Assessing substance use

“Assess substance use” (NBCC, 2027 task 2B.3)

Substance use is common among counseling clients and affects diagnosis, risk and treatment. Counselors screen every client, assess severity when screening is positive, and consider co-occurring conditions. The exam tests DSM-5-TR substance use criteria, screening tools and nonjudgmental assessment.

Key points

DSM-5-TR substance use disorders use 11 criteria covering impaired control, social impairment, risky use and pharmacological criteria (tolerance and withdrawal); severity is mild with 2 to 3 criteria, moderate with 4 to 5, and severe with 6 or more, within a 12-month period.
Tolerance and withdrawal are not counted toward the diagnosis when they occur only with medication taken as prescribed under medical supervision.
Common screening tools include the AUDIT (10 items on alcohol), CAGE, DAST-10 for drugs, and CRAFFT for adolescents.
Ask about each substance, quantity, frequency, route, last use, age of first use, consequences, prior treatment and periods of abstinence.
Withdrawal from alcohol and from benzodiazepines can be medically dangerous; refer for medical evaluation when withdrawal risk is present.
A nonjudgmental, motivational interviewing style improves the accuracy of disclosure.
Records from federally assisted substance use disorder programs are protected by 42 CFR Part 2.

In practice

A client being seen for anxiety completes the AUDIT at intake and scores in a range suggesting harmful drinking. The counselor reviews the answers with curiosity rather than alarm, learns he drinks daily to sleep, and plans further assessment of withdrawal risk with his physician.

A 16-year-old completes the CRAFFT with a positive screen. The counselor explores her use of cannabis at parties, its effects on school, and her own goals before discussing options.

Check yourself

How many DSM-5-TR criteria indicate a moderate substance use disorder?

Four to five criteria within a 12-month period.

Which substances carry a risk of dangerous withdrawal that requires medical evaluation?

Alcohol and benzodiazepines, because withdrawal can cause seizures and other medical complications.

Name a screening tool designed for adolescents.

The CRAFFT, a brief screen developed for adolescent substance use.

NBCC's knowledge and skills for 2B. Assessment

Knowledge of: Foundational knowledge of statistics; Diagnostic criteria - DSM-5-TR; Diagnostic Criteria - ICD-11; Symptoms of trauma; Medical diagnoses and symptoms that can contribute to mental health symptoms; Differential diagnoses, co-occurring diagnoses, and comorbidities; Risk assessment and risk factors or symptoms; Cultural idioms of distress; Cultural implications of diagnosis.

Skill in: Conducting a diagnostic assessment and evaluation; Conducting and interpreting assessments; Conducting formal assessments; Conducting informal assessments; Conducting lethal means restriction.

A study guide written by ExamDragon from NBCC's published task; not NBCC material and not part of the exam.