CADC Substance Use Disorder (SUD) Counseling Certification
Exam | Comprehensive QUESTION Bank & Practice Exam
(2026/2027)
QUESTION 1
What are the primary symptoms associated with severe alcohol
withdrawal, which can be life-threatening and include delirium tremens
(DTs)?
A. Mild fatigue, increased appetite, and low-grade headache
B. Auditory and visual hallucinations, severe autonomic instability,
disorientation, tremors, and potential seizures
C. Extreme lethargy, euphoria, and pupil constriction
D. Persistent depressive mood and hypersomnia
Correct Answer: B. Auditory and visual hallucinations, severe
autonomic instability, disorientation, tremors, and potential seizures
Detailed Rationale: Severe alcohol withdrawal (delirium tremens) is a
medical emergency characterized by profound central nervous system
hyper-excitability, autonomic instability, confusion, and potential
seizures, requiring medical detoxification.
QUESTION 2
Which screening tool is specifically designed to detect alcohol problems
and uses the acronym CAGE (Cut down, Annoyed, Guilty, Eye-opener)?
A. AUDIT
,B. CAGE Questionnaire
C. DAST-10
D. CIWA-Ar
Correct Answer: B. CAGE Questionnaire
Detailed Rationale: The CAGE is a quick, widely used 4-item screening
questionnaire designed to flag potential lifetime alcohol abuse and
dependence issues.
QUESTION 3
According to the Transtheoretical Model of Change (Prochaska and
DiClemente), in which stage does an individual acknowledge that they
have a problem and begin seriously considering making a change within
the next six months?
A. Precontemplation
B. Contemplation
C. Preparation
D. Action
Correct Answer: B. Contemplation
Detailed Rationale: In the contemplation stage, clients become aware
of the pros and cons of their substance use, experiencing ambivalence
while seriously considering change without yet committing to action.
QUESTION 4
What does the acronym OARS stand for in Motivational Interviewing
(MI)?
,A. Objectives, Assessment, Recovery, Support
B. Open-ended questions, Affirmations, Reflections, Summaries
C. Observation, Action, Resolution, Success
D. Options, Alternatives, Reactions, Strategies
Correct Answer: B. Open-ended questions, Affirmations, Reflections,
Summaries
Detailed Rationale: OARS represents the foundational core counseling
skills used in Motivational Interviewing to build rapport, elicit change
talk, and explore ambivalence.
QUESTION 5
What is the primary pharmacological action of Naloxone (Narcan) when
administered during an acute opioid overdose?
A. It stimulates opioid receptors to increase breathing rate.
B. It acts as a full opioid agonist to maintain comfort.
C. It acts as a competitive opioid antagonist, rapidly binding to opioid
receptors to reverse respiratory depression.
D. It completely neutralizes the chemical structure of alcohol in the
bloodstream.
Correct Answer: C. It acts as a competitive opioid antagonist, rapidly
binding to opioid receptors to reverse respiratory depression.
Detailed Rationale: Naloxone has a higher affinity for opioid receptors
than most opioids, displacing them and instantly reversing life-
threatening respiratory depression.
, QUESTION 6
When a client presents with both a substance use disorder and a co-
occurring major depressive disorder, what is considered the best
practice model of care?
A. Sequential treatment (treating the addiction entirely first, then
mental health years later)
B. Parallel treatment (treating both disorders independently at separate
agencies with no communication)
C. Integrated treatment (treating both disorders simultaneously within
the same clinical framework by coordinated staff)
D. Ignoring the depression until the client has achieved five years of
continuous sobriety
Correct Answer: C. Integrated treatment (treating both disorders
simultaneously within the same clinical framework by coordinated staff)
Detailed Rationale: Integrated treatment yields the best clinical
outcomes for co-occurring disorders because substance use and
psychiatric symptoms often interact and exacerbate one another.
QUESTION 7
In Terence Gorski’s Relapse Prevention Model, what phase precedes
physical relapse and involves emotional and psychological warning signs
such as denial, anxiety, and defensive behaviors?
