14.3 Addiction Intervention Techniques and Case Management

Why Addiction and Case Management Are Paired

Substance use disorders rarely travel alone. A client with opioid use disorder often has co-occurring depression, unstable housing, legal involvement, and fractured family support. The clinical social worker must both deliver addiction-specific intervention and coordinate the broader web of services — these two skill sets are tested together under ASWB Clinical IIIB.

SBIRT

SBIRT — Screening, Brief Intervention, Referral to Treatment — is a public-health, evidence-based framework for identifying risky substance use in non-specialty settings such as primary care, emergency departments, and schools.

flowchart TD
    S[Screening<br/>AUDIT-C, DAST, CRAFFT, NIDA Quick Screen] --> B{Positive Screen?}
    B -->|No| R1[Routine Care]
    B -->|Yes| BI[Brief Intervention<br/>MI-based, 5-15 min]
    BI --> BT{Brief Treatment Needed?}
    BT -->|No, low risk| R2[Monitor + Follow-up]
    BT -->|Yes, moderate-severe| RT[Referral to Treatment<br/>SUD specialty, MOUD, inpatient]

• Screening uses validated tools (AUDIT-C for alcohol, DAST for drugs, CRAFFT for adolescents, NIDA Quick Screen for general use)
• Brief intervention is a 5- to 15-minute motivational interviewing conversation that provides feedback, raises awareness of risk, and supports change
• Referral to treatment links the client to specialty SUD care, MOUD prescribers, or inpatient levels as needed

SBIRT is brief enough for non-specialty settings and is reimbursable under many insurance plans.

Evidence-Based Addiction Intervention Techniques

Motivational Interviewing for SUD

Motivational interviewing (MI; Miller & Rollnick) is the foundation of brief intervention and is strongly evidence-based for SUD. Core skills — open questions, affirmations, reflective listening, summaries (OARS) — elicit and strengthen the client's own change talk.

Relapse-Prevention Skills

Relapse prevention (Marlatt & Gordon) teaches clients to identify high-risk situations, develop coping alternatives, build a balanced lifestyle, and reframe lapses as learning opportunities rather than failures.

Community Reinforcement Approach (CRA)

The community reinforcement approach restructures the client's environment so that sober behavior is more rewarding than substance use — building sober social networks, employment, recreational alternatives, and family reinforcement. CRA with vouchers (an incentive or contingency management variant) has strong evidence for stimulant use disorder.

Contingency Management

Contingency management provides tangible reinforcers — vouchers, prizes, privileges — contingent on verifiable abstinence or treatment goals. It has the strongest evidence base for stimulant use disorder, where no FDA-approved medication exists.

MOUD Coordination

Social workers do not prescribe. They coordinate with prescribers for medications for opioid use disorder (MOUD) and medications for alcohol use disorder:

The social worker's role includes explaining medication options, addressing stigma, coordinating appointments, monitoring adherence and side effects in collaboration with the prescriber, and integrating medication with psychosocial treatment.

Vignette. A client with severe OUD tells the social worker she is afraid of methadone because "it's just trading one drug for another." The worker provides accurate psychoeducation about MOUD, explores the client's values, offers to accompany her to a buprenorphine prescriber appointment, and integrates the medication decision with weekly relapse-prevention sessions. Coordination, not prescription.

Case Management Techniques

Case management is a core social work intervention for clients with complex needs. Its functions are:

• Assessment — comprehensive, strengths-based, including needs across life domains
• Planning — individualized service plan with the client
• Linking — connecting the client to formal and informal resources
• Coordination — integrating services across providers and systems
• Monitoring — tracking progress, revising the plan
• Advocacy — securing services and rights

Models of Case Management

• Broker model — the worker connects the client to services and steps back; minimal ongoing contact
• Clinical case management — the worker provides both service coordination and direct clinical intervention (Bourbon's model)
• Strengths-based case management — emphasizes client strengths, self-direction, and the client-worker relationship as the engine of change
• Intensive case management (ICM) — small caseloads, frequent contact, assertive outreach for clients with SMI; the wrap-around variant includes a multidisciplinary team

Care Coordination Across Systems

Clients with co-occurring SUD and SMI often touch multiple systems: mental health, primary medical, housing, benefits (SSI/SSDI, SNAP), justice (probation, drug court), child welfare, and vocational services. The case manager is the human glue — ensuring that medication prescribed by the psychiatrist is filled, that the housing case manager knows the court date, that the client has transportation to the MOUD clinic.

Pulling It Together

Effective addiction intervention is rarely one technique — it is SBIRT to find the client, MI to engage, MOUD coordinated with a prescriber for OUD, contingency management or CRA for stimulant use, relapse-prevention skills for maintenance, and case management to hold the service web together.