Substance abuse counselor screening questions: state credential, supervised hours, ASAM placement and Part 2
On this page
- Which substance use counseling job is it?
- Which credentials and state rules decide eligibility?
- Knockout questions
- How do you test assessment, placement and treatment skills?
- Confidentiality, documentation and boundary questions
- How does substance use counseling experience get overstated?
- A 15-minute phone-screen flow
- Scoring
- What to put in the submittal
- Lawful phrasing, and candidates in recovery
- Questions people ask
Substance abuse counselor screening questions should confirm three things before anything else: the credential the job state requires (its name, tier and whether it is active or still a trainee or intern registration), how many supervised hours the candidate has and whether the program can supervise the rest, and recent experience at the client's level of care. Then test the work itself: ASAM-based placement, withdrawal and overdose risk, medications for opioid use disorder, and the 42 CFR Part 2 consent rules that changed in 2026. As of November 2026, titles, scope and supervision rules differ by state, so check the job state's board before you submit anyone.
This page is for counselors whose caseload is substance use disorder treatment: outpatient and intensive outpatient programs, residential, withdrawal management, opioid treatment programs and drug courts. If the order is for a licensed professional counselor treating mental health conditions, use the mental health counselor screening questions; for recovery coaches hired for lived experience, use the peer support specialist screening questions; and for unit staff in detox and residential programs, the behavioral health technician screening questions.
Which substance use counseling job is it?
| Setting | What changes for the counselor | Ask the candidate |
|---|---|---|
| Outpatient and intensive outpatient | Group-heavy schedules, evening sessions, caseloads that turn over, step-down from residential | "How many groups a week did you run, and how many clients were on your individual caseload?" |
| Residential | Daily groups, treatment plans updated often, family sessions, discharge planning | "What did a normal day of groups look like, and who wrote the discharge plan?" |
| Withdrawal management (detox) | Short stays, medically monitored patients, engagement and referral more than therapy | "How did you get someone from detox into the next level of care?" |
| Opioid treatment program | Patients on methadone or buprenorphine, take-home decisions, counseling alongside dosing | "How did you work with the medical staff on a patient asking for take-homes?" |
| Criminal justice and drug courts | Court reports, probation contact, consent forms that name the court | "What did you send the court, and what consent did you have for it?" |
| Co-occurring or integrated clinic | Clients with mental health diagnoses, a team with licensed clinicians and prescribers | "Which parts of a co-occurring client's care were yours, and which went to the licensed clinician?" |
Which credentials and state rules decide eligibility?
As of November 2026. We checked these on IC&RC's, the Texas Health and Human Services Commission's, New York OASAS's and CMS's own pages. Texas and New York are examples; check the job state's own board.
- The state credential, by name. Titles differ by state, and many states have a trainee or intern tier. In Texas, the HHSC LCDC page says a candidate must first hold a counselor intern registration (which runs five years), then needs an associate degree or higher, 4,000 hours of supervised work experience at a registered clinical training institution or under a certified clinical supervisor, and a passing score on the exam given by the Texas Certification Board of Addiction Professionals. A counseling-related master's or doctorate with 48 graduate semester hours can qualify for a waiver of the 4,000 hours. In New York, OASAS issues the Credentialed Alcoholism and Substance Abuse Counselor (CASAC) credential, and its Verify a Credential tool shows CASAC, CASAC-T (trainee) and CASAC-P status.
- IC&RC standards. IC&RC credentials are issued through its member boards. IC&RC's Alcohol and Drug Counselor (ADC) minimum standards require 6,000 hours of supervised work experience with a high school diploma, 5,000 with an associate degree, 4,000 with a bachelor's and 2,000 with a master's or higher, plus 300 hours of education, the ADC exam and 40 hours of continuing education every two years. Member boards can add requirements.
- Scope. Credentials do not all allow the same work. The Texas LCDC program page says an LCDC can diagnose substance disorders but is not qualified to treat a person with a mental health disorder, or to provide family counseling where the presenting problems do not include substance use.
- Medicare. CMS's mental health counselor page says addiction counselors and alcohol and drug counselors who meet all the requirements of a mental health counselor (a qualifying master's or doctoral degree, state licensure or certification, and two years or 3,000 hours of post-master's supervised experience) may enroll in Medicare as MHCs. A counselor without a master's degree cannot bill Medicare this way.
