CAADE Co-Occurring Disorders 3 — Questions and Answers
Question 1: The term 'diagnostic overshadowing' in COD refers to:
- Using multiple diagnoses simultaneously
- Attributing psychiatric symptoms solely to substance use and missing an underlying disorder (Correct answer)
- Prescribing too many medications at once
- Overlapping treatment groups for different disorders
Correct answer: Attributing psychiatric symptoms solely to substance use and missing an underlying disorder
Diagnostic overshadowing occurs when clinicians attribute all symptoms to substance use, causing them to miss a co-occurring mental health disorder.
Question 2: A client in early recovery from opioid use disorder presents with persistent depressive symptoms. Best practice recommends waiting how long after abstinence before diagnosing a mood disorder?
- 2 weeks
- 4 weeks (Correct answer)
- 3-6 months
- 1 year
Correct answer: 4 weeks
Most clinical guidelines recommend waiting approximately 4 weeks of abstinence to differentiate substance-induced mood symptoms from an independent depressive disorder.
Question 3: Which approach to group therapy has the strongest evidence base for clients with co-occurring schizophrenia and substance use disorder?
- Confrontational 12-step facilitation
- Seeking Safety curriculum
- Dual Recovery Anonymous modified groups (Correct answer)
- High-intensity cognitive processing therapy
Correct answer: Dual Recovery Anonymous modified groups
Dual Recovery Anonymous and similar modified self-help groups are designed specifically for individuals managing both a psychiatric disorder and substance use disorder.
Question 4: A counselor learns a client was recently started on buprenorphine by their prescriber. In relation to the client's co-occurring depression, buprenorphine may:
- Worsen depressive symptoms significantly
- Have some antidepressant properties at therapeutic doses (Correct answer)
- Require immediate psychiatric medication adjustment
- Be contraindicated if the client takes an SSRI
Correct answer: Have some antidepressant properties at therapeutic doses
Research suggests buprenorphine has some antidepressant properties, partly due to kappa-opioid receptor antagonism, which can improve mood in some patients.
Question 5: The ASAM criteria address COD through which dimension?
- Dimension 1 - Acute Intoxication
- Dimension 3 - Emotional/Behavioral Conditions (Correct answer)
- Dimension 5 - Relapse Potential
- Dimension 6 - Recovery Environment
Correct answer: Dimension 3 - Emotional/Behavioral Conditions
ASAM Dimension 3 (Emotional, Behavioral, or Cognitive Conditions and Complications) specifically addresses co-occurring psychiatric and cognitive disorders.
Question 6: Cultural competence in COD treatment includes recognizing that:
- Western diagnostic categories apply universally across all cultures
- Mental health stigma is uniform across cultural groups
- Cultural factors influence how symptoms are expressed and whether treatment is sought (Correct answer)
- Language barriers are the only cultural consideration in treatment
Correct answer: Cultural factors influence how symptoms are expressed and whether treatment is sought
Cultural factors significantly shape symptom expression, help-seeking behavior, and attitudes toward both mental health and substance use treatment.
Question 7: Which legal consideration is MOST relevant when a COD client discloses current suicidal ideation with a plan?
- Duty to protect third parties
- Mandatory reporting of substance use to licensing boards
- Duty to warn or protect and possible involuntary hold (Correct answer)
- HIPAA prohibition on any disclosure
Correct answer: Duty to warn or protect and possible involuntary hold
A client with active suicidal ideation and a plan triggers the clinician's duty to protect, which may include initiating an involuntary psychiatric hold under California law.
CAADE Co-Occurring Disorders 3
The term 'diagnostic overshadowing' in COD refers to: