NCAC cheat sheet

DSM-5 substance use disorder requires at least 2 of 11 criteria within a 12-month period; 2-3 criteria = mild, 4-5 = moderate, 6 or more = severe.

The 11 DSM-5 criteria are grouped as impaired control (4), social impairment (3), risky use (2), and pharmacological criteria (2: tolerance and withdrawal).

DSM-5 added craving as a criterion and removed the DSM-IV 'legal problems' criterion.

ASAM defines addiction as a chronic, relapsing brain disease involving impaired control, craving, and dysfunction of reward, motivation, memory, and related brain circuits.

The mesolimbic dopamine pathway (ventral tegmental area to nucleus accumbens) is the primary reward circuit; addictive drugs raise synaptic dopamine within it.

Remission specifiers: early remission = at least 3 but less than 12 months without criteria except craving; sustained remission = 12 months or more.

Twin and family studies place the heritability of alcohol dependence at roughly 50 percent.

A diagnosis can be met without tolerance or withdrawal when other criteria are present; these two criteria are substance-specific rather than universal.

Co-occurring mental illness is common in substance use disorder populations, and integrated treatment of both conditions is associated with better outcomes than sequential or parallel care.

ASAM Criteria dimensions: 1 = intoxication and withdrawal potential, 2 = biomedical conditions, 3 = psychiatric and cognitive conditions, 4 = readiness to change, 5 = relapse and continued use potential, 6 = recovery and living environment.

ASAM levels of care: Level 1 outpatient, Level 2 intensive outpatient or partial hospitalization, Level 3 residential, Level 4 medically managed inpatient.

Prochaska and DiClemente stages: precontemplation, contemplation, preparation, action, maintenance; relapse returns the person to an earlier stage rather than ending the process.

Motivational interviewing spirit is partnership, acceptance, compassion, and evocation; core skills are OARS (open questions, affirmations, reflections, summaries).

Methadone is a full mu-opioid agonist (Schedule II, dispensed through an opioid treatment program); buprenorphine is a partial agonist with a ceiling effect; naltrexone is an antagonist.

Naltrexone requires roughly 7-10 days of opioid abstinence before induction to avoid precipitated withdrawal; buprenorphine can precipitate withdrawal if started too soon after a full agonist.

FDA-approved medications for alcohol use disorder: naltrexone (oral and long-acting injectable), acamprosate, and disulfiram.

Contingency management applies operant conditioning by providing verified rewards such as vouchers or prizes for objectively confirmed abstinence or treatment attendance.

Relapse prevention (Marlatt) distinguishes a lapse from a full relapse and targets high-risk situations, coping skills, outcome expectancies, and the abstinence violation effect.

42 CFR Part 2 protects substance use disorder treatment records: disclosure requires written patient consent containing specified elements, and redisclosure of the information is prohibited.

Screening instruments are brief and flag probable problems (CAGE, AUDIT, DAST); assessment is comprehensive and ongoing, establishes diagnosis, and drives treatment planning.

A treatment plan goal is a broad statement of desired outcome; an objective is measurable, behavioral, and time-bound.

Common progress note formats: SOAP (Subjective, Objective, Assessment, Plan) and DAP (Data, Assessment, Plan).

Limits of confidentiality: imminent danger to self or an identifiable other, suspected child or elder abuse, valid court order, and medical emergency.

Trauma-informed care principles: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; cultural, historical, and gender responsiveness.

A relapse prevention plan specifies high-risk situations, coping strategies, support contacts, and a concrete response plan for a lapse.

Suicide risk is assessed by asking directly about ideation, plan, intent, means, and prior attempts, using a structured tool such as the C-SSRS or ASQ.

Reflective listening and summarization predict better retention and outcomes than advice-giving or confrontation.

Core ethical principles: nonmaleficence, beneficence, autonomy, justice, fidelity, and veracity.

Informed consent covers the nature of services, risks and benefits, fees, confidentiality and its limits, counselor qualifications, and the right to refuse or withdraw.

Sexual or romantic relationships with current clients are prohibited without exception; post-termination relationships are governed by a defined waiting period and remain ethically high risk.

A counselor practices within the scope of competence and refers or obtains supervision when client needs exceed training and experience.

Correcting a clinical record: draw a single line through the error, add the date and initials, and write a brief explanation; original text is never obliterated or deleted.

A counselor whose substance use or mental health condition impairs professional judgment must suspend practice and engage treatment or a peer assistance program.

Clinical supervision is ongoing, documented oversight of a counselor's work focused on skill development, ethical practice, and client welfare.

Documentation must be timely, objective, behavioral, and free of speculation because it is a legal record that may be subpoenaed.

Burnout presents as emotional exhaustion, depersonalization or cynicism, and reduced sense of accomplishment; it is distinct from a substance use disorder and raises impairment risk.