Illinois CADC Study Guide
ICB / IAODAPCA & IC&RC Aligned
Illinois CADC Exam Study Guide
Certified Alcohol and Other Drug Abuse Counselor • Core Competencies & High-Yield Review
Exam Structure
150 Questions (125 Scored)
3-Hour Computer Exam
Domain 1 (23%)
Screening & Assessment
Rule in/out SUD, severity, ASAM
Domain 2 (27%)
Treatment Planning & Referral
SMART goals, placement, care links
Domain 3 (28%)
Counseling
Individual, group, family, MI, CBT
Domain 4 (22%)
Ethics & Professional Duty
42 CFR Part 2, HIPAA, ANCRA
The 12 Core Functions Crosswalk
1. Screening: Determine eligibility/fit
2. Intake: Administrative forms & consent
3. Orientation: Rules, rights, costs
4. Assessment: Strengths, history, diagnosis
5. Treatment Planning: SMART goals
6. Counseling: Evidence-based skills
7. Case Management: Linking supports
8. Crisis Intervention: Acute safety
9. Client Education: SUD & recovery info
10. Referral: Outside specialty services
11. Reports & Records: Charting & progress
12. Consultation: Supervision & team review
DSM-5-TR Diagnostic Criteria for SUD (11 Criteria in 4 Clusters)
12-Month Period
Cluster A: Impaired Control
- Substance taken in larger amounts/longer than intended
- Persistent desire or unsuccessful efforts to cut down
- Excessive time spent obtaining, using, or recovering
- Craving, or strong desire/urge to use the substance
Cluster B: Social Impairment
- Recurrent use failing major obligations (work/school/home)
- Continued use despite interpersonal/social conflict
- Important social/work/recreational activities reduced
Cluster C: Risky Use
- Recurrent use in physically hazardous situations (e.g. driving)
- Continued use despite knowing physical/psych problems
Cluster D: Pharmacological
- Tolerance: Markedly increased dose needed for effect
- Withdrawal: Syndrome or use to relieve symptoms
- *Exempt if under supervised medical management
Mild: 2–3 criteria Moderate: 4–5 criteria Severe: 6+ criteria Early Remission: 3–12 months criteria-free Sustained: 12+ months
ASAM Placement Criteria: 6 Dimensions & Levels of Care
Dim. 1
Acute Intoxication & Withdrawal
Dim. 2
Biomedical Conditions
Dim. 3
Emotional / Behavioral / Cognitive
Dim. 4
Readiness to Change
Dim. 5
Relapse / Continued Use Potential
Dim. 6
Recovery / Living Environment
Level 0.5Early Intervention
Level 1.0Outpatient (<9 hrs/wk)
Level 2.1 / 2.5IOP (≥9h) / PHP (≥20h)
Level 3.1–3.7Residential / Inpatient
Level 4.0Medically Managed Inpatient
Exam Trap (Screening vs. Assessment): Screening identifies presence/absence of risk (rules in/out); Assessment evaluates multidimensional depth, severity, diagnosis, and ASAM level.
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Domain 1 & Domain 3 Competencies
Pharmacology, Withdrawal Syndromes & MAT
Medical Foundations
Major Drug Classes, Intoxication & Life-Threatening Withdrawal
| Drug Class | Key Agents & Mechanism | Intoxication Signs | Withdrawal & Danger Level |
|---|
| Depressants / Alcohol | Ethanol, Benzodiazepines, Barbiturates (GABA agonism, NMDA inhibition) | Slurred speech, ataxia, nystagmus, CNS depression, sedation | CRITICAL / FATAL RISK: Tremors, CIWA-Ar ≥10, DTs (Delirium Tremens 48-72h), grand mal seizures. Requires medical detox. |
| Opioids | Heroin, Fentanyl, Oxycodone, Morphine (Mu-opioid receptor agonists) | Pinpoint pupils (miosis), respiratory depression, nod, bradycardia, hypotension | Dysphoria, nausea, muscle aches, lacrimation, rhinorrhea, pupillary dilation (mydriasis), piloerection. Rarely fatal alone; COWS scale. |
| Stimulants | Cocaine, Methamphetamine, Prescription amphetamines (Dopamine reuptake block) | Tachycardia, hypertension, pupil dilation, diaphoresis, hypervigilance, paranoia | Severe depression ("crash"), vivid unpleasant dreams, hypersomnia, hyperphagia, intense suicidal ideation. |
| Hallucinogens / Cannabis | THC, LSD, Psilocybin, MDMA, PCP (5-HT2A agonists, CB1, NMDA antagonist) | Perceptual distortion, synesthesia, ataxia, conjunctival injection; PCP: rotatory nystagmus, violence | Cannabis: irritability, insomnia, appetite loss. Hallucinogens: flashbacks / HPPD (Hallucinogen Persisting Perception Disorder). |
Evidence-Based Pharmacotherapies (FDA-Approved MAT)
Opioid Use Disorder (OUD)
Methadone: Full mu-agonist. Reduces cravings/withdrawal, prevents euphoria. Highly regulated; dispensed via licensed Opioid Treatment Programs (OTPs).
