F.  Is Rehabilitation An Acceptable Mode Of Treatment To The Patient?
For DoD Active Duty, A Referral Is Required.  For Refusal, Contact Command To Discuss Administrative and Clinical Options

 

OBJECTIVE

 

Determine, along with the patient, the most appropriate treatment approach.

 

ANNOTATION

 

1.         When acceptable to the patient, a specialty care rehabilitation plan is generally indicated.

2.         Care management is likely to be a more acceptable and effective alternative when one of the following applies:

·     The patient refuses referral to rehabilitation, but continues to seek some services, especially medical and/or psychiatric services.

·     The patient has serious co-morbidity that precludes participation in available rehabilitation programs.

·     The patient has been engaged repeatedly in rehabilitation treatment with minimal progress toward optimal or intermediate rehabilitation goals.

3.         Regarding DoD active duty patients:

·   DoD active duty refusing rehabilitation—contact command to discuss command directed treatment 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

 

Even when patients refuse referral or are unable to participate in specialized addiction treatment, many are accepting of general medical or psychiatric care.  Clinicians in multiple settings can deliver care management for patients with SUDs.  The chronic illness approach is consistent with management approaches for many other disorders treated in medical and psychiatric settings (Drake & Mueser, 2000; McLellan et al., 2000; Willenbring & Olson, 1999).