National Certified Addiction Counselor Level I (NCAC I) — Questions and Answers

Question 1: Post-Traumatic Stress Disorder (PTSD) and substance use disorders frequently co-occur because:

Substance use causes PTSD in most cases
Trauma automatically causes addiction
Both are caused by the same genetic mutation
Substances are often used to cope with trauma symptoms (Correct answer)

Correct answer: Substances are often used to cope with trauma symptoms

People with PTSD often turn to alcohol or drugs as a way to numb hyperarousal, intrusive memories, and emotional pain, leading to dependence.

Question 2: Susan was referred for an Alcohol Assessment by her Primary Care Physician. She scored a 17 on the AUDIT assessment. Which risk zone and action recommendation would be the most appropriate?

Zone III; Brief education or referral for specialized treatment (Correct answer)
Zone IV; Referral to a specialist for treatment
Zone I; Brief education
Zone II; Brief intervention

Correct answer: Zone III; Brief education or referral for specialized treatment

AUDIT scores ranging from 13-19 for a Woman fall into Zone III with the recommendation of simple advice plus brief counseling and continued monitoring. When scoring the AUDIT, the gender of the client will aide in determining the recommendation. Zone recommendations are as follows: Zone I: Brief education, Zone II: Brief intervention, Zone III: Brief intervention or referral to specialized treatment, Zone IV: Referral to specialized treatment

Question 3: A 67 year old female, Mary, attends an intake assessment with you on Monday. You diagnosis her with Alcohol Use Disorder, Severe and Bipolar I. You gave her a treatment schedule to engage her in group sessions along with a referral for a doctor on staff to assess for medications. Mary lives alone and has limited mobility due to severe arthritis. Mary misses her group session on Wednesday. As her primary clinician, you call her to follow up regarding her absence. While on the phone, it becomes apparent that she is inebriated and she reported falling down stairs and is struggling to get up. You encourage her to call 911, however she refuses. Which would be the best course of action to present to your supervisor?

Call 911 for a wellness check. (Correct answer)
Talk to her about the incident when she comes in for group and discuss the danger she put herself in.
Document the call; process the call if she brings is up with you.
Call her son so he can go check on her.

Correct answer: Call 911 for a wellness check.

The best option to discuss with your supervisor would be to call for a Wellness Check. Her apparent intoxication, limited mobility, living alone and her self-report of falling with a difficulty of getting up poses a concern for her safety. Therefore, you have an ethical responsibility to break confidentiality to ensure her safety. Consulting with your supervisor or colleague allows you the opportunity to receive feedback regarding your plan of action.

Question 4: Under HIPAA, clients have the right to:

Demand that providers delete all of their records
Prevent providers from using any information in their treatment
Share their records with any third party without restrictions
Access and obtain a copy of their own protected health information (PHI) (Correct answer)

Correct answer: Access and obtain a copy of their own protected health information (PHI)

HIPAA's Privacy Rule grants clients the right to inspect and receive copies of their own PHI held by covered entities, with limited exceptions.

Question 5: Which principle requires that clinical documentation be completed as close to the time of service as possible?

Completeness
Timeliness (Correct answer)
Accuracy
Legibility

Correct answer: Timeliness

Timely documentation ensures that clinical information is recorded while details are fresh, reducing errors and supporting continuity of care.

Question 6: Which therapeutic approach emphasizes the client's inherent capacity for growth and self-determination?

Rational Emotive Behavior Therapy
Psychoanalysis
Person-centered therapy (Correct answer)
Behavioral therapy

Correct answer: Person-centered therapy

Person-centered therapy, developed by Carl Rogers, is built on the belief that clients have the inner resources to grow when provided with the right therapeutic conditions.

Question 7: Which stage of the Transtheoretical Model (Stages of Change) is characterized by a client acknowledging a problem but not yet committing to action?

Contemplation (Correct answer)
Precontemplation
Preparation
Action

Correct answer: Contemplation

In the Contemplation stage, clients are aware of their problem and consider change but have not made a commitment to act.