Buprenorphine (Suboxone / Subutex): Partial mu-agonist with ceiling effect (lower overdose risk). Formulated with Naloxone (4:1) to deter IV misuse.
Naltrexone (Vivitrol / Revia): Full opioid antagonist. Blocks euphoric effects. Requires 7–10 days opioid-free before induction to avoid precipitated withdrawal!
Naloxone (Narcan): Pure antagonist; immediate acute reversal for opioid overdose. Short half-life (monitor for re-sedation).
Alcohol Use Disorder (AUD)
Disulfiram (Antabuse): Aldehyde dehydrogenase inhibitor (aversive therapy). Alcohol ingestion causes toxic acetaldehyde buildup: severe nausea, flushing, tachycardia.
Acamprosate (Campral): Restores GABA/glutamate balance. Best for maintaining abstinence in detoxed patients. Cleared renally (safe in liver disease).
Naltrexone (Revia oral / Vivitrol IM monthly): Blocks endorphin release associated with drinking, reducing cravings and binge frequency.
Off-Label Adjuncts: Gabapentin (craving/insomnia/mild withdrawal), Topiramate (craving reduction).
Standardized Assessment Instruments
CIWA-Ar Clinical Institute Withdrawal Assessment for Alcohol. 10 items (scores >15 indicate high risk of severe complications).
COWS Clinical Opiate Withdrawal Scale. 11 items assessing heart rate, pupil size, tremor. Used to time buprenorphine induction.
AUDIT & CAGE AUDIT: 10-item WHO gold standard. CAGE: 4 items (Cut down, Annoyed, Guilty, Eye-opener; 2+ positive suggests AUD).
ASI Addiction Severity Index. Semistructured interview assessing 7 functional life domains (Medical, Employment, Drug, Alcohol, Legal, Family, Psych).
High-Yield Exam Alert: Only two withdrawal syndromes carry an inherent medical risk of death: Alcohol and Sedatives/Benzodiazepines (due to excitotoxic seizures & DTs). Opioid withdrawal is acutely miserable but non-fatal in healthy individuals.
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Domain 3 Competencies
Counseling Theories, Modalities & Evidence-Based Practices
Clinical Application
Stages of Change (Prochaska & DiClemente) & Counselor Tasks
1. Precontemplation
No plan to change in next 6 mo; unaware/denial.
Task: Validate, personalize risk, raise awareness without arguing.
2. Contemplation
Ambivalent; considering change within 6 mo.
Task: Explore pros & cons, resolve ambivalence, elicit change talk.
3. Preparation
Taking small steps; action planned in 30 days.
Task: Clarify goals, develop realistic action plan, overcome barriers.
4. Action
Actively modifying behavior (<6 months).
Task: Bolster self-efficacy, restructure environment, coping skills.
5. Maintenance
Sustained change >6 months; preventing relapse.
Task: Relapse prevention plan, lifestyle balance, peer supports.
MI Core Spirit (PACE) & OARS Skills
- Spirit: Partnership, Acceptance, Compassion, Evocation
- O: Open-ended questions (invite exploration)
- A: Affirmations (recognize client strengths/efforts)
- R: Reflective listening (simple vs. complex reflections)
- S: Summaries (collecting, linking, transitioning)
Eliciting Change Talk (DARN-CAT)
Prep Talk: Desire, Ability, Reasons, Need.
Mobilizing Talk: Commitment, Activation, Taking Steps.
Rolling with Resistance: Never argue or confront resistance directly. Resistance indicates counselor has moved ahead of the client's readiness stage. Shift approach!
CBT & Relapse Prevention Models (Beck, Marlatt & Gordon)
Cognitive Behavioral Therapy
Emotions and actions are mediated by automatic thoughts and cognitive distortions (all-or-nothing thinking, catastrophizing). Focuses on behavioral skills and cognitive restructuring.
High-Risk Situations & HALT
Internal triggers (negative emotional states) & external triggers (people, places, things). Core vulnerability trigger acronym: Hungry, Angry, Lonely, Tired.
Abstinence Violation Effect (AVE)
When a slip occurs, guilt and internal blame can trigger full relapse ("I blew it, might as well keep using"). Differentiate a lapse (single slip) from a relapse (return to pattern).
Group Therapy (Yalom) & Family Roles (Wegscheider-Cruse)
Yalom's Curative Factors & Group Stages
• Universality: Recognizing one is not alone in suffering.
• Altruism: Gaining self-esteem by supporting peers.
• Cohesiveness: Sense of belonging, warmth, and acceptance.
• Stages: Forming (orientation) → Storming (conflict/power) → Norming (cohesion) → Performing (work) → Adjourning (termination).
Wegscheider-Cruse Family Roles in Addiction
• The Enabler: Shields person with SUD from natural consequences.
• The Hero: High achiever, provides family pride, hides inner pain.
• The Scapegoat: Acts out, receives blame, deflects from SUD.
• The Lost Child: Quiet, withdrawn, invisible, avoids conflict.
• The Mascot: Uses humor/hyperactivity to break family tension.
Clinical Wisdom for the CADC Exam: Always prioritize Client Autonomy and Empathy. Outdated confrontational approaches ("break down denial") are strictly incorrect on the exam. Use Motivational Interviewing and evidence-based collaboration.
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Domain 4 Competencies
Confidentiality, Ethics & Illinois Statutes
Legal & Ethical Review
Federal Confidentiality: 42 CFR Part 2 vs. HIPAA
Highest Exam Weight
42 CFR Part 2 is substantially more restrictive than general HIPAA rules. It protects any patient-identifying information maintained by federally assisted substance use disorder programs.
Valid Consent Requirements (Part 2)
- Specific name of patient & program making disclosure
- Specific individual or organization receiving disclosure
- Explicit clinical/administrative purpose of disclosure
- How much/what specific information will be disclosed
- Patient's right to revoke in writing at any time
- Specified date, event, or condition of expiration
- Must include formal Prohibition on Redisclosure Notice
Exceptions to Consent under Part 2
- Medical Emergency: Immediate bona fide threat to life/health
- Child Abuse / Neglect: Reporting suspected abuse under state law
- Crimes on Premises: Threatened/committed against staff or facility
- Court Order WITH Subpoena: Subpoena alone is NEVER sufficient under Part 2 without a special judicial finding of good cause!
- Qualified Audits / Program Research: Under strict research protocols
Illinois Legal Mandates & Reporting Obligations
Illinois ANCRA Mandate
Abused & Neglected Child Reporting Act. CADCs are Mandated Reporters. Must immediately report suspected physical, sexual abuse, or neglect to DCFS hotline (1-800-25-ABUSE), followed by a written report within 48 hours.
Illinois Duty to Protect
Tarasoff standard codified: When client poses a serious, imminent, credible threat of physical violence against a clearly identified or readily identifiable victim, the counselor has an affirmative duty to warn victim and notify law enforcement.
Adult Protective Services
Illinois Adult Protective Services Act mandates reporting of suspected abuse, neglect, or financial exploitation of adults aged 60+ and adults aged 18–59 with disabilities who cannot seek help independently.
ICB / IAODAPCA Code of Ethics & Professional Boundaries
Dual / Multiple Relationships: Counselors must avoid dual relationships (business, social, personal) that impair professional judgment or increase exploitation risk.
Sexual Intimacy: Strictly prohibited with current clients and former clients (ICB maintains absolute prohibitions; zero tolerance).
Gifts & Bartering: Generally discouraged. Bartering only under rare, non-exploitative, culturally normative, documented situations.
Competence & Scope of Practice: Do not diagnose conditions or practice modalities outside CADC credentials without proper licensure/supervision.
Self-Care & Impairment: Ethical obligation to seek help and suspend clinical duties if personal substance use or emotional impairment compromises client care.
Supervision & Consultation: When faced with an ethical dilemma, the FIRST step is always consulting relevant codes, policies, and a clinical supervisor.
Master Exam Decision Rule: "What Should the Counselor Do FIRST?"
1. Immediate Safety Assess acute suicidality, homicidality, severe medical distress, or child abuse before any other clinical work.
2. Clarify / Assess Gather necessary information and understand the client's perspective before jumping to an intervention or solution.
3. Collaborate Involve the client in goal setting and treatment planning. Never dictate or impose counselor values.
4. Consult & Document In ethical/legal ambiguity, consult your supervisor, check state statute, and document all clinical actions thoroughly.
Final Exam Tip: A valid subpoena by itself cannot compel disclosure of SUD records under 42 CFR Part 2. It MUST be accompanied by a court order signed by a judge after a hearing showing "good cause."
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