CADC Alcohol and Drug Counselor Crisis Intervention Strategies 5 — Questions and Answers
Question 1: A counselor responding to a client in a methamphetamine-induced psychosis crisis should prioritize:
- Conducting a detailed substance use history interview
- De-escalating the environment and ensuring safety while awaiting medical support (Correct answer)
- Beginning cognitive restructuring to address paranoid beliefs
- Encouraging the client to call their sponsor
Correct answer: De-escalating the environment and ensuring safety while awaiting medical support
Meth-induced psychosis can involve dangerous agitation; de-escalation and environmental safety are paramount while medical backup is secured.
Question 2: The 'EARS' model used in crisis telephone counseling stands for:
- Empathize, Assess, Refer, Summarize (Correct answer)
- Explore, Acknowledge, Reflect, Support
- Evaluate, Act, Respond, Stabilize
- Engage, Assess, Respond, Safety plan
Correct answer: Empathize, Assess, Refer, Summarize
The EARS model — Empathize, Assess, Refer, Summarize — provides a structured framework for crisis telephone counselors to guide calls efficiently.
Question 3: When conducting a crisis assessment for a client with co-occurring PTSD and stimulant use disorder, the counselor should be aware that:
- PTSD symptoms are unrelated to stimulant use and should be assessed separately at a later date
- Stimulant intoxication and PTSD hyperarousal can overlap, complicating accurate risk assessment (Correct answer)
- Clients with PTSD are at lower suicide risk than the general population
- Crisis intervention is contraindicated until the PTSD is fully treated
Correct answer: Stimulant intoxication and PTSD hyperarousal can overlap, complicating accurate risk assessment
Stimulant intoxication can mimic or amplify PTSD hyperarousal symptoms, making it challenging to accurately assess risk level and crisis severity.
Question 4: In crisis intervention, the term 'disposition' refers to:
- The client's emotional attitude toward treatment
- The agreed-upon plan for where and how the client will receive care after the crisis contact (Correct answer)
- The counselor's legal documentation of the crisis event
- The client's prognosis for long-term recovery
Correct answer: The agreed-upon plan for where and how the client will receive care after the crisis contact
Disposition is the action plan that determines the client's next level of care, such as hospitalization, referral to outpatient services, or a follow-up appointment.
Question 5: Which of the following is an example of secondary traumatic stress (STS) in a substance use crisis counselor?
- Feeling tired after a long shift of counseling sessions
- Developing intrusive thoughts and emotional numbing after repeated exposure to clients' trauma narratives (Correct answer)
- Disagreeing with a supervisor's clinical decision
- Experiencing burnout from administrative paperwork
Correct answer: Developing intrusive thoughts and emotional numbing after repeated exposure to clients' trauma narratives
STS involves trauma-like symptoms — intrusive thoughts, avoidance, hyperarousal — that develop in helpers exposed vicariously to clients' traumatic experiences.
Question 6: A counselor determines that a client in crisis does NOT meet criteria for inpatient psychiatric hospitalization. The MOST appropriate next step is to:
- Discharge the client with no follow-up plan
- Develop a collaborative safety plan and arrange a timely follow-up contact or appointment (Correct answer)
- Recommend the client attend a 12-step meeting immediately
- Refer the client to a physician for medication without further counselor involvement
Correct answer: Develop a collaborative safety plan and arrange a timely follow-up contact or appointment
When hospitalization is not warranted, a collaborative safety plan combined with a structured follow-up contact bridges the gap between crisis and ongoing care.
Question 7: Which legislative act most directly impacts how substance use disorder crisis records can be shared with other treatment providers during a crisis situation?
- HIPAA Privacy Rule (1996)
- 42 CFR Part 2 (Confidentiality of Substance Use Disorder Patient Records) (Correct answer)
- The Mental Health Parity and Addiction Equity Act
- The Americans with Disabilities Act
Correct answer: 42 CFR Part 2 (Confidentiality of Substance Use Disorder Patient Records)
42 CFR Part 2 imposes stricter confidentiality protections on SUD records than HIPAA, restricting disclosure even in some crisis situations without specific consent.
CADC Alcohol and Drug Counselor Crisis Intervention Strategies 5
A counselor responding to a client in a methamphetamine-induced psychosis crisis should prioritize: