CADC practice test for the IC&RC ADC exam

A voluntary client in residential treatment for opioid use disorder, who completed withdrawal and takes no opioid medication, insists on leaving after 10 days, against staff advice. The client is not intoxicated and is not a danger to self or others. What should staff do?

Mark a letter. The key, plus a line on every option, opens at once.

1. Ask the police to return the client to the program

   Police have no basis to return a voluntary adult who poses no danger, and involving them turns a clinical decision into an enforcement one.
2. Discharge the client with no referrals or follow-up plan

   Leaving against advice is no reason to withhold continuing-care planning; this is when overdose risk is highest.
3. Let the client leave and warn about lowered tolerance

   A voluntary client may leave; after 10 days without opioids tolerance has dropped, so a dose the client once used can be fatal, and that warning, with naloxone and an open door to return, is the protective step.
4. Block the exits until the client agrees to stay

   Holding a voluntary, competent client against their will violates client rights and can be unlawful restraint.

Compared with cannabis available in the 1990s, most cannabis products sold today contain

1. less THC

   Legal markets have not pushed potency down; average THC content has climbed, not fallen.
2. mostly CBD with little THC

   Most products are bred for THC, and CBD in typical cannabis has stayed low.
3. about the same amount of THC

   Potency has not stayed flat; today's flower and especially concentrates carry much more THC than earlier cannabis.
4. far more THC

   THC concentration in cannabis has risen several-fold since the 1990s, and concentrates go far higher, which raises the risks of dependence and psychotic symptoms.

A client has severe agitation, a racing heart, and acute psychosis, but a standard urine drug panel is negative. The substance MOST likely responsible is

1. methamphetamine or amphetamine

   Amphetamines produce similar signs, but they are part of standard panels and would usually show up.
2. high-potency cannabis

   Plant cannabis of any strength produces THC metabolites that a standard panel detects.
3. phencyclidine (PCP)

   PCP can cause this picture, but it is on the standard five-drug panel, so a negative result makes it unlikely.
4. synthetic cannabinoids

   Synthetic cannabinoids cause agitation, a racing heart and psychosis, and standard panels miss them because they look for THC metabolites, not these lab-made compounds.

A client who smokes high-potency cannabis daily reports repeated bouts of severe vomiting that are relieved only by long, hot showers. This pattern MOST suggests

1. cannabinoid hyperemesis syndrome

   Cyclic vomiting in a heavy daily user that eases with hot showers is the hallmark of this syndrome; it resolves only when cannabis use stops.
2. cannabis withdrawal

   Withdrawal brings irritability, poor sleep and low appetite, not repeated vomiting relieved by hot water, and this client is still using daily.
3. acute cannabis intoxication

   Intoxication usually reduces nausea; recurrent severe vomiting relieved by heat points to a chronic-use syndrome.
4. an overdose of a synthetic cannabinoid

   The client uses plant cannabis, and the pattern recurs over time rather than appearing as one acute poisoning.

Higher rates of substance use disorders among LGBTQ+ people are BEST explained by

1. a genetic link between orientation and addiction

   No genetic tie between sexual orientation and addiction explains these rates.
2. minority stress from stigma and discrimination

   The minority stress model links higher substance use among LGBTQ+ people to chronic stress from stigma, rejection and discrimination, not to identity itself.
3. sexual orientation itself as a direct cause

   Treating orientation as the cause confuses an identity with the harmful conditions placed on it.
4. higher tolerance to alcohol in this population

   There is no evidence of different alcohol tolerance in this population.

Several models explain why mental illness and SUD so often co-occur. The 'common factors' model proposes that

1. substance use directly triggers the mental illness

   That is the secondary psychiatric disorder model, in which use causes the mental illness.
2. the two disorders co-occur by chance alone

   Co-occurrence is far more frequent than chance predicts, which is why models try to explain it.
3. shared risks like genes or trauma raise both

   The common factors model holds that genetic vulnerability, trauma and other shared risks raise the chance of both disorders on their own.
4. mental illness leads people to self-medicate with drugs

   Self-medication is a separate model in which the mental illness comes first and leads to substance use.

In addiction, disrupted serotonin signaling, rather than dopamine, is MOST closely linked to problems with

1. mood regulation

   Serotonin dysregulation is tied mainly to mood, anxiety and impulse control, which is why low mood and irritability are common in early abstinence.
2. autonomic arousal

   Arousal and the hyperactivity of withdrawal are driven mostly by norepinephrine.
3. reward processing

   Reward and reinforcement are dopamine's role, which the stem sets aside.
4. memory formation

   Memory problems in addiction center on the hippocampus and glutamate signaling rather than serotonin.

Research on relapse identifies three main triggers of renewed drug seeking: drug-associated cues, stress, and

1. the end of acute withdrawal

   The end of acute withdrawal brings relief and is not a known trigger of renewed seeking.
2. a small priming dose

   Reinstatement research finds three triggers: drug cues, stress, and a small dose of the drug itself, which can restart seeking after abstinence.
3. a lasting drop in tolerance

   A fall in tolerance is not one of the triggers this research identified; the three are cues, stress and the drug itself.
4. normal restoration of sleep

   Sleep returning to normal is a sign of recovery, not a relapse trigger.

At intake, a client reports 30 days without opioid use, but the counselor notices fresh track marks and the client appears drowsy. The counselor should NEXT

1. record the self-report as accurate and continue

   Accepting the report while ignoring visible evidence leaves the assessment incomplete and the risk unaddressed.
2. discharge the client for dishonesty at intake

   Inconsistent reporting is common at intake and is a clinical issue to explore, not a reason to deny treatment.
3. request a drug test and explore the mismatch

   Objective signs that conflict with self-report call for a drug test and a nonjudgmental conversation about the mismatch before any decision.
4. refer to detox based on appearance alone

   Drowsiness and track marks warrant assessment, but placement on looks alone skips the assessment of withdrawal risk and need.

With the client's consent, which collateral source would BEST verify a history of alcohol withdrawal seizures?

1. Hospital or emergency department records

   Medical records document seizures, dates and treatment, which makes them the most reliable source for a withdrawal-seizure history.
2. The client's direct supervisor at work

   A supervisor is unlikely to know medical details, and contacting an employer adds needless privacy risk.
3. A score from a previous AUDIT screen

   An AUDIT score rates drinking risk but records nothing about seizures.
4. A friend who drank with the client

   A drinking companion may have seen events but is not a reliable source of medical history.

A client with moderate opioid use disorder is homeless, sleeps in a park known for drug sales, and has no supportive contacts. Under the ASAM Criteria (4th edition), these facts bear MOST directly on which dimension?

1. Substance Use-Related Risks

   Dimension 4 weighs the likelihood and harms of continued use from the person's own patterns, not the surroundings.
2. Person-Centered Considerations

   Dimension 6 records the person's preferences, barriers and readiness, not the environment they return to.
3. Intoxication, Withdrawal, and Addiction Medications

   Dimension 1 addresses intoxication, withdrawal and medication needs, none of which the stem describes.
4. Recovery Environment Interactions

   ASAM Dimension 5 covers living situation, social supports and exposure to drug use, so homelessness near a drug market with no supportive contacts is assessed there.

A counselor wants to match interventions to a client's readiness to change their drinking. Which instrument is designed for this purpose?

1. The SASSI-4

   The SASSI-4 screens for the likelihood of a substance use disorder; it does not measure readiness.
2. The AUDIT

   The AUDIT screens for risky drinking and does not measure readiness.
3. The URICA

   The URICA places a client in a stage of readiness, which lets the counselor match interventions to it.
4. The ASI

   The ASI rates problem severity across life areas such as medical, legal and family, not motivation.

A client in a methadone program tests positive for morphine and denies using heroin. Which report from the client could MOST plausibly explain the result?

1. Taking an extra dose of methadone

   Methadone is a synthetic opioid that is not converted to morphine, so extra doses cannot cause a morphine positive.
2. Using a dextromethorphan cough syrup

   Dextromethorphan can cross-react on some PCP screens, but it does not produce morphine.
3. Eating a poppy-seed bagel

   Poppy seeds contain morphine and codeine, so a large amount can give a positive morphine result; confirmation levels help tell this apart from heroin use.
4. Taking prescribed tramadol

   Tramadol breaks down to its own metabolites, not morphine, so it would not explain this result.

A program switches some drug tests from urine to oral fluid. The MAIN advantage of oral fluid collection is that it

1. is easy to observe directly

   Direct observation is easy because oral fluid is swabbed in full view of staff, which makes substitution or tampering much harder than with unobserved urine collection.
2. is not affected by very recent use

   Oral fluid is good at catching very recent use, the opposite of this claim.
3. never needs confirmatory testing

   Positive oral fluid screens still need laboratory confirmation before they are acted on.
4. detects use over the past 90 days

   A 90-day window describes hair testing; oral fluid reflects use in roughly the past one to two days.

An assessment identifies uncontrolled hypertension as a significant risk in ASAM Dimension 2 (Biomedical Conditions). Which treatment plan objective addresses this need MOST directly?

1. Check blood pressure daily and take medications as prescribed

   A Dimension 2 problem needs a measurable biomedical objective, and daily readings with medication adherence target the blood pressure itself.
2. Discuss the long-term health effects of substance use

   General health education is not a measurable step toward controlling blood pressure.
3. Explore stress that raises the client's blood pressure

   Exploring stress may help, but it targets emotional factors and leaves the medical risk unmonitored.
4. Identify substance use triggers that add physical stress

   Identifying triggers is a relapse prevention objective; it does not directly manage the hypertension.

A client who is uncomfortable with references to a higher power at AA meetings still wants mutual support. Which option is MOST appropriate to suggest?

1. Al-Anon

   Al-Anon is for family and friends of people who drink, not for the person seeking recovery.
2. Narcotics Anonymous

   Narcotics Anonymous follows the Twelve Steps, including reliance on a higher power, so it does not resolve the client's concern.
3. SMART Recovery

   SMART Recovery is a secular, skills-based mutual-help group, so it offers peer support without references to a higher power.
4. Alateen

   Alateen serves teenagers affected by someone else's drinking, so it does not fit this client.

A functional analysis shows that a client drinks mainly when alone at night after arguments with a partner. Based on this finding, the MOST targeted intervention is

1. more frequent breath alcohol testing at sessions

   More testing monitors drinking but does nothing about the arguments and evenings that set it off.
2. general education on the health effects of alcohol

   General health information ignores the specific pattern the analysis revealed.
3. referral to a residential treatment program

   Nothing suggests the client needs a higher level of care; the finding calls for a targeted skill, not a new setting.
4. conflict-resolution and evening coping skills

   A functional analysis ties use to its triggers, so skills for handling arguments and lonely evenings target the exact situation that leads to drinking.

A client in treatment for alcohol use disorder has a 14-year-old child who is failing school, skipping classes, and fighting, and relatives blame the child for the family's problems. In family systems terms, the child is playing the role of the

1. hero

   The hero overachieves and makes the family look good instead of failing school.
2. lost child

   The lost child withdraws and stays out of the way, the opposite of fighting and skipping classes.
3. mascot

   The mascot uses humor and clowning to ease family tension rather than acting out.
4. scapegoat

   The scapegoat acts out, gets into trouble and draws the blame, which diverts the family's attention from the parent's drinking.

A client in early recovery acts on impulse and struggles to plan ahead, consistent with reduced prefrontal function. Which approach BEST compensates for this deficit?

1. open-ended exploration of emotions

   Unstructured exploration adds demands on planning and offers little help with impulsive choices.
2. external structure and pause skills

   Weak planning and impulse control call for supports from outside the client, such as schedules, reminders and a practiced pause before acting.
3. reliance on the client's own willpower

   Relying on willpower asks the impaired system to fix itself, which is unlikely in early recovery.
4. early, in-depth trauma processing

   Intensive trauma work this early can overwhelm a client who is still building basic control skills.

A client refuses to promise never to drink again. Using the Community Reinforcement Approach, the counselor suggests trying 30 days without alcohol and then reviewing how it went. This technique is

1. urge surfing

   Urge surfing is a mindfulness skill for riding out a craving, not an agreement to try abstinence.
2. sobriety sampling

   Sobriety sampling, from the Community Reinforcement Approach, asks for a time-limited trial of abstinence instead of a lifelong promise, then reviews what happened.
3. contingency contracting

   Contingency contracting links rewards or consequences to behavior, and this plan attaches no reward.
4. decisional balance

   Decisional balance lists a client's reasons for and against drinking to explore ambivalence; it asks for no time-limited trial of abstinence.

A client's chronic unemployment appears only under 'Background Information' in the treatment plan. To address this social determinant of recovery, the counselor should

1. increase the number of individual therapy sessions

   More therapy does not address the unemployment itself.
2. note the unemployment in the discharge summary

   Noting it at discharge only records the problem after treatment ends.
3. postpone work issues until 90 days of sobriety

   Delaying work issues leaves a key recovery barrier unaddressed; employment support can begin early.
4. add objectives for linkage to vocational services

   A barrier that affects recovery belongs in the plan as a goal with objectives, here linkage to vocational services, not only as background.

A client collapses in the waiting room of a Part 2 program with pinpoint pupils and slow, shallow breathing. Paramedics ask staff what the client may have taken. Staff should

1. refuse until the client signs a release

   A client with slow, shallow breathing cannot sign, and waiting for a release in an apparent overdose could cost the client's life.
2. disclose what is needed to treat the emergency

   Part 2 allows disclosure without consent to medical personnel in a bona fide medical emergency, limited to what they need to treat the client.
3. wait for the program director's approval

   The emergency exception requires no director sign-off, and delay in an apparent overdose is dangerous.
4. share only the client's name and date of birth

   Giving only a name and date of birth does not help paramedics decide treatment; the exception covers the clinical information they need.

A residential treatment program's written policy refuses admission to anyone taking prescribed buprenorphine or methadone. Under the ADA, this blanket exclusion is

1. unlawful disability discrimination

   Taking buprenorphine or methadone as prescribed by a licensed clinician is not illegal drug use, so people in treatment for opioid use disorder are protected by the ADA, and refusing everyone on that medication is discrimination.
2. lawful if written into policy

   Putting a discriminatory rule in writing does not make it lawful; admission decisions must rest on individual assessment.
3. required by federal opioid treatment rules

   Federal opioid treatment rules govern how these medications are dispensed; they do not require other programs to turn away patients who take them.
4. unlawful only if the program receives federal funds

   Private treatment programs are public accommodations under the ADA whatever their funding; federal money adds other duties but is not what makes the exclusion unlawful.

A client in a Part 2 program reveals being HIV positive and having unprotected sex without telling partners. The counselor should

1. warn the partners, as Tarasoff requires

   Tarasoff concerns threats of violence against an identifiable victim and creates no Part 2 exception for HIV status.
2. keep confidentiality and discharge the client

   Confidentiality holds, but ending treatment abandons the client and does nothing to lower the partners' risk.
3. warn the partners under a Part 2 exception

   Part 2's exceptions are narrow, and none of them lets a program warn partners without the client's consent.
4. keep confidentiality and urge disclosure

   Part 2 has no exception for warning sexual partners, so the counselor keeps the information confidential and works with the client on telling partners and reducing risk.

