CART Co-Occurring Substance Use 3 — Questions and Answers
Question 1: A client discloses opioid use to manage chronic pain but denies any anger problems. Their spouse reports frequent rage episodes at home. The CART therapist's best next step is:
- Accept the client's self-report and focus only on pain management
- Explore the discrepancy between self-report and collateral information with the client (Correct answer)
- Immediately diagnose anger disorder and substance use disorder
- Dismiss the spouse's report as biased
Correct answer: Explore the discrepancy between self-report and collateral information with the client
Exploring discrepancies between self-report and collateral information in a non-confrontational manner is central to motivational and ethical clinical practice.
Question 2: Cannabis use is associated with anger in some clients primarily because of:
- Paradoxical disinhibition and increased paranoia in certain users (Correct answer)
- Universal calming effects for all users
- Direct dopamine suppression
- Decreased heart rate preventing anger arousal
Correct answer: Paradoxical disinhibition and increased paranoia in certain users
While cannabis has calming effects for many users, it can cause paradoxical disinhibition, anxiety, and paranoia in some, triggering or worsening anger responses.
Question 3: Which of the following best describes 'telescoping' in the context of substance use and anger?
- A longer interval between relapses over time
- A more rapid progression of substance use disorder in certain populations (Correct answer)
- A technique to visualize anger triggers over time
- A method to reduce withdrawal symptoms
Correct answer: A more rapid progression of substance use disorder in certain populations
Telescoping refers to the accelerated progression of substance use disorder seen in some populations (often women), moving faster from first use to dependence.
Question 4: When treating co-occurring anger and stimulant use disorder, which coping skill addresses both the physiological arousal of anger and drug craving simultaneously?
- Thought records
- Diaphragmatic breathing and progressive muscle relaxation (Correct answer)
- Cognitive restructuring only
- Journaling past experiences
Correct answer: Diaphragmatic breathing and progressive muscle relaxation
Diaphragmatic breathing and progressive muscle relaxation reduce physiological arousal that underlies both anger escalation and craving responses.
Question 5: A CART therapist notices a client frequently cancels sessions the day after reported heavy drinking. The most appropriate response is to:
- Discharge the client for non-compliance
- Ignore the pattern and focus only on scheduled sessions
- Address the pattern collaboratively and adjust treatment structure (Correct answer)
- Report the client to their employer
Correct answer: Address the pattern collaboratively and adjust treatment structure
Addressing attendance patterns collaboratively allows therapists to adapt the treatment plan to the client's actual capacity and reduce barriers to engagement.
Question 6: Which of the following best explains why benzodiazepine withdrawal can trigger intense anger in clients?
- Withdrawal causes dopamine spikes
- GABA suppression during withdrawal increases CNS excitability and irritability (Correct answer)
- Benzodiazepines permanently damage anger circuits
- Withdrawal leads to serotonin flooding
Correct answer: GABA suppression during withdrawal increases CNS excitability and irritability
Benzodiazepine withdrawal suppresses GABA, causing CNS hyperexcitability, anxiety, and heightened irritability that can manifest as intense anger.
Question 7: Trauma-informed care in the context of co-occurring anger and substance use recognizes that:
- Trauma history is irrelevant if substances are the primary concern
- Substance use and anger are often trauma responses rather than character flaws (Correct answer)
- Clients should process trauma before any anger work begins
- Trauma only affects women with substance use disorders
Correct answer: Substance use and anger are often trauma responses rather than character flaws
Trauma-informed care views both substance use and anger as adaptive responses to traumatic experiences, reducing stigma and improving therapeutic engagement.
CART Co-Occurring Substance Use 3
A client discloses opioid use to manage chronic pain but denies any anger problems.
Their spouse reports frequent rage episodes at home.
The CART therapist's best next step is: