MAC (NBCRNA) flashcards

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

Substance use disorder severity

Counting DSM-5-TR criteria: 2-3 criteria indicate mild disorder, 4-5 indicate moderate, and 6 or more indicate severe disorder. Remission is graded by duration since last criterion was met.

AUDIT-C positive screen

A three-item alcohol screen scored 0 to 12. A score of 4 or more in men or 3 or more in women is positive and warrants a fuller assessment for alcohol use disorder.

CAGE questionnaire

Four yes/no items: Cut down, Annoyed, Guilty, Eye-opener. Two or more positive answers suggest clinically significant alcohol problems and prompt further diagnostic evaluation.

CIWA-Ar scoring

A ten-item scale scored 0 to 67 for alcohol withdrawal. Scores of 8 to 15 indicate mild withdrawal; scores above 15 signal risk of severe withdrawal requiring medication protocols.

ASAM six dimensions

Assessment framework covering intoxication and withdrawal risk, biomedical conditions, emotional and behavioral conditions, readiness to change, relapse potential, and recovery environment to determine appropriate level of care.

Physiological dependence distinction

Tolerance and withdrawal reflect physiological dependence but are not counted toward DSM-5-TR criteria when the substance is used solely under appropriate medical supervision, as with prescribed opioids.

Early versus sustained remission

Early remission means no criteria met for at least 3 but less than 12 months; sustained remission means 12 months or more, excluding craving or urges in some substance categories.

OARS microskills

Core motivational interviewing skills: open-ended questions, affirmations, reflective listening, and summaries. These build engagement and evoke change talk rather than sustain talk.

Stages of change

Precontemplation, contemplation, preparation, action, and maintenance. Relapse represents a return to an earlier stage and is treated as part of the change process, not failure.

Contingency management

Reinforcing verified abstinence with tangible rewards such as vouchers or prizes. Escalating-value schedules show the strongest evidence, particularly for stimulant use disorder.

Lapse versus relapse

A lapse is a single episode of use; a relapse is a return to the prior pattern of use. Relapse prevention targets high-risk situations, coping skills, and abstinence violation effects.

Treatment plan elements

A compliant plan states the problem, measurable goals, behavioral and time-bound objectives, specific interventions, responsible parties, and target dates, and is reviewed and revised on schedule.

Medication for opioid use disorder

Methadone and buprenorphine are evidence-based treatments for opioid use disorder. Counseling is an adjunct; no counseling prerequisite should delay access to medication.

Twelve-step facilitation

A structured, manualized approach explaining sponsorship, step work, and attendance expectations. It differs from simple referral and is delivered as an active clinical intervention.

42 CFR Part 2 consent

Records of federally assisted substance use disorder programs require written patient consent specifying recipient, purpose, and expiration. Part 2 remains stricter than HIPAA for most disclosures.

Mandatory reporting override

Child abuse reporting laws override client confidentiality. The clinician reports to the designated state authority and documents the report without investigating or notifying the alleged abuser.

Duty to warn

When a client poses a serious threat to an identifiable third party, the clinician takes protective action permitted by state law, such as warning or notifying authorities, and documents the rationale.

Informed consent elements

Disclosure of service nature, risks and benefits, alternatives, fees, confidentiality limits, and the right to withdraw consent at any time, documented before treatment begins.

Dual relationship threshold

Not all dual relationships are prohibited. They become unethical when they risk exploitation or impaired objectivity; when unavoidable, the clinician documents safeguards and rationale.

Record retention rule

Retention follows state and payer rules; common standards keep adult records 5 to 7 years after last service and minors' records until majority plus the retention period.

Discrimination model

A supervision model applying three supervisor roles, teacher, counselor, and consultant, across three focus areas: intervention skills, conceptualization, and personalization of the supervisee.

Developmental supervision stages

Models such as Stoltenberg's IDM move supervisees from dependent to autonomous practice, shifting supervisor style from directive early on to collaborative and consultative later.

Supervision contract contents

Written agreement specifying goals, methods, frequency, duration, evaluation criteria, documentation, and confidentiality limits, including how client risk information is shared with the supervisor.

Vicarious supervisor liability

Supervisors are legally responsible for client welfare. They must verify supervisee competence, ensure clients know the supervisee's status, and maintain crisis protocols.

Live observation value

Recorded sessions, co-therapy, and live observation yield more valid data than supervisee self-report. Feedback should be specific, behavioral, and delivered close to the observed session.

Burnout versus compassion fatigue

Burnout involves emotional exhaustion, depersonalization, and reduced efficacy. Compassion fatigue is secondary traumatic stress from exposure to clients' trauma material.

Contemporaneous documentation

Notes record session date, service provided, client response, plan, and any risk assessment. Late entries are labeled as late rather than altered or backdated.

Integrated co-occurring treatment

Mental health and substance use services delivered by the same team in the same setting. Sequential and parallel models, where services are separate, show weaker outcomes.

Quadrant model

Classifies co-occurring clients by severity of mental illness and severity of substance use across four quadrants, guiding service intensity and coordination between systems.

Alcohol withdrawal risk

Withdrawal can be fatal, especially after prior seizures or delirium tremens. Benzodiazepines are first-line management; antipsychotics do not prevent withdrawal seizures.

Opioid overdose response

Administer naloxone, call emergency services, and provide rescue breathing. Naloxone precipitates withdrawal but is not dangerous in opioid-naive individuals.

Pregnancy and opioid use disorder

Methadone or buprenorphine should be offered during pregnancy. Abrupt detoxification raises relapse and fetal distress risk, so medication is preferred over withdrawal management.