Question 8: James was engaged in group and individual counseling in your outpatient program. He has maintained his sobriety and has found a medication regimen that helps him manage his depressive symptoms. James attends Alcoholic Anonymous four times per week and has been active in working the steps with his sponsor. Which of the following recommendations would be the least effective at his discharge?

Continue contact with prescribing doctor for psychotropic medications
Begin another outpatient program (Correct answer)
Attend AA regularly; maintain contact with his sponsor
Step work

Correct answer: Begin another outpatient program

Once an outpatient program is completed, it is not necessary for the client to engage in an additional program. Programs usually begin in phases which would not align with a person who has attained and maintained recovery.

Question 9: When assessing a client for co-occurring disorders, a counselor should wait how long after last substance use before evaluating psychiatric symptoms?

24 hours
Long enough for acute intoxication and withdrawal effects to clear (typically 2–4 weeks) (Correct answer)
Until the client has been sober for one year
Immediately at intake regardless of use

Correct answer: Long enough for acute intoxication and withdrawal effects to clear (typically 2–4 weeks)

Waiting 2–4 weeks allows the counselor to distinguish substance-induced symptoms from underlying psychiatric disorders.

Question 10: The CAGE-AID is a screening tool containing four yes/no items. How many questions need to be answered "yes" to be considered a positive screen?

Three
Two
One (Correct answer)
Four

Correct answer: One

The CAGE-AID is screened positive when at least one question is indicated "yes." The CAGE-AID is screened negative if the answer to all four questions is "no."

Question 11: What does 'empathic confrontation' mean in addiction counseling?

Pointing out discrepancies between a client's stated values and behavior in a compassionate way (Correct answer)
Aggressively challenging denial to break through resistance
Forcing a client to acknowledge consequences of use
Asking family members to confront the client

Correct answer: Pointing out discrepancies between a client's stated values and behavior in a compassionate way

Empathic confrontation gently highlights inconsistencies between what a client says they value and how they are acting, without aggression or judgment.

Question 12: When treating co-occurring depression and alcohol use disorder, research indicates that:

Depression always resolves spontaneously once alcohol use stops
Alcohol use disorder must be in remission before antidepressants work
Treating depression first eliminates the need to address alcohol use
Treating both simultaneously produces better outcomes than treating either alone (Correct answer)

Correct answer: Treating both simultaneously produces better outcomes than treating either alone

Integrated treatment of co-occurring depression and AUD yields superior outcomes, as the disorders maintain each other and must be addressed together.

Question 13: What is the role of measurable objectives in demonstrating treatment effectiveness?

They satisfy billing requirements for insurance reimbursement
They motivate clients by making goals seem more attainable
They are required only for court-mandated clients
They provide observable indicators of progress that can be documented and evaluated (Correct answer)

Correct answer: They provide observable indicators of progress that can be documented and evaluated

Measurable objectives allow counselors to track, document, and communicate client progress in concrete, verifiable ways.

Question 14: Why is accurate and complete clinical documentation important for addiction counselors?

It protects the counselor from disciplinary action only
It is primarily required for insurance audits
It replaces the need for clinical supervision
It supports continuity of care, accountability, billing, and legal/ethical compliance (Correct answer)

Correct answer: It supports continuity of care, accountability, billing, and legal/ethical compliance

Documentation serves multiple critical purposes: ensuring continuity of care across providers, meeting legal and ethical standards, supporting reimbursement, and providing a basis for accountability.

Question 15: A 'crisis safety plan' developed collaboratively with a client in addiction treatment should include:

The counselor's personal contact information and home address
Only the client's medication schedule
Warning signs, coping strategies, support contacts, and steps to take in an emergency (Correct answer)
A list of substances the client agrees to avoid indefinitely

Correct answer: Warning signs, coping strategies, support contacts, and steps to take in an emergency

A comprehensive safety plan includes personal warning signs, internal coping strategies, social supports, professional contacts, and emergency steps to reduce risk during a crisis.

Question 16: A client's treatment plan includes addressing their unemployment as a barrier to recovery. This reflects which ASAM dimension?

Dimension 2 — Biomedical Conditions
Dimension 6 — Recovery/Living Environment (Correct answer)
Dimension 3 — Emotional/Behavioral Conditions
Dimension 5 — Relapse Potential

Correct answer: Dimension 6 — Recovery/Living Environment

ASAM Dimension 6 addresses the recovery environment, including housing, employment, family support, and social networks that affect treatment outcomes.

Question 17: Cannabis withdrawal syndrome commonly includes which symptoms?

Hallucinations and paranoid delusions
Irritability, anxiety, insomnia, and decreased appetite (Correct answer)
Seizures and delirium
Sweating, tremors, and fever

Correct answer: Irritability, anxiety, insomnia, and decreased appetite

Cannabis withdrawal, officially recognized in DSM-5, includes irritability, anxiety, sleep disturbance, and reduced appetite, typically peaking in the first week of abstinence.

Question 18: Which practice ensures that clients are active participants in developing their own treatment plan?

Presenting a pre-written plan for the client to approve
Consulting with family members before writing the plan
Collaborative treatment planning with the client's input and signature (Correct answer)
Having the client complete a self-report questionnaire only

Correct answer: Collaborative treatment planning with the client's input and signature

Involving clients directly in developing their treatment goals increases buy-in, motivation, and the likelihood that goals will reflect what is meaningful to the client.

Question 19: What does the ethical principle of 'nonmaleficence' obligate a counselor to do?

Avoid causing harm to clients (Correct answer)
Treat all clients fairly and equitably
Do good and promote client welfare
Keep all client information confidential

Correct answer: Avoid causing harm to clients

Nonmaleficence, meaning 'do no harm,' obligates counselors to avoid actions that could hurt clients, either directly or indirectly.

Question 20: In Dialectical Behavior Therapy (DBT), which skill module focuses on tolerating distress without making it worse?

Mindfulness
Emotion Regulation
Distress Tolerance (Correct answer)
Interpersonal Effectiveness

Correct answer: Distress Tolerance

The Distress Tolerance module in DBT teaches clients to survive crisis moments without resorting to harmful behaviors like substance use.

Question 21: Lee is coming into the clinic for a substance use assessment. He reports using Xanax occasionally, but is unsure if he has a problem. During the course of the assessment, you learn that when he first started taking Xanax he used about one pill at a time. He reports that he is now taking three pills during each use because "one just doesn't do it for me anymore." You also learn that he decided he wanted to stop using Xanax altogether, but that he "keeps going back to it." He denied any other issues related to Xanax. When assessing the severity of Lee's Xanax use, what severity specifier would be most appropriate?

Moderate
Severe
No severity specifier should be given as he does not meet criteria for a substance use disorder
Mild (Correct answer)

Correct answer: Mild

According to the DSM-5, when 2-3 criteria are indicated, a mild severity specifier is appropriate. Based on the information provided, we can identify that he meets the criteria for two criteria. Needing three pills instead of one to get the same effect indicates tolerance. He also demonstrates a desire to cut down or eliminate use and being unsuccessful which is another criteria.

Question 22: Which of the following drugs would be present on a Urine Drug Screen (UDS) 5 days after use?

Methamphetamine
Marijuana (Correct answer)
Cocaine
Heroin

Correct answer: Marijuana

The active ingredient in marijuana, THC, is fat soluble whereas the other substances listed are water soluble. Fat cells are harder to burn, therefore can remain in a person&'s system longer.

Question 23: Which of the following best describes 'relapse' versus 'lapse' in addiction treatment?

A lapse is longer in duration than a relapse
A lapse is a single episode of use, while a relapse is a return to problematic patterns of use (Correct answer)
A lapse requires hospitalization while a relapse does not
A relapse only applies to alcohol use disorders

Correct answer: A lapse is a single episode of use, while a relapse is a return to problematic patterns of use

A lapse is typically a brief, isolated episode of substance use, while a relapse represents a return to the full pattern of problematic use.

Question 24: Joseph comes into your office for an intake assessment required by his Probation Officer. Joseph is reluctant to discuss his opiate use. However, he is compliant because he knows that the results of the intake would be reported to his PO. He shared that he is on probation as a result of being arrested for stealing. Joseph explained that he was stealing to support his heroin use and has continued to use since his arrest. Joseph began using Oxycodone recreationally at age 17 which progressed to daily use soon after. Joseph began using heroin approximately 8 months later due to the cost difference. Joseph has used to avoid withdrawal symptoms. He recently began to share needles and noted that he is aware of the health risk that this behavior poses. Joseph's family began distancing themselves from him when he continued using heroin after being arrested. With the information provided, how would you diagnose Joseph?

Opiate Use Disorder, Severe
Opiate Use Disorder, Mild
Opiate Use Disorder
Opiate Use Disorder, Moderate (Correct answer)

Correct answer: Opiate Use Disorder, Moderate

"The summary above falls into the moderate level of the DSM-V for Opiate Use Disorder. The severity rating scale is as follows: Mild: 2-3 Symptoms Moderate: 4-5 Symptoms Severe: 6 or more Symptoms - Symptoms identified in the summary were as follows. Joseph had continued use despite persistent social and interpersonal issues (discord with family). Joseph continued to use in physically dangerous situations (sharing needles). Joseph has developed a tolerance which led to him using larger amounts over time. Lastly, he has experienced withdrawal and uses to avoid symptoms. "

Question 25: In 12-Step Facilitation therapy, what is the counselor's primary role?

Conducting structured behavioral experiments
Encouraging engagement with 12-Step fellowship and its principles (Correct answer)
Directly leading 12-Step meetings
Providing pharmacological support

Correct answer: Encouraging engagement with 12-Step fellowship and its principles

12-Step Facilitation therapy is a structured clinical approach that prepares and encourages clients to engage actively with AA/NA and adopt its principles.

Question 26: Which option correctly represents the Stages of Change Model?

Contemplation, preparation, action, maintenance and relapse
Pre-contemplation, contemplation, preparation, action and maintenance (Correct answer)
Contemplation, preparation, action and maintenance
Pre-contemplation, contemplation, action and relapse

Correct answer: Pre-contemplation, contemplation, preparation, action and maintenance

The Stages of Change Model was developed by Prochaska and DiClemente in the 1970&'s to allow professionals to gauge a client&'s readiness for change to aide in treatment planning.

Question 27: Which technique helps clients identify triggers for substance use by examining antecedents, behavior, and consequences?

Decisional balance
Harm reduction planning
SMART goal setting
Functional analysis (ABC model) (Correct answer)

Correct answer: Functional analysis (ABC model)

Functional analysis, or the ABC model, helps clients identify what triggers use (Antecedents), the use behavior itself (Behavior), and its outcomes (Consequences).

Question 28: What should a counselor do if they make an error in a written (paper) clinical record?

Leave the error and note it in the next progress note
Use correction fluid (whiteout) to cover the error and rewrite it
Destroy the page and rewrite the entire document
Draw a single line through the error, write 'error,' date and initial it, then write the correct information (Correct answer)

Correct answer: Draw a single line through the error, write 'error,' date and initial it, then write the correct information

The proper correction method preserves the original entry (for legal integrity), documents who made the correction and when, and clearly presents the accurate information.

Question 29: Which ASAM Patient Placement Criteria dimension addresses a client's 'Readiness to Change'?

Dimension 2
Dimension 1
Dimension 6
Dimension 4 (Correct answer)

Correct answer: Dimension 4

ASAM Dimension 4 specifically evaluates a client's readiness and motivation to change, which informs the intensity of motivational interventions in the plan.

Question 30: Which of the following best describes the primary goal of crisis intervention in addiction counseling?

Hospitalize the client for long-term treatment
Conduct a comprehensive psychological evaluation
Eliminate the client's drug use immediately
Stabilize the client and restore functioning to pre-crisis level (Correct answer)

Correct answer: Stabilize the client and restore functioning to pre-crisis level

Crisis intervention aims to stabilize the individual and restore them to their pre-crisis level of functioning, not to resolve all underlying issues immediately.

National Certified Addiction Counselor Level I (NCAC I)

The NCAC I is NAADAC's national certification for addiction counselors, assessing knowledge across the treatment process including assessment, counseling practices, treatment planning, and professional ethics for substance use disorder professionals.

Questions

35 min

Time Limit

67%

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