addressing suicidal thoughts and behaviors in … · addressing suicidal thoughts and behaviors in...

Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Part One-Chapter One: Information You Need To Know

Suicide is a leading cause of death among people who abuse alcohol and drugs, and compared to the general

population, individuals treated for alcohol abuse or dependence are at about ___ times greater risk to eventually die

by suicide compared with the general population, and people who inject drugs are at about

___ times greater risk for eventual suicide.

a. 6; 10 c. 10; 14

b. 8; 12 d. 12: 16

2. People with substance use disorders who are in treatment are at especially high risk of suicidal behavior for many

reasons. All of the following are reasons that the authors include for this EXCEPT:

a. They enter treatment at a point when their

substance abuse is out of control,

increasing a variety of risk factors for

suicide

c. They enter treatment at peaks in

depressive symptoms

b. They enter treatment when a number of

co-occurring life crises may be happening

d. Many have a co-occurring disorder, most

commonly borderline, dependent, or

avoidant personality disorder, which may

increase suicide risk

3. Clients in substance abuse treatment should be screened for suicidal thoughts and behaviors routinely at intake and

at specific points in the course of treatment, and counselors need to be direct with their clients, learning to ask such

questions as , “Are you thinking about killing yourself?”

a. True b. False

4. Good counselors are empathic, warm, and supportive, and trust their experience and intuition, and they need to use

these skills when dealing with suicidal clients. Which of the following accurately describes how counselors

should interact and work with suicidal clients?

a. Counselors must aggressively question

these clients on their thoughts and feelings

related to suicide

c. Clients should be involved in their own

suicide prevention plan, and if they realize

the therapist is truly alarmed about the

possibility of suicide, they will likely be

willing to work collaboratively on a plan

b. It is a good idea for counselors to ask

every one of their clients about suicidality,

not only for the clients’ sakes but also to

help the counselor become more

d. All of the above

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5. Although clients who are seriously suicidal have likely already made up their mind that they want to die, being

conflicted about wanting to live or die is typical of most other individuals who have suicidal thoughts and

ideations.

a. True b. False

6. The consensus panel believes that suicide contracts are a very important part of suicide intervention, and they

should be used to ensure client safety and to help prevent future litigation whenever possible.

a. True b. False

7. In working with suicidal clients, an empathic attitude can assist you in engaging and understanding people in a

suicidal crisis, and a negative attitude can cause you to miss opportunities to offer hope and help or cause

overreaction to people who are contemplating suicide. Each of the following is a correct statement about attitudes

and behavioral issues to consider when working with the client EXCEPT:

a. Expressions of suicidality indicate

significant distress and must be taken

seriously except in the circumstances

where clients appear to be purposefully

using reports of suicidal thoughts or plans

to manipulate their treatment regimen

c. Suicidal people in substance abuse

treatment settings often need additional

services to ensure their safety

b. Talking about a client’s past suicidal

behavior can provide information about

triggers for suicidal behavior

d. Therapists should give clients who are at

risk of suicide the telephone number of a

suicide hotline, as it does no harm and

could actually save a life

8. Alcohol’s acute effects include disinhibition, intense focus on the current situation with little appreciation for

consequences, and promoting depressed mood, all of which may increase risk for suicidal behavior, and acute

alcohol intoxication is present in about ______ percent of suicide attempts and suicides.

a. 15 to 25 c. 25 to 35

b. 20 to 30 d. 30 to 40

9. Intense, short-lived depression is prevalent among treatment-seeking people who abuse cocaine,

methamphetamines, and alcohol, and even transient depression is a potent risk factor for suicidal behavior among

people with substance use disorders.

a. True b. False

10. A suicide attempt is a deliberate act of self-harm that does not result in death and that has at least some intent to

die. When a client aims to make a suicide attempt and drafts a note or takes precautions against discovery at the

time of an attempt, this is known as:


a. Suicidal ideation c. Suicidal preparation

b. Suicide intention d. None of the above

11. Non suicidal self injury (NSSI) or deliberate self harm such as self mutilation or cutting is different from a suicide

attempt or suicide because NSSI does not include suicidal intent. Additionally, although both NSSI and suicidal

behaviors can lead to serious bodily injury, they usually do not exist in the same person.

a. True b. False

12. Prior history of suicide attempts and family history of suicide are both risk factors for suicidal thoughts and

behaviors. Which of the following are NOT additional factors mentioned by the authors?

a. Severe substance use and a co-occurring

disorder

c. Stressful life circumstances such as

unemployment and low level of education,

divorce, or legal difficulties

b. History of childhood abuse and rigid

personality disorders

d. Lack of spiritual guidance and a tendency

to look at the negative side of life

13. Age, gender, and race are factors in suicide attempts and completions. Which of the following is an accurate

statement about these factors?

a. Adolescents and young adults are more

likely to make nonfatal suicide attempts

than older individuals, while older

individuals are more likely to die by

suicide

c. Whites and African Americans have

higher rates of suicide than Native

Americans, and males are at highest risk

in all of racial groups except African

Americans

b. Women are more likely to attempt suicide

than men, but men are more likely to die,

carry out more suicidal acts, and tend to

show higher intent to die

d. All of the above

14. The consensus panel formulated procedures for substance abuse counselors in addressing suicidal thoughts and

behaviors, which they identified by the acronym GATE. Which of the following is NOT part of the GATE

process?

a. Gather information c. Access supervision and/or consultation

b. Ask direct questions d. Extend the action

15. When the client answers “’yes” to a screening question about suicide during the intake process, it is important to

follow up with an open ended question such as, “Can you tell me about the suicidal thoughts?”, as this may

provoke the client to give all the information that is needed.

a. True b. False


16. Screening questions should be asked of all new clients when you note warning signs and any time you have a

concern about suicide, as long as you can pinpoint the reason. In addition, routine monitoring of suicide risk

throughout treatment should be a basic standard in all substance abuse treatment programs.

a. True b. False

17. Mental health clinicians who deal with suicidal clients need to obtain regular supervision or consultation from

other professionals. Circumstances that require immediate consultation include all of the following EXCEPT:

a. Direct warning signs are evident such as

suicidal communication, seeking access to

a method, and making preparations

c. The client with a history of suicidal

thoughts or behavior experiences an acute

stressful life event or a setback in

treatment, even if there are no

accompanying warning signs or other

indications to suspect current risk for

suicidal behavior

b. Followup questions to suicide screening

questions or indirect warning signs

suggest that there is current risk

d. Additional information from the referral

source, family member, or medical record

suggests that there is current risk

18. When working with a suicidal client, professionals should take responsible actions that cover the intensity and

immediacy of the situation. The key factor in considering which action to take is:

a. The history of suicide attempts c. The support system of the client including

other mental health professionals and the

client’s family

b. The seriousness of the risk involved d. None of the above

19. As part of the action plan, the clinician and client can create a safety card that the client can use in the event of a

return of acute suicidality. Which of the following is NOT one of the minimum items to include on the card?

a. A reminder to call 911 immediately when

feeling suicidal

c. The counselor’s contact information and

the number of a 24-hour crisis number

b. The phone number and address of the

nearest hospital emergency department

d. Contact information for additional

supportive individuals that the client may

turn to when needed

20. Suicide prevention efforts are not one-time actions, and they should be ongoing because suicidal clients are

vulnerable to a recurrence of risk. A team approach is also essential, as it requires you to follow up on referrals and

coordinate with other providers in an ongoing manner.

a. True b. False


21. Documentation of suicidality entails providing a written summary of any steps taken pertaining to GATE, along

with a statement of conclusions that shows the rationale for the resultant plan. The summary is critical in

coordinating care among professionals, establishing a solid medical and legal record, and:

a. Formulating a treatment plan c. Increasing the clinician’s general

knowledge about suicidality

b. Promoting client safety d. All of the above

22. In the gathering information phase of addressing suicidal thoughts and behaviors in substance abuse treatment,

clinicians should try to understand the client’s distress and point of view and mange the anxiety that arises when

listening to clients.

a. True b. False

23. As the counselor takes action by developing and implementing a treatment plan to address suicidality and

coordinating the plan with other providers, which of the following is NOT one of the skills competencies that is

recommended?

a. Respond to positive screens and warning

signs at intake, during treatment, and at

transitions in care

c. Apply principles of crisis management

with actively suicidal clients

b. Participate in the development and

implementation of a written assessment

and treatment plan that addresses the

client’s risk for suicide and as well as

substance abuse problems

d. Help clients accept and follow through on

community referrals

24. It is important that clinicians honor and respect the beliefs, language, interpersonal styles, and behaviors of the

cultures of individuals and families receiving services. In demonstrating cultural competence in working with

suicidal clients, clinicians should:

a. Recognize that clients need to present

their dilemma in the context of their

cultural norms

c. Ask questions and make referrals in a

culturally sensitive manner

b. Appreciate that different cultures use and

represent suicide differently

d. All of the above

25. Part One: Chapter Two

The consensus panel uses examples of various counseling approaches for people with substance use disorders who

are experiencing suicidal thoughts and behaviors. These approaches include motivational interviewing,

cognitive-behavioral therapy, and:

a. Group psychotherapy c. Crisis intervention methods


b. Brief systemic therapy d. All of the above

26. In this chapter’s case of Clayton, the 61 year old addict and alcoholic who has had recent suicidal thoughts, the

three types of action demonstrated include each of the following EXCEPT:

a. Removing the potential suicide weapon c. Involving the family in treatment

b. Making a referral to a specialized

community resource for further

assessment

d. Showing Clayton the relationship between

substance abuse and suicidal behavior

27. In working with Clayton, the counselor is careful to acknowledge the physical pain that Clayton feels as a result of

his liver disease, and then connects this pain to hopelessness and thoughts of suicide.

a. True b. False

28. As the counselor probes, he begins to realize that Clayton has taken some steps that may indicate that he his

preparing to die. The counselor thinks about calling in his supervisor to help work with Clayton on this serious

issue, but decides against it because he is worried about damaging his relationship with Clayton.

a. True b. False

29. As in treatment of substance abuse illnesses, family and significant others can be an important recovery resource.

Some of the steps the counselor can take with family members of clients who may be suicidal include:

a. Providing information about suicide,

particularly dispelling misconceptions and

providing accurate information

c. Making suggestions for how to recognize

the need for and provide emotional

support to a person who might be feeling

overwhelmed, and planning for how to

access and possibly remove suicide

methods, such as guns or pills, to reduce

the likelihood of high-risk behaviors

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

d. All of the above

30. The second case study outlines the story of Angela, who has also struggled with substance abuse and a

suicide-related history. Which of the following is an accurate statement about Angela’s difficulties?

a. Angela has a long history of cocaine

dependence with relatively brief periods

of abstinence, and was hospitalized for

cocaine dependence three times in the past

two years, all of which has greatly

complicated her borderline illness

c. Angela’s family has just notified her that

they are not willing to have her return to

their home and be with their children if

there is a risk of drug relapse, and this,

along with other environmental stressors

and her illness indicate a high potential for


relapse and resultant crises, and possibly a

return of suicidal thoughts

b. Angela has made two suicide attempts, the

first one while in her thirties and a recent

attempt, which precipitated her admission

to the co-occurring disorders unit, and was

made while coming off cocaine

d. Angela’s family refuses to speak to

Angela and her counselor, which

negatively impacts the treatment plan

31. Clients with an active mental illness who relapse with alcohol or drugs are at significant risk for suicidal thoughts

and behaviors. A relapse plan should be included in part of the treatment process, and elements of the plan should

include all of the following EXCEPT:

a. Develop a plan for safety in the event of

relapse in individuals who you have

reason to believe will be at risk for suicide

upon relapse such as calling or coming to

the clinic to see the counselor, calling the

National Suicide Prevention Lifeline, or

going to the hospital

c. Use mental health interventions to aid in

relapse prevention and encourage the

client to be actively involved in a 12-Step

or other supportive program

b. Be aware of and address client speech that

projects a suicidal result from relapse such

as, “If I relapse, that will be the end for

me”

d. Make suggestions on how to talk to a

loved one who is experiencing suicidal

thoughts: what to say, and equally

important, what not to say

32. Sometimes family members experience reactions toward suicidal clients that can be counterproductive and

interfere with recovery. While some family members may want to withdraw from the clients, it is more beneficial

if they can watch closely so that clients don’t attempt again, and frequently talk to them about what they are

feeling.

a. True b. False

33. Leon is a young African American Iraq war veteran who is seen at his college counseling center after being rushed

to the local hospital in a stuporous state. After initially speaking to Leon, his counselor is very concerned about

his risk for suicide, especially since high rates of suicide and nonfatal suicidal behavior among Black males,

particularly among youth, are cause for alarm. Research indicates that depending on the age, the suicide rate

among Black males ranges from_________ times higher than among Black females.

a. One to six c. Three to eight

b. Two to seven d. Four to nine

34. Leon is in need of an integrated treatment plan that must address his suicidal thoughts and behaviors, his drinking,

his PTSD and depressive symptoms, and his disconnection or isolation from friends and family. Which of the

following is NOT one of decisions that the counselor and his supervisor reach regarding Leon?

a. Further evaluation for suicidality is

important, including consultation with the

emergency department where Leon was

c. Intensive substance abuse treatment and

case management are important over the

next few weeks until Leon has stabilized,


seen this morning

and this can best be accomplished in the

local VA treatment facility

b. After the referral process, the counselor

needs to continue to maintain contact with

Leon to ensure that he accepts the referral

and continues to participate in treatment

d. Although Leon’s potential for suicide does

not seem to be directly linked to his

mental health symptoms and substance

abuse, both issues need to be addressed in

treatment

35. On most college campuses, mental health resources are limited, but it is important to develop a campus suicide

prevention team. The team should create policies and procedures to support both voluntary and involuntary

medical leave processes for at-risk students.

a. True b. False

36. The case study of Rob illustrates how a counselor must intervene after a client has made the statement, “I might be

better off dead” during a group session. Although the counselor realizes that clients who have relapsed to

substance use are particularly susceptible to suicidal thinking and, potentially, to suicidal behavior , she is careful

not to ask him about his current substance use at the beginning of the session because she does not want to alienate

him.

a. True b. False

37. Early in the session, the counselor needs to determine if Rob is minimizing his suicidality or if he really just made

an impulsive statement in group to express his frustration. Once she is satisfied that there is little data to indicate

current risk, she switches the focus to his impact on the group.

a. True b. False

38. The break-up by a partner or a threat to a partner relationship is a common precipitant of suicide among vulnerable

males with substance use disorders. In addition, studies show that men who abuse alcohol and/or drugs and are

confronted with a break-up or threat to their relationship, particularly those showing a pattern of jealousy, domestic

violence, legal difficulties, or prior suicidal behavior, may also be prone to committing homicide followed by

suicide.

a. True b. False

39. In some cases, a clinician may make the decision that a client is in such distress that he or she may need an

immediate emergency room evaluation for suicide risk. Although the counselor should focus on eliciting as much

cooperation from the client as possible to obtain the emergency evaluation, it should be clear that the need for

such an evaluation is nonnegotiable.

a. True b. False


40. While rates vary widely among tribes, American Indian and Alaska Native people, as a whole, have significantly

higher rates of suicidal behavior than people of other races and ethnicities. Which of the following accurately

describes suicidal behavior among these populations?

a. Some of the variables that seem to affect

this elevated suicide rate include high

rates of substance abuse, major psychiatric

illness and cultural alienation that can

increase risk factors and lower protective

factors for suicide

c. Those who live on geographically isolated

reservations may have limited educational

and employment opportunities, and poor

access to mental health or substance abuse

services, which are factors in the high

rates of suicide, particularly among

American Indian males, ages 25-34

b. A higher percentage of American Indian

suicides are related to illicit drug use,

compared with the general population

d. All of the above

41. A hope box is a cognitive-behavioral intervention that is used to challenge suicidal clients to think of actions they

can take other than suicide. This is accomplished by having them put something in the box that reminds them of

people, events, activities, or times that have given them hope or that have prevented them from attempting suicide.

Each of the following is an accurate statement about the use of the hope box EXCEPT:

a. Clients should describe a time in their

lives when they felt proud of themselves

or something they did and put an item in

the box to remind them of that time

c. The clients should be encouraged to add

one new item to the hope box on a regular

basis, usually at least two to three times

per week

b. When they have a new item for the hope

box, clients should explain to the

counselor what it is, its significance, and

in what way it makes them feel hopeful

d. Clients should go to the help box when

they feel hopeless or sad, an pick an item

that can help them regain the positive

feelings they have experienced in the past

42. Children tend to be a tangible marker of hope for clients, so it is important for clients to recognize and understand

the impact of suicidal behavior on their children and the vulnerability and risk it can create. Similarly, it is critical

to emphasize that in their role as parent, they are protector and nurturer and can provide safety, protection, and

love.

a. True b. False

43. Shame-based people often feel they don’t deserve help so it is critical that the therapist works to convince people

of their self-worth and value while working with them substance abuse and suicide related issues.

