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Friday, June 14, 2013

What is Involved With Substance Abuse Care?

Over the past decade, substance abuse services policy has tended toward a more unified, integrated system that combines prevention and treatment. Providers and researchers increasingly recognize that prevention entails more than discouraging use - it can include any effort to prevent negative consequences, that result from harmful drug or alcohol use, as well as attempts to prevent hazardous use from progressing to dependence.

Using estimates from  the Institute of Medicine, a Robert Wood Johnson Foundation report and the National Household Drug Survey it is calculated that about 13.6 million users of illicit drugs and 18 million people with alcohol use problems need treatment, but only one fourth of them will receive it.

Understanding Substance Use Disorders
  • Substance use disorders share many characteristics with other chronic medical conditions like hypertension.  Among the similarities between the two are late onset of symptoms, unpredictable course, come complex etiologies, behavioral oriented treatment, and favorable prognosis for recovery.

Late Onset of Symptoms
  • Clinical problems related to substance abuse develop slowly and may remain undetected for a long time unless a traumatic injury, problem in the workplace, confrontation with police, or other serious event calls attention to it before physical symptoms become apparent. As with hypertension, routine screening for substance abuse is necessary to identify problems in the early stages of develop.

Unpredictable Course
  • At this time, it is difficult to predict with any certainty which subset of heavy drinkers and drug users will develop serious substance abuse problems. Further, it is not possible to predict whose problems are situational and transient and whose will remain chronic and progressive.

Complex Etiologies
  • The interplay between genetic familial predisposition and lifestyle influences the development of substance abuse disorders just as it influences hypertension. At the same time, people without inherited suspect ability may develop problems as a response to external stresses or internal discomfort if they continue using alcohol or other drugs over time. Individual patients, for example, may use alcohol or other drugs to make themselves better, or more tolerable, or “self-medicate” psychiatric symptoms or gradually adjust/increase the dose of a medications.

 Behaviorally Oriented Treatment
  • Like treatment for hypertension, behaviorally oriented substance abuse treatment requires the patient to assume primary responsibility for making difficult behavioral changes. As with any chronic condition that depends on behavioral change to improve outcome, patients will have to accept that they have a problem. Compliance with treatment is ongoing and may be difficult.

Favorable Prognosis for Recovery
  • Many substance abuse patients - such as patients with diabetes, elevated cholesterol, or hypertension - do respond to clinical recommendations and modify their behavior. The rate of 20% of problem drinkers (those meeting the DSM criteria for alcohol abuse) who successfully reduce their drinking compares favorably with the prognosis rates of many chronic health conditions primary care providers routinely address.
  • Today, current data contradicts the widespread belief that substance abuse treatment does not work. When treatment is available, there have been documented reductions in use, hospitalizations, medical costs and sick time, family problems, and criminal activity as well as increases in employment, job retention, income, and improvements in an array of other health indicators.
  • As with other chronic conditions, the efficiency of substance abuse treatment is helped tremendously when family and friends support patients’ efforts to change their behavior, when patients themselves are ready to make significant lifestyle changes, and the effects of co-occurring disorders are minimized.

Brief Intervention

Brief Intervention(BI) is appropriate for individuals identified through screening to be at moderate risk for substance use problems.Brief Intervention (BI) can be provided through single one on one sessions. These interventions focus on increasing a individuals insight into and awareness about substance use and behavioral change. BI can be tailored to a particular population or setting. It can be a stand-alone treatment for those at risk or a vehicle for engaging those in need of more intensive levels of care. BI typically is provided at the same site as screening.
  • Brief intervention is quite inexpensive for the yields, involving clinician/doctor - patient contacts for 10 to 15 min. - the typical duration of an office visit - and a limited number of sessions. At least one follow-up visit is usually recommended, but the number and frequency of sessions depends on the severity of the problem and the individual patient's response.

Critical Moments of Brief Interventions

1.    Give feedback about screening results, impairment, and risks while clarifying the findings.
2.    Inform the patient about safe consumption limit and offer advice about change.
3.    Access the patient's readiness to change.
4.    Negotiate goals and strategies for change.
5.    Arrange for follow-up treatment.

Deciding to Refer for Further Assessment or Treatment

Individuals identified as needing brief treatment or more intensive treatment than brief intervention are referred to specialty SUD treatment providers. The primary goal of referral to treatment are to identify and appropriate treatment program and to facilitate engagement of the individuals treatment. Referral to treatment can be a complex process involving coordination across different types of services. It requires a proactive and collaborative effort between SBIRT providers and those providing specially treatment to ensure that and individual, once referred, has access to and engages in the appropriate level of care.
  • One of the most important concepts of substance use treatment is that one treatment failure is no reason to give up. Clinicians/doctors are prepared for brief intervention to fail: you may not be able to achieve or maintain the mutually established goal of reducing or stopping use after one or even several tries.

RE: Management of Substance Use Disorder (SUD) (2009)PTSD and Substance Abuse in VeteransSubstance UseDisorder and Posttraumatic Stress Disorder Comorbidity: Addiction andPsychiatric Treatment Rates