Assessment, Diagnosis, and Treatment Planning for Adolescents
Domain 2: Assessment, Diagnosis, and Treatment Planning for Adolescents
This domain tests structured, developmentally appropriate assessment; differential diagnosis; ASAM-based level-of-care decisions; and treatment plans that link problems, goals, objectives, and interventions.
Assessment components
A comprehensive biopsychosocial assessment covers presenting problem, substance use history (age of first use, pattern, consequences, prior treatment), medical and psychiatric status, trauma, family, school, peers, legal involvement, strengths, and culture. Use multiple sources; collateral contacts require a signed release. Screening tools include CRAFFT 2.1 (validated for ages 12–21; a score of 2 or more signals risk), AUDIT-C, DAST-10, PHQ-A, and the GAIN. Screening identifies risk; it does not diagnose.
ASAM Criteria
Rate six dimensions: (1) intoxication/withdrawal, (2) biomedical, (3) emotional/behavioral/cognitive, (4) readiness to change, (5) relapse/continued-use potential, (6) recovery environment. Match the adolescent to the least restrictive level that meets safety needs, and justify the level in writing.
Differential diagnosis
Distinguish substance-induced from independent psychiatric disorders, rule out medical causes, and interpret urine drug screens cautiously: they show recent exposure, not impairment or SUD.
Worked example
A 15-year-old vapes daily, has panic attacks, falling grades, and low readiness to change. Dimension 3 is high because of panic; dimension 4 is low; there is no withdrawal risk and the home environment is supportive. The defensible plan is outpatient care with integrated anxiety treatment and family involvement, not residential care.
Traps that cost marks
- Diagnosing SUD from a screening score or positive drug test.
- Skipping collateral and trauma history.
- Failing to document the ASAM rationale for level of care.
- Using an adult-only placement when family and school supports exist.