a. True b. False

44. Crisis phone calls provide clients an opportunity to vent, and it is important that the crisis worker or professional

does not argue with the client. Which of the following is NOT a true statement about these phone calls?

a. The most critical thing to remember about

crisis phone calls is to remain calm and

c. It is important to remain on the phone long

enough to engage the client, but if the call


patient throughout, as a calm, patient, and

persistent orientation facilitates hope

goes on for too long, crisis diffusion will

likely become ineffective

b. The crisis call is about effective regulation

of emotions and problem solving

d. Curing the crisis call, it is imperative to

make sure that the client’s method for

suicide has been removed

45. Since in most states it is not permissible to violate confidentiality during a suicidal crisis, it is important to

consider having the patient sign crisis management consent forms early in the treatment process, allowing the

clinician to contact specific family members if and when a suicidal crisis emerges.

a. True b. False

46. Part Two-Chapter One: The Administrative Response to Suicidality in Substance Abuse Treatment

Settings

People with substance use disorders who are in treatment are at especially elevated risk for a number of reasons

including the fact that they enter treatment at a time when their substance abuse is out of control and when stress

from marital, legal, job, health, or interpersonal problems is exceptionally high . Additionally, they may have

other issues that increase their risk for suicide, including co-occurring mental health problems and substance-abuse

effects such as substance-induced depression, anxiety, or psychosis.

a. True b. False

47. There are twp pivotal areas regarding services for substance abuse clients exhibiting suicidal thoughts and

behaviors. Each of the following is a correct statement about these services EXCEPT:

a. The most critical role of the substance

abuse treatment program is to provide

security and sanctuary for its clients

c. It is imperative that counselors have a

consistent clinical protocol, supported by

strong and effective agency policies and

clinical supervision, that allows them to

act effectively when clients who are

suicidal are identified

b. Treating suicidal thoughts and behaviors

is often beyond the scope of services in

substance abuse programs, but

nevertheless, these programs have an

obligation to recognize suicidal ideation

and behaviors, to address those symptoms,

and to assist clients in getting the help

they need

d. Service providers must recognize

suicidality when it appears, have policies

and procedures for addressing suicidal

thoughts and behaviors, and ensure that

treatment for the substance use disorder is

not lost in the suicidal crisis

48. Proactively addressing suicidality in substance abuse treatment programs is advantageous from a number of

perspectives. It saves lives, keeps clients from dropping out of treatment, and leads to positive programmatic

efforts for the program.

a. True b. False


49. Level One program involvement in suicide prevention and interventions includes which of the following?

a. The program has the capability to continue

substance abuse treatment services for

clients with suicidal thoughts and

behaviors while monitoring those clients

for suicidal symptoms and an exacerbation

of psychiatric symptoms

c. The program has at least one staff member

who is specifically skilled in providing

suicide prevention and intervention

services and in providing clinical

supervision to other program staff

working with clients with suicidal

thoughts and behaviors

b. The program’s clinical staff recognize that

clients in substance abuse treatment are at

increased risk for suicidal thoughts and

behaviors

d. The program has the capability to continue

substance abuse treatment services for


behaviors while monitoring those clients

for suicidal symptoms and an exacerbation

of psychiatric symptoms

50. Level Three programs have the ability to provide services to acutely suicidal clients that allow the client to

continue receiving substance abuse treatment while in the midst of a suicidal crisis and are most commonly

implemented on an outpatient or residential basis.

a. True b. False

51. Clinical supervisors and senior counselors play a critical role in responding to clients’ suicidal thoughts and

behaviors in substance abuse treatment settings, and they are typically the “go-to” staff when a counselor suspects

that a client is suicidal. Which of the following most accurately describes their role in supporting programming

for clients with suicidal thoughts and behaviors?

a. They work to create an environment that

fosters rapid identification of and quality

services to clients with suicidal thoughts

and behavior

c. They communicate a vision of how the

program can benefit by providing services

to clients who are suicidal

b. They inspire others in the organization to

become aware of and committed to

reducing the incidence of clients’ suicidal

thoughts and behaviors in the program

d. They make clinical decisions that affect

client care and the overall functioning of

the clinical services component of a

substance abuse treatment agency

52. The legal issues regarding suicidality for substance abuse programs are primarily related to standards of care,

maintaining appropriate confidentiality, and obtaining informed consent. Which of the following is NOT one of

the three common malpractice “failures” for work with suicidal clients?

