A positive screen is not a diagnosis: the AUDIT item that tests what you do next
Screening items on the NCE rarely ask you to interpret the score. They ask what you do with it, and the tempting answers are the ones that skip a step.
By Dr. Andrew Wichterman · September 22, 2026 · 5 min read · Updated October 22, 2026
Screening items on the NCE rarely ask you to interpret the score. They ask what you do with it, and the tempting answers are the ones that skip a step.
The practice item discussed here was written for this site in the style of the NCE. It is not a question from the actual exam. NBCC does not release its items, and candidates sign a nondisclosure agreement.
The item
At intake, a client scores 14 on the AUDIT. He reports drinking "a few beers most nights" and denies any problems. The counselor's MOST appropriate next step is:
A. Diagnose alcohol use disorder, moderate
B. Conduct a fuller assessment of his alcohol use, including DSM-5-TR criteria and consequences
C. Refer him immediately to inpatient detoxification
D. Note the score and proceed with the presenting problem, since he denies difficulties
Keyed answer: B. A score of 14 is well above the AUDIT cutoff of about 8 and is a positive screen. A positive screen means one thing: assess further. It is not a diagnosis, and it is not by itself grounds for a level-of-care decision. Denial of problems does not cancel a positive screen; it is part of what the assessment explores.
What the item is really testing
The sequence: screen, then assess, then diagnose, then place. Each step is separate, and the exam builds distractors by collapsing two of them. "Diagnose from the screen" collapses screen and diagnosis. "Refer to detox" collapses screen and placement. The keyed answer is almost always the next step, not the last one.
Why each wrong answer tempts you
A. A screen cannot diagnose. Diagnosis requires assessing the eleven criteria over twelve months.
C. No withdrawal risk or medical instability is described; detox is a level-of-care decision made after assessment.
D. Ignoring a positive screen because the client minimizes is the error the screen exists to prevent.
The instruments and their numbers
AUDIT: World Health Organization, ten items, covers consumption, dependence and harm; cutoff about 8. CAGE: four questions (Cut down, Annoyed, Guilty, Eye-opener); two or more positive is a positive screen. DAST-10 for drugs other than alcohol. CRAFFT for adolescents. MAST is the older, longer alcohol instrument. The exam wants the name, the population and the cutoff, and it wants you to call all of them screens.
Sensitivity is the point
Screens are built to catch true cases, so they accept false positives. That is why a positive screen must lead to assessment rather than action: some of the people who screen positive do not have the disorder. A candidate who treats the screen as definitive is misusing the instrument in exactly the way the assessment domain warns against.
When the client minimizes
"A few beers most nights" and a denial of problems are normal at intake and are not evidence against the screen. The assessment domain expects you to hold the discrepancy without confrontation, ask about quantity, frequency, consequences and prior attempts to cut down, and use motivational interviewing if ambivalence appears. Items that reward arguing with the client or accepting the denial at face value are both wrong.
Where this lives in the course
Domain 2, Intake, Assessment & Diagnosis: the lesson "Screening for risk and substance use: the instruments and the questions". Read it, take its quiz, and add the key terms to your flashcard queue.
Check the current handbook. Exam logistics, fees and policies change. Confirm specifics against the NBCC candidate handbook and your state board's current rules. Aligned to the current NCE blueprint, valid for exams through June 30, 2027.
Every deep-dive item on this site was written for the site in the style of the NCE. None is from the actual exam.