CARN Managing Co-Occurring Disorders 5 — Questions and Answers
Question 1: A patient with co-occurring PTSD and opioid use disorder is most likely to disengage from treatment when:
- Trauma-focused therapy is introduced too rapidly before adequate stabilization (Correct answer)
- Buprenorphine is initiated for opioid use disorder
- Peer support specialists are integrated into the treatment team
- Motivational interviewing techniques are used by the nurse
Correct answer: Trauma-focused therapy is introduced too rapidly before adequate stabilization
Introducing trauma-focused therapy before a patient is stabilized can increase distress and dropout risk; phased treatment is recommended for this population.
Question 2: Which population is at highest risk for co-occurring substance use and mental health disorders according to epidemiological data?
- Adults over 65 years old with no prior psychiatric history
- Individuals with severe mental illness such as schizophrenia or bipolar disorder (Correct answer)
- College students with first-episode alcohol use
- Pregnant women without prior substance use history
Correct answer: Individuals with severe mental illness such as schizophrenia or bipolar disorder
Individuals with severe mental illness have rates of co-occurring substance use disorders estimated at 50% or higher, far exceeding the general population.
Question 3: A patient with co-occurring antisocial personality disorder (ASPD) and alcohol use disorder presents for treatment. The CARN should recognize that:
- ASPD is easily treated with standard CBT and the prognosis is excellent
- ASPD is frequently associated with higher rates of treatment dropout and recidivism (Correct answer)
- Patients with ASPD are never motivated for treatment and should be excluded
- Diagnosing ASPD is straightforward and does not require a period of abstinence
Correct answer: ASPD is frequently associated with higher rates of treatment dropout and recidivism
ASPD is associated with poorer treatment engagement and higher rates of dropout and recidivism, requiring tailored approaches focused on extrinsic motivation.
Question 4: Which of the following best supports the 'stress-diathesis model' as applied to co-occurring disorders?
- Substance use is always the primary cause of mental illness
- A biological vulnerability combined with environmental stressors leads to the development of mental illness (Correct answer)
- Mental illness occurs randomly without biological or environmental factors
- Environmental stress alone is sufficient to cause substance use disorders in all individuals
Correct answer: A biological vulnerability combined with environmental stressors leads to the development of mental illness
The stress-diathesis model posits that genetic vulnerability combined with environmental stress leads to the expression of mental illness, relevant to understanding co-occurring disorders.
Question 5: A CARN is caring for a patient with co-occurring major depression and cannabis use disorder. The patient asks if stopping cannabis will improve their depression. The evidence-based response is:
- Cannabis has no effect on depression symptoms
- Cannabis abstinence often leads to improvement in depressive symptoms over time, though not always (Correct answer)
- Depression always resolves completely within two weeks of cannabis cessation
- Cannabis use has been shown to reliably treat major depression
Correct answer: Cannabis abstinence often leads to improvement in depressive symptoms over time, though not always
Research shows depressive symptoms often improve with cannabis abstinence, but some patients have an independent major depressive disorder requiring separate treatment.
Question 6: In the context of medication-assisted treatment (MAT) for a patient with co-occurring opioid use disorder and bipolar disorder, the most important monitoring consideration is:
- Monitoring buprenorphine blood levels daily
- Assessing for mood stabilizer drug interactions with MAT medications and monitoring for mood episodes (Correct answer)
- Discontinuing mood stabilizers during opioid tapering
- Using benzodiazepines as the primary mood stabilizer
Correct answer: Assessing for mood stabilizer drug interactions with MAT medications and monitoring for mood episodes
Drug-drug interactions between mood stabilizers and MAT medications, as well as mood episode monitoring, are critical to safe treatment in this population.
Question 7: Which ethical principle is most directly challenged when a patient with a co-occurring disorder refuses recommended psychiatric medication due to a substance-use-related cognitive impairment?
- Justice
- Beneficence
- Autonomy (Correct answer)
- Veracity
Correct answer: Autonomy
When cognitive impairment from substance use affects decision-making capacity, the patient's autonomy to refuse treatment is in tension with their ability to make an informed, voluntary decision.
CARN Managing Co-Occurring Disorders 5
A patient with co-occurring PTSD and opioid use disorder is most likely to disengage from treatment when: