Alcoholism, Substance Abuse and Dependency
1)

How is alcoholism (alcohol use disorder) generally defined?
 
An occasional choice to drink socially with no health consequences A temporary bad habit that resolves on its own without treatment A chronic disease characterized by compulsive use, loss of control, and negative emotional states when not drinking A condition only affecting individuals with no family history of alcohol use
 
2)

Approximately how many deaths worldwide are attributed each year to drug use disorders?
 
60,000 600,000 6 million 60 million
 
3)

In the U.S., about how many Americans ages 12 and older met criteria for Alcohol Use Disorder in the past year according to the 2023 NSDUH?
 
2.9 million 10.2 million 28.9 million 105 million
 
4)

Which of the following is a common co-morbid condition that frequently complicates treatment for individuals with substance use disorders?
 
Common cold Diabetes Depression and anxiety Osteoporosis
 
5)

What is one major societal consequence of high rates of drug use in neighborhoods?
 
Increased tourism and economic growth Homelessness and strained social services Improved community engagement Higher property values
 
6)

Approximately how much does alcohol misuse alone cost the U.S. economy each year?
 
$7.4 billion $74 billion $249 billion $2.49 trillion
 
7)

Where was the earliest evidence of fermented beverage production discovered, dating back to around 7000 BCE?
 
Mesopotamia Ancient Egypt Jiahu, China Indus Valley
 
8)

Which ancient civilization worshipped Ninkasi, the goddess of brewing?
 
Ancient Greece Sumerians (Mesopotamia) Romans Egyptians
 
9)

What action did the Roman Senate take in 186 BCE due to concerns about public disorder from Bacchanalian cults?
 
Legalized unrestricted wine trade Built state-run taverns Issued the Senatus consultum de Bacchanalibus restricting gatherings Established a wine tax for citizens
 
10)

What public health crisis did London experience between 1695 and 1751 due to cheap, adulterated spirits?
 
The Gin Craze The Whiskey Rebellion The Rum Riot The Absinthe Epidemic
 
11)

Which 19th-century movement emphasized peer support and storytelling, resembling early 12-step principles?
 
The American Temperance Society The Women’s Christian Temperance Union (WCTU) The Washingtonian Movement The Sons of Liberty
 
12)

What U.S. law enforced the national ban on alcoholic beverages after the 18th Amendment was ratified?
 
Harrison Act Sherman Antitrust Act Civil Rights Act Volstead Act
 
13)

Which brain pathway did neurobiological research identify as being altered by chronic substance use, supporting the disease model of addiction?
 
Cerebellar motor pathway Mesolimbic dopamine pathway Hypothalamic–pituitary axis Reticular activating system
 
14)

What was one major unintended consequence of the U.S. “War on Drugs” policies of the 1970s and 1980s?
 
Decline in drug trafficking cartels Reduced incarceration rates Mass incarceration, disproportionately affecting communities of color Elimination of opioid misuse
 
15)

Which country decriminalized personal possession of all drugs in 2001 and redirected users toward treatment rather than incarceration?
 
Netherlands Switzerland Portugal Canada
 
16)

What do family, twin, and adoption studies suggest about the heritability of substance use disorders?
 
Heritability estimates range from 40% to 60% for alcohol and many drugs There is no evidence of genetic influence on addiction Heritability is less than 5% for most substances Adoption completely eliminates genetic vulnerability
 
17)

Which gene has been most studied for its role in addiction due to its link with dopamine receptor density?
 
DRD2 (dopamine D2 receptor gene) ACTH (adrenocorticotropic hormone gene) APOE (apolipoprotein E gene) HBB (hemoglobin beta gene)
 
18)

What role does the extended amygdala play in addiction and relapse?
 
It enhances memory recall for substance-related cues It improves impulse control under stress It reduces withdrawal symptoms and cravings It becomes overactive during withdrawal, creating stress and emotional dysregulation that drive relapse
 
19)

According to cognitive-behavioral theories, what often drives the cycle of substance use?
 
Distorted thoughts and learned behavioral patterns that link substances with relief Purely genetic predisposition and neurochemical imbalance A lack of access to substances in the environment Random chance and coincidence
 
20)

In the CBT model of addiction, which step follows a distorted thought such as ‘One drink won’t hurt’?
 
Trigger Thought Consequence Recovery
 
21)

What was Lena’s core belief in the vignette that fueled her reinforcement cycle of drinking wine?
 
Drinking will make me popular. Wine helps me work faster. I can’t relax without a glass of wine. Alcohol improves my creativity.
 
22)

From a psychodynamic perspective, addiction is best understood as:
 
An attempt to soothe unresolved inner conflicts and unmet emotional needs A conscious decision to maximize pleasure at all costs A behavior entirely caused by faulty brain chemistry A simple habit with no deeper meaning
 
23)

According to Khantzian’s Self-Medication Hypothesis, what motivates people to choose specific substances?
 
They use substances as tools to manage unbearable emotional states such as anger, anxiety, or depression They randomly experiment with drugs without any underlying reason They choose substances strictly based on cultural availability They are motivated solely by social pressure from peers
 
24)

In the casevignette, why did Anthony rely on alcohol for many years?
 
He enjoyed the taste and variety of alcoholic drinks He wanted to fit in with friends at social gatherings It was the only tool he knew to calm the deep anxiety wired into him from childhood experiences He believed alcohol improved his work productivity
 
25)

From an object relations perspective, what do substances often function as for people with early attachment wounds?
 
A chemical enhancer of productivity A tool for peer acceptance and social status A way to improve memory and concentration A surrogate attachment figure providing the illusion of safety and consistency
 
26)

In the case vignette, why did Samantha describe alcohol as feeling like ‘a friend waiting for me at the end of the day’?
 
It gave her more energy for work tasks It symbolized the dependable comfort and stability she never fully received from her caregivers It helped her feel more socially confident at parties It increased her ability to concentrate on legal cases
 
27)

Which concept from learning theory best explains why Mark experienced intense cravings when passing the pub after work on Friday nights?
 
Operant conditioning Observational learning Classical conditioning Social reinforcement
 
28)

According to Bandura’s Social Learning Theory, how do many people first learn about substance use?
 
By reading medical pamphlets in school Through random experimentation without influence By observing family members, peers, or cultural role models using substances By studying clinical research about addiction
 
29)

How can clinicians apply Social Learning Theory in recovery work?
 
By encouraging clients to observe and imitate positive role models in therapy, peer groups, or communities By removing clients from all forms of social contact By focusing only on genetic explanations of addiction By ignoring cultural influences on behavior
 
30)

In Jordan’s case vignette, what was the main reason he started drinking?
 
He enjoyed the bitter taste of beer He wanted to improve his school performance He wanted to feel a sense of belonging with his peer group He was pressured by his parents to drink at home
 
31)

From a family systems perspective, addiction is best understood as:
 
Part of the larger emotional ecosystem of the family, affecting and being affected by all members A problem that belongs solely to the individual who uses substances A random event unrelated to family dynamics A behavior determined only by cultural norms outside the home
 
32)

In addicted families, what role is typically characterized by perfectionism, overachievement, and fear of failure?
 
Mascot Hero Scapegoat Lost Child
 
33)

What is meant by the term “intergenerational transmission” in the context of addiction?
 
The biological passing of addiction through DNA alone A cultural phenomenon that only affects grandparents The way substance misuse, trauma, and coping strategies are passed down through family patterns across generations A process where recovery cannot influence future family members
 
34)

Why do many adolescents or young adults begin using substances in peer settings?
 
Because they are biologically more addicted than older adults Because they enjoy the bitter taste of alcohol or drugs Because they want to belong, fit in, and share in what others seem to enjoy Because health classes encourage experimentation
 
35)

Which major change did DSM-5 (2013) introduce regarding substance use disorders?
 
It eliminated craving as a diagnostic feature It kept abuse and dependence as separate diagnoses It removed severity levels from diagnoses It unified abuse and dependence into one diagnosis—Substance Use Disorder—measured on a continuum of severity
 
36)

Which of the following is an example of an intervention targeting perceived norms around substance use?
 
Mentorship programs Refusal skills training Social norms media campaigns Genetic counseling
 
37)

According to sociocultural theories, what makes cultural messages so influential in shaping substance use?
 
They are consciously ignored by most individuals They only affect adolescents, not adults They teach people what is considered “normal,” acceptable, or taboo regarding substance use They are limited only to television advertisements
 
38)

In cultures where heavy episodic drinking is tolerated or celebrated, how might individuals who drink heavily perceive their behavior?
 
As shameful and abnormal As sociable, affirming, or even a source of cultural pride As medically irresponsible As unrelated to their identity or community
 
39)

What effect do higher alcohol taxes typically have on consumption, especially among young people?
 
They decrease overall consumption They increase consumption by making alcohol seem more valuable They have no measurable impact on drinking behavior They only affect older adults with steady income
 
40)

What is the primary difference in focus between the DSM-5-TR and ICD-11?
 
The DSM-5-TR is used internationally, while ICD-11 is used only in the U.S. The DSM-5-TR provides a detailed, clinically focused picture for U.S. practice, while ICD-11 emphasizes accessibility across cultures and global health systems The DSM-5-TR applies only to adolescents, while ICD-11 applies only to adults ICD-11 eliminates substance-related diagnoses altogether
 
41)

How did the DSM-5-TR change the way substance problems are categorized compared to earlier editions?
 
It eliminated all diagnostic labels related to substance use It divided people more strictly into abuse versus dependence It replaced ‘abuse’ and ‘dependence’ with a single diagnosis: Substance Use Disorder, measured on a continuum of severity It reduced all categories to one general “addictive disorder” without criteria
 
42)

According to DSM-5-TR, how many symptoms must be present within a 12-month period to diagnose a mild substance use disorder?
 
2–3 symptoms 4–5 symptoms 6 or more symptoms Only 1 symptom is required
 
43)

How did the DSM-I (1952) and DSM-II (1968) describe substance-related problems?
 
As clearly defined medical conditions with operational criteria As primarily neurological disorders with precise thresholds As vague “addictions,” “habit disturbances,” or “drug dependence,” reflecting stigma and limited science As spectrum-based disorders with severity levels
 
44)

What was the key innovation of the DSM-III (1980) in diagnosing substance use?
 
It eliminated all diagnostic categories for substance use It merged abuse and dependence into one unified diagnosis It introduced operationalized criteria distinguishing substance abuse from substance dependence It classified addiction solely as a personality disorder
 
45)

Approaches in motivational interviewing include all of the following, except:
 
Focus on client strengths Individualized and person-centered treatment Labeling clients as “addicts” or “alcoholics” Use of empathy, not authority and power
 
46)

Why are structured interviews like the SCID-5 valuable in assessing substance use disorders?
 
They prevent clients from exaggerating symptoms They guarantee a faster diagnosis every time They ensure consistency across clients and help clinicians avoid overlooking important details They replace the need for clinical judgment entirely
 
47)

In Carlos’s vignette, what was the significance of using both the AUDIT and DAST-10 screeners?
 
They showed he had no problems with alcohol or drugs They were used mainly to confirm what Carlos initially reported They allowed the counselor to avoid asking direct questions about use They revealed patterns Carlos minimized at first, showing the value of screening for all substances
 
48)

What is one advantage of dual coding a client’s diagnosis in both DSM-5-TR and ICD-11 formats?
 
It ensures clarity and continuity of care if records are shared across countries or health systems It avoids the need for documenting functional impacts of substance use It eliminates the possibility of insurance denials altogether It guarantees that treatment will always be fully covered by insurance
 
49)

What does the term “comorbidity” (or dual diagnosis) mean in the context of substance use disorders?
 
A person who has relapsed multiple times after treatment A person who meets criteria for both a substance use disorder and another psychiatric condition A person who has switched from one substance to another A person who experiences withdrawal without tolerance
 
50)

Approximately how many U.S. adults experienced both a mental illness and a substance use disorder in 2022?
 
5.5 million 10.2 million 21.5 million 40 million
 
51)

Why is integrated care (treating both conditions together) recommended for clients with comorbidity?
 
It guarantees sobriety within three months It avoids the need for any psychiatric medication Because treating only one condition (SUD or mental illness) often fails, while integrated care leads to far better outcomes Because it eliminates the need for relapse prevention strategies
 
52)

How can clinicians distinguish between primary depression and substance-induced depression in clients with both conditions?
 
By testing only family history of depression By assuming all depressive symptoms are caused by substance use By checking for tolerance and withdrawal symptoms only By examining the timeline—whether depressive symptoms began before substance use and persist after 4–6 weeks of sobriety
 
53)

What treatment risk must medical personnel be cautious about when prescribing benzodiazepines to clients with anxiety disorders and SUDs?
 
They may permanently cure anxiety within a few weeks They have no effect on panic symptoms They carry a high risk of dependence and can worsen the cycle of anxiety and withdrawal They are ineffective for any short-term anxiety relief
 
54)

Why do PTSD and substance use so often co-occur?
 
Because substances provide temporary relief from trauma symptoms but ultimately worsen them through disrupted sleep, tolerance, and withdrawal Because trauma memories are permanently erased when substances are used Because PTSD prevents the body from metabolizing alcohol and drugs Because PTSD clients universally prefer substances to therapy
 
55)

Why is diagnosing bipolar disorder with co-occurring substance use often difficult for clinicians?
 
Because bipolar disorder is unrelated to substance effects Because clients rarely use substances during manic or depressive episodes Because substance effects (e.g., cocaine intoxication, alcohol withdrawal) can mimic mood episodes Because bipolar disorder has no overlapping symptoms with SUDs
 
56)

What is the first priority in treating clients with both bipolar disorder and substance use disorder?
 
Eliminating all substances before addressing mood symptoms Stabilizing mood with medications such as lithium, valproate, or atypical antipsychotics Beginning with antidepressant monotherapy Focusing only on sleep hygiene while deferring medication
 
57)

How can clinicians distinguish substance-induced psychosis from schizophrenia-spectrum disorders?
 
By focusing only on family history of psychosis By assuming all psychotic symptoms are due to substances By mapping the timeline—substance-induced psychosis clears when the drug leaves the system, while schizophrenia-spectrum symptoms persist during abstinence By prescribing benzodiazepines immediately without assessment
 
58)

What happens to the risk of substance use disorder (SUD) when ADHD is left untreated?
 
It goes down over time It remains the same as in the general population It rises sharply, as clients may self-medicate with substances It disappears once adolescence ends
 
59)

Which ADHD medication approach is preferred when substance misuse risk is high?
 
High-dose short-acting stimulants Herbal supplements only Non-stimulants such as atomoxetine, bupropion, or guanfacine No medication of any kind
 
60)

Which therapy is specifically adapted for clients with both borderline personality disorder (BPD) and substance use?
 
Cognitive Processing Therapy (CPT) Prolonged Exposure Therapy (PE) Dialectical Behavior Therapy for Substance Use Disorders (DBT-S) Psychoanalysis
 
61)

What dangerous trend sometimes occurs in young adults with eating disorders?
 
`Drunkorexia`—restricting food intake to offset calories from alcohol Eating more to balance alcohol metabolism Exclusively drinking water before parties Avoiding alcohol completely
 
62)

Which treatment is considered the gold standard for chronic insomnia in clients with substance use history?
 
Long-term benzodiazepine therapy Herbal teas and supplements only Cognitive Behavioral Therapy for Insomnia (CBT-I) Hypnosis alone
 
63)

Why is suicide assessment essential in substance use disorder treatment?
 
Because substances permanently cure suicidality Because suicide is unrelated to addiction Because suicide risk is low in addiction clients Because intoxication and withdrawal both heighten impulsivity, despair, and risk of acting on lethal thoughts
 
64)

Which brain structure is most directly responsible for self-control and decision-making, and is impaired by chronic substance use?
 
