MAC (NBCRNA) cheat sheet

DSM-5-TR substance use disorder severity is counted from 11 criteria: 2-3 mild, 4-5 moderate, 6 or more severe; remission is specified as early (3-12 months) or sustained (over 12 months).

Tolerance and withdrawal are not counted toward the 11 criteria when the substance is taken solely under appropriate medical supervision (e.g., prescribed opioids, benzodiazepines).

A diagnosis of substance intoxication requires reversible, substance-specific maladaptive behavioral or psychological changes developing during or shortly after use, plus physiologic evidence of use.

Withdrawal requires substance-specific symptoms plus clinically significant distress or impairment; physiological dependence alone does not equal a substance use disorder.

ASAM criteria place clients along six dimensions (intoxication/withdrawal risk, biomedical, emotional/behavioral, readiness to change, relapse potential, recovery environment) to determine level of care.

The AUDIT-C screens with 3 items (score 0-12); a score of 4 or more in men and 3 or more in women is a positive screen warranting further assessment.

The CAGE has 4 yes/no items (Cut down, Annoyed, Guilty, Eye-opener); 2 or more positive responses suggest clinically significant alcohol problems.

The CIWA-Ar has 10 items and scores 0-67; scores of 8-15 indicate mild withdrawal, and scores above 15 indicate risk of severe withdrawal requiring medication protocols.

Differential diagnosis must rule out medical conditions and other substances; the DSM-5-TR specifier 'in early remission' applies when no criteria are met for at least 3 but less than 12 months.

A compliant treatment plan contains problem statements, measurable goals, specific objectives, interventions with responsible parties, and target dates; objectives must be behavioral and time-bound.

Motivational interviewing uses the OARS microskills: open questions, affirmations, reflective listening, and summaries; sustain talk predicts poorer outcomes and change talk predicts behavior change.

The stages of change are precontemplation, contemplation, preparation, action, and maintenance; relapse is a return to an earlier stage rather than a failure of the model.

Contingency management reinforces verified abstinence with tangible rewards; prize-based or voucher schedules with escalating value show the strongest evidence for stimulant use disorder.

Cognitive behavioral relapse prevention distinguishes a lapse (single use) from a relapse (return to prior pattern) and targets high-risk situations, coping skills, and abstinence violation effects.

Medication-assisted treatment includes methadone and buprenorphine for opioid use disorder and naltrexone for opioid or alcohol use disorder; counseling is an adjunct, not a prerequisite for medication access.

Twelve-step facilitation is a structured, manualized approach that differs from simple referral; it explains sponsorship, working the steps, and attendance expectations.

Treatment plan reviews occur at least every 90 days in many licensing standards and must document progress toward objectives, revision of goals, and client participation.

42 CFR Part 2 protects records of federally assisted substance use disorder programs; disclosure requires written patient consent that specifies recipient, purpose, and expiration, and it remains stricter than HIPAA.

HIPAA permits disclosure without authorization for treatment, payment, and operations, but Part 2 records require consent even for most treatment communications with outside providers.

Mandatory child abuse reporting overrides confidentiality; the clinician reports to the designated state authority and documents the report, but does not need to investigate or notify the alleged abuser.

Duty to warn or protect (Tarasoff-derived) applies when a client poses a serious threat to an identifiable third party; the clinician takes protective action permitted by state law and documents the rationale.

Informed consent requires disclosure of the nature of services, risks and benefits, alternatives, fees, confidentiality limits, and the right to withdraw consent at any time.

Dual relationships are problematic when they risk exploitation or impaired objectivity; not all are prohibited, but the clinician documents the rationale and safeguards when avoidance is not feasible.

The 2014 SAMHSA/NAADAC code and most state boards prohibit sexual relationships with current clients and typically impose a period (commonly 2-5 years, varies by state) after termination.

Records must be retained per state and payer rules; many jurisdictions require retention of adult records for 5-7 years after last service and minors' records until age of majority plus the retention period.

The discrimination model of supervision uses three supervisor roles (teacher, counselor, consultant) applied across three focus areas (intervention skills, conceptualization, personalization).

Developmental supervision models (e.g., Stoltenberg's IDM) progress supervisees through stages from dependent to autonomous, with supervisor style shifting from directive to collaborative.

Supervision contracts specify goals, methods, frequency, duration, evaluation criteria, documentation, and limits of confidentiality, including how client risk information is shared.

Supervisor liability is vicarious; the supervisor is responsible for client welfare and must ensure supervisee competence, informed consent disclosure of supervisee status, and crisis protocols.

Live observation, co-therapy, or recorded sessions provide more valid data than self-report alone; feedback should be specific, behavioral, and timely.

A 1:1 supervision ratio is commonly defined by state rule; many boards require roughly one hour of individual supervision per 20-40 hours of clinical work for licensure candidates.

Burnout differs from compassion fatigue: burnout involves emotional exhaustion, depersonalization, and reduced efficacy, while compassion fatigue is secondary traumatic stress from exposure to client trauma.

Documentation standards require contemporaneous notes covering session date, service, client response, plan, and any risk assessment; late entries are marked as such rather than altered.

Integrated treatment for co-occurring disorders delivers mental health and substance use services by the same team in the same setting; sequential and parallel models show weaker outcomes.

The quadrant model of co-occurring disorders classifies clients by severity of mental illness and severity of substance use, guiding service intensity across four quadrants.

Alcohol withdrawal can be fatal; risk rises with prior withdrawal seizures or delirium tremens, and benzodiazepines are first-line for management while antipsychotics do not prevent seizures.

Opioid overdose response includes naloxone administration, calling emergency services, and rescue breathing; naloxone precipitates withdrawal but is not harmful in opioid-naive individuals.

Adolescent treatment requires developmentally adapted assessment, family involvement, and attention to confidentiality limits with guardians; medication decisions weigh developmental and legal consent rules.

Pregnant clients with opioid use disorder should be offered methadone or buprenorphine; abrupt detoxification increases risk of relapse and fetal distress.

Trauma-informed care assumes widespread trauma prevalence, prioritizes safety, choice, and collaboration, and avoids reenactment; it does not require trauma disclosure to provide services.

Older adults metabolize alcohol and drugs more slowly and are more sensitive to benzodiazepine-related falls and cognitive impairment; screening tools such as the AUDIT perform reasonably well in this group.

DSM-5-TR substance use disorder severity is counted from 11 criteria: 2-3 mild, 4-5 moderate, 6 or more severe; remission is specified as early (3-12 months) or sustained (over 12 months).

Tolerance and withdrawal are not counted toward the 11 criteria when the substance is taken solely under appropriate medical supervision (e.g., prescribed opioids, benzodiazepines).

A diagnosis of substance intoxication requires reversible, substance-specific maladaptive behavioral or psychological changes developing during or shortly after use, plus physiologic evidence of use.

Withdrawal requires substance-specific symptoms plus clinically significant distress or impairment; physiological dependence alone does not equal a substance use disorder.

ASAM criteria place clients along six dimensions (intoxication/withdrawal risk, biomedical, emotional/behavioral, readiness to change, relapse potential, recovery environment) to determine level of care.

The AUDIT-C screens with 3 items (score 0-12); a score of 4 or more in men and 3 or more in women is a positive screen warranting further assessment.

The CAGE has 4 yes/no items (Cut down, Annoyed, Guilty, Eye-opener); 2 or more positive responses suggest clinically significant alcohol problems.

The CIWA-Ar has 10 items and scores 0-67; scores of 8-15 indicate mild withdrawal, and scores above 15 indicate risk of severe withdrawal requiring medication protocols.

Differential diagnosis must rule out medical conditions and other substances; the DSM-5-TR specifier 'in early remission' applies when no criteria are met for at least 3 but less than 12 months.

A compliant treatment plan contains problem statements, measurable goals, specific objectives, interventions with responsible parties, and target dates; objectives must be behavioral and time-bound.

Motivational interviewing uses the OARS microskills: open questions, affirmations, reflective listening, and summaries; sustain talk predicts poorer outcomes and change talk predicts behavior change.

The stages of change are precontemplation, contemplation, preparation, action, and maintenance; relapse is a return to an earlier stage rather than a failure of the model.

Contingency management reinforces verified abstinence with tangible rewards; prize-based or voucher schedules with escalating value show the strongest evidence for stimulant use disorder.

Cognitive behavioral relapse prevention distinguishes a lapse (single use) from a relapse (return to prior pattern) and targets high-risk situations, coping skills, and abstinence violation effects.

Medication-assisted treatment includes methadone and buprenorphine for opioid use disorder and naltrexone for opioid or alcohol use disorder; counseling is an adjunct, not a prerequisite for medication access.

Twelve-step facilitation is a structured, manualized approach that differs from simple referral; it explains sponsorship, working the steps, and attendance expectations.

Treatment plan reviews occur at least every 90 days in many licensing standards and must document progress toward objectives, revision of goals, and client participation.

42 CFR Part 2 protects records of federally assisted substance use disorder programs; disclosure requires written patient consent that specifies recipient, purpose, and expiration, and it remains stricter than HIPAA.

HIPAA permits disclosure without authorization for treatment, payment, and operations, but Part 2 records require consent even for most treatment communications with outside providers.

Mandatory child abuse reporting overrides confidentiality; the clinician reports to the designated state authority and documents the report, but does not need to investigate or notify the alleged abuser.

Duty to warn or protect (Tarasoff-derived) applies when a client poses a serious threat to an identifiable third party; the clinician takes protective action permitted by state law and documents the rationale.

Informed consent requires disclosure of the nature of services, risks and benefits, alternatives, fees, confidentiality limits, and the right to withdraw consent at any time.

Dual relationships are problematic when they risk exploitation or impaired objectivity; not all are prohibited, but the clinician documents the rationale and safeguards when avoidance is not feasible.

The 2014 SAMHSA/NAADAC code and most state boards prohibit sexual relationships with current clients and typically impose a period (commonly 2-5 years, varies by state) after termination.

Records must be retained per state and payer rules; many jurisdictions require retention of adult records for 5-7 years after last service and minors' records until age of majority plus the retention period.

The discrimination model of supervision uses three supervisor roles (teacher, counselor, consultant) applied across three focus areas (intervention skills, conceptualization, personalization).

Developmental supervision models (e.g., Stoltenberg's IDM) progress supervisees through stages from dependent to autonomous, with supervisor style shifting from directive to collaborative.

Supervision contracts specify goals, methods, frequency, duration, evaluation criteria, documentation, and limits of confidentiality, including how client risk information is shared.

Supervisor liability is vicarious; the supervisor is responsible for client welfare and must ensure supervisee competence, informed consent disclosure of supervisee status, and crisis protocols.

Live observation, co-therapy, or recorded sessions provide more valid data than self-report alone; feedback should be specific, behavioral, and timely.

A 1:1 supervision ratio is commonly defined by state rule; many boards require roughly one hour of individual supervision per 20-40 hours of clinical work for licensure candidates.

Burnout differs from compassion fatigue: burnout involves emotional exhaustion, depersonalization, and reduced efficacy, while compassion fatigue is secondary traumatic stress from exposure to client trauma.

Documentation standards require contemporaneous notes covering session date, service, client response, plan, and any risk assessment; late entries are marked as such rather than altered.

Integrated treatment for co-occurring disorders delivers mental health and substance use services by the same team in the same setting; sequential and parallel models show weaker outcomes.

The quadrant model of co-occurring disorders classifies clients by severity of mental illness and severity of substance use, guiding service intensity across four quadrants.

Alcohol withdrawal can be fatal; risk rises with prior withdrawal seizures or delirium tremens, and benzodiazepines are first-line for management while antipsychotics do not prevent seizures.

Opioid overdose response includes naloxone administration, calling emergency services, and rescue breathing; naloxone precipitates withdrawal but is not harmful in opioid-naive individuals.

Adolescent treatment requires developmentally adapted assessment, family involvement, and attention to confidentiality limits with guardians; medication decisions weigh developmental and legal consent rules.

Pregnant clients with opioid use disorder should be offered methadone or buprenorphine; abrupt detoxification increases risk of relapse and fetal distress.

Trauma-informed care assumes widespread trauma prevalence, prioritizes safety, choice, and collaboration, and avoids reenactment; it does not require trauma disclosure to provide services.

Older adults metabolize alcohol and drugs more slowly and are more sensitive to benzodiazepine-related falls and cognitive impairment; screening tools such as the AUDIT perform reasonably well in this group.