Post Test: Dual Diagnosis Update
Text: Assessment and Treatment of Patients with
Coexisting Mental Illness and Alcohol and Other Drug Abuse
Treatment Improvement Protocol (TIP) Series 9
By: Richard Ries, M. D.
Exam copyright (c) 2001 by:
Institute of Addiction Awareness
24881 Alicia Pkwy, #E-519
Laguna Hills, CA 92653
www.CEUInstitute.com
949-643-3802
1. What effect can alcohol and other drug abuse have on psychiatric
symptoms?
a. None
b. Minimal and transient
c. May induce, worsen or diminish then
d. Always makes them worse
2. The symptoms of a coexisting psychiatric disorder may be
misinterpreted as poor or incomplete "recovery" from AOD addiction.
a. True
b. False
3. Which statement is true about patients with mental disorders?
a. There is clear evidence of a relationship between mental illness and
AOD abuse.
b. They have an increased risk for AOD addiction.
c. They have a decreased risk for AOD addiction.
d. The evidence is unclear about the relationship between mental
illness and AOD.
4. Evidence of physiologic dependence and tolerance of a substance is:
a. sufficient for a diagnosis of AOD abuse.
b. always an indication that a mental illness coexists with dependence.
c. an indication that a coexisting mental illness is not present.
d. not sufficient for a diagnosis of AOD abuse.
5. In the treatment of AOD abuse and addiction self-help groups are
considered:
a. an integral adjunct to professional treatment services.
b. a necessary community treatment service.
c. a paraprofessional treatment modality.
d. both b. and c. above
6. The purpose of case management is to:
a. allocate limited resources to those clients who will benefit the most
from treatment.
b. help to engage, link and support patients in needed community
services.
c. prevent relapse in high-risk individuals.
d. both a. and c. above
7. The serial or nonsimultaneous participation in both mental health and
addiction treatment settings is known as:
a. concurrent treatment.
b. community based therapy.
c. sequential treatment.
d. integrated treatment.
8. The process of initiating and sustaining the patient's participation in
the ongoing treatment process is:
a. case management.
b. therapeutic alliance.
c. treatment engagement.
d. none of the above
9. To treat patients with a mental illness and a substance abuse disorder
it is necessary to have separate case management for the mental illness
and substance abuse.
a. True
b. False
10. The management of physical, psychiatric or drug toxicity crises is:
a. acute stabilization.
b. subacute stabilization.
c. crisis management.
d. comprehensive care.
11. Ideally, what dictates the intensity of treatment for a dual diagnosis
patient?
a. Disorder severity
b. Patient motivation
c. Personal and local treatment resources
d. all of the above
12. Profiles of patients with dual disorders indicate that they:
a. are less disabled than patients with a single disorder.
b. require fewer services than patients with a single disorder.
c. more or differently disabled than patients with a single disorder.
d. none of the above
13. Providers should base admission and placement criteria on:
a. the patient's diagnosis.
b. behaviors and skills required to participate in and benefit from a
program.
c. economic resources.
d. both b. and c. above
14. Current reimbursement practices __________ integration of services
and effective treatment.
a. inhibit
b. encourage
c. are irrelevant to the
d. have a positive effect on the
15. Which statement best describes the availability of staff trained in
AOD and mental health treatment?
a. There is a shortage of qualified staff despite generous financial
compensation.
b. There is no shortage of qualified staff.
c. Programs are generally unable to compensate staff for their
specialized abilities.
d. There is both a shortage of qualified staff and an inability to financially
compensate qualified staff for their specialized abilities.
16. What proportion of patients with dual disorders require social
services?
a. a large proportion
b. a small proportion of chronically mentally ill persons
c. about half of those with less than a year's sobriety
d. the same as those with AOD disorders
17. Historically, physicians have received no education about AOD
treatment in medical school.
a. True
b. False
18. __________ is often a substitute for AOD abuse and mental health
treatment.
a. Involuntary hospitalization
b. Incarceration
c. both a. and b. above
d. none of the above
19. When a patient with dual disorders is incarcerated, the criminal
justice system should conduct an assessment for dual disorders:
a. prior to release into the community.
b. upon admission.
c. after a detainee is sober.
d. both b. and c. above
20. ___________ is a chronic mood disturbance characterized by loss of
interest or pleasure in most activities of daily life characterized by mild to
moderate depression
a. Major depressive episode
b. Cyclothymia
c. Substance-induced mood disorder
d. Dysthymia
21. Hypomanic episodes are severe enough to cause marked impairment
in social functioning and to require hospitalization.
