LCAS Exam 1 – North Carolina Study Guide
Questions and 100% Verified Answers with
Rationales | A+ Graded | Latest Update
2025/2026 (BRAND NEW!!!)
1. A 45-year-old male presents for an initial assessment and reports drinking "a few beers after work daily." His wife
states he drinks every night and has missed work twice this month. What is the primary purpose of screening at this
stage?
A. Diagnose alcohol use disorder
B. Determine need for further comprehensive assessment
C. Develop a treatment plan immediately
D. Refer to inpatient detoxification
Answer: B
Screening establishes the likelihood of a substance use disorder and determines whether further comprehensive
assessment is needed; it does not provide a definitive diagnosis or treatment plan.
2. A client in an intake interview denies having any substance use problem but is present because "my job made me
come." According to the Transtheoretical Model (Stages of Change), which stage best describes this client?
A. Contemplation
B. Preparation
C. Precontemplation
D. Action
Answer: C
The precontemplation stage is characterized by lack of awareness or denial of a problem and no intention to change
behavior in the foreseeable future.
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,3. A counselor notices significant conflict and power struggles emerging among members of an early-stage
addiction treatment group. Members are challenging the facilitator and arguing about group rules. Yalom would
identify this as which stage of group development?
A. Forming
B. Storming
C. Norming
D. Performing
Answer: B
The storming stage is characterized by conflict, power struggles, and disagreement among members as they establish
roles, norms, and hierarchy within the group.
4. A client with alcohol use disorder states, "I only drink because my job is so stressful. If I had a different job, I
wouldn‘t need to drink at all." According to Rational Emotive Behavior Therapy (REBT), this statement reflects
which core concept?
A. Healthy negative emotion
B. Irrational belief
C. Behavioral activation
D. Unconditional positive regard
Answer: B
REBT posits that emotional distress results from irrational beliefs that external events cause problems; the client‘s
statement externalizes responsibility rather than addressing the actual belief that drinking is required to cope with
stress.
5. A client in an opioid treatment program asks about methadone. Which statement correctly describes methadone’s
pharmacological action?
A. It is a short-acting partial opioid antagonist
B. It is the only long-acting full opioid agonist approved for opioid use disorder
C. It works by precipitating immediate withdrawal symptoms
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,D. It is a non-opioid medication that blocks cravings without receptor activity
Answer: B
Methadone is a long-acting synthetic full opioid agonist that suppresses withdrawal symptoms and cravings for 24-
36 hours, allowing once-daily dosing while preventing euphoria from other opioids.
6. A 32-year-old female with opioid use disorder is prescribed Suboxone (buprenorphine/naloxone). Which
statement about this medication is accurate?
A. The naloxone component prevents abuse by injection
B. Buprenorphine is a full opioid agonist with high abuse potential
C. This medication is only available in daily injectable form
D. It cannot be prescribed in an office-based setting
Answer: A
Suboxone combines buprenorphine (partial agonist) with naloxone (antagonist); naloxone is not absorbed orally but
precipitates withdrawal if the medication is crushed and injected, deterring diversion .
7. A client prescribed disulfiram (Antabuse) for alcohol use disorder asks what will happen if she drinks alcohol
while taking the medication. The counselor should explain:
A. The medication will block the euphoric effects of alcohol
B. She will experience a severe adverse reaction including flushing, nausea, vomiting, and palpitations
C. Nothing will happen because disulfiram has no interaction with alcohol
D. She will feel increased relaxation and reduced craving
Answer: B
Disulfiram inhibits aldehyde dehydrogenase, causing acetaldehyde accumulation when alcohol is consumed,
producing a reaction with flushing, nausea, vomiting, tachycardia, and hypotension .
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, 8. A 55-year-old male with severe alcohol use disorder, now abstinent for 10 days, reports ongoing insomnia,
anxiety, and restlessness. He has completed detoxification but continues to struggle with these protracted withdrawal
symptoms. Which MAT medication is specifically indicated for this presentation?
A. Naltrexone
B. Disulfiram
C. Acamprosate (Campral)
D. Methadone
Answer: C
Acamprosate reduces symptoms of protracted withdrawal (insomnia, anxiety, restlessness, dysphoria) by
normalizing brain systems disrupted by chronic alcohol consumption; it is most effective in patients with severe
alcohol use disorder .
9. A group therapy member tearfully shares, "I thought I was the only person in the world who felt this way. Hearing
others share the same struggles makes me feel less alone." According to Yalom, which therapeutic factor is being
demonstrated?
A. Altruism
B. Universality
C. Catharsis
D. Imitative behavior
Answer: B
Universality is the recognition that one is not alone in their struggles and suffering; it reduces isolation and
demoralization and is often cited by group members as one of the most healing factors .
10. A client in a substance abuse assessment discloses a history of childhood physical abuse and reports feeling
"trapped" when the counselor schedules sessions without his input. The counselor recognizes this response as
consistent with which treatment principle?
A. Resistance to change
B. Trauma-informed care (avoiding re-traumatization)
4|Page
SUCCESS!!
!
