NAADAC NCAC II cheat sheet

ASAM Criteria dimension set: (1) intoxication/withdrawal potential, (2) biomedical conditions, (3) emotional/behavioral/cognitive conditions, (4) readiness to change, (5) relapse/continued use potential, (6) recovery/living environment - each rated 0-4, with the highest dimension driving the recommended level of care.

Levels of care: 0.5 early intervention, 1 outpatient, 2.1 intensive outpatient, 2.5 partial hospitalization, 3.1 clinically managed low-intensity residential, 3.5 clinically managed high-intensity residential, 3.7 medically monitored intensive inpatient, 4 medically managed intensive inpatient.

DSM-5-TR SUD threshold: >=2 of 11 criteria within a 12-month period; severity is mild (2-3), moderate (4-5), severe (6+). Remission is early (3-12 months) or sustained (12+ months).

A diagnosis of SUD requires that the pattern cause clinically significant impairment or distress; tolerance and withdrawal alone do not establish SUD when the substance is taken as prescribed under medical supervision.

Withdrawal risk rules: alcohol and benzodiazepine withdrawal can be life-threatening (seizure, delirium tremens, typically 48-96 h after last drink); opioid withdrawal is intensely uncomfortable but rarely fatal; stimulant withdrawal has no established pharmacological detox protocol.

Screening vs. assessment: screens (AUDIT, DAST-10, CRAFFT for adolescents, PHQ-9 for depression) identify probable cases; a full biopsychosocial assessment establishes diagnosis, severity, and level of care.

Screening instruments and cutoffs: AUDIT score >=8 indicates hazardous drinking (>=4 for women); CRAFFT is positive at >=2; DAST-10 >=3 indicates moderate problems.

Mandated reporting: suspected child abuse or neglect and imminent threat of serious harm to an identified person trigger duty-to-warn/protect obligations that vary by state statute; verify the jurisdiction's rule before any disclosure.

Treatment plans must be individualized, measurable, and time-linked: each problem statement pairs with goals (broad, client-centered) and objectives (specific, behavioral, measurable), with stated interventions and review dates.

Motivational interviewing rests on four processes (engaging, focusing, evoking, planning) and four spirit elements (partnership, acceptance, compassion, evocation); change talk is elicited with open questions, affirmations, reflections, and summaries (OARS).

Reflections outnumber questions in skilled MI sessions; complex reflections (adding meaning or feeling) are preferred over simple parroting, and sustain talk is met with amplified or double-sided reflection rather than argument.

CBT chain: identify the activating situation, automatic thought, resulting emotion and behavior, then test the thought's evidence and generate a balanced alternative; behavioral experiments test predictions in vivo.

Contingency management is the intervention with the strongest evidence for stimulant use disorder: vouchers or prizes contingent on verified abstinence, with reinforcement schedules thinning over time.

Relapse prevention (Marlatt) distinguishes a lapse from a relapse; the abstinence violation effect is the shame-and-guilt spiral after a slip that predicts escalation.

Twelve-step facilitation is an evidence-based, manualized approach that actively introduces clients to AA/NA; it is distinct from simply referring clients and is supported by Project MATCH findings.

Group work: early-stage groups emphasize safety, structure, and universality; later-stage groups can tolerate confrontation. Counselors screen for contraindications such as acute withdrawal or active psychosis.

Trauma-informed practice applies the principles of safety, trustworthiness, peer support, collaboration, empowerment, and cultural humility; it does not require the counselor to elicit a detailed trauma narrative.

Co-occurring disorders are treated with integrated, parallel interventions addressing both conditions rather than sequential referral, which raises dropout risk.

42 CFR Part 2 protects records of federally assisted SUD programs: disclosure requires written patient consent meeting specific elements, and the consent is revocable and time-limited; HIPAA alone is generally not sufficient for SUD records.

Confidentiality exceptions: written consent, medical emergency, court order meeting Part 2 requirements, suspected child abuse or neglect, and duty to warn/protect where state law imposes it.

A subpoena is not a court order. Part 2 requires a special court order using the regulation's criteria before records are released in most legal proceedings.

Mandatory reporting duties typically cover suspected child abuse or neglect, elder and dependent-adult abuse, and threats of serious harm to identifiable persons; the counselor reports to the designated authority, not to the alleged abuser.

Dual relationships: sexual or romantic involvement with current clients is prohibited and generally prohibited with former clients for a defined period (for example, two years under NAADAC and many licensure boards); nonsexual dual relationships require documented safeguards or avoidance.

Informed consent must cover the nature of services, fees, confidentiality limits, risks, alternatives, the right to withdraw, and supervision status of trainees, documented before services begin.

Scope of practice: counselors do not diagnose or treat conditions outside their training and licensure, and they do not provide medical or legal advice; referral is the appropriate response.

Competence and impairment: counselors pursue continuing education, seek supervision when facing unfamiliar issues, and must not practice while impaired by substances or untreated conditions.

Records: retain per state and payer rules, secure storage, and release only with valid authorization; clients generally have a right to access their own records subject to Part 2 procedures.

Supervision is a distinct professional relationship with three functions: administrative (quality, compliance, documentation), clinical/educational (skill and case conceptualization), and supportive (stress, burnout, self-care).

Supervision is not therapy. Personal counseling is referred out when personal issues impair clinical work; the supervisor addresses the impact on client care, not the underlying personal history.

The discrimination model (Bernard) defines supervisor roles (teacher, counselor, consultant) crossed with foci (intervention, conceptualization, personalization), matched to the supervisee's developmental level.

Developmental models (e.g., Stoltenberg) hold that supervisees move from dependence to autonomy; supervision structure and directiveness should decrease as competence grows.

Live observation, co-therapy, and recorded sessions give more valid data than self-report; supervisors document observed behavior and specific feedback rather than impressions.

Supervision contracts specify goals, methods, frequency, documentation, evaluation criteria, and limits of confidentiality, and are signed at the start of the relationship.

Gatekeeping duty: supervisors must remediate or, when remediation fails, prevent unsafe supervisees from advancing, documenting due process including written feedback and improvement plans.

Supervision documentation should be separate from the client record and should capture dates, topics, interventions discussed, directives given, and supervisee progress toward goals.

A supervisor must hold the appropriate license and supervisory credential required by the state board, and supervisee hours typically count only under an approved supervisor.

Program accreditation and certification: CARF and The Joint Commission accredit behavioral health programs; state licensure authorizes operation; SAMHSA certification applies to opioid treatment programs.

ASAM levels of care determine staffing ratios and credentialing requirements; higher-intensity levels require 24-hour medical or nursing coverage.

Revenue cycle: verify eligibility and benefits before service, obtain prior authorization when required, document medical necessity, submit claims, and manage denials within payer appeal windows.

Common payer sources: Medicaid, Medicare, commercial insurance, state block grants, and self-pay; sliding-fee scales must comply with anti-kickback and false claims rules and be applied consistently.

HIPAA Security Rule requires administrative, physical, and technical safeguards for electronic protected health information; breach notification timelines vary by state and federal rule.

Quality improvement uses measurable indicators (engagement within 7 days, retention at 30 and 90 days, completion rates) and PDSA cycles to test changes before spreading them.

Staff turnover drivers in SUD treatment include caseload size, documentation burden, and supervision quality; workload standards and supervision are the most modifiable levers.

Cultural and linguistic competence requires translated materials, interpreter access, and workforce diversity, and is a condition of many federal funding streams.

Ethical marketing and admissions: no misleading claims, no unlicensed solicitation of clients in crisis, and no compensation for referrals of federal health care program beneficiaries.