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Quantum Units Education

Ethics in Addictions Treatment

Chapter 1: Ethical Foundations Of Substance Abuse Treatment-Pervasiveness

1. Which of the following accurately describes the pervasiveness of substance abuse based on a 2007 National Survey on Drug Use and Health?

A. An estimated 18.4 million people met the criteria for either substance abuse or dependence in 2006

B. 4.6 million people abused or were dependent on alcohol and illicit drugs

C. 3.8 million misused or were dependent on drugs alone

D. 13.8 million abused or were dependent on alcohol alone


The Moral and Ethical Salience of Living with Addictions

2. Substance use disorders are highly stigmatized and hence require more rigorous confidentiality protections than do other medical conditions.

A. True

B. False


Ethical Principles

3. The most complicated and agonizing ethical conflicts substance-use clinicians will confront will likely be those related to:

A. Autonomy and compassion

B. Privacy and respect for persons

C. Nonmaleficence and beneficence

D. Confidentiality and truth-telling


Ethical Dilemmas

4. The first step in resolving an ethical dilemma is to recognize it as a true clinical problem rather than a legal question or on institutional matter.

A. True

B. False


Confidentiality, Truth Telling, and Clinical Practice

5. The rationale for more robust confidentiality protections in addiction treatment than in other forms of medical care lies in the greater _____________ attached to substance use disorders.

A. Morality issues

B. Stigma

C. Legal implications

D. None of the above


Clinical Considerations

6. General exceptions to confidentiality requirements include each of the following EXCEPT:

A. Past criminal activity that involves an unsolved crime

B. Communication with an outside entity that provided support to the program

C. Patient information that does not disclose that the patient has a substance use disorder

D. Disclosure to a qualified service organization assisting program


Conclusion

7. Research indicates that the most common reasons individuals will not seek treatment for drug or alcohol abuse are insurance barriers and the cost of treatment.

A. True

B. False


Chapter 2: The Therapeutic Relationship in Substance Abuse Treatment-Clinical Considerations

8. Reflective listening, a key component in eliciting behavior change, has been described as the ability to actively listen to the patient and to understand the patient's perspective.

A. True

B. False


Clinical Boundaries

9. Clinicians who are in recovery from alcohol or drug abuse must be careful not to allow boundary violations to occur when they overidentify with their patients or allow their personal experience to interfere with the treatment of their patients.

A. True

B. False


Dual Relationships With Patients

10. A study examining substance abuse counselors' beliefs regarding multiple relationships found that nonrecovering individuals saw more behaviors regarding multiple relationships to be ethically concerning than recovering individuals.

A. True

B. False


Scope of Practice

11. It is estimated that between _________ percent of drug abusers have a concurrent (co-occurring) mental illness.

A. 35 to 65

B. 30 to 60

C. 25 to 55

D. 20 to 50


Chapter 3: The Ethics of Harm Reduction

12. The term “harm reduction” describes a public health approach intended to reduce risks and adverse consequences of behavioral choices, and it is generally seen as an alternative to “zero tolerance”.

A. True

B. False


Controlled Drinking: A Prototypic Experience

13. Alcohol use disorders are recognized by experts to be dichotomous, rather than being distributed along a continuum.

A. True

B. False


Ethical Considerations in Harm Reduction

14. Harm reduction practices typically address what might be regarded as a natural consequence of risky behavior, such as ____________ , unwanted pregnancy, or overdose.

A. Incarceration

B. Illness

C. Infection

D. Injury


Feasibility

15. The probability of stable moderation for a person who has had problems with alcohol appears to depend on the severity of problems and dependence that the person has experienced.

A. True

B. False


Core Concepts

16. The psychological phenomenon whereby attempts to restrict freedom or choice may paradoxically strengthen the occurrence and persistence of a behavior is known as:

A. Opposition

B. Emendation

C. Inversion

D. Reactance


17. Individuals with co-occurring disorders are often present in substance abuse treatment settings and they represent the population with poorest outcomes and highest costs.

A. True

B. False


Chapter 4: Ethical Issues in The Treatment of Persons With Co-Occurring Disorders-Overview of Co-Occurring Disorders

18. Over the past two decades clinicians and administrators have become much more aware of individuals with co-occurring substance abuse and mental health disorders, and have ensured that their care be prioritized.

A. True

B. False


19. Successful treatment programs for patients with co-occurring disorders welcome and engage patients as desirable clients, and connect with them through relationships and programming that is empathetic, hopeful, and:

A. Comprehensive

B. Strategic

C. Integrated

D. Diverse


Consequences of an Unwelcome Treatment Climate

20. A review of state system patients who died in behavior health care revealed each of the following EXCEPT:

A. Those with co-occurring disorders died at higher rates

B. They frequently died of substance-related complications that were identified but ignored during their clinical care

C. They frequently died (of a wide range of causes) within a short time of coming into a health care setting

D. Analysis of the death reviews indicated many potential contributors to these poor outcomes for patients with co-occurring disorders


Effective Treatment Approaches

21. Treatment approaches for individuals with co-occurring disorders may include strategies to manage trauma-related issues and substance abuse skills training for people with persistent mental illness.

A. True

B. False


Core Concepts

22. Case management and adequate support must be balanced with expectation, ______________, and positive contingent learning for each person in any setting.

A. Empathy

B. Consequences

C. Feedback

D. Assessment


Chapter 5: Cultural and Spiritual Dimensions of Addiction Treatment

23. In terms of ethical guidelines, culture has historically included the following:

A. Age, gender, race, sexual orientation

B. Ethnicity, national origin, religion

C. Disabilities, language, socioeconomic status

D. All of the above


Ethics in Relation to Culture

24. The term “ethical multiculturalism” refers to the belief that ethical principles are universal and independent of culture.

A. True

B. False


Beneficence and Social Justice

25. The ethical goal of improving social justice for all involves exploring with clients how their substance use problem may be related to other sociopolitical forces such as racism, marginalization, and powerlessness.

A. True

B. False


Ethical Principles Relating to Culture and Spirituality in Addiction Treatment

26. The principle that suggests that in order to make decisions about treatments options, patients should be provided with relevant information about all reasonable treatment options is:

A. Respect for persons

B. Justice

C. Personal responsibility and voluntarism

D. Beneficence


Spirituality and Addiction

27. Religion and spirituality are best conceptualized as multidimensional constructs that overlap and are conceptually intertwined.

A. True

B. False


Chapter 6: Forensic Issues in the Treatment of Addictions

28. Clinicians may be reluctant to accept patients who have been court mandated to attend substance abuse treatment because they may be skeptical of the patients' motivation to stop using substances.

A. True

B. False


Disability from Alcoholism and Drug Dependence

29. Which of the following in NOT one of the workplace discrimination protections for persons with substance abuse issues under the Americans with Disabilities Act (ADA) of 1990?

A. Those addicted to illegal drugs are protected under ADA only if they are in treatment or have completed treatment for their addiction and are not currently abusing illegal drugs

B. The ADA requires that individuals addicted to controlled substances be under the care of a licensed health care professional to receive ADA protection

C. The ADA does not protect addicted people who are a danger to the safety of others

D. Those addicted to alcohol are protected under the ADA in the same manner as those addicted to illegal drugs


30. Although society has never held voluntary intoxication to be a valid excuse for illegal actions, some substance related psychosis and organic brain syndromes may affect behavior in such a way that an insanity defense may be possible.

A. True

B. False


Core Concepts

31. Malpractice in addiction psychiatry is an important area of interaction between addiction treatment and criminal law.

A. True

B. False


Chapter 7: Ethical Issues in the Treatment of Women with Substance Abuse

32. Keys factors in approaching the female substance abusing patient ethically are the influence of stereotypes in the clinician and ________________.

A. Previous experience

B. Self-awareness

C. Personal values

D. None of the above


Stereotyping of Women

33. When women are perceived to control men through sexuality or feminist ideology, this is referred to as antagonistic sexism.

A. True

B. False


Risk Factors for Substance Abusing Women

34. The rate of alcoholism among women is highest among Native Americans, followed by African Americans and Hispanics, while prescription medication abuse is most common among white women.

A. TRue

B. False


Bioethical Principles

35. Informed consent revolves around ensuring that patients are fully aware of the treatment options available to them and of the nature of their illnesses, and is viewed as a dynamic process that involves continuous interaction between provider and patient.

A. True

B. False


Bioethical Principles and Hostile/Benevolent Sexism with Female Substance Abusers

36. Examples of benevolent sexism include each of the following EXCEPT:

A. Infantilizing patient

B. Overidentification with patient

C. Underestimation of intellect

D. Overestimating patients' autonomy


Chapter 8: Ethical Aspects of the Treatment of Substance Abuse in Children and Adolescents

37. Research indicates that alcohol use contributes to ___ percent of adolescent fatalities in motor vehicle crashes and ___ percent of adolescent drownings.

A. 25; 30

B. 30; 35

C. 35; 40

D. 40; 45


Informed Consent

38. In recent years, legislators, clinicians, and researchers have recognized youth who possess the requisite cognitive and emotional abilities to provide informed consent, who are known as developed minors.

A. True

B. False


Evidence-Based Treatments

39. Although methadone therapy is rarely approved for adolescents, there is evidence that buprenorphine replacement therapy is beneficial for older adolescents with opioid dependence.

A. True

B. False


Core Concepts

40. Evidence-based treatments for substance abuse incorporate each of the following EXCEPT:

A. A developmental perspective

B. Multidisciplinary strategies

C. Cognitive-behavioral therapy

D. Family-based interventions


Chapter 9: Ethical Dilemmas in Treating Chronic Pain in the Context of Addiction-Treating Chronic Nonmalignant Pain

41. Chronic pain involves not only physical symptoms but also psychological, emotional, behavioral, and social influences, and affects not only the patient but also the family members closely involved with caring for the patient.

A. True

B. False


Pain and Addiction Terminology

42. The signs and symptoms of addiction can closely resemble the behaviors seen in the patient who remains in severe pain and is undertreated, known as pseudoaddiction.

A. True

B. False


A Harm Reduction Approach

43. Clinicians of all disciplines must recognize that patients with substance use disorders often have a higher pain tolerance and lower pain medication threshold than their non-substance using peers.

A. True

B. False


Ten Steps in the Ethical Management of Chronic Pain

44. Ten Steps in the Ethical Management of Chronic Pain include all of the following EXCEPT:

A. Establish the pathophysiology of pain where possible and appropriate

B. Begin with nonpharmacological treatments and move to medications only if those do not provide sufficient relief

C. Maximize use of non-narcotic adjunctive medications before utilizing opioids

D. Minimize risk of addiction by using short-acting opioid preparations and scheduled dosing rather than long acting drugs


45. For addiction professionals perhaps the most significant component of harm reduction is:

A. The vigorous diagnosis and treatment of other comorbid mental health and psychosocial problems

B. Collaborating with primary care physicians and other addiction professionals to provide ideal care

C. Helping patients set realistic goals and expectations about addiction, relapse, and recovery

D. None of the above


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