Chapter 11 - MCQ Flashcards by Maxim Voloshin

The first alcohol consumed by humans was
A) wine.
B) beer.
C) vodka.
D) mead.
E) spirits.

D) mead.

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Alcohol was widely consumed by the Europeans in part because
A) alcoholism was widespread across Europe.
B) it made colonizing North and South America an easier task.
C) it was believed to have beneficial health effects.
D) they wanted North American aboriginals to engage in self-destructive activities.
E) the quality of the drinking water was quite poor.

E) the quality of the drinking water was quite poor.

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Problems in relationships, missing work, failing exams, putting yourself or others in danger: These could all be consequences of
A) habituation.
B) substance intoxication.
C) tolerance.
D) substance use disorder.
E) substance dependence.

D) substance use disorder.

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Tolerance is best defined as
A) a need for increased amounts of a substance in order to achieve previous effects.
B) a lack of control over the use of a substance.
C) physiological changes in the body due to use of a substance.
D) being accustomed to a substance due to regular usage.
E) a reversible and temporary condition that results from substance use.

A) a need for increased amounts of a substance in order to achieve previous effects.

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Nausea, headache, and tremors are all withdrawal symptoms and may be caused by the
A) removal of the substance from the body.
B) ingestion of several different substances at one time.
C) when a substance loses its addictive qualities.
D) ingestion of too much alcohol.
E) body’s attempt to fight a foreign substance in the bloodstream.

A) removal of the substance from the body.

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Sylvia finds that having a few drinks doesn’t really affect her very much, but she got extremely dizzy and nauseous after drinking wine when taking an aspirin. These effects resulted because
A) the combination of the two substances had a greater effect than one alone.
B) Sylvia hadn’t yet developed a tolerance for the drugs.
C) Sylvia was displaying withdrawal symptoms.
D) Sylvia had forgotten to eat before drinking.
E) Sylvia was exhibiting an impairment of control.

A) the combination of the two substances had a greater effect than one alone.

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Synergistic effects occur when
A) combined drug effects are different or greater than the sum of their individual effects.
B) drug effects are greater when combined with alcohol.
C) combined drug effects last longer than the sum of their individual effects.
D) the risk of addiction is greater when a drug is taken with alcohol.
E) a drug’s effect is neutralized when taken together with another drug.

A) combined drug effects are different or greater than the sum of their individual effects.

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According to a recent survey, approximately ___________ of every 5 Canadians reported drinking alcohol in the previous year.
A) 1
B) 2
C) 3
D) 4
E) 5

D) 4

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The majority of people who have reported drinking can be categorized as ___________ drinkers.
A) light frequent
B) light infrequent
C) heavy infrequent
D) moderate frequent
E) heavy frequent

B) light infrequent

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In a recent survey of Ontario high school students, high-risk drinking was reported by _____% of respondents.
A) 75
B) 20
C) 5
D) 50
E) Less than 1

B) 20

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Susan’s friend bought her a drink, and told her that it contained alcohol, even though it didn’t. However, after drinking several of these “fake cocktails,” Susan began to feel more relaxed, sociable, and sexually attractive. These effects were probably most influenced by
A) Susan’s evening out with her friend.
B) the fact that Susan’s friend lied to her.
C) Susan’s beliefs about the effects of alcohol.
D) Susan not feeling very well.
E) the atmosphere of the bar.

C) Susan’s beliefs about the effects of alcohol.

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Research into the perceived effects of alcohol consumption has shown that
A) perceived and actual effects appear unrelated.
B) physiological arousal and aggressive behaviour are inversely related to the perceived amount of alcohol consumed.
C) most people can tell the difference between the perceived and actual effects of alcohol.
D) subjects behave more aggressively and report more sexual arousal when they believed they have consumed alcohol.
E) subjects who drank an alcoholic beverage without knowing it reported less sexual arousal, even though physiological measures showed arousal.

D) subjects behave more aggressively and report more sexual arousal when they believed they have consumed alcohol.

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Which of the following statements is true regarding the absorption of alcohol?
A) Most alcohol is absorbed into the bloodstream from the large intestine.
B) Alcohol is generally absorbed by fatty tissues in the body.
C) Most alcohol passes directly into the blood from the stomach.
D) Alcohol requires digestion to enter the bloodstream.
E) Most alcohol is absorbed into the bloodstream from the small intestine.

E) Most alcohol is absorbed into the bloodstream from the small intestine.

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The removal of alcohol from the body is NOT dependent upon
A) the proportion of body fat.
B) the amount of alcohol dehydrogenase in the body.
C) rate of alcoholic intake.
D) the amount of food one consumes prior to drinking.
E) whether a person is male or female.

D) the amount of food one consumes prior to drinking.

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Alcohol is a(n) ___________ but the initial effect of alcohol is __________.
A) hallucinogen; depressing
B) stimulant; relaxing
C) depressant; stimulating
D) stimulant; depressing
E) depressant; relaxing

C) depressant; stimulating

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Susan is of average size and weight. In order for her to maintain a constant BAL, she should consume no more than
A) 1 drink every five hours.
B) 1 drink every hour.
C) 5 drinks in one night.
D) 1 drink every two hours.
E) 2 drinks per hour.

D) 1 drink every two hours.

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Alcohol begins to affect driving ability at a BAL of
A) .05.
B) .03.
C) .01.
D) .10.
E) .08.

A) .05.

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angover symptoms such as upset stomach, fatigue, headache, and thirst can be remedied by
A) vegetable juice.
B) rest and time.
C) coffee and cigarettes.
D) more alcohol.
E) a bowl of cereal.

B) rest and time.

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Moderate consumption of alcohol has been related to
A) lower incidence of coronary heart disease.
B) liver damage.
C) cancer.
D) malnutrition.
E) damage to the heart muscle.

A) lower incidence of coronary heart disease.

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The two brain regions most damaged by heavy alcohol use are
A) limbic system and medulla.
B) cerebral cortex and hippocampus.
C) basal ganglia and cerebellum.
D) thalamus and hypothalamus.
E) septum and amygdala.

D) thalamus and hypothalamus.

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Moderate alcohol consumption is associated with ___________ whereas heavy alcohol use has been associated with __________.
A) temporary enhancement of the heart muscle and vascular system functionality; damage to the cardiovascular system
B) moderately elevated risk of heart disease; damage to heart muscle and vascular system
C) reduced risk of heart disease; damage to the heart muscle and vascular system
D) mildly elevated blood pressure; dangerous suppression of the cardiovascular system
E) mildly elevated risk of heart disease; damage to the heart muscle and vascular system

C) reduced risk of heart disease; damage to the heart muscle and vascular system

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Wernicke-Korsakoff syndrome is a disease characterized by memory loss and a loss of contact with reality and results from
A) cardiomyopathy.
B) cell loss in the brain.
C) liver damage.
D) alcohol dependence.
E) severe malnutrition.

B) cell loss in the brain.

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In a general survey conducted by Statistics Canada regarding whether drinking had adversely affected people’s lives in several areas, it was found that
A) the majority of problems involved work or school.
B) the number one problem concerned personal happiness.
C) men and women were equally as likely to report drinking-related problems.
D) youths were most likely to report legal violations related to drinking.
E) most problems were related to health, finance, and friendships.

E) most problems were related to health, finance, and friendships.

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Which groups represent the greatest number of alcohol-related causes of death?
A) motor vehicle accidents, cancer of the liver, Wernicke-Korsakoff syndrome
B) motor vehicle accidents, cancer of the stomach, heart attack
C) cirrhosis of the liver, Wernicke-Korsakoff syndrome, cancer
D) motor vehicle accidents, cirrhosis of the liver, suicide
E) accidental shootings, cancer of the mouth, suicide

D) motor vehicle accidents, cirrhosis of the liver, suicide

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According to statistics reported in Canada in 2002, which substance was associated with the greatest direct health care costs? A) cannabis B) alcohol C) cocaine D) tobacco E) ecstasy

D) tobacco

In terms of the genetic influences in the development of alcohol use disorders, it has been shown that A) most offspring of people with alcohol use disorders develop these disorders as well. B) the enzyme necessary for breaking down alcohol is not present in those with alcohol use disorders. C) the brains of people with alcohol use disorders contain a gene that influences the sensitivity of dopamine receptors to alcohol. D) Individuals who are prone to alcohol use disorders have a specific abnormality on chromosome 10. E) the concordance rate for monozygotic twins is generally higher than it is for dizygotic twins.

E) the concordance rate for monozygotic twins is generally higher than it is for dizygotic twins.

