UCSB ADCSM (Civil Service Management) cheat sheet

Screening instruments (AUDIT, DAST-10, CAGE, PHQ-9, GAD-7) are brief, low-cost, and indicate need for further evaluation; they do not establish a diagnosis.

ASAM Criteria dimension 1 (intoxication/withdrawal potential) must be assessed before placement; severe withdrawal risk (e.g., history of DT or seizure) requires medically managed detoxification.

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).

Tolerance and withdrawal are not counted toward the 2-criterion threshold when the substance is taken only under appropriate medical supervision.

Diagnosis of substance-induced disorder requires that symptoms developed during or within 1 month of intoxication or withdrawal and are not better explained by an independent disorder.

AUDIT-C uses 3 items with cutoffs of 4 or more for men and 3 or more for women; a positive screen triggers the full 10-item AUDIT.

Withdrawal timelines: alcohol 6-24 hours (DTs at 48-96 hours), opioids 8-24 hours, benzodiazepines 1-4 days and later, cannabis variable and often delayed.

Collateral and record review are indicated when the client minimizes use; self-report alone underestimates consumption and should be corroborated.

An individualized treatment plan states problem statements, measurable goals, specific objectives, interventions, responsible staff, and target dates.

Objectives must be behavioral and measurable (e.g., 'attend 3 AA meetings weekly for 4 weeks'), not global ('get better').

ASAM placement reflects the least restrictive level that safely meets needs, matched to each of the six dimensions, and is reviewed when the client changes levels.

Progress notes should link each intervention to a plan objective; documentation of medical necessity supports continued authorization.

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

DAP format: Data, Assessment, Plan; commonly used in outpatient and group settings.

Treatment plan reviews occur at least every 90 days in most California-certified programs, or sooner if required by the payer or program policy.

Discharge summary documents presenting problems, services provided, progress toward goals, continuing-care referrals, and final status.

Warm handoffs (direct contact between providers with the client present) reduce dropout compared with passive referrals.

Referral decisions consider ASAM dimensions, client preference, transportation, insurance, language, and cultural fit.

Medication for opioid use disorder (buprenorphine, methadone, naltrexone) is first-line and should be coordinated with the SUD counselor, not withheld as a condition of counseling.

Mandated reporting: suspected child abuse or neglect must be reported to the appropriate agency; California counselors report to Child Protective Services or law enforcement per statute.

Coordination with probation, drug court, and child welfare requires signed releases and clear role boundaries; the counselor does not act as an enforcement officer.

Continuity of care planning includes primary care, mental health, housing, employment, and peer support linkages.

For clients with co-occurring disorders, integrated treatment (same team, same setting) is preferred over sequential or parallel treatment.

Release of information must specify the recipient, purpose, information covered, and expiration date, and is revocable in writing.

Motivational interviewing core skills: open questions, affirmations, reflections, and summaries (OARS); the spirit is partnership, acceptance, compassion, and evocation.

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

The stages of change (precontemplation, contemplation, preparation, action, maintenance) guide intervention selection; relapse is common and does not restart the process.

Relapse prevention identifies high-risk situations, coping skills, and a lapse-management plan; a lapse is not a relapse unless the client returns to prior pattern.

Cognitive behavioral techniques target automatic thoughts and high-risk beliefs; contingency management provides tangible reinforcement for verified abstinence.

Twelve-step facilitation explains AA/NA steps and sponsorship; SMART Recovery uses a CBT-based, self-management approach.

Harm reduction includes naloxone distribution, safer-use education, and syringe services; these do not require abstinence as a precondition.

Group counseling requires ground rules on confidentiality, respect, and no intoxicated attendance; the counselor manages process and safety.

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

Dual relationships are avoided when they risk exploitation or impaired objectivity; unavoidable ones require documentation and consultation.

Boundary crossings (e.g., accepting a small gift) differ from boundary violations (e.g., sexual contact), which are always prohibited.

Counselor impairment (substance use, burnout, untreated mental illness) requires self-monitoring, supervision, and possible withdrawal from duties.

Confidentiality exceptions: imminent danger to self or others, suspected child/elder/dependent adult abuse, court order, and written authorization.

Scope of practice: SUD counselors do not diagnose or treat independent mental disorders unless licensed or supervised to do so.

Cultural humility and non-discrimination are ethical obligations; treatment must be adapted to language, faith, and identity.

Ethical decision-making models (e.g., identify the problem, consult codes and law, consult peers, choose and document) should be applied and recorded.

42 CFR Part 2 protects SUD treatment records and is stricter than HIPAA; disclosure generally requires specific written consent.

A Part 2 consent must identify the program, the recipient, the purpose, the records, the expiration, and the client's right to revoke.

Part 2 permits disclosure without consent for a bona fide medical emergency and for court orders meeting specific criteria.

Records must be accurate, timely, legible, and never altered retroactively; corrections are made by dated addendum.

Minimum necessary standard applies; share only the information needed for the stated purpose.

Clients have the right to access their records, subject to limited exceptions such as imminent harm.

Retention periods are set by state law and program policy; California programs generally retain records for at least 7 years after discharge.

Breach notification and incident reports are documented when protected information is improperly disclosed.

The disease model frames addiction as a chronic, relapsing brain condition; the biopsychosocial model adds psychological and social determinants.

The brain disease model implicates mesolimbic dopamine and prefrontal impairment in reward, motivation, and impulse control.

Recovery capital includes social (relationships), physical (health, housing), human (skills, education), and cultural (values, identity) resources.

Recovery-oriented systems of care emphasize person-centered, strengths-based, and community-supported long-term recovery.

The transtheoretical model describes change as cyclical, with relapse as an expected stage rather than a failure.

The social learning model (Bandura) emphasizes modeling, self-efficacy, and reinforcement in the development and cessation of use.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a public-health approach delivered in general medical settings.

Recovery is defined by the client, not only by abstinence; improved functioning, relationships, and quality of life are valid outcomes.

Co-occurring disorder means at least one substance use disorder plus at least one mental disorder; either may be primary and both require treatment.

Integrated treatment is the evidence-based standard; sequential (treat one then the other) and parallel models produce poorer outcomes.

The quadrant model classifies severity of mental illness (low/high) against severity of substance use (low/high) to guide service intensity.

Gambling disorder is classified in DSM-5-TR under disruptive, impulse-control, and conduct disorders; it is a behavioral addiction with SUD-like features.

Internet gaming disorder is listed in DSM-5-TR as a condition for further study; it is not a formal diagnosis.

Suicide risk screening is mandatory for co-occurring clients; ask directly, assess plan and means, and document the response.

Medication interactions matter: disulfiram with alcohol causes a severe reaction; naltrexone reduces craving but requires liver monitoring.

Trauma-informed care assumes high prevalence of trauma and avoids re-traumatization through safety, choice, and collaboration.

Program licensure and certification in California are administered by the Department of Health Care Services (DHCS); certification of counselors is through recognized certifying bodies.

Clinical supervision ratios and qualifications are set by state regulation and payer contracts; supervisors must document supervision hours.

Utilization review tracks authorization, length of stay, and medical necessity to maintain payer reimbursement.

Quality improvement uses plan-do-study-act cycles, chart audits, and outcome measures (e.g., retention, completion, readmission).

Staff training, credential verification, and background checks are administrative responsibilities that support compliance.

Budget management includes staffing costs, billing, and grant compliance; fee schedules must reflect actual service costs.

Program evaluation uses process measures (services delivered) and outcome measures (client change) to demonstrate effectiveness.

Documentation audits and incident reporting protect the program legally and support continuous improvement.