CASAC Exam Flashcards

Q: What is the CASAC exam?

The CASAC credential is the New York State qualification for alcoholism and substance abuse counselors. The exam itself is the IC&RC Alcohol and Drug Counselor (ADC) examination, administered by computer through Pearson VUE and overseen in New York by the Office of Addiction Services and Supports (OASAS). Passing it grants reciprocity with most other US states and several international jurisdictions.

Q: How many questions are on the CASAC exam and how long do I have?

The IC&RC ADC exam contains 150 multiple-choice questions: 125 scored items and 25 unscored pretest items that do not count toward your result. Candidates have 3 hours to complete the computer-based exam at a Pearson VUE testing center. Questions appear in random order and are offered in English or Spanish.

Q: What is the passing score for the CASAC exam?

Scoring uses a scaled-score model. Scores are reported on a scale ranging from 200 to 800, and the minimum passing scaled score is 500 for all IC&RC examinations. Because of scaling, experts estimate that answering roughly 93 to 95 of the 125 scored items correctly (about 75%) typically produces a passing result, though this varies by exam form. OASAS does not publish an official pass rate.

Q: What happens if I fail the CASAC exam?

Candidates who do not pass may retest once every 90 days during the active period of their application. The retest fee is $245. After three failures, candidates must complete an OASAS-approved CASAC Foundations or Ready to Test course before they are eligible to register again. Applications remain active for five years from the date of first review.

Q: How often must a CASAC credential be renewed?

The CASAC certificate must be renewed every three years. Renewal requires a minimum of 60 clock hours of continuing professional education, including 6 hours of OASAS-approved ethics training and professional boundaries training completed at every renewal cycle. The completed renewal application must be submitted at least 75 days before the credential expiration date.

Question 1

Tolerance

Accepted Answer

A pharmacological adaptation in which the body requires increasing amounts of a substance to achieve the same effect. It develops through receptor down-regulation and is a predictor of physical dependence, but tolerance alone is not the same as addiction.

Question 2

Physical dependence vs. psychological dependence

Accepted Answer

Physical dependence produces measurable withdrawal symptoms when the substance is stopped. Psychological dependence is the emotional or cognitive drive to use for reward, craving relief, or coping. A client can have one without the other, and treatment must address both.

Question 3

Withdrawal syndrome

Accepted Answer

A characteristic cluster of physiological and psychological symptoms that appears when a substance is reduced or stopped after sustained use. The presentation is substance-specific (alcohol, opioids, stimulants differ) and severity guides whether medical detoxification is required.

Question 4

Cross-tolerance

Accepted Answer

Reduced responsiveness to one substance because of tolerance developed to a chemically related substance. Clinically relevant when switching opioids or sedatives: the new drug may be less effective or require dose adjustment to avoid undertreatment or overdose.

Question 5

Agonist vs. antagonist

Accepted Answer

An agonist binds and activates a receptor, mimicking the effects of the substance (e.g., methadone at opioid receptors). An antagonist blocks a receptor without activating it, preventing the substance from exerting its effect (e.g., naltrexone). The distinction drives medication-assisted treatment choices.

Question 6

Alcohol withdrawal severe presentation

Accepted Answer

Severe alcohol withdrawal can progress to delirium tremens, characterized by autonomic hyperactivity, confusion, hallucinations, and risk of seizure. Symptoms typically peak 24-72 hours after the last drink. This is a medical emergency requiring supervised detoxification, not outpatient counseling alone.

Question 7

Opioid overdose triad

Accepted Answer

The classic overdose presentation combines pinpoint pupils, respiratory depression, and decreased level of consciousness. Recognizing it promptly is essential because opioid antagonists can reverse it if administered before hypoxic injury occurs.

Question 8

Naloxone mechanism of action

Accepted Answer

Naloxone is a short-acting opioid antagonist that displaces opioids from mu-receptors, rapidly restoring respiration. Its effect is temporary, so a person revived with naloxone still needs medical evaluation because respiratory depression can return once the antagonist wears off.

Question 9

Dual diagnosis (co-occurring disorder)

Accepted Answer

The simultaneous presence of a substance use disorder and an independent mental health disorder in the same client. Comorbidity is common, complicates treatment, and requires integrated care rather than treating each condition in isolation.

Question 10

Sequential vs. integrated treatment for co-occurring disorders

Accepted Answer

Sequential treatment addresses one disorder first and the other later, which can leave the untreated condition destabilizing progress. Integrated treatment addresses both disorders concurrently in the same setting by a coordinated team, and is the evidence-based standard for co-occurring disorders.

Question 11

Self-medication hypothesis

Accepted Answer

The clinical observation that some clients use substances to relieve symptoms of an underlying mental health condition. It explains part of the overlap between SUD and psychiatric disorders but is not the only pathway; intoxication and withdrawal can also cause or worsen psychiatric symptoms.

Question 12

Substance-induced vs. independent psychiatric disorder

Accepted Answer

A substance-induced disorder is caused by intoxication or withdrawal and typically resolves with sustained abstinence. An independent disorder persists regardless of substance use. Distinguishing them requires observing the client during a period of abstinence and shapes the treatment plan.

Question 13

Common co-occurring pairings

Accepted Answer

Depression and alcohol use disorder, anxiety and benzodiazepine use, PTSD and opioid use, and bipolar disorder and stimulant use are frequent overlaps. Each pairing carries elevated relapse and suicide risk, so safety planning must account for both conditions.

Question 14

DSM-5-TR substance use disorder severity levels

Accepted Answer

DSM-5-TR defines severity by the count of met criteria: mild is 2-3 criteria, moderate is 4-5, and severe is 6 or more out of 11. The count drives diagnosis and informs intensity of recommended care.

Question 15

DSM-5-TR SUD criteria overview

Accepted Answer

The 11 criteria span impaired control, social impairment, risky use, and pharmacological indicators (tolerance and withdrawal). Meeting 2 or more within a 12-month period establishes a diagnosis. Withdrawal and tolerance alone are not sufficient without the behavioral criteria.

Question 16

Biopsychosocial assessment

Accepted Answer

A structured evaluation covering biological (substance history, medical, family), psychological (mental health, trauma, coping), and social (relationships, employment, legal, housing) domains. It provides the clinical foundation for diagnosis, treatment planning, and level-of-care placement.

Question 17

ASAM six assessment dimensions

Accepted Answer

ASAM criteria evaluate intoxication and withdrawal, biomedical conditions, emotional and behavioral complications, readiness to change, relapse potential, and recovery environment. Together they determine the appropriate intensity and level of care.

Question 18

Differential diagnosis

Accepted Answer

The process of distinguishing a substance use disorder from other conditions that produce similar symptoms, such as psychiatric illness, medical illness, or medication effects. It requires a substance-free observation period and corroborating records when available.

Question 19

Toxicology screening in assessment

Accepted Answer

Laboratory testing of biological samples to detect recent substance use. It is an objective adjunct to self-report, can confirm or contradict the clinical interview, and supports treatment matching, but a single result is not diagnostic of a substance use disorder.

Question 20

Collateral information

Accepted Answer

Information obtained from sources other than the client, such as family, prior providers, or records, used to verify or supplement self-report. It must be gathered only with the client's written consent under 42 CFR Part 2 and can reveal discrepancies the client does not report.

Question 21

CAGE questionnaire

Accepted Answer

A brief four-question screen for alcohol problems: Cut down, Annoyed, Guilty, Eye-opener. Two or more positive responses suggest a likely alcohol use disorder and indicate that a fuller assessment is warranted. It is a screen, not a diagnostic instrument.

Question 22

AUDIT (Alcohol Use Disorders Identification Test)

Accepted Answer

A 10-item screening tool developed by the WHO to detect hazardous and harmful alcohol use. A score of 8 or more in men (7 or more in women, or lower in some guidance) indicates risky drinking. It covers consumption, dependence symptoms, and alcohol-related harm.

Question 23

DAST (Drug Abuse Screening Test)

Accepted Answer

A screening instrument for non-alcohol substance use problems. The DAST-10 short form asks about drug-related consequences and dependence signs; a higher score indicates greater involvement with drugs and signals the need for a comprehensive assessment.

Question 24

SBIRT model

Accepted Answer

Screening, Brief Intervention, and Referral to Treatment is a public health approach that identifies risky substance use in general settings, delivers a short motivational conversation, and refers those with likely disorders to specialty care. The brief intervention is typically a few minutes, not full treatment.

Question 25

Cognitive Behavioral Therapy core principle

Accepted Answer

CBT teaches that thoughts, feelings, and behaviors are interconnected, so changing distorted thoughts and maladaptive behaviors reduces substance use. Clients learn to identify triggers, challenge cognitive distortions, and rehearse coping skills. It is one of the most evidence-based modalities for SUD.

Question 26

Stages of Change (Prochaska-DiClemente)

Accepted Answer

The model describes readiness as a progression through precontemplation, contemplation, preparation, action, and maintenance, with relapse as a possible return rather than failure. The counselor matches interventions to the client's current stage rather than pushing action on a precontemplative client.

Question 27

12-step facilitation therapy

Accepted Answer

A structured, manualized approach that introduces clients to the principles and fellowship of 12-step programs such as AA or NA. The counselor works on acceptance, surrender, and active involvement in a mutual-help community. It is distinct from simply telling a client to attend meetings.

Question 28

Relapse prevention model

Accepted Answer

A cognitive-behavioral approach that teaches clients to anticipate high-risk situations and develop coping responses before a lapse occurs. It distinguishes a lapse (a single use) from a relapse (return to problematic patterns) and treats lapses as learning opportunities, not failures.

Question 29

Harm reduction

Accepted Answer

A set of strategies that reduce the negative consequences of substance use without requiring immediate abstinence. Examples include syringe services, naloxone distribution, and managed alcohol programs. It meets clients where they are and can be a pathway to engagement rather than an alternative to recovery.

Question 30

Group therapy forming and storming

Accepted Answer

Early group stages involve members testing trust and the leader, often with hesitation and conflict. The counselor's task is to establish safety, norms, and cohesion. Skipping this work leads to superficial participation and higher dropout; productive working-stage change depends on it.

Question 31

OARS in motivational interviewing

Accepted Answer

Open-ended questions, Affirmations, Reflective listening, and Summaries are the four core counseling skills of motivational interviewing. They reduce defensiveness and elicit the client's own motivation for change rather than the counselor arguing for it.

Question 32

Change talk vs. sustain talk

Accepted Answer

Change talk is client speech favoring movement toward change (desire, ability, reasons, need, commitment). Sustain talk favors the status quo. The counselor deliberately elicits and strengthens change talk while softening sustain talk, because the balance predicts behavioral outcomes.

Question 33

Rolling with resistance

Accepted Answer

Instead of confronting or arguing with a client's resistance, the counselor reframes or reflects it, shifting the dynamic without opposition. This avoids power struggles and preserves the therapeutic alliance, which is essential for engagement.

Question 34

Developing discrepancy

Accepted Answer

Helping the client perceive a gap between their current behavior and their own goals or values. The discrepancy is drawn from the client's own words, not imposed by the counselor, and it creates internal motivation for change.

Question 35

SMART goals in treatment planning

Accepted Answer

Goals that are Specific, Measurable, Achievable, Relevant, and Time-bound. They turn vague intentions into observable behavioral targets, allow progress to be tracked, and are revised collaboratively as treatment advances.

Question 36

ASAM levels of care

Accepted Answer

ASAM defines a continuum from 0.5 (early intervention) through 1 (outpatient), 2 (intensive outpatient or partial hospitalization), 3 (residential), to 4 (medically managed inpatient). Each level specifies intensity of service and is matched to the client's assessed needs across the six dimensions.

