Dental Hygiene Certification Board of Canada (NDHCB) Written Examination

Correct: Trauma-informed care integrates the understanding that early life stress, such as neglect, can cause permanent alterations in the HPA axis and the brain’s reward circuitry. This neurobiological shift makes the individual more reactive to stress and less able to experience natural rewards, leading to substance use as a way to self-medicate or stabilize their internal state. By acknowledging this link, the counselor can better address the root causes of the addiction.

Incorrect: Focusing solely on genetics ignores the profound impact of environmental trauma on brain development and the HPA axis. High-pressure or confrontational interviews can trigger a fight or flight response and are contrary to the safety and empowerment principles of trauma-informed care. While withdrawal may be present, ignoring the trauma-related hypervigilance misses a critical component of the client’s clinical presentation and neurobiology, potentially leading to an incomplete treatment plan.

Takeaway: Effective trauma-informed counseling links neurobiological dysregulation, such as HPA axis sensitivity, to the client’s reliance on substances for emotional regulation.

Correct: In trauma-informed care, the immediate priority when a client shows signs of distress or dissociation is to re-establish safety and grounding. Validating the client’s experience and providing them with autonomy (choice) over the session’s direction prevents the feeling of being trapped or forced, which is central to avoiding re-traumatization. This approach aligns with the core principles of safety, trustworthiness, and empowerment.

Incorrect: Encouraging the client to continue the narrative while they are in a state of distress or dissociation can lead to further psychological harm and reinforces the lack of control associated with the original trauma. Transitioning to a rigid screening tool like the AUDIT prioritizes administrative data over the client’s immediate clinical needs and emotional safety. While providing neurobiological education is a valid therapeutic technique, it is inappropriate as an immediate intervention for a client who is currently experiencing a traumatic stress response and needs grounding.

Takeaway: Trauma-informed assessment prioritizes the client’s immediate emotional safety and autonomy over the completion of a historical narrative or diagnostic checklist.

Correct: Trauma-informed care (TIC) is the gold standard in addiction counseling due to the high prevalence of trauma among individuals with substance use disorders. This approach involves realizing the widespread impact of trauma, recognizing signs and symptoms in clients, and responding by integrating this knowledge into all clinical interactions. By prioritizing safety, trustworthiness, and choice, the counselor creates an environment that reduces the risk of re-traumatization and fosters a stronger therapeutic alliance, which is critical for clients with complex histories.

Incorrect: Postponing trauma inquiry for a fixed period of abstinence is a common misconception; while deep trauma processing may require stability, a trauma-informed assessment must acknowledge trauma early to provide appropriate support. Focusing exclusively on neurobiology ignores the significant role that environmental and psychological stressors play in addiction etiology. Using direct confrontation is an outdated and potentially harmful technique that can trigger a ‘fight or flight’ response in trauma survivors, further damaging the therapeutic relationship and increasing the likelihood of treatment dropout.

Takeaway: A trauma-informed approach is essential in addiction counseling to ensure client safety and prevent re-traumatization, given the high correlation between traumatic experiences and substance use disorders.

Correct: The standard of care for benzodiazepine withdrawal is a gradual taper, often substituting a short-acting agent like alprazolam with a long-acting agent like diazepam or chlordiazepoxide. This approach maintains more stable blood levels and prevents the sudden drop in GABAergic tone that leads to life-threatening seizures and autonomic instability.

Incorrect: Selective serotonin reuptake inhibitors do not address the physiological risk of seizures or the GABA-related neuroadaptation associated with benzodiazepine withdrawal. Using short-acting benzodiazepines on an as-needed basis creates unstable plasma concentrations, which can exacerbate withdrawal symptoms and increase seizure risk. Opioid antagonists have no pharmacological effect on benzodiazepine receptors and would be ineffective in this clinical scenario.

Takeaway: The primary clinical priority in benzodiazepine withdrawal is the prevention of seizures through a controlled, gradual taper using long-acting medications.

Correct: Naltrexone is primarily metabolized by the liver. While it is an effective medication for reducing cravings and the rewarding effects of alcohol, it carries a risk of dose-related hepatotoxicity. Clinical guidelines for addiction counselors and medical staff require monitoring liver enzymes (LFTs) and observing for adverse reactions like severe nausea or jaundice to ensure the client’s physiological safety during the course of treatment.

Incorrect: Supervised dosing is a standard for Schedule II substances like methadone in Opioid Treatment Programs but is not the standard of care for Naltrexone. Medication-Assisted Treatment is intended to be used in conjunction with therapy, not as a replacement for it, so assuming therapy can be eliminated is clinically unsound. Naltrexone works by blocking opioid receptors to reduce the ‘high’ from alcohol; it is not an aversive agent like Disulfiram, so adjusting dosage to create a physical aversion is a misunderstanding of the drug’s neurobiology.

Takeaway: Effective monitoring of Medication-Assisted Treatment requires balancing subjective client reports with objective physiological data, such as liver function tests, to manage potential adverse reactions.

Correct: Bipolar I Disorder, particularly during manic or hypomanic episodes, is characterized by heightened impulsivity, impaired judgment, and grandiosity. In the context of a co-occurring Stimulant Use Disorder, these symptoms create a high-risk environment where the individual may seek stimulants to further fuel the mania or may simply lack the inhibitory control to resist cravings or social pressure. Effective risk management requires stabilizing the mood disorder simultaneously with the substance use disorder to mitigate this acute risk of relapse.

Incorrect: The second option is incorrect because mania is generally associated with decreased social inhibition rather than increased social anxiety. The third option is incorrect because while medication interactions are a concern, the primary clinical risk for relapse in Bipolar I during mania is behavioral impulsivity rather than a reaction to sedation. The fourth option is incorrect because the dopamine surge during mania actually increases the risk of relapse by priming the reward system and lowering the threshold for seeking chemical reinforcement.

Takeaway: In dual diagnosis cases involving Bipolar I, the manic phase represents a high-risk period for relapse due to the clinical combination of impulsivity and impaired judgment.

Correct: Trauma-informed care recognizes that traumatic experiences can lead to chronic dysregulation of the HPA axis and the autonomic nervous system. This often results in a state of hyper-vigilance or emotional dysregulation. Individuals may turn to substances because they provide a temporary, exogenous way to manage this internal distress by acting on the brain’s reward system (dopamine pathways), essentially self-medicating the physiological symptoms of trauma to achieve a temporary sense of homeostasis.

Incorrect: Physical lesions in the nucleus accumbens are not a standard result of psychological trauma. Neuroplasticity is not permanently halted by trauma; the brain remains capable of change throughout the lifespan. In trauma survivors, the prefrontal cortex (the executive center) actually tends to become under-active or less effective at regulating emotions, while the amygdala becomes over-active, which is the opposite of the scenario where the prefrontal cortex is described as over-active.

Takeaway: Trauma-informed addiction counseling views substance use as a physiological attempt to stabilize a dysregulated stress response system and reward circuitry.

Correct: Integrating a genogram is a standard clinical tool used to visualize and analyze the complex interplay between genetic predisposition and environmental modeling (social learning) that characterizes intergenerational transmission. By identifying these patterns across three generations, the counselor can tailor interventions that address both the biological risk and the learned behaviors or trauma passed down through the family system, which is essential for breaking the cycle of addiction.

Incorrect: Focusing only on current reinforcement schedules ignores the deep-seated developmental and biological influences of family history. Relying solely on standardized 12-step programs or pharmacological maintenance fails to provide the comprehensive, individualized assessment needed to understand and break specific intergenerational cycles. These approaches may address symptoms but do not specifically target the transmission mechanisms identified in the gap analysis.

Takeaway: Effective management of intergenerational addiction requires a comprehensive assessment of both genetic vulnerabilities and environmental modeling within the family system to develop targeted prevention strategies.

Correct: The best option involves moving the client to a clinically managed high-intensity residential service (ASAM Level 3.5). This aligns with the continuum of care by recognizing that while the client is medically stable, their lack of a supportive environment and history of rapid relapse necessitate a structured, 24-hour living environment. This level of care provides the necessary ‘step-down’ from medical stabilization to psychosocial rehabilitation, ensuring the client is not overwhelmed by environmental triggers too early in the process.

Incorrect: Discharging to standard outpatient care is inappropriate because it fails to address the client’s high risk of relapse and lack of environmental support. Maintaining the client in a medically monitored inpatient setting after stabilization is an inefficient use of resources and does not align with the principle of treating in the least restrictive environment. Referring exclusively to mutual aid groups ignores the clinical need for professional intervention and structured support during the early, high-risk stages of recovery.

Takeaway: The continuum of care is a fluid system where treatment intensity must be matched to the client’s multidimensional risks and environmental stability, rather than following a fixed or arbitrary timeline.