NAADAC NCAC II flashcards

44 cards. Read the term and the definition here. The deck at the top of this page is optional.

ASAM dimension 1

Intoxication and withdrawal potential. Assesses current intoxication, risk of severe withdrawal, and need for medically monitored detoxification; rated 0-4 and can alone justify a higher level of care.

ASAM dimension 4

Readiness to change. Rates the client's motivation stage and receptiveness to treatment, using the transtheoretical model. Low readiness alone does not usually mandate a more restrictive level of care.

DSM-5-TR SUD severity

Severity is set by the number of criteria met in 12 months: 2-3 mild, 4-5 moderate, 6 or more severe. A single criterion does not meet the disorder threshold.

Delirium tremens

Severe alcohol withdrawal with confusion, tachycardia, hypertension, fever, and hallucinations, typically arising 48-96 hours after the last drink. It is a medical emergency with meaningful mortality risk.

CRAFFT screening

Six-item adolescent substance use screen: Car, Relax, Alone, Forget, Family/Friends, Trouble. A score of 2 or more is positive and indicates the need for further assessment.

Measurable treatment objective

A specific, behavioral, time-bound statement describing observable change the client will achieve, such as attending three AA meetings weekly for four weeks, allowing progress to be verified at review.

Biopsychosocial assessment

Structured evaluation covering biological, psychological, and social domains, plus strengths and history, used to establish diagnosis, severity, and the appropriate level of care.

Duty to warn

Obligation, recognized in many jurisdictions following Tarasoff, to take protective action when a client poses a serious threat to an identifiable third party; specific requirements vary by state law.

Transtheoretical stages

Precontemplation, contemplation, preparation, action, and maintenance. Interventions are matched to stage; confrontational approaches for precontemplation typically increase dropout and resistance.

Relapse prevention plan

Written identification of high-risk situations, warning signs, coping strategies, and emergency contacts, developed with the client before discharge and reviewed whenever the treatment plan is updated.

OARS

Core motivational interviewing microskills: Open questions, Affirmations, Reflections, and Summaries. Counselors use them to evoke and reinforce the client's own arguments for change.

Change talk

Client statements favoring change, such as desire, ability, reasons, need, and commitment language. Counselors deliberately evoke and reflect it, since commitment talk predicts behavior change.

Sustain talk

Client speech favoring continued use or opposing change. It is treated as normal ambivalence, met with reflection rather than confrontation or correction.

Abstinence violation effect

The guilt, shame, and loss of control following a lapse that turns a single slip into a full relapse. Reframing lapses as learning events reduces this risk.

Contingency management

Reinforcement of verified abstinence with vouchers or prizes. It has the strongest evidence base for stimulant use disorder and requires objective verification such as urine testing.

Twelve-step facilitation

A manualized, evidence-based therapy that actively engages clients in AA or NA, explaining the steps and fellowship. Project MATCH found outcomes comparable to CBT and MI.

Cognitive restructuring

Identifying automatic thoughts that drive substance use, examining supporting and contradicting evidence, and generating a balanced alternative that reduces the urge to use.

Integrated treatment

Coordinated treatment of substance use and co-occurring mental health disorders by one team or a collaborating team, rather than sequential or parallel referral, improving engagement and outcomes.

Trauma-informed care

An organizational and clinical approach built on safety, trustworthiness, peer support, collaboration, empowerment, and cultural humility, avoiding re-traumatization rather than requiring trauma-narrative disclosure.

Double-sided reflection

A reflection that names both the client's argument for change and the argument against it, capturing ambivalence without taking sides or provoking defensiveness.

42 CFR Part 2

Federal regulation protecting records of substance use disorder treatment at federally assisted programs. It requires specific written consent for disclosure and is stricter than HIPAA in most situations.

Mandatory reporting

Legal duty to report suspected child abuse or neglect, elder or dependent-adult abuse, and sometimes threats of serious harm, to the designated authority, overriding confidentiality for that specific purpose.

Subpoena versus court order

A subpoena compels appearance or document production but is not a court order authorizing release of Part 2 records. Counselors must seek legal guidance and typically a special court order.

Informed consent

Documented agreement covering services, fees, confidentiality limits, risks, benefits, alternatives, and the right to withdraw, obtained before treatment begins and revisited when the plan changes.

Dual relationship

A second role with a client, such as business partner, friend, or family member, that risks impaired judgment or exploitation. Nonsexual dual relationships require documented safeguards or avoidance.

Scope of practice

The range of services a counselor is legally and ethically authorized to provide based on licensure and training. Services outside that range require referral or supervision.

Counselor impairment

Diminished professional functioning from substance use, burnout, or untreated mental health conditions. Counselors must withdraw from practice and seek help rather than continue providing services.

Minimum necessary standard

Under HIPAA, disclosures should be limited to the least information needed for the stated purpose. Part 2 programs apply an analogous limiting principle to authorized releases.

Supervision contract

A written agreement specifying supervision goals, methods, frequency, evaluation criteria, documentation, and confidentiality limits, signed at the outset and revisited as the supervisee develops.

Discrimination model

Bernard's framework crossing three supervisor roles (teacher, counselor, consultant) with three foci (intervention, conceptualization, personalization) to select the response a supervisee needs.

Developmental supervision

The principle that supervision should become less directive and more collaborative as supervisee competence and autonomy increase, matching structure to the supervisee's current developmental level.

Gatekeeping duty

The supervisor's ethical obligation to remediate, or when remediation fails, prevent supervisees who are unsafe or incompetent from advancing, using documented due process.

Live observation

Direct observation of sessions through recording, co-therapy, or one-way observation. It yields more valid information than supervisee self-report and supports specific behavioral feedback.

Supervision versus therapy

Supervision focuses on client care and professional development; personal therapy addresses the supervisee's own history. Personal issues are explored only as they affect clinical work.

Supervision documentation

Records kept separately from client files that note dates, topics, directives, observed performance, and progress toward goals, supporting evaluation and gatekeeping decisions.

CARF accreditation

A voluntary accreditation by the Commission on Accreditation of Rehabilitation Facilities that signals quality and is often required for payer contracts; it is distinct from state licensure to operate.

Medical necessity

The payer's criterion that services are reasonable and required to diagnose or treat a condition. Documentation must link assessed symptoms to the level of care and interventions billed.

Prior authorization

Payer approval obtained before delivering specified services. Missing authorization commonly causes claim denials, so eligibility and authorization are verified before the first billable session.

PDSA cycle

Plan-Do-Study-Act, a rapid quality improvement method for testing a small change, measuring results, and then adopting, adapting, or abandoning the change before spreading it.

Access and engagement metric

A measurable indicator such as the percentage of clients seen within seven days of first contact or retained at 30 and 90 days, used to evaluate program performance objectively.

Anti-kickback statute

Federal law prohibiting remuneration for referrals of items or services paid by federal health care programs. It constrains marketing arrangements and referral payments in treatment programs.

HIPAA Security Rule

Requires administrative, physical, and technical safeguards to protect electronic protected health information, including access controls, audit logs, encryption, and workforce training.

Sliding fee scale

A reduced-fee schedule based on documented income, applied consistently and published in policy, so that discounts do not function as improper inducements or discriminatory pricing.

Caseload and turnover

Excessive caseloads and documentation burden are consistent predictors of counselor turnover; adjusting workload and strengthening supervision are the most modifiable retention levers.