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Cheat sheet

CASAC Cheat Sheet

Practice QuestionsStudy Guide

Scientific Principles

25%of exam

PharmacologyBrain and RiskSubstancesCo-occurringWithdrawal

Screening and Assessment

20%of exam

DSM-5 DiagnosisScreening ToolsASAM DimensionsBiopsychosocialToxicology

Treatment and Counseling

30%of exam

ModalitiesStages of ChangeASAM Levels12 Core FunctionsTreatment Planning

Professional Ethics

25%of exam

ConfidentialityBoundariesScope of PracticeDocumentationCultural Competence

Quick Facts

Exam
IC&RC ADC
Questions
150 (125+25)
Time
3 hours
Pass
Scaled 500/800
Retake
Every 90 days
Renewal
3 years 60 CE
Fee
$245
Admin
Pearson VUE

Tolerance vs Dependence

Tolerance

  • Need more drug
  • Pharmacological adaptation
  • Receptor down-regulation

Dependence

  • Withdrawal on stop
  • Physical adaptation
  • Can exist alone

Dose effect vs stop effect

Pharmacology

Tolerance
Need more for effect
Dependence
Withdrawal on stop
Cross-tolerance
Tolerance to related drug
Agonist
Activates receptor
Antagonist
Blocks receptor
Withdrawal
Stop symptoms cluster
Delirium tremens
Severe alcohol withdrawal
Naloxone
Opioid overdose reversal

Agonist vs Antagonist

Agonist

  • Activates receptor
  • Mimics substance effect
  • Methadone buprenorphine

Antagonist

  • Blocks receptor
  • Prevents effect
  • Naltrexone naloxone

Activate vs block

Brain and Risk

Reward pathway
Mesolimbic dopamine circuit
Dopamine
Reinforcement neurotransmitter
Risk factors
Genetics trauma peers
Protective factors
Family support coping
Disease model
Chronic relapsing brain disease

Physical vs Psychological Dependence

Physical

  • Withdrawal symptoms
  • Measurable physiological
  • Detox may be needed

Psychological

  • Craving and coping
  • Emotional drive to use
  • Reward-driven

Body vs mind drive

Substances

Alcohol
Depressant; DTs risky
Opioids
Respiratory depression overdose
Stimulants
Cocaine meth paranoia
Benzodiazepines
Sedative; seizure withdrawal
Cannabis
Mild withdrawal low overdose
Nicotine
Cessation craving dysphoria

Co-occurring Disorders

Dual diagnosis
SUD plus mental disorder
Self-medication
Using to relieve symptoms
Integrated care
Treat both concurrently
Substance-induced
Resolves with abstinence
Independent disorder
Persists despite abstinence

DSM-5 Severity

2-3 mild 4-5 moderate 6+ severe

2-3 mild4-5 moderate6+ severe11 total criteria

Screening vs Assessment

Screening

  • Brief first check
  • Flag possible problem
  • CAGE AUDIT DAST

Assessment

  • Full biopsychosocial
  • Diagnose and plan
  • ASI dimensions

Flag vs diagnose

Screening Tool Picker

  1. Quick alcohol flag→CAGE(4 questions)
  2. WHO standard screen→AUDIT(10 items)
  3. Non-alcohol drugs→DAST(10 items)
  4. Primary-care public health→SBIRT(Brief intervene refer)
  5. Full severity profile→ASI(Multi-domain interview)
  6. Objective drug use→Toxicology screen(Urine blood oral)

DSM-5 Diagnosis

11 criteria
Control social risky Pharma
Mild
2-3 criteria met
Moderate
4-5 criteria met
Severe
6+ criteria met
Impaired control
Using more longer
Risky use
Danger despite consequences

Screening Tools

CAGE
4-question alcohol screen
AUDIT
10-item WHO alcohol
DAST
Drug abuse screen
SBIRT
Screen brief intervene refer
ASI
Addiction severity index
SASSI
Substance subtle screening
CIWA
Alcohol withdrawal scale

ASAM Dimensions

Dim 1
Intoxication withdrawal risk
Dim 2
Biomedical conditions
Dim 3
Emotional behavioral complications
Dim 4
Readiness to change
Dim 5
Relapse potential
Dim 6
Recovery environment

OARS MI Skills

Open Affirm Reflect Summarize

Open questionsAffirmationsReflective listeningSummaries

MI vs Confrontation

Motivational Interviewing

  • Elicit change talk
  • Roll with resistance
  • OARS skills

Confrontation

  • Argue for change
  • Increase defensiveness
  • Power struggle

Elicit vs impose

ASAM Level Picker

  1. Acute intoxication→Level 3.7 detox(Medical withdrawal mgmt)
  2. Severe withdrawal risk→Level 4 inpatient(Medically managed)
  3. Unstable home→Level 3 residential(24h structured)
  4. Day support needed→Level 2.5 PHP(Partial hospital)
  5. Work school flexible→Level 2.1 IOP(9h week)
  6. Stable low risk→Level 1 outpatient(1-2h week)
  7. Psychoeducation only→Level 0.5(Early intervention)
  8. Co-occurring crisis→Integrated referral(Both disorders)

Counseling Modalities

CBT
Thoughts feelings behaviors
MI
Elicit change talk
12-step facilitation
AA NA engagement
Relapse prevention
Cope high-risk situations
Harm reduction
Reduce harm no abstinence
Group therapy
Peer feedback cohesion
Family systems
System not individual

FRAMES Brief Intervention

Feedback Responsibility Advice Menu Empathy Self-efficacy

FeedbackResponsibilityAdvice optionsEmpathySelf-efficacy

Lapse vs Relapse

Lapse

  • Single use event
  • Brief isolated
  • Learning opportunity

Relapse

  • Return to patterns
  • Sustained problematic use
  • Reevaluate plan

Slip vs return

MI Response Picker

  1. Sustain talk→Reflect(Do not argue)
  2. Resistance→Roll with it(Reframe not oppose)
  3. Low motivation→OARS(Open questions)
  4. Goal behavior gap→Develop discrepancy(Client own words)
  5. Commitment language→Strengthen(Elicit plan)

Stages of Change

Precontemplation
No problem awareness
Contemplation
Ambivalent considering change
Preparation
Ready planning action
Action
Actively changing behavior
Maintenance
Sustaining preventing relapse

Stages of Change

Pre Con Prep Act Maintain

PrecontemplationContemplationPreparationActionMaintenance

ASAM Levels

Level 0.5
Early intervention
Level 1
Outpatient
Level 2.1
Intensive outpatient
Level 2.5
Partial hospitalization
Level 3
Residential
Level 4
Medically managed inpatient

ASAM Levels

0.5 1 2 3 4 continuum

0.5 early1 outpatient2 IOP PHP3 residential4 inpatient

12 Core Functions

Screening
Brief problem check
Intake
Admit to program
Assessment
Biopsychosocial evaluation
Treatment planning
Goals objectives dates
Counseling
Individual group family
Referral
Link to services

Treatment Planning

SMART goals
Specific measurable achievable
Individualized plan
Collaborative written goals
Continuum of care
Match intensity to need
Continuing care
Aftercare recovery support
Discharge planning
Transition and termination

Confidentiality vs Duty to Warn

Confidentiality

  • Protect all records
  • 42 CFR Part 2
  • Written consent required

Duty to Warn

  • Break for danger
  • Warn foreseeable victim
  • Tarasoff principle

Protect vs prevent harm

Confidentiality

42 CFR Part 2
Stricter than HIPAA
HIPAA
General health privacy
Duty to warn
Protect foreseeable victim
Tarasoff
Duty to protect case
Informed consent
Voluntary ongoing agreement
Mandated reporting
Report suspected child abuse

Professional Boundaries

Dual relationships
Avoid exploitative roles
Scope of practice
CASAC cannot prescribe
Supervision
Consult senior clinician
Cultural competence
Awareness of bias
Documentation
If not written not done

Common Traps

Tolerance vs dependence

Tolerance equals need more ≠ Dependence equals withdrawal

Screen vs diagnose

Screening flags risk ≠ Assessment diagnoses plans

Part 2 vs HIPAA

Part 2 is stricter ≠ HIPAA is general privacy

Lapse vs relapse

Lapse is single use ≠ Relapse is sustained return

Agonist vs antagonist

Agonist activates receptor ≠ Antagonist blocks receptor

Sequential vs integrated

Sequential treats one first ≠ Integrated treats both together

Change talk vs sustain

Change talk favors movement ≠ Sustain talk favors status quo

Last Minute

  1. 1.150 Q = 125 scored + 25 pretest
  2. 2.Pass equals scaled 500 of 800
  3. 3.Domains 25 20 30 25%
  4. 4.DSM-5 2-3 mild 4-5 mod 6+
  5. 5.ASAM 6 dims pick level
  6. 6.Part 2 stricter than HIPAA
  7. 7.OARS equals MI core skills
  8. 8.Stages Pre Con Prep Act Maintain
  9. 9.Retake 90d; renew 3yr 60h
  10. 10.Duty to warn breaks confidentiality
  11. 11.12 Core Functions equals scope

CASAC

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