Assessment and Diagnosis
Assessment gathers the biopsychosocial picture: substance use history (onset, pattern, consequences, prior treatment), medical and psychiatric comorbidity, family and social history, strengths, and readiness for change. Candidates must understand the DSM-5-TR substance use disorder criteria (impaired control, social impairment, risky use, pharmacological criteria) and the mild/moderate/severe threshold (2–3, 4–5, 6+ criteria). Distinguish substance use disorders from intoxication, withdrawal, and substance-induced disorders.
Traps include: counting tolerance and withdrawal as required criteria (they are not required and may be absent); confusing a diagnosis with a screening score; missing co-occurring disorders; and overlooking that diagnosis must be based on a qualifying time frame (e.g., 12 months) and clinically significant impairment. Also know the difference between a provisional diagnosis and one requiring further information, and the role of collateral information with proper consent.
Rule of thumb: diagnosis requires a pattern of criteria within a 12-month period causing clinically significant impairment or distress-not a single event or a positive lab.
Worked example: A client meets criteria for impaired control, craving, continued use despite health problems, and tolerance-four criteria-so the diagnosis is moderate substance use disorder. A candidate who labels it severe because tolerance and withdrawal are 'serious' has fallen into the count trap.