MAC cheat sheet

Biopsychosocial assessment covers substance use history, medical and psychiatric status, family/social, legal, and employment functioning; the ASAM Criteria six dimensions organize the findings.

DSM-5-TR substance use disorder: 2-3 criteria met in 12 months = mild, 4-5 = moderate, 6 or more = severe.

Withdrawal severity scales: CIWA-Ar for alcohol and benzodiazepine withdrawal (score 0-67), COWS for opioid withdrawal; scores drive the need for medically monitored detoxification.

Screening instruments detect risk (AUDIT, AUDIT-C, CAGE, DAST-10, PHQ-9); only a full assessment establishes diagnosis, severity, and level of care.

AUDIT total score of 8 or more indicates hazardous or harmful drinking; AUDIT-C is positive at 4 or more for men and 3 or more for women.

The Addiction Severity Index (ASI) rates seven problem areas: medical, employment, alcohol, drug, legal, family/social, and psychiatric.

A positive suicide item (PHQ-9 item 9) requires a direct follow-up risk assessment, safety planning, and documentation of the decision made.

Mental status examination components: appearance, behavior, speech, mood and affect, thought process and content, cognition, insight, and judgment.

ASAM levels of care: 1.0 outpatient, 2.1 intensive outpatient (9+ hours/week for adults), 2.5 partial hospitalization (20+ hours/week), 3.1/3.5/3.7 residential, 4.0 medically managed inpatient.

Placement rule: select the least intensive level of care that can safely and effectively meet the client's needs across all six ASAM dimensions.

A goal is a broad desired outcome; objectives are SMART (specific, measurable, achievable, relevant, time-bound) and describe observable behavior.

Each problem statement must be specific and linked to an ASAM dimension, and must be paired with an intervention, a responsible clinician, and a frequency.

The plan is developed collaboratively with the client; the client's signature documents participation in and agreement with the plan.

Review and update the plan when there is a change in level of care, a significant change in clinical status, or at the program's or payer's required interval.

Write discharge and continuing care criteria at admission so that transitions are planned rather than reactive.

Objectives must be measurable by a stated date; 'client will understand' is not a measurable objective, while 'client will attend 3 AA meetings weekly for 4 weeks' is.

Refer when the client's needs exceed the counselor's competence, the program's level of care, or legal authority, such as medically supervised detoxification or psychiatric evaluation.

A 42 CFR Part 2-compliant written consent is required before disclosing substance use disorder information to an outside provider.

A valid Part 2 consent names the recipient, states the purpose, specifies how much and how long information may be disclosed, and includes revocation and expiration terms.

A warm handoff (direct contact by phone, in person, or joint session) produces higher referral completion than giving the client a phone number.

Document the referral date, reason, receiving provider, information disclosed, consent obtained, and the follow-up outcome.

Follow up within a defined timeframe to confirm that the client connected with the referred service, and document if the client declines.

Mandated referrals from courts, employers, or licensing boards still require informed consent for treatment and disclosure.

Imminent risk indicators-psychosis, mania, suicidal or homicidal ideation, or acute medical instability-trigger immediate referral rather than routine scheduling.

Core case management functions: assessing needs, planning services, linking to resources, monitoring progress, and advocating within and across systems.

Interdisciplinary team meetings coordinate medical, psychiatric, legal, and recovery support needs and keep one shared plan current.

Under 42 CFR Part 2, each disclosure of substance use disorder information must be limited to what the consent permits and be recorded.

Medication for opioid use disorder (methadone, buprenorphine, naltrexone) is coordinated with the prescriber and integrated into the treatment plan, not treated as a separate track.

Continuing care planning begins at intake and specifies ongoing services, appointments, recovery supports, and relapse warning signs.

Peer recovery support specialists provide non-clinical, lived-experience services; peers do not diagnose, provide psychotherapy, or supervise clinical staff.

A discharge summary states the reason for discharge, progress toward goals, services provided, medications, functioning at exit, and referrals made.

Coordination with criminal justice or child welfare requires attention to confidentiality limits, consent requirements, and mandated reporting duties.

Motivational interviewing microskills (OARS): Open-ended questions, Affirmations, Reflections, Summaries; reflections should outnumber questions roughly 2 to 1.

Change talk categories DARN-CAT: Desire, Ability, Reasons, Need (preparatory) and Commitment, Activation, Taking steps (mobilizing).

Stages of change: precontemplation, contemplation, preparation, action, maintenance; relapse is an expected part of the cycle rather than a treatment failure.

Confrontational styles increase dropout and defensiveness; empathic, reflective responses are associated with better retention and outcomes.

Cognitive behavioral therapy targets maladaptive thoughts and beliefs and pairs cognitive restructuring with skills practice and behavioral experiments.

Contingency management reinforces biologically verified abstinence with escalating tangible rewards and is among the best-supported psychosocial interventions.

Relapse prevention (Marlatt) identifies high-risk situations, builds coping skills, and reframes a lapse as information rather than as total failure.

Confidentiality limits disclosed at intake: imminent danger to self or others, suspected child or elder abuse, and valid court orders or subpoenas.

Psychoeducation presents substance use disorder as a chronic, relapsing condition with effective treatments, reducing shame and supporting engagement.

Family education addresses enabling, detachment, and codependency patterns; Al-Anon and Nar-Anon provide 12-step support for family members.

CRAFT (Community Reinforcement and Family Training) teaches families to reward non-using behavior, allow natural consequences, and invite the person into treatment.

Naloxone education covers overdose recognition, administration, rescue breathing, and calling emergency services, and reduces opioid overdose mortality.

Harm reduction accepts any positive change and does not require abstinence as a precondition for receiving services.

Prenatal alcohol exposure is a leading preventable cause of intellectual disability; no safe amount or trimester of alcohol use in pregnancy has been established.

Education about medications for opioid use disorder corrects the misconception that agonist therapy is substituting one drug for another.

Community prevention planning commonly follows SAMHSA's Strategic Prevention Framework: assessment, capacity, planning, implementation, and evaluation.

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

DAP note format: Data (what occurred and was observed), Assessment (clinical interpretation), Plan (interventions and follow-up).

Correct errors with a single line through the entry so it remains legible, then add 'error' or the correction, initials, and date; never erase or use correction fluid.

Progress notes are best completed within 24 hours of the service; late entries are labeled as late and carry the actual date of writing.

42 CFR Part 2 protections for substance use disorder records are more stringent than HIPAA and are not overridden by HIPAA authorization.

A release of information must specify the purpose, the information covered, an expiration date, and the client's right to revoke.

Notes should describe the client's response to the intervention, progress toward the stated objective, and the plan, using behavioral language rather than labels.

Record missed appointments, refusals of service, and unsuccessful contact attempts; undocumented outreach is treated as not having occurred.

The NAADAC/NCC AP code is organized around autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity.

Scope of practice is bounded by education, training, and supervised experience; practicing outside it is an ethics violation even when well intended.

Dual relationships are avoided when they risk exploitation or impaired judgment; unavoidable overlaps (such as attending the same 12-step meeting) require consultation and documentation.

Tarasoff duty to protect applies when a client poses a serious threat to an identifiable third party and is met by warning, notifying police, or other protective action.

Mandated reporting of suspected child abuse or neglect is a legal duty that overrides confidentiality and does not require client permission.

Informed consent discloses the nature of treatment, risks, benefits, alternatives, fees, confidentiality limits, and the right to refuse or withdraw.

A workable ethical decision-making sequence: identify the dilemma, consult the code, law, and supervisor, weigh options and consequences, act, then document.

Gifts and barter are acceptable only when not exploitative, culturally appropriate, and documented, and never in exchange for clinical services.