New93 role standards, now public
MedTality
Role standards

Behavioral health

Substance use counselor

What a certified alcohol and drug counselor must do safely on their own caseload: assess and place a client on evidence, keep them alive through suicide and overdose risk, plan treatment with them, and protect a record the law protects more tightly than any other health record. Drawn from the IC&RC Alcohol and Drug Counselor examination that most US certification boards use to make that decision.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
4
Sources
4
Version
1

Built from International Certification and Reciprocity Consortium, Substance Abuse and Mental Health Services Administration, American Society of Addiction Medicine, US Department of Health and Human Services, via eCFR. Reviewed by clinicians, last on .

01What the role is measured on#

Every verdict is made of the same five dimensions. Each is scored on its own, so a candidate sees where they are strong and where to work.

  • Clinical skillsThe hands-on and judgement work of the role: recognising what matters, acting in the right order, and knowing when something cannot wait.
  • Workflow and toolsGetting the work done in a real setting: the systems, records, equipment and handoffs the role runs on, used correctly and on time.
  • Patient communicationHow the role talks with patients, families and colleagues: listening, explaining plainly, and confirming what was understood.
  • Compliance and safetyThe rules that protect people: privacy, consent, infection control, reporting duties and the safety checks the role is accountable for.
  • Role knowledgeKnowing the job itself: what the role is responsible for, where its scope ends, and who to bring in when it does.

02What a ready hire does#

What a competent substance use counselor does on day one, dimension by dimension.

Clinical skills

  • Takes a full substance use history, applies the DSM-5-TR criteria and works through the six ASAM dimensions, so the diagnosis and the level of care follow from evidence rather than from the referral or the client's first account.
  • Uses the spirit and core skills of motivational interviewing - open questions, affirmations, reflections and summaries - to draw out the client's own reasons for change instead of arguing for it.

Workflow and tools

  • Builds an individual treatment plan with the client from the assessment - problems in the client's words, measurable objectives, named interventions and a level of care - and revises it whenever the client's needs change.
  • Documents assessments, sessions and contacts accurately and promptly, so the record shows what was done, what the client said, how it relates to the plan and what happens next.

Patient communication

  • Assumes any client may have a trauma history, offers safety, choice, transparency and collaboration, and recognises and responds to a trauma reaction without retraumatising the client.
  • Teaches clients and families about substance use, overdose risk and treatment options in plain language, including naloxone and medications for addiction, and checks what they understood.

Compliance and safety

  • Screens every client for suicide risk, asks directly, assesses ideation, plan, intent, means and history with a validated tool, and acts on the risk found - safety planning, lethal means and escalation - without leaving it for the next session.
  • Protects substance use treatment records under 42 CFR Part 2 and HIPAA: discloses only with valid written consent or a named legal exception, and does not confirm that someone is a client without it.

Role knowledge

  • Keeps the relationship professional and in the client's interest - no dual, sexual, financial or social relationships, and self-disclosure only when it serves the client - and consults when a boundary is tested.
  • Recognises needs outside their competence - medical, psychiatric, legal, housing - and links the client to the right service with consent, a warm handoff and a check that the link held.

03Safety red lines#

Any one of these keeps a candidate from Ready Day One, whatever the rest of the score. They are published so nobody meets them for the first time in the assessment.

  • Places or keeps a client with signs of dangerous withdrawal - daily heavy drinking with past withdrawal seizures or delirium, dependence on benzodiazepines or other sedatives, or current withdrawal symptoms - in a setting without medical assessment, or advises them to stop alcohol or sedatives abruptly on their own.

    Alcohol and sedative withdrawal can cause seizures and delirium and can kill, and the counselor who places the client is often the only person positioned to route them to medical care in time.

  • Ends the session, or plans to revisit it at a later appointment, after a client discloses suicidal thoughts without asking about plan, intent and means and without a safety plan or escalation, or leaves a client who has stated current intent or a plan alone.

    People with substance use disorders die by suicide at several times the general rate, and the gap between disclosure and action can be hours; risk that is not assessed is risk that is not treated.

  • Makes stopping a prescribed medication for opioid use disorder a condition of treatment or progress, advises a client to taper or stop it, or plans discharge because of a return to use without a medical, safety and continuing-care plan.

    Losing buprenorphine, methadone or treatment itself after a return to use removes the strongest protection against fatal overdose at the moment tolerance is lowest, and medication decisions belong to the prescriber.

  • Would enter a romantic, sexual, business or financial relationship with a current or former client, or lend money to or accept money or valuable gifts from a client.

    Clients in addiction treatment are often in crisis and dependent on their counselor; these relationships exploit that dependence, damage the client's recovery, and are prohibited by addiction counseling ethics codes and state certification rules.

04Outside the role#

Knowing where the role stops is part of the standard. Going past it is not extra credit.

  • Does not prescribe, adjust, or advise starting or stopping any medication, including medication for opioid or alcohol use disorder.Takes medication questions to the prescriber, supports the client in the prescribed plan, and shares what they observe with consent.
  • Does not manage withdrawal or treat medical conditions, and does not diagnose mental disorders beyond their credential.Screens, documents what they observe, and refers for medical or psychiatric assessment. Where a state lets an entry-level certified counselor diagnose a substance use disorder only under supervision or co-signature, they follow that rule.
  • Does not disclose that a person is a client, or anything from their record, to courts, probation, employers or family without valid written consent or a court order under 42 CFR Part 2.Checks the consent on file, shares only what it covers, and takes subpoenas and legal requests to the supervisor or privacy officer. Outside the US, Part 2 does not apply and they follow the local confidentiality law.
  • Does not provide trauma-focused psychotherapy or other treatment outside their training and credential.Keeps addiction treatment trauma-informed and refers to a qualified clinician for trauma-specific care.

05How it is assessed#

  • A spoken assessment

    An examiner talks the candidate through realistic cases from this role, and follows up the way a senior colleague would.

  • Five dimensions

    Each answer is read against the expectations above and rated on the same four-level scale.

  • The 70 bar

    Every scorecard shows the score against 70, overall and for each dimension, with the reason for the verdict.

  • Safety first

    Crossing one of the safety red lines holds a pass back, however strong the rest was.

The four levels

  1. Not yet
  2. Developing
  3. Proficient
  4. Exemplary
How a verdict is made

06Sources and review#

Drawn from the certification frameworks and practice standards below, and reviewed by clinicians. Version 1, last reviewed .

Cited as sources. Not an endorsement by the organizations named.

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