Continuum of Care: Treatment for Substance Use Disorders (SUD), Mental Health (MH), and Co-Occurring Disorders (COD)

Question 1

Four Quadrants of Care

Answer 1

• Not all co-occurring disorders are created equally.

Quad. 1: Less severe MH disorder/Less severe SA disorder

Question 2

Four Quadrants of Care

Answer 2

• Not all co-occurring disorders are created equally.

Quad. 1: Less severe MH disorder/Less severe SA disorder
- Locus of care: primary health care, sa system, mh
Quad. 2: More severe MH/Less severe SA
- Locus of care: MH system
Quad. 3: Less severe MH/More severe SA
- Locus of care: SA system
Quad. 4: More severe MH/More severe SA
- Locus of care: Inpatient, state hospitals, DOC, jails, shelter, ERs, etc.
- Requires specialized integrated care MH/SUD

Question 3

Ways Systems Manage COD

Answer 3

Single diagnosis systems - not well equipped for COD
Sequential service systems are not always the best - bad theory/science
FULLY INTEGRATED SYSTEMS/TREATMENT IS OPTIMAL

**When different systems/teams are involved the client may experience different treatment philosophies and messages, which may be in conflict

Question 4

Placement Based on Acuity and Need

Answer 4

Inpatient psychiatric hospitalization - suicidal? psychosis?
Partial hospitalization - 4+ days of intensive services
Intensive outpatient (IOP) - 3 days
Routine outpatient - may be community/home based, includes psychiatric eval and med management
Case Management
Skills Instruction
Peer Recovery Specialists

Question 5

Substance Use Disorders Services System

Answer 5

Level of care and continuum of care placement based on ASAM, 6 dimensions.

Question 6

ASAM 6 Dimensions

Answer 6

1) Acute intoxication and withdrawal potential: relates to intoxication and withdrawal risks and also compulsive use
2) Biomedical conditions and complications (ex. pregnant, liver condition, etc.)
3) Emotional, behavioral or cognitive conditions and complications (stable?)
4) Readiness to change
5) Relapse, continued use, or continued problem potential
6) Recovery/living environment

• The first 3 are most important for medical detox or psychiatric inpatient due to risk factors

Question 7

ASAM Criteria: Continuum of Care

Answer 7

Early intervention - usually people with no SUD dx
Outpatient services - 1x/week or less
IOP - multiple contacts per week
Partial hospitalization - 4

Question 8

6 Guiding Principles of COD

Answer 8

1) Employ a Recovery Focus - long-term process of internal change. Tx plan for care over time; this changes based on severity. Specific interventions at each stage.
2) Adapt a Multi-Problem Viewpoint - Tx must have ability to meet therapeutic and functional needs
3) Develop a Phased Approach to Tx - generally: engagement, stabilization, treatment, and continuing care (chronic disease model). Stage appropriate interventions developed
4) Address Specific Real Life Problems Early in Tx
5) Plan for the Client’s Cognitive and Functional Impairments
6) Use Support Systems to Maintain and Extend Tx Effectiveness

Question 9

Guiding Principles of Recovery

Answer 9

• There are many pathways to recovery.
• Recovery is self-directed and empowering.
• Recovery involves a personal recognition of the need for change and transformation.
• Recovery is holistic.
• Recovery has cultural dimensions.
• Recovery exists on a continuum of improved health and wellness.
• Recovery is supported by peers and allies.
• Recovery emerges from hope and gratitude.
• Recovery involves a process of healing and self-redefinition.
• Recovery involves addressing discrimination and transcending shame and stigma.
• Recovery involves (re)joining and (re)building a life in the community.
• Recovery is a realist. It can, will, and does happen.

Question 10

NIDA 13 Principles of Effective Treatment

Answer 10

1) Addiction is a complex treatable disease that affects brain function and behavior: attention to risk of relapse. (brain disorder)
2) No single treatment is appropriate for everyone: Individual care
3) Treatment needs to be readily available: no wrong door and easy access. (no long waits)
4) Effective treatment attends to the multiple needs of the individual, not just his or her drug use: implications for case management and systems of care.
5) Remaining in treatment for an adequate period of time is critical: 3 MONTHS MINIMUM duration and multiple episodes typical.
6) Behavioral therapies-including individual, family, or group-are the most commonly used forms of drug abuse treatment: multiple options including focus on motivation.
7) Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies: medication assisted recovery.
8) An individual’s treatment and service plan must be assessed continually and modified as necessary to ensure that it means changing needs are addressed
9) Many drug-addicted individuals also have other MH disorders: COD and benefits of psychiatric medication management
10) Medication assisted detox is only the first step of addiction treatment, and by itself, does very little to change long-term drug abuse: continuum of services after detox is essential.
11) Treatment does not need to be voluntary to be effective
12) Drug use during treatment must be monitored continuously, as lapses during treatment do occur.
13) Treatment programs should test patients for HIV/AIDS and Hep B and C.