CARN-AP cheat sheet

AUDIT-C is positive at ≥3 in women and ≥4 in men; AUDIT total ≥8 indicates hazardous use, ≥16 harmful use, and ≥20 warrants dependence evaluation.

CAGE ≥2 affirmative answers suggests clinically significant alcohol problems; it is a screening tool, not a diagnostic test.

DSM-5-TR substance use disorder requires ≥2 of 11 criteria within 12 months; 2–3 mild, 4–5 moderate, ≥6 severe.

CIWA-Ar quantifies alcohol withdrawal: 8–15 moderate, >15 severe with elevated seizure and delirium risk; it is not validated for opioid withdrawal.

COWS quantifies opioid withdrawal: 13–24 moderate, 25–36 moderately severe, >36 severe; buprenorphine induction typically begins at COWS ≥8–12.

Standard urine immunoassay can miss low-potency benzodiazepines such as clonazepam and lorazepam; LC-MS/MS confirmation is needed when results conflict with clinical findings.

Ethyl glucuronide remains detectable in urine for up to about 80 hours after alcohol elimination; a positive EtG indicates recent exposure, not necessarily impairment.

Alcohol withdrawal delirium and hepatic encephalopathy can both cause confusion; withdrawal timing, tremor, and autonomic hyperactivity favor withdrawal, while asterixis and liver failure favor encephalopathy.

Naltrexone requires 7–10 opioid-free days before initiation; it is contraindicated during current opioid use and requires baseline and periodic liver enzyme monitoring.

Buprenorphine is a partial μ-agonist; giving it while full agonists are present can precipitate withdrawal, so induction is timed to COWS ≥8–12.

Methadone carries dose-dependent QT prolongation risk; obtain ECG when risk factors are present and monitor for sedation and respiratory depression.

Acamprosate is dosed 666 mg three times daily; reduce dose in moderate renal impairment (CrCl 30–50 mL/min) and avoid in severe renal impairment.

Disulfiram is contraindicated in severe myocardial disease, psychosis, pregnancy, and recent alcohol or disulfiram-like substance use; baseline liver tests are required.

In alcohol withdrawal with hypoglycemia risk, give thiamine before or with glucose to reduce Wernicke encephalopathy risk.

Naloxone may be repeated every 2–3 minutes until respiratory drive returns; it can precipitate acute opioid withdrawal.

Bupropion lowers seizure threshold and is contraindicated in seizure disorders and eating disorders; SSRIs combined with MAOIs risk serotonin syndrome.

Motivational interviewing uses OARS: open questions, affirmations, reflections, and summaries; the goal is to evoke change talk rather than to confront.

Change talk predicts behavior change; sustain talk predicts maintenance of use, and clinicians respond to sustain talk with reflection rather than argument.

Contingency management provides tangible reinforcers for verified abstinence; it has the strongest evidence for stimulant use disorders.

CBT relapse prevention maps high-risk situations, automatic thoughts, and coping responses; it includes lapse management rather than abstinence-only framing.

CRAFT teaches family members to reinforce abstinence and reduce enabling; it improves treatment engagement compared with confrontation-based family approaches.

SBIRT is a public-health model: universal screening, brief intervention for risky use, and referral to treatment for moderate-to-severe disorders.

Twelve-step facilitation is a structured referral model that explains AA/NA principles and encourages attendance; it is distinct from generic group therapy.

42 CFR Part 2 protects SUD treatment records more stringently than HIPAA; redisclosure generally requires written patient consent unless a specific exception applies.

ASAM criteria range from level 0.5 early intervention through level 4 medically managed intensive inpatient care; level 3.7 is medically managed inpatient.

A warm handoff transfers care directly between clinicians with the patient present; it reduces dropout compared with fax-only referrals.

The MAT Act eliminated the X-waiver; prescribers still need a DEA registration and must comply with state licensure, training, and attestation requirements.

SBIRT referral is indicated when screening reveals moderate-to-severe SUD or imminent risk; brief intervention alone is insufficient for dependence.

Interprofessional care for SUD combines pharmacotherapy, behavioral treatment, case management, and primary care; shared treatment plans reduce fragmented care.

Confidentiality exceptions include medical emergency, suspected child abuse, and a court order meeting 42 CFR Part 2 standards.

Recovery capital includes social, physical, human, and cultural resources that support sustained remission; it is assessed at intake and during recovery.

Syringe services programs reduce HIV and hepatitis C transmission and do not increase injection frequency or crime.

PrEP with tenofovir/emtricitabine reduces HIV acquisition; eligibility includes ongoing injection drug use with sharing or high-risk sexual behavior.

HALT-hungry, angry, lonely, tired-is a relapse-prevention self-monitoring framework for identifying vulnerability states.

Peer recovery specialists use lived experience to support engagement, linkage, and recovery planning; they do not replace licensed clinical assessment.

Hepatitis B vaccination is recommended for people who inject drugs; hepatitis A vaccination is also recommended for those at risk.

Naloxone distribution and overdose education are core harm-reduction strategies; take-home naloxone reduces overdose mortality.

Tobacco cessation should be integrated into SUD treatment; quitting does not worsen drug or alcohol outcomes.

Tarasoff duty to warn or protect arises when a patient poses a serious threat to an identifiable third party; scope varies by state law.

Mandated reporting laws require clinicians to report suspected child abuse or neglect; the report is made to the designated agency, not to the family.

Informed consent requires capacity, disclosure of risks and alternatives, voluntariness, and documentation; it is an ongoing process.

Dual relationships occur when a clinician has a secondary role with a patient; they risk exploitation and are generally avoided when possible.

PDMP checks are required or recommended before prescribing controlled substances; they identify multiple prescribers and high-risk combinations.

Impaired practice includes substance use or psychiatric impairment that affects clinical performance; reporting obligations follow state nurse practice acts.

Ethical principles include autonomy, beneficence, nonmaleficence, and justice; when these conflict, the clinician documents the reasoning.

Telehealth prescribing requires compliance with state licensure and DEA rules; the patient's location generally determines the applicable state.