a. True
b. False
22. The prevalence rate for depression among alcoholic women is
___________ the rate among men.
a. the same as
b. less than
c. greater than
d. both a. and b. above
23. ___________ psychoactive drugs cause alterations in normal mood.
a. Many
b. Some
c. All
d. Few
24. Hallucinosis has several features in common with psychotic disorders
and a few in common with mood disorders.
a. True
b. False
25. The responsibility to protect some patients from suicide or violence
due to mental illness is:
a. mitigated by confidentiality laws with respect to AOD addiction.
b. governed by confidentiality laws that supercede those covering AOD.
c. not mitigated by confidentiality laws with respect to AOD addiction.
d. both b. and c. above
26. Which of the following conditions are associated in every recent
study of successful or attempted suicide?
a. Stimulant withdrawal and hypomania.
b. AOD use and major depression.
c. AOD abuse and dysthymia.
d. Psychoactive substances and cyclothymia.
27. Interviewers must be aware that AOD-dependent patients:
a. have a tendency to distort information.
b. are generally better historians than mentally ill patients.
c. are generally worse historians than mentally ill patients.
d. may have memory gaps because of AOD use.
28. Treatment for acute sedative-hypnotic withdrawal does not require
medically managed detoxification.
a. True
b. False
29. Patients who receive treatment for their psychiatric disorder while
participating in a strong recovery-oriented AOD abuse treatment program
are receiving:
a. sequential treatment.
b. integrated treatment.
c. parallel treatment.
d. concurrent treatment.
30. Psychotherapy has been shown ________________ the efficacy of
addiction treatment.
a. to have no affect on
b. to reduce
c. to improve
d. both a. and c. above
31. Family issues are best dealt with:
a. in the subacute phase of treatment.
b. in the detoxification phase of treatment.
c. in the acute phase of treatment.
d. in the long term phase of treatment.
32. A distinct period of intense fear or discomfort that develops abruptly,
usually reaching a crescendo within a few minutes or less is a:
a. panic disorder.
b. phobia.
c. panic attack.
d. compulsion.
33. What are the most common psychiatric symptoms seen in AOD
abusers?
a. Mood disturbances
b. Character disorders
c. Psychosis
d. Anxiety
34. Patients in a blackout or altered state may appear to be sober, and
may in fact be sober.
a. True
b. False
35. Acute marijuana intoxication may include:
a. periods of apathy.
b. periods of anxiety and panic.
c. periods of grandiosity.
d. periods of excitation and hyperactivity.
36. What condition, in association with anxiety, markedly increases the
risk for suicide?
a. Mania
b. Acute drug intoxication
c. Psychosis
d. Depression
37. ___________ is the sensation of something crawling on or under the
skin associated with withdrawal from alcohol or stimulant intoxication.
a. Tactile hallucination
b. Formication
c. Psychotic feature
d. both a. and b. above
38. Socially anxious patients may be encouraged to participate in 12-step
group meetings by using the principles of:
a. behavioral approximation.
b. shaping.
c. systematic desensitization.
d. total immersion.
39. AOD use:
a. may trigger or worsen personality disorder.
b. has little effect on personality disorder.
c. is seldom associated with personality disorder.
d. may lessen the social impact of a patient's personality disorder.
40. _________ personality disorder involves a pervasive pattern of
indifference to social relationships and a restricted range of emotional
experience and expression.
a. Borderline
b. Antisocial
c. Narcissistic
d. Schizoid
41. People with _______ personality disorder often use AODs in chaotic
and unpredictable patterns and in polydrug patterns involving alcohol
and other sedative-hypnotics taken for self-medication.
a. borderline
b. antisocial
c. narcissistic
d. schizoid
42. ________________ refers to distortions in the therapeutic process
due to the therapist's unresolved conflicts.
a. Transference
b. Countertransference
c. Identification
d. Enabling
43. During crisis stabilization, the therapist treating a patient with AOD
and mental illness should:
a. avoid psychodynamic confrontations and should not engage in
therapy for abuse or trauma.
b. foster psychodynamic confrontations and engage in therapy for
abuse.
c. continue to use verbal and written behavioral contracts.
d. both a. and c. above
44. 12-step program sponsors ______ understand how important
boundaries are in helping borderlines feel safe.
a. may be more effective if they
b. must
c. have no need to
d. are likely to
45. The primary motivation of the patient with antisocial personality
disorder is to be right and to be successful.
a. True
b. False
46. People with antisocial personality disorder:
a. are rarely at risk for suicide.
b. are especially at risk for suicide when confronted with failure.
c. are especially at risk for suicide during intoxication or acute
withdrawal.
d. are always at high risk for suicide.
47. ____________ is a useful setting in which people with antisocial
personality disorder can learn to identify errors not only in their own
thinking, but also in the thinking of others.
a. Individual therapy
b. Behavior modification
c. Group therapy
d. Cognitive therapy
48. When patients with antisocial personality disorder shed aspects of
the disorder they may become:
a. more independent.
b. less dependent.
c. more verbal.
d. more dependent.
49. ___________ sexual prowess is part of the narcissistic ego-inflation.
a. Often
b. Rarely
c. For men
d. both a. and c. above
50. It is sometimes helpful for a therapist to view the patient with
narcissistic personality disorder as:
a. an insensitive patient with a passive-aggressive personality disorder.
b. a high functioning borderline patient.
c. a hypersensitive patient with an antisocial personality disorder.
d. a low functioning borderline patient.
51. To engage the person with passive-aggressive personality disorder in
treatment, the therapist should attempt to correct the world-view of the
patient.
a. True
b. False
52. Psychotic persons retain the ability to differentiate between
information that originates in the external world and information that
originates from the inner world of the mind.
a. True
b. False
53. The diagnosis of ___________ requires a minimum 6 months duration
of symptoms with active psychotic symptoms for 1 week.
a. schizophreniform disorder
b. delusional disorder
c. schizophrenia
d. induced psychotic disorder
54. Acute marijuana intoxication can produce a:
a. drug-induced psychosis.
b. schizophreniform episode.
c. induced psychotic disorder.
d. delusional disorder.
55. In the early phase of assessment the goal is to:
a. establish a diagnosis.
b. promote patient safety.
c. stabilize the crisis.
d. both a. and b. above
56. The best predictor of current risk for suicidal and homicidal behavior
is:
a. a recent history of such behaviors.
b. a family history of such behaviors.
c. any history of such behaviors.
d. patients' statements of intent to harm themselves or others.
57. Aggressive social crisis intervention is not a part of acute
management of patients with a psychotic disorder and an AOD abuse
disorder.
a. True
b. False
58. In programs that treat patients with psychotic and AOD use disorders,
the treatment team should have representatives from:
a. the medical system.
b. the mental health system.
c. the addiction system.
d. all of the above
59. An important component of relapse prevention is assisting the dual
diagnosis patient to recognize the early warning signs of:
a. psychiatric disorders.
b. medical disorders.
c. AOD use disorders.
d. both a. and c. above
60. Clinical staff training must be ___________ for a program to be
successful.
a. episodic and diagnosis specific
b. approved by licensing boards
c. ongoing and routine
d. relevant
61. The term __________ describes the ability of certain medications,
drugs and other substances to cause acute psychomotor effects and a
relatively rapid change in mood or thought.
a. psychedelic
b. psychoactive
c. mind-altering
d. mood-altering
62. All drugs of abuse are by definition psychoactive.
a. True
b. False
63. Patients with a family history of AOD use disorder:
a. are at no higher risk of developing an AOD use disorder than the
general public.
b. have the same risk of developing an AOD use disorder as the
general population.
c. are at high risk of developing an AOD use disorder.
d. are at low risk of developing an AOD use disorder.
64. Antidepressants ___________.
a. are euphorigenic
b. cause acute mood alterations
c. both A and B
d. neither A nor B
65. _____________ are the most commonly used agents to moderate
alcohol withdrawal.
a. Benzodiazepines
b. Hypnotic-sedatives
c. Antidepressants
d. Beta blockers
66. Tolerance to the anti-panic effects of clonidine:
a. is rare.
b. can develop within several weeks of initiating therapy.
c. is common.
d. can take months to develop if the dose is appropriate.
67. The standard and first-line treatment for manic episodes is:
a. valproic acid.
b. lithium.
c. Haldol.
d. anticonvulsants.
68. Marijuana has anticholinergic effects and when combined with
anticholinergic medications can lead to psychosis.
a.True
b.False
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