12 Core Functions: The 12 Core Functions of Addiction Counseling

Written by Sam Medley

On the road to becoming a substance abuse counselor, you’ll likely study, practice, and one day become an expert in the 12 core functions of addiction counseling. Generally speaking, the 12 core functions are a set of duties you’ll perform to help people through every stage of recovery from admission to discharge and beyond.

However, the 12 core functions aren’t just a list to memorize or a set of motions to go through. They’re a symbol of how far addiction counseling has come. They’re an evidence-based framework you can use to help people in one-on-one counseling sessions, community education events, and any recovery-focused setting.

In essence, the 12 core functions define what it means to be an addiction counselor today. In this guide, we’ll explore each one in detail and talk about different ways you can approach them as you guide your clients through recovery.

An Overview of the 12 Core Functions and Global Criteria

The 12 core functions are a set of duties that outline just about every aspect of a substance use disorder counselor’s job. If you pursue a substance use disorder (SUD) counseling certification or license, you’ll likely be trained and tested on them by your school or credentialing agency. And when it comes time to start your new job, your employer will likely use them to define your duties.

The 12 core functions of substance abuse counseling are:

Screening
Intake
Orientation
Assessment
Treatment Planning
Counseling
Case Management
Crisis Intervention
Client Education
Referral
Report and Recordkeeping
Consultation with Other Professionals

However, each of these functions are also made up of a few smaller, more specific skills called global criteria. To master each function, you’ll have to master each global criteria first. We’ll cover each function’s global criteria in later sections.

Variations in the 12 Core Functions of the Substance Abuse Counselor

There’s not a uniform process for becoming a counselor in the US. Each state gets to set its own standards. Some have stricter requirements than others. These variations also mean that not every state or organization uses the 12 core functions.

For example, the International Certification and Reciprocity Consortium (IC&RC) is one of the country’s leading counselor certification agencies. Most states use IC&RC guidelines to inform their own regulations. The IC&RC builds its tests and training processes around the 12 core functions.

However, there’s another major counselor certification agency in America that also informs state regulations: the National Association for Alcoholism and Drug Abuse Counselors (NAADAC). The NAADAC does not use the 12 core functions. Instead, they test and train new counselors based on nine skill areas:

Treatment admissions including screening, intake, and orientation.
Clinical assessment.
Treatment planning.
Counseling including individual, group, and family counseling, crisis intervention, and client education.
Documentation.
Case management.
Continuing care and discharge planning.
Legal, ethical, and professional development issues.
Physiology and psychopharmacology.

You’ll notice, though, that these skill areas are extremely similar to the 12 functions. So while agencies in your state might not use the term “12 core functions,” they likely use a similar concept. As you explore degree programs and investigate regulations in your state, it’s important to keep these details in mind.

Who Created the 12 Core Functions?

The 12 core functions as they’re used today weren’t created by one person at a single point in time. Instead, they were developed and refined over years by numerous organizations and SUD treatment professionals.

According to Dave Parisi, a now-retired Master Licensed Alcohol and Drug Abuse Counselor with over 40 years in the field, the 12 core functions were first drafted in 1980. This was done by a group of agencies in different states that were trying to make substance use disorder treatment a more consistent, clinically-focused field. The global criteria were added in 1993 to help with the training process and define counselors’ exact duties.

Why Were the 12 Core Functions Created?

The 12 core functions were created shortly after the American Medical Association recognized SUDs of all kinds as a disease in 1987. This was one of the most important developments in the history of SUD counseling in the US. It signaled that addiction should be treated like other diseases: clinically, professionally, and without stigma.

But even though the days of dubious elixirs, lobotomies, and dehumanizing treatment techniques were largely over, there was still a large vacuum in the recovery community.

While substance use disorder counselors existed, there weren’t many agreed-upon training programs for new counselors. Many of the people who found their way into the field were psychologists, medical doctors, social workers, and other professionals. If you wanted to become a substance use disorder counselor, you’d likely have to enter the field indirectly through one of those professions and seek training through an organization like the IC&RC or NAADAC.

