NAADAC National Certified Addiction Counselor Level II (NCAC II)

A counselor supervising a CADC intern observes that the intern routinely shares personal recovery details with clients. Which is the BEST supervisory intervention?

• AIgnore - personal recovery sharing builds rapport
• BDiscuss the clinical purpose, risks, and boundaries of self-disclosure and require superv…
• CTerminate the supervisee immediately
• DDocument only and take no action

A client meets DSM-5-TR criteria for severe opioid use disorder and severe major depressive disorder. Which integrated care plan is MOST consistent with evidence-based practice?

• ABuprenorphine/naloxone induction plus SSRI initiation, integrated counseling, and same-te…
• BRefer for inpatient psychiatric care first, then SUD treatment after discharge
• CWait 30 days of abstinence before starting any psychiatric medication
• DTreat depression with benzodiazepines while initiating MAT

Which ASAM Criteria dimension addresses ongoing readiness to change?

• ADimension 1 - Acute intoxication/withdrawal
• BDimension 4 - Readiness to Change
• CDimension 5 - Relapse/continued use potential
• DDimension 6 - Recovery environment

Under 42 CFR Part 2, which scenario is permissible without prior written client consent?

• ADisclosure to law enforcement to investigate possession
• BDisclosure to a contracted lab under a Qualified Service Organization Agreement (QSOA) fo…
• CRoutine disclosure to employer
• DDisclosure to a sponsor

Which is the BEST supervisory response to a supervisee reporting symptoms of vicarious trauma?

• AIgnore and refocus on caseload
• BValidate, assess severity, support self-care, consider caseload adjustment and EAP referr…
• CDischarge supervisee
• DIncrease caseload to build resilience

Which is the BEST description of the four MI processes in sequence?

• AEngaging, Focusing, Evoking, Planning
• BAssessing, Diagnosing, Treating, Discharging
• CConfronting, Educating, Persuading, Monitoring
• DListening, Reflecting, Summarizing, Closing

Which is the MOST advanced clinical judgment for assessing severity of alcohol withdrawal?

• ASelf-report of last drink only
• BCIWA-Ar serial assessment combined with vital signs, electrolytes, and history of prior D…
• CFamily report only
• DAUDIT score

Which is the BEST application of Bowen family systems theory to addiction work?

• AFocus exclusively on the index client
• BRecognize triangulation, differentiation, and multigenerational patterns and engage famil…
• CAvoid family work entirely
• DIgnore family-of-origin influences

Which medication is dosed monthly via intramuscular injection and requires 7-10 days opioid-free before induction?

• AMethadone
• BBuprenorphine sublingual
• CExtended-release naltrexone (Vivitrol)
• DAcamprosate

A client on methadone reports new co-administration of fluoxetine, sertraline, and ciprofloxacin. The supervisor should flag which concern?

• ANo interactions of concern
• BPossible additive QTc prolongation - recommend ECG monitoring and medication review
• CIncrease methadone dose immediately
• DDiscontinue methadone

Which is the MOST appropriate use of contingency management in stimulant use disorder treatment?

• AVerbal praise alone
• BEscalating-value prize-based or voucher reinforcement contingent on objective negative UDS
• CPunitive reductions in privileges
• DRandom unannounced rewards

Which describes the BEST application of the 'Engaging' MI process?

• ASetting goals immediately
• BBuilding a working alliance through respect, empathy, OARS, and clarifying expectations
• CListing the client's problems
• DConfronting denial

A client mandated by a state child-welfare agency expresses no desire to engage in treatment. The MOST clinically effective initial approach is:

• AConfront the client about denial
• BEngage with MI, explore values, develop discrepancy, and avoid premature persuasion
• CDischarge for non-engagement
• DRecommend abstinence ultimatums

Which is a HIGH-yield ethical principle for telehealth SUD counseling per the NAADAC Code?

• AState licensure portability is unimportant
• BUse of secure HIPAA/Part 2-compliant platforms, jurisdictional licensure verification, in…
• CPersonal phones are sufficient
• DRecording sessions without consent is permitted

Which BEST describes the function of motivational enhancement therapy (MET) per SAMHSA TIP 35?

• AA 12-session manualized CBT program
• BA brief structured intervention combining MI with personalized assessment feedback
• CAversive conditioning
• DFamily systems therapy

Which best describes a supervisor's gatekeeping responsibility?

