IC&RC AADC cheat sheet

The ASAM Criteria assesses six dimensions: (1) intoxication and withdrawal potential, (2) biomedical conditions, (3) emotional/behavioral/cognitive conditions, (4) readiness to change, (5) relapse and continued use potential, and (6) recovery/living environment.

DSM-5 substance use disorder uses 11 criteria grouped as impaired control (4), social impairment (3), risky use (2), and pharmacological (2: tolerance and withdrawal); the DSM-IV legal-problems criterion was removed.

DSM-5 severity thresholds: 2-3 criteria = mild, 4-5 = moderate, 6 or more = severe; meeting 0-1 criteria does not establish a substance use disorder.

Alcohol and sedative-hypnotic (benzodiazepine) withdrawal can be fatal through seizures and delirium tremens; opioid withdrawal is extremely distressing but rarely life-threatening.

CIWA-Ar quantifies alcohol withdrawal severity and COWS quantifies opioid withdrawal severity; scores inform level-of-care and medication decisions.

Screening instruments (AUDIT, CAGE, DAST, TCU drug screen) are brief and determine whether a full assessment is warranted; the assessment is comprehensive, ongoing, and drives diagnosis and placement.

A biopsychosocial assessment covers substance use history, medical and psychiatric status, family/social functioning, legal, employment, trauma, and strengths, plus a mental status exam and suicide-risk screen.

ASAM withdrawal management levels (3rd ed.): 1-WM ambulatory without extended on-site monitoring, 2-WM ambulatory with extended monitoring, 3.2-WM clinically managed residential, 3.7-WM medically monitored inpatient, and 4-WM medically managed inpatient.

A complete treatment plan contains a problem statement, goal(s), measurable objectives, specific interventions/strategies, the responsible staff member, target dates, and a review/revision date, and is signed by the client and counselor.

Goals are broad statements of desired outcome, ideally in the client's own language; objectives are specific, measurable, time-limited behavioral steps that mark progress toward the goal.

Placement follows the least restrictive ASAM level of care that safely addresses needs across all six dimensions, and is reassessed whenever the client's condition changes.

ASAM Criteria (3rd ed.) levels: 0.5 early intervention, 1 outpatient, 2.1 intensive outpatient (9+ hours/week for adults), 2.5 partial hospitalization (20+ hours/week), 3.1/3.3/3.5 residential, 3.7 medically monitored intensive inpatient, 4 medically managed inpatient.

Objectives must be written so that achievement can be verified from progress notes; if it cannot be observed or counted, it is not a usable objective.

Discharge and continuing-care planning begins at admission and specifies relapse prevention, recovery supports, and concrete community linkages.

Plans are revised when goals are met, when needs change, or at the program/payer-defined review interval, commonly every 30 days.

Treatment plans address culture, language, trauma history, family involvement, co-occurring disorders, and legal mandates so that the plan is individualized rather than program-standard.

Motivational interviewing rests on the spirit of partnership, acceptance, compassion, and evocation; it is directive toward change while honoring client autonomy.

OARS microskills: Open-ended questions, Affirmations, Reflections, and Summaries; reflections should outnumber questions in a typical MI session.

Stages of change: precontemplation, contemplation, preparation, action, maintenance, plus relapse; movement is cyclical rather than linear, and interventions are matched to stage.

Change talk types (DARN): desire, ability, reasons, need; mobilizing change talk (CAT): commitment, activation, taking steps. Counselors evoke and strengthen change talk.

The righting reflex (arguing for change, warning, persuading) elicits sustain talk and resistance; confrontational styles are associated with poorer retention and outcomes.

Cognitive behavioral interventions identify and restructure cognitive distortions and build coping skills; relapse prevention (Marlatt) maps high-risk situations, coping responses, and lapse-to-relapse management.

Contingency management delivers tangible, verifiable reinforcers for objectively confirmed target behaviors such as drug-free urine results.

Mutual-help groups such as AA and NA are peer-led and free; 12-step facilitation is a professional strategy for connecting clients to them, and a "higher power" is defined by the individual member.

Case management core functions: outreach/engagement, assessment, service planning, linkage and brokering, advocacy, monitoring, and evaluation of service delivery.

A valid 42 CFR Part 2 consent names the disclosing program, the recipient, the client, the purpose, the kind and amount of information, a statement of revocability and right to revoke, an expiration date or event, the client's signature and date, and the redisclosure prohibition.

HIPAA's minimum-necessary standard governs uses and disclosures; disclosures for treatment, payment, and health care operations are permitted with proper authorization or as otherwise allowed.

Mandatory reporting laws for child, elder, and dependent-adult abuse override client confidentiality; the report goes to the designated authority under state law.

Duty to warn/protect (Tarasoff) arises when a client presents a serious threat of violence toward an identifiable person; the exact duty and who must be notified vary by state.

Coordination with medication-assisted treatment prescribers requires monitoring adherence, side effects, and toxicology results, with a signed release covering that communication.

Integrated treatment, one team and one plan addressing both substance use and mental health disorders, outperforms sequential or parallel models for co-occurring disorders.

Referrals are documented with the target agency, date, information shared, and follow-up outcome so continuity of care can be verified.

Prevention classification: universal (entire population), selective (groups with elevated risk), and indicated (individuals showing early warning signs).

Substance use disorder is presented as a chronic, relapsing condition; genetic factors account for roughly half of the variance in risk for alcohol use disorder.

No amount of alcohol is known to be safe during pregnancy; prenatal alcohol exposure is a leading preventable cause of birth defects and intellectual disability (fetal alcohol spectrum disorders).

Naloxone reverses opioid overdose by opioid antagonism and has no effect in non-opioid overdose; many states' Good Samaritan laws protect people who call for emergency help.

Harm-reduction services such as syringe services programs reduce transmission of HIV and hepatitis and increase referral to treatment and other health services.

CRAFT (Community Reinforcement and Family Training) coaches concerned significant others to change reinforcing contingencies, which increases the likelihood the identified person enters treatment.

Person-first, non-stigmatizing language ("person with a substance use disorder," "positive urine test" rather than "dirty") supports engagement and is the standard in clinical and community education.

Teach-back, asking the learner to explain the information in their own words, is a more reliable check of comprehension than asking "Do you understand?"

SOAP format: Subjective (client report), Objective (observable and factual data), Assessment (clinical interpretation and progress toward goals), Plan (next steps and services).

DAP format: Data, Assessment, Plan; it is a briefer alternative used when the service plan is unchanged.

A progress note should identify the date, time, service type, duration, participants, the client's statements and observed behavior, the counselor's interventions, progress toward a specific plan objective, and the counselor's signature with credentials.

Notes use objective, behavioral, non-judgmental language; labels such as "manipulative," "in denial," or "unmotivated" are replaced by descriptions of the specific behavior observed.

Corrections: draw a single line through the error so it stays legible, write "error," then initial and date; never erase, use correction fluid, or delete an entry.

Late entries are labeled as late and carry both the date of the actual entry and the date of the service; backdating or predating entries is fraudulent.

Documentation must support the medical necessity of each billed service and be consistent with the billed code and time units.

Under 42 CFR Part 2 clients generally have the right to review their own record, subject to narrow exceptions and applicable state law.

NAADAC ethical principles: nonmaleficence, beneficence, autonomy, justice, fidelity, and veracity.

Informed consent covers the nature of services, risks, benefits, alternatives, fees, confidentiality and its limits, and the client's right to withdraw from services.

Avoid dual and multiple relationships; when one is unavoidable, disclose it to the client and supervisor, document it, and consult rather than proceed unexamined.

Sexual or romantic relationships with clients are prohibited; many professional codes and state laws extend the prohibition for a defined period after termination, commonly 2 to 5 years.

Confidentiality exceptions: valid client consent, imminent danger to self or others, suspected child or vulnerable-adult abuse, a court order, and legally required public health reporting.

Scope of practice: provide only services within your training, supervision, and credential, and refer or consult when a client's needs exceed your competence.

Impaired colleagues require action, not silence: intervene, document, and report to the appropriate supervisor, licensing board, or peer assistance program as the code and law require.

Ethical decision-making steps: define the problem, consult the code and the law, consult supervisors and peers, generate and weigh options, act, document, and evaluate the outcome.