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Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment (Updated) - Part 1


1. People with substance use disorders who are in treatment are at especially high risk of suicidal behavior for which reason?

A. They enter treatment at a point when their substance abuse is out of control, increasing a variety of risk factors for suicide.

B. They enter treatment when a number of co-occurring life crises may be occurring.

C. They enter treatment at peaks in depressive symptoms.

D. All of the above.

2. The consensus panel recommends that counselors be prepared to develop and implement a treatment plan to address suicidality and coordinate the plan with other providers.

A. True

B. False

Getting Ready to Address Suicidality

3. Which of the following is a guaranteed conversation-ending question?

A. You don’t have thoughts about killing yourself, do you?

B. Will you tell me about your suicidal thoughts?

C. Are you thinking about killing yourself?

D. What makes your suicidal thoughts worse?

4. Empirical evidence suggests that talking to a person about suicide will make them suicidal.

A. True

B. False

5. Clients should be given the impression that everything is confidential and that all types of treatment are always voluntary.

A. True

B. False

6. Interventions that successfully address major risk factors such as severe substance use, depression, and marital strife have the potential to reduce suicidal behavior.

A. True

B. False

7. A tragic outcome of death, by itself, equates to improper treatment of suicidality.

A. True

B. False

8. All clients should be screened for suicidal thoughts and behaviors as a matter of routine.

A. True

B. False

9. Which of the following actions should be taken in order to prevent clients from being exposed to life-threatening situations and to prevent the counselor and agency from being exposed to legal risk of malpractice?

A. Follow up with a client when risk has been previously documented.

B. Document suicide-related screening and interventions.

C. Communicate suicide risk to another professional or agency.

D. All of the above.

10. Even if a client really does not want to die, if his or her reports of suicidal ideation are not taken seriously, the client may act on them to “save face.”

A. True

B. False

Background Information

11. Indicators of which of the following include drafting a suicide note and taking precautions against discovery at the time of an attempt?

A. Suicidal ideation

B. Suicide plans

C. Suicidal intention

D. Suicide attempt

12. The most potent risk factor for suicidal thoughts and behaviors is:

A. Family history of suicide.

B. Prior history of suicide attempts.

C. Severe substance use.

D. Co-occurring mental disorder.

13. Protective factors:

A. May sustain someone showing ongoing signs of risk.

B. Immunize clients from suicidal behavior.

C. Afford protection in acute crises.

D. All of the above.

GATE: Procedures for Substance Abuse Counselors

14. A counselor should only attempt to manage suicide risk alone if they have substantial specialized training and education.

A. True

B. False

15. Consultation is a more formal process whereby information and advice are obtained from any of the following, except for:

A. A professional with clear supervisory responsibilities.

B. A peer.

C. A multidisciplinary team that includes professional(s) with supervisory responsibilities.

D. A consultant experienced in managing suicidal clients who have been vetted by the agency for this purpose.

16. Circumstances during treatment that require access to immediate supervision or consultation include all of the following, except:

A. Emergence or re-emergence of direct warning signs.

B. Emergence or re-emergence of indirect warning signs that, on followup questioning, suggest current risk.

C. A client with a history of suicidal thoughts or behavior experiences an acute stressful life event or a setback in treatment, but there are no accompanying warning signs or other indications to suspect current risk for suicidal behavior.

D. The client’s answers to suicide screening questions asked during the course of treatment suggest current risk.

17. All of the following require supervisory involvement or consultation, except for:

A. When clients exhibit direct suicide warning signs.

B. When clients exhibit indirect suicide warning signs.

C. When clients report at intake having made a recent suicide attempt.

D. When clients who have a history of suicidal behavior or attempts have a substance abuse relapse during treatment.

18. _____ is defined as the likelihood that a suicide attempt will occur and the potential consequences of an attempt.

A. Intention

B. Urgent

C. Seriousness

D. High-priority

19. Immediate action include all of the following, except:

A. Arranging transportation to a hospital emergency department for evaluation.

B. Contacting a spouse to have him or her arrange for removal of a gun from the home and arrange safe storage.

C. Making a referral for a client to an outpatient mental health facility for evaluation.

D. Arranging on the spot to have a mental health specialists in the program further evaluate a client.

20. With all clients with suicidal risk, consider developing with the client a written safety card that includes at a minimum:

A. A 24-hour crisis number.

B. The phone number and address of the nearest hospital emergency department.

C. The counselor’s contact information.

D. All of the above.

21. Suicidal behavior may occur in the context of substantial improvement in mood and energy, therefore, monitoring for signs of a return of suicidal thoughts or behavior is essential.

A. True

B. False

22. Documentation entails:

A. Providing a written summary of any steps taken pertaining to GATE.

B. Providing a statement of conclusions that shows the rationale for the resultant plan.

C. Both (A) and (B).

D. None of the above.

23. Even with the use of a checklist, a conclusion statement and the articulation of the plan are always needed.

A. True

B. False

Vignette 1 - Clayton

24. Which of the following is a specific point to consider when discussing suicide with a client?

A. Use clear, direct terms, not euphemisms for suicide.

B. Ask direct questions, but do so with care and compassion.

C. Ask open-ended questions that require more than a “yes” or “no” answer.

D. All of the above.

25. When a reply to a question indicates the presence of suicidal thoughts or behaviors, the counselor should follow up with open-ended questions that seek to obtain additional information.

