CAADC Co-occurring Disorders 5 — Questions and Answers
Question 1: In treating a client with generalized anxiety disorder and benzodiazepine use disorder, the most evidence-based approach is:
- Continue benzodiazepines indefinitely to manage anxiety
- Gradual taper of benzodiazepines combined with CBT for anxiety (Correct answer)
- Abrupt discontinuation of benzodiazepines followed by anxiety management
- Switching to alcohol as a safer anxiolytic
Correct answer: Gradual taper of benzodiazepines combined with CBT for anxiety
A medically supervised gradual taper combined with CBT addresses both the physical dependence and the underlying anxiety disorder.
Question 2: Which factor most significantly predicts poorer outcomes in clients with co-occurring disorders compared to those with a single disorder?
- Lower socioeconomic status
- Higher rates of treatment disengagement and relapse (Correct answer)
- Older age at first treatment contact
- Rural residence
Correct answer: Higher rates of treatment disengagement and relapse
Co-occurring disorders are strongly associated with higher treatment dropout rates and more frequent relapse episodes compared to single-diagnosis clients.
Question 3: A client with major depressive disorder and alcohol use disorder has been sober for 30 days but reports persistent depressive symptoms. The counselor should:
- Conclude the depression is purely alcohol-induced and will resolve with more time sober
- Recommend immediate antidepressant initiation without further assessment
- Conduct a thorough assessment to determine if an independent depressive disorder is present (Correct answer)
- Discharge the client since substance use is the primary concern
Correct answer: Conduct a thorough assessment to determine if an independent depressive disorder is present
After a sufficient abstinence period, persistent symptoms suggest an independent mood disorder requiring its own treatment plan.
Question 4: The concept of 'diagnostic overshadowing' in co-occurring disorders refers to:
- Using multiple diagnostic labels for a single client
- Attributing all psychiatric symptoms to substance use and overlooking independent mental disorders (Correct answer)
- A client concealing symptoms to avoid a psychiatric diagnosis
- Prescribing medications that mask addiction symptoms
Correct answer: Attributing all psychiatric symptoms to substance use and overlooking independent mental disorders
Diagnostic overshadowing occurs when clinicians incorrectly attribute all symptoms to substance use, missing an underlying independent psychiatric condition.
Question 5: A client with ADHD and stimulant use disorder is being evaluated for medication-assisted treatment. The prescriber's primary consideration should be:
- Avoiding all stimulant medications due to misuse potential
- Assessing risk versus benefit and considering non-stimulant ADHD medications or closely monitored stimulants (Correct answer)
- Prescribing the highest dose stimulant to prevent drug-seeking behavior
- Treating ADHD only after 12 months of sobriety
Correct answer: Assessing risk versus benefit and considering non-stimulant ADHD medications or closely monitored stimulants
Non-stimulant options like atomoxetine or bupropion may be preferred, but structured use of stimulants can be appropriate with close monitoring.
Question 6: When a client with co-occurring disorders experiences a psychiatric crisis during early recovery, the CAADC's first priority is to:
- Restart the substance use treatment from the beginning
- Ensure the client's immediate safety and coordinate crisis intervention (Correct answer)
- Interpret the crisis as a relapse trigger and increase 12-step meeting attendance
- Reduce the intensity of treatment services to lower stress
Correct answer: Ensure the client's immediate safety and coordinate crisis intervention
Safety is always the first priority in a psychiatric crisis; the counselor must initiate crisis protocols and collaborate with mental health professionals.
Question 7: Which of the following best describes the relationship between trauma and substance use disorder in clients with co-occurring PTSD?
- Trauma typically follows substance use disorder and is caused by it
- Trauma and substance use disorder have a bidirectional, mutually reinforcing relationship (Correct answer)
- PTSD develops independently of substance use with no shared mechanisms
- Substance use consistently reduces PTSD symptom severity over time
Correct answer: Trauma and substance use disorder have a bidirectional, mutually reinforcing relationship
PTSD and substance use disorder are bidirectionally linked: trauma increases substance use risk, and substance use impairs trauma recovery and increases re-traumatization risk.
CAADC Co-occurring Disorders 5
In treating a client with generalized anxiety disorder and benzodiazepine use disorder, the most evidence-based approach is: