefit from treatment goals and objectives planned to enhance their beliefs in their own ability to change their drinking or drugging behaviors. Their initial self-efficacy for change may be low because: [Help]

A They continue using drugs or alcohol despite repeatedly trying to quit.

B Substance use is a healthy strategy for coping with stress.

C They have hope and realistic expectations for reaching their goals.

D They take initiative and responsibility for making healthy choices.

A treatment plan to address a client's concerns about personal substance use incorporates performance objectives by: [Help]

A Setting a condition requiring the client to abstain from all psychoactive substance use.

B Encouraging the client to discuss and choose new behavioral tasks that are within the client's abilities.

C Persuading clients to try new behaviors that they aren't sure they can or want to do.

D All of the above.

Strong emotions like anxiety can reduce a client's confidence and self-efficacy toward changing excessive drinking or drug use. Methods recommended for helping a client better manage strong emotional arousal include: [Help]

A Together identifying situations that trigger difficult emotions for the client.

B Generating and practicing ways to cope with intense emotions without using psychoactive substances.

C Reinforcing valid attempts and successful outcomes of identified alternative responses to difficult feelings.

D All of the above.

Clients exhibiting substance use disorders can learn from vicarious experience of success in changing behavior by: [Help]

A Talking to friends or family members who are current substance users.

B Confronting their therapist about the therapist's substance use history.

C Participating in group therapy or a self-help group on recovery from substance-related disorders.

D Persuading their therapists to self-disclose personal biases about drugs and alcohol.

A therapist's verbal persuasion to change is most motivating when the: [Help]

A Client is challenged to attempt a new task that the client has never before considered.

B Client's emotional arousal is increased to promote greater anxiety.

C Therapist expresses a sincere faith in the client's potential to change.

D Client has some confidence in being able to achieve a task s/he is already considering.

Therapists who attempt to engage clients in change activities that are inconsistent with the client's current stage of readiness tend to: [Help]

A Decrease the client's anxiety.

B Carefully assess the client's stage of readiness for change.

C Elicit client resistance in some form.

D Encourage contemplative clients to prepare before taking action.

Treatment methods based on Motivational Interviewing strategies establish interpersonal conditions for the therapy relationship that communicate: [Help]

A The necessary imposition of the therapist's expert opinion.

B The therapist's intentions to respect the client's perspective.

C Arguments against the client's continuing drug or alcohol use.

D The client's responsibility for achieving insight into the causes of his or her disordered substance use.

The transtheoretical model of the stages of change emphasizes that most personal change requires: [Help]

A Insight.

B Action.

C Both.

D Neither.

When the treatment goal is to increase insight into the implications of the client's substance use and the client denies that his or her substance use is a problem, an appropriate treatment objective would be to: [Help]

A Determine whether there is a problem to be addressed.

B Prepare the client to undertake a course of action to reduce drinking or drug use.

C Change the rewards and punishments the client associates with substance use.

D Weigh options to help resolve the problems identified by other people with respect the client's substance use.

In response to an admitted problem with frequent drinking to the point of blackouts, Jen's objective is to decide whether or not she wants to change her typical pattern of alcohol consumption, which she says is "wicked fun." Which of the following methods would you as a therapist recommend for Jen, a client in the contemplation stage of change? [Help]

A Refrain from alcohol use as a condition for continuing therapy.

B Engage in self-forgiveness for past mistakes.

C Role-play how to avoid people and situations that trigger cravings to use alcohol or other drugs.

D Generate and weigh options to clarify goals and possible strategies.

As clients in the preparation stage ready themselves to take action, their commitment to resolve problems may conflict at times with continuing urges to use alcohol or other drugs. Thus therapists at this point should be skilled at dealing with client: [Help]

A Ambivalence.

B Strategies.

C Consequences.

D Certainty.

Changing substance use behavior in the action stage of change involves a plan that specifies behavioral criteria of change. From a classical conditioning perspective, action objectives aim to sever the connection between: [Help]

A A signal that substances are available and the behavioral response the client makes to that signal.

B An abstract strategy and concrete tasks that meet criteria for change.

C Emotional reactions and behavioral responses to drugs or alcohol.

D The client's substance use and the rewards or punishments that follow it.

In the action stage of change, which of the following methods can be utilized to help clients control exposure to stimuli (such as certain music, beer posters, or drug pipes) that the client wishes to avoid because those stimuli trigger urges and cravings to resume substance use? [Help]

A Generating and brainstorming possible options for future behavior

B Identifying specific events that will confront the client with triggering stimuli

C Articulating and practicing steps clients can take to minimize exposure

D Both 2 and 3

For clients with problematic substance use, making choices to avoid alcohol and other drugs and to seek other types of rewards instead is a challenge that must be faced. Using an operant conditioning approach, treatment methods can help modify the patterns of reinforcement for the client's behavior. The method that involves applying meaningful rewards for behaviors that are incompatible with substance use is called: [Help]

A Counterconditioning.

B Contingency management.

C Revaluation.

D Commitment to taking action.

Efforts to modify the consequences of the client's behaviors work better if the therapist: [Help]

A Avoids discussion of rewards the client experiences from using drugs or alcohol.

B Focuses solely on raising client awareness of detrimental consequences of substance use.

C Acknowledges the benefits as well as the costs the client associates with substance use.

D Rules out the possibility of mixed motivations the client may experience.

Although he tries to avoid situations with cues reminding him of alcohol, Ron can't help noticing bar ads on campus and beer commercials on TV. He needs methods for resisting urges stimulated by such cues to help him meet his treatment goal of abstinence from drinking. When stimuli that trigger thoughts of drinking or using drugs cannot be eliminated from the client's environment, "re-evaluation" can be incorporated into the client's treatment plan to help identify maladaptive thoughts, such as Ron's beliefs that urges to drink are compulsory. In Ron's case, re-evaluation can help to: [Help]

A Replace such beliefs with messages Ron can give himself about being willing and able to resist the temptation triggered by the ads.

B Provide tokens or vouchers that reward Ron for watching beer commercials during sporting events.

C Turn off the TV or leave the room any time Ron is confronted with a cue that reminds him of drinking.

D Evaluate whether he is actually capable of controlling his environment to limit exposure to alcohol related cues and stimuli.

Clients are presumed to be in a better position to participate effectively in their own therapy if the: [Help]

A Therapist insists on the client's complete abstinence for the duration of therapy.

B Client has little knowledge of how therapy works or what to expect.

C Therapist provides psychoeducation about the nature of therapy.

D Therapist keeps her or his methods mysterious.

The therapist educates the client about confidentiality so that: [Help]

A Protections of confidentiality can be emphasized to facilitate trust.

B The limitations of therapeutic confidentiality are understood and accepted by the client.

C Questions the client might have about confidentiality and disclosure can be discussed and clarified.

D All of the above

Psychoeducation about the abstinence expectation for coming to therapy sessions "clean and sober" involves the therapist explaining reasons to the client and being receptive to the client's reaction. A rationale for expecting abstinence from drugs and alcohol at least for the day of the session is that the: [Help]

A Therapist does not want to have to smell the bad breath of a client who has used drugs, alcohol or cigarettes right before the session.

B Therapist believes that more productive work can be done when the client's emotions and cognitions are not compromised by the psychoactive substances.

C Client is wrong to argue that being high or intoxicated is not a barrier to his or her functioning because that is a normal state of mind for the client.

D Therapist will automatically terminate therapy with the client if the client ever shows up for a session under the influence of alcohol or other drugs.

When conducting telehealth, a therapist will not have cues like odor or full body movements that might indicate in person that a client has used drugs or alcohol before the therapy session. This suggests that: [Help]

A Substance use therapy should not be undertaken in a telehealth format.

B In telehealth, the therapist has no reason to wonder or need to know if the client has been using since the client does not have to travel to get to the session.

C The therapist's establishment of the ground rule for reporting recent substance use makes it easier to ask and talk about recent use, if any.

D Since breath and body odor or physical gestures are unreliable indicators, telehealth therapist will do better than in person therapists at detecting when a client is using substances from their facial expressions or bloodshot eyes.

In addition to coming to sessions "clean and sober," therapists convey a second minimum expectation to the client, asking clients to report honestly any substance use between sessions. The therapist asks the client each week about recent alcohol and drug use because it: [Help]

A Helps get an accurate indication of the client's recent behavior.

B Creates a context for straightforwardly discussing the topic.

C Effectively shames the client into future abstinence.

D Both 1 and 2

If a therapist has not established ground rules about abstinence and regular report of recent substance use: [Help]

A The client will be more likely to openly reveal current substance use.

B The therapist can easily inquire later if suspicions arise about client substance use that is inconsistent with treatment goals.

C It can be quite awkward for the therapist to raise questions about client substance use later.

D The client will not be surprised or put off if the therapist later asks if the client has been recently using drugs or alcohol.

Psychoeducation for clients about the effects of psychoactive substances on the brain emphasizes that drugs and alcohol: [Help]

A Can modify normal functions of the brain in a manner that may disrupt thinking, emotion, and behavior.

B Contribute to disorders only in persons who have an alcoholic or addicted parent.

C Are never safe for human use, so total abstinence is required in all circumstances.

D Are risky to use in the short term, but have few dangerous long-term consequences.

In North America, laws and social attitudes toward drug and alcohol use shift and change over time. When planning therapeutic treatment for problematic substance use, this means that: [Help]

A Therapists should become familiar with relevant laws and policies both at the federal level and in their own states or provinces.

B Therapists can engage clients in psychoeducation to explore the nature of relevant laws and policies, apparent options and discrepancies, and personal implication.

C Psychoeducation in substance use therapy will likely examine the client's own attitudes and perceptions of changing social attitudes regarding psychoactive substance use.

D All of the above

Jim tells his therapist that he is interested in trying medical cannabis, now that it has been legalized in his state, to cope with the chronic pain he has mentioned multiple times. The therapist will talk with him about incorporating this into his treatment plan by: [Help]

A Writing Jim a medical authorization to use medical cannabis.

B Working with Jim to find out what medical conditions qualify and how to apply for a state medical cannabis authorization card.

C Assuring him there are no known medical or legal risks of using medical marijuana.

D Urging Jim to realize that it is not worth the risks of using a drug that is still classified as illegal under federal law.

Clients may benefit from psychoeducation about possible harm that high levels of exposure to drugs and alcohol can inflict on the human body. These hazards include: [Help]

A Embarrassing behavior in social situations.

B Coming to therapy sessions under the influence of alcohol or other drugs.

C Keeping an open mind about the pleasures of substance use.

D Damaging the organs' abilities to rid the body of foreign chemicals.

Therapists can provide psychoeducation about how clients can move in the direction of beneficial change by inviting clients to: [Help]

A Make passive rather than active choices about future behavior.

B Create idealistic expectations about substance use disorder therapy and recovery.

C Develop a plan and obtain support for rewarding success and accepting setbacks.

D All of the above

Relapse prevention strategies involve both helping the client learn to avoid resumption of problematic alcohol or drug use and related behaviors, as well as: [Help]

A Accepting that any future substance use indicates a failure of treatment.

B Building skills for coping with high-risk situations and occasional lapses if they occur.

C Continuing indefinitely in therapy with the realization that substance users cannot control their own behavior.

D Dismissing memories of past disordered substance use since there is nothing to be learned from them.

Relapse prevention planning helps counter-condition persons who have decided to quit disordered use of substances by replacing old learned responses to drugs and alcohol with new and incompatible ones. Thus, as clients identify factors that have triggered their own urges and cravings to drink or use drugs, what does the therapist do? [Help]

A Ensure that the client will not be further exposed to any factors or cues that trigger those urges and cravings to use substances.

B Encourage clients to put themselves in risky situations, like attending a bar or party, that will test their resolve to prevent relapse.

C Persuade the client to attend 30 Alcoholics Anonymous or Narcotics Anonymous groups over the next 30 days.

D Help clients consider and practice new behavioral options in response to triggers, urges and cravings encountered in daily life.

Reframing self-defeating thoughts about reducing substance use and preventing relapse can include cognitive restructuring techniques like thought-stopping and thought-substitution, possibly with rhythmic repetition to reinforce alternative positive messages. Cognitive restructuring works best when the client: [Help]

A Externalizes problems as outside of personal control.

B Maintains ambivalence about whether personal substance use is actually problematic.

C Believes the therapist understands and accepts the client's initial thoughts as well as personally meaningful alternatives they generate together.

D Doubts the need or ability to change thoughts or actions regarding her or his own use of drugs or alcohol.

It is not unusual or unlikely for a client in therapy for substance-related disorders to experience an occasional relapse during the course of therapy and recovery. In such instances, it is most useful for the therapist and client together to: [Help]

A Accept the possibility of relapse.

B Deal with feelings about relapse.

C Determine what can be learned from the relapse.

D All of the above

Alice has shown progress in her ability to deflect relapse by developing new hobbies and engaging in new activities to replace her former habit of marijuana use. To expand Alice's relapse prevention skills, her therapist discusses with her: [Help]

A The limitations of trusting that the recent changes she has made will be lasting or ultimately satisfying.

B Ways to revise her treatment plan to reinforce steps she is already taking and clarify new priorities and next steps for implementation.

C Termination of therapy so that Alice can have more time to pursue her hobbies and interests.

D Testing the strength of her relapse prevention skills by resuming friendships with people with whom Alice used to smoke marijuana.

Planning treatment to help a client reduce the harms associated with any substance use involves considering with the clients: [Help]

A Personal intentions regarding future substance use along with experiences of current and past use of alcohol or other drugs.

B Plans to abstain completely from use of all psychoactive substances.

C Scare tactics about harsh punishments given to anyone who violates laws against drug use or possession.

D Avoiding dangerous relapse at all costs given the physical and psychological harms that will result.

By communicating respect for the rights of people who use drugs, harm reduction strategies: [Help]

A Aim to promote social justice through addressing disparities in health care treatment that provide less adequate care for marginalized persons.

B Give voice in planning their own treatment to clients regardless of their race, ethnicity, gender, sexual orientation, religious preferences, or economic status.

C Convince clients to admit that any use of drugs or alcohol is harmful and must be stopped.

D Both 1 and 2 are correct.

Which of the following is NOT a harm reduction principle implemented in treatment planning with clients who use alcohol or other drugs in a problematic manner? [Help]

A Acknowledging and discussing how social inequities, social isolation, trauma, and discrimination contribute to vulnerabilities that can decrease one's capacity for dealing with related harms.

B Accepting the occurrence of drug and alcohol use instead of ignoring or condemning it, recognizing that some forms of substance use are safer than others.

C Downplaying the risks, harms, and dangers associated with psychoactive substance use.

D Offering nonjudgemental, noncoercive treatments and resources that empower people to be agents of their own decisions and changes.

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