a. Failure in assessment c. Failure in followup

b. Failure in treatment d. Failure to safeguard


53. There is an expectation that a practitioner in the mental health or substance abuse field should be able to anticipate

the potential suicidal risk that a client might experience. This is known as the counselor’s _______________ in

regards to suicide.

a. Forecastability c. Perceivability

b. Predictability d. Forseeability

54. Maintaining safety for clients with suicidal thoughts and behaviors means making reasonable efforts to promote

their immediate and long-term well-being. Which of the following is NOT a true statement about these efforts?

a. Since there is little evidence that

no-suicide contracts are effective in

preventing suicide attempts and deaths, a

more contemporary approach to client

contracting called a Commitment to

Healing Agreement is recommended

c. Every agency should have a written policy

and procedure for removing weapons that

might be used to cause bodily harm or

death

b. Commitment agreements can support and

enhance engagement with the client,

possibly lowering risk, by conveying a

message of collaboration

d. Program policies and procedures to match

the level on this continuum with the

applicable safety needs and concerns for


behaviors should be established

55. Program policies should be clear that simply acknowledging suicidal thoughts or behaviors is not sufficient cause

for violating a client’s rights to confidentiality by contacting family members, friends, or another treatment agency

without first obtaining a consent for release of information.

a. True b. False

56. Informed consent for substance abuse treatment is an ongoing process in which the client is an active participant in

defining what treatment methods and approaches will be undertaken, the expected outcomes of that intervention,

the risks and expected efficacy inherent in the care, and:

a. Specific factors that will lead to

termination of treatment

c. Ethical considerations in treatment

b. Alternative treatments that might be used

d. None of the above

57. Clients cannot be discharged from substance abuse treatment simply because they are discovered to have suicidal

thoughts and behaviors. It is unethical and may be illegal to discharge a client in clear distress without guaranteed

and subsequently confirmed followup with an appropriate provider.

a. True b. False

58. Chapter Two: Building a Suicide Prevention and Intervention Capable Agency


Substance abuse treatment programs need to work hard to become Level Two programs so that clients can remain

in substance abuse treatment even though co-occurring problems like suicidality are present. The accrued benefits

of becoming a Level 2 substance abuse treatment program include all of the following EXCEPT:

a. The Level 2 substance abuse program can

be responsive to a variety of crisis states

related to suicide that might otherwise

disrupt functioning for the client who is

suicidal, other clients, and program staff

c. These treatment program has formalized

referral relationships with programs

capable of addressing the needs of clients

with suicidal thoughts and behaviors and

specific protocols for how a referral is

made

b. The responsiveness of the program to

issues of suicidality may increase the

capacity of the program to respond to

other client crises that present in the

treatment program

d. Being a Level 2 substance abuse treatment

program means staff have additional skills

and diversity that can benefit the overall

treatment program

59. Historically, organizational change organizational change in substance abuse treatment settings has tended to occur

as a result of pressure from the outside: mandates from funding resources, rules and regulations from state

agencies, or standards from accrediting bodies. But more and more, as programs and management become

increasingly skilled and sophisticated, the perception of organizational assessment and change as an ongoing,

internal, data-based, quality improvement-focused process has evolved.

a. True b. False

60. In order to get a snapshot of an organization’s current ability to address suicidal thoughts and behaviors, which of

the following questions must be asked?

a. How are clients with suicidal thoughts and

behaviors currently identified in the

treatment population?

c. How do suicidal thoughts and behaviors

among clients in the program affect

treatment in the program?

b. What might be done to identify those

clients whose suicidality is “under the

program radar”?

d. Are the client’s suicidal thoughts and

behaviors and the organization’s response

(including consultations) integrated as a

clinical issue into the treatment plan?

