Part 2 — Answer key

Compare your answers after you have finished Part 1.

1. Which wording is most person-first and stigma-reducing?
   A person with a substance use disorder
2. Finishing withdrawal management (detox) is usually enough for long-term recovery from a substance use disorder.
   False
3. What is naloxone used for?
   Reverse an opioid overdose
4. Tolerance means needing more of a substance to get the same effect.
   True
5. SAMHSA’s recovery framework is often summarized with four dimensions, which one is NOT one of them?
   Willpower
6. A friend finds someone unresponsive with slow or no breathing after using pills from an unknown source. What is naloxone designed to do?
   Reverse an opioid overdose
7. Someone takes a prescribed opioid as directed, but gets diarrhea, chills, and anxiety if they stop suddenly. What term best fits this situation?
   Physiologic dependence
8. Using “clean” and “dirty” to describe drug test results is neutral clinical language.
   False
9. Which outcome is most strongly associated with syringe services programs?
   Reduced HIV and hepatitis C transmission
10. A recovery coach helps someone find stable housing after leaving treatment. Which SAMHSA recovery dimension is this most directly supporting?
    Home
11. Methadone and buprenorphine are opioids, but they can be used therapeutically to treat opioid use disorder.
    True
12. After months without alcohol, someone has one drink at a wedding and stops there. What term best fits this event?
    A lapse
13. A negative drug test should be documented as “clean.”
    False
14. Distributing naloxone encourages people to use more opioids.
    False
15. Which description best matches how naltrexone helps in opioid use disorder treatment?
    Blocks opioid effects
16. A program helps people in recovery earn a certification and return to work. Which SAMHSA dimension is most directly supported?
    Purpose
17. Cravings often peak and pass even if you do not act on them.
    True
18. Which action best fits a harm reduction approach?
    Carry naloxone and learn how to use it
19. Withdrawal refers to the set of symptoms that can occur when a substance is reduced or stopped after the body has adapted to it.
    True
20. Someone who used to feel pain relief from 10 mg oxycodone now needs 20 mg for the same relief. What is this change called?
    Tolerance
21. SAMHSA describes recovery as a process of change, not a one-time event.
    True
22. A friend says they are not ready to stop using opioids but want to stay alive. What suggestion best fits harm reduction?
    Carry naloxone and teach others to use it
23. Which example is an internal trigger for return to use?
    Feeling lonely after work
24. A coworker says, “He’s an addict, he just doesn’t want it badly enough.” What reply best reduces stigma while staying accurate?
    “Substance use disorder is a treatable health condition, recovery is a process.”
25. A person can be physically dependent on a medication without having an addiction.
    True
26. Someone starts attending a recovery community organization (RCO) and builds sober friendships. Which SAMHSA dimension is most directly strengthened?
    Community
27. In relapse prevention, what does “urge surfing” mean?
    Noticing the urge, riding it out, and letting it pass
28. Harm reduction and abstinence are mutually exclusive goals.
    False
29. Which option best describes MOUD in evidence-based treatment for opioid use disorder?
    FDA-approved medications used as part of treatment, often alongside counseling and supports
30. After a lapse, what is usually the most recovery-supportive next step?
    Contact a support person and revisit the plan
31. Which phrase focuses on behavior and supports change, rather than labeling the person?
    They returned to use
32. Why is overdose risk often higher right after detox, hospitalization, or incarceration?
    Tolerance can drop quickly during abstinence
33. Person-first language is mainly about being polite, it has no impact on treatment engagement or stigma.
    False
34. Which example best reflects the SAMHSA principle that recovery is supported by peers and allies?
    Working with a peer recovery coach and building mutual support
35. Naltrexone is an opioid antagonist that blocks opioid effects.
    True
36. In an outpatient program, a clinician offers small gift cards when a person attends sessions and meets agreed-upon goals (like negative drug screens). What evidence-based approach is this?
    Contingency management
37. Someone says, “Methadone is just replacing one addiction with another.” Which response is most accurate?
    “MOUD may cause dependence, but it reduces cravings and overdose risk and supports functioning.”
38. Naloxone can trigger sudden withdrawal symptoms in someone who uses opioids regularly.
    True
39. A client has great medical follow-up and attends a mutual-help group, but is couch surfing and at risk of eviction. Which recovery dimension is most urgent to address?
    Home
40. A counselor asks for a written plan that lists personal triggers, early warning signs, coping strategies, and who to call for help. What is this document usually called?
    Relapse prevention plan
41. Starting buprenorphine too soon after using a full opioid agonist can make withdrawal feel suddenly worse.
    True
42. Someone returns to opioid use after three months of abstinence and wants to reduce overdose risk. Which step is most protective right away?
    Start with a much smaller test amount because tolerance has dropped
43. Which chart note is most stigma-aware and clinically precise?
    “Patient with opioid use disorder reports return to use, discuss safety and treatment options.”
44. After one use, someone thinks, “I blew it, so I might as well keep using.” What concept does this illustrate?
    Abstinence violation effect
45. Which option is NOT an example of harm reduction?
    Refuse care until the person is abstinent
46. A patient asks about starting naltrexone for opioid use disorder. Which point is most important to prevent immediate problems when starting it?
    You must be opioid-free for a period before starting
47. In relapse chain analysis, which situation is the best example of a “seemingly irrelevant decision” that increases risk?
    Stopping by your old using neighborhood “just to see what’s new”
48. Which plan best addresses all four SAMHSA recovery dimensions (Health, Home, Purpose, Community)?
    Therapy and medication, stable housing, job training, peer support group
49. Which rewrite keeps documentation accurate while avoiding stigma?
    “Patient returned to use, reassess risks and modify the treatment plan.”