Questions and 100% Verified Answers with
Rationales | A+ Graded | Latest Update
2025/2026 (BRAND NEW!!!)
1. A 45-year-old male presents for an initial assessment and reports drinking "a few beers after work daily." His wife
states he drinks every night and has missed work twice this month. What is the primary purpose of screening at this
stage?
A. Diagnose alcohol use disorder
B. Determine need for further comprehensive assessment
C. Develop a treatment plan immediately
D. Refer to inpatient detoxification
Answer: B
Screening establishes the likelihood of a substance use disorder and determines whether further comprehensive
assessment is needed; it does not provide a definitive diagnosis or treatment plan.
2. A client in an intake interview denies having any substance use problem but is present because "my job made me
come." According to the Transtheoretical Model (Stages of Change), which stage best describes this client?
A. Contemplation
B. Preparation
C. Precontemplation
D. Action
Answer: C
The precontemplation stage is characterized by lack of awareness or denial of a problem and no intention to change
behavior in the foreseeable future.
1|Page
SUCCESS!!
!
,3. A counselor notices significant conflict and power struggles emerging among members of an early-stage
addiction treatment group. Members are challenging the facilitator and arguing about group rules. Yalom would
identify this as which stage of group development?
A. Forming
B. Storming
C. Norming
D. Performing
Answer: B
The storming stage is characterized by conflict, power struggles, and disagreement among members as they establish
roles, norms, and hierarchy within the group.
4. A client with alcohol use disorder states, "I only drink because my job is so stressful. If I had a different job, I
wouldn‘t need to drink at all." According to Rational Emotive Behavior Therapy (REBT), this statement reflects
which core concept?
A. Healthy negative emotion
B. Irrational belief
C. Behavioral activation
D. Unconditional positive regard
Answer: B
REBT posits that emotional distress results from irrational beliefs that external events cause problems; the client‘s
statement externalizes responsibility rather than addressing the actual belief that drinking is required to cope with
stress.
5. A client in an opioid treatment program asks about methadone. Which statement correctly describes methadone’s
pharmacological action?
A. It is a short-acting partial opioid antagonist
B. It is the only long-acting full opioid agonist approved for opioid use disorder
C. It works by precipitating immediate withdrawal symptoms
2|Page
SUCCESS!!
!
,D. It is a non-opioid medication that blocks cravings without receptor activity
Answer: B
Methadone is a long-acting synthetic full opioid agonist that suppresses withdrawal symptoms and cravings for 24-
36 hours, allowing once-daily dosing while preventing euphoria from other opioids.
6. A 32-year-old female with opioid use disorder is prescribed Suboxone (buprenorphine/naloxone). Which
statement about this medication is accurate?
A. The naloxone component prevents abuse by injection
B. Buprenorphine is a full opioid agonist with high abuse potential
C. This medication is only available in daily injectable form
D. It cannot be prescribed in an office-based setting
Answer: A
Suboxone combines buprenorphine (partial agonist) with naloxone (antagonist); naloxone is not absorbed orally but
precipitates withdrawal if the medication is crushed and injected, deterring diversion .
7. A client prescribed disulfiram (Antabuse) for alcohol use disorder asks what will happen if she drinks alcohol
while taking the medication. The counselor should explain:
A. The medication will block the euphoric effects of alcohol
B. She will experience a severe adverse reaction including flushing, nausea, vomiting, and palpitations
C. Nothing will happen because disulfiram has no interaction with alcohol
D. She will feel increased relaxation and reduced craving
Answer: B
Disulfiram inhibits aldehyde dehydrogenase, causing acetaldehyde accumulation when alcohol is consumed,
producing a reaction with flushing, nausea, vomiting, tachycardia, and hypotension .
3|Page
SUCCESS!!
!
, 8. A 55-year-old male with severe alcohol use disorder, now abstinent for 10 days, reports ongoing insomnia,
anxiety, and restlessness. He has completed detoxification but continues to struggle with these protracted withdrawal
symptoms. Which MAT medication is specifically indicated for this presentation?
A. Naltrexone
B. Disulfiram
C. Acamprosate (Campral)
D. Methadone
Answer: C
Acamprosate reduces symptoms of protracted withdrawal (insomnia, anxiety, restlessness, dysphoria) by
normalizing brain systems disrupted by chronic alcohol consumption; it is most effective in patients with severe
alcohol use disorder .
9. A group therapy member tearfully shares, "I thought I was the only person in the world who felt this way. Hearing
others share the same struggles makes me feel less alone." According to Yalom, which therapeutic factor is being
demonstrated?
A. Altruism
B. Universality
C. Catharsis
D. Imitative behavior
Answer: B
Universality is the recognition that one is not alone in their struggles and suffering; it reduces isolation and
demoralization and is often cited by group members as one of the most healing factors .
10. A client in a substance abuse assessment discloses a history of childhood physical abuse and reports feeling
"trapped" when the counselor schedules sessions without his input. The counselor recognizes this response as
consistent with which treatment principle?
A. Resistance to change
B. Trauma-informed care (avoiding re-traumatization)
4|Page
SUCCESS!!
!
