CAS Risk Management & Mitigation 3 — Questions and Answers
Question 1: Under the ethical principle of duty to warn, a CAS counselor is legally obligated to break confidentiality when a client:
- Reports past criminal activity involving drug trafficking
- Makes a credible specific threat to harm an identifiable third party (Correct answer)
- Discloses ongoing use of illegal substances
- Expresses general frustration and anger toward a family member
Correct answer: Makes a credible specific threat to harm an identifiable third party
The Tarasoff duty to warn applies when there is a specific, credible threat against an identifiable victim, requiring the counselor to notify authorities and/or the potential victim.
Question 2: Which protective factor most reliably reduces long-term relapse risk in individuals recovering from alcohol use disorder?
- High educational attainment
- Strong social support network engaged in recovery (Correct answer)
- Prior history of treatment completion
- Employment in a low-stress occupation
Correct answer: Strong social support network engaged in recovery
Peer and family social support is consistently identified as the strongest protective factor against relapse in longitudinal outcome research.
Question 3: A client in a methadone maintenance program tests positive for cocaine during a random urine drug screen. The MOST appropriate clinical response is:
- Immediately discharge the client from the program
- Explore triggers and circumstances with the client and adjust the treatment plan accordingly (Correct answer)
- Increase the methadone dose to reduce drug-seeking behavior
- Report the client to law enforcement for illegal substance use
Correct answer: Explore triggers and circumstances with the client and adjust the treatment plan accordingly
A positive screen is a clinical data point that should prompt collaborative problem-solving and treatment plan revision rather than punitive discharge.
Question 4: When assessing suicide risk in a client with stimulant use disorder, the counselor should be particularly alert to increased danger during:
- The peak intoxication phase
- The crash or withdrawal phase following a binge (Correct answer)
- The first week of abstinence
- Periods of moderate controlled use
Correct answer: The crash or withdrawal phase following a binge
The stimulant crash involves profound dysphoria, anhedonia, and hopelessness that dramatically elevate suicide risk.
Question 5: Which document BEST serves as a legally and ethically sound tool for managing risk with a suicidal client?
- A no-suicide contract signed by the client
- A collaborative safety plan with specific coping steps, contacts, and crisis resources (Correct answer)
- A written promise from the client not to harm themselves
- A medication agreement restricting prescription access
Correct answer: A collaborative safety plan with specific coping steps, contacts, and crisis resources
Evidence-based safety planning, not no-suicide contracts, is the recommended standard because it actively builds coping skills and support connections.
Question 6: A client with cannabis use disorder works in a state where marijuana is legal but her employer conducts random drug testing. Which risk area should the counselor prioritize in treatment planning?
- Legal consequences of cannabis possession
- Occupational risk including potential job loss and financial instability (Correct answer)
- Physical health effects of cannabis smoke inhalation
- Social stigma associated with cannabis use disorder
Correct answer: Occupational risk including potential job loss and financial instability
Employment jeopardy creates financial instability and stress that directly threaten recovery capital and should be a central treatment planning focus.
Question 7: A CAS counselor discovers a client has been sharing their prescribed naltrexone with a roommate who is not in treatment. The counselor's FIRST obligation is to:
- Terminate the client's prescription immediately
- Address the safety and legal risks with the client and document the conversation (Correct answer)
- Report the client to the prescribing physician without informing the client
- Ignore the behavior since naltrexone is not a controlled substance
Correct answer: Address the safety and legal risks with the client and document the conversation
The counselor must directly address the safety and diversion risks with the client in session and document it, maintaining the therapeutic alliance while managing the risk.
CAS Risk Management & Mitigation 3
Under the ethical principle of duty to warn, a CAS counselor is legally obligated to break confidentiality when a client: