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Dual Diagnosis: Understanding Co-Occurring Mental Illness and Substance Use Disorders


1. Most experts believe that with dual diagnosis, the initial condition, whether it’s a mental disorder or substance use issue, tends to influence a person’s path to the second condition, and that mental illness and substance use interact to make each diagnosis worse and to have serious, adverse effects on many areas of functioning.

A. True

B. False


2. Various theories have attempted to explain the relationship between mental illness and substance abuse, and why co-existence of these behaviors is prevalent, including each of the following EXCEPT:

A. The Self-Medication Theory proposes that people begin using drugs in an attempt to alleviate symptoms from a psychiatric condition they already have or to counter the side effects of anti-psychotic medications, and as a result, these substances may not be chosen randomly, but rather with a specific purpose

B. The Alleviation of Dysphoria Theory suggests that individuals with characteristics of dysphoria may use substances excessively to lessen feelings associated with depression, anxiety, loneliness, or boredom

C. The Attainment/Reactivity Theory states that while a dual diagnosis situation might develop in response to some kind of genetic issue, it might also develop when damage caused by addiction comes into contact with a genetic abnormality that could lead to mental illness

D. The Multiple Risk Factor/Environmental Triggers Theory postulates that there may be shared risk factors that can lead to both substance abuse and mental illness, including poverty, lack of structured daily activity, lack of adult role responsibility, living in areas with high drug availability, and association with people who already misuse drugs

Screening and Assessmnent

3. According to the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment, assessment is a formal interviewing and/or testing process that identifies areas of a client’s life that might need further examination and evaluates for the possible presence of a problem.

A. True

B. False

Twelve Steps in the Assessment Process

4. During the assessment process, diagnosis is generally established more by current symptom presentation than by history, and it is most important to gather and document information related to prevailing issues and problems.

A. True

B. False


5. Positive outcomes for dual diagnosis will most likely be achieved if both diagnoses are addressed, if the individual is actively involved in decision-making, setting goals, and developing a plan, if it includes basic education about substance use and mental health disorders and related problems, and if:

A. Healthy coping skills and strategies are taught

B. Services are specialized and independent

C. Objectives are focused on building productive relationships

D. None of the above

6. Which of the following are NOT included in the evidence-based principles of service delivery for co-occurring disorders that experts believe provide a framework for developing appropriate clinical practice guidelines?  

A. Co-occurring issues and conditions are an expectation, not an exception, and the foundation of a recovery partnership is an empathic, hopeful, integrated, strength-based relationship

B. All people with co-occurring conditions are not the same, so different parts of the system have responsibility to provide co-occurring capable services for different populations

C. Recovery involves moving through stages of change and phases of recovery for each co-occurring condition or issue, and interventions and outcomes must be matched to stage of change and phase of recovery

D. When co-occurring issues co-exist, the issue or condition that is considered to be primary as well as the one that is secondary need to be identified so that appropriate treatment matching may occur

Treatment Modalities Most Commonly Used for Dual Diagnosis

7. Rational Emotive Behavior Therapy (REBT) helps clients with dual diagnosis identify, challenge, and replace their destructive thoughts and convictions with healthier, adaptive thoughts, and empirical studies demonstrate that this process incites emotional well-being and goal achievement.

A. True

B. False

Locations and Levels of Care for Dual Diagnosis

8. Clients who participate in the ___________________________ level of care can live independently in the community, are usually stepping down from a more intensive treatment level, and do not require frequent contact with professionals in order to maintain health and recovery.

A. Basic Rehabilitation Services

B. Recovery Maintenance and Health Management

C. Low Intensity Community Based Services

D. Individually Monitored Non-Residential Services

9. According to current literature, the most common mental health/addiction combinations in play today are alcoholism and anti-social personality disorder, marijuana addiction and schizophrenia, cocaine addiction and anxiety disorders, opioid addiction and PTSD, and heroin addiction and depression.

A. True

B. False

10. Individuals with a personality disorder and substance use have more problematic symptoms and poorer treatment compliance than those without a personality disorder, and this is primarily true with narcissistic and obsessive-compulsive personality disorders, where multiple comorbidity is common.

A. True

B. False

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