CARN Co-Occurring Disorders 5 — Questions and Answers
Question 1: A patient with co-occurring major depression and opioid use disorder is started on buprenorphine/naloxone. Which additional benefit of this medication is particularly relevant to this patient's psychiatric comorbidity?
- Buprenorphine has no psychotropic effects beyond addiction treatment
- Buprenorphine has demonstrated antidepressant properties through kappa-opioid receptor antagonism (Correct answer)
- Naloxone component treats depression independently
- Buprenorphine increases serotonin levels equivalent to SSRIs
Correct answer: Buprenorphine has demonstrated antidepressant properties through kappa-opioid receptor antagonism
Buprenorphine's antagonism at kappa-opioid receptors, which are implicated in depressive states, may contribute to antidepressant effects in patients with co-occurring depression and opioid use disorder.
Question 2: A nurse in an integrated treatment program notices a patient with co-occurring disorders is rotating between individual therapy, group therapy, and case management in the same week. This model is BEST described as:
- Sequential treatment
- Parallel treatment
- Integrated treatment (Correct answer)
- Step-down treatment
Correct answer: Integrated treatment
Integrated treatment involves a unified team addressing both substance use and mental health within the same program simultaneously, which is distinct from sequential or parallel models.
Question 3: Which of the following is a key principle of Assertive Community Treatment (ACT) that makes it particularly effective for individuals with co-occurring serious mental illness and substance use disorders?
- Office-based appointments during standard business hours
- High staff-to-patient ratios with outreach in the community (Correct answer)
- Mandatory medication compliance as a condition of services
- Group-only treatment format to reduce costs
Correct answer: High staff-to-patient ratios with outreach in the community
ACT uses high staff-to-patient ratios and meets patients in their natural environment, making it highly effective for engaging individuals with serious mental illness and co-occurring substance use disorders who struggle with traditional clinic-based care.
Question 4: A patient with co-occurring alcohol use disorder and liver cirrhosis needs pharmacotherapy for depression. Which antidepressant should be used with GREATEST caution?
- Sertraline
- Escitalopram
- Nefazodone (Correct answer)
- Citalopram
Correct answer: Nefazodone
Nefazodone carries a black box warning for potentially fatal hepatic failure and is contraindicated in patients with liver disease, making it particularly dangerous in patients with alcohol-related cirrhosis.
Question 5: When using the SAMHSA No Wrong Door approach for individuals with co-occurring disorders, the primary goal is to:
- Ensure patients are triaged to the most restrictive level of care
- Allow any system entry point to connect individuals to comprehensive services (Correct answer)
- Separate mental health and addiction services for clearer accountability
- Require patients to self-identify their primary diagnosis for routing
Correct answer: Allow any system entry point to connect individuals to comprehensive services
The No Wrong Door approach ensures that regardless of which system a person enters — mental health, substance use, or primary care — they are connected to comprehensive, coordinated services for all their needs.
Question 6: A patient with co-occurring cocaine use disorder and depression has been abstinent for 3 weeks but reports persistent anhedonia and low mood. The nurse should FIRST:
- Start an SSRI immediately as this confirms independent major depression
- Reassess after 4-6 weeks of abstinence before diagnosing independent depression (Correct answer)
- Recommend inpatient psychiatric hospitalization for mood stabilization
- Attribute symptoms entirely to post-acute withdrawal and provide no intervention
Correct answer: Reassess after 4-6 weeks of abstinence before diagnosing independent depression
Cocaine-induced depression can persist beyond 2 weeks; reassessing after 4-6 weeks of abstinence allows clinicians to distinguish substance-induced from independent depressive disorders before initiating antidepressant pharmacotherapy.
Question 7: Which approach to trauma-informed care is MOST important when working with patients with co-occurring PTSD and substance use disorders?
- Requiring patients to process trauma before addressing substance use
- Creating a safe environment that emphasizes trust, choice, and collaboration (Correct answer)
- Using exposure-based techniques in early treatment regardless of substance use status
- Minimizing discussion of trauma to avoid triggering relapse
Correct answer: Creating a safe environment that emphasizes trust, choice, and collaboration
Trauma-informed care emphasizes creating physical and emotional safety, building trust, offering choice and collaboration, and empowering patients — foundational elements especially critical for patients with co-occurring PTSD and substance use disorders.
CARN Co-Occurring Disorders 5
A patient with co-occurring major depression and opioid use disorder is started on buprenorphine/naloxone.
Which additional benefit of this medication is particularly relevant to this patient's psychiatric comorbidity?