Question 37

Individualized treatment plan

Accepted Answer

A written document stating the client's measurable goals, objectives, interventions, and target dates, developed collaboratively with the client. It is strengths-based, reviewed and updated regularly, and must reflect the assessed needs rather than a one-size program template.

Question 38

Continuum of care

Accepted Answer

The principle that clients move through differing intensities of service as their needs change, for example from detoxification to residential to outpatient to aftercare. Matching the client to the right level at the right time reduces relapse and dropout.

Question 39

Continuing care (aftercare)

Accepted Answer

Lower-intensity support following formal treatment, including recovery support groups, peer services, and check-ins. It sustains gains made during active treatment and addresses the chronic, relapsing nature of substance use disorders.

Question 40

42 CFR Part 2

Accepted Answer

The federal confidentiality rule governing substance use disorder treatment records. It is stricter than HIPAA: a separate, specific written consent is required before disclosing SUD treatment information, even to other providers, with limited exceptions for medical emergency and certain audits.

Question 41

HIPAA vs. 42 CFR Part 2

Accepted Answer

HIPAA sets a general national privacy standard for protected health information. 42 CFR Part 2 overlays additional, more restrictive protections for SUD records. When both apply, Part 2 governs, so a general HIPAA authorization is not sufficient to release Part 2 records.

Question 42

Duty to warn

Accepted Answer

The ethical and legal obligation to protect a foreseeable victim when a client poses a serious threat of harm. The counselor may need to warn the intended victim and notify authorities, breaking confidentiality only to the extent necessary to prevent the harm.

Question 43

Informed consent

Accepted Answer

The process of ensuring a client understands the nature, risks, benefits, limits, and alternatives of treatment before agreeing to participate. Consent must be voluntary and ongoing, documented in writing, and revisited when the treatment approach changes.

Question 44

Dual relationships (multiple relationships)

Accepted Answer

Situations in which a counselor has another role with the client outside the professional one, such as friend, employer, or family member. These relationships risk exploiting the client and impairing clinical judgment, so they must be avoided or managed and documented when unavoidable.

Question 45

Mandated reporting

Accepted Answer

The legal requirement to report suspected child abuse or neglect, and in some states elder or vulnerable adult abuse, to authorities. It overrides confidentiality and applies when the counselor has reasonable cause to suspect abuse, not only when it is confirmed.

Question 46

Tarasoff principle

Accepted Answer

The California case establishing that a therapist owes a duty to protect a foreseeable victim of a client's serious threat. It is the basis of duty-to-warn obligations nationwide and demonstrates that confidentiality has defined limits when identifiable third parties are at risk.

Question 47

12 Core Functions of an addiction counselor

Accepted Answer

Screening, intake, orientation, assessment, treatment planning, counseling, case management, crisis intervention, client education, referral, reports and record keeping, and consultation. These functions define the counselor's scope of practice and frame the content of the IC&RC ADC exam.

Question 48

CASAC scope of practice limit

Accepted Answer

A CASAC provides counseling, assessment, and case management for substance use disorders but cannot prescribe medication, diagnose independent medical conditions, or practice outside addiction counseling. Recognizing this boundary triggers referrals to qualified medical or psychiatric professionals.

Question 49

Confidentiality of SUD records in New York

Accepted Answer

In addition to 42 CFR Part 2, New York rules protect SUD treatment information and require written consent for most disclosures. The counselor must inform clients of these protections at intake, obtain specific consent before any release, and never confirm or deny a client's presence in treatment without consent.

Question 50

CASAC recertification requirements

Accepted Answer

The CASAC credential renews every three years and requires at least 60 continuing education clock hours, including 6 hours of OASAS-approved ethics training and professional boundaries training at each cycle. The renewal application is due at least 75 days before expiration, and training records must be retained for six years.

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