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2023 Edition

Addiction Counselor Practice Test

Try this free addiction counselor practice test to see what's on a licensing or certification exam for counselors who work with substance addiction.

Most states require that an addiction counselor be certified or licensed. Organizations such as the National Board for Certified Counselors (NBCC) and the National Certification Commission for Addiction Professionals (NCC AP) provide education and certification opportunities. To become a certified addiction counselor, a candidate has to pass an exam. The NCC AP offers different levels of certification such as National Certified Addiction Counselor I and II and Master Addiction Counselor (MAC). The NBCC offers certification as a Masters Addition Counselor. Addiction counselor exams cover such subjects as screening, assessment and engagement, treatment planning, collaboration and referral, case management, individual and group counseling and professional responsibility.

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Screening, Assessment and Engagement

1.	All of the following are questions on the CAGE questionnaire EXCEPT?
		a. Have you ever felt the need to cut down on your drinking?
		b. Have you ever felt annoyed by others criticizing your drinking?
		c. Have you ever experienced delirium tremens?
		d. Have you ever felt guilty about your drinking?
Delirium tremens are a severe form of alcohol withdrawal which is not included on the CAGE questionnaire. Delirium tremens usually occur three days into withdrawal and can last 2-3 days. Incorrect answer. Please choose another answer.

2.	Which of the following drugs would be present on a Urine Drug Screen (UDS) 5 days after use?
		a. Cocaine
		b. Marijuana
		c. Methamphetamine
		d. Heroin
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. Incorrect answer. Please choose another answer.

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3.	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?
		a. Opiate Use Disorder, Severe
		b. Opiate Use Disorder, Mild
		c. Opiate Use Disorder, Moderate
		d. Opiate Use Disorder
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. Incorrect answer. Please choose another answer.

4.	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?
		a. Zone I; Brief education
		b. Zone II; Brief intervention
		c. Zone II; Brief education or referral for specialized treatment
		d. Zone IV; Referral to a specialist for 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 Incorrect answer. Please choose another answer.

5.	Which option correctly represents the Stages of Change Model?
		a. Pre-contemplation, contemplation, preparation, action and maintenance
		b. Pre-contemplation, contemplation, action and relapse
		c. Contemplation, preparation, action and maintenance
		d. Contemplation, preparation, action, maintenance and relapse
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. Incorrect answer. Please choose another answer.

Treatment Planning, Collaboration and Referral

6.	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?
		a. Call her son so he can go check on her.
		b. Talk to her about the incident when she comes in for group and discuss the danger she put herself in.
		c. Document the call; process the call if she brings is up with you.
		d. 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. Incorrect answer. Please choose another answer.

7.	All of the following are indicators that a person would be appropriate for inpatient treatment except:
		a. Continued use of marijuana
		b. Use of alcohol to prevent withdrawal symptoms
		c. Cocaine use that impairs functioning at work
		d. Inability to engage in daily living skills
A referral for inpatient treatment is appropriate when a person's use is having a significant impairment on their daily living skills, threatens their safety and/or safety of others around them and a risk of death. Answer a does not include a description of any impact on daily living skills. Incorrect answer. Please choose another answer.

8.	Thomas is currently engaged in group and individual counseling with you and has a diagnosis of Alcohol Use Disorder, Severe and ADHD. Thomas has a positive Urine Drug Screen for stimulants and reported that he is currently prescribed stimulants for his ADHD by Dr. Smith. Which of the following actions would not be appropriate for you to do?
		a. Collaborate with Dr. Smith regularly.
		b. Continue to have Urine Drugs screens to monitor medication compliance.
		c. Encourage Thomas to stop using his medication due to risk for cross addiction.
		d. Sign a consent of release for Dr. Smith.
Medication regimen and recommendations is likely not in your professional scope, therefore is not appropriate for you to be changing. Through continued collaboration with his prescriber, you are able to verbalize any concerns you may have about cross addiction and misuse of the medication. Incorrect answer. Please choose another answer.

9.	Treatment plans should be updated_________.
		a. once per month
		b. continuously
		c. every 8 weeks
		d. after a relapse
Treatment plans should be updated to reflect progress and regressions. Objectives and goals should be realistic and attainable. Incorrect answer. Please choose another answer.

10.	Sara is currently engaged in group and individual sessions with you. A current goal is to receive the Vivitrol injection to aid in her abstinence from opiate use. As her counselor, how can you best support her?
		a. Trust that she is honest about her use with her prescriber.
		b. Identify barriers to this goal and aide in developing skills to manage them.
		c. Collaborate with her prescriber regarding compliance and treatment plan.
		d. Both b and c
Collaborating with her prescriber will provide a team approach which will aide in communication. For example, if Sara were to relapse days before the injection, receiving the Vivitrol injection would induce withdrawal symptoms. Identifying barriers and identifying skills would help Sara maintain sobriety until she is able to receive the injection. Incorrect answer. Please choose another answer.

11.	Who should be involved in developing the treatment plan?
		a. Counselor and their supervisor
		b. Counselor and the client
		c. Counselor only
		d. Counselor, their supervisor and the client
Treatment plans should be a collaboration between the counselor and the client. Goals and objectives should be realistic and align with the client's goals. Using the Stages of Change Model can help the clinician offer appropriate goals. Incorrect answer. Please choose another answer.

12.	Mary just completed her intake session with you. Her use of alcohol has had a significant negative impact on her life. Consequences of her use were discord with her husband, missing her children's soccer games, daily use of alcohol and decreased productivity at work. Which consequence should be addressed first?
		a. Attain and maintain sobriety.
		b. Attend her children's soccer game this week.
		c. Improve communication with her husband.
		d. Improve her performance at work.
Attaining sobriety should be the first goal. Once that is accomplished, other consequences can be addressed appropriately. Incorrect answer. Please choose another answer.

Case Management, Discharge and Continuing Care

13.	At what phase of treatment does case management begin?
		a. At the first counseling session
		b. At the first contact with client
		c. When the treatment plan is created
		d. At the client's intake session
Case management begins at a client's intake and continues throughout their treatment. The first goal of case management is to coordinate care which is appropriate for the client which can be done at the conclusion of the intake session. Incorrect answer. Please choose another answer.

14.	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?
		a. Attend AA regularly; maintain contact with his sponsor
		b. Begin another outpatient program
		c. Step work
		d. Continue contact with prescribing doctor for psychotropic medications
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. Incorrect answer. Please choose another answer.

15.	Susan is being discharged as a result of continued relapses and inconsistent attendance for group therapy. Despite your best efforts, she is reluctant to agree with your recommendation for inpatient treatment. Which of the following would be the most appropriate course of action at the conclusion of her discharge session?
		a. Wish her the best in future endeavors.
		b. Encourage her to re-engage in outpatient treatment when she is ready to stop drinking.
		c. Provide her with written information about different inpatient options.
		d. Inform her emergency contact of her discharge and non-compliance with your recommendation for inpatient treatment.
Providing Susan with written information gives her the opportunity to look into them should she change her mind about your recommendation. The information provided does not provide enough evidence to be concerned about her safety and is not appropriate to contact her emergency contact. Incorrect answer. Please choose another answer.

16.	All of the following are models of case management except:
		a. Strengths perspective
		b. Clinical/ rehabilitation
		c. Weakness/ growth perspective
		d. Broker/ generalist
The models of case management are strengths perspective, clinical/ rehabilitation, broker/ generalist and assertive community treatment. Incorrect answer. Please choose another answer.

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17.	All of the following are benefits of aftercare treatment except:
		a. Step work
		b. Continued routine
		c. Validation from others in a similar situation
		d. Continued support in a therapeutic environment
Step work is a part of AA and other similar groups which are not a part of aftercare programs. Incorrect answer. Please choose another answer.

18.	All case management approaches can be considered ______-_______.
		a. Individually- based
		b. Community- based
		c. Crisis- based
		d. Routine- based
Case management is community based. The main goal is to help the client's familiarize themselves with their community and services available. Examples would be self-help groups, church, individual resources and family resources. Incorrect answer. Please choose another answer.

Counseling (Individual and Group)

19.	You work in an outpatient program with a team of addiction counselors, social workers, a nurse and a physician. You facilitate an intensive outpatient group in the mornings from 9am-12. Around 9:30 am you notice that Scott appears to be nodding off in the group. You also observe that group members have noticed him as well and appear uncomfortable. You are aware that Scott uses opiates and has been struggling to abstain from use. What is your best course of action?
		a. Continue facilitating the group as normal.
		b. Ask Scott to come into the hall with you, explain what you observed and that you would like him to be assessed by the nurse and/or physician.
		c. Call on Scott in the group to engage in discussion
		d. Ask Scott to come into the hall with you, explain what you observed and ask him to go home.
Scott may be inebriated, or he may be tired. Either way, the appearance of nodding off is often triggering for other group members which means that he is not appropriate for the group at this time. Since your concern is that he may be inebriated, he should be assessed by a medical professional before going home to ensure safety. Once you return to the group after Scott leaves, it may be necessary to process how group members were impacted after seeing Scott's presentation in group. If this is the case, keep the discussion off of Scott and on how others felt when seeing someone appear inebriated (ie. Triggered, sad, anxious, angry, etc.). Incorrect answer. Please choose another answer.

20.	Which of the following is not a consequence of glorifying drug use in a group session?
		a. Triggering others
		b. Continuing in an addictive behavior and thinking patterns for the person sharing
		c. A distraction in the group from appropriate topics
		d. Create group unity
Glorifying is talking about drinking and/or drug use in a manner that makes it sound exciting and positive. More times than not, this tends to have a negative impact on the group and can create some anger. Members often feel triggered by the topics and the person sharing continues to use their addictive thought processes. Should a person be glorifying in a group session, this should be addressed immediately before the negative impact intensifies. Incorrect answer. Please choose another answer.

21.	Which form of counseling has been shown to have the most benefit with addiction?
		a. Family Counseling
		b. Crisis Counseling
		c. Group Counseling
		d. Individual Counseling
Often times in addiction, a person becomes isolated and feels as though no one can understand their situation. Being a group setting, a client is exposed to others who have similar experiences, thoughts and feelings which can normalize a person's experience. Group sessions also allow others to observe others being vulnerable which increase the chances of others doing the same. Group sessions can be a place where clients can learn from each other's struggles and triumphs. Incorrect answer. Please choose another answer.

22.	Which therapeutic approach is the most effective when working with a resistant client?
		a. Cognitive Behavioral Therapy
		b. Motivational Interviewing
		c. Psychodynamic
		d. EDMR
Motivational Interviewing is a client centered model of counseling that works to identify what the client wants compared to what others want for them. Motivation, or lack thereof, is a common barrier for individuals in treatment. Incorrect answer. Please choose another answer.

23.	Matt is a heroin addict. Which group would be an appropriate suggestion for him?
		a. AA
		b. NA
		c. GA
		d. CA
NA refers to a Narcotics Anonymous group. Should Matt feel as though he does not like the groups offered and/or the others in the group, attending Alcoholic Anonymous may be more appropriate. Each group follows the 12 step model, however they have individual differences. Incorrect answer. Please choose another answer.

24.	You are facilitating a co-occurring mental health and substance abuse group. One of the group members, Sally, shares that she has been struggling with her depression symptoms and feels as though being sober is "too much". She noted that yesterday on her way home from work she was driving by a liquor store and stayed in the parking lot for approximately 35 minutes before calling her sponsor. Which approach are you least likely to use?
		a. Allow her to discuss her challenges, support her in the group.
		b. Have the group help her in identifying healthy behaviors when her depressive symptoms occur.
		c. Change the topic to avoid triggering other group members.
		d. Process her experience yesterday and support her for calling her sponsor.
Changing the topic would be the least helpful for both Sally and other group members. Process groups should offer a safe space for members to share about their difficulties, receive support from others and create a sense of normalization. Changing the topic would make others less likely to share about their struggles in the group. Incorrect answer. Please choose another answer.

Professional and Ethical Responsibility

25.	What is transference?
		a. Having romantic feelings for a client.
		b. When your feelings about one person is transferred to another.
		c. When a client goes from an active status in treatment to non-active.
		d. Transferring a client from your case load to a colleague.
Transference often occurs when a client reminds a clinician of someone in their personal life. The feelings transferred can be positive or negative. Should a clinician feel as though they are experiencing transference, this should be brought up in supervision to address appropriately. Incorrect answer. Please choose another answer.

