Assessment and Diagnosis
What this domain tests
Assessment and Diagnosis tests whether you can gather enough valid information to support a defensible diagnosis and a level-of-care decision. CASAC candidates are expected to distinguish screening from comprehensive assessment, apply DSM-5-TR criteria to substance use disorders, use the ASAM Criteria dimensions, and recognize medical and psychiatric risk that changes the plan.
Core rules
- Screening identifies probable need; assessment establishes diagnosis, severity, strengths, and safety. A score alone is not a diagnosis.
- DSM-5-TR substance use disorder requires a problematic pattern causing impairment or distress, with criteria such as tolerance, withdrawal, larger or longer use, craving, and continued use despite harm. Severity is mild, moderate, or severe.
- ASAM dimensions cover withdrawal and intoxication risk, biomedical conditions, emotional and behavioral conditions, readiness to change, relapse potential, and recovery environment.
- Assess withdrawal risk directly: prior seizures, delirium tremens, high daily use, medical illness, and concurrent sedative use raise risk.
- Screen for suicide, overdose, trauma, medication, and co-occurring psychiatric symptoms. Use collateral only with a valid release.
- Diagnosis is provisional until intoxication and withdrawal are considered; substance-induced symptoms may resolve with abstinence.
Worked example
A 34-year-old reports daily alcohol use, a morning drink, and two withdrawal seizures. An AUDIT score is 18, and the client reports anxiety. The reasoning should be: the pattern supports severe alcohol use disorder under DSM-5-TR, but the anxiety is not automatically an independent disorder. The seizure history places the client at high withdrawal risk on ASAM dimension 1, so referral for medically supervised withdrawal is indicated before relying on outpatient counseling alone. Reassess anxiety after withdrawal and early abstinence.
Traps that cost marks
- Treating a positive screen as a diagnosis.
- Missing prior withdrawal seizures or delirium tremens.
- Diagnosing while the client is intoxicated or in acute withdrawal.
- Assigning all symptoms to substance use or all to mental illness without reassessment.
- Obtaining collateral without consent or a valid release.