Continuum of Care

Substance Abuse Patients

Substance abuse disorders develop within a complex constellation of biological, psychosocial, and structural factors, and comprehensive treatment tailored to [Page 232]the patient's unique constellation may increase the likelihood of stable recovery: the continuum of patient care for substance abuse and dependency facilitates such comprehensive treatment. The array of treatment options available may be used sequentially or episodically as appropriate for an individual patient and may be described as ranging from less to more intensive in the nature of the intervention and from brief to long term in their duration. A structured patient assessment allows providers to determine the appropriate level of care and define specific treatment goals. Patient assessment includes signs and symptoms of withdrawal; treatment history; Diagnostic and Statistical Manual of Mental Disorders criteria for substance abuse disorders; the Global Assessment of Functioning, which measures social, psychological, and occupational function and level of impairment; general assessment of need, willingness, and cognitive ability to engage in treatment; the presence or absence of family and social support for treatment; and other diagnoses that may impact on the individual's response to substance abuse treatment.

Levels of Intensity

At the low-intensity end of the treatment continuum of care are outpatient interventions for people with moderate levels of substance abuse. These interventions include individual and/or family therapy sessions, group sessions, and support groups for substance abusers and those close to them. Sessions aim to decrease substance use behavior, strengthen coping and problem solving skills, and provide emotional and social support through the process of recovery. For people with dual diagnoses, such treatment may include support for adherence to care for mental illness or other co-occurring conditions. Brief, low-intensity interventions can be delivered in bimonthly sessions, or they may also be offered several times a week, and they may last for several weeks to a few months. Outpatient pharmacological treatments for management of opioid withdrawal, including buprenorphine and methadone, are long term. Day treatment programs, partial hospitalization, and inpatient rehabilitation lasting 2 to 4 weeks represent more intensive interventions for individuals for whom outpatient treatment has failed or who require a more structured intervention and more intensive monitoring. In addition to more intensive individual and group therapy, these interventions may offer comprehensive case management services and planning for appropriate follow-up care. Therapeutic communities provide such structure for sustained periods and are appropriate for people with longer histories of substance use and/or more severe substance use disorders. They offer life skills-building activities, including vocational training, occupational therapy, and general education in a highly structured setting. Medical detoxification, in which continuous medical attention is needed to manage symptoms of withdrawal, represents the most intensive extreme of the treatment continuum of care. Additional assessment criteria, including physical and psychological symptoms, are used to determine the need for medical detoxification. The medical team managing detoxification works in collaboration with medical specialists as necessary.

...