What Is Intensive Outpatient Substance Abuse Treatment
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A good addiction treatment plan is a comprehensive set of tools and strategies that address the client’s identifiable strengths as well as her or his problems and deficits. It presents an approach for sequencing resources and activities, and identifies benchmarks of progress to guide evaluation.—Center for Substance Abuse Treatment (CSAT) 1994d , p.
A treatment plan is a map specifying where clients are in recovery from substance use and criminality, where they need to be, and how they can best use available resources (personal, program-based, or criminal justice) to get there – what is mat in substance abuse treatment. At a minimum, the treatment plan serves as a basis of shared understanding between the client and treatment providers.
The severity of substance abuse-related problems must be determined, since this is the basis for appropriate placement in a treatment program. In addition, the presence of co-occurring mental disorders must be assessed because these may limit the type of treatment approach and identify the need for psychiatric care. Also important is assessing factors such as procriminal attitudes and psychopathy that may suggest persistent criminality unrelated to substance abuse.
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Finally, offender-clients should be involved in developing their treatment plan so that they can be referred to appropriate services in the community (does cigna cover substance abuse treatment). Posttraumatic Stress Disorder (PTSD) and DepressionSevere Mental DisordersIntermittent Explosive DisorderBorderline Personality Disorder Sources of CriminalityPsychopathy Focus on Personal Strengths Offender Involvement in the Development of the Treatment PlanCoordination of Treatment Planning and Sharing of Treatment InformationLinkages With Community Treatment Treatment planning within the criminal justice system requires a comprehensive assessment of an offender’s substance abuse history and patterns of use, including drug(s) of abuse, chronological patterns of use, specific reasons for use, consequences of use, and family history of drug and alcohol abuse.
Although the number and type of substance-related charges is sometimes a fairly good indicator of substance abuse and related problems, the offense category alone is not a foolproof indicator of treatment need or of appropriateness of referral to a specific program – how long is substance abuse treatment. The presence of intoxicants in blood or urine at the time of arrest is a better, albeit imperfect, indicator.Using multiple indicators for assessing the severity of a substance use disorder is important because individuals with few substance-related problems typically do not respond favorably to intensive treatment and fail to identify with the process of recovery.
Minimally, an assessment of severity should focus on determining the impact of use on the individual’s community adjustment. Usually this also entails taking a drug history that inquires about the frequency, dosage, and types of drugs used. A drug history may also inquire about the times at which, or settings in which, an offender uses.Assessment of the severity of a substance use disorder may lead to an actual diagnosis of a substance use or dependence disorder.
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Also, most settings lack the qualified staff and time required to make formal diagnoses, and clients are sometimes in the setting for too short a time to delay treatment while awaiting formal diagnosis of a substance use disorder. In these settings, clinical impressions are more feasible than are formal diagnoses, and common sense, assisted where possible by standardized assessment instruments, should prevail in deciding whether and how to provide treatment services.
Offenders with severe substance use disorders have relatively high rates of affective disorders, anxiety disorders, and personality disorders. These disorders can contribute to the development of substance use problems, or the emotional disorders may develop as a consequence of the physiological effects of long-standing drug use and the stressful or traumatic life events that are often experienced as part of a lifestyle in which drug use plays a central role – does medicare pay for substance abuse treatment.
Commonly encountered disorders include anxiety, depression, and posttraumatic stress disorder (PTSD) (Teplin et al – does fmla cover substance abuse treatment. 1996). Developing programs to assist those with co-occurring mental and substance use disorders requires integrating treatments and modifying commonly used interventions to take into account possible cognitive disabilities and increased need for support among these individuals.
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2001). (See also TIP 42, Substance Abuse Treatment for Persons With Co-Occurring Disorders[CSAT 2005b]. )Although the treatment of co-occurring severe mental disorders and substance use disorders sometimes is provided in specialized, more intensive programs, less severe mental disorders that do not cause major functional impairment can be treated and managed effectively within mainstream programs.