A. True

B. False

26. The information a counselor should obtain during a current session is:

A. Information that is directly relevant to treatment planning.

B. Information that might be useful in later treatment.

C. Both (A) and (B).

D. None of the above.

27. Agencies should have a policy that specifically states that if a counselor feels he or she needs direction in a life-threatening crisis, a supervisor or other senior staff member should be contacted for input.

A. True

B. False

28. Which of the following is a step the counselor can take with family members?

A. Provide information about suicide, particularly dispelling misconceptions and providing accurate information.

B. Increasing awareness of signs and symptoms that a loved one might be experiencing suicidal thoughts and/or behaviors, especially recognizing warning signs or a significant change in risk factors.

C. Making suggestions about how to talk to a loved one who is experiencing suicidal thoughts: what to say, and what not to say.

D. All of the above.

29. Sometimes family members are not a positive force for suicide prevention and intervention, so care must be taken to assess how responsive the family members are to helping the client and if they possess the capacity to be a positive force in the client’s life at this time.

A. True

B. False

Vignette 2 - Angela

30. It is important for counselors to be aware of ongoing residential treatment and housing options for all of the following clients, except:

A. Those who have a history of homelessness.

B. Those who have co-occurring disorders.

C. Those who have a history of instability in obtaining and maintaining housing.

D. Those in need of long-term supervised care.

31. The counselor should encourage the client to be actively involved in a 12-Step or other supportive program.

A. True

B. False

32. Families should do all of the following after a client with a history of a previous suicide attempt and/or other significant risk factors has been discharged, except:

A. Family members should remain watchful for warning signs.

B. Before the patient leaves the hospital, family members should have a specific plan for whom to call and/or what to do in the event of acute warning signs.

C. Family members should presume that because a family member was just in the hospital, they are protected from suicidal behavior.

D. Family members should be involved in inpatient and outpatient treatment of their relatives.

33. Which of the following reactions from family members is counterproductive?

A. Hovering over the person to ensure that they don’t attempt again.

B. Frequently interrogating the suicidal person about their thinking.

C. Emotionally withdrawing from the suicidal person.

D. All of the above.

34. While clients may deny or minimize risk, those close to them often experience distrust and anxiety.  The counselor can address and normalize this experience and then reorient both parties back to the need for developing plans to support recovery and safety.

A. True

B. False

Vignette 3 - Leon

35. A potentially acutely suicidal client should never be left alone.

A. True

B. False

36. To develop a campus suicide prevention team:

A. Identify campus professionals who have responsibility for students at risk.

B. Identify a variety of situations and what the issues are.

C. Develop a smaller group to meet weekly to discuss at-risk students and coordinate mental health, academic, and environmental risks.

D. All of the above.

Vignette 5 - Vince

37. Men who abuse alcohol and/or drugs and are confronted with a break-up or threat to their relationship, may be prone to committing homicide followed by suicide, particularly those showing a pattern of any of the following, except for:

A. Depression

B. Jealousy

C. Domestic violence

D. Legal difficulties

Vignette 6 - Rena

38. All clients with suicide risk factors or at risk for a suicide crisis:

A. Can benefit from a Commitment to Treatment agreement.

B. Should have a safety card.

C. Both (A) and (B).

D. None of the above.

39. The first section of a safety plan should be:

A. A list of the warning signs that indicate that a crisis may be developing.

B. Coping strategies that clients can use without the help of another person.

C. Friends or family members that the client can call.

D. Telephone numbers of professionals who can be contacted in times of crisis.

40. All of the following are true with regards to the hope box, except for:

A. When clients have a new item for the hope box, they should explain to the counselor what it is, its significance, and in what way it makes them feel hopeful.

B. A commitment from the client should be elicited for them to practice thinking about one item in the hope box every day at home. They should describe to themselves how they feel when they recall the person, event, or time.

C. The client should be encouraged to add one new item to the hope box each week (or appropriate length of time).

D. After the hope box has been established, clients should be reminded to go to their hope box when they are feeling hopeless or sad, pick an item, and try to regain the feelings they have experienced in the past.

41. The hope box:

A. Is a practical exercise designed to activate reasons for living and disrupt the cycle of despair.

B. Helps reorient the client toward constructive problem solving and effective regulation of emotions.

C. Is an intervention that facilitates self-management.

D. All of the above.

42. It is more common for external events, rather than internal events, to activate the suicidal crisis.

A. True

B. False

43. “Shame-based” people often feel they don’t deserve help.

A. True

B. False

44. The most critical thing to remember about crisis phone calls is to:

A. Remain calm and patient throughout.

B. Always be oriented toward productive solutions.

C. Keep the call going as long as possible.

D. Stay focused on effective regulation of emotions and problem solving.

45. In most States, it is permissible to violate confidentiality during a suicidal crisis.

A. True

B. False

46. In order to contact family members during a crisis, the counselor needs to:

A. Have access to the appropriate phone numbers.

B. Know which family members offer healthy, supportive relationships.

C. Both (A) and (B).

D. None of the above.

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