CADC study guide: IC&RC ADC domains, old and new

The MOST common cause of MDMA-related death is

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

1. dangerously high body temperature

   Most MDMA deaths involve hyperthermia: the drug raises body heat, and hot, crowded venues and hours of dancing push it higher, leading to muscle breakdown and organ failure.
2. seizures during MDMA withdrawal

   Deaths occur during intoxication, not withdrawal; stopping MDMA brings low mood and fatigue rather than dangerous seizures.
3. an allergic reaction to pill fillers

   Fillers and adulterants carry their own risks, but allergic reactions are not the leading cause of MDMA-related death.
4. opioid-like respiratory depression

   MDMA is a stimulant with empathogenic effects; it does not suppress breathing the way opioids do.

Which statement about cannabis and driving is MOST accurate?

1. it makes users safer, more cautious drivers

   Some impaired drivers slow down, but that does not offset slower reactions and poorer attention, and crash risk rises after use.
2. impairment occurs only with smoked, not edible, cannabis

   Edibles also impair driving; their effect starts later and lasts longer, which can lead people to drive while still affected.
3. THC slows reaction time, and alcohol adds to it

   THC impairs reaction time, attention and lane keeping, and adding alcohol produces more impairment than either drug alone.
4. regular, tolerant users cannot be impaired

   Tolerance blunts some effects in daily users, yet testing still finds impaired performance, so no user is immune.

Varenicline helps people stop smoking MAINLY because it

1. makes cigarettes taste bad, as disulfiram does with alcohol

   Varenicline is not an aversive drug, and disulfiram works through a toxic reaction to alcohol, not through taste.
2. partly activates nicotine receptors, blunting reward

   Varenicline is a partial agonist at nicotinic receptors: it eases craving and withdrawal while blocking much of the reward from a cigarette.
3. works only by treating underlying depression

   Varenicline is not an antidepressant; its effect comes from acting on nicotine receptors in the brain's reward system.
4. delivers nicotine through the skin at a steady rate

   That describes a nicotine patch; varenicline is a tablet that contains no nicotine.

In a biopsychosocial assessment, a client's hepatitis C status, liver disease, and history of withdrawal seizures belong to which area?

1. Psychological

   The psychological area covers mood, thinking, trauma and mental health history, not liver disease or seizures.
2. Social

   The social area covers family, housing, work and legal matters rather than medical conditions.
3. Spiritual

   The spiritual area covers meaning, faith and values; physical health findings are recorded elsewhere.
4. Biological

   Medical history, infectious disease status and past withdrawal seizures all describe the body, so they belong in the biological part of the assessment.

Under the Risk-Need-Responsivity model, a justice-involved client assessed as LOW risk of reoffending should generally receive

1. intensive services

   Intensive services are meant for high-risk clients; giving them to low-risk clients wastes resources and can worsen outcomes.
2. the same services as high-risk clients

   The model rejects one-size-fits-all programming; service intensity differs by assessed risk.
3. less intensive services

   The risk principle matches intensity to risk: low-risk clients do best with lighter services, and intensive programs can raise their reoffending by mixing them with higher-risk peers.
4. services only after reoffending

   Low risk still calls for some service matched to need; waiting for a new offense ignores the assessment.

A client reports smoking crack cocaine once, five days ago. A standard urine immunoassay is negative for cocaine metabolites. The MOST likely explanation is that

1. the client is falsely reporting use

   The report and the result do not conflict: use five days earlier can leave no detectable metabolite, so the result is no reason to doubt the client.
2. the metabolite fell below the cutoff

   Cocaine's main urine metabolite usually stays above the screening cutoff for only about two to four days after occasional use, so a negative five days later is expected.
3. the test failed and must be repeated

   A negative result five days after a single reported use fits the normal detection window, so nothing suggests the test failed.
4. a dilute specimen masked the metabolite

   Dilution can lower results, but nothing points to it here, and the time since use already explains the negative.

A pregnant client with opioid use disorder says she fears her baby will be taken if she admits using. The counselor should

1. advise her to detox right away

   Withdrawal during pregnancy carries a high relapse risk, and relapse is what endangers the fetus, so medication is preferred over detox.
2. report her use to CPS immediately

   An immediate report is not the clinical response this disclosure calls for; it would confirm her fear and push her away from the prenatal care and treatment that protect the baby.
3. link her to prenatal care and MOUD

   Methadone or buprenorphine with prenatal care is the standard of care for opioid use disorder in pregnancy and lowers risks to mother and baby; offering it also builds the trust she needs to stay engaged.
4. refer her elsewhere until after birth

   Delaying care until after birth leaves her and the baby untreated during the period of highest risk.

Contingency management programs can appropriately reinforce

1. verifiable goals such as session attendance

   Contingency management works when the target can be checked objectively, so attendance, negative tests or completed tasks are rewarded right after they are confirmed.
2. a client's promise to stay abstinent

   A promise is not a completed behavior; reinforcement follows what the client actually did, once it is verified.
3. self-reported abstinence without verification

   Rewarding unverified reports rewards the report rather than the behavior and invites false claims.
4. attitude changes noted by the counselor

   A counselor's impression of a better attitude is subjective, so rewards for it are inconsistent and shape no specific behavior.

A Part 2 program joins a health information exchange (HIE). Administrators propose signing a QSOA so the HIE can share patient data with every participating hospital for care coordination. This is insufficient because

1. a QSOA covers only services to the program

   A QSOA lets a Part 2 program share records with an organization that provides services to the program itself; passing records on to hospitals for their own care of the patient needs the patient's consent.
2. federally assisted programs cannot join an HIE

   Part 2 programs can take part in an HIE; the question is what legal basis covers each disclosure, not whether joining is allowed.
3. the HIE must first obtain a court order

   A court order is one route for certain disclosures, but routine care coordination through an HIE rests on patient consent.
4. electronic records cannot separate Part 2 data

   Systems can segment or tag Part 2 data; technical difficulty is not why a QSOA falls short here.

Residential staff propose withholding meals from clients who break program rules. This practice is

1. a violation only if the client is a minor

   Withholding meals violates the rights of adult clients too; basic rights such as adequate food do not depend on age.
2. a violation of basic client rights

   Food is a basic need, and withholding meals as punishment is a rights violation that no handbook or admission agreement can make acceptable.
3. an acceptable behavioral consequence

   Program consequences must be therapeutic and humane; denying food is punitive deprivation, not a behavioral consequence.
4. allowed if written in the handbook

   Putting a punishment in writing does not make it lawful or ethical; program rules cannot override basic client rights.

A Part 2 program's intake packet asks clients to waive their right to file privacy complaints with HHS before they can be admitted. Under the 2024 Part 2 rule, this requirement is

1. prohibited only for Medicare or Medicaid patients

   The bar protects every patient of a Part 2 program; it does not depend on who pays for treatment.
2. allowed if the program has its own process

   An internal grievance process is good practice, yet it does not replace the patient's right to complain to HHS.
3. allowed if the client signs it voluntarily

   A signature given to get admitted is not a free choice, and the rule bars the requirement whether or not the client signs.
4. prohibited as a condition of treatment

   The 2024 Part 2 rule lets patients file complaints with HHS and bars programs from requiring a waiver of that right as a condition of treatment, payment, enrollment or eligibility.

A client in an intensive outpatient program is reviewed for a possible step-up in level of care. Which finding justifies moving to a more intensive level?

1. One positive drug screen after the first week

   A single early positive screen calls for adjusting the plan; it is the pattern of continued use that justifies a step-up.
2. A request for more individual therapy sessions

   A wish for more sessions can be met within the current level and says nothing about whether the setting controls use.
3. Resistance voiced toward the current counselor

   Friction with a counselor is handled by working on the relationship or reassigning, not by changing the level of care.
4. Ongoing use despite full adherence to the plan

   When a client follows the plan yet keeps using, the current intensity is not enough to control use, which is the core reason to move to a more structured level of care.