Master-level addictions and psychology practice in Kansas rewards one habit above all: making decisions you can trace from data to action. This guide builds that habit around three distinctions — screening versus diagnosis, primary versus substance-induced disorders, and screen score versus multidimensional referral decision. Work the two scenarios below as if you were writing the case file: name the mistake, write the better decision, and state why it changes the plan. Then run the vignette exercise and grade yourself against the rubric before moving to the next content area.
Where LMLP Scope Ends and Referral Begins
The defining skill is judging which activities fall within master-level psychological practice in Kansas and which require supervision, consultation, or another license; build a personal scope decision rule before studying the content areas.
The LMLP credential is regulated by the Kansas Behavioral Sciences Regulatory Board, and master-level psychological practice operates within a defined scope shaped by board rules, training, and setting conditions. Studying scope means sorting activities into three categories: what you do directly, what you do conditionally under required supervision or consultation, and what belongs to another license or level. The boundary is hard to hold because it is not a memorized list: the same kind of decision — diagnosing, continuing a course of treatment, or arranging a handoff — can land in different columns depending on supervision conditions, setting, and the client's presentation.
Build the sorting tool yourself. Using the board's regulations as your source, list every activity in the exam topics — assessment, diagnosis, intervention, referral, record handling — into a three-column table: always within scope, conditional, outside scope. Mark ambiguous items as confirm with supervisor and board rules rather than guessing. Then test the table against vignettes: for each case decision, cite which column it came from. A written decision rule converts regulatory uncertainty into a checkable habit you can reuse under time pressure.
Diagnosing SUDs: DSM-5 Criteria and the Substance-Induced Differential
Accurate SUD diagnosis means applying the DSM-5 criterion groups, grading severity from counted criteria, and ruling substance-induced or withdrawal states in or out before a primary diagnosis is finalized.
Work the criteria as groups, not a list to skim: impaired control, social impairment, risky use, and pharmacological features. Severity follows the count — mild in the two-to-three range, moderate at four-to-five, severe at six or more — but each criterion needs documented evidence from the interview or record. Practice tracing one criterion at a time: what did the client say or do that demonstrates tolerance, that demonstrates failed role obligations? A count without evidence is a guess wearing a number.
Scenario: a client reports low mood, insomnia, and guilt after a job loss, plus nightly drinking of six or more drinks for several months. The plausible mistake is recording major depressive disorder and filing the alcohol use under history. The better decision: build a timeline of mood and use, screen with an instrument such as the AUDIT, hold alcohol-induced mood disorder and an independent depressive episode as competing hypotheses, and document a provisional diagnosis with a reassessment plan tied to reduced use when clinically safe. The differential changes both the treatment plan and the referral pathway.
Matching Screening Instruments to the Referral Question
Each instrument answers a different question: the AUDIT grades current alcohol risk, the CAGE flags lifetime problem patterns, the DAST-10 covers consequences of other drugs; select by population, time frame, and the decision the score informs.
Keep screening and diagnosis separate: a screen estimates probability, a diagnosis requires criteria. Note the time frames — the AUDIT samples roughly the past year while the CAGE asks about lifetime patterns, so a client can be CAGE-positive with a low AUDIT and vice versa, and the follow-up differs each way. Treat cutoffs as flags that trigger structured follow-up, not verdicts, and verify any threshold against the instrument's manual before relying on it in a plan.
Practice interpretation in pairs of results. A high AUDIT with elevated dependence items points toward questions about withdrawal risk and medical involvement; an elevated CAGE with modest current use points toward a past-problem history worth exploring for relapse context. Write one sentence per result stating what it raises, what it rules out, and what you would ask next. This habit makes instrument choice defensible: you can say why this screen fit this referral question and what its limits were.
| Instrument | Targets | Typical time frame | Strength | Main limitation |
|---|---|---|---|---|
| AUDIT | Alcohol consumption and alcohol-related problems | Around the past 12 months | Detects hazardous use before dependence is established | Longer to administer than ultra-brief screens |
| CAGE | Lifetime signs of an alcohol problem | Lifetime | Very brief; useful as an initial flag | Misses current hazardous use; yes/no format limits detail |
| DAST-10 | Consequences of non-alcohol drug use | Around the past 12 months | Brief and covers a broad range of drugs | Says little about pattern, route, or severity of use |
| SBIRT-style brief intervention | Linking a positive screen to a structured conversation | Current encounter | Connects screening directly to intervention and referral | Effect depends on fidelity to the model |
From Positive Screen to Multidimensional Referral Decision
A positive screen should trigger a fuller assessment across use pattern, consequences, withdrawal and biomedical risk, readiness, and environment; the referral decision follows that multidimensional picture, not the screen score alone.
Multidimensional frameworks used in addictions care — commonly organized around acute intoxication and withdrawal risk, biomedical conditions, emotional and behavioral complexity, readiness to change, relapse potential, and recovery environment — exist because no single number sets the level of care. You do not need one program's criteria memorized to reason this way: list the dimensions, gather one or two data points for each, and rank which dimensions drive the decision. The output is a written justification, not just a destination.
Scenario: a client's DAST-10 lands in the higher range, but he calls the use recreational and refuses specialty treatment. The plausible mistake is either confronting him with the score or referring straight to an intensive program on the number alone. The better decision: stay in a motivational stance, use a readiness ruler to quantify ambivalence, obtain collateral with consent, and map withdrawal risk and home environment before matching the referral to the profile. The score opened the question; the dimensions answer it, and a forced referral can end the engagement.
Treatment Planning That Connects Assessment Data to Interventions
A strong plan states measurable goals, names each intervention and its evidence base, and specifies how progress will be measured; every goal should trace back to a specific assessment finding.
Trace one chain end to end. Assessment shows drinking is cued by empty evenings after work and maintained by short-term relief. Goal: reduce unsupervised evening drinking episodes using a weekly log. Interventions: cognitive-behavioral coping skills for cue situations and relapse-prevention planning that names high-risk states. Measure: daily log reviewed each session, plus a consequence checklist. Every element names its source in the assessment, which is exactly what separates a plan from a template with the client's name filled in.
Watch for two planning drifts. One is copying global goals — client will abstain — with no mechanism, no measure, and no link to data. The other is treating use-reduction and consequence-reduction as interchangeable: a client may cut drinking days while harms stay constant, or stabilize harms while use continues, and the intervention differs in each case. Where the multidimensional picture suggests a level of care beyond office practice, the plan should include coordination with specialty providers rather than substituting weekly counseling for it.
Ethics, Legal Duties, and Multicultural Competence in Addictions Work
Addictions cases add specific ethical tasks: informed consent for screening, confidentiality limits including extra federal protection for some substance use records, duty-to-protect judgments, and culturally sound use of instruments.
Anchor duties in the board's code and Kansas law, and add the federal layer: certain substance use treatment records receive heightened confidentiality protection under federal rules, which affects what you can share during coordination and collateral contact. Practice the judgment, not just the label: given a worried spouse calling for information, decide what consent exists, what the record's protections allow, and what a safety exception would require — then write the reasoning you would document.
Multicultural competence in this content is concrete: check whether an instrument's wording and reference groups fit the client in front of you, use professional interpreters rather than family members for substance use interviews, and expect stigma and disclosure norms to vary across communities. Where a cutoff was not validated for the client's population, say so in your interpretation and adjust your confidence accordingly. Documenting that reasoning is part of the ethical record, not an optional reflection.
A Self-Check Exercise, Rubric, and Preparation Sequence
Prepare by writing complete case decisions from vignettes, grading them against a rubric, and cycling content areas in a repeatable sequence; readiness means producing the work, not recognizing the terms.
Exercise: take any vignette combining mood symptoms with substance use. In forty-five minutes, produce the instruments you would administer with a one-line rationale each, a criterion-counted provisional diagnosis with a differential, a referral judgment justified across the multidimensional dimensions, and a three-goal plan. Grade against a six-point rubric — one point each: screens match the question; timeline is explicit; DSM-5 criteria counted with evidence; differential addressed; referral justified by multiple dimensions; goals measurable and linked to data. Compare your first and fourth attempts: earlier drafts should show gaps such as a single screen score doing all the work, and later drafts should close them.
A six-week sequence you can adapt: weeks one and two, build the scope table and drill DSM-5 criterion application; week three, instrument selection and interpretation pairs; week four, treatment-planning chains; week five, ethics and multicultural judgments applied to short vignettes; week six, timed integrated cases using the rubric. Reorder based on rubric results — a weak referral row moves multidimensional work earlier. Use practice questions and flashcards for retrieval between case days, but let full vignettes, not item drills, be the readiness measure.
- You can write your scope decision rule from memory and cite it for a vignette decision.
- Given a mood-plus-substance vignette, you produce a counted provisional diagnosis with a differential in ten minutes.
- You can justify a referral across at least three multidimensional dimensions without notes.
- Your rubric scores are stable across two independent vignettes, not improving only through repetition of the same case.
References and further reading
Use these references to explore the concepts and check the latest information from the relevant organizations.