Care CEUs

1. Cognitive-behavioral and self-management intervention (CB/SM) is a relapse-prevention approach that is used in a counselor-led group treatment setting to help older adults overcome substance use disorders. The treatment approach and main goals of CB/SM are to engage and support clients as they receive skills training using CB/SM and:

2. Which of the following is NOT one of the four phases of CB/SM?

3. Clients' motivation to use CB/SM skills after finishing the treatment program is very important and likely to be influenced by how the training focused on changing each client's antecedents to substance abuse. In addition, the degree of clarity that clients attained about substance abuse triggers and their growth in self-control are very important.

4. CB/SM is appropriate for older adults over the age of 55 with substance use problems ranging from occasional risky behavior to heavy substance abuse and signs of dependence.

5. The Substance Abuse and Mental Health Services Administration has identified the abuse of alcohol, prescription drugs, and illicit drugs as a "hidden epidemic" in the expanding older adult population. It is estimated that as many as _____________ of adults older than age 60 are affected by alcohol abuse and prescription drug misuse.

6. Misuse of prescription and over-the-counter medications can lead to serious medical concerns for older adults. Which of the following is NOT a correct statement about this type of substance abuse?

7. Society has a tendency to dismiss older adults' problems as a function of aging rather than to investigate possible medical, social, or psychological causes. This potential barrier to appropriate treatment for older adults is known as elder discrimination

8. Counselors are encouraged to create a supportive atmosphere when working with older adults. The use of familiar forms such as "hon" or "dear" to address the client is recommended to help put the client at ease.

9. Older women are more likely than older men to take psychoactive prescription drugs. Among older women, the use of these drugs correlates with higher rates of middle- and late-life divorce, widowhood, stress, and:

10. The counselor's role in CB/SM is a blend of supportive listener and knowledgeable consultant. Which of the following is an accurate statement about how CB/SM counselors view slips or relapses?

11. One type of antecedent before substance use behavior (e.g., the first drink) is what CB/SM defines as a strong desire for alcohol or drugs, followed by self-talk in which a person gives himself or herself permission to use a substance. The authors refer to this as:

12. CB/SM treatment modules are designed so that all counselors, regardless of level of experience or training, can deliver nearly the same content, exercises, and general examples to groups. One advantage of adhering to the outlined step-by-step approach is that counselor turnover does not necessarily affect the consistency of program content and methodology.

13. Problem solving skills are an important part of the CB/SM treatment approach. The basic steps in the problem solving process include each of the following EXCEPT:

14. The cognitive-behavioral and self-management intervention (CB/SM) for relapse-prevention treatment begins with identifying the components of the client's substance use behavior chain. Before group sessions begin, each client's substance abuse is analyzed individually, using the NIDA -Modified Alcohol, Smoking, and Substance Involvement Screening Test.

15. Feelings are important factors in substance use, and counselors work to help clients understand how situations or thoughts trigger unwanted feelings. These feelings may lead to self-medication by substance use, or trigger the desire for other immediate positive consequences.

16. For most people, the immediate rewards of normal substance use seem positive. For example, one alcoholic drink seems to perk up your spirits, while one prescribed dose of pain pills or tranquilizers relieves pain or anxiety. However, those with substance abuse issues must be willing to see negative long-term consequences of substance use behavior and remind themselves of the positive consequences of not using alcohol or illegal drugs or not misusing addictive prescription drugs.

17. The authors describe long-term negative consequences of substance use that can rapidly decrease the quality of one's life. Categories of substance use consequences include family/marriage/social problems, medical/health problems, legal problems, employment/financial problems and:

18. Keeping a substance use log may help clients track substance use behavior, because the more they understand the behavior, the more they will be empowered to cope with urges for substance use. The log should include each of the following EXCEPT:

19. The goal of Module 2 is to It teach clients how to recognize and respond to social pressure situations that influence substance abuse. In session 1, the objectives are to teach clients new ways to handle social pressure and to:

20. A situation refers to where clients are, what they are doing, and whom they are with just before using a substance. If clients can change something about the situation, they can break the substance use behavior chain at its earliest link, and do something about it immediately before moving any closer to using a substance.