But with the establishment of the 12 core functions, there was finally a straightforward path. New counselors had concrete skills to learn. Their trainers and educators had a framework for preparing them for their new careers. Government agencies could now regulate the profession like they had done with doctors and nurses. People could find professionals who were trained to help them specifically.

Since then, schools across the country at every level have started degree programs for students who want to enter this life-saving field. There’s still work to be done, but the 12 core functions of a substance abuse counselor provide a blueprint for future advancements.

Function 1: Screening

Global Criteria

Evaluate clients for the social, psychological, and physiological signs of substance use disorders.
Determine if clients should be admitted or referred to other programs.
Determine if clients are eligible for admission.
Screen for co-occurring disorders and decide if clients need further assessment or support.
Observe all laws and regulations regarding SUD treatment services.

Screening is the process by which a counselor determines if a person needs treatment and what level of treatment will help them the most. If you work for a provider that offers different forms of treatment like inpatient, outpatient, and partial hospitalization, it’s extremely important to have a meticulous screening process in place.

Determining Client Needs

While some treatment providers may have their own screening processes, there are a few widely-used screening tools. Some organizations use different combinations of these tools to screen potential clients and patients:

The Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) Tool — a screening tool that focuses on frequency of use.
Brief Screener for Tobacco, Alcohol, and Other Drugs (BSTAD) — another frequency-focused tool but tailored to adolescents.
The Brief Addiction Monitor (BAM) — a 17-question form that asks about use, how use has affected a client’s health and sleep, and their existing support system.

Screening tools are often brief, but that’s fully intended. Screening is all about determining if further assessment is required. You’ll learn more about your client’s needs as you carry out the rest of the 12 core functions.

Determining If a Program Can Meet a Client’s Needs

During screening, determining what kind of help a client needs is only half the battle. The other half is determining if you and your team are equipped to meet your client’s needs.

To answer that question, you may have to consider:

Any co-occurring disorders your potential client is facing. Co-occurring disorders are mental, physical, and psychological issues related to a substance use disorder.
Cultural and language differences. While recovery communities strive to be inclusive, being able to connect with clients on a basic cultural level is vital to treatment. If that might pose an issue, you may need to refer clients to other providers. However, this should be an informed, compassionate decision that takes your client’s input into consideration.
Financial eligibility. Because SUD treatment isn’t always covered by insurance, costs can sometimes limit where a person can seek help. Counselors and their office personnel must often explore financial options on behalf of their clients and help them find accessible treatment if necessary.

Some of these circumstances can be discovered through simple questionnaires. However, you may also have to consult with other specialists, review medical histories, and conduct client interviews to find your place in their journeys.

Co-Occurring Disorders: One of the Most Important Factors To Consider During Screening, Treatment, and Beyond

Co-occurring disorders can take many forms. For example, many people suffering from depression, anxiety, and other mental health disorders self-medicate using non-prescribed drugs and alcohol. Some mental health disorders are made worse by using alcohol and other drugs. Similarly, substance use disorders can lead to chronic health problems such as cirrhosis of the liver or HIV.

And according to the Substance Abuse and Mental Health Services Administration (SAMHSA), co-occurring disorders are extremely common. SAMHSA reports that over 21 million people with SUDs have a co-occurring disorder.

Treating a substance use disorder often means treating these conditions, as well. During screening, you may have to determine if your clinic has the means to do that. If not, you may have to refer the client to another provider or a specialist who can help you and your client throughout the process.

Function 2: Intake

Global Criteria

Fill out all admission paperwork.
Fill out all documents related to clients’ eligibility and appropriateness for the program.
Get consent forms from clients when needed for referral and consultation.

Once you’ve screened a client and found that they might benefit from your program’s services, it’s time to prepare your client for admission through a process called intake. As the global criteria imply, intake is largely an administrative process that requires a lot of paperwork.