61. Organizations should consider what other programs in the area are already doing and the efforts they made to

arrive at their current level of competence in meeting the needs of clients who are suicidal, but must never

duplicate services or create overlapping environments.

a. True b. False

62. In organizing a team or work group to become a Level Two program for addressing suicidality, each of the

following should be considered EXCEPT:

a. Obtain the commitment of the chief

executive officer of the agency to

c. Choose two people to lead the effort so

that al least one will always be available,


articulate the vision for implementation

throughout the agency, with all

stakeholders, and to the public

and make sure they have the backing of

senior administration and the respect of

clinical staff

b. Convene an implementation work group

consisting of key leaders from different

stakeholder groups: consumer leaders,

family leaders, team leaders, clinical

leaders, and program and administrative

leaders

d. Identify the program oversight committee

to which the work group will report its

findings, recommendations, strategic

plans, and modifications

63. The organizational work group should include some issues specific to suicide in the planning process and should

be able to:

a. Arrive at specific targets for change c. Be willing to make organizational changes

in large chunks

b. Have a general plan for strengthening the

substance abuse treatment program

d. None of the above

64. It is very unlikely that existing programs already have policy and programmatic elements that will translate to

suicidal crises or will help in the care of clients who acknowledge suicidal thoughts and behaviors, so it is usually

necessary to implement entirely new policies.

a. True b. False

65. In establishing new program policies such as determining clinical staff training and competence or special

considerations for observing clients in a residential facility, the authors recommend that policies include each of

the following EXCEPT:

a. The topic c. Procedures

b. A policy statement d. Goals

66. In training professionals to develop skills to work with clients with suicidal thoughts and behaviors, which of the

following is an important consideration?

a. A single full day session is the preferred

format for initial training

c. Training should focus on introducing new

skills sets for working with suicidal clients

b. Trainers should understand the needs and

limits of practice of substance abuse

counselors and not offer skills that most

counselors are not prepared to use

d. All of the above

67. Most clients expressing suicidal thoughts and behaviors are likely in an acute crisis and warrant crisis management

by trained professionals. Even though the situation is crisis driven, it should be managed adequately in a

matter-of-fact, methodical manner.


a. True b. False

68. In addition to active suicidality on the part of the client, the consensus panel reports that other types of crises that

are likely to occur in a substance abuse treatment program include all of the following EXCEPT:

a. Backsliding and relapse c. Severe injuries or health crises with clients

b. Threats of violence toward others d. Death of a client

69. The goal of agency policy for managing clients who are acutely suicidal is to give enough direction to clinicians

and clinical supervisors to guide them in crisis situations, while at the same time attempting to anticipate every

kind of crisis situation related to suicidal thoughts and behaviors that may occur.

a. True b. False

70. The aftermath of suicide must be dealt with for all survivors including family, friends, fellow students, teachers,

coworkers, supervisors, fellow patients, counselors, physicians, or any other people who knew the individual and

may be affected by the suicide. This is known as:

a. Debriefing c. Postvention

b. Followthrough d. None of the above

71. Because of the elevated risk of suicidality among clients in substance abuse treatment, it is important for programs

to have a clear policy statement affirming that all clients entering substance abuse treatment are screened for

suicidal thoughts and behaviors. Indirect warnings that should be assessed include all of the following EXCEPT:

a. Ideation and purposelessness c. Hopelessness and feeling trapped

b. Anxiety and withdrawal d. Aggression and impulsivity

72. Clinical supervisors should make sure that all clinical staff are aware of the policy and that the policy procedures

are followed. They should also conduct a periodic review of all staff to ensure that they are current on suicide

policy in the agency.

a. True b. False

73. An example of a tool for rating a client’s current suicidal thoughts and behaviors by evaluating the areas of suicidal

ideation, behavior, general mood, and cognition/perception is called:

a. The 24-Hour Suicide Assessment Tool c. Beck Scale for Suicide Risk

b. Scale for Suicide Ideation d. Self Monitoring Suicide Ideation Scale

74. As a program becomes more experienced in working with clients with suicidal thoughts and behaviors, it can be

expected that a more consistent repertoire of responses to suicidality will evolve, and responses to clients will

become more stereotyped and efficient.

a. True b. False


75. It is important for counselors and program administrators to understand that program responsibilities do not end

with a client’s referral to another agency. Which of the following does NOT correctly demonstrate this point?

a. The counselor and administrators continue

to have a responsibility to ensure that the

client follows through on the referral, that

the referring agency accepts the client for

treatment, and that treatment is actually

implemented

c. The program needs to have a standardized

system of documenting followup, just as it

does with documentation of clinical

interventions undertaken by the

counseling staff

b. Clinicians have an ethical responsibility to

ensure that the client’s substance abuse

treatment needs do not get lost in the

process of referral

d. Clinicians must always check in with the

client and significant others to ensure that

care is progressing


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