A. Post-Acute Withdrawal Syndrome (PAWS)
B. Acute physical withdrawal
C. The transition stage of relapse
Exam | Comprehensive QUESTION Bank & Practice Exam
(2026/2027)
QUESTION 1
What are the primary symptoms associated with severe alcohol
withdrawal, which can be life-threatening and include delirium tremens
(DTs)?
A. Mild fatigue, increased appetite, and low-grade headache
B. Auditory and visual hallucinations, severe autonomic instability,
disorientation, tremors, and potential seizures
C. Extreme lethargy, euphoria, and pupil constriction
D. Persistent depressive mood and hypersomnia
Correct Answer: B. Auditory and visual hallucinations, severe
autonomic instability, disorientation, tremors, and potential seizures
Detailed Rationale: Severe alcohol withdrawal (delirium tremens) is a
medical emergency characterized by profound central nervous system
hyper-excitability, autonomic instability, confusion, and potential
seizures, requiring medical detoxification.
QUESTION 2
Which screening tool is specifically designed to detect alcohol problems
and uses the acronym CAGE (Cut down, Annoyed, Guilty, Eye-opener)?
A. AUDIT
,B. CAGE Questionnaire
C. DAST-10
D. CIWA-Ar
Correct Answer: B. CAGE Questionnaire
Detailed Rationale: The CAGE is a quick, widely used 4-item screening
questionnaire designed to flag potential lifetime alcohol abuse and
dependence issues.
QUESTION 3
According to the Transtheoretical Model of Change (Prochaska and
DiClemente), in which stage does an individual acknowledge that they
have a problem and begin seriously considering making a change within
the next six months?
A. Precontemplation
B. Contemplation
C. Preparation
D. Action
Correct Answer: B. Contemplation
Detailed Rationale: In the contemplation stage, clients become aware
of the pros and cons of their substance use, experiencing ambivalence
while seriously considering change without yet committing to action.
QUESTION 4
What does the acronym OARS stand for in Motivational Interviewing
(MI)?
,A. Objectives, Assessment, Recovery, Support
B. Open-ended questions, Affirmations, Reflections, Summaries
C. Observation, Action, Resolution, Success
D. Options, Alternatives, Reactions, Strategies
Correct Answer: B. Open-ended questions, Affirmations, Reflections,
Summaries
Detailed Rationale: OARS represents the foundational core counseling
skills used in Motivational Interviewing to build rapport, elicit change
talk, and explore ambivalence.
QUESTION 5
What is the primary pharmacological action of Naloxone (Narcan) when
administered during an acute opioid overdose?
A. It stimulates opioid receptors to increase breathing rate.
B. It acts as a full opioid agonist to maintain comfort.
C. It acts as a competitive opioid antagonist, rapidly binding to opioid
receptors to reverse respiratory depression.
D. It completely neutralizes the chemical structure of alcohol in the
bloodstream.
Correct Answer: C. It acts as a competitive opioid antagonist, rapidly
binding to opioid receptors to reverse respiratory depression.
Detailed Rationale: Naloxone has a higher affinity for opioid receptors
than most opioids, displacing them and instantly reversing life-
threatening respiratory depression.
, QUESTION 6
When a client presents with both a substance use disorder and a co-
occurring major depressive disorder, what is considered the best
practice model of care?
A. Sequential treatment (treating the addiction entirely first, then
mental health years later)
B. Parallel treatment (treating both disorders independently at separate
agencies with no communication)
C. Integrated treatment (treating both disorders simultaneously within
the same clinical framework by coordinated staff)
D. Ignoring the depression until the client has achieved five years of
continuous sobriety
Correct Answer: C. Integrated treatment (treating both disorders
simultaneously within the same clinical framework by coordinated staff)
Detailed Rationale: Integrated treatment yields the best clinical
outcomes for co-occurring disorders because substance use and
psychiatric symptoms often interact and exacerbate one another.
QUESTION 7
In Terence Gorski’s Relapse Prevention Model, what phase precedes
physical relapse and involves emotional and psychological warning signs
such as denial, anxiety, and defensive behaviors?
A. Post-Acute Withdrawal Syndrome (PAWS)
B. Acute physical withdrawal
C. The transition stage of relapse