It is important to note, however, that the early stages of recovery often are marked by increases in depression and anxiety, due, in part, to residual effects of substance withdrawal and also to the individual’s recognition of consequences related to his substance abuse, including incarceration or other restrictions to his liberty.
Thus, assessments should be repeated regularly during the treatment process.• After a few months of abstinence, most clients will show a decrease in negative mood related to their substance use. However, abstinence may reveal the presence of other, more serious mental disorders (such as posttraumatic stress disorder, depression, schizophrenia, intermittent explosive disorder, or borderline personality disorder) that will require collaboration with a mental health professional.
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Whether identified initially or after a period of treatment, it is important that these issues be reflected in the treatment plan, matched with interventions likely to be effective, and tracked with regard to progress. For example, while most clients will find that negative mood will decrease over the first few months of abstinence and treatment, an individual’s depression, nightmares, and other trauma-related symptoms might persist after several months.What Is Contingency Management In Substance Abuse Treatment
The referral could result in recommendations for antidepressants and/or antianxiety medications and/or involvement in cognitive-behavioral therapy related to trauma and substance abuse issues. These interventions may be instrumental in preventing substance abuse relapse and allowing the client to continue making progress within her substance abuse treatment program.Although they occur less frequently than PTSD and mild anxiety or depression, serious mental disorders (including schizophrenia, delusional disorder, bipolar disorder, and major depression) can adversely affect the ability of treatment programs to manage an offender’s behavior.
These more severe behaviors require involvement of mental health professionals for diagnostic workup and treatment interventions.In the case of serious mental disorders and threatening behavioral disorders, an assertive, psychiatrically based treatment approach is needed during the most intensive phases of the disorder. After the more severe symptoms have abated (usually through medication and behavioral management on a specialized unit or in a hospital), collaboration between mental health and substance abuse professionals is needed to determine the best approach to manage and treat the individual.
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Other individuals will require more intensively integrated care and intervention for their co-occurring disorders.Treatment planning for individuals who present with an intermittent threatening behavioral disorder is complex. If these behaviors are fairly frequent, it will be impractical to manage the individual in a mainstream program – does fmla cover substance abuse treatment. If these behaviors occur infrequently, the individual may be manageable in the mainstream setting, but only with additional assessment as to the causal antecedents (immediate situation and circumstances) of the outbursts or self-harm behaviors and an analysis of the incentives and perpetuating factors that fuel the behavior.
In many cases psychiatric consultations and medication management can be helpful.Individuals diagnosed with borderline personality disorder (BPD) sometimes engage in severely disruptive behaviors. Individuals with this disorder typically experience many specific negative emotions (vulnerability, hostility, sadness, anxiety, etc.) or a nonspecific but intense sense of distress or “feeling bad.” This is combined with an inability to monitor and control emotions, alternating chaotic or contradictory ways of relating to self and others, and self-harm or dramatically self-destructive behaviors.Dialectical Behavior Therapy (DBT) (Linehan 1993) has been developed specifically for treatment of BPD.
DBT approaches can be successfully integrated with substance abuse treatment in much the same way that the treatment of severe mental disorders is coordinated with mainstream substance abuse treatment. Clients participating in DBT do so on a voluntary basis, and agree to attend skills training sessions and to work on reducing suicidal or self-injurious behavior and other behaviors that interfere with treatment.
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Problemsolving skills are used throughout DBT, as are contingency management, cognitive-behavioral treatment approaches, supervised “exposure” to past trauma events, and use of psychotropic medication.The DBT approach typically consists of at least 1 year of treatment, comprising weekly individual psychotherapy and group therapy sessions. Individual sessions explore problematic behaviors and chains of events leading up to the behaviors, while therapy sessions focus on interpersonal effectiveness skills, tolerance of distress, emotional regulation, and self-awareness or “mindfulness” skills.