A client seeking substance use treatment shows signs of a severe, untreated psychotic disorder that prevents them from following the counseling process. The counselor has no mental health training. The counselor should

1. refer to a co-occurring treatment provider

   When a condition is beyond the counselor's training and blocks treatment, the ethical step is referral to a provider who treats both conditions together.
2. treat the client while reading about psychosis

   Reading about psychosis does not create competence, and treating severe untreated psychosis without training risks harm.
3. treat only the substance use for now

   Treating only the substance use ignores the psychosis that keeps the client from engaging, leaving both problems untreated.
4. have a colleague sit in to monitor symptoms

   A colleague sitting in as an observer does not supply the missing expertise or any psychiatric care.

A commercial truck driver who failed a federally required workplace drug test is referred to a counselor serving as a DOT substance abuse professional (SAP). Which task belongs to the SAP?

1. Provide the driver's treatment in the SAP's own practice

   To avoid conflicts of interest, a SAP generally may not refer the employee to the SAP's own practice or to a provider that pays the SAP.
2. Assess the driver and recommend education or treatment

   Under DOT rules the SAP evaluates the employee face to face, recommends education or treatment, and later checks compliance before return-to-duty testing.
3. Challenge the positive test result for the driver

   Test results are verified by the medical review officer, and the SAP's job is to protect safety, not to contest results for either side.
4. Decide whether the employer must rehire the driver

   The return-to-duty decision belongs to the employer; the SAP reports only whether the employee followed the recommendations.

A client who recently stopped heavy cocaine use reports crushing fatigue, sleeping long hours, vivid unpleasant dreams, and a ravenous appetite. These symptoms MOST likely reflect

1. stimulant withdrawal

   Fatigue, long sleep, vivid unpleasant dreams and increased appetite soon after heavy cocaine use stops are the DSM-5-TR features of stimulant withdrawal, the crash.
2. stimulant intoxication

   Stimulant intoxication brings alertness, little sleep and poor appetite, the opposite of this client's symptoms.
3. bipolar depression

   Bipolar depression would require a past manic or hypomanic episode, which nothing suggests, and the symptoms began right after cocaine stopped.
4. major depressive disorder

   Major depression needs two weeks of symptoms not better explained by a substance; this picture follows directly from stopping cocaine.

A client with a craving is taught to imagine the whole sequence of what would follow "just one drink," all the way to the next morning. This technique is called

1. asking the miracle question

   Asking the miracle question invites the client to describe a morning when the problem has vanished; it does not trace what one drink would lead to.
2. playing the tape through

   Playing the tape through has the client picture the whole chain after "just one drink," including the regret and consequences, which weakens the pull of the first drink.
3. cue exposure

   Cue exposure presents real alcohol or drug cues without use so the craving fades; it is not an imagined walk through the night.
4. thought stopping

   Thought stopping tries to cut a craving thought off, not to follow it to its outcome.

A managed care organization denies a client's continued residential stay. To support an appeal based on medical necessity, which documentation should the counselor emphasize?

1. The client's sense of not being ready to leave

   Feeling not ready is subjective and, by itself, does not show clinical need.
2. Recent incidents of the client acting on cravings

   Medical necessity reviews look for current, specific evidence that the client still needs this level of care, and recent episodes of acting on cravings show that risk.
3. Program relapse rates after early discharge

   Program-wide statistics describe other clients, not this client's current condition.
4. The team's preference for a full 28-day stay

   A fixed length of stay reflects program habit, not individual need, and reviewers do not accept it as a basis for continued stay.

With the client's signed consent on file, a drug court judge asks the counselor whether the client should be jailed after a positive drug test. The counselor should

1. recommend a brief jail sanction

   Recommending jail moves the counselor into a punitive role, and a positive test during treatment is first a signal to adjust care.
2. decline to share any clinical details

   With valid consent for court reporting on file, refusing to share clinical information breaks the program's agreement with the court.
3. describe progress and clinical needs

   On a drug court team the counselor's role is clinical: report treatment progress and recommend treatment changes, while sanctions stay the judge's decision.
4. advocate release to protect rapport

   Arguing for release to protect the relationship is advocacy, not clinical information, and blurs the counselor's role.