CARN Managing Co-Occurring Disorders 3 — Questions and Answers
Question 1: A patient with PTSD and alcohol use disorder is most at risk for relapse when:
- Participating in group therapy with other trauma survivors
- Experiencing trauma triggers or PTSD symptom exacerbation (Correct answer)
- Beginning trauma-focused cognitive behavioral therapy
- Engaging in mindfulness-based relapse prevention
Correct answer: Experiencing trauma triggers or PTSD symptom exacerbation
PTSD symptom activation, including intrusive memories and hyperarousal, significantly increases craving and relapse risk in patients with co-occurring alcohol use disorder.
Question 2: Which antidepressant class is generally preferred for treating depression co-occurring with alcohol use disorder due to its safety profile and evidence base?
- Tricyclic antidepressants (TCAs)
- Monoamine oxidase inhibitors (MAOIs)
- Selective serotonin reuptake inhibitors (SSRIs) (Correct answer)
- Benzodiazepines
Correct answer: Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are preferred for co-occurring depression and alcohol use disorder due to their favorable safety profile, low abuse potential, and evidence of efficacy.
Question 3: A CARN is treating a patient with borderline personality disorder (BPD) and opioid use disorder. Which therapeutic approach has the strongest evidence for treating BPD in this population?
- Standard CBT without modification
- Dialectical Behavior Therapy (DBT) (Correct answer)
- Psychoanalytic therapy
- 12-step facilitation alone
Correct answer: Dialectical Behavior Therapy (DBT)
DBT was originally developed for BPD and has been adapted for co-occurring substance use disorders, with strong evidence supporting its effectiveness.
Question 4: In integrated dual diagnosis treatment (IDDT), the primary advantage over sequential treatment is:
- It is less expensive and requires fewer providers
- Both disorders are addressed simultaneously by the same treatment team (Correct answer)
- Patients must achieve sobriety before addressing mental health needs
- Mental health treatment is prioritized over addiction treatment
Correct answer: Both disorders are addressed simultaneously by the same treatment team
IDDT ensures that both disorders are treated concurrently by the same team, eliminating gaps and inconsistencies that occur with sequential approaches.
Question 5: A nurse notices a patient with major depressive disorder has significantly increased alcohol use over the past week. The most appropriate initial intervention is:
- Increase the antidepressant dose without further assessment
- Explore the relationship between depressive symptoms and increased alcohol use (Correct answer)
- Discharge the patient for violating treatment rules
- Refer to a detox program and discontinue psychiatric treatment
Correct answer: Explore the relationship between depressive symptoms and increased alcohol use
Exploring the relationship between mood symptoms and substance use is essential to understanding the functional connection and guiding integrated treatment.
Question 6: Which of the following best describes the 'bidirectional relationship' between mental health disorders and substance use disorders?
- Mental illness always causes substance use disorders
- Substance use always causes mental illness
- Each disorder can trigger, worsen, or maintain the other disorder (Correct answer)
- The disorders are unrelated and must be treated independently
Correct answer: Each disorder can trigger, worsen, or maintain the other disorder
The bidirectional relationship means mental illness can lead to substance use and vice versa, with each disorder reinforcing and complicating the other.
Question 7: A patient with co-occurring ADHD and stimulant use disorder requires medication management. Which medication is most appropriate?
- Amphetamine salts due to superior ADHD efficacy
- Atomoxetine, a non-stimulant ADHD medication (Correct answer)
- High-dose methylphenidate for symptom control
- Avoid all ADHD medications and rely on behavioral strategies only
Correct answer: Atomoxetine, a non-stimulant ADHD medication
Atomoxetine is a non-stimulant ADHD medication with no abuse potential, making it the preferred choice for patients with co-occurring stimulant use disorder.
CARN Managing Co-Occurring Disorders 3
A patient with PTSD and alcohol use disorder is most at risk for relapse when: