Quiz — Chapter 33: Addiction, Compulsion, and Recovery

Instructions

25 multiple-choice questions covering the core concepts of Chapter 33. Each question has one best answer. Check your answers against the key at the end.

1. The contemporary scientific understanding of addiction classifies it as:

a) A moral failing resulting from weakness of will and poor decision-making b) A brain disorder of motivation, reward, and cognitive control involving neurobiological changes c) A learned behavior that can be unlearned through sufficient willpower and motivation d) A genetic predisposition that is essentially unchangeable without pharmacological intervention

2. The mesolimbic dopamine pathway — the core neurological circuit in addiction — projects primarily from:

a) The prefrontal cortex to the hippocampus, mediating memory for rewarding experiences b) The ventral tegmental area (VTA) to the nucleus accumbens (NAc), mediating reward and motivation c) The amygdala to the nucleus accumbens, mediating fear-based avoidance of withdrawal d) The hypothalamus to the thalamus, regulating arousal and sleep-wake cycles

3. Sensitization in addiction refers to which specific phenomenon?

a) The nervous system becomes less responsive to the addictive substance, requiring more to produce the same effect b) The reward system becomes increasingly responsive to cues associated with the substance, producing intensified wanting c) The immune system becomes sensitized to the substance, producing withdrawal symptoms that mimic allergic reactions d) The prefrontal cortex becomes sensitized to craving signals, producing more effective inhibitory control over time

4. Tolerance in addiction involves which neurological change?

a) Increased dopamine production in the ventral tegmental area, requiring higher doses to maintain normal function b) Downregulation of dopamine receptors in the nucleus accumbens, reducing responsiveness to natural rewards c) Sensitization of the amygdala to stress signals, increasing emotional reactivity to normal stressors d) Increased serotonin availability, reducing the emotional experience of withdrawal

5. The prefrontal cortex's role in addiction is best described as:

a) The primary reward-generating region; its damage explains why people with addiction no longer enjoy other activities b) The structure whose degraded function reduces the capacity to inhibit impulses and weigh long-term consequences c) The region responsible for generating cravings and withdrawal symptoms d) The regulatory center whose increased activity explains the compelled nature of addictive behavior

6. Which statement best describes the paradox of sensitization and tolerance in the addictive brain?

a) More wanting + more liking = escalating use until a natural ceiling is reached b) Less wanting + more liking = reduced use as tolerance develops c) More wanting + less liking = intensified drive toward the substance with reduced reward d) Less wanting + less liking = natural recovery as the substance loses its appeal

7. Nora Volkow's PET scan research established which finding relevant to the brain disease model of addiction?

a) Addicted brains show increased dopamine receptors in the striatum, indicating elevated reward sensitivity b) Addicted brains show reduced dopamine receptors in the striatum and reduced PFC metabolic activity c) Addicted brains show no measurable difference from non-addicted brains, suggesting addiction is primarily psychological d) Addicted brains show elevated amygdala activity, indicating that addiction is primarily a fear-learning disorder

8. Research on genetic factors in addiction indicates that approximately what percentage of addiction risk variance is heritable?

a) 5–10% b) 20–30% c) 40–60% d) 80–90%

9. The connection between ACE (Adverse Childhood Experiences) scores and addiction risk is most accurately explained by:

a) Genetic factors that produce both adverse family environments and addiction vulnerability are inherited together b) Childhood trauma produces neurological changes that directly destroy the dopamine system c) Substances provide short-term relief from the emotional pain produced by adversity, making use reinforcing in a context of limited alternatives d) ACE research reflects correlation, not causation; the association is due to shared socioeconomic risk factors

10. The "self-medication hypothesis" of addiction proposes that:

a) Most addiction begins with legitimate medical prescriptions that are then misused b) People with addiction are attempting to treat underlying emotional states (anxiety, depression, trauma) that haven't been adequately addressed c) Medication-assisted treatment is the most effective long-term strategy because it replaces the addictive self-medication with a safer alternative d) Self-administered medication always produces addiction; prescribed medication does not

11. Denial in addiction is most accurately understood as:

a) Deliberate deception of others about the extent of use b) A combination of neurologically impaired self-assessment, motivated reasoning, and psychological self-protection c) A defense mechanism specific to severe addiction; mild-to-moderate addiction typically does not involve denial d) A conscious strategy for avoiding consequences of use

12. According to the chapter, which approach is most effective for working with denial in addiction?

a) Confrontation with evidence — presenting the data about consequences until the person's denial breaks down b) Motivational interviewing — exploring the person's own stated values and the discrepancy with their behavior c) Ultimatum-based pressure — making clear that relationships and support will end without behavior change d) Cognitive restructuring — challenging the specific beliefs that constitute denial as distortions

13. The Vietnam veterans heroin use finding — that approximately 90% of veterans who used heroin regularly in Vietnam stopped upon returning home — is most consistent with which interpretation of addiction?

a) Addiction is primarily genetic; the veterans who continued were genetically predisposed b) Willpower is sufficient to overcome addiction when motivation is high enough c) Environment and social context powerfully shape both the initiation and maintenance of addictive behavior d) Heroin is less addictive than commonly believed; the soldiers were simply habitual users, not addicted

14. Alexander's "rat park" experiments demonstrated that:

a) All rats given morphine access inevitably develop addiction, supporting the primacy of the substance b) Rats in enriched social environments use morphine significantly less than isolated rats, even after prior exposure c) Social contact increases addiction risk by providing drug-using peers who model addictive behavior d) Isolation itself produces neurological changes equivalent to drug exposure

15. According to the chapter, which of the following most accurately characterizes recovery rates from addiction?

a) Recovery is rare — less than 10% of people with severe addiction achieve sustained recovery b) Approximately 50% of people with severe addiction recover over their lifetimes c) Recovery requires professional treatment; self-directed recovery is not sustainable d) Recovery rates are low without medication-assisted treatment; behavioral approaches alone are insufficient

16. Naltrexone is used in the treatment of both alcohol use disorder and opioid use disorder. Its mechanism is:

a) A long-acting opioid agonist that prevents withdrawal and reduces craving through continuous opioid receptor activation b) An aversive conditioning agent that produces an unpleasant reaction when alcohol or opioids are consumed c) An opioid receptor antagonist that blocks the rewarding effects of opioids and alcohol d) A partial opioid agonist with a ceiling effect that provides partial relief without euphoria

17. Medication-assisted treatment (MAT) with methadone or buprenorphine for opioid use disorder is described in the chapter as:

a) A controversial and largely unproven approach that should be reserved for patients who have failed behavioral treatment b) Strongly evidence-based, reducing mortality by 50–70%; stigma against it is not evidence-based and costs lives c) Effective for short-term stabilization but no more effective than behavioral treatment for long-term outcomes d) Most appropriate for older adults with chronic opioid dependence; younger populations respond better to abstinence-based approaches

18. Motivational interviewing (MI) is best described as:

a) A confrontational technique designed to break through denial by challenging the person with evidence of harm b) A client-centered approach that explores the person's own reasons for change to resolve ambivalence c) A structured intervention requiring 12–20 sessions to achieve meaningful behavior change d) A primarily behavioral approach focused on reinforcement of abstinence behavior

19. Contingency management is described in the chapter as:

a) A therapy for managing contingent family relationships affected by addiction b) An approach that provides tangible rewards for treatment participation and negative drug tests c) A framework for understanding the contingent (context-dependent) nature of addiction risk d) A risk stratification tool for identifying patients who are contingently dependent versus chronically addicted

20. The chapter states that shame, in the context of addiction, tends to:

a) Motivate change by creating sufficient discomfort with the current pattern b) Predict return to treatment after relapse, because shame signals the need to change c) Motivate hiding, isolation, and continued use — and is associated with worse outcomes d) Have a neutral effect on outcomes; the relevant variable is motivation to change, not shame

21. The concept of post-acute withdrawal syndrome (PAWS) is relevant to recovery because:

a) It explains why acute medically supervised detoxification should last 90 days rather than the typical 7–10 days b) Neurological and psychological symptoms (emotional dysregulation, cognitive difficulties, sleep disturbance) can persist for 1–2 years after acute withdrawal, extending the relapse-risk window c) PAWS produces acute craving responses that require ongoing pharmacological treatment to prevent relapse d) PAWS affects only people with opioid use disorder; alcohol and stimulant recovery follows a simpler trajectory

22. The CRAFT (Community Reinforcement and Family Training) approach to helping family members is notable because:

a) It teaches family members communication and reward strategies that increase the probability of treatment engagement, while also improving family wellbeing independent of treatment entry b) It focuses exclusively on the family member's wellbeing and avoids addressing the addicted person's behavior directly c) It requires the family to present a unified intervention (similar to traditional intervention approaches) that confronts the person with the consequences of their behavior d) It was developed specifically for partners of people with alcohol use disorder and has not been validated for other substances

23. The chapter describes relapse as:

a) Treatment failure — indicating that the treatment approach was ineffective and a different approach is needed b) Expected in early recovery; comparable to relapse rates for other chronic conditions; does not mean the treatment has failed c) Inevitable — everyone with addiction will relapse at least once before achieving sustained recovery d) Primarily a pharmacological event caused by inadequate medication dosing during the maintenance phase

24. The distinction between wanting and liking in the neuroscience of addiction (Berridge's framework, referenced implicitly) holds that:

a) Wanting and liking are synonymous — both reflect the dopaminergic reward system's response to a stimulus b) Liking (hedonic response) and wanting (motivational drive) are dissociable; addiction sensitizes wanting while blunting liking c) Wanting is a cortical, deliberate process; liking is a subcortical, automatic response; addiction disrupts both equally d) The distinction is primarily theoretical; clinically, wanting and liking are impossible to differentiate

25. The chapter's core argument about addiction and connection proposes that:

a) Social pressure and peer modeling are the primary causes of addiction initiation and maintenance b) Connection and meaningful engagement are protective factors; isolation is among the most powerful predictors of both initiation and relapse c) Group therapy is the most effective treatment format because it directly addresses the disconnection underlying addiction d) Digital connection (online support communities) is equivalent to in-person connection for recovery support

Short-Answer Extensions

Choose two:

Extension 1: The chapter presents two frameworks for understanding addiction: the brain disease model (Volkow) and the social/environmental model (Hari, Alexander's rat park). How do these frameworks complement rather than contradict each other? What does an integrative model look like, and what treatment implications does it carry?

Extension 2: The average first-year relapse rate for alcohol use disorder is approximately 50–80%. Many people interpret this as evidence that treatment doesn't work. How would you use the chronic disease comparison (hypertension, asthma, Type 2 diabetes) to reframe this statistic, and what treatment model does the chronic disease comparison imply?

Extension 3: A friend tells you that they don't believe medication-assisted treatment (MAT) is "real" recovery — that using buprenorphine to stay off heroin is just replacing one addiction with another. Using the chapter's evidence, construct a response that addresses the neurobiological rationale, the outcome data, and the implications of the stigma.

Answer Key