During intake, you might have your client fill out:

But like screening, intake isn’t always about collecting information from the client. You may also want to give them information about your program’s values, what techniques you use, and your own qualifications. For clients, intake can be an intimidating process. Letting them get to know you and your organization can alleviate the anxiety surrounding treatment.

Function 3: Orientation

Global Criteria

Communicate your program’s goals to clients.
Inform clients about your program’s rules and their rights.
Describe your program to clients in detail.

After you’ve processed all required paperwork, you or another member of staff will conduct an orientation. While you may have already discussed what your services involve during intake, orientation is when you go into more detail. You may even have clients sign paperwork acknowledging they’ve read and understand your program’s policies.

The global criteria for orientation do a great job explaining what you’ll do at this time. However, it’s important to remember that clients will likely have their own questions. Answering them clearly and compassionately can help them feel more comfortable with the idea of treatment. That can be a powerful thing in the early days of recovery.

Function 4: Assessment

Global Criteria

Gather client history using appropriate interview methods. This can include family, treatment, and substance use history.
Obtain information about history from other sources (doctors, psychologists, etc.) when necessary.
Identify appropriate assessment tools.
Explain the assessment process to clients.
Create a holistic assessment of your clients needs based on their strengths, struggles, and co-occurring disorders.

After reading the global criteria for assessment, it may seem like a repeat of screening and intake. However, assessment is much more involved and usually involves interviewing clients face-to-face instead of giving them questionnaires. This is so you can truly understand their struggles and goals and tailor your approach to meet their needs.

While some of the global criteria are pretty self-explanatory, understanding interview and assessment techniques is key to understanding your role as both a counselor and a source of support.

Interview Techniques

In the SUD counseling world, appropriate interview techniques are ways of communicating that foster clear communication and trust between clients and counselors. The interview techniques you’ll learn about during training have all likely been tested and reviewed repeatedly.

There are many types of interview techniques but some of the most widely-used ones include:

Reflective Listening. This involves a counselor repeating what a client has said or summarizing an issue they’re describing. Reflection can encourage clients to think more deeply about their thoughts. It can also help counselors make sure they understand their clients.
Asking open-ended questions. Open-ended questions invite clients to give insightful answers in their own words. For example, “How do you think being sober will help?” is an open-ended question while, “Do you want to quit drinking?” is a simple yes-no question that may not elicit helpful responses.
Affirmations. Offering genuine compliments to a client can help them recognize their strengths and feel encouraged about treatment.
Summarizing. Summarizing is similar to reflective listening in that it usually involves a counselor restating what a client has said. However, summarizing also involves highlighting key points a client may have made without realizing it. This is especially useful in helping clients identify goals and reasons they want to seek treatment.

These techniques all belong to a counseling strategy called motivational interviewing. Motivational interviewing helps counselors and clients discover and work towards specific goals. Just as importantly, it helps clients play an active part in their own recovery. This collaborative approach to counseling can break down barriers between you and your clients. It’s a signal that you’re not there to judge. You’re there to help.

Assessment Tools

Like interview techniques, SUD counselors use a wide range of assessment tools and may even use combinations of them to get a clear picture of their clients’ needs. Assessments can be given in the form of questionnaires, interviews, or both. At the end, clients typically receive a score that tells counselors the level of care they might need.

Some popular assessment tools include:

TAPS-2: a followup to the TAPS screening tool that focuses on how often clients use intoxicants, why, and their efforts to stop or cut back.
The Michigan Alcohol Screening Test (MAST): a widely-used 25-question assessment that asks questions about potential physical, social, and mental symptoms of alcohol use.
Substance Abuse Subtle Screening Inventory, 3rd Edition (SASSI-3): a 93-item questionnaire that assesses how much a client may be trying to conceal the effects of an SUD from people in their everyday lives.

