IC&RC Co-Occurring Mental Health & Substance Use Disorders — Questions and Answers
Question 1: What is the currently preferred approach to treating clients with co-occurring mental and substance use disorders?
- Treat the substance use first, then the mental disorder after a year of abstinence
- Integrated treatment that addresses both disorders at the same time (Correct answer)
- Refer only to mental health services
- Refer only to substance use services
Correct answer: Integrated treatment that addresses both disorders at the same time
Evidence supports integrated treatment, with both conditions addressed concurrently, ideally by the same team, because each disorder affects the course of the other.
Question 2: A client in early abstinence reports persistent depressed mood. What is the best first step?
- Assume it is only a withdrawal effect and take no action
- Immediately stop all treatment
- Assess symptom history and timing, monitor suicide risk, and refer for a diagnostic evaluation if needed (Correct answer)
- Tell the client to wait six months before discussing it
Correct answer: Assess symptom history and timing, monitor suicide risk, and refer for a diagnostic evaluation if needed
Symptoms may be substance-induced or an independent disorder. Careful assessment, suicide risk screening, and referral for diagnosis are standard practice.
Question 3: Which of the following is a common co-occurring condition among people with substance use disorders?
- Posttraumatic stress disorder (Correct answer)
- Color blindness
- Seasonal allergies
- Myopia
Correct answer: Posttraumatic stress disorder
PTSD, depression, anxiety, bipolar disorder, and ADHD frequently co-occur with substance use disorders.
Question 4: The 'self-medication hypothesis' suggests that:
- Clients use substances to relieve psychiatric symptoms or distress (Correct answer)
- Medications cause addiction
- Clients should dose themselves in treatment
- Only prescribed drugs are addictive
Correct answer: Clients use substances to relieve psychiatric symptoms or distress
The hypothesis holds that some people use substances to cope with psychiatric symptoms such as anxiety or trauma responses, which is why treating the underlying condition matters.
Question 5: Under SAMHSA's quadrant model, a client with a high-severity mental disorder and a high-severity substance use disorder should receive services that are:
- Limited to primary care
- Coordinated or integrated across systems, with intensive support (Correct answer)
- Provided only in outpatient prevention programs
- Delayed until symptoms disappear
Correct answer: Coordinated or integrated across systems, with intensive support
Clients with high severity in both areas need intensive, integrated or closely coordinated care across the mental health and addiction systems.
Question 6: Which screening tool is commonly used to screen for depression in substance use treatment settings?
- CAGE
- PHQ-9 (Correct answer)
- AUDIT-C
- ASAM Dimensions grid
Correct answer: PHQ-9
The PHQ-9 is a validated 9-item depression screener. CAGE and AUDIT-C screen alcohol use, and the ASAM criteria guide level-of-care placement.
