During assessment, a client reports that over the past year she has repeatedly drunk more than she planned, tried several times to cut down without success, missed work twice a month because of hangovers, and kept drinking even though her husband threatens to leave over it. No other criteria are present. Which DSM-5-TR severity rating applies?

Alcohol use disorder cannot be diagnosed without tolerance or withdrawal

Jason began taking oxycodone after a sports injury. When prescriptions ended, he bought pills, and he now injects fentanyl daily, has overdosed once, and wants to stop. Which treatment recommendation is MOST consistent with current evidence?

Referral for medication for opioid use disorder combined with counseling

A brief detoxification followed by discharge with no further care

Counseling alone, because medications only substitute one addiction for another

Attendance at mutual-help meetings as the only intervention

Approach Clients Relapsed at 12 months Standard group counseling 120 61% CBT alone 115 47% CBT plus contingency management 118 38% A county compared 12-month relapse rates for three outpatient approaches (table). Which conclusion is BEST supported?

CBT plus contingency management had the lowest relapse rate

CBT alone and CBT plus contingency management were equally effective

Standard group counseling was the most effective approach

Contingency management works only when it is used without CBT

A man with chronic back pain takes his prescribed hydrocodone exactly as directed. He reports that he now needs the full dose for relief and becomes achy if a dose is late. He has no other problems related to use. Which conclusion is MOST accurate?

He does not meet criteria for an opioid use disorder

He meets criteria for a mild opioid use disorder

He meets criteria for opioid intoxication

He meets criteria for a moderate opioid use disorder

A 21-year-old began using prescribed oxycodone after surgery. Which of the following behaviors MOST strongly suggests that she has developed an opioid use disorder rather than physical dependence alone?

Running out early and obtaining pills from several prescribers

Needing her full prescribed dose to keep her pain under control

Feeling achy when a scheduled dose is several hours late

Taking each dose on schedule as directed by her surgeon

Which task is within the scope of a peer recovery support specialist?

Sharing lived experience and linking the client to recovery resources

Providing individual trauma-focused psychotherapy sessions

Diagnosing co-occurring disorders using the DSM-5-TR criteria

Writing the client's clinical treatment plan, goals, and objectives

Addiction Counselor

Free Addiction Counselor Practice Questions

10 sample questions for the Addiction Counselor, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: The Pharmacology of Psychoactive Substances, The Counseling Practice, The Theoretical Base of Counseling, The Professional Issues.

Question 1 · The Pharmacology of Psychoactive Substances
During assessment, a client reports that over the past year she has repeatedly drunk more than she planned, tried several times to cut down without success, missed work twice a month because of hangovers, and kept drinking even though her husband threatens to leave over it. No other criteria are present. Which DSM-5-TR severity rating applies?
- A.Alcohol use disorder cannot be diagnosed without tolerance or withdrawal
- B.Mild alcohol use disorder
- C.Severe alcohol use disorder
- D.Moderate alcohol use disorder
Show answer and explanation
Answer: D. Moderate alcohol use disorder
The client meets four criteria (larger amounts than intended, unsuccessful efforts to cut down, failure to fulfill role obligations, and continued use despite interpersonal problems), and four to five criteria indicates moderate severity. Mild requires two to three criteria and severe requires six or more. Tolerance and withdrawal are not required for diagnosis; they are only two of the eleven criteria.
Question 2 · The Pharmacology of Psychoactive Substances
Jason began taking oxycodone after a sports injury. When prescriptions ended, he bought pills, and he now injects fentanyl daily, has overdosed once, and wants to stop. Which treatment recommendation is MOST consistent with current evidence?
- A.Referral for medication for opioid use disorder combined with counseling
- B.A brief detoxification followed by discharge with no further care
- C.Counseling alone, because medications only substitute one addiction for another
- D.Attendance at mutual-help meetings as the only intervention
Show answer and explanation
Answer: A. Referral for medication for opioid use disorder combined with counseling
Methadone and buprenorphine reduce illicit opioid use, overdose deaths, and infectious disease transmission, and they are the standard of care for opioid use disorder, ideally alongside counseling and support. Detoxification alone is followed by high relapse rates and raises overdose risk because tolerance falls. Describing these medications as a substitute addiction is a misconception that keeps people from effective treatment.
Question 3 · The Counseling Practice
A client tells her counselor that she has just finished writing "a searching and fearless moral inventory" with her sponsor. Which of the twelve steps has she completed?
- A.Step 4
- B.Step 12
- C.Step 1
- D.Step 9
Show answer and explanation
Answer: A. Step 4
Step 4 is making a searching and fearless moral inventory, which is then shared in Step 5. Step 9 is making direct amends to people harmed, a later step that builds on the inventory, while Step 1 is admitting powerlessness and Step 12 is carrying the message to others.
Question 4 · The Theoretical Base of Counseling
A 16-year-old in treatment says, 'Partying is who I am. If I stop, I won't have any friends or know who I am.' According to Erikson, which developmental crisis is most relevant to this statement?
- A.Industry vs. inferiority
- B.Identity vs. role confusion
- C.Autonomy vs. shame and doubt
- D.Intimacy vs. isolation
Show answer and explanation
Answer: B. Identity vs. role confusion
Adolescence centers on identity vs. role confusion, the task of forming a coherent sense of self and belonging; for this teen, substance use has become intertwined with identity and peer acceptance. Treatment can help him explore alternative identities and sober peer groups. Intimacy vs. isolation is the young-adult task of forming close relationships after identity is established.
Question 5 · The Professional Issues
Approach Clients Relapsed at 12 months
Standard group counseling 120 61%
CBT alone 115 47%
CBT plus contingency management 118 38%
A county compared 12-month relapse rates for three outpatient approaches (table). Which conclusion is BEST supported?
- A.CBT alone and CBT plus contingency management were equally effective
- B.CBT plus contingency management had the lowest relapse rate
- C.Standard group counseling was the most effective approach
- D.Contingency management works only when it is used without CBT
Show answer and explanation
Answer: B. CBT plus contingency management had the lowest relapse rate
Relapse was lowest with CBT plus contingency management (38%), compared with 47% for CBT alone and 61% for standard group counseling. The table does not show the two CBT conditions as equal, and it includes no contingency-management-only group, so no conclusion about contingency management alone can be drawn.
Question 6 · The Pharmacology of Psychoactive Substances
A man with chronic back pain takes his prescribed hydrocodone exactly as directed. He reports that he now needs the full dose for relief and becomes achy if a dose is late. He has no other problems related to use. Which conclusion is MOST accurate?
- A.He meets criteria for a mild opioid use disorder
- B.He meets criteria for opioid intoxication
- C.He meets criteria for a moderate opioid use disorder
- D.He does not meet criteria for an opioid use disorder
Show answer and explanation
Answer: D. He does not meet criteria for an opioid use disorder
DSM-5-TR specifies that tolerance and withdrawal are not counted when a medication is taken as prescribed under appropriate medical supervision. With no other criteria present, he does not meet the two-criterion minimum for a use disorder. Labeling expected physical dependence as a use disorder is a common error that can lead to stigma and undertreated pain.
Question 7 · The Pharmacology of Psychoactive Substances
A 21-year-old began using prescribed oxycodone after surgery. Which of the following behaviors MOST strongly suggests that she has developed an opioid use disorder rather than physical dependence alone?
- A.Needing her full prescribed dose to keep her pain under control
- B.Running out early and obtaining pills from several prescribers
- C.Feeling achy when a scheduled dose is several hours late
- D.Taking each dose on schedule as directed by her surgeon
Show answer and explanation
Answer: B. Running out early and obtaining pills from several prescribers
Obtaining opioids from multiple prescribers and running out early reflect loss of control and time spent obtaining the drug, which are behavioral hallmarks of a use disorder. Mild withdrawal when a dose is late and needing the prescribed dose for pain are expected physiological effects of prescribed opioid therapy and are not counted when the medication is taken as directed.
Question 8 · The Counseling Practice
Which task is within the scope of a peer recovery support specialist?
- A.Sharing lived experience and linking the client to recovery resources
- B.Providing individual trauma-focused psychotherapy sessions
- C.Diagnosing co-occurring disorders using the DSM-5-TR criteria
- D.Writing the client's clinical treatment plan, goals, and objectives
Show answer and explanation
Answer: A. Sharing lived experience and linking the client to recovery resources
Peer recovery specialists provide non-clinical support based on their lived experience, including mentoring, recovery planning, and help navigating community resources. Diagnosis, clinical treatment planning, and psychotherapy are clinical functions that belong to licensed or credentialed clinicians.
Question 9 · The Theoretical Base of Counseling
A 27-year-old in recovery says he has avoided close relationships, fearing that if anyone gets to know him they will leave. He spends most evenings alone. Which of Erikson's stages is most relevant?
- A.Identity vs. role confusion
- B.Trust vs. mistrust
- C.Intimacy vs. isolation
- D.Generativity vs. stagnation
Show answer and explanation
Answer: C. Intimacy vs. isolation
Young adulthood centers on intimacy vs. isolation, the task of forming close, committed relationships; failing to resolve it leads to loneliness and isolation, which are also relapse risk factors. Generativity vs. stagnation concerns middle adulthood's focus on contributing to the next generation.

Approach	Clients	Relapsed at 12 months
Standard group counseling	120	61%
CBT alone	115	47%
CBT plus contingency management	118	38%

Question 10 · The Professional Issues

Condition (all with medical management)	Result vs placebo
Naltrexone	Better drinking outcomes
Acamprosate	No significant difference
Naltrexone + acamprosate	No added benefit over naltrexone
Placebo + combined behavioral intervention	Better drinking outcomes

The COMBINE study tested medications and behavioral therapy for alcohol dependence. Based on the summary below, which conclusion is BEST supported?

A.Naltrexone with medical management produced better outcomes than placebo
B.Medications worked only when combined with the intensive behavioral therapy
C.Medical management alone was as effective as naltrexone with medical management
D.Acamprosate was the most effective of the medications tested in the study

Show answer and explanation

Answer: A. Naltrexone with medical management produced better outcomes than placebo

The COMBINE study found that naltrexone with medical management produced better drinking outcomes than placebo, while acamprosate showed no significant benefit over placebo. Combined behavioral intervention also helped, but adding it did not improve on naltrexone with medical management, so the medications did not require intensive therapy.

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