21. Every time a client refuses an offer to use a substance in real situations, this refusal will be reinforced by the positive consequences of not using a substance. Which of the following is NOT one of the basic steps to refusing a substance?

22. The Substance Use Refusal Bill of Rights states that a person has the right to refuse substances without feeling guilty and has the right to be the final judge in his or her own behavior.

23. When people have a lot of social plans or activities scheduled, they are at high risk for substance abuse. Older adults must strike a balance between socializing and being by themselves, since many also abuse substances when they are at home and alone.

24. When counselors are working on teaching older substance abusing clients new ways to handle being at home and alone, the authors recommend four steps to implement during the presentation phase. These steps include each of the following EXCEPT:

25. The more activities older adults become involved and the more they associate with others who share their interests, the less likely they will be to experience boredom, loneliness, and depression and ultimately return to substance abuse.

26. The two sessions in Module 4 assist clients in recognizing when negative emotions occur and what to do about them. Which of the following is an accurate statement about how screening clients for the presence of psychiatric disorders during this phase?

27. Everyone has negative thoughts sometimes in life. Older adults with substance abuse issues should learn to take steps to prevent and cope with unpleasant feelings, especially since depression is a normal part of the aging process.

28. Thought stopping is a technique used in substance abuse treatment to control negative thoughts that interfere with getting well. Going over the same negative thoughts is never productive for clients and interferes with problem solving skills.

29. In general, older adults may be reluctant to participate in group sessions for substance abuse treatment. Which of the following is NOT one of the author's recommendations to increase participation?

30. When rating negative thoughts and emotions associated with substance use behavior, counselors may use a rating form to determine if the client was able to demonstrate desired behavior. Categories to be rated include: Did the client recognize negative self-talk?, Did the client make a positive statement?, and Did the client demonstrate assertive skills to stop thoughts?

31. Once negative self-talk is recognized and interrupted, the next step is to:

32. When feeling sad, self-talk is almost always negative and inaccurate and such statements rarely are based on truth or concrete evidence. Which of the following is NOT one of the three major categories of negative self-talk?

33. Turning one small mistake into a major problem is an example of amplification, and it can lead to adverse thinking and behavior.

34. Anxiety and tension are a normal part of everyone's life, and how an individual manages the feelings and physical sensations that go along with anxiety and tension is key. Since people experience anxiety in different ways, clients need to recognize the signs of tension in their bodies.

35. Problem solving skills are a critical part of relapse prevention, and steps for problem solving include recognizing that a problem exists, stating the problem as a positive goal and breaking it down into manageable parts, and:

36. Just as negative feelings such as depression, sadness, and grief are antecedents to substance abuse, so are physical symptoms such as worries, tension, or nervousness.

37. In order to prevent anxiety from becoming a substance use trigger, the goal should be to break the substance use behavior chain at the situation- or thought-to-feeling link and at the ______________ link.

38. Stress is the adjustment your body makes when faced with changes. Each of the following is a correct statement about stress EXCEPT:

39. The first step in taking control of stress before it gets out of hand is to learn to recognize the body's first signs or distress.

40. In addition to using problem solving skills, positive steps toward managing anxiety and tension include relaxing, talking about the problem with someone, and networking with the community.

41. Counselors may instruct clients to control their negative thinking by ordering themselves to stop these thoughts. This is an example of "client covert interpretation of covert thought."

42. Negative self-talk based on unreasonable beliefs leads to maladaptive behavior and errors in thinking. The five errors in thinking include exaggerating, black-and-white thinking, overgeneralizing, ignoring the positive, and:

43. Demonstrating how to think positively may be as simple as teaching clients to say to themselves, "I can handle this."

44. Relaxation is both a physical and mental state and can be very helpful in reducing tension. However, it is possible and even quite common to remain anxious or uncomfortable when relaxed.

