1.1 Screening and Intake Procedures

1.1 Screening and Intake Procedures

[!IMPORTANT] NCAC I Official Examination Parameters & Administration (NAADAC/NCC AP):

• Total Questions: 150 multiple-choice, objective questions
• Time Allowed: 3 hours
• Passing Score: 67% correct (100/150) per NAADAC NCAC I page
• Initial Credential Fee: $235 (non-refundable); examination/test fees are separate from the credential application fee
• Administration: Computer-based testing through NCC AP's testing partner Kryterion testing locations, plus optional distance proctoring (home/office webcam)
• Domain Weights: Orientation to Treatment Process 14%; Assessment 23%; Ongoing Treatment Planning & Implementation 25%; Addiction Counseling Practices & Skills 21%; Professional Practices 17% In addiction counseling, the entry point to care is governed by the first two of the 12 Core Functions established by the National Certification Commission for Addiction Professionals (NCC AP) and NAADAC: Screening (Core Function 1) and Intake (Core Function 2). Master candidates for the NCAC I exam must thoroughly understand the operational distinctions, standardized tools, administrative workflows, client rights disclosures, and legal confidentiality frameworks that define these initial clinical encounters.

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Distinguishing Screening from Assessment

One of the most frequent conceptual traps on the NCAC I examination is confusing screening with assessment. Although both occur early in the client's treatment trajectory, their clinical purposes, scope, and outcomes are fundamentally distinct.

Screening answers the core question: "Does this individual need substance use treatment, and is our specific agency equipped to safely provide it?" If the client presents with acute medical conditions, severe active psychosis, or severe withdrawal risk that exceeds the agency's licensure, screening immediately triggers a referral to an appropriate level of care (e.g., medically managed inpatient withdrawal management).

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Standardized Substance Use Screening Instruments

Addiction counselors must be fluent in selecting, scoring, and interpreting validated, standardized screening instruments. The NCAC I exam tests knowledge of specific cut-off scores, targeted populations, and item structures across several key screening tools.

1. Alcohol Use Disorders Identification Test (AUDIT & AUDIT-C)

Developed by the World Health Organization (WHO), the AUDIT is a 10-item instrument designed to detect hazardous and harmful alcohol consumption. It covers three domains: alcohol intake (items 1–3), dependence symptoms (items 4–6), and alcohol-related problems (items 7–10). Each item is scored 0 to 4, yielding a maximum score of 40.

• Score 0–7: Low risk.
• Score 8–15: Hazardous or harmful alcohol use (suggests brief intervention).
• Score 16–19: Harmful use (suggests brief counseling and monitoring).
• Score 20+: High risk / probable moderate-to-severe Alcohol Use Disorder (warrants diagnostic assessment).

The AUDIT-C is a shortened 3-item version focusing exclusively on consumption (frequency of drinking, typical quantity per drinking day, and frequency of heavy episodic drinking). Cut-off scores for hazardous drinking on the AUDIT-C are 4 or higher for men and 3 or higher for women and older adults.

2. Drug Abuse Screening Test (DAST-10)

The DAST-10 is a 10-item self-report tool evaluating drug use consequences over the past 12 months (excluding alcohol and tobacco). Questions are answered with a simple Yes/No (1 or 0 points).

• Score 0: No problems reported.
• Score 1–2: Low level of problems (monitor or brief advice).
• Score 3–5: Moderate level (suggests further diagnostic assessment).
• Score 6–8: Substantial level (warrants intensive assessment and structured treatment).
• Score 9–10: Severe level (requires intensive intervention and specialized care).

3. CAGE Questionnaire

The CAGE is a classic, brief 4-item screening tool for alcohol dependence. It relies on the mnemonic:

• C – Have you ever felt you ought to Cut down on your drinking?
• A – Have people Annoyed you by criticizing your drinking?
• G – Have you ever felt Guilty about your drinking?
• E – Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?

Each positive response scores 1 point. A total score of 2 or higher is clinically significant and strongly indicates alcohol dependence, necessitating comprehensive assessment.

4. ASSIST (Alcohol, Smoking and Substance Involvement Screening Test)

Developed by the WHO, the ASSIST is an 8-domain interviewer-administered screening tool that evaluates risk across multiple substance classes (tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, sedatives, hallucinogens, inhalants, opioids, and other drugs). It assesses lifetime use, past 3-month frequency, craving, financial/health problems, failed obligations, and concern expressed by relatives. The ASSIST produces a Specific Substance Involvement (SSI) score for each category, classifying risk as low, moderate, or high to guide appropriate intervention (brief intervention vs. specialized referral).

5. CRAFFT (Adolescent Screening)

The CRAFFT is a validated screening tool specifically designed for adolescents under age 21. It begins with three initial consumption questions, followed by six behavioral risk questions formatted around the CRAFFT mnemonic:

• C – Have you ever ridden in a Car driven by someone (including yourself) who was high or had been using alcohol/drugs?
• R – Do you ever use alcohol or drugs to Relax, feel better about yourself, or fit in?
• A – Do you ever use alcohol or drugs while you are Alone?
• F – Do you ever Forget things you did while using alcohol or drugs?
• F – Do your family or Friends ever tell you that you should cut down on your drinking or drug use?
• T – Have you ever gotten into Trouble while you were using alcohol or drugs?

A score of 2 or higher on the CRAFFT indicates a high risk for a substance use disorder and mandates full diagnostic assessment and clinical follow-up.

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Intake Administrative Workflow and Client Rights

Intake (Core Function 2) is the formal administrative process of admitting a client into a treatment facility following a positive screening. While screening establishes eligibility, intake officially creates the clinical record and establishes the contractual treatment relationship.

Administrative Components of Intake

1. Demographic & Administrative Enrollment: Collecting verifying identification, contact information, emergency contacts, financial/insurance eligibility data, and referral source details.
2. Financial Agreements: Informing the client of program fee schedules, sliding-fee arrangements, third-party billing protocols, and financial responsibilities prior to service delivery.
3. Initial Consents for Treatment: Obtaining signed consent to participate in care, which specifies the scope of services provided by the facility.
4. Client Rights Disclosure: Providing written and verbal explanation of the Patient Bill of Rights, which includes:
   • The right to respectful, non-discriminatory care.
   • The right to an individualized treatment plan and participation in clinical decisions.
   • The right to complete information regarding treatment risks, benefits, and alternative therapies.
   • The right to confidentiality under state and federal laws.
   • The right to lodge formal grievances without fear of retaliation, including clear instructions on the agency's grievance submission and appeal procedures.

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Legal and Confidentiality Mandates: 42 CFR Part 2 and HIPAA

Admitting a client into a substance use disorder (SUD) program imposes rigorous federal confidentiality requirements. Candidates must master 42 CFR Part 2 (Confidentiality of Substance Use Disorder Patient Records) and HIPAA, including the 2024 Final Rule updates (compliance date February 16, 2026).

Federal Confidentiality Hierarchy:
┌──────────────────────────────────────────────────────────────────────────┐
│                     42 CFR Part 2 (SUD Specific)                         │
│  Requires patient consent for most disclosures; 2024 rule allows a       │
│  single consent for future Treatment/Payment/Operations (TPO) uses.      │
│  Still stricter than HIPAA for investigating/prosecuting the patient.    │
└──────────────────────────────────┬───────────────────────────────────────┘
                                   │ Overlays and Exceeds (when both apply)
┌──────────────────────────────────▼───────────────────────────────────────┐
│                       HIPAA Privacy Rule (General PHI)                    │
│  Standard PHI protections; many TPO uses without individual authorization│
└──────────────────────────────────────────────────────────────────────────┘

Key Distinctions for the NCAC I Exam

• Scope of Coverage: HIPAA applies broadly to covered entities and PHI. 42 CFR Part 2 applies specifically to federally assisted programs that hold themselves out as providing SUD diagnosis, treatment, or referral for treatment.
• Disclosure Requirements: Under HIPAA, providers can often share PHI for TPO without individual authorization. Under Part 2, patient consent is still required for most disclosures—including TPO—but the 2024 Final Rule permits a single consent for all future TPO uses and disclosures. Recipients acting under that TPO consent may redisclose for TPO without a brand-new consent for each transfer. Narrow exceptions remain (medical emergencies, mandated child-abuse reporting, Part 2–compliant court orders, audits).
• Mandatory Consent Elements: A valid written consent must identify who may disclose, what may be disclosed, to whom, for what purpose, when consent expires, the right to revoke in writing, and the patient signature/date.
• Notice and Non-TPO Limits: Disclosures still carry Part 2 notice language. Non-TPO redisclosures (employment, licensing, litigation against the patient) still need specific consent or another lawful exception. An attorney subpoena alone is not enough for proceedings against the patient.