NAADAC NCAAC cheat sheet

Adolescent brain development: prefrontal cortex matures last (mid-20s), while limbic system is earlier; this imbalance increases sensation-seeking and risk-taking, including substance experimentation.

Substance use typically follows a sequence: alcohol and tobacco first, then cannabis, then other illicit drugs; early initiation (before age 15) predicts higher risk of substance use disorder (SUD).

Protective factors include strong family bonds, parental monitoring, academic engagement, and involvement in prosocial activities; risk factors include family history of SUD, peer substance use, and early conduct problems.

Developmental stages: early adolescence (11-14) focuses on identity and peer approval; middle (15-17) on autonomy and experimentation; late (18-21) on transition to adult roles; interventions should match stage.

Adolescents often use substances to cope with negative affect, stress, or trauma; screening should assess motives and co-occurring mental health symptoms.

Neuroadaptation: repeated substance use during adolescence can disrupt brain development, leading to impaired executive function, increased impulsivity, and higher risk of addiction.

Peer influence peaks in early adolescence; peer substance use is one of the strongest predictors of adolescent use.

Gender differences: males tend to have higher rates of alcohol and illicit drug use; females may progress faster from use to dependence (telescoping effect).

Use validated screening tools: CRAFFT (Car, Relax, Alone, Forget, Family/Friends, Trouble) for substance use; PHQ-9 or GAD-7 for mood/anxiety; AUDIT or DAST for alcohol/drugs.

DSM-5 SUD criteria: 11 criteria across four categories (impaired control, social impairment, risky use, pharmacological); severity: mild (2-3), moderate (4-5), severe (6+).

Assessment must be developmentally appropriate: use language-adjusted interviews, collateral information from parents/teachers, and observe behavior; self-report may be unreliable due to social desirability.

Treatment planning should be individualized, strengths-based, and include measurable goals; consider level of care using ASAM criteria (dimensions: withdrawal, medical, emotional, readiness, relapse, environment).

Confidentiality: minors have rights to confidential substance use treatment in many jurisdictions; obtain informed consent from parent/guardian and assent from adolescent, but clarify limits (e.g., safety).

Differential diagnosis: distinguish SUD from other mental health conditions (e.g., ADHD, depression) and from normative experimentation; use longitudinal history and functional impairment.

Motivational interviewing (MI) is effective for engaging adolescents and building readiness to change; avoid confrontational approaches.

Screening for trauma and co-occurring disorders is essential; use tools like the Child PTSD Symptom Scale (CPSS) or Trauma Symptom Checklist for Children (TSCC).

Evidence-based approaches: Cognitive Behavioral Therapy (CBT), Motivational Enhancement Therapy (MET), Multidimensional Family Therapy (MDFT), and Contingency Management (CM) for adolescents.

Motivational Interviewing (MI) core skills: OARS (Open questions, Affirmations, Reflections, Summaries); avoid the righting reflex; roll with resistance.

CBT for adolescent SUD: identify triggers, develop coping skills, challenge maladaptive thoughts, and plan for high-risk situations; typically 12-16 sessions.

Family-based treatments (e.g., MDFT, Functional Family Therapy) are more effective than individual therapy alone for adolescent SUD.

Contingency management: provide tangible rewards for verified abstinence (e.g., urine drug screens); effective for adolescents, especially for cannabis and stimulant use.

Twelve-step facilitation: encourage attendance at AA/NA meetings; adapt for adolescents (e.g., young people's meetings).

Relapse prevention: identify high-risk situations, develop coping strategies, and create a written relapse prevention plan; include lifestyle balance and support network.

Engagement strategies: use developmentally appropriate activities (e.g., art, sports), build rapport, and involve peers in treatment (e.g., group therapy).

Family involvement is a strong predictor of treatment engagement and positive outcomes; family therapy should be offered as a primary component.

Systems perspective: adolescent behavior is influenced by family, school, peers, and community; assess and intervene at multiple levels.

Family-based interventions: Multidimensional Family Therapy (MDFT), Functional Family Therapy (FFT), and Multisystemic Therapy (MST) have strong evidence for adolescent SUD.

Parental monitoring and supervision are protective; low monitoring is associated with increased substance use.

Family psychoeducation: teach family members about SUD, communication skills, and boundary setting; reduce blame and criticism.

Engage fathers and extended family when possible; address family conflict and parental substance use as part of treatment.

Collaborate with schools, juvenile justice, and child welfare systems; obtain releases of information to coordinate care.

Cultural considerations: family roles, acculturation gaps, and cultural norms about substance use should be assessed and integrated into treatment.

Co-occurring disorders (COD) are common: up to 60% of adolescents with SUD have a co-occurring mental health disorder (e.g., depression, anxiety, ADHD, PTSD).

Integrated treatment is recommended: treat SUD and mental health simultaneously rather than sequentially.

Trauma-informed care principles: safety, trustworthiness, peer support, collaboration, empowerment, and cultural sensitivity; avoid re-traumatization.

Screen for trauma using validated tools (e.g., Childhood Trauma Questionnaire, UCLA PTSD Reaction Index); assess for PTSD symptoms.

Trauma and substance use: adolescents may use substances to cope with trauma-related distress; address trauma in treatment (e.g., Trauma-Focused CBT).

Medication-assisted treatment (MAT) for opioid use disorder: buprenorphine is FDA-approved for ages 16+; methadone for ages 18+ (with exceptions); naltrexone for ages 18+.

Suicide risk assessment is critical: screen for suicidal ideation and self-harm; use tools like the Columbia Suicide Severity Rating Scale (C-SSRS).

Avoid confrontational approaches with trauma survivors; use grounding techniques and emotional regulation skills.

Confidentiality: minors have legal rights to confidential SUD treatment in many states (e.g., 42 CFR Part 2); parental consent requirements vary by state and service type.

Informed consent: obtain parental/guardian consent and adolescent assent; explain limits of confidentiality (e.g., danger to self/others, abuse).

Mandated reporting: counselors must report suspected child abuse or neglect; inform adolescents of this limit at the outset.

42 CFR Part 2: federal regulations protect SUD treatment records; disclosure requires written consent, except in medical emergencies or with court order.

Duty to warn/protect: if an adolescent poses a serious threat to an identifiable victim, counselors may have a duty to warn/protect (Tarsoff principle).

Ethical principles: beneficence, nonmaleficence, autonomy, justice, fidelity; apply to adolescent cases with consideration of developmental autonomy.

Boundaries: avoid dual relationships; maintain professional boundaries, especially with adolescents (e.g., no social media contact).

Documentation: keep accurate records; document consent, assessment, treatment plan, and progress; ensure security of records.