When assessing a client in the next step, it’s important to be straightforward about the goals of each assessment tool and discuss results in non-stigmatized terms. Coming to you for help was likely a tough decision.

Function 5: Treatment Planning

Global Criteria

Discuss assessment results clearly with your clients.
Prioritize issues including SUDs and co-occurring disorders.
Come up with long-term goals with your client. Focus on actionable behavior-focused goals.
Determine which level of treatment and what methods you’ll use. Also include any outside resources you plan to use in the treatment plan.

At this point in the treatment process, you’ve hopefully found out everything you need to know about your client and their needs. During the treatment planning stage, you’ll combine that information with your counseling knowledge and plot out the course of their recovery in detail and in writing.

While you may need to remain adaptable and react to your client’s changing needs, your treatment plan will be your guide throughout the whole process.

And once again, communication with your client is of the utmost importance. They and their loved ones are vulnerable. If they’ve gone through treatment before and had bad experiences, they might even be resistant. Being as clear as possible about your treatment plan, even if it has to change later, is a crucial step in building trust.

Function 6: Counseling

Global Criteria

Identify which counseling theories and techniques you’ll use.
Use those techniques in individual, group, and family counseling to discuss relevant issues.
Use those techniques to examine and discuss clients’ feelings when appropriate.
Take personal factors into account. This can include their gender identity, lifestyle, and cultural background.
Maintain an appropriate therapeutic relationship with clients.
Use counseling to help clients come up with their own solutions and be a guide throughout that process
Implement your treatment plan.

Once you’ve assessed a client and made a treatment plan, it’s time to put that information to work as you carry out the sixth function: counseling. Once again, the global criteria do a good job of summarizing what this function entails.

However, there’s a whole world of counseling theories and techniques out there. While you’ll likely study and practice them during your training and education, a brief introduction to a few important counseling theories can help you understand what the counseling process is actually like. Throughout counseling, you might decide that a client responds to one type of therapy best or that you should combine different elements of each type.

Cognitive Behavioral Therapy (CBT)

CBT focuses on helping people change negative behaviors by first changing the negative thought process behind them. Over time, you can help clients stop negative thought processes by introducing new ones and helping them develop coping mechanisms. CBT is one of the most widely-used techniques in both SUD and mental health counseling.

Gestalt Therapy

Gestalt Therapy is an active, holistic type of therapy that focuses on self awareness and being present in the moment. Like CBT, this can help people recognize and change the negative thought patterns that often come into play with substance use disorders. Counselors often combine Gestalt Therapy with roleplaying and artistic exercises to help people explore their feelings.

Rational Emotive Behavior Therapy (REBT)

In REBT, counselors help clients slow down their thought processes and determine if thoughts and actions are rational. For example, if you have a client who is overwhelmed by their work or personal responsibilities, they may feel like they’ll fail no matter what they do.

This thought might fuel an SUD. However, it might be rooted more in anxiety than the reality of their situation. Through REBT, you may be able to help the client restructure their thinking and base decisions on what’s directly in front of them.

Function 7: Case Management

Global Criteria

Coordinate outside services for clients as needed.
Explain why you’re recommending each service.

As you help a client through recovery, you may find that they need more than counseling to be successful during treatment. They might need job counseling, affordable and safe housing, a support group, or any number of other services. The act of bringing these services together is called case management.

As you gather resources for clients, you’ll have to be resourceful, creative, and, at times, persistent. To ensure you’re providing relevant resources, you’ll also need to discuss them with your clients and ask them about their progress. In that sense, you’re not just an SUD counselor — you’re an advocate for vulnerable people in your community.

Function 8: Crisis Intervention

Global Criteria

Determine if a client is going through a crisis.
Take immediate action when necessary.
Integrate crisis moments into counseling when they occur.

As a counselor, your main goal will be empowering people to make healthy long-term changes. But in some cases, you may need to take steps to keep your clients safe in the here and now. This is called crisis intervention. While you may have had to confront a crisis during screening or intake, crisis intervention may be needed during any step of the counseling process.

