CAADC Co-occurring Disorders 2 — Questions and Answers
Question 1: What is the recommended approach when a client presents with both major depressive disorder and alcohol use disorder?
- Treat alcohol first, then depression
- Treat depression first, then alcohol
- Address both simultaneously using integrated treatment (Correct answer)
- Refer to separate providers for each
Correct answer: Address both simultaneously using integrated treatment
Evidence supports integrated treatment addressing both disorders simultaneously, as they interact and exacerbate each other.
Integrated treatment uses a single treatment plan addressing the interplay between disorders, employing coordinated interventions such as MI for substance use alongside CBT for depression.
Question 2: A client with schizophrenia and methamphetamine use exhibits paranoid ideation. How should the counselor approach assessment?
- Assume all symptoms are drug-induced
- Assume all symptoms are from schizophrenia
- Carefully assess whether symptoms are substance-induced, psychiatric, or both (Correct answer)
- Postpone assessment for 6 months
Correct answer: Carefully assess whether symptoms are substance-induced, psychiatric, or both
Thorough assessment must distinguish between substance-induced and primary psychiatric symptoms.
The counselor should gather comprehensive history including temporal relationships between substance use and symptoms, presentation during abstinence, and family history. Collaboration with psychiatric providers is essential.
Question 3: What is 'substance-induced mood disorder' and why must CAADC counselors understand it?
- A permanent mood disorder from any substance use
- A mood disturbance developing during or after intoxication/withdrawal that resolves after substance effects abate (Correct answer)
- A disorder only in people with no psychiatric history
- A disorder requiring lifelong medication
Correct answer: A mood disturbance developing during or after intoxication/withdrawal that resolves after substance effects abate
Substance-induced mood disorder typically resolves with sustained abstinence, requiring different treatment than a primary mood disorder.
If depressive symptoms are substance-induced, they typically resolve within weeks of abstinence without antidepressant medication. Misdiagnosis leads to inappropriate treatment.
Question 4: Which treatment was specifically designed for co-occurring PTSD and substance use disorders?
- Applied Behavior Analysis
- Seeking Safety (Correct answer)
- Electroconvulsive Therapy
- Purely pharmacological treatment
Correct answer: Seeking Safety
Seeking Safety is a present-focused treatment specifically designed for co-occurring PTSD and SUD.
Developed by Lisa Najavits, Seeking Safety addresses 25 topics through cognitive, behavioral, and interpersonal themes. It does not require trauma narrative processing, making it accessible early in treatment.
Question 5: What does the 'four-quadrant model' classify in co-occurring disorders treatment?
- The four phases of recovery
- Clients by severity of both mental health and substance use disorders to guide service settings (Correct answer)
- Four types of psychotropic medications
- Four stages of motivational interviewing
Correct answer: Clients by severity of both mental health and substance use disorders to guide service settings
The model categorizes clients based on mental health severity (high/low) and substance use severity (high/low).
The model helps organize services: low/low can be served in primary care; high MH/low SU in mental health; low MH/high SU in addiction treatment; high/high requires specialized integrated programs.
Question 6: A client with bipolar disorder and cocaine use is in a manic episode with increased cocaine use. What is the clinical priority?
- Focus exclusively on reducing cocaine use
- Ensure immediate safety, coordinate with psychiatric providers, and develop an integrated crisis plan (Correct answer)
- Discharge from addiction treatment until mania resolves
- Increase group therapy frequency only
Correct answer: Ensure immediate safety, coordinate with psychiatric providers, and develop an integrated crisis plan
During a co-occurring crisis, safety is paramount and psychiatric coordination is essential.
Mania increases impulsivity and risk-taking, amplified by cocaine's stimulant effects. Priorities include safety assessment, psychiatric contact for medication management, crisis safety planning, and potentially a higher level of care.
CAADC Co-occurring Disorders 2
What is the recommended approach when a client presents with both major depressive disorder and alcohol use disorder?