• ASupporting the supervisee at all costs
• BHonestly evaluating competency and only endorsing supervisees who meet professional stand…
• CAvoiding all evaluative feedback
• DAllowing all supervisees to advance

Which is the BEST counseling approach for a client with severe PTSD and severe SUD?

• ATreat PTSD first, defer SUD treatment
• BIntegrated trauma-informed care addressing both conditions simultaneously (e.g., Seeking…
• CAvoid trauma topics
• DUse only CBT for SUD

Which DSM-5-TR feature distinguishes substance-induced anxiety from primary GAD?

• APersistence of anxiety beyond expected withdrawal/intoxication
• BSeverity of symptoms
• CPresence of family history
• DUse of substances at any point

Which BEST describes a counselor's role in MAT for OUD?

• APrescribe MAT directly
• BProvide psychosocial counseling, monitor adherence/side-effects, advocate for MAT access,…
• CDiscourage MAT use
• DOnly support abstinence-based treatment

A client presents with active suicidal ideation, plan, and access to a firearm. The MOST appropriate intervention sequence is:

• ASchedule next session and provide phone number
• BConduct formal risk assessment (e.g., C-SSRS), develop safety plan including means restri…
• CDischarge for safety
• DNotify only the family

Which intervention BEST aligns with the integrated dual-diagnosis treatment (IDDT) model's 'persuasion' stage?

• ADetoxification only
• BBuilding motivation through MI and personalized feedback while addressing both SUD and MH…
• CDischarge for non-readiness
• DIntensive trauma processing

Which BEST describes the role of a recovery community organization (RCO)?

• AA clinical treatment provider
• BA peer-led organization providing recovery support services, advocacy, and community buil…
• CA funding agency
• DAn academic research center

Which is the BEST description of how culturally responsive care for Black/African American clients should be operationalized?

• AUse a single one-size-fits-all approach
• BAddress structural racism, historical trauma, intersectional identities, faith/spirituali…
• CAvoid discussions of race
• DApply only general TIC principles

Which is the BEST application of evidence-based group counseling principles?

• ASingle-modality confrontational marathon groups
• BStructured group with clear focus (CBT, RP, seeking safety, MI-based), trained facilitato…
• CUnstructured open groups for all clients
• DAvoiding group counseling

Which scenario constitutes a violation of the NAADAC Code's prohibition on dual relationships?

• AGreeting a former client at a community event
• BHiring a current client as a contractor in your private business
• CProviding professional referral resources
• DAccepting a thank-you note

Which is consistent with SAMHSA TIP 45 recommendations for pregnant women with OUD?

• ADetoxification without MAT
• BMethadone or buprenorphine MAT as standard of care during pregnancy
• CNaltrexone is preferred
• DAvoid all medications

Which is the MOST appropriate response when a supervisee discloses they are in early personal recovery?

• ATerminate supervision
• BDiscuss potential triggers, self-care, scope-of-practice considerations, and ongoing supe…
• CIgnore the disclosure
• DRequire disclosure to all clients

Which neurobiological finding is consistent with the chronic course of SUD?

• ANormal mesolimbic dopamine functioning
• BMesolimbic hyperdopaminergia during acute use, with prefrontal hypofunction and HPA dysre…
• CIncreased prefrontal control with chronic use
• DComplete recovery within 30 days of abstinence

Which intervention BEST addresses the 'Recovery Environment' (ASAM Dimension 6) for a client returning home post-discharge?

• ANo intervention needed
• BRecovery housing referral, peer-support engagement, harm-reduction planning, and family/s…
• CDischarge to original unstable environment without supports
• DIncrease frequency of UDS only

Which is the BEST application of mindfulness-based relapse prevention (MBRP)?

• AReplacing MAT
• BIntegrating mindfulness practices to enhance awareness of triggers, urges (urge surfing),…
• CDiscouraging all clinical engagement
• DAvoiding any focus on substance use

Which is the MOST appropriate use of urine drug screening (UDS) in outpatient SUD treatment?

• APunitive evidence for discharge
• BClinical information that informs treatment planning, supports honest dialogue, and verif…
• CAlways required for billing
• DRequired to be witnessed by staff at all times

Which describes a key indicator for transitioning a client from ASAM Level 3 residential to Level 2.1 IOP?

• AWorsening withdrawal
• BStabilized acute symptoms, established skills, supportive recovery environment, and conti…
• CSevere relapse
• DRefusal of all treatment

Which approach BEST addresses the 'historical trauma' experienced by some American Indian/Alaska Native communities?

• AAvoid discussions of history
• BAcknowledge historical trauma, integrate traditional healing practices when desired, and…
• CApply only individual-focused CBT
• DRefuse to engage with culture

Which is the BEST description of how the counselor should respond to a supervisee's repeated documentation errors despite previous corrective feedback?

• AIgnore continued errors
• BImplement a documented remediation plan with specific goals, timelines, support, and revi…
• CTerminate supervision immediately
• DAllow the supervisee to self-correct without support

Which is the BEST initial intervention for a client presenting with active fentanyl use and uncertain motivation?

• ARefuse engagement until abstinence is demonstrated
• BEngage with MI, provide overdose education and naloxone, assess MAT eligibility (buprenor…
• CRecommend a 12-step meeting only
• DRequire detoxification before any conversation

Which BEST describes when 42 CFR Part 2 permits disclosure without client consent?

• AAnytime law enforcement requests
• BMandated reporting of child abuse, medical emergencies, court-ordered disclosures after g…
• CWhenever family asks
• DWhenever the employer asks

Which describes the BEST clinical use of the GAIN-SS (Global Appraisal of Individual Needs - Short Screener)?

• AAs a primary diagnostic tool
• BAs a brief multi-domain screening for SUD, mental health, and crime/violence in clinical…
• COnly for inpatient detoxification
• DOnly for adolescents

Which is the BEST application of structural family therapy (Minuchin) to SUD work?

• AAvoid considering family structure
• BExamine boundaries, hierarchy, alliances, and subsystems to identify maladaptive patterns…
• CApply only to adolescents
• DApply only when families request it

Which BEST describes a counselor's response when an LGBTQ+ client discloses a recent hate-crime victimization?

• AMinimize the experience
• BValidate the experience, assess for safety/PTSD/SUD risk, provide affirming support, and…
• CAvoid discussing the event
• DInsist on a particular treatment modality

Which is the BEST application of an outcomes-monitoring system in a SUD program?

• ADocument outcomes once at discharge only
• BPeriodically measure retention, substance use, MH symptoms, recovery capital, and functio…
• CUse only billing data
• DAvoid outcome measurement to protect privacy

Which best describes the appropriate setting for buprenorphine induction in a client using fentanyl?

• AStandard waiting-room induction without modification
• BMicrodosing protocol or low-dose initiation with monitoring to reduce risk of precipitate…
• CDiscontinue fentanyl 48 hours and induct as usual
• DAvoid buprenorphine entirely

Which best describes the counselor's role in supporting medication adherence for an AUD client on naltrexone?

• ANo role - adherence is medical only
• BProvide psychoeducation, address side effects collaboratively, monitor adherence through…
• CWithhold counseling if adherence lapses
• DReplace medication with abstinence-only counseling

Which is the BEST initial response to a client who reports their AA sponsor has begun sharing the client's information at meetings?

• ADiscuss the boundary issue with the client, support the client's autonomy to address it w…
• BContact the sponsor directly
• CEnd the client's AA involvement
• DDisclose the issue to the AA central office

Which is the BEST application of motivational interviewing 'rolling with resistance' (now termed 'softening sustain talk and discord')?

• ADirect argument
• BAcknowledging the client's perspective, reflecting without judgment, and shifting strateg…
• CPushing harder for change
• DDischarging the client

Which is the BEST initial assessment when a client presents with severe AUD plus chronic liver disease?

• ABegin oral medication without medical evaluation
• BCoordinate with medical/hepatology, consider acamprosate (renally adjusted) over hepatica…
• CAvoid all medications
• DUse only AA referral

Which BEST describes a counselor's responsibility when working with a client involved in human trafficking?

• ANo special considerations
• BTrauma-informed engagement, safety planning, mandated reporting where applicable, connect…
• CMandatory immediate police involvement
• DDischarge from SUD treatment until trafficking resolves

Which BEST characterizes 'recovery capital' across personal, family/social, community, and cultural domains?

• AOnly financial resources
• BThe breadth and depth of personal, family/social, community, and cultural resources that…
• COnly mutual-help attendance
• DOnly employment status