10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The NCAC exam has 150 questions and runs 3 hours.
These 10 free NCAC questions are organized by exam domain, so you can see how each part of the National Certified Addiction Counselor, Level I (NCAC) blueprint is tested. Reveal the answer and explanation under each question.
At an alcohol screening visit, a 42-year-old man reports drinking two 24-fluid-ounce cans of 8% alcohol-by-volume beer over about two hours. He calls this "only two drinks." Using U.S. standard-drink equivalents and the NIAAA binge-drinking benchmark for men, what feedback accurately describes this episode?
Correct answer: D - About 6.4 standard drinks; above the usual binge-drinking benchmark for men.
During a private CRAFFT 2.1 interview, a 16-year-old reports zero days of alcohol, cannabis, or other substance use in the past year. The counselor asks the Car item, and the teenager describes regularly riding home with a friend who has been using cannabis. No other immediate safety concern is identified. Today's brief intervention should focus on:
Correct answer: A - Developing a realistic plan for declining impaired rides and obtaining safe transportation.
A client with an established diagnosis of severe cocaine use disorder has spent eight months meeting no substance use disorder criteria except occasional craving. The client lives in the community with unrestricted access to substances. Which DSM-5-TR classification describes the current course?
Correct answer: D - Cocaine use disorder in early remission, despite the occasional craving
A client who stopped prolonged heavy drinking about 60 hours ago arrives at an outpatient program sweating and visibly shaking. The client cannot identify the location, repeatedly swats at insects that others cannot see, and has a pulse of 128/min. Which action takes precedence?
Correct answer: A - Activate emergency medical services and remain with the client.
A client's PHQ-9 total is 8. On item 9, the client reports thoughts of being better off dead or of self-harm on several days. The counselor has not yet asked about current suicidal thoughts, intent, or access to means. What does this endorsement require at this visit?
Correct answer: C - Ask directly about suicidal thoughts, intent, a plan, and access to means.
Mara often stops at a bar beside her bus stop after late shifts. Her treatment goal is to get home without drinking. She agrees to try an alternate route and call her sister when urges become difficult to manage. Which objective best captures that agreement?
Correct answer: B - For two weeks, use the alternate route after late shifts, call her sister during strong urges, and record both.
A client stable on prescribed buprenorphine for opioid use disorder learns she is 10 weeks pregnant. A relative tells her that stopping the medication now will protect the baby from withdrawal. She has not changed her dose and asks her counselor whether she should taper. Which recommendation is consistent with recommended pregnancy care?
Correct answer: C - Continue prescribed treatment while coordinating prenatal and addiction care; neonatal withdrawal risk alone does not justify stopping.
A client says, "I know drinking is hurting my health, but the evenings would feel empty without it. I'd like to be more present with my kids." Which response best elicits the client's own reasons for change, rather than suggesting how to change?
Correct answer: C - What would being more present with your children look like to you?
An outpatient team adds contingency management for clients with stimulant use disorder. The agreed target is stimulant abstinence, verified through scheduled toxicology testing. Which arrangement directly reinforces that target?
Correct answer: D - Deliver the agreed incentive promptly after each verified stimulant-negative specimen.
In April 2026, a federally assisted substance use treatment program receives a routine request from a client's primary care physician for a medication list, treatment summary, and separately maintained notes analyzing counseling-session conversations. The program has a valid Part 2 consent covering future treatment, payment, and health care operations, but no separate consent for those counseling notes. Under 42 CFR Part 2, what does the existing consent permit?
Correct answer: C - Release the medication list and treatment summary; the separately maintained counseling notes require separate consent.
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