NCAC II, NCAC I Exam, NCAC I
Pharmacology, NCAC Practice Test -
Momentix Book, Alcoholics Anonymous
(AA)
Study Guide from Modules I-III
Family
... [Show More] Structure - ANS-Alcoholic marries an enabler, the first child is the Hero... they
are usually perfect "see we are good" The second child is the scapegoat and can do no
right. Then is the lost child. If they have another that child is the mascot.
Lost Child - ANS-Most likely to commit suicide
Epinephrine/NE - ANS-*Body's natural stimulant
*responsible for anxiety and fear, anger, hostility & violence
*Instinctual fight or flight
*predominant neurotransmitter in brain
*affected by cocaine and amphetamines
Serotonin - ANS-*responsible for calmness and sleep, appetite, some memories
*responsible for some types of depression
*offsets the effects of E/NE
*affected by cocaine and amphetimines
GABA - ANS-*Natural anti-anxiety, anti-convulsant.
*Helps cope with stressful situations
*affected by etoh, benzo, barbs
Endorphins - ANS-*body's natural pain killer
*brain does not distinguish between physical, emotional & spiritual pain. In all instances
endorphins are released
*More pain receptor sites than pleasure receptor sites.
* We remember painful events more vividly our our brains are designed to avoid these
situations.
*Increase in endorphins vis exercise, laughter, meditations, sleep, food, healthy
relationships/sex & music
*Affected by opiates, soma & etoh
Dynorphin - ANS-Form of endorphin that is released at childbirth. 700x stronger than
morphine. Helps offset fatigue, forget the intensity of the pain, bonds mother and child.
Acetylcholine - ANS-*Memory, Movement, Motivation, New Learning (learning in
general)
*Depletion results in alzheimers symptoms
*Affected by THC
Anandamide - ANS-Similar to aceylcholine.
*Memory, New Learning specific, calmness, controlling movement
*Affected by THC
Glutamate - ANS-*Memory
*Duck tape of the brain... regenerates and mimics other neurotransmitters to fill the
gaps for the ones that have been damaged
*Anti Convulsant
Dopamine - ANS-*Pleasure (located in the pleasure pathway)
*every drug mimics or releases dopamine
*cocaine and other stimulates actually block the re-uptake of dopamine so that it
increases the dopamine response
*etoh & opiates enhance dopamine release that would otherwise block/inhibit dopamine
secreting neurons.
*Schizophrenia is noted to be too much dopamine in the brain
*too few dopamines mimic parkinsons
*Affected by all drugs but mostly meth.
Methamphetimine high - ANS-most resembles schizophrenia
Meth withdrawal - ANS-mimics parkinsons
Meth results in the release of so much dopamine - ANS-that it can take YEARS for the
person to learn to feel pleasure again.
PIP (phenylimide Indoleamine Pyrimidine) - ANS-*responsible for feeling of true
care/love
*affects various parts of the brain at one time
*decreases after about 3 years bc the brain cannot sustain the same level of intensity.
The passion sorta burns out.
*PIP changes to endorphins after decades in a relationship
Adverse Effects of substances are usually seen - ANS-in those with ADHD or Bipolar w
Korsacoff Wenicke Syndrome - ANS-After prolonged alcohol abuse, the person is
unable to walk steadily (like walking in sand), eyes twitch back and forth
State Dependent Learning - ANS-Learn when high on THC, does not remember when
sober, does remember when under the influence of THC later.
Pharmacology - ANS-Branch of science that examines how psychoactive substances
taken to alter bodily functions or enhance bodily functions interact with the brain and
body
Psychoactive Substance - ANS-any drug that affects the CNS and alters consciousness
and or perceptions
physiological effects - ANS-physical signs
psychological effects - ANS-alterations in perception or judgment caused by substance.
chemical interaction - ANS-physiological and psychological effects of 2 or more
substances administered at the same time
withdrawal - ANS-signs and symptoms that occur when an indiv that is physically
dependent on a substance discontinues its use.
treatment applications - ANS-method of detox, stabilization & maintenance
tolerance - ANS-after repeated admin. a given dose of a substance produces a
decreased effect or conversely with increased/larger doses must be administered to get
the effect observed with the original dose
dependence - ANS-known as addictions, a behavioral pattern of compulsive substance
use characterized by consistent involvement with the use of a substance, securing of its
supply and a high tendency to relapse after withdrawal.
detoxification - ANS-eliminating the substance from your body
*The first step in sobriety and treatment
Levels of Psychoactive Substance Use - ANS-Recreational- Circumstantial-Intensified
Use- cCompulsive Use
cross tolerance - ANS-the ability of pharmacologically similar substances to substitute
for one another in relation to tolerance and prevention of withdrawal (ie using
hydrocodone when heroin isn't available)
Schedule I - ANS-No medical Use, cannot be dispensed by a prescriber. Severe
dependence, high potential for abuse
Schedule II - ANS-Severe dependence, high potential for abuse.
Some accepted medical use, but with severe restrictions
Schedule III - ANS-Moderate or low physical dependence OR high psychological
dependence. Moderate potential for abuse
Has accepted medical uses and can be dispensed by authorized prescriber
Schedule IV - ANS-Limited physical or psychological dependence. Low abuse potential.
accepted medical use.
Schedule V - ANS-limited dependence, very low potential for abuse, medcial use
Methods of Administration - ANS-*orally (inhale or ingested)
*nasally (longest acting)
*IM
*IV (most instense)
*subcutaneously
*topically
*sublingually
*rectally
Blood Brain Barrier - ANS-series of cells that prevent certain chemicals from reaching
the brain
metabolites - ANS-by-product of the liver breaking substances down that can be
eliminated
metabolism - ANS-body getting rid of the substance. elimination
CNS - ANS-brain and spinal cord
PNS - ANS-all neurons outside the CNS
CNS is made of - ANS-Reticular Activating System: Awake/Asleep
Limbic System: feelings
Basal Ganglia: fine motor skills
Limbic System is made of - ANS-Cerebral Cortex: voluntary motor skills, sensory input
Hypothalamus: Liaison between CNS & PNS
PNS is - ANS-the Autonomic Nervous System (unconscious bodily functions) which is
sympathetic nervous system *increases breathing, etc) and parasympathetic
(decreases)
Neurotransmitters are either - ANS-inhibitory or excitatory
Agonist - ANS-psychoactive substance binds to neurons and elicits a reaction as if it
were a neurotransmittor
Antagonist - ANS-substance binds and prevents other neurotransmitters form binding to
that neuron
CNS depressants - ANS-Alcohol, barbituates, benzos
Short term effects of depressants - ANS-impaired coordination, slurred speech,
staggered gait, drowsiness, muscle relaxation, slowing of breath, slowing of HR,
dizziness, sedation, loss of memory, euphoria, impaired judgement, decreased
inhibition, decreased fear, confusion, irritability, paranoia,
Pathological Intoxication - ANS-Unusual reaction to depressants. The person becomes
agitated and belligerent after only small doses
habituation - ANS-repetition of behaviors until hey are a habit.
Legal limit of alcohol in 21+ in most states - ANS-.08
Toxic alcohol levels - ANS-.4
Cirrhosis - ANS-swollen, scarred or dead liver tissue
Stages of alcohol dependence - ANS-Early: escaping from social situations, sneaking to
drink, feelings of guilt, difficulty stopping & preoccupation
Middle: Loss of control, impaired social relationships, changes in drinking patterns, temp
sobriety, morning drinking, neglect of health needs.
Late: drink in order to function, binges, withdrawal sx, blackouts, etc
Alcohol must be detoxed - ANS-under medical supervision due to risk of seizures. Often
given Librium.
Alcohol Withdrawal - ANS-Stage 1: Tremors 24-36 hr after last drink, irritability, nausea,
vomiting, slurred speech, jitters, tremors. 90% of alcohol dependent people experience
Stage 2: Hallucinations distorted perceptions occur in 25%
Stage 3: Wdrawal Seizures Grand Mal, 7-48hr after last drink, peak is 13-24 hr. 1/3 of
clients experience
Stage 4: DT Confusion, delusions, hallucinations, severe agitation, tachycardia, dilated
pupil, fever, 3-5 days after drinking, 15% fatality rate. Lasts 72 hours or less in 80%
Pharmacotherapy - ANS-Medications prescribed to treat SUD
Anesthetic - ANS-sub used to induce a controlled state of unconsciousness
Analgesic - ANS-sub used to relieve pain
Barbituates paired with etoh - ANS-exacerbated effects due to potentiation
Benzo - ANS-*tolerance develops QUICKLY, within 1-3 weeks, but does not develop to
the anti-anxiety effects. Dependence is likely if used over 4 months, 80-85% who take
over 2 years.
*medical detox due to risk of seizures
Stimulants include - ANS-amphetamines, cocaine, caffeine, nicotine
Potency of stimulants - ANS-1. Cocaine
2 Meth
3 Dexedrine
4 amphetamine
5 ritalin
6 caffeine
7 nicotine
Amphetamines use outside of adhd - ANS-often for weight loss
Meth is - ANS-schedule II
Reverse Tolerence - ANS-when a psychoactive substance produces an enhanced
response to a smaller dose than the original. Seen in amphetamines
You can withdraw from Amphetamines after the first use - ANS-even without
dependence. Tx includes some antidepressants
Cocaine Overdose - ANS-1) vomit, headache, cold sweats, muscle twitches
2) convulsions, rapid gasping breaths, decreased blood pressure
3) dilated pupils, paralyzed, unable to breath, cardiac arrest and death
*no medicinal treatment to counter the overdose
Cocaine Withdrawal phases - ANS-1. crash- depression, anxiety, exhaustion, cravings
2. hypersomnia, decreased att span, poor recall, increased appetite, muscle twitching
3. intense cravings marked by reduction to enjoy life and pleasure
*meds that help; Provigil, symmetrel, parlodel, tofranil, norpramin
Alcohol and cocaine are often combined - ANS-VERY dangerous. Produces
cocaethylene
Caffiene - ANS-Xanthines: naturally occurring stimulants. includes caffeine, theophylline
(tea) and theobromine (chocolate)
Caffienism - ANS-over 650mg of caffeine- 5 cups of coffee
Tobacco withdrawl - ANS-coughing, lack of concentration, dizziness, fatigue,
nervousness, stomach issues, throat problems, sleep disturbance, skin issues, mood
alterations.
Narcotics - ANS-Opioids and Opiates
Opiates - ANS-opium, morphine, codeine
Opioids - ANS-synthetic opiates- demeral, hydros, oxys, etc
Heroin Long Term effects - ANS-increased risk of infection, pneumonia, irregular levels
of sex hormones, asthma & bronchial infections, liver disease, collapsed veins,
abnormal cortisol levels, chronic constipation, etc
OVERDOSE ON HEROIN - ANS-is imminent- especially with the way it is being cut with
fentanyl
needle freaks - ANS-people psychologically dependent on heroin, not physiological
Treatment for heroin - ANS-Ovedose: Narcan (naloxone)
Antagonists: Naloxone, Naltrexone
Use of vivitrol- which is naltrexone
Therapeutic Communities (NA, etc) - ANS-are being used in the criminal justice field in
the treatment of heroin addicts.
Speed Balling - ANS-Combining Heroin with a stimulant like cocaine. Very dangerous.
Causes heart to give out.
LAAM - ANS-old school treatment of opiate addiction. Not used now due to the abuse
ability. every 3 or so days.
Methadone - ANS-detox is harder than that of the actual opiate. daily basis.
Buprenorhine - ANS-suboxone, subutext,
Fentanyl and Demerol - ANS-causing major public health concern
Hallucinogens - ANS-LSD, MDMA, Shrooms, PCP, peyote, etc
Bad Trip - ANS-Can include anxiety attacks, depressive episodes, and psychotic breaks
that resemble schizophrenia. Can last for days especially with PCP
PCP - ANS-can be physically dependent. All others are psychological only. Many claim
this is the most dangerous drug ever to be abused.
LSD - ANS-starts in gastrointestinal tract
Lasts up to 12 hours
can cause permanent damage to the brain
flashbacks can be permanent
detox - ANS-Quiet room with little to no stimulation
MDMA - ANS-starts with a weird period that lasts about 30-60 min, then a rush period
for 20-30 min and the high period that last several hours.
Can be fatal due to dehydration, increased heart rate and decreased blood pressure
paired with high body temps
Cannabis - ANS-Marijuana (Schedule I) Hashish (Sched I) Marinol (Sched III)
Effects last 8-12 hours
Marijuana - ANS-potency ranges from .5 to 11%, street grade is about 3%.
Hashish - ANS-30%THC or more. European/Middle Eastern cannabis
Amotivation Syndrome - ANS-condition characterized by regular users of cannabis
being lethargic, lacking drive, being apathetic, etc
Inhalants - ANS-gases that are administered via breathing through mouth or nose
within 10 seconds they relax the muscles around the heart and brain.
Lipid soluble - can damage the brain quickly.
Solvents, Nitrites and Anesthetics have similar effects.
Can result in death due to respiratory asphyxia or heart arythmia
Steroids - ANS-anabolic- memic natural steroids
androgen- natural male hormones
Adlerian Psychology - ANS-*Individual Psychology. Goal directed.
*Everyone is striving to toward superiority and perfection. *Must learn how to handle
inferiority.
*Fictional Functioning imagined central goal that gives a client purpose or guides
behavior
*Lifestyle- clients chosen method on moving through life
*phenomenolgy- viewing the world from the client's perspective
*private logic- subjective reality as we view it
*Social Interest- an awareness of being part of the human community and how one
interacts with the social world
*The goal is to further develop the client's social interest and help them connect with the
social world in a more meaningful way.
Behavioral Therapy - ANS-Pavlov- Classical Conditioning (UCS = UCR, CS=CR)
Skinner- Operant Conditioning behavior is reinforced and learned by the consequences
of the bx
Bandura- Social Learning. Bx is learned by observing the consequences of other's
behavior
Human behavior is learned and can be unlearned
Applications:
Contingency Management: rewards are given for period of abstinence (chips)
Community Reinforcement: social circle reinforces healthy behavior
Assertion Training: Ct learns skill to resist negative influences and bx in life
Cue Exposure training: constantly exposed to triggers and cues
covert sensitization: client imagines himself using and immediately visualized worst
possible outcome.
aversion therapy: use is paired with unpleasant feeling such as electric shock or nausea
Brief Therapy - ANS-Shorter time period and fewer sessions. Good for those without
insurance, etc.
Stages:
Induction: ct makes decision to seek therapy and the clinician assesses the client's
willingness to change. Therapy matches motivation level
Alliance: Counselor forms an alliance with the ct. Clinician assesses impediments to
change and motivation to change as well as setting goals and doing tx plan and contract
Refocus/Change: working phase. every session is on task with homework, goal setting,
applying lessons, etc.
Termination/Homework: assist with relapse prevention. Set long term goals
Continuation/Follow up: check in or f/u apt for as long s homework is planned. make
sure that they are connected.
CBT - ANS-*Counseling that focuses simultaneously learning new behaviors and
restructuring automatic thoughts
*Used for depression, anxiety SUD, pain d/o and other disorders
*Ct can be assisted in recognizing and discarding selfdefeating behaviors, emotions, etc
*"What keeps them doing _____"
Client must have willingness to change for this method to work. there must be
commitment.
Gestalt - ANS-*Client gains awareness of their bx and learns how to accept personal
responsibility for those bx
*Based on existentialism- focus on present day and personal responsibility for ones own
destiny
*Contact is the procvess of interacting with nature & with other people without losing
one's sense of individuality.
* Uses empty chair method
By acknowledging the under dog and top dog they can work through the problems
Motivational Enhancement therapy (MET) - ANS-*method of counseling where the
client's internal motivation is the driving force for changing problem bx
*FRAMES (feedback, emphasis on personal responsibility, clear advice to change, a
menu of alternative, therapist empathy, facilitation of client self efficacy)
*Goes hand in hand with the stages of change
Used in arenas where sessions are infrequent
Stages of Change - ANS-Precontemplation, Contemplation, Preparation, Action,
Maintenance, Relapse
not considering treatment- casually considering treatment- makes decision to changebegins change- continued commitment- return to problem behavior
Person Centered Therapy - ANS-Carl Rogers
Approach to counseling where the client directs the treatment process bc she is capable
of invoking change within herself.
Based on humanism- the movement that focuses on the innate nature of all humans to
achieve our potential and find meaning in our lives
3 characteristics- congruence (match external bx with internal feelings / thoughts.
Unconditional positive regard (counselor shows the client constant acceptance and
caring) empathy (identify with & understand the subjective world of the client.
Decreases defensiveness and encourage openness. Explore inner secrets and issues
Psychoanalytical Therapy - ANS-FreudA deterministic method of counseling where the mental dysfunction results from internal
conflict and memory.
Human bx is largely influenced by internal drives.
We all have an unconscious mind that functions outside of our awareness. It is brought
to the conscious mind via the analysis of resistance.
3 components: Id (unconscious aggression and sex, the animal) Superego ( the
conscience) and Ego ( mediates for the other 2)
Defense Mechanisms stem from this theory.
Good with those who chronically relapse or have deep seeded personality issues.
