CASAC cheat sheet

DSM-5-TR substance use disorder requires at least 2 of 11 criteria within a 12-month period; severity is mild (2-3), moderate (4-5), or severe (6 or more).

The 11 criteria group into four clusters: impaired control, social impairment, risky use, and pharmacological indicators (tolerance, withdrawal).

Tolerance and withdrawal alone do not establish a disorder when the substance is taken under appropriate medical supervision.

Withdrawal is coded only when the substance is known to produce a withdrawal syndrome; cannabis, caffeine, and hallucinogens carry caveats in DSM-5-TR.

Standard screening instruments: AUDIT (alcohol, 10 items), DAST-10 (drugs, 10 items), CAGE (4 items), and the single-item screening question for unhealthy alcohol use.

A brief intervention follows a positive screen: feedback, advice, goal negotiation, and follow-up; SBIRT is the framework for this sequence.

ASAM Criteria dimension 1 (intoxication/withdrawal potential) and dimension 2 (biomedical conditions) determine medical risk and the need for medically managed care.

Collateral information from family, employers, or prior records is used when self-report is unreliable, with written consent required for release of information.

A treatment plan is individualized, written, and includes problem statements, measurable goals, specific objectives, interventions, and target dates for review.

Objectives must be behavioral and measurable; 'client will attend 3 AA meetings per week for 4 weeks' qualifies, 'client will feel better' does not.

The ASAM Criteria place clients by level of care: 0.5 early intervention, 1 outpatient, 2.1 intensive outpatient, 2.5 partial hospitalization, 3 residential, 4 medically managed inpatient.

Level-of-care matching uses all six ASAM dimensions: withdrawal potential, biomedical, emotional/behavioral/cognitive, readiness to change, relapse potential, and recovery environment.

The plan is developed with the client, not for the client; client participation in goal setting increases engagement and is a documentation expectation.

Progress notes should tie back to plan objectives so that review can determine whether goals are met, modified, or discontinued.

Treatment plan review intervals are set by state licensure and payer rules; a common standard is every 30 to 90 days and whenever the level of care changes.

Discharge planning begins at admission, addressing housing, income, transportation, and continuing care supports before the last session.

Referral requires a signed release of information specifying the agency, the purpose, and an expiration date before any protected health information is shared.

42 CFR Part 2 applies to federally assisted substance use disorder programs and is stricter than HIPAA: consent must be specific and redisclosure is restricted.

Coordinated care addresses medical, psychiatric, housing, employment, legal, and childcare needs, not only substance use treatment.

Warm handoffs (direct contact between providers with the client present) reduce failed referrals compared with giving a phone number.

Case management functions include outreach, assessment, service planning, linkage, monitoring, and advocacy.

Documentation of a referral includes the date, the receiving provider, the reason, the information shared, and the outcome or follow-up.

Mandated reporting duties for suspected child abuse or neglect override confidentiality and do not require client consent.

Coordination with criminal justice, child welfare, and medication prescribers requires role clarity to avoid conflicting treatment expectations.

Motivational interviewing rests on four processes: engaging, focusing, evoking, and planning, delivered in a spirit of partnership, acceptance, compassion, and evocation.

OARS skills are Open questions, Affirmations, Reflective listening, and Summaries; reflections should outnumber questions in a session.

Change talk (desire, ability, reason, need, commitment, activation, taking steps) is elicited and reinforced; sustain talk is reflected without argument.

The stages of change are precontemplation, contemplation, preparation, action, maintenance, and termination; interventions are matched to stage.

Confrontation and labeling increase dropout; the righting reflex, the urge to fix, is a common MI error to avoid.

Cognitive behavioral skills include identifying triggers, thought records, coping skills rehearsal, and relapse prevention planning.

Group work stages are forming, storming, norming, and performing; early groups need structure and safety norms.

Trauma-informed communication emphasizes safety, choice, collaboration, and avoiding reenactment of powerlessness.

Family education covers addiction as a chronic condition, the role of relapse, and how family behavior can unintentionally enable use.

CRAFT (Community Reinforcement and Family Training) teaches concerned significant others to reduce enabling and increase treatment engagement.

Adolescent education should include accurate information on nicotine and cannabis potency and on polysubstance risk.

Overdose education includes recognizing respiratory depression, calling emergency services, and administering naloxone; naloxone reversal requires breathing support until help arrives.

Community education targets stigma reduction, screening access, and awareness of local treatment capacity.

Health literacy and language level of materials should be checked; plain-language materials are recommended at roughly a sixth-to-eighth grade reading level.

Education on medication for opioid use disorder should distinguish agonist (methadone), partial agonist (buprenorphine), and antagonist (naltrexone) mechanisms.

Confidentiality rules limit what can be shared with family without consent; general education can be provided without disclosing client status.

Common note formats include SOAP (subjective, objective, assessment, plan) and DAP (data, assessment, plan); the format is set by agency policy.

Notes are written in objective, behavioral language; avoid conclusory labels such as 'manipulative' or 'in denial' without supporting description.

Each note documents date, time, duration, service type, participants, interventions used, client response, and plan for next contact.

Errors are corrected with a single line through the entry, initials, date, and reason; never erase, white out, or delete an electronic entry.

Records are retained per state and payer requirements; many jurisdictions require 7 years for adults and longer for minors.

Late entries are labeled as such and dated with the actual date of entry, not backdated to the service date.

Progress notes must support billing codes; service documentation that does not match the billed service is a fraud risk.

Release of information forms must name the recipient, purpose, information covered, expiration, and the client's right to revoke.

Informed consent covers the nature of services, risks and benefits, alternatives, fees, confidentiality limits, and the right to withdraw.

Dual relationships are avoided when they risk exploitation or impaired judgment; not all multiple roles are unethical, but they require examination and supervision.

Boundary crossings (minor, non-exploitative) differ from boundary violations (exploitative or harmful); gifts, self-disclosure, and bartering need a documented rationale.

Competence is limited to training and scope; counselors refer when a client's needs exceed their competence.

Supervision and consultation are the standard response to ethical dilemmas, along with the agency's ethics process and licensure board guidance.

Scope of practice prohibits diagnosing outside one's credential; in many states only licensed clinicians may render independent diagnoses.

Impaired practice, whether from substance use or burnout, requires self-report and removal from client contact.

Ethical decision-making models typically sequence: identify the problem, consult codes and law, consider stakeholders, choose, act, and review.

Methadone is a full mu-opioid agonist used for opioid use disorder; it prolongs the QT interval and requires monitored dosing.

Buprenorphine is a partial agonist with high receptor affinity; precipitated withdrawal occurs if it is started too soon after a full agonist.

Naltrexone is an opioid antagonist; it requires full detoxification first and blocks opioid analgesia, so it must be disclosed before surgery.

Acamprosate supports abstinence in alcohol use disorder; disulfiram inhibits aldehyde dehydrogenase and causes an aversive reaction with alcohol.

Alcohol withdrawal can progress to seizures and delirium tremens; benzodiazepines are first-line and untreated withdrawal can be fatal.

Co-occurring disorders are treated concurrently, not sequentially; integrated treatment for mental health and substance use is the expected standard.

Common co-occurring conditions include major depression, PTSD, anxiety disorders, ADHD, and bipolar disorder; each affects medication selection.

Tobacco use is a substance use disorder and cessation support is part of treatment, not deferred until other substances are addressed.

Suicide risk assessment covers ideation, plan, intent, means access, prior attempts, and protective factors; direct asking does not increase risk.

Lethal-means counseling (locking or removing firearms and stockpiled medication) is a specific, evidence-supported safety step.

A safety plan lists warning signs, coping strategies, people and places for distraction, people to call, professionals to contact, and means restriction.

Alcohol or sedative withdrawal, opioid overdose, and delirium are medical emergencies requiring emergency services, not counseling alone.

Opioid overdose signs: pinpoint pupils, slow or absent breathing, unresponsiveness, and cyanosis; respond with naloxone and rescue breathing.

De-escalation uses calm tone, reduced stimulation, physical space, and offering choices; restraints are a last resort with legal and documentation requirements.

Duty to protect may require warning an identifiable third party or notifying authorities when a client makes a credible threat of violence; state law governs.

After a crisis, conduct a debrief, document the event and response, and update the treatment plan and safety plan.