Free IC&RC ADC Exam Flashcards

The brain's primary reward circuit, running from the ventral tegmental area (VTA) to the nucleus accumbens. Virtually all drugs of abuse increase dopamine release here, producing reinforcement that drives compulsive use.

Diagnosis requires at least 2 of 11 criteria within a 12-month period. Severity: mild = 2-3 criteria, moderate = 4-5 criteria, severe = 6 or more. Criteria fall into four groups: impaired control, social impairment, risky use, and pharmacologic (tolerance/withdrawal).

Tolerance = needing more of a substance to achieve the same effect (receptor adaptation). Physical dependence = withdrawal symptoms appear when use stops. Either alone can occur with prescribed medications and does not by itself indicate a substance use disorder.

Mild symptoms (tremor, anxiety) begin 6-12 hours after last drink; hallucinations at 12-24 hours; seizures peak at 24-48 hours; delirium tremens (DTs) at 48-96 hours. DTs carry up to 5% mortality and require medical detox with benzodiazepines.

Onset depends on half-life: heroin/short-acting opioids start at 8-24 hours; methadone at 24-48 hours. Symptoms include lacrimation, rhinorrhea, yawning, muscle aches, diarrhea, and piloerection. Extremely uncomfortable but rarely fatal in healthy adults.

Increase dopamine and norepinephrine availability, producing euphoria, increased energy, and decreased appetite. Withdrawal is primarily psychological (depression, anhedonia, hypersomnia, intense cravings) and is not life-threatening but elevates suicide risk.

Enhance GABA inhibition, producing sedation and anxiolysis. Share cross-tolerance with each other. Combined use multiplies overdose risk; abrupt discontinuation after heavy use can cause life-threatening seizures requiring medical taper.

The simultaneous presence of a substance use disorder and a mental health disorder in the same person. Best practice is integrated, concurrent treatment of both conditions by a single team rather than sequential or parallel care.

A 10-item WHO-developed screen for risky alcohol use. Scores: 0-7 low risk, 8-15 hazardous use, 16-19 harmful use, 20+ likely dependence. Validated across cultures and gender; the AUDIT-C is a 3-item short version.

A 4-item alcohol screen: Cut down, Annoyed by criticism, Guilty about drinking, Eye-opener morning drink. Two or more 'yes' answers indicate likely problem drinking and warrant further assessment. Quick but less sensitive than AUDIT.

A 10-item self-report screen for drug use other than alcohol over the past 12 months. Scores: 1-2 low, 3-5 moderate, 6-8 substantial, 9-10 severe. A score of 3 or more typically triggers a full diagnostic assessment.

A 6-item screen specifically validated for adolescents (ages 12-21). Acronym: Car, Relax, Alone, Forget, Family/Friends, Trouble. Two or more 'yes' responses indicate high risk for a substance use disorder and warrant further evaluation.

A 10-item clinician-rated scale that quantifies alcohol withdrawal severity (max score 67). Scores under 10 = minimal withdrawal, 10-18 = mild-moderate, 19+ = severe. Used to guide symptom-triggered benzodiazepine dosing in medical detox.

Multidimensional assessment for placement and continued-stay decisions: (1) Acute intoxication/withdrawal potential, (2) Biomedical conditions, (3) Emotional/behavioral/cognitive conditions, (4) Readiness to change, (5) Relapse/continued use potential, (6) Recovery environment.

Level 0.5 = early intervention; Level 1 = outpatient (<9 hrs/wk); Level 2.1 = intensive outpatient (9-19 hrs/wk); Level 2.5 = partial hospitalization (20+ hrs); Level 3 = residential (3.1, 3.3, 3.5, 3.7); Level 4 = medically managed intensive inpatient.

A comprehensive evaluation covering biological factors (medical, genetic, pharmacologic), psychological factors (mood, trauma, cognition), and social factors (family, employment, legal, housing, culture). Forms the foundation for individualized treatment planning.

A structured clinical interview measuring problem severity across seven domains: medical, employment, alcohol, drug, legal, family/social, and psychiatric. Yields both composite and severity ratings; widely used for treatment planning and outcomes research.

Screening = brief process identifying whether a problem may exist (yes/no decision to proceed). Assessment = comprehensive evaluation establishing diagnosis, severity, and treatment recommendations. Screening does not diagnose; assessment does.

Prochaska & DiClemente's model: Precontemplation (no intent to change), Contemplation (considering), Preparation (planning within 30 days), Action (changed behavior <6 months), Maintenance (sustained 6+ months), and sometimes Relapse/Recurrence.

A collaborative, person-centered counseling style for strengthening motivation to change. Four elements of MI spirit: Partnership, Acceptance, Compassion, and Evocation (PACE). The counselor evokes the client's own reasons for change rather than imposing them.

Open-ended questions, Affirmations, Reflective listening, and Summaries. These four micro-skills build rapport, elicit change talk, and resolve ambivalence. Reflective listening is considered the most central MI skill.

Change talk = client statements favoring change (DARN-CAT: Desire, Ability, Reasons, Need, Commitment, Activation, Taking steps). Sustain talk = statements favoring status quo. MI clinicians selectively reflect change talk and soften sustain talk.

An MI principle of avoiding direct argument when a client resists change. Instead the counselor reflects, reframes, or shifts focus, recognizing resistance as a signal to change strategy rather than a client trait. In MI-3 this is reframed as 'responding to discord.'

A structured, time-limited therapy that identifies triggers, distorted thoughts, and maladaptive behaviors, then teaches coping skills, refusal skills, and relapse-prevention planning. Evidence-based across alcohol, stimulant, and cannabis use disorders.

A manualized, evidence-based approach designed to engage clients in community 12-step programs (AA, NA) by promoting acceptance, surrender, and active involvement. Project MATCH demonstrated outcomes comparable to CBT and MET.

An operant-conditioning intervention providing tangible rewards (vouchers, prizes) for verified abstinence or treatment-plan compliance. Strongest evidence base for stimulant use disorder, where no FDA-approved medications exist.

A cognitive-behavioral approach identifying high-risk situations, developing coping strategies, and addressing the Abstinence Violation Effect (the all-or-nothing thinking after a lapse). Distinguishes a lapse (single slip) from a relapse (return to prior use pattern).

Eleven curative factors including instillation of hope, universality, imparting information, altruism, group cohesiveness, catharsis, and interpersonal learning. Group is cost-effective and uniquely powerful for reducing isolation common in SUD.

Forming (orientation), Storming (conflict), Norming (cohesion), Performing (productive work), and Adjourning (termination). Counselor leadership style shifts from directive in early stages to facilitative as the group matures.

Goals should be Specific, Measurable, Achievable, Relevant, and Time-bound. Plans are individualized, strength-based, and developed collaboratively with the client. Required components: problem list, goals, measurable objectives, interventions, and review dates.

Three FDA-approved options: methadone (full mu agonist, dispensed only at OTPs), buprenorphine (partial agonist, office-based, ceiling effect on respiratory depression), and naltrexone (opioid antagonist, extended-release injection blocks effects).

An opioid receptor antagonist used for both alcohol and opioid use disorders. Available as daily oral or monthly extended-release injection (Vivitrol). Requires 7-10 days opioid-free before initiation to avoid precipitated withdrawal.

A glutamate-system modulator that reduces post-acute alcohol withdrawal symptoms and craving in abstinent patients with alcohol use disorder. Best used after detox; dosed three times daily; renal excretion makes it preferred when liver disease is present.

Inhibits aldehyde dehydrogenase, causing flushing, nausea, vomiting, and tachycardia when alcohol is consumed. Aversive-conditioning approach; effectiveness depends heavily on adherence, supervision, and informed consent about the reaction.

Partial mu-opioid agonist with a ceiling effect on respiratory depression, making it safer than methadone in overdose. Combined with naloxone (Suboxone) to deter injection. Initiate when client is in mild-to-moderate withdrawal to avoid precipitated withdrawal.

A pragmatic public-health approach that meets clients 'where they are,' reducing negative consequences of use without requiring abstinence as an entry condition. Examples: naloxone distribution, syringe-services programs, fentanyl test strips, safer-use education.

Linking clients to community resources (housing, employment, primary care, legal aid, recovery support) and coordinating across providers. Counselor should match referrals to client need, follow up to confirm engagement, and obtain releases of information.

Begins at admission, not at termination. Includes step-down level of care, mutual-help engagement, medication continuation, relapse-prevention plan, emergency contacts, and follow-up appointments scheduled before discharge to improve retention.

Federal regulation providing stricter confidentiality for SUD treatment records than HIPAA. Prohibits disclosure or even acknowledgment that a person is a patient at a Part 2 program without specific written consent, except for narrow exceptions (medical emergency, court order with good cause, audit, research).

Disclosure without written consent is permitted only for: bona fide medical emergencies, mandated reporting of child abuse/neglect, crimes on program premises or against program staff, court-ordered disclosure with good cause, audits/evaluations, and properly de-identified research.

Voluntary, written agreement requiring disclosure of: nature and purpose of services, risks and benefits, alternatives, confidentiality limits, fees, counselor credentials, right to refuse or withdraw, and grievance procedures. Must be documented and updated as treatment changes.

When a client makes a credible threat of serious harm against an identifiable victim, the counselor has a legal duty to take reasonable steps to protect the intended victim. This duty can override confidentiality and varies by state statute; document the threat assessment and actions taken.

All states require counselors to report suspected child abuse or neglect; most also require reporting of elder or dependent-adult abuse. Reports are based on reasonable suspicion, not proof. Mandated-reporting laws override both HIPAA and 42 CFR Part 2 consent requirements.

Non-clinical relationships (social, sexual, financial, employer) with current or recent clients that could impair objectivity or exploit the power differential. Sexual contact with current clients is prohibited; many ethics codes maintain the prohibition for at least 2-5 years post-termination, with several extending it permanently.

Sharing personal information should be intentional, brief, and directly therapeutic for the client - never for the counselor's own needs. In peer-recovery roles disclosure is more accepted; in clinical roles it should follow a clear clinical rationale and supervision review.

The counselor's unconscious emotional reactions toward a client, often shaped by the counselor's own history, biases, or unresolved issues. Managed through clinical supervision, self-care, personal therapy, and ongoing self-awareness rather than ignored or acted upon.

Ongoing ability to deliver effective services across language, race, ethnicity, gender identity, sexual orientation, religion, age, and ability. Requires self-awareness of bias, knowledge of the client's worldview, adaptation of interventions, and humility toward the client as the cultural expert.

Assess ideation, plan, means, intent, and prior attempts. Use a structured tool (e.g., Columbia Protocol). Restrict access to lethal means, develop a safety plan with warning signs and coping steps, and arrange the least restrictive level of care that maintains safety. Document risk reasoning.

Records should be timely, factual, legible, signed, and linked to the treatment plan. Document services rendered, client response, plan changes, risk assessments, releases of information, and supervisor consultations. Late entries must be clearly labeled with date entered and date of service.

A formal, ongoing relationship in which a credentialed supervisor monitors a counselor's clinical work, develops professional skills, ensures client welfare, and addresses ethical issues. IC&RC ADC eligibility requires 100-300 hours of supervision with at least 10 hours per content domain.