CADC Alcohol and Drug Counselor Screening and Assessment Techniques 5 — Questions and Answers
Question 1: A counselor is reviewing assessment results and notes that a client's self-reported use is significantly lower than what collateral sources indicate. The counselor should interpret this discrepancy as:
- Evidence that collateral sources are unreliable
- A potential indicator of minimization or denial warranting clinical exploration (Correct answer)
- Grounds for discharging the client from treatment
- Proof that the client has co-occurring antisocial personality disorder
Correct answer: A potential indicator of minimization or denial warranting clinical exploration
Discrepancies between self-report and collateral data are common in substance use disorders due to shame, denial, or minimization, and should be explored therapeutically rather than punitively.
Question 2: The Opioid Risk Tool (ORT) is used primarily to:
- Diagnose opioid use disorder
- Predict risk of opioid misuse in patients being considered for long-term opioid therapy (Correct answer)
- Screen for fentanyl contamination in the drug supply
- Assess severity of opioid withdrawal
Correct answer: Predict risk of opioid misuse in patients being considered for long-term opioid therapy
The ORT was developed to stratify patients' risk of aberrant drug-related behavior before initiating chronic opioid pain management.
Question 3: In motivational interviewing theory, assessing 'importance' and 'confidence' using a 0–10 scale during a substance use evaluation helps the counselor:
- Determine the client's DSM-5 diagnosis
- Understand the client's ambivalence and self-efficacy around change (Correct answer)
- Calculate an ASI composite score
- Identify withdrawal symptoms
Correct answer: Understand the client's ambivalence and self-efficacy around change
Importance-confidence rulers reveal how much a client values change and how capable they feel, directly informing motivational interviewing strategies.
Question 4: A counselor documents that a client has been using heroin daily for two years and recently lost their job and spouse due to use. Which DSM-5 severity level is most appropriate?
- Mild (2–3 criteria)
- Moderate (4–5 criteria)
- Severe (6 or more criteria) (Correct answer)
- Unspecified
Correct answer: Severe (6 or more criteria)
Daily use over two years combined with significant social and occupational consequences indicates multiple DSM-5 criteria met, consistent with severe opioid use disorder.
Question 5: Which of the following best describes 'functional assessment' in the context of substance use counseling?
- Evaluating liver function through laboratory tests
- Analyzing the antecedents, behaviors, and consequences of substance use to understand its function for the client (Correct answer)
- Determining the client's level of care using ASAM criteria
- Screening for cognitive impairment using the MMSE
Correct answer: Analyzing the antecedents, behaviors, and consequences of substance use to understand its function for the client
Functional assessment (often using an ABC model) examines what triggers use, the use behavior itself, and its consequences, revealing the substance's reinforcing role in the client's life.
Question 6: When assessing a client from a cultural background where substance use stigma is very high, the counselor's most effective strategy is to:
- Skip sensitive questions to avoid discomfort
- Use culturally adapted screening tools and create a nonjudgmental atmosphere to encourage honest disclosure (Correct answer)
- Rely entirely on collateral sources since self-report will be unreliable
- Administer only biological tests
Correct answer: Use culturally adapted screening tools and create a nonjudgmental atmosphere to encourage honest disclosure
Culturally adapted tools and a nonjudgmental approach reduce stigma-related underreporting, improving assessment validity across diverse populations.
Question 7: The ASAM Patient Placement Criteria use a multidimensional assessment to match clients to the appropriate level of care. Which dimension addresses a client's likelihood of engaging and remaining in treatment?
- Dimension 1: Acute Intoxication and Withdrawal Potential
- Dimension 3: Emotional, Behavioral, or Cognitive Conditions
- Dimension 4: Readiness to Change (Correct answer)
- Dimension 6: Recovery Environment
Correct answer: Dimension 4: Readiness to Change
ASAM Dimension 4 (Readiness to Change) specifically evaluates a client's motivation, engagement, and willingness to participate in treatment.
CADC Alcohol and Drug Counselor Screening and Assessment Techniques 5
A counselor is reviewing assessment results and notes that a client's self-reported use is significantly lower than what collateral sources indicate.
The counselor should interpret this discrepancy as: