CARN study guide
CARN · Work through your exam, one topic at a time.
The Certified Addictions Registered Nurse (CARN) credential is a specialty certification for registered nurses who provide care to people with substance use disorders and co-occurring conditions. It signals that a nurse has moved beyond generalist practice into addictions nursing: assessment, withdrawal management, medication-assisted treatment, recovery support, and the ethical and legal frameworks that shape this work. The CARN study guide has 11 sections and about 2,862 words.
01Theories, Models, and Principles of Addiction and Recovery
Candidates must be able to distinguish the disease model (addiction as a chronic, relapsing brain condition), the biopsychosocial model (biological, psychological, and social factors interact), the moral/legal model (use as deviance), and the harm reduction model (meeting people where they are to reduce consequences). Know the stages of change (precontemplation, contemplation, preparation, action, maintenance, and relapse as a stage in the cycle) and the transtheoretical model's processes of change, decisional balance, and self-efficacy.
319 words, about 2 min02Neurobiology and Pharmacology of Substance Use
Understand the mesolimbic dopamine pathway (ventral tegmental area → nucleus accumbens) as the reward circuit, plus the role of the prefrontal cortex (impulse control) and amygdala (stress/craving). Know tolerance, dependence, withdrawal, and sensitization .
273 words, about 1 min03Screening, Assessment, and Diagnosis
Distinguish screening (brief, broad, identifies risk - e.g., AUDIT, AUDIT-C, DAST, CRAFFT for adolescents, PHQ-9 for depression) from assessment (comprehensive, multidimensional) and diagnosis (DSM-5-TR criteria). Know the 11 DSM-5-TR criteria grouped into impaired control, social impairment, risky use, and pharmacological criteria; severity is mild (2–3), moderate (4–5), severe (6+) .
273 words, about 1 min04Detoxification and Withdrawal Management
Detoxification is medically supervised withdrawal management , not treatment itself. Know CIWA-Ar for alcohol withdrawal and COWS for opioid withdrawal.
251 words, about 1 min05Treatment Modalities and Levels of Care
Know the ASAM levels of care : Level 1 (outpatient), Level 2 (intensive outpatient/partial hospitalization), Level 3 (residential/inpatient), Level 4 (medically managed intensive inpatient). Understand evidence-based modalities : CBT, motivational enhancement therapy, contingency management (strong evidence for stimulant use disorder), 12-step facilitation, family therapy, and medication-assisted treatment.
271 words, about 1 min06Pharmacological and Medication-Assisted Treatment
Opioid use disorder : buprenorphine (partial agonist; ceiling effect; precipitated withdrawal risk if given too soon after full agonists), methadone (full agonist; requires OTP dispensing), naltrexone (antagonist; requires detox first). Alcohol use disorder : naltrexone (reduces craving/reward), acamprosate (reduces craving; good with liver disease), disulfiram (aversive; requires adherence and abstinence), topiramate and gabapentin (off-label).
232 words, about 1 min07Co-occurring Psychiatric and Medical Conditions
Co-occurring disorders are common; integrated treatment is the standard. Understand common pairings: depression and alcohol, PTSD and substance use, ADHD and stimulants, anxiety and benzodiazepines.
233 words, about 1 min08Relapse Prevention, Recovery Support, and Continuing Care
Relapse prevention draws on Marlatt's model: high-risk situations , coping skills , outcome expectancies , abstinence violation effect , and lapse vs. Understand triggers (internal/external), craving management , and relapse prevention plans .
257 words, about 1 min09Family, Group, and Community Interventions
Family systems concepts: homeostasis, boundaries, roles, enabling, codependency (use with caution), and family therapy models (structural, strategic, multisystemic therapy for adolescents, behavioral couples therapy - strong evidence). Group therapy : stages (forming, storming, norming, performing), therapeutic factors (Yalom: universality, instillation of hope, universality, interpersonal learning), and group rules (confidentiality, attendance).
245 words, about 1 min10Ethics, Legal Issues, Confidentiality, and Professional Practice
42 CFR Part 2 provides stricter confidentiality for SUD treatment records than HIPAA; requires written consent for most disclosures, with limited exceptions (medical emergency, court order, suspected child abuse). Know mandatory reporting (child abuse, some infectious diseases), duty to warn/protect (Tarás-off), and informed consent .
254 words, about 1 min11Health Promotion, Prevention, and Harm Reduction
Prevention levels: universal, selective, indicated (Institute of Medicine classification). Risk and protective factors across individual, family, school, and community domains.
254 words, about 1 min