MAC Co-Occurring Disorders 3 — Questions and Answers
Question 1: A client presents with mood instability, impulsivity, and stimulant use disorder. The counselor notices that the client's mood symptoms only appear during periods of active cocaine use. This pattern most suggests:
- Bipolar I disorder
- Substance-induced mood disorder (Correct answer)
- Major depressive disorder
- Persistent depressive disorder
Correct answer: Substance-induced mood disorder
When mood symptoms are temporally linked to substance intoxication or withdrawal and resolve with abstinence, a substance-induced disorder is the most appropriate diagnosis.
Question 2: Which of the following best describes the 'no wrong door' approach in co-occurring disorder services?
- Clients must enter through the mental health system first
- Any point of entry (mental health, substance use, primary care) can initiate integrated care (Correct answer)
- Clients are turned away only if they are acutely intoxicated
- Emergency departments are the sole entry point for dual-diagnosis clients
Correct answer: Any point of entry (mental health, substance use, primary care) can initiate integrated care
The 'no wrong door' policy ensures that clients can access integrated co-occurring disorder services regardless of which system or provider they initially contact.
Question 3: When treating a client with co-occurring anxiety disorder and alcohol use disorder, counselors should be aware that:
- Alcohol reliably reduces anxiety long-term and is an appropriate coping tool
- Alcohol withdrawal can produce or worsen anxiety symptoms (Correct answer)
- Anxiolytics should never be prescribed in this population
- Anxiety always precedes alcohol use disorder in terms of onset
Correct answer: Alcohol withdrawal can produce or worsen anxiety symptoms
Alcohol withdrawal commonly produces rebound anxiety, which may be confused with or exacerbate an underlying anxiety disorder.
Question 4: In integrated dual-diagnosis treatment, which therapeutic approach has the strongest evidence base for addressing both PTSD and substance use disorder simultaneously?
- 12-Step Facilitation
- Seeking Safety (Correct answer)
- Rational Emotive Behavior Therapy
- Psychodynamic therapy
Correct answer: Seeking Safety
Seeking Safety is a manualized, evidence-based treatment specifically designed to address PTSD and substance use disorder concurrently.
Question 5: A client with co-occurring ADHD and stimulant use disorder asks about medication. The counselor's most appropriate response is to:
- Inform the client that no medications are appropriate given their substance history
- Collaborate with the prescriber, as non-stimulant ADHD medications may be indicated (Correct answer)
- Recommend stimulant medications because they will reduce cravings
- Discourage any psychiatric medication while in early recovery
Correct answer: Collaborate with the prescriber, as non-stimulant ADHD medications may be indicated
Non-stimulant medications such as atomoxetine or bupropion may be appropriate for ADHD in clients with stimulant use disorder and should be considered in collaboration with a prescriber.
Question 6: Which of the following statements about the prevalence of co-occurring disorders is most accurate?
- Co-occurring disorders affect fewer than 5% of individuals with SUD
- Approximately half of individuals with a lifetime SUD also meet criteria for a mental health disorder (Correct answer)
- Mental health disorders are rarely seen in individuals with alcohol use disorder specifically
- Co-occurring disorders are more common in women than in any other demographic
Correct answer: Approximately half of individuals with a lifetime SUD also meet criteria for a mental health disorder
Epidemiological data (e.g., NESARC, NESARC-III) consistently shows that roughly 50% of individuals with a substance use disorder have a co-occurring mental health condition.
Question 7: A counselor working with a dually diagnosed client who is psychiatrically stable but actively using should prioritize:
- Terminating services until the client achieves abstinence
- Addressing only the mental health condition until substance use resolves
- Maintaining engagement and addressing both conditions with harm reduction principles (Correct answer)
- Hospitalizing the client immediately
Correct answer: Maintaining engagement and addressing both conditions with harm reduction principles
Maintaining therapeutic engagement using harm reduction principles is essential for clients who are not yet abstinent but are psychiatrically stable.
MAC Co-Occurring Disorders 3
A client presents with mood instability, impulsivity, and stimulant use disorder.
The counselor notices that the client's mood symptoms only appear during periods of active cocaine use.
This pattern most suggests: