ALCOHOL AND DRUG COUNSELOR (ADC) EXAM 2026–2027

Alcohol is a depressant that can cause or worsen depression, and depression can lead to drinking. Using a tool such as the PHQ-9 helps screen for depression, once the person has been abstinent for a time.

They co-occur at high rates, particularly in justice-involved populations. Antisocial personality disorder shows a long pattern of disregard for and violation of others' rights.

They co-occur very often. Substances can trigger mood episodes, stimulants may precipitate mania, and substance use worsens the course of illness and treatment adherence.

They co-occur frequently. Borderline personality disorder involves unstable relationships and self-image, impulsivity and self-harm, and dialectical behavior therapy is an effective approach.

They often co-occur. Stimulants, laxatives or diet pills may be misused for weight control, and alcohol or other drugs may be used to cope. Both conditions need to be addressed together.

HIV spreads through shared needles and through risky sexual behavior while intoxicated. Harm reduction includes testing, syringe services programs, PrEP, condoms and linkage to care.

By timing and course: symptoms that start during or soon after use or withdrawal and fade within about a month of abstinence suggest a substance-induced disorder, while symptoms that predate use or persist suggest an independent one.

Panic attacks bring a sudden surge of intense fear with palpitations, sweating and dread. Stimulants, caffeine and withdrawal from alcohol or sedatives can mimic them, so timing of use should be examined.

In stages: fatty liver, alcoholic hepatitis, fibrosis and cirrhosis. Fatty liver can reverse with abstinence, but cirrhosis is largely irreversible and raises the risk of liver failure and cancer.

It is the one behavioral addiction included in the Substance-Related and Addictive Disorders chapter, because it shares reward-system features and symptoms such as craving, tolerance and loss of control.

Persistent depressive disorder (dysthymia) is a chronic, milder depressed mood lasting at least two years in adults, while major depression involves discrete episodes of more severe symptoms.

Rates of smoking, alcohol and cannabis use are high. Substance use worsens symptoms, increases relapse and hospitalization, and lowers medication adherence.

It raises the risk. Intoxication lowers inhibition and impairs judgment, and risk factors include prior attempts, hopelessness, recent losses, access to lethal means, depression and isolation.

Untreated ADHD raises the risk of substance use disorders and earlier onset. Treatment is possible with careful monitoring, long-acting or non-stimulant medication, and attention to misuse and diversion.

Excessive anxiety and worry occurring more days than not for at least six months, with restlessness, fatigue, poor concentration, irritability, muscle tension or sleep disturbance. People often use alcohol or benzodiazepines to cope.

People with social anxiety may drink to reduce fear in social situations, which raises the risk of alcohol use disorder and keeps the underlying anxiety untreated.

Ask directly and without judgment about thoughts, plan, intent, means and prior attempts. Asking does not plant the idea, and structured tools such as the Columbia Suicide Severity Rating Scale help.

With medication such as methadone or buprenorphine and prenatal care, rather than detoxification alone, because withdrawal can harm the fetus. Newborns may need monitoring for neonatal opioid withdrawal syndrome.

Positive symptoms are hallucinations, delusions and disorganized speech or behavior. Negative symptoms are flat affect, reduced speech, and lack of motivation. Cognitive problems also occur.

Intrusion (flashbacks, nightmares), avoidance, negative changes in thoughts and mood, and arousal and reactivity (hypervigilance, irritability, sleep problems), lasting more than a month after trauma.

Five or more symptoms for at least two weeks, including depressed mood or loss of interest, plus changes in sleep, appetite, energy, concentration, guilt or worthlessness, and thoughts of death.

At least one week of elevated or irritable mood with increased energy, decreased need for sleep, grandiosity, pressured speech, racing thoughts, distractibility and risky behavior.

Cluster A odd or eccentric (paranoid, schizoid, schizotypal), Cluster B dramatic or erratic (antisocial, borderline, histrionic, narcissistic), and Cluster C anxious or fearful (avoidant, dependent, obsessive-compulsive).

Sequential (one after the other), parallel (separate providers at the same time) and integrated (one team treats both together). Integrated treatment is the best practice.

Stimulants can cause heart attack, arrhythmia and stroke, and heavy alcohol use causes hypertension and cardiomyopathy. Injection drug use can cause endocarditis.

A framework that sorts clients by the severity of mental health and substance use problems (low or high on each) to guide where care should be delivered and how services should coordinate.

Gastritis, ulcers, GI bleeding, esophageal varices and pancreatitis, along with poor absorption of nutrients such as thiamine and folate.

The presence of both a substance use disorder and a mental health disorder in the same person, sometimes called dual diagnosis. Each condition affects the other and both need treatment.

A written, collaborative plan listing personal warning signs, coping strategies, people and places for distraction, people to ask for help, professionals and crisis lines, and steps to limit access to lethal means.

A present-focused, evidence-based integrated treatment for PTSD and substance use that teaches safe coping skills and does not require the client to retell the trauma story.

The idea that some people use substances to relieve symptoms of mental illness or distress, such as using alcohol for anxiety or opioids for emotional pain.

Smoking tobacco or other substances can cause chronic bronchitis, COPD and cancer, and opioids, sedatives and alcohol can slow breathing to dangerous levels.

Amphetamines, cocaine, hallucinogens, PCP, cannabis (especially high-potency and synthetic forms), and alcohol or sedative withdrawal.

They spread through shared injection equipment and are common among people who inject. Hepatitis B can be prevented by vaccination, and hepatitis C is now curable with direct-acting antivirals.

Risky sexual behavior while using, sex for drugs, crowded settings, and homelessness raise exposure, so routine testing, education and referral are part of care.

Generally no. It remains confidential unless a specific legal duty applies, such as ongoing child abuse, and Part 2 limits reporting of crimes to those on the premises or against staff.

They are kept separate from the medical record and have extra protection. Most disclosures require a specific patient authorization, and the patient has no general right of access.

It aligned Part 2 more closely with HIPAA, allowing one patient consent for all future treatment, payment and health care operations, adding breach notification, and strengthening protections against use of records in legal proceedings. Check current compliance rules.

HIPAA allows disclosures for treatment, payment and operations without a specific authorization. Part 2 has historically required specific written consent for most disclosures, with the rules narrowing the gap since 2024.

A patient referred by probation, parole or a court may sign a consent to share treatment attendance and progress with the criminal justice system that can be irrevocable until a stated event, such as the end of the case.

It depends on state law. Some states allow minors to consent to their own substance use treatment, and Part 2 follows state law on who may consent and who may receive information.

The counselor explains what will be reported to the court or probation, that the client chooses whether to participate, and the consequences of refusing, and obtains a signed release.

No. A subpoena alone is not sufficient. Disclosure requires patient consent or a court order that follows Part 2 procedures and findings, and the program should seek legal advice.

No. It is an ongoing process, revisited when services, risks, fees or the plan change, and documented in the record.

Only with the client's written consent, or as the law permits. A counselor may listen to family without confirming anything, and can offer general education.

Only for a crime committed on the premises or against program personnel, and then only limited information such as circumstances and the suspect's identity. Past crimes disclosed in treatment stay confidential.

No. Acknowledging that someone is a patient at a substance use treatment program reveals protected information, so staff may not confirm or deny it without consent.

In many states, yes. Reporting duties vary by state and by the counselor's role, so counselors must know their state law.

The nature and goals of services, risks and benefits, alternatives, fees, confidentiality and its limits, the counselor's qualifications and supervision, record-keeping, and the right to refuse or withdraw.

Medical emergencies, qualified research, audit and program evaluation, a crime on the program's premises or against its staff, reports of suspected child abuse, and a court order that meets Part 2 requirements.

Civil and criminal penalties, which the 2024 rule aligned with HIPAA penalties, in addition to loss of trust, licensing action and civil liability.

Use secure, compliant platforms, confirm the client's identity and location, protect the session from being overheard, avoid unsecured texting or email for clinical content, and include telehealth in informed consent.

Protected health information held or transmitted by covered entities and their business associates, by limiting uses and disclosures and giving patients rights over their information.

Administrative, physical and technical safeguards for electronic protected health information, such as access controls, encryption, audit logs, workstation security and staff training.

A federal regulation that protects the confidentiality of substance use disorder patient records from federally assisted programs. It is stricter than HIPAA and exists so that people will not avoid treatment out of fear of exposure.

A document that tells patients how their information may be used and disclosed and describes their rights, which covered providers must give at the first service and make available.

A written agreement under which an outside service provider, such as a lab or billing company, receives Part 2 information to serve the program, and agrees to protect it and follow Part 2.

Disclosing only the smallest amount of information needed for the purpose, which applies to most uses and disclosures other than treatment.

The patient's name, who is disclosing and who will receive the information, the purpose, how much and what kind of information, the patient's signature and date, a statement that consent may be revoked, and an expiration date or event.

Notify affected individuals without unreasonable delay and no later than 60 days after discovery, and notify HHS, and for large breaches the media.

Capacity to understand, adequate information in clear language, and voluntariness without coercion. Capacity may be affected by intoxication, withdrawal or acute mental illness.

To see and get a copy of their records, request amendments, receive an accounting of disclosures, request restrictions, ask for confidential communications, and file a complaint.

When a client poses a serious, imminent danger to self or others, in cases of suspected child, elder or dependent adult abuse, when ordered by a court, or in a medical emergency, subject to federal and state law.

At the first session, in plain language and in writing, and again when the issue arises, so clients can decide what to share.

Federally assisted programs that hold themselves out as providing substance use disorder diagnosis, treatment or referral, including specialized units in general medical settings.

The client rates, on a scale of 0 to 10, how important change is and how confident they are. The counselor asks why the number is not lower, to evoke change talk.

Empathy is understanding and reflecting the client's feelings and perspective without taking them on. Sympathy is feeling sorry for the client, which can create distance or imply pity.

Explore ambivalence, tip the decisional balance, evoke reasons for change and build confidence, without pressing for a decision.

Build rapport, raise doubt and awareness gently, provide information with permission, and avoid pushing for action that the client is not ready for.

Help set specific goals, develop a plan, strengthen commitment, teach coping skills and arrange supports, then reinforce progress.

Visual, auditory, reading and writing, and kinesthetic. Matching handouts, discussion, written exercises and role play to the client improves understanding.

Resist the righting reflex, Understand the client's own motivations, Listen with empathy, and Empower the client.

Engaging, focusing, evoking and planning.

Giving full attention, using nonverbal encouragers, paraphrasing, reflecting feelings, asking open questions, clarifying, summarizing, and avoiding interrupting, advising too soon or judging.

Passive avoids stating needs, aggressive pushes needs at others' expense, and assertive states needs clearly and respectfully. Teaching assertiveness helps clients refuse drugs and set boundaries.

Precontemplation, contemplation, preparation, action and maintenance, with relapse possible and treated as part of the process. Interventions should match the stage.

Collecting summaries gather what the client said, linking summaries connect ideas such as ambivalence and values, and transitional summaries mark movement to a new topic or phase.

Helping the client see a gap between current behavior and their values or goals, so that the client, and not the counselor, voices the reasons for change.

Not opposing it or arguing, but responding with reflection, empathy or a shift in approach, so the client's resistance is reduced and the conversation moves forward.

A structured look at the pros and cons of changing and of staying the same, which helps a client explore ambivalence and clarify their values.

Acknowledging both sides of the client's ambivalence in one statement, often joined by "and," such as "You enjoy drinking with friends, and you're worried about what it's doing to your health."

Holding two conflicting feelings about change at once, such as wanting to stop using while also wanting to continue. It is a normal part of the change process, not a sign of denial or lack of motivation.

Reflecting what the client said in an exaggerated form, without sarcasm, so the client pulls back and voices the other side, for example "So there's no reason at all to change."

Client statements that favor change. Preparatory change talk is Desire, Ability, Reasons and Need, and mobilizing change talk is Commitment, Activation and Taking steps.

Checking the counselor's understanding, or asking the client to explain unclear statements, to make sure both are on the same page and to prevent misunderstanding.

A signal of strain in the relationship, such as defensiveness or arguing, often caused by counselor behavior. The counselor responds by changing approach, reflecting and emphasizing the client's choice.

A way to share information respectfully: ask what the client already knows, offer information with permission, then ask for the client's reaction and understanding.

Being authentic and consistent in words, behavior and attitude, so the client experiences the counselor as honest and real. It is one of Rogers' core conditions.

Words that put the person before the condition, such as "person with a substance use disorder" instead of "addict" or "abuser," which reduces stigma and supports engagement.

A trusting, collaborative relationship between counselor and client. It predicts engagement, honesty and retention in treatment, and is a basis of change in counseling.

Offering a new way to see a situation or behavior so it takes on a different meaning, for example presenting a relapse as useful information about what to strengthen.

Client behavior that signals disagreement or discord, such as arguing, interrupting, denying, ignoring or changing the subject. It often reflects ambivalence or a counselor approach that is moving too fast.

Client statements that favor staying the same, such as reasons to keep using. A counselor responds with reflection and explores ambivalence instead of arguing.

The urge to fix a client's problem by giving advice and correcting, which often triggers resistance and is resisted in motivational interviewing.

Sit Squarely, Open posture, Lean slightly forward, appropriate Eye contact and Relaxed manner, which show attention and openness. Cultural norms can change what is appropriate.

A collaborative, evocative approach summarized as PACE: Partnership, Acceptance, Compassion and Evocation, which respect the client's autonomy and draw out their own reasons for change.

Accepting and valuing the client as a person without judgment, even when disapproving of certain behavior, so the client feels safe to explore their problems.

Posture, eye contact, facial expression, tone and pace of voice, fidgeting or restlessness, and incongruence between words and body language. Their meaning can vary across cultures.

Arguing for change leads the client to defend the other side and hold on more tightly, which increases resistance and sustain talk and damages rapport.

Reminding clients that the decision to change is theirs lowers defensiveness and supports autonomy, which is more likely to produce lasting change than pressure.

In most states, yes. They must report reasonable suspicion of child abuse or neglect to the authorities, and 42 CFR Part 2 permits such reports.

Trauma-informed care changes the whole approach so that services are sensitive to trauma and avoid harm. Trauma-specific services are treatments aimed directly at healing trauma, such as Seeking Safety or trauma-focused CBT.

Trauma results from an event, series of events or set of circumstances that is experienced as physically or emotionally harmful or life-threatening and has lasting adverse effects on functioning and wellbeing.

Provide accessible facilities, communication aids such as sign language interpretation, materials in suitable formats, and flexibility in pacing, as required by the Americans with Disabilities Act.

Prioritize safety and medical needs, do not confront, avoid counseling tasks, arrange safe transport and a medical evaluation if needed, and reschedule the session.

Reduce stimulation, speak simply and calmly, do not argue with delusions, keep a safe distance and exit, avoid touching, and seek emergency help if there is danger.

Believe and support the client, assess immediate safety, help with a safety plan and local resources, avoid couples counseling at first, and follow reporting rules.

Coordinate with the prescriber, use non-opioid and non-drug pain approaches, and keep medication for opioid use disorder in place. Pain and addiction both need treatment.

With a brief validated screen such as the PC-PTSD-5, without forcing details, explaining why the questions are asked, offering choice and pacing, and referring for a trauma assessment if positive.

Strategies that bring a person back to the present during flashbacks or distress, such as naming things seen or heard, slow breathing, holding a cold object, or describing the room.

Safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and attention to cultural, historical and gender issues.

Limited service availability, long travel distances, stigma, lack of privacy and fewer providers. Telehealth, mobile services and community partnerships can improve access.

Automatic survival reactions to threat: fight is aggression or confrontation, flight is escape or avoidance, and freeze is immobility or shutdown. Clients may show them in session.

Ensure safety, stabilize the person, reduce distress, restore prior level of functioning and link the person to ongoing resources.

Gender-responsive, trauma-informed services, child care, safe women's groups, attention to violence and relationships, and support that reduces shame and barriers such as custody fears.

Stay calm, speak in a low, slow voice, listen and show empathy, give space, avoid arguing or threatening postures, offer simple choices, and keep the environment quiet and safe.

Assess lethality and safety, establish rapport, identify major problems, deal with feelings and emotions, generate and explore alternatives, implement an action plan, and follow up.

Stigma, norms of self-reliance, and reluctance to show vulnerability can delay help-seeking. Engagement works best with respectful, practical, strengths-based approaches.

An ongoing stance of self-reflection, openness and learning about the client's culture and experiences, recognizing power imbalances, disparities in care and historical mistrust of systems.

A time-limited state in which a person's usual coping and problem-solving abilities are overwhelmed by a hazardous event, leading to distress and impaired functioning.

A court-supervised program combining treatment, frequent drug testing, judicial monitoring, and incentives and sanctions, as an alternative to incarceration for people with substance use disorders.

Exposure to repeated or prolonged trauma, often in childhood and within relationships, which affects emotion regulation, identity, trust and relationships and is linked to a high risk of substance use.

Reliving trauma through an experience that resembles the original. Confrontational methods, loss of control, restraint, forced disclosure of details, and lack of privacy can retraumatize clients.

From Tarasoff, a duty in many states for a counselor to take reasonable steps, such as warning the victim or notifying police, when a client poses a serious threat of violence to an identifiable person. State law varies.

Providing permanent housing without requiring sobriety first, followed by supportive services. It improves housing stability and engagement for people experiencing homelessness.

Developmental stage, family and school involvement, peer influence, screening with tools such as the CRAFFT, and consent and confidentiality laws, which differ by state and substance.

Historical trauma and disparities contribute to high rates of substance use. Engagement is strengthened by respect for tribal sovereignty, community, spirituality and traditional healing practices.

Many have trauma and co-occurring disorders, may be mandated to treatment, and benefit from structured programs, case management and coordination with probation or courts, with proper consent to share information.

Use is often missed or mistaken for aging. Older adults are more sensitive to alcohol and medications, prescription misuse and polypharmacy are risks, and use may be late-onset in response to loss.

They face higher rates of substance use linked to minority stress and discrimination. Use affirming care, chosen names and pronouns, avoid assumptions, and know that conversion efforts are harmful.

They get priority access to treatment under federal block grant rules. Provide prenatal care, medication such as methadone or buprenorphine for opioid use disorder, child care and nonjudgmental support to reduce fear of losing the child.

High rates of PTSD, traumatic brain injury, chronic pain and suicide risk are common. Understand military culture, ask about service, and coordinate with VA services.

Call emergency services, give naloxone, begin rescue breathing or CPR if needed, place the person in the recovery position, and stay until help arrives.

A qualified, trained interpreter, not a family member, friend or child, to protect accuracy and confidentiality.

Tolerance falls during abstinence in custody, so the risk of fatal overdose is greatest in the first weeks after release. Planning should include naloxone, medication and linkage to care.

Generally yes, under HIPAA and Part 2, with access usually provided within 30 days. Limited exceptions apply, such as psychotherapy notes or information likely to cause serious harm.

Objective notes record observable facts and behavior, and subjective notes record the client's own words and feelings. Avoid unsupported opinions or judgmental language.

People with a history of substance use disorder, including those taking prescribed medication for opioid use disorder, are protected from discrimination in services and employment, though current illegal drug use is not protected.

Voluntary treatment is entered by the client's own consent and can generally be left. Involuntary treatment is ordered by a court or authorized process when strict legal criteria are met.

It varies by state, payer and program, commonly 6 to 10 years after discharge, longer for minors, and records must be securely destroyed afterward.

Listen without being defensive, take it seriously, explain the grievance process, follow policy, document the complaint and response, and never retaliate.

With a single line through the error, initialed and dated, and a correct entry beside it, never erasing, deleting or using correction fluid. Electronic systems should keep an audit trail.

Record each member's participation and progress in his or her own record, without naming or revealing other group members.

In locked cabinets or encrypted systems with access limited to authorized staff, with audit logs, backups and secure destruction, in line with HIPAA and Part 2.

Promptly, ideally the same day or within the time required by policy, payer and law, because late notes are less accurate and less defensible.

Yes. Rights must be explained verbally and in writing at admission, in language the client understands, and the client should receive a copy.

To be treated with dignity and respect without discrimination, to confidentiality, to informed consent, to take part in treatment planning, to refuse treatment, to see records, to be free of abuse and unnecessary restraint, and to file a grievance.

SOAP (Subjective, Objective, Assessment, Plan), DAP (Data, Assessment, Plan) and BIRP (Behavior, Intervention, Response, Plan).

It is written, explained at admission, easy to use, and includes informal resolution, a formal written complaint with timelines, an appeal, and information on external agencies.

Subjective: the client's report. Objective: the counselor's observations and data. Assessment: clinical impression and progress. Plan: next steps and interventions.

Clients have the right to receive treatment in the least restrictive setting that is safe and effective, and to be free from seclusion and restraint except in emergencies.

A final record of the course of treatment, including the reason for admission, services given, progress, diagnosis, medications, reason for discharge and aftercare or referral plan.

Medical necessity is the need for a level of care or service based on the diagnosis and assessment. Records must show the diagnosis, ASAM dimensions, symptoms, functional impairment and why the service is required.

Clear, professional, objective and nonjudgmental language, using only approved abbreviations, person-first terms and the client's own words in quotes, and avoiding slang and jargon.

The facts, risk assessment, actions taken, consultation, and the client's response, as soon as possible, because documentation is the main evidence of reasonable care.

Consents and releases, screening and assessment, diagnosis, treatment plans and reviews, progress notes, referrals and contacts, lab results, incident reports, discharge summary and aftercare plan.

When treatment is court-ordered, or under civil commitment for danger to self or others or inability to care for oneself, following legal procedures that protect due process.

The state licensing or certification board, the state substance use authority, accrediting bodies such as CARF or the Joint Commission, the HHS Office for Civil Rights for privacy issues, and protection and advocacy agencies.

It shows the quality and continuity of care, supports treatment planning, communication among providers, billing and legal and accreditation requirements, and protects clients and counselors.

Clients may fear losing services if they complain. Policy and ethics codes forbid retaliation, so clients can raise concerns safely and programs can improve.

Immunoassay is a quick, inexpensive screen that can cross-react and produce false positives. Gas or liquid chromatography with mass spectrometry (GC-MS or LC-MS) is the accurate confirmatory method.

By temperature (within minutes of collection), creatinine, specific gravity and pH, and by observed collection to prevent tampering. Dilute urine has low creatinine.

Treat it as clinical information, not a verdict: confirm it, review medications and context, discuss it openly and without punishment, and use it to adjust the treatment plan.

Cannabis about 3 days after a single use and 30 days or more with chronic heavy use, benzodiazepines from a few days to several weeks depending on the drug's half-life, and PCP about 7 to 14 days.

Cocaine (as benzoylecgonine) and amphetamines about 2 to 4 days, and opioids such as heroin and morphine about 1 to 3 days. Windows vary with dose, frequency, metabolism and hydration.

Ethyl glucuronide and ethyl sulfate, direct alcohol metabolites in urine that can show alcohol use for up to about 80 hours, even after alcohol is gone from the blood. They can be triggered by incidental exposure to alcohol.

It is easy to collect under observation, hard to adulterate, and reflects recent use within roughly 24 to 48 hours.

To confirm use, monitor abstinence and progress, inform treatment planning, detect relapse early, and support accountability, ideally as a clinical tool and not as punishment.

Testing outside the detection window, dilution of urine, adulteration or substitution, a result below the cutoff, or a drug not included in the panel.

Cross-reacting substances: poppy seeds for opiates, pseudoephedrine and some other medicines for amphetamines, certain antibiotics for opiates, and some antidepressants for other drug classes. Confirmation testing resolves them.

Results are protected health information. Under 42 CFR Part 2 and HIPAA they may be shared only with the client's written consent or as the law allows, and clients should know in advance who will see them.

Alcohol in exhaled air, which estimates blood alcohol concentration and shows recent use or current impairment only, not use in the past day.

The level of a substance or metabolite above which a test is reported positive. A result below the cutoff is reported negative even if some drug is present.

A skin patch worn for 7 to 14 days that collects sweat to detect drug use over that period. It is useful for continuous monitoring but can be contaminated or removed.

The documented, unbroken record of who collected, handled, stored and tested a specimen, which protects its integrity and allows results to be used in legal or employment decisions.

Phosphatidylethanol, a direct alcohol biomarker in blood that can show moderate to heavy alcohol use over the preceding two to four weeks.

Up to about 90 days for each 1.5 inches of hair, but it cannot detect very recent use for about a week, and environmental contamination and hair treatments can affect results.

Elevated GGT, carbohydrate-deficient transferrin (CDT), mean corpuscular volume (MCV), and an AST to ALT ratio above 2. They indirectly point to chronic heavy use.

It is noninvasive, inexpensive, has a reasonable detection window, and allows rapid on-site cup tests and laboratory confirmation.

Standard immunoassays often do not detect fentanyl, synthetic cannabinoids, synthetic cathinones, or many designer drugs, which require specific assays.

Moderate, since 4 to 5 criteria indicate a moderate disorder.

On a scale from 0 (no risk) to 4 (severe risk), where higher ratings point to a more intensive level of care.

They were reorganized: Dimension 1 covers intoxication, withdrawal and addiction medications, Dimension 4 substance use-related risks, Dimension 5 recovery environment interactions, and Dimension 6 person-centered considerations.

Clients are reassessed regularly using the same dimensions. Treatment moves to a different level when goals are met, needs change, or the person is not benefiting at the current level.

As a single disorder for each substance, combining the former abuse and dependence categories, diagnosed by meeting at least 2 of 11 criteria within a 12-month period.

Caffeine intoxication and caffeine withdrawal are diagnoses, but caffeine use disorder is listed only as a condition for further study.

Tobacco use disorder is diagnosed with the same 11 criteria, and tobacco withdrawal is also a recognized diagnosis.

By meeting at least four of nine criteria within 12 months, such as needing to gamble with increasing amounts, restlessness when cutting down, chasing losses, and jeopardizing relationships or jobs.

Early remission means no criteria (except craving) have been met for at least 3 months but less than 12 months. Sustained remission means none for 12 months or longer.

By the number of criteria met: mild is 2 to 3, moderate is 4 to 5, and severe is 6 or more.

Mental disorders such as depression, anxiety or psychosis that develop during or soon after intoxication or withdrawal, with symptoms beyond what is typical for the substance and not better explained by an independent disorder.

1-WM ambulatory without extended onsite monitoring, 2-WM ambulatory with extended onsite monitoring, 3.2-WM clinically managed residential, 3.7-WM medically monitored inpatient, and 4-WM medically managed intensive inpatient.

Recent use, clinically significant problematic behavioral or psychological changes during or shortly after use, and signs or symptoms specific to the substance, not due to another medical or mental disorder.

A syndrome that develops after stopping or reducing heavy, prolonged use, with substance-specific symptoms that cause significant distress or impairment and are not due to another condition.

"In a controlled environment" for people in settings with limited access to the substance, and "on maintenance therapy" for those taking medication such as methadone or buprenorphine.

Impaired control, social impairment, risky use, and pharmacological criteria (tolerance and withdrawal).

Using more or longer than intended, unsuccessful efforts to cut down, much time spent obtaining, using or recovering, and craving.

Level 0.5 and Level 3.3 were removed, 3.2 withdrawal management was folded into 3.5, and recovery support, harm reduction, co-occurring capability and telehealth were emphasized. Check which edition your exam uses.

Recurrent use in physically hazardous situations, and continued use despite knowing it causes or worsens a physical or psychological problem.

1 Acute intoxication and withdrawal potential, 2 Biomedical conditions, 3 Emotional, behavioral or cognitive conditions, 4 Readiness to change, 5 Relapse, continued use or continued problem potential, and 6 Recovery and living environment.

Failure to fulfill major role obligations, continued use despite social or interpersonal problems caused by it, and giving up important activities because of use.

Clinically managed services are run by clinicians and non-physician staff. Medically monitored services add 24-hour nursing and physician availability. Medically managed services have a physician and nursing directly managing care in a hospital.

Each substance has its own code family, such as F10 for alcohol and F11 for opioids, and the code reflects severity, such as F10.20 for moderate or severe alcohol use disorder.

Current intoxication, the risk of withdrawal, and past withdrawal experience, such as seizures or delirium tremens. It identifies who needs withdrawal management and at what intensity.

Biomedical conditions and complications, such as chronic illness, infections, pregnancy and pain, that need monitoring or treatment during substance use treatment.

Emotional, behavioral and cognitive conditions, such as mental illness, suicidal thinking, trauma and cognitive impairment, and whether they are stable and how they affect treatment.

Readiness to change: the person's awareness of the problem, motivation, stage of change and willingness to take part in treatment.

The likelihood of relapse, continued use or continued problems without treatment, considering past relapse, insight, coping skills and recognition of triggers.

The recovery and living environment: housing stability, family and peer supports, safety, employment and exposure to people who use.

Risk of severe withdrawal, unstable medical or psychiatric conditions, poor readiness to change, high relapse risk, and an unsafe or unsupportive recovery environment.

Early intervention for people who are at risk for developing a substance-related problem but do not meet diagnostic criteria for a substance use disorder.

Outpatient services, generally fewer than 9 hours of services per week for adults, such as individual and group counseling.

Intensive outpatient treatment, with 9 or more hours of structured services per week for adults, allowing the person to live at home and keep working or attend school.

Partial hospitalization, with 20 or more hours of services per week and ready access to psychiatric, medical and laboratory services, while the person lives at home.

Clinically managed low-intensity residential treatment, such as a halfway house, with 24-hour supportive living and at least 5 hours of clinical services a week.

Clinically managed population-specific high-intensity residential treatment for people with significant cognitive impairments, with a slower pace and more repetition. The fourth edition removed it.

Clinically managed high-intensity residential treatment, with 24-hour structured care and trained staff for people who need a safe, stable recovery environment. It is not medically staffed around the clock.

Medically monitored intensive inpatient treatment, with 24-hour nursing, physician availability and counseling for people with significant biomedical or psychiatric needs.

Medically managed intensive inpatient treatment in a hospital setting, with 24-hour medical and nursing care and daily physician management for severe, unstable conditions.

The DSM-5-TR (2022) is a text revision with updated descriptions, research, and coding, plus changes such as adding prolonged grief disorder. The substance use disorder criteria stayed the same.

To provide a multidimensional, standardized way to assess clients and match them to the least restrictive level of care that is safe and effective, based on individual needs and not on diagnosis alone.

Place the client at the nearest appropriate level with interim services, document the gap, advocate for access, and not choose a level just because it is available.

When they occur only as an expected result of appropriate medical treatment, such as opioid pain medication taken as prescribed under medical supervision.

Craving was added. The recurrent legal problems criterion was removed.

It depends on state law and credential. Many certified counselors may not independently diagnose and instead contribute assessment information and work under a licensed clinician, so counselors must know their scope.

By assessing readiness, motivation, safety, severity of symptoms, and fit with the group's purpose. Clients with acute psychosis, active violence or severe crisis may need individual care first.

A structured group follows a planned curriculum with set topics and skills, as in psychoeducation. A process group focuses on members' interactions, feelings and relationships in the here and now.

Gently redirect, invite others to participate, set time limits, use structure such as rounds, and speak with the member privately if the pattern continues.

CRA builds rewarding activities, relationships and employment so that sobriety is more rewarding than use. CRAFT teaches family members to encourage a loved one to enter treatment.

Psychoeducational groups, skills development groups, cognitive-behavioral groups, support groups and interpersonal process groups.

Forming, storming, norming, performing and adjourning.

Instillation of hope, universality, imparting information, altruism, corrective recapitulation of the family group, socializing techniques, imitative behavior, interpersonal learning, group cohesiveness, catharsis and existential factors.

The leader will protect members' information, but cannot guarantee that other members will keep it private. Members should be told the limits and asked to commit to confidentiality.

A structured, skills-based approach that helps clients link thoughts, feelings and behaviors, identify triggers through functional analysis, change distorted thinking and build coping and refusal skills.

A behavioral treatment that provides tangible rewards, such as vouchers or prizes, for objective evidence of abstinence like negative drug tests. It has strong evidence, especially for stimulant use.

A cognitive behavioral therapy that teaches mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. It is useful for emotion dysregulation, self-harm and co-occurring borderline personality disorder.

The integration of the best available research evidence with clinical expertise and the client's values, preferences and culture, to decide on care.

The sense of belonging, trust and mutual support among members, which is one of the strongest predictors of benefit from group therapy.

A brief, manual-guided form of motivational interviewing, typically about four sessions, that builds motivation to change using personalized feedback and a change plan.

Open groups allow new members to join at any time, while closed groups have a fixed membership and time frame. Closed groups tend to build deeper cohesion, and open groups improve access.

A structured 16-week intensive outpatient approach developed for stimulant use, combining relapse prevention, family education, social support, drug testing and 12-step participation.

To create safety, set norms, keep the focus, encourage participation, model respectful behavior, manage conflict, and link members' experiences so that they support each other.

A structured, manual-guided approach that encourages acceptance of the addiction and active participation in 12-step fellowships such as AA or NA.

It is cost-effective and offers peer support, reduces isolation and shame, provides feedback and role models, and allows members to practice skills together.

To establish safety, expectations about attendance, respect, confidentiality, participation and substance use, which supports cohesion and reduces conflict.

Screening is a brief process that identifies whether a problem may exist and whether further evaluation is needed. Assessment is a comprehensive evaluation that gathers detailed information to diagnose, plan treatment and decide level of care.

A simple reflection repeats or rephrases what the client said. A complex reflection adds meaning, feeling or an inferred message, which moves the conversation forward.

Build rapport first, explain confidentiality and its limits, use normalizing statements such as "Many people in your situation...", and move from general to specific questions.

Sensitivity is a tool's ability to correctly identify people who have the condition. Specificity is its ability to correctly identify people who do not.

Brief self-report scales for depression (PHQ-9, scored 0 to 27) and anxiety (GAD-7, scored 0 to 21). Scores of 5, 10 and 15 mark mild, moderate and moderately severe levels, and a positive screen calls for further evaluation.

Alcohol screens developed for pregnant women and women. T-ACE asks about Tolerance, Annoyed, Cut down and Eye-opener. TWEAK asks about Tolerance, Worry, Eye-openers, Amnesia and Cut down.

Stabilizing safety and medical needs, such as arranging emergency care or medical detoxification, before continuing the full assessment and treatment planning.

Substance use, medical and mental health history, family history, social and cultural background, education and employment, legal history, trauma and abuse, living situation, strengths and supports.

Open-ended questions, Affirmations, Reflective listening and Summaries, the core micro-skills of motivational interviewing and of effective interviewing generally.

Screening, Brief Intervention and Referral to Treatment, an approach for finding people at risk in general health settings, giving a brief motivational intervention, and referring those who need more care.

The elements of effective brief intervention: Feedback, Responsibility, Advice, a Menu of options, Empathy and Self-efficacy.

A short, structured motivational conversation, usually 5 to 15 minutes, that gives feedback about risk and helps the person consider changing substance use. It is aimed at risky users, not people who need specialty treatment.

A structured observation of appearance, behavior, speech, mood and affect, thought process and content, perception, orientation, memory, insight and judgment, used to detect impairment or co-occurring conditions.

"How many times in the past year have you had five or more drinks in a day (four or more for women)?" Any answer of one or more is a positive screen.

Follow-up questions or prompts that clarify, expand or deepen the client's answers, used with care to avoid sounding interrogating.

A 10-item measure of adverse childhood experiences such as abuse, neglect and household dysfunction. Higher scores predict greater risk of substance use and health problems, but it is not a diagnostic tool.

A semi-structured interview that measures problem severity in seven areas: medical, employment and support, alcohol, drug use, legal, family and social, and psychiatric status. It is used for assessment, treatment planning and outcome tracking.

The WHO Alcohol, Smoking and Substance Involvement Screening Test, which rates risk (low, moderate, high) for each substance used and guides the level of intervention.

A three-item version of the AUDIT focused on alcohol consumption, scored 0 to 12, with a positive screen at 4 or more for men and 3 or more for women.

The Alcohol Use Disorders Identification Test, a 10-item WHO screen with scores of 0 to 40. A score of 8 or more indicates hazardous or harmful drinking, and higher scores suggest dependence.

A four-item alcohol screen: have you felt you should Cut down, been Annoyed by criticism, felt Guilty, or needed an Eye-opener. Two or more yes answers suggest a problem.

The Clinical Institute Withdrawal Assessment for Alcohol, revised, a 10-item scale that rates withdrawal severity and guides medication. Scores under about 8 to 10 are mild, 8 to 15 moderate, and above 15 severe.

A structured screening tool that asks about the severity of suicidal ideation and behavior using plain yes or no questions, which guides risk level and response in any setting.

The Clinical Opiate Withdrawal Scale, an 11-item clinician-rated scale of opioid withdrawal signs. Scores of 5 to 12 are mild, 13 to 24 moderate, 25 to 36 moderately severe, and above 36 severe. It is used to time buprenorphine induction.

A six-item screen for adolescent substance use: Car, Relax, Alone, Forget, Friends, Trouble. Two or more yes answers indicate need for further assessment.

A 10-item yes or no self-report screen for drug use (not alcohol or tobacco) in the past 12 months, scored 0 to 10, with higher scores showing greater severity.

Open-ended questions invite detailed answers, such as "Tell me about your drinking," and build rapport. Closed-ended questions get brief yes or no answers and are useful for specific facts.

The Michigan Alcoholism Screening Test, a 24-item yes or no questionnaire of alcohol-related problems. A score of 5 or more suggests an alcohol problem.

A single-question screen about past-year use of alcohol, tobacco, illegal drugs and prescription drug misuse, followed by a more detailed tool such as the NIDA-Modified ASSIST if the answer is positive.

To identify people who may have a substance use problem and need further assessment. It does not diagnose and is not meant to determine treatment.

The Substance Abuse Subtle Screening Inventory, a self-report tool with obvious and subtle items that can identify a probable substance use disorder even when the person denies or minimizes use.

Using person-first language, explaining why questions are asked, giving the client choice and pacing, avoiding labels and confrontation, and attending to safety so the process does not retraumatize.

Substances used, age of first use, route, amount and frequency, pattern, last use, periods of abstinence, withdrawal and overdose history, consequences, and previous treatment and what helped.

Family, other providers and records can confirm or add to the client's account. A signed release is needed before contacting anyone, consistent with confidentiality rules.

Denial, stigma, fear of consequences and memory problems can lead to underreporting, so results should be combined with interviews, collateral information and, where appropriate, testing.

Yes. Treatments adapted to a group's language, values and context tend to improve engagement and outcomes compared with unmodified approaches.

In collectivist cultures family and community needs may outweigh individual choice, so decisions may involve family. Individualist cultures emphasize personal autonomy. Counselors should ask rather than assume.

Poverty, housing, discrimination, lack of insurance and neighborhood conditions affect risk, access, treatment quality and outcomes, which produces disparities across groups.

A generalization is a starting hypothesis about a group that is tested against the individual. A stereotype is a fixed belief applied to every member without regard to the person.

Competence suggests a skill that can be mastered. Humility is a lifelong stance of self-reflection, openness, learning from the client and awareness of power differences.

Cost, lack of insurance, transportation, child care, unstable work and housing are barriers. Counselors help by linking clients to funding, sliding-scale options and supportive services.

It leads to shame, delay in seeking care and discrimination in health care, work and housing. Counselors reduce it with person-first language, avoiding terms such as "clean" and "dirty," and by advocating for equitable treatment.

Ask respectfully about the client's beliefs and whether they are a source of strength, support their choices, and offer secular options for those who prefer them.

Use inclusive intake forms, ask openly and respectfully, use the name and pronouns the client gives, and correct mistakes simply, without making the client explain.

Brief, often unintentional comments or behaviors that communicate hostile or demeaning messages toward members of marginalized groups. They harm trust and should be repaired when they occur.

Counselor awareness of own assumptions and biases, knowledge of the worldviews of culturally different clients, and skills in culturally appropriate interventions.

Acting at individual, community and systems levels to remove barriers and promote equity, such as helping a client access services, speaking up about discriminatory policies, and supporting inclusive programs.

Shared values, beliefs, language, customs and norms, shaped by race, ethnicity, nationality, gender, sexual orientation, age, religion and spirituality, disability, socioeconomic status and region.

Qualified interpreters and translated materials for clients with limited English proficiency, and plain-language, health-literate communication for all clients.

The process of adapting to a new culture. Acculturative stress, family conflict and loss of social supports can contribute to substance use and affect engagement.

The ability to work effectively with people of different cultures by combining self-awareness, knowledge of clients' cultural backgrounds, and skills for adapting practice to them.

Unconscious attitudes or stereotypes that influence perceptions and decisions. Counselors manage it through self-reflection, feedback, supervision and structured decision-making.

The way a person's overlapping identities, such as race, gender, class and sexual orientation, combine to shape experiences of privilege and discrimination, so no single identity explains a client.

A set of questions that explores how the client understands the problem, cultural identity, stressors, supports and what they expect from care, to guide culturally sensitive assessment.

Nondiscrimination policies, diverse and trained staff, welcoming spaces and materials, accessible services, culturally relevant programming and ongoing feedback from the community.

Yes, to a degree. Neuroplasticity allows partial recovery of brain function and dopamine systems over months to years, which supports the case for long-term recovery support.

ACEs and trauma raise the risk of substance use disorders in a dose-response way, because many people use substances to cope with distress, hyperarousal or numbing.

Through classical conditioning, people, places, objects and emotions that were paired with drug use become triggers that provoke craving and physiological arousal, even after long abstinence.

The moral model sees addiction as a failure of willpower or character. The disease model sees a chronic medical condition. The biopsychosocial model holds that biological, psychological and social factors interact and all need treatment.

It weakens executive functions such as judgment, planning and impulse control, which makes it harder to resist craving and to weigh long-term consequences.

Physical dependence is a physiological adaptation shown by tolerance and withdrawal and can occur with prescribed medication taken as directed. Addiction involves compulsive use, loss of control and continued use despite harm.

Roughly 40 to 60 percent of vulnerability is attributed to genetic factors, with environment and development accounting for the rest.

The prealcoholic, prodromal, crucial and chronic phases, moving from social drinking to blackouts, loss of control and finally physical and social deterioration.

Strong family bonds, parental monitoring, positive peer groups, school engagement, coping skills, connection to community or faith, and access to prevention and support.

Craving, loss of Control over use, Compulsive use, and Continued use despite adverse Consequences.

Metabolic (pharmacokinetic) tolerance from faster drug breakdown, functional (pharmacodynamic) tolerance from adapted brain cells, behavioral tolerance from learning to function while intoxicated, and acute tolerance within a single session.

Binge and intoxication, withdrawal and negative affect, and preoccupation and anticipation (craving). The cycle repeats and intensifies over time.

Using more or longer than intended, repeated failed attempts to cut down, spending large amounts of time obtaining or recovering from use, and giving up other activities.

Minimization, rationalization, projection and blaming, intellectualization and denial, all of which protect the person from facing the consequences of use.

Family substance use and conflict, peer use, neighborhood stress, easy access to drugs, poor supervision, community norms that accept use, and low school or social engagement.

Wegscheider-Cruse's roles: the chief enabler, family hero, scapegoat, lost child and mascot, each a way of coping with the family's stress.

A pattern in which a person is overly preoccupied with and tries to control another person's behavior or problems, often at the cost of their own needs, commonly seen in partners and family of people with addiction.

An intense desire or urge to use a substance, often set off by cues, stress or mood states, and a symptom in the DSM-5 criteria for substance use disorder.

Tolerance to one drug that carries over to other drugs in the same class, such as alcohol and benzodiazepines.

A defense mechanism in which the person fails to recognize or accept the extent of the problem and its consequences. It is a common part of the illness, not a lie in the ordinary sense.

Behavior by family or others that protects the person from the consequences of substance use, such as making excuses, covering for them or bailing them out, and so unintentionally helps the use continue.

Changes in gene expression, without changes in DNA sequence, caused by environmental factors such as stress or drug exposure, which can alter vulnerability and may be passed on.

An increased response to a substance after repeated exposure, seen with some effects of stimulants and linked to craving and relapse.

A faster progression from first use to dependence and treatment entry, often described in women compared with men, and seen with some substances.

The mesolimbic dopamine pathway, running from the ventral tegmental area to the nucleus accumbens, which reinforces behaviors such as eating and social bonding and is hijacked by drugs.

Abstinence, experimental use, social or recreational use, habitual or risky use, harmful use (abuse) and dependence, with people able to move in either direction.

Positive reinforcement is use to gain pleasure or euphoria. Negative reinforcement is use to remove or avoid discomfort, such as withdrawal or distress.

Addiction is a chronic, relapsing brain disorder marked by compulsive substance use despite harmful consequences, caused by changes in brain circuits for reward, stress and self-control.

It drives stress, anxiety and irritability during withdrawal and abstinence, producing negative emotional states that motivate renewed use.

The need for increasing amounts of a substance to achieve the same effect, or a reduced effect from the same amount.

The set of physical and psychological symptoms that occur when a person who is dependent on a substance stops or sharply reduces use, usually opposite to the drug's effects.

They support habit formation, so repeated use shifts from voluntary, pleasure-seeking behavior to automatic, compulsive routines triggered by cues.

Drugs cause a larger and faster dopamine surge than natural rewards. With repeated use, dopamine signaling is blunted, so the person needs the drug to feel normal and gets less pleasure from other things.

The prefrontal cortex is still maturing while reward and emotion systems are highly active, so they are more prone to risk taking and less able to control impulses.

Use that starts in adolescence is linked to a higher chance of developing a substance use disorder, because the developing brain is more vulnerable to lasting changes.

Abstinence-based approaches aim for no use of the substance, often without medication. Medication-supported approaches use medicines such as methadone, buprenorphine or naltrexone alongside counseling and are an evidence-based form of recovery.

It is a partial mu agonist with a ceiling effect that lowers overdose risk. It comes as a sublingual product often combined with naloxone to deter injection, or as a monthly injection, and can be started in office settings.

It blocks the enzyme that breaks down acetaldehyde, so drinking causes flushing, nausea and palpitations. Adherence is poor unless it is supervised, so it works best for highly motivated clients.

It is a long-acting full mu opioid agonist that prevents withdrawal and craving, taken once daily. For opioid use disorder it is dispensed through certified opioid treatment programs, and it can prolong the QT interval.

It is an opioid receptor antagonist that blocks opioid effects and reduces alcohol craving and heavy drinking. For opioid use, the person must be opioid-free first (about 7 to 10 days), and a monthly injection is available.

A process of change through which people improve their health and wellness, live a self-directed life, and strive to reach their full potential. Its four dimensions are health, home, purpose and community.

There is no set limit. Duration depends on the person's progress, and stopping too soon raises the risk of relapse and overdose, so the decision to taper should be shared with the prescriber.

NA applies the 12-step model for any drug. Al-Anon (and Nar-Anon) provide a 12-step fellowship for family and friends affected by someone else's use.

Naltrexone to reduce craving and heavy drinking, acamprosate to support abstinence after detox, and disulfiram as an aversive agent. Each is combined with counseling.

People recover in different ways, including treatment, medication, mutual support, faith-based, culturally based, natural recovery and harm reduction, so counselors respect each client's choice and fit.

A set of practical strategies, such as syringe services, naloxone, drug checking and safer use education, that reduce negative consequences of drug use without requiring abstinence, and meet people where they are.

MOUD uses FDA-approved medicines with counseling and recovery support. It is not substitution, since the medicine stabilizes the brain and reduces craving, overdose and death, and lets people function.

The internal and external resources, such as social support, stable housing, employment, health, skills and community connection, that people can use to begin and sustain recovery.

A secular, science-based mutual-help program using cognitive-behavioral and motivational tools in a four-point program: building motivation, coping with urges, managing thoughts and behaviors, and living a balanced life.

Because it has high receptor affinity, it can displace full agonists and trigger precipitated withdrawal if given while the person is not yet in mild to moderate withdrawal.

A person with lived experience of recovery, often certified, who offers mentoring, navigation, advocacy and support. Peer support improves engagement and retention in care.

It reverses an opioid overdose but does not treat opioid use disorder. Clients and families should be given naloxone and trained to use it.

A peer fellowship based on 12 steps and 12 traditions, with sponsors, regular meetings (open or closed), anonymity, no dues and a spiritual but non-religious focus, and abstinence as the goal.

Nicotine replacement (patch, gum, lozenge), varenicline and bupropion. Combining a patch with a short-acting form is more effective than one form alone.

Benzodiazepines are first-line for alcohol withdrawal, with thiamine. For opioid withdrawal, buprenorphine or methadone are best, and clonidine or lofexidine ease symptoms. All require medical supervision.

Mild relaxation and impaired judgment appear around 0.02 to 0.05, legal impairment at 0.08, confusion and stupor above 0.20, coma around 0.30, and possible death from respiratory depression at 0.40 and above.

They enhance the effect of GABA at the GABA-A receptor, producing sedation and reduced anxiety. Examples are alprazolam, lorazepam, diazepam and clonazepam.

Both increase dopamine and norepinephrine. Cocaine blocks reuptake, while amphetamines also cause release of the neurotransmitters, producing euphoria, energy and alertness.

They act mainly as serotonin 5-HT2A receptor agonists, altering perception, mood and thought, with visual distortions, synesthesia and distorted time sense.

They bind to mu opioid receptors in the brain and spinal cord, producing pain relief, euphoria, sedation and respiratory depression, and they trigger dopamine release in the reward pathway.

Pharmacokinetics is what the body does to a drug: absorption, distribution, metabolism and excretion. Pharmacodynamics is what the drug does to the body: its effects and mechanism of action.

THC binds to CB1 cannabinoid receptors, affecting mood, memory, coordination and perception, and it increases dopamine release in the reward pathway.

It is a short-acting opioid antagonist that reverses an overdose within minutes. Its effect may wear off before the opioid does, so repeated doses and emergency care are needed. It can precipitate withdrawal.

It binds nicotinic acetylcholine receptors and releases dopamine in the reward pathway. It reaches the brain within seconds when smoked or vaped, which makes it highly addictive.

Schedule I drugs have high abuse potential and no accepted medical use. Schedules II through V have decreasing abuse potential and accepted medical use, such as oxycodone and cocaine in II and benzodiazepines in IV.

Intravenous injection and inhalation act within seconds, intranasal and sublingual within minutes, and oral use slowest. The faster the onset, the greater the reinforcing effect and abuse potential.

A drinking pattern that raises BAC to 0.08 or higher, typically about five or more drinks for men and four or more for women in roughly two hours.

At a roughly constant rate of about one standard drink per hour, lowering BAC by about 0.015 percent per hour, regardless of how much has been consumed.

Provide a calm, quiet, safe setting, reassure and orient the person, avoid confrontation, and stay with them. Medical help is needed if there is danger or medical complication.

Natural: morphine and codeine. Semi-synthetic: heroin, oxycodone and hydrocodone. Synthetic: fentanyl, methadone and tramadol.

Stimulant-like synthetic drugs that can cause severe agitation, paranoia, hallucinations, hyperthermia, and violent behavior. Their ingredients are unpredictable.

The triad of unresponsiveness or coma, pinpoint pupils and slow, shallow or absent breathing. Respiratory depression is the cause of death.

Hyperthermia, seizures, heart attack, stroke, arrhythmia and agitation or psychosis. There is no specific antidote, so treatment is supportive.

They cause sedation, memory loss and loss of control, and are linked to drug-facilitated assault. GHB can cause coma and respiratory depression, and ketamine is dissociative and can damage the bladder.

It releases serotonin, causing euphoria and empathy, but also hyperthermia, dehydration, hyponatremia, and serotonin syndrome. Heavy use can lead to depression after the drug wears off.

A dissociative drug causing agitation, aggression, numbness to pain, nystagmus, high blood pressure and psychosis. People may be violent and at risk of injury, so a low-stimulation setting is needed.

Effects last 8 to 24 hours, with a strong risk of dependence, psychosis, severe dental problems, weight loss and long-term neurotoxicity affecting memory and emotion.

Liver damage, heart disease, acne, mood swings and aggression, and in men testicular atrophy and breast growth, and in women masculinization. Use is for muscle growth, not for intoxication.

Volatile solvents such as glue and paint thinner, aerosols, gases such as nitrous oxide, and nitrites such as poppers.

Alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics and anxiolytics, stimulants, tobacco, and other or unknown substances.

Dependence, impaired attention and learning, impaired driving, respiratory problems from smoking, cannabis hyperemesis syndrome, and a link to psychosis in vulnerable people, especially with early use.

Red eyes, dry mouth, increased appetite, rapid pulse, impaired coordination and memory, slowed time perception, and in some people anxiety or paranoia.

Euphoria followed by drowsiness, slurred speech, pinpoint pupils, slowed breathing and pulse, itching, constipation and nodding off.

Dilated pupils, rapid pulse, high blood pressure, euphoria, talkativeness, agitation, reduced appetite and sleep, sweating, and with heavy use paranoia and psychosis.

Tremor, sweating, anxiety, nausea, insomnia and rapid pulse begin about 6 to 12 hours after the last drink and peak at 24 to 72 hours. Seizures can occur at roughly 12 to 48 hours, and delirium tremens at 48 to 96 hours.

Flu-like symptoms: muscle aches, runny nose, yawning, sweating, dilated pupils, nausea, vomiting, diarrhea and anxiety. For short-acting opioids it starts at 6 to 12 hours and peaks at 1 to 3 days. It is very uncomfortable but rarely life-threatening.

Irritability, anxiety, craving, difficulty concentrating, increased appetite, restlessness and insomnia, typically peaking within the first week.

Non-benzodiazepine hypnotics such as zolpidem and zaleplon, which act on GABA-A receptors to treat insomnia. They can cause tolerance, dependence, and complex sleep behaviors.

Overdose, infections such as HIV, hepatitis B and C, endocarditis and skin abscesses, and collapsed veins, especially when needles are shared.

About 14 grams of pure alcohol: 12 ounces of 5 percent beer, 5 ounces of 12 percent wine, or 1.5 ounces of 80-proof distilled spirits.

The ratio between the dose that produces a toxic effect and the dose that produces the desired effect. A narrow index, as with alcohol and barbiturates, means a small margin of safety.

Alcohol is a central nervous system depressant that enhances the inhibitory neurotransmitter GABA and inhibits the excitatory neurotransmitter glutamate.

Irritability, anger, nervousness, sleep difficulty, decreased appetite, restlessness, depressed mood and physical discomfort, usually starting within a few days and lasting up to one to two weeks.

A severe, life-threatening form of alcohol withdrawal with confusion, disorientation, hallucinations, fever, high pulse and blood pressure, and autonomic instability. It is a medical emergency requiring hospital care.

The time for the blood concentration of a drug to fall by half. It affects how long effects last, how soon withdrawal begins, and how long the drug can be detected.

Recurrent visual disturbances, such as flashbacks or trails, that continue after the drug's effects have worn off and cause distress or impairment.

Fatal cardiac arrhythmia caused by inhalants, which can occur even the first time a person uses them. Chronic use can also damage the brain, liver and kidneys.

An additive effect equals the sum of two drugs. A synergistic effect is greater than the sum, as when alcohol is combined with benzodiazepines or opioids, raising the risk of respiratory depression.

An agonist activates a receptor fully, an antagonist blocks it, and a partial agonist activates it weakly with a ceiling effect. Methadone is a full agonist, naloxone an antagonist, and buprenorphine a partial agonist.

Alcohol crosses the placenta and can cause fetal alcohol spectrum disorders, with growth, facial and brain damage. No amount of alcohol is known to be safe during pregnancy.

A synergistic depression of breathing that can cause coma and death. The combination with opioids carries an FDA boxed warning.

A period of fatigue, sleepiness, depression, increased appetite, vivid dreams and intense craving after stopping, with a risk of suicidal thoughts. It is usually not medically dangerous.

A brain disorder caused by thiamine (vitamin B1) deficiency in chronic alcohol use. Wernicke's encephalopathy shows confusion, ataxia and eye movement problems, and Korsakoff syndrome shows severe memory loss and confabulation. Thiamine is given as treatment.

Smoked crack gives a fast, short, intense high that drives compulsive use. Mixing cocaine with alcohol forms cocaethylene in the liver, which prolongs the effects and adds toxicity to the heart.

In the liver, mainly by cytochrome P450 enzymes. Liver disease, other drugs and genetics change metabolism and can cause toxic levels or dangerous interactions.

They have a narrow therapeutic index and strong respiratory depression, so overdose is more likely and more lethal, and they are rarely prescribed now.

They are full agonists at cannabinoid receptors with unpredictable potency and ingredients, and can cause severe agitation, seizures, psychosis, kidney injury and death.

It is a synthetic opioid roughly 50 to 100 times more potent than morphine, often hidden in counterfeit pills or other drugs, so small amounts can cause fatal overdose. Test strips and naloxone reduce harm.

Combined drugs can interact, with additive or synergistic effects, mask each other's signs, complicate withdrawal and treatment, and increase the risk of overdose.

Abrupt cessation can cause seizures, delirium, hyperthermia and cardiovascular collapse. Withdrawal needs medical supervision and a gradual taper.

No. Paying or accepting payment for referring patients is prohibited by federal anti-kickback laws and by patient brokering laws in several states, and violates ethics codes.

Beneficence is acting for the client's good. Nonmaleficence is doing no harm, such as avoiding exploitation, harmful interventions and boundary violations.

A crossing is a departure from usual practice that may be harmless or helpful, such as attending a client's recovery celebration. A violation exploits the client or harms the relationship.

Accurately and honestly, stating only the credential, degree and training actually held, and not implying licensure or competence they do not have.

Identify it early, disclose it to the client and supervisor, avoid or end the dual role, refer the client if objectivity is impaired, seek consultation, and document the steps taken.

Consider the value, timing, motive and culture, follow agency policy, accept only tokens of modest value when appropriate, and document and discuss it with the client.

Set clear limits in informed consent about availability and use of crisis services, and keep contact professional so that it does not blur boundaries.

No. A counselor may support medication adherence, share education and encourage the client to talk to the prescriber, but dosing and prescribing decisions belong to the prescriber.

No. Being both counselor and sponsor creates a dual relationship, and confidentiality, power and role conflicts. A counselor should refer the client to someone else for sponsorship.

Not without appropriate training, supervision and consent. Using untested or unfamiliar techniques exceeds competence and can harm the client.

Extending sessions, giving special treatment, sharing personal problems, meeting outside the office, keeping secrets, or feeling protective of or attracted to a client. They call for consultation and correction.

Treating a friend or relative, accepting payment for referrals, financial ties to a facility being recommended, pressure to keep beds filled, and gifts from clients or vendors.

Disclose only when it is purposeful, brief and for the client's benefit, then return the focus to the client. Counselors in recovery should avoid sharing details that shift attention to the counselor.

Do not accept friend requests from clients, keep personal accounts private, avoid searching for clients online without a reason, and set a social media policy in informed consent.

Autonomy, beneficence, nonmaleficence, justice, fidelity and veracity.

Identify the problem, consult the code and laws, consider the people affected, generate options, weigh them, choose and act, evaluate the results, and document the process.

Justice is fairness and equitable access to services, fidelity is keeping promises and being loyal and trustworthy, and veracity is honesty and truthfulness with clients.

Respecting the client's right to make informed, self-directed choices, which underlies informed consent and motivational approaches.

Practicing only within the limits of education, training, supervised experience and credential, and obtaining training, supervision or consultation before using new methods or serving new populations.

A situation in which a counselor's personal, financial or professional interests could compromise, or appear to compromise, objectivity or the client's best interests.

To cooperate fully and honestly with the credentialing board or investigating body, and to keep clients' confidential information protected as the law requires.

A situation in which the counselor has a second role with a client, such as friend, business partner, employer, relative or sponsor, which risks impaired judgment and exploitation.

A limit that defines safe and appropriate behavior in the counseling relationship, protecting the client from exploitation by keeping the focus on the client's needs.

The range of services a professional is authorized, trained and credentialed to provide under law and certification. Practicing outside it is an ethical and legal violation.

To guide professional conduct, protect clients and the public, define standards of practice and accountability, and give a basis for discipline. Counselors follow their credentialing body's code, such as IC&RC or NAADAC.

They are prohibited with current clients and are considered high-risk with former clients, with restrictions and waiting periods set by the applicable code and state law.

Recognize it, seek help, limit or stop practice as needed, and not provide services while impaired by illness, stress, substance use or burnout. Ethics codes require self-monitoring.

Put the client's welfare first, raise the concern with the supervisor, use the code of ethics and agency grievance channels, seek consultation, and avoid practices that harm clients, such as unnecessary extension of treatment.

Consider addressing it directly if appropriate and safe, and if it is serious or unresolved, report it to the supervisor, employer or credentialing board as the code requires.

Seek consultation and supervision, document the reasoning, and follow the law when it conflicts, while working to resolve the conflict in a way that protects the client.

Recognize them, consult, and refer to a qualified provider, such as a physician for medical issues, a psychiatrist for medication, or an attorney for legal advice, while continuing to support the client.

Small communities and shared recovery meetings, counselors in recovery, and overlap in social circles make contact outside treatment hard to avoid, so counselors must plan how to manage it.

A supervisor, peer or ethics committee gives perspective, reduces bias and errors, and shows due diligence. The consultation should be documented, without revealing identifying client information unless allowed.

A written record of the facts, options considered, consultation and rationale shows that the counselor acted reasonably and protects both the client and the counselor.

It creates a dual relationship and risks exploitation or conflicting expectations. If used, it must be fair, documented and part of a client-initiated agreement.

With the client's consent, through family education, support groups such as Al-Anon, family sessions and planning for recovery support, which improves engagement and outcomes.

Assessment, planning, linking the client to resources, monitoring progress, and advocating for the client, coordinating services across systems.

Identify the need, select an appropriate resource, discuss options with the client, get written consent, make the connection, and follow up to confirm that the client was served.

Housing and shelters, food, transportation, medical and mental health care, employment and education, legal aid, benefits such as Medicaid, mutual-help groups and recovery community centers, kept in an updated resource list.

A personal, in-person or live introduction of the client to another provider, often with the client present, which increases the likelihood that the client connects with the new service.

The client's written consent naming what information, to whom and for what purpose, an expiration date, and a statement of the right to revoke it. Substance use records need a Part 2-compliant consent.

Broker of services, advocate, coordinator, and educator, helping clients navigate systems such as housing, health care, benefits, legal and employment services.

When a client's needs are beyond the counselor's competence or scope, a higher or different level of care is indicated, specialized services are needed, or a conflict of interest or lack of progress makes the relationship ineffective.

Counselors, physicians and nurses, psychiatrists, psychologists, social workers, peer specialists, case managers and, with consent, probation or family, who share information to plan and provide care.

To confirm the client reached the service, address barriers, ensure continuity of care, and learn the outcome, which closes the loop and reduces dropout.

Manageable caseloads, supportive supervision, fair pay and recognition, trauma-informed workplace policies, time for self-care, and a culture that normalizes seeking help.

Burnout comes from work stress and overload, compassion fatigue is exhaustion from ongoing caring, and secondary traumatic stress involves PTSD-like symptoms from hearing about clients' trauma.

To prepare for sessions, be open and honest including about mistakes and doubts, accept and apply feedback, follow ethical and legal standards, and document supervision.

Healthy boundaries, manageable caseloads, regular supervision and peer support, rest, exercise, hobbies, healthy relationships, time off, mindfulness and personal counseling when needed.

Emotional exhaustion, depersonalization or cynicism, and a reduced sense of personal accomplishment, usually caused by chronic workplace stress such as heavy caseloads and low support.

Administrative (policies, accountability), educational (skills and knowledge), and supportive (encouragement, stress management), alongside clinical oversight of cases.

Education in the field, supervised work and practicum experience, passing the exam, an ethics commitment and renewal with continuing education, with the details set by the member board.

Training in evidence-based practices, conferences, reading, supervision, professional organizations such as NAADAC, mentoring and advancing certification.

Peer consultation, case conferences, expert consultation, ethics committees and consultation with a supervisor, each helping with complex clinical, ethical or cultural questions.

A counselor's emotional reaction to a client, often arising from the counselor's own history. It is managed by self-awareness, supervision and consultation so it does not harm the client.

The habit of regularly examining one's own work, biases, mistakes and growth areas, with feedback, to improve competence and stay within scope.

To develop the counselor's skills, safeguard client welfare, monitor quality and ethical practice, serve as a gatekeeper for the profession, and provide support.

Lasting changes in a counselor's beliefs, sense of safety and worldview from repeated empathic engagement with clients' trauma. Signs include intrusive images, hypervigilance, cynicism and withdrawal.

Maintain a recovery program and supports, watch for stress and warning signs, avoid working outside competence, and seek help or step back from clinical work if a relapse or serious risk occurs.

To maintain competence, stay current with research, laws and ethics, and renew certification. Boards set required hours, often including ethics.

Safety and imminent risks come first, such as suicidality or severe withdrawal, followed by urgent medical and mental health needs, then problems that threaten engagement, then longer-term goals.

Relapse rates are about 40 to 60 percent, similar to other chronic illnesses such as hypertension and asthma, and show the need for ongoing treatment and monitoring, not that treatment failed.

Practical barriers such as transportation, child care, housing, employment and cost can derail engagement, so the plan should include case management and resources to address them.

Goals are broad statements of the desired outcome, such as achieving abstinence. Objectives are specific, measurable steps toward the goal, such as attending three support meetings a week.

Relapse is a return to substance use after a period of abstinence, and is often seen as a process rather than a single event. A lapse is a single slip or brief use that need not become a full return to prior patterns.

Try to re-engage, provide crisis and overdose information and naloxone, coordinate a safe discharge and referral where possible, and keep the door open to return. Leaving early raises overdose and relapse risk.

Without judgment: assess safety, explore what happened, reaffirm the client's worth, treat it as information, adjust the treatment plan and level of care, and re-engage the client quickly.

Avoiding or leaving triggers, delaying the decision, distraction, calling a supportive person, refusal skills, relaxation, exercise and urge surfing.

Individual and group counseling, cognitive behavioral skills training, motivational interviewing, family sessions, medication, case management, recovery support and referral to community resources.

Internal triggers are feelings, thoughts and physical states, such as stress or boredom. External triggers are people, places, objects and situations associated with use.

Changes in attitudes, thinking, mood and behavior that appear before a return to use, such as complacency, skipping meetings, isolating, romanticizing use, or dropping routines. Gorski's model maps these stages.

A continuing care or aftercare plan, follow-up appointments, recovery support and peer groups, housing, employment or education, medication, relapse prevention and crisis plan, and referrals.

Problem statements, goals, measurable objectives, interventions or strategies, who is responsible, target dates, and the client's strengths, with signatures showing participation.

Negative emotional states, interpersonal conflict, social pressure to use, and positive emotional states and cues linked to prior use.

Hungry, Angry, Lonely and Tired, common physical and emotional states that raise the risk of relapse and should prompt self-care.

Specific, Measurable, Achievable, Relevant and Time-bound.

Relapse results when a person in a high-risk situation lacks coping skills and confidence. Helping clients identify high-risk situations, build coping responses and raise self-efficacy lowers relapse risk.

An integrated plan that addresses both the substance use and mental health conditions together, coordinating medications and services among providers.

The guilt, shame and sense of failure after a lapse, which may cause the person to give up and keep using. Counselors help clients treat a lapse as a learning event.

An individualized, written roadmap that sets out the client's problems, goals, measurable objectives and the services to be used, based on assessment, and used to guide and measure progress.

A mindfulness technique in which the person observes a craving like a wave that rises, peaks and passes, without acting on it.

Personal triggers and high-risk situations, early warning signs, coping strategies, supports and contacts, a plan to respond to a lapse, and how to get help quickly.

At admission. Planning for continuing care starts early and is revised throughout treatment.

When goals are met, the client no longer needs the service, or is not benefiting, or when a referral is needed. Termination should be planned, discussed with the client, and documented, with referrals and continuing care in place.

At regular intervals set by the program or payer, and whenever goals are met, new problems arise, the client is not progressing, or the level of care changes.

Each client has different needs, strengths, culture and goals. Standardized plans ignore these differences, reduce engagement and may not meet payer or accreditation standards.

Sustained contact after the intensive phase of treatment is linked to better outcomes and lower relapse, because recovery is a long-term process.

Healthy routines, exercise, sleep, positive activities, work and relationships reduce stress and the desire for escape, which helps protect recovery.

Collaborative plans reflect the client's own goals, values and culture, build commitment and motivation, and are an ethical requirement of client rights and informed consent.

So that care is documented as purposeful and measurable, shows progress or the lack of it, supports continued stay and billing, and guides adjustments to the plan.