The Canadian Centre on Substance Abuse (2006) data shows that _______ accounts for 43% of all substance related costs, whereas ___________ and ________ account for 37% and 20.7% respectively A) tobacco; marijuana; alcohol B) illegal drugs; alcohol; tobacco C) tobacco; alcohol; illegal drugs D) alcohol; marijuana; illegal drugs E) alcohol; illegal drugs; tobacco

C) tobacco; alcohol; illegal drugs

If you were a physician examining the brain wave activity of people with alcohol use disorder, non-problem drinkers, and their children, you would likely find that A) sons and daughters of alcoholic-dependent parents show smaller P300 amplitudes than do children of non-alcoholic parents. B) sons of alcohol-dependent fathers show higher than normal rates of theta waves. C) sons of alcohol-dependent fathers show higher than normal rates of alpha waves. D) sons and daughters of alcohol-dependent parents show larger P300 amplitudes than do children of non-alcoholic fathers. E) sons of alcohol-dependent fathers have lower than normal rates of beta waves.

A) sons and daughters of alcoholic-dependent parents show smaller P300 amplitudes than do children of non-alcoholic parents.

Which of the following statements is true regarding markers of vulnerability to alcohol? A) Men with alcohol-dependent relatives tend to show an increased heart rate after consuming alcohol. B) MAO activity is higher in alcohol-dependent persons. C) Sons of alcohol-dependent fathers have lower than normal rates of the fast beta wave. D) High levels of serotonin have been associated with impulsivity, aggressiveness, and antisocial behaviour. E) Men who show the greatest increases in heart rate are less inclined to drink regularly.

A) Men with alcohol-dependent relatives tend to show an increased heart rate after consuming alcohol.

The personality characteristic most strongly associated with alcohol use disorders is A) psychoticism. B) negative emotionality. C) perfectionism. D) introversion. E) behavioural disinhibition.

E) behavioural disinhibition.

Using animal models, Siegel and others demonstrated that through the principles of ___________, cues in the environment can become conditioned stimuli to the effects of drug use. A) psychoticism. B) negative emotionality. C) classical conditioning. D) operant conditioning. E) positive reinforcement.

C) classical conditioning.

Which of the following statements support the alcohol expectancy theory? A) Joe drinks a lot because he believes it will put him in a better mood, even though he actually becomes more aggressive. B) Adolescents are unaffected by positive expectancies of alcohol effects. C) Both alcohol-dependent and nonalcohol dependent individuals drink less when they believe their drinks contain alcohol. D) Non-problem drinkers are more likely to believe that alcohol will have a positive effect. E) Alcohol-dependent and heavy social drinkers are more likely to believe that alcohol will have a negative effect.

A) Joe drinks a lot because he believes it will put him in a better mood, even though he actually becomes more aggressive.

Given the behavioural tolerance effect of drug use, a person with an addiction might be most severely impaired when drinking A) with his friends at the bar that they frequent once a week. B) at a house that he has never been to before. C) home alone where he always drinks. D) at night when he watches television. E) at an office party.

B) at a house that he has never been to before.

Certain patient characteristics have been found to predict success with non-abstinence treatment programs for alcohol. Which of the following is NOT one of those characteristics? A) younger age. B) older age. C) employment. D) being female. E) having a stronger belief in one's ability to moderate drinking.

B) older age.

What is the main goal of the Minnesota model for the treatment of alcohol dependence? A) abstinence B) changing the expectations drinkers have about alcohol's effects C) controlled drinking D) treating the withdrawal symptoms E) educating people about the consequences of alcohol abuse

A) abstinence

Medications are sometimes used in the treatment of alcohol use disorders, mainly to A) reduce the impact of the stressors that are causing people to drink in the first place. B) decrease feelings of nausea when alcohol is consumed. C) counter the effects of malnutrition caused by drinking excessively. D) ease the negative effects of hangovers. E) reduce the pleasurable feelings that result from drinking.

E) reduce the pleasurable feelings that result from drinking.

Rico has alcohol use disorder, and even though he sometimes tries to quit, he craves alcohol and feels better after drinking it. His doctor has prescribed Naltrexone to help him abstain from alcohol. How does this medication work? A) It blocks the neurotransmitters that mediate alcohol's effects on the brain. B) It reduces the positive expectations of alcohol. C) It blocks the action of the enzyme that metabolizes alcohol, making the individual sick. D) It acts to mimic the effects of alcohol, thus making withdrawal more bearable. E) It reduces some of the tendencies associated with certain personality characteristics that lead to drinking.

A) It blocks the neurotransmitters that mediate alcohol's effects on the brain.

Antabuse is successful at reducing alcohol use because A) it increases the amount of acetyladehyde dehydrogenase in the body. B) it makes people feel better without having to drink. C) compliance is generally not a problem. D) it changes positive cognitions about alcohol's effects to negative ones. E) it causes many unpleasant physiological effects when a person drinks.

E) it causes many unpleasant physiological effects when a person drinks.

Alcoholics Anonymous is A) a religious group that condemns the use of alcohol. B) one of the best-known approaches to the treatment of alcoholism. C) an intensive, short-term support group for alcohol-dependent persons. D) a treatment program based on psychodynamic principles. E) a treatment group, consisting of alcohol-dependent persons at different stages, run by a therapist who was a former alcoholic.

B) one of the best-known approaches to the treatment of alcoholism.

The treatment philosophy of Alcoholics Anonymous is based on a ___________ model and the treatment goal is __________. A) personal; support B) disease; abstinence C) physical; somatic D) mental; education E) psychosocial; abstinence

B) disease; abstinence

The twelve steps that define AA indicate that A) that alcohol-dependent individuals are powerless to control drinking and must rely on a Higher Power. B) alcohol-dependent individuals can follow these steps on their own and eventually quit drinking. C) success depends on social support. D) alcohol use disorders can be cured if meetings are attended regularly. E) alcohol-dependent individuals must attend mass regularly in conjunction with AA meetings.

A) that alcohol-dependent individuals are powerless to control drinking and must rely on a Higher Power.

The ___________ hypothesis, that drinking is reinforced by its ability to reduce unpleasant emotions has received ___________ support in the research literature. A) tension reduction; inconsistent B) tension reduction; strong C) positive reinforcement; inconsistent D) positive reinforcement; moderate E) contingency-expectancy; modest

A) tension reduction; inconsistent

Consistent with the notion of ___________, Elliot finds that he uses ________ heroin at home compared with when he is visiting the home of a new friend. A) tension reduction; less B) behavioural tolerance; more C) negative reinforcement; more D) behavioural tolerance; less E) tension reduction; more

B) behavioural tolerance; more

Classical conditioning approaches to the treatment of alcoholism generally A) focus on the thought and attitudes of alcohol-dependent persons. B) attempt to associate alcohol with unpleasant stimuli. C) assume that alcohol use disorder is a disease. D) follow the philosophy of Alcoholics Anonymous. E) use contingency management.

B) attempt to associate alcohol with unpleasant stimuli.

Operant conditioning approaches to treatment of alcohol use disorders are based on ___________ and can be used with the goal(s) of __________. A) aversion therapy; complete abstinence B) contingency management; complete abstinence C) contingency management; complete abstinence or moderated drinking D) differential reinforcement; responsible drinking behavior E) aversion therapy and differential reinforcement; responsible drinking behavior

C) contingency management; complete abstinence or moderated drinking

Behavioural treatments such as the Community Reinforcement approach use which of the following strategies for treating alcoholism? A) Enforcing controlled drinking B) Teaching a family member or a friend to reinforce sobriety C) Punishing the alcoholic with community work when he or she fails to abstain D) Pairing alcohol with an unpleasant stimulus E) Increasing communication between families and partners

B) Teaching a family member or a friend to reinforce sobriety

In relapse prevention treatment, people are taught that a relapse is A) an indication of a severe drinking problem that requires more intense therapy. B) an indication of a brain abnormality underlying the problem. C) a temporary occurrence brought on by a specific situation, from which a person can recover. D) a sign that the addiction to alcohol is probably not treatable. E) a failure to cope with the problems of alcoholism.

C) a temporary occurrence brought on by a specific situation, from which a person can recover.

Relapse prevention treatment focuses on A) integrating medication, support groups, and contingency contracts to prevent relapse. B) emphasizing the importance of controlled drinking as a means of preventing over- consumption of alcohol. C) involving family members in the treatment to help prevent relapse. D) offering time-limited and specific advice regarding the need to reduce or eliminate alcohol consumption. E) assisting the individual in changing his or her beliefs about drinking.

E) assisting the individual in changing his or her beliefs about drinking.

When family members establish roles that are defined by the disordered substance use and their behaviour actually prevents changes in the abuse pattern, they are referred to as A) scapegoats. B) facilitators. C) codependents. D) enmeshed. E) resistant.

C) codependents.

Interventions that involve the family of alcohol-dependent persons generally target A) the self-defeating thoughts and distorted beliefs espoused by the family. B) communication and relationship roles. C) how families may be causing relapses. D) the effect of the substance-dependent person on other family members. E) the amount of alcohol that everyone in the family drinks.

B) communication and relationship roles.

Of all the treatment approaches that have been empirically evaluated,___________ has/have the strongest support. A) behavioural treatment B) mutual support groups C) relapse prevention D) pharmacotherapy E) brief interventions

E) brief interventions

Motivational interviewing is an approach that involves: A) The therapist interviewing the client to determine whether they are ready for Antabuse. B) The therapist exploring, in a somewhat confrontational manner, why the client uses alcohol. C) The client interviewing their family members regarding their thoughts and feelings about the client's alcohol use. D) Identifying strategies for relapse prevention. E) The therapist helping the client to identify and discuss, in a non-confrontational manner, the pros and the cons of their alcohol use.

E) The therapist helping the client to identify and discuss, in a non-confrontational manner, the pros and the cons of their alcohol use.

One of the first drugs developed as a treatment for tension and anxiety was/were A) benzodiazepines. B) tranquilizers. C) Valium. D) barbituric acid. E) vitamin B12.

D) barbituric acid.

At low doses, barbiturates cause ___________ but with large doses they can cause __________. A) mild euphoria; lowered respiration, blood pressure, and heart rate to dangerous levels B) sleep; coma C) relaxation of the diaphragm muscles; personality changes D) slurred speech; mild euphoria E) blurred vision; muscle paralysis

A) mild euphoria; lowered respiration, blood pressure, and heart rate to dangerous levels

Deri has been undergoing treatment for barbiturate abuse. The drug has been reduced very slowly for a while now, and at this time his doctor is reducing it by 10% every day. Deri has begun to feel achy, depressed, anxious, and he is unable to fall asleep. His symptoms have been characterized as the A) tolerance effect. B) abstinence syndrome. C) recurrent withdrawal syndrome. D) treatment relapse. E) dependency problem.

B) abstinence syndrome.

Stimulant drugs, such as nicotine, amphetamines, cocaine, and caffeine, achieve their effects by A) increasing heart rate and blood pressure. B) decreasing the rate of dopamine and serotonin entering the brain. C) increasing the availability of GABA and ACH to the nucleus accumbens. D) increasing the availability of dopamine, serotonin, and norepinephrine to the nucleus accumbens. E) influencing the rate of blood flow into the brain.

D) increasing the availability of dopamine, serotonin, and norepinephrine to the nucleus accumbens.

The decline in smoking over time has not been due to: A) increasing tobacco prices. B) Antismoking media campaigns. C) Smoking bans in restaurants. D) Smoking bans in buses. E) Increases in fitness-related images in the media.

E) Increases in fitness-related images in the media.

Addiction produced by ___________ is thought to be even greater than that produced by other addictive substances. A) cocaine B) heroin C) caffeine D) alcohol E) tobacco

E) tobacco

Overall, results of psychological smoking cessation programs have been A) mixed. B) promising. C) lacking. D) not at all encouraging. E) very encouraging.

A) mixed.

During the 1930s, amphetamines were developed as A) a decongestant and asthma treatment. B) treatment for hyperactive children. C) a treatment for alcohol abuse. D) a way to calm psychiatric patients. E) a treatment for obesity.

A) a decongestant and asthma treatment.

At low doses, amphetamines cause ___________ and at very high doses, they result in __________. A) increased confidence; increased alertness B) increased alertness; restlessness and anxiety C) fatigue and sadness; brain damage D) confusion; hyperactivity E) feelings of exhilaration; toxic psychosis

B) increased alertness; restlessness and anxiety

Jennifer was taken to the hospital by her friends late Saturday night. She complained that she felt weak and nauseous, and when she was examined by the physician, her heartbeat was found to be irregular, her blood pressure was high, and her pupils were dilated. Apparently, she had "taken something" at a party, but her friends didn't know what it was. It appears that she had taken A) LSD. B) sedatives. C) benzodiazepines. D) amphetamines. E) barbiturates.

D) amphetamines.

In small amounts, cocaine produces ___________, while high doses lead to __________. A) anger and aggression; toxic psychosis B) feelings of confidence; brain damage C) feelings of euphoria and well-being; overstimulation of the CNS D) understimulation of the CNS; anger and aggression E) no effects; mood swings and insomnia

C) feelings of euphoria and well-being; overstimulation of the CNS

Why is treatment for stimulant addiction difficult? A) Doctors are generally reluctant to treat substance use disorder. B) Stimulant users tend to use other drugs to counteract some of the effects of the stimulants and become dependent on these drugs as well. C) Stimulants are very addicting, and it often takes many years to quit using them. D) Psychological and biological treatments must be used in conjunction, never separately. E) It is easier to treat those who are addicted to socially acceptable drugs.

B) Stimulant users tend to use other drugs to counteract some of the effects of the stimulants and become dependent on these drugs as well.

Which of the following groups of drugs belong to the opiate family? A) morphine, heroin, methadone B) morphine, nicotine, opium C) caffeine, nicotine, and cocaine D) codeine, benzoic acid, Demerol E) heroin, cocaine, codeine

A) morphine, heroin, methadone

Opioids, known as exogenous opiates, tend to mimic the effects of A) serotonin. B) depressants. C) dopamine. D) stimulants. E) the body's natural painkillers.

E) the body's natural painkillers.

The immediate effect of heroin is ___________; at higher doses it results in __________. A) calming; pupil constriction B) hyperactivity; paranoia C) intensely pleasurable; respiratory failure D) nausea; coma E) anxiety; euphoria

C) intensely pleasurable; respiratory failure

What is the main objection to the harm reduction approach to managing problematic substance use? A) It goes against the principles of some religions B) It is an ineffective approach C) It creates more work for the police D) It is not scientifically-supported E) It is sometimes seen as supporting illicit drug use

E) It is sometimes seen as supporting illicit drug use

In 2015, the most commonly used and most widely available illicit drug in Canada was A) speed. B) marijuana. C) cocaine. D) heroin. E) alcohol.

B) marijuana.

With relatively small doses of cannabis, most users report A) sexual arousal. B) feelings of tension and anxiety. C) paranoia. D) hallucinations. E) a feeling of euphoria and sociability.

E) a feeling of euphoria and sociability.

A syndrome found in long-term cannabis users characterized by apathy, lack of pursuit of vocational goals, self-absorption, and detachment from family and friends is known as A) cannabis sativa. B) amotivational syndrome. C) toxic psychosis. D) abnormal cannabis reaction. E) unusual dependency.

B) amotivational syndrome.

Whereas it was once believed that marijuana ___________ addictive, recent evidence supports that marijuana use __________. A) is mildly; does not result in dependence or withdrawal B) is strongly; results in withdrawal only for susceptible persons C) is not; results in mild dependence and withdrawal symptoms D) is not; results in severe dependence and withdrawal symptoms E) is mildly; can result in severe dependence and/or withdrawal symptoms

C) is not; results in mild dependence and withdrawal symptoms

Which of the following groups of drugs are found under the category "hallucinogens"? A) cocaine, heroin, psychedelics B) alcohol, LSD, magic mushrooms C) mescaline, acid, marijuana D) amphetamines, marijuana, alcohol E) mescaline, LSD, psilocybin

E) mescaline, LSD, psilocybin

When Albert Hoffman was investigating ergot (a fungus that affects rye and wheat) in 1938, he accidentally discovered A) hashish. B) cocaine. C) LSD. D) mescaline.

C) LSD.

Hallucinogens have an ___________ effect on the CNS and mimic the effects of __________. A) excitatory; dopamine B) inhibitory; serotonin C) excitatory; epinephrine D) excitatory; serotonin E) inhibitory; dopamine

D) excitatory; serotonin

Which of the following negative side effects occur due to hallucinogen use? A) flashbacks B) amotivational syndrome C) recurrent headaches D) respiratory problems E) high blood pressure

A) flashbacks

Risk factors for problem gambling include all of the following except: A) Being male B) Being Indigenous C) Having a low level of education D) Playing VLTs daily E) Regular purchase of lottery tickets

E) Regular purchase of lottery tickets