Patient with substance use disorder (SUD) referred to specialty care for evaluation and/or treatment. [A]
Complete physiologic stabilization, if necessary. [B]
Obtain a comprehensive biopsychosocial assessment. [C]
Develop integrated summary and initial treatment plan. Discuss treatment options with patient. [D]
Can treatment plan be implemented in primary care? [E]
Go to Care Management Module C.
Is rehabilitation an acceptable mode of treatment to the patient? [F]
DoD active duty: Referral to rehabilitation (box 6 & 8) is required. For refusal, contract command to discuss administrative and clinical options.
Provide motivational intervention renegotiate treatment plan. [G]
Is rehabilitation an acceptable mode of treatment to the patient? [F]
Go to Care Management Module C.
Determine appropriate initial intensity level of treatment. [H]
Ensure appropriate housing and access to treatment. [I]
Negotiate specific rehabilitation goals with the patient. [J]
Initiate addiction-focused psychosocial therapy. [K]
Initiate/continue treatment of coexisting problems (e.g., medical, psychiatric, family, vocational, and/or legal) and other compulsive behavior (e.g., gambling or spending) [L]
Is patient nicotine dependent? [M]
Manage nicotine dependence. (Use VHA/DoD Guideline to Promote Tobacco Use Cessation)
Is addiction-focused pharmacotherapy indicated? [N.]
Initiate appropriate medication. Go to Module P.
Provide periodic reassessment of problems, goals, and response to psychosocial treatment and pharmacotherapy. Modify treatment plan and level of care if indicated. [O]
Create recovery plan. [P]
Are there indications to continue treatment in specialty care? [Q]
Return to Box 16
Discontinue treatment in specialty care; arrange for transition to primary care. [R]
Follow-up in primary care: - Monitor substance use - Monitor biological indicators - Continue addiction focused pharmachitherapy if indicated - Encourage reduction of abstinence - Provide motivational support - Assess adherence to recovery plan - Educate about substance use, associated problem, and prevention of relapse. [ S]