Screening, Assessment, and Engagement
22%of exam
Treatment Planning, Collaboration, and Referral
24%of exam
Counseling and Education
30%of exam
Professional Responsibilities and Ethical Considerations
24%of exam
Quick Facts
- Exam
- IC&RC AADC
- Credential
- Advanced Addiction Counselor
- Questions
- 150 (125 scored)
- Time
- 3 hours
- Pass
- Scaled 500/800
- Level
- Master's required
- Blueprint
- Mar 16 2026
- Retake
- 90-day minimum wait
ASAM Six Dimensions
Dims 1-5 place; Dimension 6 decides with client.
1: Intox/withdrawal2: Biomedical3: Psychiatric/cognitive4: Use-related risk5: Recovery environment6: Person-centered
Screening vs Assessment
Screening
- Brief flag
- Decides next step
- Not a diagnosis
Assessment
- Deep biopsychosocial process
- Supports the diagnosis
- Ongoing, not one-time
Flag vs formulate
Level-of-Care Picker
- High Dimension 1 risk→Manage intox/withdrawal(Medical support)
- High Dimension 2 risk→Address biomedical needs(Coordinate medical care)
- High Dimension 3 risk→Treat psychiatric symptoms(Integrated care needed)
- High Dimension 4 risk→Raise level of care(Relapse risk driver)
- Unsafe Dimension 5→More structured setting(Environment risk driver)
- Dimension 6 barriers→Shared decision-making(Not the placement calc)
- Any dimension high→Consider higher level(One dimension can drive)
- All dimensions stable→Step down level(Documented milestones needed)
DSM-5-TR Severity
- 11 criteria
- Total DSM-5-TR SUD criteria
- Mild SUD
- 2-3 criteria met
- Moderate SUD
- 4-5 criteria met
- Severe SUD
- 6 or more criteria
- 12-month window
- Criteria counting timeframe
- Substance-induced
- Clears as substance clears
- Independent disorder
- Predates use, persists ~1 month
DSM-5-TR Severity
2-3 mild, 4-5 moderate, 6-plus severe.
11 criteria total12-month windowMild: 2-3Moderate: 4-5Severe: 6-plus
Substance-Induced vs Independent
Substance-induced
- Starts with use
- Clears with time
- Expected to resolve
Independent
- Predates the use
- Persists about a month
- Needs its own treatment
Clears vs persists
ASAM 4th Ed Dimensions
- Dimension 1
- Intox/withdrawal, addiction meds
- Dimension 2
- Biomedical conditions
- Dimension 3
- Psychiatric, cognitive conditions
- Dimension 4
- Substance use-related risks
- Dimension 5
- Recovery environment interactions
- Dimension 6
- Person-centered considerations
- Dims 1-5
- Set level-of-care recommendation
Stages Of Change
Precontemplation to maintenance, five stages total.
Precontemplation: not yetContemplation: weighing itPreparation: planning itAction: doing itMaintenance: sustaining it
Assessment Practice
- Bio/psycho/social/spiritual
- Four-domain clinical interview
- Cultural fit
- Match tool to population
- Qualified interpreter
- Not a family member
- MAT screening
- Substance, stability, prior response
- Danger screening
- Ideation, plan, means, intent
- Co-occurring dx
- Formulate both diagnoses together
- Results discussion
- Collaborative, not one-way
Stages Of Change
- Precontemplation
- Not yet considering change
- Contemplation
- Weighing pros and cons
- Preparation
- Planning the change step
- Action
- Actively changing behavior
- Maintenance
- Sustaining the change
- Style match
- Fit approach to stage
Integrated vs Sequential Treatment
Integrated
- One coordinated plan
- TIP 42 preferred model
- Avoids conflicting guidance
Sequential
- Treats one disorder first
- Then treats the other
- Can delay second disorder
Together vs one-at-a-time
SMART Treatment Plans
- Specific
- Clear target behavior
- Measurable
- Verifiable in session
- Achievable
- Realistic for this client
- Relevant
- Tied to client's goals
- Time-bound
- Has a target date
- Collaborative
- Client co-authors the goal
Warm Handoff vs Passive Referral
Warm handoff
- Active, scheduled connection
- Happens before care ends
- Lower drop-off rate
Passive referral
- Just a name or number
- Client follows up alone
- Higher drop-off rate
Connects vs hands off
Recovery Pathways + Supports
- 12-step
- Mutual-help recovery pathway
- MAT pathway
- Medication-supported recovery
- Harm reduction
- Reduces risk, not abstinence-only
- Faith-based
- Values-driven recovery pathway
- Secular pathway
- Non-spiritual recovery option
- Formal resource
- Licensed, structured service
- Informal support
- Peer, faith, mutual-help
Referral + Care Coordination
- Warm handoff
- Active connection before discharge
- Passive referral
- Name only, high drop-off
- Referral note
- Contact, consent, outcome, follow-up
- Scope boundary
- No meds, no override
- Step-down
- Driven by documented milestones
- Step-up
- Driven by new risk
Co-Occurring Treatment Models
- Sequential
- One disorder, then other
- Parallel
- Both treated, separate providers
- Integrated
- Both, one coordinated plan
- TIP 42
- SAMHSA co-occurring guide
- Preferred model
- Integrated treatment, per TIP 42
MI Four Processes
Engage, focus, evoke, plan in order.
