Delirium tremens are a severe form of alcohol withdrawal which is not included on the CAGE questionnaire. Delirium tremens usually occur three days into withdrawal and can last 2-3 days.

The active ingredient in marijuana, THC, is fat soluble whereas the other substances listed are water soluble. Fat cells are harder to burn, therefore can remain in a person's system longer.

The summary above falls into the moderate level of the DSM-V for Opiate Use Disorder. The severity rating scale is as follows:

Mild: 2-3 Symptoms
Moderate: 4-5 Symptoms
Severe: 6 or more Symptoms

Symptoms identified in the summary were as follows. Joseph had continued use despite persistent social and interpersonal issues (discord with family). Joseph continued to use in physically dangerous situations (sharing needles). Joseph has developed a tolerance which led to him using larger amounts over time. Lastly, he has experienced withdrawal and uses to avoid symptoms.

AUDIT scores ranging from 13-19 for a Woman fall into Zone III with the recommendation of simple advice plus brief counseling and continued monitoring. When scoring the AUDIT, the gender of the client will aide in determining the recommendation. Zone recommendations are as follows:

Zone I: Brief education
Zone II: Brief intervention
Zone III: Brief intervention or referral to specialized treatment
Zone IV: Referral to specialized treatment

The Stages of Change Model was developed by Prochaska and DiClemente in the 1970's to allow professionals to gauge a client's readiness for change to aide in treatment planning.

The best option to discuss with your supervisor would be to call for a Wellness Check. Her apparent intoxication, limited mobility, living alone and her self-report of falling with a difficulty of getting up poses a concern for her safety. Therefore, you have an ethical responsibility to break confidentiality to ensure her safety. Consulting with your supervisor or colleague allows you the opportunity to receive feedback regarding your plan of action.

A referral for inpatient treatment is appropriate when a person's use is having a significant impairment on their daily living skills, threatens their safety and/or safety of others around them and a risk of death. Answer a does not include a description of any impact on daily living skills.

Medication regimen and recommendations is likely not in your professional scope, therefore is not appropriate for you to be changing. Through continued collaboration with his prescriber, you are able to verbalize any concerns you may have about cross addiction and misuse of the medication.

Treatment plans should be updated to reflect progress and regressions. Objectives and goals should be realistic and attainable.

Collaborating with her prescriber will provide a team approach which will aide in communication. For example, if Sara were to relapse days before the injection, receiving the Vivitrol injection would induce withdrawal symptoms. Identifying barriers and identifying skills would help Sara maintain sobriety until she is able to receive the injection.

Treatment plans should be a collaboration between the counselor and the client. Goals and objectives should be realistic and align with the client's goals. Using the Stages of Change Model can help the clinician offer appropriate goals.

Attaining sobriety should be the first goal. Once that is accomplished, other consequences can be addressed appropriately.

Case management begins at a client's intake and continues throughout their treatment. The first goal of case management is to coordinate care which is appropriate for the client which can be done at the conclusion of the intake session.

Once an outpatient program is completed, it is not necessary for the client to engage in an additional program. Programs usually begin in phases which would not align with a person who has attained and maintained recovery.

Providing Susan with written information gives her the opportunity to look into them should she change her mind about your recommendation. The information provided does not provide enough evidence to be concerned about her safety and is not appropriate to contact her emergency contact.

The models of case management are strengths perspective, clinical/ rehabilitation, broker/ generalist and assertive community treatment.

Step work is a part of AA and other similar groups which are not a part of aftercare programs.

Case management is community based. The main goal is to help the client's familiarize themselves with their community and services available. Examples would be self-help groups, church, individual resources and family resources.

Scott may be inebriated, or he may be tired. Either way, the appearance of nodding off is often triggering for other group members which means that he is not appropriate for the group at this time. Since your concern is that he may be inebriated, he should be assessed by a medical professional before going home to ensure safety. Once you return to the group after Scott leaves, it may be necessary to process how group members were impacted after seeing Scott's presentation in group. If this is the case, keep the discussion off of Scott and on how others felt when seeing someone appear inebriated (ie. Triggered, sad, anxious, angry, etc.).

Glorifying is talking about drinking and/or drug use in a manner that makes it sound exciting and positive. More times than not, this tends to have a negative impact on the group and can create some anger. Members often feel triggered by the topics and the person sharing continues to use their addictive thought processes. Should a person be glorifying in a group session, this should be addressed immediately before the negative impact intensifies.

Often times in addiction, a person becomes isolated and feels as though no one can understand their situation. Being a group setting, a client is exposed to others who have similar experiences, thoughts and feelings which can normalize a person's experience. Group sessions also allow others to observe others being vulnerable which increase the chances of others doing the same. Group sessions can be a place where clients can learn from each other's struggles and triumphs.

Motivational Interviewing is a client centered model of counseling that works to identify what the client wants compared to what others want for them. Motivation, or lack thereof, is a common barrier for individuals in treatment.

NA refers to a Narcotics Anonymous group. Should Matt feel as though he does not like the groups offered and/or the others in the group, attending Alcoholic Anonymous may be more appropriate. Each group follows the 12 step model, however they have individual differences.

Changing the topic would be the least helpful for both Sally and other group members. Process groups should offer a safe space for members to share about their difficulties, receive support from others and create a sense of normalization. Changing the topic would make others less likely to share about their struggles in the group.

Transference often occurs when a client reminds a clinician of someone in their personal life. The feelings transferred can be positive or negative. Should a clinician feel as though they are experiencing transference, this should be brought up in supervision to address appropriately.

Since you do not have a consent signed, you are not able to disclose that she is a client of yours. As a counselor, you are able to listen to concerns that anyone has regarding a person in active addiction. After the phone call, you should clearly document what you said as well as inform Mary of her mother's phone call.

When meeting with your supervisor, it would be best to discuss making a CPS report. Steven's mother is aware of his use of Xanax and has continued to leave her prescription in an unsecured location. The use of Xanax does cause concern for his safety and would warrant a mandated report.

This scenario would warrant a mandated report as the children living with Joe are minors and unable to care for themselves. Joe reported drinking every night to the point of blacking out which means that he and his wife are no longer able to properly care for their children. Psychoeducation about parenting would be appropriate, however the children's safety is a priority.

Conducting the assessment, having this person in your group and/or working with them individually would all create a dual relationship which would blur the professional lines of this relationship. This could be explained to the person if they wonder why they do not work with you. Remembering the limits of confidentiality would be important as well to maintain this person's privacy.

The best way to protect the confidentiality of the person who passed is to not bring up the conversation yourself. Group members may not be in contact with this person and/or remember being in treatment with them. Confidentiality continues in death. It may be necessary for some members to process the death in which case it is best to keep the conversation on how they are impacted by the loss and not to focus on the person who passed.