Examples of crises you may encounter as a substance abuse counselor include:

Depending on the circumstances, you may need to refer your client to an inpatient facility, shelter, or hospital. You may even need to contact emergency services. But before, during, and after, you can also be a source of emotional support. In fact, the crises you help your clients navigate could very well be stepping stones towards their recovery.

Function 9: Client Education

Global Criteria

Educate clients about SUDs and treatment in relevant, relatable ways.
Educate clients about other educational resources they can take advantage of.

Aside from counseling, you’ll also play a pivotal role in educating your clients about substance use disorders and the treatment process itself. This can be done by recommending books, sharing your knowledge during sessions, or referring them to other educational resources.

For many people, learning the science behind what they’re going through can be a powerful way to overcome the self-loathing, stigma, and hopelessness that often accompanies substance use disorders. And depending on where your career takes you, you may also have the opportunity to speak to support groups, schools, and at community events.

Function 10: Referral

Global Criteria

Determine what issues you or your agency aren’t equipped to help with.
Explain to clients why you’re making a referral.
Find relevant resources for your clients.
Observe all information privacy laws when making referrals.
Help clients access and use the resources you refer them to.

At some point in your career, you’ll likely have clients who need more support than what you or your team can provide. As a counselor, you might not be trained to provide medication-assisted treatment, mental health diagnoses, or other advanced interventions. In those cases, you’ll need to refer clients to specialists who do. This is called referral.

For example, during a client’s initial screening, you may have discovered that they exhibit some signs of bipolar disorder. In that case, you might refer them to a psychiatrist, a mental health professional who can diagnose the issue, provide treatment, and prescribe medication.

However, it’s important to discuss referrals with clients and help them find accessible treatment. As a member of your local recovery network, you’re in the perfect position to do just that. Later in your career, you might even pursue a master’s degree, get a clinical counseling license, and diagnose mental health issues and other complex problems yourself.

Function 11: Recordkeeping

Global Criteria

Keep reports and records that help you and others support clients throughout all stages of treatment.
Record new information for integration into treatment.
Utilize all relevant documentation throughout treatment.

While recordkeeping might not be the most exciting of the 12 core functions of addiction counseling, it’s essential to carrying out the other 11. Without detailed recordkeeping, tracking client progress, referring them to other professionals, and determining what your next step is would be nearly impossible.

But recordkeeping isn’t just a practical concern. It’s also a legal and ethical one. Like medical records, SUD treatment records are protected by federal laws, namely Title 2, Part 2 of the Code of Federal Regulations (often shortened to 42 CFR Part 2).

Amongst other things, 42 CFR Part 2 requires SUD professionals to get clients’ written consent before their records are shared in any way. This protects people from being unfairly judged or stigmatized by employers, law enforcement, or others. Attitudes about SUDs have come a long way in recent decades, there’s still room for improvement. Maintaining integrity when it comes to client records is an extension of your duty to help and protect vulnerable people.

Function 12: Consultation With Other Professionals

Recognize skills and areas that are outside of your skill set.
Find the right sources of information and consult with them as needed.
Observe information privacy laws throughout consultation
When needed, explain why you’re consulting other professionals with your clients.

Consultation is similar to referral in that it involves you asking other professionals for help. But during consultation, you aren’t sending your client elsewhere for services. You’re simply getting input from other professionals.

For example, imagine you have a client who’s going through marital issues. They may even be facing a divorce or custody battle. While you feel equipped to help them on an emotional level, you’re not familiar with all the legal issues surrounding divorce and child custody. However, there’s another counselor in your practice who is. You might turn to this person when you need help planning your client’s treatment or preparing for the challenges they’ll face.

However, when you consult with other professionals (even those in your own practice), you must still abide by all privacy regulations. In some cases, you may even have to get the client’s consent before seeking consultation.