Engage: build relationshipFocus: pick directionEvoke: draw out talkPlan: commit to steps
Transference vs Countertransference
Transference
- Client's redirected feelings
- About the client's past
- Client's reaction to counselor
Countertransference
- Counselor's own reaction
- From counselor's own history
- Counselor manages it, not client
Client vs counselor origin
Intervention Picker
- Low motivation to change→MI(Resolves ambivalence)
- Need a quick boost→MET(Brief feedback session)
- Distorted relapse-risk thoughts→CBT(Restructure the thought)
- Need verified abstinence→Contingency management(Reinforce the behavior)
- Ambivalent about meetings→12-Step Facilitation(Engage mutual-help group)
- Craving in the moment→MBRP(Urge surfing skill)
- Trauma, not ready to process→Seeking Safety(Present-focused, skills-based)
- Adolescent client's substance use→MDFT, BSFT, or FFT(Family-based model)
Evidence-Based Interventions
- CBT
- Restructures relapse-risk thoughts
- MI
- Resolves ambivalence about change
- MET
- Brief, feedback-driven intervention
- Contingency mgmt
- Reinforces verified target behavior
- 12-Step Facilitation
- Actively engages mutual-help groups
- MBRP
- Urge-surfing core skill
- Seeking Safety
- Present-focused trauma model
MAT Mechanisms
Agonist, partial agonist, antagonist: three drug classes.
Methadone: full agonistBuprenorphine: partial, ceiling effectNaltrexone: antagonist, blocks receptor
Pharmacotherapy Picker
- Opioid use, in withdrawal→Methadone or buprenorphine(OTP or office-based Rx)
- Opioid use, needs antagonist→XR-naltrexone(Needs 7-10 opioid-free days)
- Alcohol use, liver concern→Acamprosate(Renally cleared option)
- Alcohol use, needs deterrent→Disulfiram(Requires full abstinence)
- Tobacco use disorder→Varenicline, bupropion, or NRT(Prescriber-guided combination possible)
- Too soon after agonist→Avoid early buprenorphine(Risk of precipitated withdrawal)
MI Four Processes
- Engaging
- Build the working relationship
- Focusing
- Agree on a direction
- Evoking
- Draw out change talk
- Planning
- Commit to specific steps
- Sequence matters
- Each step builds prior
Family + Trauma Models
- MDFT
- Multidimensional family therapy
- BSFT
- Brief strategic family therapy
- FFT
- Functional family therapy
- Family embedding
- Use disorder as family pattern
- Adolescent focus
- Treat family, not solo client
Pharmacotherapy
- Methadone
- Full agonist, OTP-only
- Buprenorphine
- Partial agonist, ceiling effect
- XR-naltrexone
- Antagonist, needs opioid-free days
- 7-10 days
- Opioid-free before XR-naltrexone
- Naltrexone (alcohol)
- Reduces alcohol cravings
- Acamprosate
- Preferred with liver concerns
- Disulfiram
- Deterrent, needs full abstinence
- Varenicline
- Tobacco cessation medication
- NRT
- Patch, gum, lozenge, spray
Withdrawal + Safety
- Alcohol withdrawal
- Seizure and delirium risk
- Sedative withdrawal
- Can be fatal too
- Opioid withdrawal
- Rarely life-threatening alone
- Post-tolerance risk
- Overdose danger after abstinence
- Medically managed
- Needed for alcohol, sedatives
Supervision vs Consultation
Supervision
- Ongoing and evaluative
- Shared clinical responsibility
- Assesses supervisee competence
Consultation
- Voluntary, as needed
- Non-evaluative input only
- Counselor keeps responsibility
Oversight vs advice
Confidentiality Picker
- Outside vendor needs data→QSOA(Binds vendor to Part 2)
- Subpoena alone arrives→Do not release(Court order still required)
- Court order is sought→Notify client and holder(Both get a chance)
- Unsure of own judgment→Consultation(Voluntary, non-evaluative input)
- Formal competence review needed→Supervision(Shared clinical responsibility)
- Colleague acts unethically→Report to the board(If informal fix fails)
42 CFR Part 2 Basics
- Part 2 program
- Federally assisted SUD provider
- Stricter than HIPAA
- SUD-specific extra protections
- Acknowledgment ban
- No confirming SUD-only facility
- Subpoena alone
- Not enough to disclose
- Court order
- Required, with notice first
- 2024 Final Rule
- Compliance date Feb 16 2026
- QSOA
- Binds vendor to Part 2
- Single consent
- Covers TPO disclosures now
- Still protected
- No use against patient
Boundary Crossing vs Violation
Crossing
- Stays in client's interest
- Gets reflected on after
- Not exploitive
Violation
- Exploits counselor's power
- Harms the client
- Personal benefit sought
Benign vs harmful
Duty + Telehealth
- Duty to warn
- Set by state, not IC&RC
- Telehealth consent
- Covers connection failure, ID
- EHR + tech
- Recognize service-delivery advances
- Jurisdiction rules
- Confidentiality exceptions vary by state
Court Order vs Subpoena
Court order
- Authorizes SUD disclosure
- Requires notice first
- Gives chance to respond
Subpoena alone
- Not enough by itself
- Common compliance error
- No SUD release yet
Authorizes vs insufficient
Supervision + Practice
- Supervision
- Ongoing, evaluative, shared responsibility
- Consultation
- Voluntary, non-evaluative input
- EBP
- Research plus expertise plus values
- Implicit bias
- Automatic, affects clinical decisions
- Explicit bias
- Consciously held attitude
- Unethical colleague
- Report to board or supervisor
Boundaries + Bias
- Boundary crossing
- Client's interest, reflected on
- Boundary violation
- Exploits power, harms client
- Cultural responsiveness
- Adapt, don't assume, ongoing
- DEIB
- Diversity, equity, inclusion, belonging
- Implicit in decisions
- Shows up in referral patterns
Common Traps
Screening confused with assessment
Screening only flags risk ≠ Assessment supports the diagnosis
Readiness dimension assumed missing
3rd edition had Dimension 4 ≠ 4th edition folds into Dimension 6
Subpoena treated as sufficient
Subpoena alone is not enough ≠ Court order is required
Consultation treated as supervision
Consultation stays voluntary, non-evaluative ≠ Supervision shares clinical responsibility
Buprenorphine started too early
Too soon after full agonist ≠ Can precipitate acute withdrawal
Opioid withdrawal assumed lethal
Rarely life-threatening by itself ≠ Main danger is later overdose
Every crossing called a violation
Crossing still serves the client ≠ Violation exploits counselor power
Last Minute
- 1.Counseling and Education 30%, largest
- 2.150 items: 125 scored + 25 pretest
- 3.3-hour time limit
- 4.Pass = scaled 500 of 800
- 5.Blueprint effective March 16 2026
- 6.Retake wait = 90 days min
- 7.ASAM 4th edition = 6 dimensions
- 8.Dim 6 = person-centered, not placement
- 9.Part 2 disclosure needs court order
- 10.2024 Rule compliance = Feb 2026
- 11.Supervision shares responsibility; consult does not
- 12.Integrated care preferred for co-occurring
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