45. Techniques taught to manage anxiety and tension are aimed at reducing the amount of anxiety and tension quickly, and their purpose is to break the substance use behavior chain at the feelings point before anxiety gets out of hand.

46. Anger and frustration can be major determinants for relapse to substance abuse. These emotions typically occur in ____________ situations.

47. For many older adults with substance abuse issues, anger and frustration can be controlled by learning more assertive behavior. Which of the following is NOT one of the components of the DESC model of assertive behavior?

48. Some people may believe that being assertive is undesirable, but they are likely confusing assertiveness with aggressiveness. People who are aggressive protect their rights but also violate the rights of others, and often get what they want by being hostile or threatening.

49. People who are passive do not protect their rights or the rights of others, and they do not get what they need, while those who are passive-aggressive use an indirect approach, only hinting at what they want or disguising their true intentions. In contrast, assertive people tend to protect their rights, without violating the rights of others.

50. Many people are afraid that if they use assertive behavior and persist in asking for what they want and need, they will be disliked or rejected by someone who is important to them. However, the opposite is likely to occur as people tend to respect those who begin to express themselves clearly and comfortably.

51. Which of the following is a true statement about how clients should express their feelings when being assertive?

52. When older adults are being assertive and specifying the desired change, it is important to be persistent but not to compromise, as this may be a sign of weakness or passivity.

53. At times, even in you in situations that are irritating and frustrating, it's not worth using assertive behavior. For those who tend to get ruffled about nearly everything and everyone who gets in their way, it may be better to take a closer look at the behavior and consider giving in occasionally or just walking away from an unpleasant situation.

54. Using assertive behavior to handle situations with those that are close to you is much different than with strangers. Managing stressful moments with a friend, family member or other familiar person is generally easier because it doesn't involve the same degree of risk that would be involved in confronting a stranger.

55. A cue is an object, a time, an event, or a thing that stimulates a person to use alcohol or drugs. Cues such as remembering that bottles of liquor or beer are hidden in the house, or being present when other people are using substances are known as obvious or ___________ cues.

56. Some older adults cite the beginning of each month as a major cue for substance abuse because this is when they receive their Social Security or pension checks. Clients need to learn to recognize and manage their personal cues for substance abuse and create new behaviors to avoid using alcohol or drugs.

57. The urge to use a substance is the final antecedent in the substance use behavior chain. It is explained as a strong desire for a substance that lasts for various lengths of time and:

58. When a substance abuser has a strong desire to abuse alcohol or drugs, the first and most important step to be taken, according to the CRASH model, is to remove all available substances.

59. With substance use, an urge is not a physical craving but rather self-talk that gives you permission or what seems like a good reason to use a substance. An urge also is linked to individual _____________ about substance use, which generally are based on personal experiences or cultural assumptions.

60. The cognitive components of urges frequently include unspoken, and often negative and critical self-talk by you, to you, and about you. Besides being critical of you, the self-talk often justifies using substances by rationalizing that they will change what you are feeling or thinking.

61. If an urge leads to a slip, the worst thing the substance abuser can do is panic or say something such as, 'I’ve screwed up and might as well drink the rest of this stuff!' A slip can be stopped at its earliest stage and doesn't necessarily have to lead to a full relapse.

62. The cognitive-behavioral and self-management intervention for older adults recognizes that relapses may happen. As a result, group members and counselors are encouraged to confront participants about possible relapse in order to initiate dialog for preventative solutions.

63. A slip really means that a substance abuser has made a small error, such as having one sip of alcohol or one puff of marijuana, and there is a difference between having a small slip and a complete return to a former pattern of use. A slip may also be referred to as a:

64. The Substance Abuse Relapse Prevention Program for Older Adults encourages participants to complete homework assignments to address what to do when a slip occurs. These assignments are particularly helpful so that clients can practice these skills when they are clear headed and sober.

65. Three simple steps are recommended to help older adults handle a slip. These include getting rid of substances, calling for help, and avoiding social pressures.