CAADC Skills and Competencies 5 — Questions and Answers
Question 1: A client with stimulant use disorder reports persistent anhedonia six weeks into abstinence. The counselor BEST explains this as:
- A sign the client has a co-occurring depressive disorder requiring immediate psychiatric referral
- Post-acute withdrawal syndrome related to dopamine system dysregulation (Correct answer)
- The client's ambivalence about recovery manifesting as emotional flatness
- A normal grief response to giving up substance use
Correct answer: Post-acute withdrawal syndrome related to dopamine system dysregulation
Anhedonia during early abstinence from stimulants is a hallmark of post-acute withdrawal syndrome (PAWS) caused by dopaminergic system disruption.
Question 2: Which documentation standard is MOST important for demonstrating medical necessity for continued addiction treatment services?
- Logging session start and end times accurately
- Recording client progress toward treatment goals with observable, measurable outcomes (Correct answer)
- Noting the counselor's theoretical orientation in each session note
- Documenting the client's attendance and payment history
Correct answer: Recording client progress toward treatment goals with observable, measurable outcomes
Medical necessity is demonstrated through measurable progress notes showing ongoing clinical need, treatment response, and goal attainment.
Question 3: A CAADC is working with a Native American client in recovery. Which approach BEST reflects cultural competence?
- Apply standard 12-Step protocols universally, as they are evidence-based
- Explore whether traditional healing practices and community supports can be integrated into the recovery plan (Correct answer)
- Avoid discussing cultural identity to prevent reinforcing stereotypes
- Focus solely on the biochemical aspects of addiction to remain neutral
Correct answer: Explore whether traditional healing practices and community supports can be integrated into the recovery plan
Culturally competent care involves exploring and integrating the client's cultural identity, values, and traditional healing practices into a personalized recovery plan.
Question 4: A client reports they have started gambling online since stopping alcohol use. This MOST likely represents:
- A healthy replacement activity that reduces relapse risk
- Addiction transfer, where addictive behavior shifts to another substance or activity (Correct answer)
- A cognitive distortion that should be challenged in session
- Controlled use that does not require clinical attention
Correct answer: Addiction transfer, where addictive behavior shifts to another substance or activity
Addiction transfer (also called cross-addiction or addiction substitution) occurs when someone replaces one addictive behavior with another.
Question 5: When applying the transtheoretical model, a counselor using 'consciousness raising' interventions is MOST appropriately working with clients in which stage?
- Action
- Maintenance
- Precontemplation or contemplation (Correct answer)
- Termination
Correct answer: Precontemplation or contemplation
Consciousness raising — increasing awareness of the problem and its consequences — is a process of change matched to the precontemplation and contemplation stages.
Question 6: A client in methadone maintenance treatment asks the CAADC whether they are 'really sober.' The counselor's BEST response is to:
- Agree that medication-assisted treatment is not true sobriety and encourage detoxification
- Explore the client's personal definition of recovery and validate the legitimacy of MAT as an evidence-based approach (Correct answer)
- Avoid the topic and redirect to relapse prevention planning
- Refer the question to the prescribing physician only
Correct answer: Explore the client's personal definition of recovery and validate the legitimacy of MAT as an evidence-based approach
Exploring the client's beliefs while affirming MAT as a valid, evidence-based recovery pathway addresses stigma and supports therapeutic alliance.
Question 7: In crisis intervention for a client expressing suicidal ideation with a substance use history, the counselor's FIRST priority is to:
- Conduct a comprehensive addiction assessment to understand the relationship between use and ideation
- Assess the immediacy and lethality of the suicidal risk (Correct answer)
- Contact the client's family to establish a safety network
- Document the disclosure and schedule an urgent follow-up appointment
Correct answer: Assess the immediacy and lethality of the suicidal risk
Assessing the immediacy and lethality of suicidal risk is always the first clinical priority to determine the appropriate level of intervention.
CAADC Skills and Competencies 5
A client with stimulant use disorder reports persistent anhedonia six weeks into abstinence.
The counselor BEST explains this as: