- Dopamine
- The neurotransmitter most drugs of abuse manipulate in the brain's mesolimbic reward pathway, reinforcing drug-taking behavior.
- Tolerance
- A decreased response to a substance after repeated use, so more is needed to get the same effect; a pharmacological criterion of SUD.
- Withdrawal
- A substance-specific syndrome when a heavy, long-term user stops or cuts back; for alcohol and sedatives it can be life-threatening.
- Craving
- A strong urge or desire to use a substance; one of the 11 DSM-5-TR substance use disorder criteria.
- Neuroplasticity
- The brain's ability to reorganize and form new neural connections in response to experience — the basis for both addiction and recovery.
- CNS depressants
- A drug class that slows CNS activity — alcohol, benzodiazepines, barbiturates; their withdrawal can be fatal (seizures, delirium tremens).
- Opioids
- A drug class binding opioid receptors (heroin, fentanyl, oxycodone, morphine); overdose causes respiratory depression, reversed by naloxone.
- Stimulants
- A drug class that speeds CNS activity (cocaine, methamphetamine, amphetamines); withdrawal is a 'crash,' not a medical emergency.
- Cannabis
- A psychoactive drug class (THC) that impairs memory and coordination; withdrawal is mild — irritability, sleep, and appetite changes.
- Hallucinogens
- A drug class that alters perception and thought (LSD, psilocybin, PCP, ketamine); dissociatives like PCP raise risk of dangerous behavior.
- Naloxone (Narcan)
- A pure opioid antagonist that rapidly reverses an opioid overdose; an emergency rescue medication, not maintenance.
- Methadone
- A full opioid agonist for opioid use disorder that prevents withdrawal and craving; dispensed through licensed opioid treatment programs.
- Buprenorphine
- A partial opioid agonist with a ceiling effect for opioid use disorder; often combined with naloxone (Suboxone) to deter misuse.
- Naltrexone
- An opioid antagonist that blocks opioid effects and treats both opioid and alcohol use disorder; the client must be opioid-free first.
- Disulfiram (Antabuse)
- An aversive medication for alcohol use disorder that causes an unpleasant reaction if the client drinks, supporting abstinence.
- Acamprosate
- A medication that reduces craving and supports continued abstinence after a client with alcohol use disorder has stopped drinking.
- Co-occurring disorder (dual diagnosis)
- A mental health disorder and a substance use disorder in the same person at once; best treated with integrated, coordinated care.
- Synergism (potentiation)
- When combining drugs (e.g., alcohol + benzodiazepines) produces an effect greater than the sum of each — a major overdose risk.
- Cross-tolerance
- When tolerance to one drug carries over to another drug in the same pharmacological class.
- Disease model of addiction
- The view of addiction as a chronic, relapsing brain disease marked by compulsive use and lasting changes in brain function.
- Screening
- A brief, first-pass step to detect whether a problem is likely and worth a fuller look; it is not a diagnosis.
- Assessment
- The comprehensive, in-depth process that confirms a problem, yields a diagnosis and severity, and produces a treatment plan.
- CAGE
- A four-item alcohol screen — Cut down, Annoyed, Guilty, Eye-opener; two or more 'yes' answers suggest a clinically significant problem.
- AUDIT
- The WHO's 10-item Alcohol Use Disorders Identification Test for hazardous and harmful drinking; AUDIT-C is the 3-item short form.
- DAST-10
- The Drug Abuse Screening Test — a self-report screen for drug use other than alcohol.
- CRAFFT
- A substance-use screening tool designed specifically for adolescents (Car, Relax, Alone, Forget, Friends, Trouble).
- SBIRT
- Screening, Brief Intervention, and Referral to Treatment — an evidence-based public-health approach to addressing risky use early.
- Addiction Severity Index (ASI)
- A structured clinical interview rating the severity of problems across seven life domains to guide treatment planning.
- Biopsychosocial assessment
- An intake gathering biological, psychological, and social information to understand the whole client in context.
- Mental status exam (MSE)
- A structured snapshot of current functioning — appearance, mood, affect, thought, perception, cognition, insight, and judgment.
- DSM-5-TR substance use disorder
- A diagnosis based on 11 criteria in four groups: impaired control, social impairment, risky use, and pharmacological (tolerance, withdrawal).
- SUD severity
- Set by criteria met in 12 months: mild = 2–3, moderate = 4–5, severe = 6 or more.
- ASAM Criteria
- A framework that assesses a client across six dimensions to match them to the right level of care.
- ASAM levels of care
- A continuum from early intervention (0.5) and outpatient (1) through residential (3) to medically managed intensive inpatient (4).
- Six ASAM dimensions
- Intoxication/withdrawal; biomedical; emotional/behavioral/cognitive; readiness to change; relapse potential; recovery environment.
- Motivational interviewing (MI)
- A collaborative, client-centered style that resolves ambivalence and evokes change talk; you roll with resistance rather than argue.
- OARS
- The core MI micro-skills: Open-ended questions, Affirmations, Reflective listening, and Summaries.
- Stages of change
- Prochaska & DiClemente's model: precontemplation, contemplation, preparation, action, maintenance — match the intervention to the stage.
- Cognitive behavioral therapy (CBT)
- A structured, present-focused approach that changes distorted thoughts and maladaptive behaviors driving substance use.
- Contingency management
- A behavioral approach using tangible rewards to reinforce abstinence or attendance; especially effective for stimulant use disorders.
- Relapse prevention
- Marlatt's CBT-based approach: identify high-risk situations and triggers and build coping skills before a lapse becomes a relapse.
- Medication-assisted treatment (MAT)
- FDA-approved medications combined with counseling and behavioral therapy; medication alone is not treatment.
- Harm reduction
- Strategies that reduce the harms of drug use without requiring abstinence — naloxone, syringe services, fentanyl test strips.
- 12-step facilitation
- A structured approach that actively connects clients to mutual-help groups such as AA or NA.
- Psychoeducation
- Providing clients and families with information about substance use disorders and the recovery process.
- Treatment plan
- A collaborative document tying measurable goals and objectives to the assessment, naming interventions, level of care, and progress criteria.
- SMART objective
- An objective that is Specific, Measurable, Achievable, Relevant, and Time-bound — e.g., 'attend 3 group sessions per week for 30 days.'
- Goal vs. objective
- A goal is the broad, longer-term outcome; an objective is a specific, measurable, time-bound step toward that goal.
- SOAP note
- A documentation format: Subjective (client report), Objective (observed/measured), Assessment (interpretation), and Plan (next steps).
- Integrated treatment
- Treating a co-occurring mental health and substance use disorder together rather than separately or sequentially.
- Service coordination / referral
- Linking the client to medical, housing, vocational, legal, and mutual-help resources; refer out when a need exceeds your scope.
- Continuing care (aftercare)
- Ongoing support that begins during treatment, not after discharge — building the network and coping skills for recovery.
- Informed consent
- The client's voluntary agreement to treatment after being told its nature, goals, fees, confidentiality limits, and rights; an ongoing process.
- 42 CFR Part 2
- The federal rule protecting SUD records from federally assisted programs; generally requires specific written consent and is stricter than HIPAA.
- 42 CFR Part 2 vs. HIPAA
- Part 2 is stricter for SUD records — even confirming a person attends a program is a protected disclosure requiring specific written consent.
- Dual relationship
- A second role with a client (social, financial, sexual) that risks impairing judgment or harming the client; avoid harmful ones.
- Scope of practice / competence
- Counselors practice only within their training and competence; refer out when a need exceeds it.
- Duty to warn (Tarasoff)
- The obligation to take reasonable steps to protect an identifiable victim from a client's serious, imminent threat.
- Mandated reporting
- A legal duty to report reasonable suspicion of child, elder, or dependent-adult abuse; it overrides confidentiality.
- Confidentiality limits
- Disclosure may occur in a medical emergency, for mandated abuse reporting, under the duty to warn, or with a qualifying court order.
- Subpoena vs. court order
- An ordinary subpoena alone does not pierce Part 2 protections; only a court order meeting Part 2's specific requirements can compel disclosure.
- Bioethical principles
- Autonomy (self-determination), beneficence (do good), nonmaleficence (do no harm), justice (fairness), and fidelity (loyalty).
- Autonomy
- Respecting the client's right to make their own informed decisions about treatment.
- Nonmaleficence
- The duty to do no harm and avoid actions that could injure the client.
- Ethical decision-making model
- A structured process to use when a dilemma isn't squarely covered by the code; pair it with supervision and documentation.
- IC&RC
- The International Certification & Reciprocity Consortium — develops the Alcohol and Drug Counselor (ADC) exam used by many CADC boards.
- Mesolimbic reward pathway
- The dopamine circuit from the ventral tegmental area to the nucleus accumbens that mediates reinforcement and is hijacked by addictive drugs.
- Nucleus accumbens
- A brain region central to the reward pathway where dopamine release reinforces pleasurable behaviors, including drug use.
- Prefrontal cortex
- The brain region governing judgment, impulse control, and decision-making; addiction weakens its regulation over reward-driven craving.
- Blood alcohol concentration (BAC)
- The percentage of alcohol in the blood; 0.08% is the legal driving limit in most U.S. states, and very high levels risk fatal respiratory depression.
- Delirium tremens (DTs)
- The most severe alcohol withdrawal, with confusion, hallucinations, autonomic instability, and seizures; a medical emergency that can be fatal.
- Wernicke-Korsakoff syndrome
- Brain damage from thiamine (vitamin B1) deficiency in chronic alcohol use; Wernicke's is acute and reversible, Korsakoff's causes lasting memory loss.
- Korsakoff's psychosis
- A chronic, often irreversible amnestic disorder from thiamine deficiency, marked by severe memory loss and confabulation.
- Fetal alcohol spectrum disorders (FASD)
- A range of lifelong physical, behavioral, and cognitive impairments caused by prenatal alcohol exposure; entirely preventable.
- Benzodiazepines
- CNS depressants (e.g., diazepam, alprazolam) used for anxiety and to manage alcohol withdrawal; abrupt cessation can cause fatal seizures.
- Barbiturates
- Older CNS depressant sedatives with a narrow margin between therapeutic and lethal dose; withdrawal can be life-threatening.
- Fentanyl
- A synthetic opioid roughly 50–100 times more potent than morphine; a leading driver of overdose deaths, often found in adulterated drug supplies.
- Opioid overdose triad
- Pinpoint (constricted) pupils, respiratory depression, and decreased consciousness — the classic signs of opioid overdose.
- Precipitated withdrawal
- Sudden, severe withdrawal triggered when an opioid antagonist or partial agonist displaces a full agonist; a risk when starting buprenorphine too early.
- Methamphetamine
- A potent, long-acting stimulant causing dopamine release, with risks of psychosis, dental damage ('meth mouth'), and cardiovascular harm.
- Cocaine
- A short-acting stimulant that blocks dopamine reuptake; risks include cardiac arrhythmia, stroke, and a depressive 'crash' on withdrawal.
- Stimulant 'crash'
- The post-binge withdrawal phase marked by fatigue, depression, hypersomnia, and intense craving; not usually medically dangerous but high suicide risk.
- Nicotine
- A highly addictive stimulant in tobacco; dependence is treated with nicotine replacement therapy, bupropion, or varenicline.
- Caffeine
- The most widely used psychoactive stimulant; DSM-5-TR recognizes caffeine intoxication and withdrawal but not a caffeine use disorder.
- Inhalants
- Volatile substances (glues, solvents, aerosols, nitrites) inhaled for intoxication; can cause sudden sniffing death and lasting neurological damage.
- Phencyclidine (PCP)
- A dissociative hallucinogen causing distorted perception, agitation, and violent or self-injurious behavior at high doses.
- Ketamine
- A dissociative anesthetic with hallucinogenic effects; misused recreationally and studied therapeutically for treatment-resistant depression.
- MDMA (ecstasy)
- A stimulant-hallucinogen ('empathogen') that releases serotonin; risks include hyperthermia, dehydration, and serotonin depletion.
- Half-life
- The time for the body to eliminate half of a drug's concentration; longer half-lives produce slower onset and milder, more prolonged withdrawal.
- Routes of administration
- How a drug enters the body (oral, intranasal, inhaled, injected); faster routes like IV and smoking produce more intense, addictive effects.
- Physical dependence
- A physiological adaptation in which the body needs a drug to function normally, producing tolerance and withdrawal — not the same as addiction.
- Psychological dependence
- An emotional or mental reliance on a drug to feel normal or cope, marked by craving and preoccupation, with or without physical dependence.
- Polysubstance use
- The use of more than one drug, either together or over time; complicates withdrawal management and raises overdose risk.
- Set and setting
- The user's mindset (set) and physical/social environment (setting), which shape a drug's subjective effects.
- Kindling
- The phenomenon in which repeated alcohol or sedative withdrawals make each subsequent withdrawal more severe, raising seizure risk.
- Drug interaction
- A change in one drug's effect caused by another drug, food, or condition; can be additive, synergistic, or antagonistic.
- Agonist
- A substance that binds a receptor and activates it to produce a drug effect (e.g., methadone at opioid receptors).
- Antagonist
- A substance that binds a receptor and blocks it, preventing a drug effect (e.g., naloxone or naltrexone at opioid receptors).
- Partial agonist
- A substance that activates a receptor less fully than a full agonist and has a ceiling effect (e.g., buprenorphine).
- Ceiling effect
- A dose above which a drug produces no additional effect; buprenorphine's ceiling limits respiratory depression and overdose risk.
- Gateway hypothesis
- The theory that use of one substance increases the likelihood of using others; a correlational, debated model of progression.
- Adverse childhood experiences (ACEs)
- Childhood trauma and household dysfunction that strongly raise the lifetime risk of substance use disorders and other health problems.
- Risk and protective factors
- Conditions that raise (e.g., trauma, family history) or lower (e.g., strong attachments, school engagement) the likelihood of developing an SUD.
- Genetic predisposition to addiction
- Heritable factors that account for roughly half of the risk for substance use disorders, interacting with environment.
- Alcohol withdrawal timeline
- Tremors and anxiety begin 6–24 hours after the last drink, seizures peak 12–48 hours, and delirium tremens emerges around 48–72 hours.
- Hepatitis C and substance use
- A bloodborne viral liver infection commonly transmitted by shared injection equipment; a key reason for syringe services and screening.
- MAST
- The Michigan Alcoholism Screening Test — a longer self-report instrument detecting alcohol problems over the lifetime.
- TWEAK
- A brief alcohol screen validated for use in pregnancy — Tolerance, Worried, Eye-opener, Amnesia, Cut down.
- GAIN
- The Global Appraisal of Individual Needs — a comprehensive standardized biopsychosocial assessment used in many treatment settings.
- AC-OK screen
- A brief co-occurring screening tool that flags both substance use and mental health concerns for further assessment.
- Clinical interview
- A structured or semi-structured conversation gathering history, presenting problem, and context as the core of assessment.
- Collateral information
- Data from family, records, or other providers (with proper consent) that supplements and corroborates the client's self-report.
- Toxicology screen (UDS)
- Urine or other drug testing that objectively detects recent substance use; a clinical tool, not a substitute for clinical judgment.
- Risk assessment
- Evaluating a client's danger to self or others, including suicide and violence risk, with attention to means, plan, and intent.
- Columbia Protocol (C-SSRS)
- The Columbia-Suicide Severity Rating Scale — a structured tool for assessing the presence and severity of suicidal ideation and behavior.
- CIWA-Ar
- The Clinical Institute Withdrawal Assessment for Alcohol, revised — a validated scale quantifying alcohol withdrawal severity to guide medication.
- COWS
- The Clinical Opiate Withdrawal Scale — an 11-item clinician-rated measure of opioid withdrawal severity used to time buprenorphine induction.
- Diagnostic impression
- The counselor's working diagnostic conclusion drawn from assessment data, within their scope and pending any required diagnosis by a licensed clinician.
- Differential diagnosis
- The process of distinguishing among conditions with overlapping symptoms — e.g., separating a primary mental disorder from substance-induced symptoms.
- Substance-induced disorder
- Psychiatric symptoms (e.g., depression, psychosis) caused directly by intoxication or withdrawal that typically resolve with abstinence.
- Level of care determination
- Using ASAM Criteria across the six dimensions to place a client in the least intensive setting that can meet their needs safely.
- ASAM Dimension 1
- Acute intoxication and/or withdrawal potential — the dimension assessing the need for medically managed detoxification.
- ASAM Dimension 4
- Readiness to change — the dimension assessing the client's motivation and engagement with treatment.
- ASAM Level 1
- Outpatient services — fewer than nine hours of structured programming per week for adults.
- ASAM Level 2.1
- Intensive outpatient (IOP) — typically nine or more hours of structured programming per week for adults.
- ASAM Level 3
- Residential and inpatient services providing a 24-hour structured treatment environment.
- ASAM Level 4
- Medically managed intensive inpatient services — 24-hour care with full medical and nursing resources for acute, unstable conditions.
- Strengths-based assessment
- An approach that identifies the client's resources, supports, and resilience alongside problems to inform treatment.
- Cultural formulation
- Assessing how the client's cultural identity, beliefs, and context shape their experience of substance use and help-seeking.
- Functional analysis
- Examining the antecedents, behaviors, and consequences (the ABCs) of substance use to identify triggers and reinforcement.
- Readiness ruler
- A simple scaling tool asking the client to rate importance of and confidence in changing on a 0–10 scale to gauge motivation.
- Reliability
- The consistency of an assessment instrument in producing the same results across time and raters.
- Validity
- The degree to which an assessment instrument actually measures what it claims to measure.
- Norms
- Standardized reference scores from a representative population used to interpret an individual's assessment results.
- Therapeutic alliance
- The collaborative, trusting bond between counselor and client; one of the strongest predictors of treatment outcomes.
- Empathy
- The accurate understanding and reflection of a client's feelings and perspective; a core counselor condition for change.
- Unconditional positive regard
- Rogers' core condition of nonjudgmental acceptance and respect for the client regardless of their behavior.
- Genuineness (congruence)
- Rogers' core condition in which the counselor is authentic and transparent rather than playing a role.
- Change talk
- Client statements favoring change (desire, ability, reasons, need, commitment); the counselor evokes and reinforces it in MI.
- Sustain talk
- Client statements favoring the status quo; in MI the counselor responds without amplifying or arguing against it.
- Rolling with resistance
- An MI principle of avoiding argument and using the client's own momentum rather than confronting ambivalence head-on.
- Developing discrepancy
- An MI strategy that highlights the gap between a client's values or goals and their current behavior to motivate change.
- Reflective listening
- Restating or paraphrasing the client's meaning to show understanding and deepen exploration; the backbone of MI.
- Open-ended question
- A question that invites elaboration rather than a yes/no answer, encouraging the client to do most of the talking.
- Group therapy
- Treatment delivered to several clients together, using peer support, modeling, and feedback; a primary modality in SUD treatment.
- Yalom's therapeutic factors
- Curative elements of group therapy such as universality, instillation of hope, cohesiveness, and interpersonal learning.
- Group cohesion
- The sense of belonging and trust among group members that supports disclosure, accountability, and change.
- Family systems theory
- The view that the family operates as an interconnected system, so one member's substance use affects and is shaped by the whole.
- Enabling
- Behavior by others that unintentionally shields a person from the consequences of substance use, allowing it to continue.
- Codependency
- A relational pattern of excessive caretaking and reliance on another's approval, often seen in families affected by addiction.
- Trauma-informed care
- A treatment approach that recognizes the prevalence of trauma, avoids re-traumatization, and emphasizes safety and trust.
- Seeking Safety
- An evidence-based, present-focused model for treating co-occurring trauma/PTSD and substance use without requiring trauma narration.
- Dialectical behavior therapy (DBT)
- A skills-based therapy teaching mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness; useful for co-occurring disorders.
- Community Reinforcement Approach (CRA)
- A behavioral treatment that rearranges environmental and social reinforcers to make a sober life more rewarding than using.
- Solution-focused brief therapy
- A goal-oriented approach emphasizing the client's strengths, exceptions to the problem, and a preferred future rather than problem analysis.
- Cognitive distortions
- Inaccurate, biased thought patterns (e.g., all-or-nothing thinking, catastrophizing) that CBT helps clients identify and reframe.
- Trigger
- An internal state or external cue (people, places, emotions) associated with past use that prompts craving.
- High-risk situation
- A circumstance that threatens a client's sense of control and raises relapse risk; identifying these is central to relapse prevention.
- Coping skills
- Cognitive and behavioral strategies clients use to manage triggers, cravings, and stress without returning to substance use.
- Lapse vs. relapse
- A lapse is a single slip; a relapse is a full return to the prior pattern of use. A lapse need not become a relapse.
- Abstinence violation effect
- The guilt and all-or-nothing thinking after a single slip that can drive a full relapse; relapse prevention reframes the lapse as a learning event.
- Relapse warning signs
- Early cognitive, emotional, and behavioral changes (e.g., isolation, romanticizing use) that precede a return to substance use.
- Recovery capital
- The internal and external resources — social support, housing, employment, motivation — a person can draw on to sustain recovery.
- Mutual-help groups
- Peer-led recovery supports such as AA, NA, SMART Recovery, and Refuge Recovery that supplement professional treatment.
- SMART Recovery
- A secular, science-based mutual-help program using cognitive-behavioral and motivational tools as an alternative to 12-step groups.
- Recovery-oriented systems of care
- A coordinated network of services supporting long-term recovery and wellness rather than just acute episodes of treatment.
- Peer recovery support
- Services delivered by people with lived experience of recovery to model hope, provide support, and aid navigation.
- Case management
- Coordinating a client's services across systems — medical, housing, vocational, legal — to address needs beyond direct counseling.
- Discharge planning
- Preparing a client for transition out of a level of care, with continuing-care arrangements, supports, and a relapse plan.
- Crisis intervention
- Immediate, short-term help to stabilize a client in acute distress, ensure safety, and connect them to ongoing care.
- DIRT note (DAP note)
- A documentation format recording Data, Assessment, and Plan as a streamlined alternative to SOAP.
- Progress note
- A dated record of each contact documenting the client's status, interventions delivered, and progress toward treatment-plan goals.
- Golden thread
- The clear, traceable link from assessment to diagnosis to treatment-plan goals to progress notes that documentation should maintain.
- Treatment plan review
- A scheduled reassessment of goals, objectives, and progress, updating the plan as the client's needs change.
- Brief intervention
- A short, structured conversation (often FRAMES-based) that raises awareness and motivates change in risky but non-dependent users.
- FRAMES
- Elements of effective brief intervention: Feedback, Responsibility, Advice, Menu of options, Empathy, and Self-efficacy.
- Self-efficacy
- A client's belief in their own ability to succeed at change; building it is a core aim of motivational counseling.
- Relapse prevention plan
- A written, individualized plan identifying triggers, coping strategies, supports, and emergency steps to maintain recovery.
- Wraparound services
- Comprehensive, individualized supports surrounding the client and family across life domains to sustain recovery.
- Recovery management check-ups
- Periodic post-treatment monitoring that re-engages clients early if substance use resumes, treating addiction as a chronic condition.
- NAADAC Code of Ethics
- The ethical standards of the Association for Addiction Professionals, guiding counselor conduct, client welfare, and professional responsibility.
- Confidentiality
- The ethical and legal duty to protect client information from unauthorized disclosure; for SUD records it is reinforced by 42 CFR Part 2.
- Privileged communication
- A legal protection (varying by state) that shields certain counselor-client communications from being disclosed in court.
- Qualified Service Organization Agreement (QSOA)
- A 42 CFR Part 2 contract allowing a program to share protected records with an outside service provider without separate client consent.
- Part 2 consent requirements
- A valid release must name the program, recipient, purpose, information disclosed, an expiration, and the client's signature and right to revoke.
- Redisclosure prohibition
- Under 42 CFR Part 2, a recipient of SUD records may not redisclose them without further consent and must attach a notice prohibiting redisclosure.
- Part 2 medical emergency exception
- Provider-to-provider disclosure of SUD records is permitted without consent to treat a bona fide medical emergency, with documentation required.
- Part 2 and minors
- Whether parental consent is required for a minor's SUD treatment and records depends on state law governing minor consent.
- Beneficence
- The ethical duty to act in the client's best interest and promote their well-being.
- Justice
- The ethical principle of treating clients fairly and equitably and providing equal access to services.
- Fidelity
- The ethical duty of loyalty — keeping promises, honoring commitments, and maintaining the trust placed in the counselor.
- Veracity
- The ethical duty of honesty and truthfulness in dealings with clients and others.
- Boundaries
- The professional limits that protect the counselor-client relationship; clear boundaries prevent exploitation and role confusion.
- Boundary crossing vs. violation
- A crossing is a minor, often benign deviation from the norm; a violation is a harmful or exploitative breach of the boundary.
- Counselor self-disclosure
- Sharing personal information with a client; appropriate only when brief, purposeful, and clearly in the client's interest.
- Transference
- A client's unconscious redirection of feelings about a past figure onto the counselor.
- Countertransference
- The counselor's emotional reactions toward a client rooted in their own history; must be recognized and managed through supervision.
- Clinical supervision
- A formal, ongoing professional relationship supporting a counselor's skill development, ethical practice, and accountability.
- Counselor self-care
- Deliberate practices that sustain a counselor's well-being and prevent impairment that could harm clients.
- Burnout
- Emotional exhaustion, depersonalization, and reduced accomplishment from chronic work stress; an ethical risk if it impairs care.
- Compassion fatigue
- The cumulative emotional toll of working with traumatized clients, which can erode empathy and effectiveness.
- Counselor impairment
- A condition (illness, substance use, burnout) that compromises a counselor's ability to practice safely; requires action to protect clients.
- Cultural competence
- The ongoing development of awareness, knowledge, and skills to work effectively with clients across cultures and identities.
- Cultural humility
- A lifelong stance of self-reflection, openness, and respect for the client as the expert on their own culture and experience.
- Nondiscrimination
- The ethical duty to provide services without bias based on race, ethnicity, gender, sexual orientation, religion, disability, or other status.
- Documentation and recordkeeping
- The duty to keep accurate, timely, secure records that support continuity of care and meet legal and ethical standards.
- Record retention
- The requirement to keep client records for a period set by state and federal law and to dispose of them securely afterward.
- Client right to records
- Clients generally have a right to access their own records, subject to limited exceptions and applicable law.
- Termination of services
- Ethically ending the counseling relationship with adequate notice, summary, and referral when goals are met or services are no longer appropriate.
- Abandonment
- Improperly ending services without notice, transition, or referral, leaving a client in need without care — an ethical violation.
- Gifts and bartering
- Accepting gifts or trading services for fees can blur boundaries; both require caution, documentation, and attention to client culture and need.
- Conflict of interest
- A situation in which a counselor's personal or financial interest could compromise their professional judgment or the client's welfare.
- Professional disclosure statement
- A document given to clients describing the counselor's credentials, services, fees, policies, and the limits of confidentiality.
- Continuing education
- Ongoing training required to maintain certification and ensure the counselor's knowledge and skills stay current.
- Reporting unethical conduct
- The professional duty to address, and when warranted report, a colleague's unethical or impaired practice to protect clients.
- Telehealth ethics
- Standards for remote services covering privacy, secure platforms, informed consent, jurisdiction, and managing technology limits.
- Court-ordered (mandated) clients
- Clients referred by the legal system; the counselor clarifies confidentiality limits and what information will be reported to the court.