- Private practice. The BLS Occupational Outlook Handbook notes that substance abuse counselors in private practice must be licensed, which requires a master's degree and supervised clinical experience, while requirements outside private practice vary by state.
Knockout questions
| Question | Strong answer | Red flag |
|---|---|---|
| 1. Which substance use counseling credential do you hold, in which state, and what is its number? | The exact title and tier (for example LCDC or CASAC-T), the state and a number you can verify after the call. | "I'm certified" with no state, or a national certificate offered in place of the state credential. |
| 2. If you are a trainee or intern, how many supervised hours do you have, and who signs them? | A number from their log and the supervisor's credential, with the hours still needed. | Does not know the count, or expects the client to supply a supervisor it does not have. |
| 3. Has any board taken action on a credential you hold or held? | A clear no, or a direct account with dates. | Evasion. Verify on the board's lookup either way. |
| 4. How recent is your experience at [level of care]? | Months, employer and caseload in the same setting. | Only practicum hours at this level. |
| 5. The schedule is [days, evening groups, on-call]. Does that work? | Yes, or a specific limit said now. | Wants day-only hours for an evening IOP. |
How do you test assessment, placement and treatment skills?
-
"Walk me through an intake for someone who wants residential treatment."
- Strong answer: covers all six dimensions of The ASAM Criteria (now in its fourth edition): intoxication, withdrawal and addiction medications; biomedical conditions; psychiatric and cognitive conditions; substance use-related risks; recovery environment; and person-centered considerations. The level of care comes out of the assessment, not out of what is available.
- Red flags: a checklist of substances used and nothing else; places everyone in the level the program sells.
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"A new client tells you they drank heavily until this morning and their hands are shaking. What do you do?"
- Strong answer: treats it as possible withdrawal, gets the nurse or medical provider involved straight away, follows the program's protocol and documents.
- Red flags: continues the intake and mentions it at the end of the day.
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"How do you work with a client on buprenorphine or methadone?"
- Strong answer: supports the medication plan the prescriber set; knows that SAMHSA describes buprenorphine, methadone and naltrexone as the most common FDA-approved medications for opioid use disorder, used together with counseling, and that methadone for OUD can only be dispensed through a SAMHSA-certified opioid treatment program.
- Red flags: calls medication "trading one drug for another" or pushes clients to taper. That clashes with almost every program that offers it.
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"A client returns to use in week three of IOP. What happens next?"
- Strong answer: assesses safety and overdose risk, reviews the plan with the client, considers whether the level of care still fits, and involves the team.
- Red flags: automatic discharge as a punishment, with no reassessment.
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"A client discloses depression and panic attacks. What is yours and what isn't?"
- Strong answer: screens and documents, refers to or coordinates with a licensed clinician, and stays inside their credential's scope.
- Red flags: starts treating the panic disorder on their own with a credential that does not cover it.
Confidentiality, documentation and boundary questions
Federally assisted SUD programs follow 42 CFR Part 2. HHS's fact sheet on the 2024 final rule says compliance was required by February 16, 2026: one consent can now cover all future uses for treatment, payment and health care operations, SUD counseling notes need their own separate consent, breaches follow the HIPAA breach notification rules, and records still cannot be used against the patient in legal proceedings without consent or a court order. A counselor who worked in a Part 2 program should recognize these.
| Question | Strong answer | Red flag |
|---|---|---|
| A probation officer calls asking whether your client attended this week. What do you do? | Checks for a signed consent that names that person and purpose, shares only what it allows, and documents. | Confirms attendance because "it's just yes or no". |
| What goes in your progress notes, and when do you finish them? | Notes tied to the treatment plan goals, written the same day or within the program's deadline. | Routinely a week behind. |
| Do you keep separate counseling notes? | Knows the program's policy and that separately kept SUD counseling notes need their own consent to disclose. | Has never heard the term, in a role that requires Part 2 training. |
| How large was your caseload, and how many groups did you lead? | Numbers for both, and what made a week heavy. | No numbers. |
| You see a client at a community event or meeting you also attend. How do you handle it? | Follows the code of ethics: keeps the client's confidentiality, avoids a dual relationship and talks to the supervisor. | No sense that it raises a boundary question. |
| What is your part when a client overdoses on site? | Knows the program's emergency procedure, naloxone location and who calls 911, and has been trained. | "The nurse handles that." |
How does substance use counseling experience get overstated?
- Technician years counted as counselor years. Ask when the credential was issued and what they did before.
- Trainee status described as licensed. An intern or trainee registration is not the full credential; verify the tier.
- Supervised hours rounded up. Ask for the number on the supervisor's log, not an estimate.
- "Ran groups" that were co-facilitated or psychoeducation videos. Ask what they planned and led alone.
- Co-occurring treatment claimed by someone whose credential limits them to substance use.
- OTP experience that was front-desk dosing support rather than counseling.
A 15-minute phone-screen flow
- Minutes 0 to 2: level of care, schedule, caseload and group load.
- Minutes 2 to 5: knockouts; write down the credential title, tier, state and number, and the supervised-hours count.
- Minutes 5 to 10: the intake question, the withdrawal question and either the medication or return-to-use question.
- Minutes 10 to 13: the probation call and documentation questions.
- Minutes 13 to 15: pay expectations (see salary expectation questions) and next steps.
Scoring
Pass or fail
- Holds the job state's credential at the tier the role needs, verified by you on the board's lookup.
- If a trainee: the client can supervise them under the state's rules.
- Recent experience at the client's level of care.
- Accepts the schedule, including evening groups if the role has them.
Scored 0 to 2 each (10 possible)
- Assessment and placement: uses the ASAM dimensions, not a substance checklist.
- Safety: escalates withdrawal, overdose and suicide risk at once.
- Medication-friendly practice that fits the client's program.
- Confidentiality: Part 2 consent and scope of practice.
- Documentation and caseload habits.
What to put in the submittal
Counselor: [name]
Credential: [title and tier], [state], number [number], verified [date]
Supervised hours (if trainee): [hours logged] of [hours required], supervisor [credential]
Medicare eligibility: [meets MHC criteria / does not]
Levels of care, last 3 years: [outpatient / IOP / residential / detox / OTP], months each
Caseload: [individual clients], groups led per week: [number]
Medication experience: [buprenorphine / methadone / naltrexone clients], role
Part 2 and consent: [summary of the probation-call answer]
Schedule accepted: [days, evenings, on-call]
Candidate's own gap: [e.g. "no OTP experience; co-occurring treatment outside my scope"]Lawful phrasing, and candidates in recovery
Many good counselors are in recovery, and the law limits what you may ask. The EEOC's guidance on pre-employment disability-related questions says past addiction to illegal drugs is a covered disability under the ADA for someone who is not a current user. Before an offer you may ask about current illegal drug use, but not "Have you ever been addicted to drugs?" or "Have you ever been treated for drug addiction?", and not whether someone has been in an alcohol rehabilitation program. If a candidate volunteers their recovery story, do not follow up or write it in your notes; the peer support page has a script for roles where lived experience is part of the job.
The licensing board runs its own criminal history review (Texas does under 26 TAC 562.31). Your client's own background check follows the FCRA and any state or city fair chance law; see the FCRA background check process and, for drug tests at hire, drug testing laws in hiring. The illegal interview questions guide covers the other common slips. This page is not legal advice.
Questions people ask
What credential does a substance abuse counselor need?
It depends on the state. Texas licenses Licensed Chemical Dependency Counselors through its Health and Human Services Commission, and New York credentials CASACs through OASAS. IC&RC sets minimum supervised hours by degree level in its Alcohol and Drug Counselor standard, which its member boards apply and can add to. Check the job state's own board for the exact title and requirements.
Can an addiction counselor bill Medicare?
Only by enrolling as a mental health counselor. CMS says addiction counselors and alcohol and drug counselors who meet all the requirements of a mental health counselor, including a qualifying master's or doctoral degree, a state license or certification and two years or 3,000 hours of post-degree supervised experience, may enroll and bill Medicare for those services, as of November 2026.
Can I ask a substance abuse counselor candidate if they are in recovery?
Not before an offer. EEOC guidance says past addiction to illegal drugs is a covered disability under the ADA for people who are not current users, so questions such as whether someone has been addicted or treated for addiction are not allowed at the pre-offer stage. You may ask about current illegal drug use and about the credentials the job requires.
What changed in 42 CFR Part 2 for counselors?
HHS finalized changes in February 2024, with compliance required by February 16, 2026. Patients can now sign one consent for treatment, payment and health care operations, SUD counseling notes need their own separate consent, and breaches of Part 2 records follow the HIPAA breach notification rules.