MAC Co-Occurring Disorders 5 — Questions and Answers
Question 1: When conducting a comprehensive assessment of a client suspected of having co-occurring disorders, the counselor should gather information about psychiatric symptoms:
- Only after the client has been abstinent for at least 30 days
- During both periods of active use and abstinence to differentiate primary from substance-induced disorders (Correct answer)
- Exclusively from collateral contacts to avoid client bias
- Only if the client self-identifies as having a mental health condition
Correct answer: During both periods of active use and abstinence to differentiate primary from substance-induced disorders
Assessing symptoms across different states (use vs. abstinence) is essential to distinguish primary psychiatric disorders from substance-induced conditions.
Question 2: A client with panic disorder and sedative use disorder is being medically detoxed. The counselor's primary role during this phase is to:
- Provide intensive CBT for panic disorder immediately
- Offer supportive presence, psychoeducation, and coordinate with the medical team (Correct answer)
- Avoid contact until detox is complete to prevent overstimulation
- Administer medications as directed by the physician
Correct answer: Offer supportive presence, psychoeducation, and coordinate with the medical team
During detox, the counselor provides support and psychoeducation while coordinating closely with the medical team rather than conducting intensive psychotherapy.
Question 3: Research on individuals with co-occurring antisocial personality disorder (ASPD) and substance use disorder indicates that treatment should:
- Focus exclusively on the substance use disorder because ASPD is untreatable
- Include structured behavioral interventions with clear consequences and contingency management (Correct answer)
- Use only insight-oriented psychotherapy to address the personality disorder
- Avoid any confrontation of behavior because it worsens outcomes
Correct answer: Include structured behavioral interventions with clear consequences and contingency management
Structured approaches with clear behavioral expectations and contingency management show the most promise for individuals with ASPD and co-occurring SUD.
Question 4: Which of the following statements about nicotine use in clients with co-occurring psychiatric disorders is clinically important?
- Nicotine has no meaningful interaction with psychiatric medications
- Smoking cessation should be deferred indefinitely to preserve mental health stability
- Tobacco use is disproportionately high in this population and treating it can improve overall outcomes (Correct answer)
- Clients with schizophrenia should be discouraged from quitting smoking due to clozapine interactions
Correct answer: Tobacco use is disproportionately high in this population and treating it can improve overall outcomes
Tobacco use rates are dramatically elevated among people with psychiatric disorders, and evidence shows that addressing nicotine dependence does not destabilize mental health and can improve long-term outcomes.
Question 5: A client with generalized anxiety disorder (GAD) and alcohol use disorder has been abstinent for 3 months but continues to report significant anxiety. The counselor should:
- Assure the client the anxiety will resolve within another month of sobriety
- Recognize this as likely primary GAD and ensure the client receives appropriate mental health treatment (Correct answer)
- Assume the anxiety is solely residual withdrawal and take no additional action
- Recommend the client return to controlled drinking to manage anxiety
Correct answer: Recognize this as likely primary GAD and ensure the client receives appropriate mental health treatment
Persistent anxiety after 3 months of abstinence is unlikely to be withdrawal-related and should be treated as primary GAD requiring evidence-based interventions.
Question 6: Integrated group therapy (IGT) for co-occurring disorders differs from traditional addiction groups primarily by:
- Requiring participants to be abstinent for 6 months before joining
- Addressing both mental health symptoms and substance use within the same group sessions (Correct answer)
- Excluding anyone with a psychotic disorder from participation
- Focusing exclusively on 12-Step principles
Correct answer: Addressing both mental health symptoms and substance use within the same group sessions
IGT addresses psychiatric symptoms and substance use within unified group sessions, reflecting the integrated treatment philosophy rather than siloing the two issues.
Question 7: A client with depression and opioid use disorder stabilized on buprenorphine tells their counselor they want to stop the medication because they feel 'like an addict.' The counselor's best response is to:
- Support immediate discontinuation because the client's autonomy is paramount
- Explore the stigma behind this belief and provide psychoeducation about MAT as evidence-based treatment (Correct answer)
- Agree that buprenorphine is a crutch and begin a taper immediately
- Transfer the client to a methadone clinic without further discussion
Correct answer: Explore the stigma behind this belief and provide psychoeducation about MAT as evidence-based treatment
Addressing internalized stigma about MAT through motivational exploration and psychoeducation helps clients make informed decisions and supports medication adherence.
MAC Co-Occurring Disorders 5
When conducting a comprehensive assessment of a client suspected of having co-occurring disorders, the counselor should gather information about psychiatric symptoms: