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Screening and Assessment of Co-Occurring Disorders in the Justice System (Updated)

Executive Summary

1. Mental health screening in the justice systems should include examination of _____, as behavior rates are elevated among offenders who have CODs.


B. Suicide risk

C. Depression

D. Psychotic disorders

2. Which of the following is an important predictor of treatment outcomes and can also be readily examined during screening in the justice system?

A. Psychosis

B. Intoxication

C. Motivation

D. Trauma history

3. An important component of screening is drug testing, which can enhance motivation and adherence to treatment.

A. True

B. False

4. Which of the following should be considered when conducting screening and assessment, and staff training is needed to effectively address these issues?

A. Cultural differences

B. Gender differences

C. Socioeconomic status

D. Mental disorders

5. Screening tools generally involve somewhat more in-depth questioning than assessment.

A. True

B. False

6. All of the following are key issues related to screening and assessment of CODs in the justice system, except:

A. Failure to comprehensively examine one or more of the disorders.

B. Inadequate staff training to identify and assess the disorders.

C. Use of ineffective and non-standardized screening and assessment instruments.

D. History of mental or substance use disorders and prior treatment.

Prevalence and Significance of Co-occurring Disorders in the Justice System

7. Many justice-involved individuals report that their crimes leading to the most recent arrest were committed while using drugs or alcohol.

A. True

B. False

8. Which treatment approaches have been the most successful among non-offender and offender samples?

A. Sequential

B. Parallel

C. Concurrent

D. Integrated

9. People with CODs often engage in drug use to alleviate symptoms associated with serious mental disorders, including all of the following, except:

A. Difficulty sleeping

B. Concentration difficulties

C. Paranoia

D. Depression

10. For some individuals who have CODs, using and selling drugs is a way to experience social connectedness and to create structure and a sense of meaning.

A. True

B. False

Defining Co-occurring Disorders

11. People in the justice system who have CODs are significantly more likely than those in the general population to have which of the following:

A. Diabetes

B. Stroke

C. Kidney disease

D. Chronic obstructive lung disease

12. It is recommended to combine offenders who are at significantly different risk levels in treatment and supervision services, as the different levels allow the offenders to have the most benefit from each other.

A. True

B. False

13. According to the DSM-5, depressive disorders now include:

A. Obsessive-compulsive disorder

B. Acute stress disorder

C. Premenstrual dysphoric disorder

D. Agoraphobia

14. The focus of treatment at any given time should be on remediating areas of functional impairment caused by one or both disorders.

A. True

B. False

Importance of Screening and Assessment for Co-occurring Disorders in Justice Settings

15. All of the following are common reasons for non-detection of CODs in the justice system, except for:

A. Overuse of psychotropic medications

B. Lack of staff training

C. Short duration of time and limited resources provided for screening and assessment in many correctional settings

D. Perceived or real negative consequences associated with self-disclosure of symptoms

16. Compared to other individuals, justice-involved individuals with CODs exhibit which of the following?

A. More severe psychosocial problems

B. Poorer institutional adjustment

C. Greater cognitive and functional deficits

D. Justice-involved individuals with CODs exhibit more severe psychosocial problems, poorer institutional adjustment, and greater cognitive and functional deficits than other individuals

Opportunities for Screening and Assessment

17. In general, opportunities for screening at Intercept 1 include all of the following, except:

A. Law enforcement

B. Staff of 24-hour crisis phone lines

C. Emergency medical technicians

D. Emergency room personnel

18. Jails are required to conduct at least basic screening for all of the following, except:

A. Suicide

B. Mental health

C. Sexual trauma

D. Substance use

Defining Screening and Assessment

19. Which of the following describes assessment?

A. Usually conducted by a trained professional who is either licensed or certified to provide mental health and substance use treatment services.

B. A brief, routine process designed to identify indicators, or “red flags,” for the presence of mental health, substance use, or other issues that reflect an individual’s need for treatment and for alternative types of supervision or placement in housing or institutional settings.

C. May be a brief interview, use of self-report instruments, and a review of archival records.

D. Instruments do not require that staff members are licensed, certified, or otherwise credentialed, and minimal training is usually required to administer, score, and interpret findings.

Developing a Comprehensive Screening and Assessment Approach

20. All individuals entering the justice system should be screened for mental and substance use disorders.

A. True

B. False

Key Information To Address in Screening and Assessment for Co-occurring Disorders

21. All of the following characteristics carry elevated risk for CODs, except:

A. Low educational achievement

B. History of emergency room or acute care visits

C. Poor relationships with family members

D. Female gender

22. All of the following are areas related to functional ability, except:

A. Reading and writing skills

B. Motivation to engage in treatment

C. How the individual responds to confrontation or stress

D. How the individual manages unusual thoughts and impulses

23. All of the following are key “criminal justice characteristics” among individuals in the justice system who have CODs, except for:

A. They tend to have histories of multiple incarcerations.

B. They are often unable to function independently in criminal justice settings.

C. They tend to be older at the time of their first offense.

D. They often have a history of aggressive or violent behavior.

24. In general, people in the justice system who have CODs are at no higher risk for recidivism than other offenders.

A. True

B. False

25. Which of the following is NOT a dynamic risk factor key in risk screening and assessment?

A. Substance use problems

B. Antisocial beliefs

C. Age

D. Social and family problems

26. National studies conducted by the Arrestee Drug Abuse Monitoring program indicate that over 90% of individuals charged with a criminal offense test positive for drug use at the time of arrest.

A. True

B. False

27. Which of the following is the preferred means of detecting substance use?

A. Drug testing

B. Self-report

C. Observation of symptoms

D. Drug testing, self-report, and observation of symptoms are all equally preferred means of detecting substance use

28. Which of the following can be used as a confirmatory sample because its collection is less easily tampered with?

A. Urine

B. Blood

C. Sweat

D. Saliva

29. Refusal to submit to drug testing should not be regarded as a positive test result.

A. True

B. False

30. When drug testing is performed at the pretrial stage, it typically cannot be used as evidence or considered in case outcomes, unless the arrestee enters a preplea diversion program.

A. True

B. False

31. All justice-involved individuals who have CODs, including those in jail and prison, should be drug tested.

A. True

B. False

32. Blood and hair testing are the most accurate methods of drug testing, as they are difficult to adulterate.

A. True

B. False

33. Regardless of the drug testing schedule, any onsite testing should be sent to a lab for confirmation of a positive result to ensure the results are legally admissible.  This is particularly important for all of the following alternative drug testing methods, except:

A. Hair

B. Sweat

C. Urine

D. Saliva

34. Caution should be used when conducting _____ testing because of the risk of external environmental contaminants and for racial bias.

A. Blood

B. Sweat

C. Urine

D. Hair

35. Detection time is days to weeks for which form of drug testing?

A. Urine

B. Blood

C. Sweat

D. Saliva

Enhancing the Accuracy of Information in Screening and Assessment

36. Alcohol and other drug use may mask or hide mental health symptoms or disorders.

A. True

B. False

37. In general, self-report information has been found to not:

A. Have good reliability

B. Have good specificity

C. Identify the full range of symptoms of CODs

D. Self-report information has been found to have good reliability and specificity and to identify the full range of symptoms of CODs

38. Individuals are least likely to admit to _____ use.

A. Amphetamine

B. Cocaine

C. Opiate

D. Marijuana

39. Accuracy of self-reported substance use is more accurate for patterns of recent use.

A. True

B. False

40. Male offenders are more likely than females to provide accurate self-reporting of substance use.

A. True

B. False

41. The DSM-IV-TR and DSM-5 indicate that individuals should be abstinent for approximately _____ before an accurate mental health diagnosis can be provided.

A. 2 weeks

B. 4 weeks

C. 2 months

D. 4 months

Special Clinical Issues in Screening and Assessment for Co-occurring Disorders in the Justice System

42. Treating mental disorders alone reduces the risk for recidivism among offenders with CODs.

A. True

B. False

43. Who experience better outcomes when attending frequent status hearings?

A. High-risk offenders

B. Low-risk offenders

C. Both high-risk and low-risk offenders

D. Neither high-risk nor low-risk offenders

44. When should suicide risk screening be conducted?

A. At arrest

B. Booking in jail

C. Transfer to prison

D. Screening for suicide risk should be conducted at every major transition point within the criminal justice system

45. According to the Suicide Risk Decision Tree, all of the following are components of desire, except for:

A. Fearlessness of death

B. Lack of belonging

C. Perceived burdensomeness

D. Fearlessness of death, lack of belonging, and perceived burdensomeness are all components of desire

46. There is an escalation of suicide risk with age, particularly over:

A. 25

B. 45

C. 65

D. 85

47. Which group has the highest risk for suicide?

A. Hispanics

B. Asians

C. Whites

D. Blacks

48. Motivation to engage in treatment is necessary to provide effective services for justice-involved individuals.

A. True

B. False

49. The purpose of motivational interviewing is to normalize ambivalence toward change.

A. True

B. False

50. Ethnic and racial minorities tend to have the lowest rates of successful treatment completion and higher rates of recidivism.

A. True

B. False

Key Issues in Selecting Screening and Assessment Instruments

51. Sensitivity of an instrument refers to:

A. An ability to identify individuals with mental and/or substance use disorders.

B. An ability to identify individuals without mental and/or substance use disorders.

C. An ability to identify individuals with and without mental and/or substance use disorders.

D. Sensitivity of an instrument cannot be used to identify individuals with or without mental and/or substance use disorders.

Comparing Screening Instruments

52. All of the following instruments were found to be the most effective in identifying individuals with substance use disorders, except for:

A. The Simple Screening Instrument

B. The Texas Christian University Drug Dependence Screen V

C. The Alcohol Dependence Scale and Addiction Severity Index-Drug Use section

D. The Drug Abuse Screening Test

Recommended Screening Instruments

53. All of the following are recommended screening instruments for co-occurring disorders, except for:

A. Mini International Neuropsychiatric Interview-Screen

B. Brief Jail Mental Health Screen and TCU Drug Screen V

C. Correctional Mental Health Form and TCU Drug Screen V

D. University of Rhode Island Change Assessment Scale-M

Screening Instruments for Substance Use Disorders

54. The Alcohol Dependence Scale is most effective in detecting:

A. Mild levels of alcohol use.

B. Moderate to severe levels of alcohol use.

C. Quantity of alcohol use.

D. Frequency of recent and past alcohol use.

55. The AUDIT-C may be better at identifying alcohol use disorders in women than men.

A. True

B. False

56. All of the following are questions asked on the four-item CAGE alcohol screening instrument, except for:

A. Have you felt you ought to cut down on your drinking?

B. Have people annoyed you by criticizing your drinking?

C. Have you caused harm to yourself or others while drinking?

D. Have you had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

57. The Michigan Alcoholism Screening Test has been found to do all of the following, except:

A. Be reliable

B. Effectively discriminate between problem and non-problem drinkers

C. Identify alcohol use disorders and excessive drinking problems

D. Determine quantity and frequency of alcohol use

58. Scores on the Substance Abuse Subtle Screening Inventory appear to be significantly affected by all of the following, except:

A. Age

B. Gender

C. Education level

D. Minority status

Screening Instruments for Mental Disorders

59. Elevated Beck Depression Inventory-II scores on items related to suicide ideation and _____ should be attended to carefully, since these items are the most highly predictive of suicidal behavior.

A. Depression

B. Hopelessness

C. Agitation

D. Feelings of worthlessness

60. Despite its usefulness in screening for depression and suicide, the Beck Depression Inventory-II should not be used in diagnosing depression.

A. True

B. False

61. The Brief Jail Mental Health Screen screens for:

A. Severe mental disorders

B. Anxiety

C. Depression

D. Personality disorders

62. All of the following are among the six core domains of the K6 screen, except:

A. Nervousness

B. Depression

C. Feeling as though everything takes effort

D. Functional impairment

Screening Instruments for Co-occurring Mental and Substance Use Disorders

63. The Behavior and Symptom Identification Scale examines the degree of difficulty experienced during the previous week across all fo the following domains of functioning, except:

A. Interpersonal relationships

B. Self-harm

C. Indecisiveness

D. Psychosis

Screening and Assessment Instruments for Suicide Risk

64. Among jail inmates, 80% of suicides occur within 2 days of a court hearing.

A. True

B. False

Screening and Diagnostic Instruments for Trauma and PTSD

65. The Stressful Life Events Screening Questionnaire-Revised screen can misidentify “true” traumatic events among which respondents:

A. Low-income minorities

B. Females

C. Those that are very young

D. The LGBTQ population

66. Which of the following is considered to be the “gold standard” for diagnosing PTSD?

A. The Trauma History Screen

B. The Trauma History Questionnaire

C. The Clinician-Administered PTSD Scale

D. The Posttraumatic Stress Diagnostic Scale

Screening Instruments for Motivation and Readiness for Treatment

67. The Circumstances, Motivation, Readiness, and Suitability Scale items are related to therapeutic communities, and thus, the instrument may not generalize to other treatment settings for assessing circumstances, motivation, and readiness for change.

A. True

B. False

68. Which item on the Texas Christian University Motivation Form identifies whether the respondent is paying attention while completing the measure?

A. Problem Recognition

B. Treatment Readiness

C. Pressures for Treatment

D. Accuracy

Assessment Instruments for Substance Use and Treatment Matching Approaches

69. The Addiction Severity Index includes all of the following domains of functioning commonly affected by substance use, except:

A. Legal status

B. Quantity of drug and alcohol use

C. Family and social relationships

D. Medical status

Assessment and Diagnostic Instruments for Co-occurring Mental and Substance Use Disorders

70. The Psychiatric Research Interview for Substance and Mental Disorders has excellent reliability in diagnosing:

A. Manic episodes

B. Major depression

C. Eating disorders

D. Psychotic disorders

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