Defense Mechanisms: - ANS-Denial- refusing to accept reality
Displacement- transferring a feeling about an unpleasant situation onto another
individual (grading wasn't' fair)
Projection- attributing unacceptable thoughts or feelings to another ind or object (she
only has friends bc of $)
Rationalization- hiding the true reason behind a bx or feeling but doing so in a self
serving way with incorrect explanations (I didn't run for president bc I didn't want to
upset you win I won)
Repression- blocking unpleasant experiences or thoughts from the conscious mind (I
don't remember that night...)
Sublimation- redirecting maladaptive bx into a socially accepted bx (I am sad so I will go
to lunch w a friend)
Rational Emotive Behavioral Therapy (REBT) - ANS-a method that focuses on changing
the problematic beliefs of an individual as a result of the events of his life
Events do not disturb people, their view of it does.
ABC ModelActivating Event - negative event in ones life
Belief- how a person thinks or feels about an activating event
Consequences- how an ind behaved based on the beliefs concerning the activating
event
Counselor should dispute and correct illogical beliefs
Targets thought distortions often associated with SUD
Reality Therapy/Control Theory - ANS-*method that focuses on how the client perceives
the external world & behaviors he exhibits fit those perceptions and needs
*it isn't important how the world really exists, only the client's perception of how it exists.
* basic principles- dev a therapeutic relationship, focus on current bx, ask client to eval
that bx, develop a plan for change, get commitment from client, accept 0 excuses, no
punishment, never give up on client.
*there are 4 components that guide our functioning (doing, thinking, feeling and
physiology)
*Success Identity- the place in therapy where the client has self worth is able to love
and be loved
Self Help Meetings - ANS-12 step, celebrate recovery, rational recovery, etc
Solution Based Therapy - ANS-primarily focuses on the problem, not the person.,
Utilization- where counselor uses previous successes to motivate change
Positive and self affirming, gets good results
Family Systems Counseling - ANS-SUD person has an enabler (provides
responsibility), a hero (provides self worth), scapegoat (provides focus), lost child
(provides relief) and a mascot (provides distraction)
Group Counseling - ANS-counseling with group members who have similar situations
and experiences. The effectiveness depends greatly on the effectiveness of the leader.
Qualities of a good leader- courage, stamina, self-awareness, openness, sense of
humor, belief in the process, caring/goodwill, abilty to be a role model, aware of cultural
perspectives and bias, maintain power posture, willingness to seek new experience,
commitment
Have an informed consent.
Stress confidentiality
Screening v Assessments - ANS-Screening tools are brief and determine basic
information, assessment goes further into the meat of things.
Develop an individualized treatment plan - ANS-this is based on the assessment toole
should have a problem statement, goal statement, measurable objectives, and include
strategies
Treatment Modalities - ANS-Indiv Counseling,
Group Counseling
Family or Systems Counseling,
Detox Tx
Inpatient- hospital style, 24 hr staff
Residential- 24 staff, medical on call
IOP-
OP- assessment/referral programs, education programs, Therapeutic community,
transitional programs,
Documentation - ANS-Make sure to complete progress notes on each visit. These
should include the personal account of the visit, and where the person is on the clinical
course and treatment plan goal
Progress Notes: DAP- data assessment plan or SOAP- subjective, objective
assessment plan
Referral - ANS-the proves of seeking assistance for an issues that is beyond the scope
of your practice. Can be for additional services or to replace you if there is a reason you
are ineffective
multidisciplinary team - ANS-a group of professionals that are all working on the client.
example would be the probation officer, dcs, dhs, and mental health provider
Coordination of care - ANS-collaboration between the client and the multidisciplinary
team
Relapse - ANS-The return to the use of the substance
*usually preceded by clear signs
*begins much earlier than actual use
*Usually due to lack of skills
*Often a reflexive and unconscious matter
*opportunity to learn from mistakes and alter the plan
Identify triggers!!!
Termination & Continuing Care - ANS-termination is when the client leaves treatment
and the relationship is severed.
continuing care plan- an individualized outline of how the ct will continue to receive
services and support
Ct Family and Community Ed - ANS-Prevention & Education
Addiction Counseling Qualities - ANS-Demonstrate warmth, genuineness, immediacy,
personal ability, and positive regard/respect
Clarification - ANS-ensure accuracy in understanding- "are you saying" "Could you
clarify that"
Paraphrasing - ANS-restatement- "I sense that.." "Sounds like..."
Reflection - ANS-identify feelings of the client and repeat them- "it is clear that you are
angry" "it seems like you are feeling..."
Summarization - ANS-tie together multiple elements
Listening Responses.... [Show Less]