26.	Mary is an 18 year old female who is currently engaged in outpatient treatment with you. She has been actively using cocaine and has reported continued discord with her mother. Mary has not signed a consent for her mother at this time. While in your office, you receive a phone call from her mother insisting to know the results from Mary's recent drug screens. Mary's mother stated that she believes her daughter is using cocaine based on her current behaviors and "attitude". What is the most appropriate response?
		a. You should ignore the phone call since there's no consent.
		b. "Let me call her and make sure she is OK with me sharing her results with you"
		c. "At this time I do not have her permission to share information with you."
		d. "I cannot confirm or deny that your daughter is a client. However, I am happy to listen to concerns you may have about your daughters use."
Since you do not have a consent signed, you are not able to disclose that she is a client of yours. As a counselor, you are able to listen to concerns that anyone has regarding a person in active addiction. After the phone call, you should clearly document what you said as well as inform Mary of her mother's phone call. Incorrect answer. Please choose another answer.

27.	Steven is a 15 year old male who was referred to treatment by his school counselor after he was observed impaired at school. Steven has been abusing Xanax and acknowledges use at school. He currently lives with his mother who has a legal prescription for Xanax which she does not keep in a locked location. Steven's mother is aware that this is her son's drug of choice and has decided to not keep her prescription in a secure location. Knowing that your client's drug of choice is not securely locked in the house, what would be the best course of action to discuss with your supervisor?
		a. Do nothing
		b. Involve CPS
		c. Document that you told his mom to secure her medication.
		d. Have a family session to create a safe space for an open discussion regarding boundaries.
When meeting with your supervisor, it would be best to discuss making a CPS report. Steven's mother is aware of his use of Xanax and has continued to leave her prescription in an unsecured location. The use of Xanax does cause concern for his safety and would warrant a mandated report. Incorrect answer. Please choose another answer.

28.	Sally and Joe have been married for 16 years and have a pattern of verbal and physical abuse when drinking. Both persons are engaged in treatment within your facility. You work with Joe and your colleague works with Sally individually. Joe informs you that he and Sally have been drinking every night to the point of blacking out. He explains that they often wake up in the living room and do not remember several hours of the evening before. You are aware that they have 2 children, ages 7 and 4 who live with them. You feel as though you need to do something regarding the children's safety. Which of the following is the best option to discuss with your supervisor?
		a. Engage in a family session with your colleague to provide psychoeducation about responsible parenting behaviors.
		b. Provide psychoeducation to your client regarding responsible parenting behaviors.
		c. Encourage joe to abstain from alcohol use.
		d. Involve CPS.
This scenario would warrant a mandated report as the children living with Joe are minors and unable to care for themselves. Joe reported drinking every night to the point of blacking out which means that he and his wife are no longer able to properly care for their children. Psychoeducation about parenting would be appropriate, however the children's safety is a priority. Incorrect answer. Please choose another answer.

29.	While working in an outpatient clinic, you recognize the name of a person you are supposed to conduct an intake assessment with at 2pm in the afternoon. You recognize the name because this person is friends with your brother. What is the best course of action?
		a. Conduct the assessment as scheduled.
		b. Conduct the assessment and work with them individually since you know them.
		c. Have a colleague do the assessment and ensure they are not your client.
		d. Have a colleague conduct the assessment and have them placed in your morning group.
Conducting the assessment, having this person in your group and/or working with them individually would all create a dual relationship which would blur the professional lines of this relationship. This could be explained to the person if they wonder why they do not work with you. Remembering the limits of confidentiality would be important as well to maintain this person's privacy. Incorrect answer. Please choose another answer.

30.	You facilitate an after care group for clients who have successfully completed your inpatient program. This group is on an outpatient basis and occurs once per week. You are notified that a person who was engaged in the inpatient treatment at the same time as some of your aftercare patients has overdosed and died. How should you proceed?
		a. Do not mention the death, re-direct if brought up in group.
		b. Start your next group session by processing this loss and how the group members feel.
		c. Process the death only if brought up by a group member.
		d. Attend the funeral services to pay your respects.
The best way to protect the confidentiality of the person who passed is to not bring up the conversation yourself. Group members may not be in contact with this person and/or remember being in treatment with them. Confidentiality continues in death. It may be necessary for some members to process the death in which case it is best to keep the conversation on how they are impacted by the loss and not to focus on the person who passed. Incorrect answer. Please choose another answer.

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