H.  Is Specialty Referral Indicated And Acceptable To The Patient?

 

OBJECTIVE

 

Promote enhanced patient commitment to change and adherence to the planned treatment regimen.

 

ANNOTATION

 

Negotiate and set specific rehabilitation goals with the patient:

1.       Establish treatment goals in the context of a negotiation between the treatment provider and the patient.

2.       Review with the patient results of previous efforts at self-change and formal treatment experience, including reasons for treatment dropout.

3.       Use motivational enhancement techniques when appropriate.

4.       Consider bringing the addiction specialist into your office to assist with referral decision.

5.       Regarding DoD active duty:

§   Referral to addictions specialty care for assessment is required for all active duty patients involved in an incident involving/suspected to involve substances (see Module A, Appendix A-2).

§   Should such patients refuse referral, notify the commanding officer so consideration can be given to either (a) order the patient to comply, (b) invoke administrative options (e.g., administrative separation from service), or (c) do nothing.  This is the commander's decision, with input from the medical staff.

 

DISCUSSION

 

When both parties agree on what is to be accomplished and how this is to be done, the chances of achieving a favorable outcome are enhanced (Putnam et al., 1994; Sanches-Craig & Lei, 1986).  Discussing treatment history and expectations can reduce reliance on previously ineffective treatment approaches and increase the likelihood of realistic goals for the current episode of care.

 

EVIDENCE TABLE

 

	Recommendations	Sources of Evidence	QE		R
1	Establish treatment goals through negotiation.	Heinssen et al., 1995 Miller, 1995 Miller & Rollnick, 1991 Sanchez-Craig & Lei, 1986 Sobell et al., 1992 Stark, 1992	II-1		A
2	Review prior treatment experience.	Stark, 1992	III		B

QE = Quality of Evidence; R = Recommendation (See Introduction)