Hippocampus Amygdala Prefrontal cortex (PFC) Cerebellum
 
65)

Why does stress often trigger relapse in people with substance use disorders?
 
Stress improves prefrontal cortex function The amygdala becomes sensitized, reactivating emotional triggers and cravings Stress erases hippocampal memories of substance use Stress prevents neurotransmitter release
 
66)

Which brain region explains why environmental cues—like the smell of a bar—can spark cravings even years later?
 
Prefrontal cortex Amygdala Thalamus Hippocampus
 
67)

Long-term alcohol use can damage prefrontal circuits, leading to which common difficulty?
 
Improved multitasking and focus Enhanced creativity and emotional stability Increased appetite and weight gain Impairments in planning, decision-making, and impulse contro
 
68)

Neuroimaging studies from 2023–2025 consistently show what about individuals with a history of substance use?
 
Their brain structures reset completely after 30 days of abstinence Persistent disruptions in reward circuitry and reduced prefrontal activation Increased hippocampal growth and enhanced memory recall Elimination of emotional dysregulation after one year of sobriety
 
69)

Which DSM-5-TR alcohol use disorder criterion is illustrated by Maria’s repeated pattern of drinking more and longer than she intended?
 
Craving, or a strong desire to use alcohol Recurrent use in hazardous situations Alcohol is often taken in larger amounts or over a longer period than was intended Withdrawal
 
70)

David repeatedly tries to limit his alcohol use to weekends but fails. Which diagnostic criterion does his story best represent?
 
Failure to fulfill major role obligations Persistent desire or unsuccessful efforts to cut down or control alcohol use Spending a great deal of time using or recovering from alcohol Craving
 
71)

Samantha plans her weekends around drinking, with alcohol dominating both her activities and recovery time. Which criterion does this demonstrate?
 
Withdrawal symptoms relieved by alcohol Tolerance Craving A great deal of time is spent in activities necessary to obtain, use, or recover from alcohol
 
72)

Globally, harmful alcohol use accounts for how many deaths each year, according to WHO (2023)?
 
300,000 deaths 1 million deaths More than 3 million deaths 500,000 deaths
 
73)

Why are adolescents and young adults at particularly high risk for alcohol-related harms?
 
They metabolize alcohol faster than adults Their brains—especially the frontal lobes—are still developing, reducing judgment and impulse control They usually drink more expensive alcohol Alcohol advertising is banned for this age group
 
74)

Compared to men, women face sharper health consequences from alcohol at lower levels of drinking because:
 
They consume alcohol with fewer meals They lack alcohol dehydrogenase completely They have lower body water content and hormonal differences, leading to higher alcohol concentration They typically binge drink less often
 
75)

Why are screening tools like the AUDIT, CAGE, and MAST considered essential in detecting alcohol misuse?
 
Because alcohol problems are always visible without structured tools Because most people voluntarily disclose their drinking habits accurately Because alcohol misuse often hides behind social norms and requires structured, evidence-based questions Because they are legally required in all medical visits
 
76)

What is one limitation of the CAGE screening tool identified in recent studies (2023–2024)?
 
It produces too many false positives in older adults It may miss hazardous drinking in younger adults who binge but don’t yet feel guilt or need morning drinks It is no longer valid in any setting It requires 50 questions to administer
 
77)

Why does the MAST remain especially useful in older adults compared to newer screening tools?
 
It is shorter than the AUDIT or CAGE It is required by Medicare for all seniors It asks more questions about physical health symptoms It focuses on social consequences, which often reveal alcohol-related problems in geriatric populations
 
78)

Which receptor do opioids primarily bind to in order to relieve pain and create euphoria?
 
Dopamine receptors Serotonin receptors GABA receptors Mu-opioid receptors
 
79)

According to the CDC (2024), fentanyl is now implicated in what percentage of opioid overdose deaths in the United States?
 
About 25% Around 40% Nearly 55% More than 70%
 
80)

What primary brain systems do stimulants like cocaine, methamphetamine, and prescription amphetamines activate?
 
Dopamine and norepinephrine Endorphin and acetylcholine Histamine and glutamate Serotonin and GABA