L.  Initiate/Continue Treatment Of Coexisting Problems (e.g., Medical, Psychiatric, Family, Vocational, And/Or Legal) And Other Compulsive Behavior (e.g., Gambling Or Spending)

 

OBJECTIVE

 

Provide comprehensive individualized treatment that will improve clinical outcome and functional status.

 

ANNOTATION

 

1.              Prioritize and address other coexisting biopsychosocial problems with services targeted to these areas, rather than increasing drug and alcohol counseling alone.

2.              Treat concurrent psychiatric disorders consistent with VHA/DoD clinical practice guidelines (e.g., those for treating patients with Major Depressive Disorder or Psychoses) including concurrent pharmacotherapy.

3.              Provide multiple services in the most accessible setting to promote engagement and coordination of care (Kraft et al., 1997).

4.              Monitor and address deferred problems and emerging needs through ongoing treatment plan updates.

5.              Coordinate care with other providers.

 

DISCUSSION

 

Treatment providers should identify psychiatric, medical, family/social, employment, and legal problems and evaluate the degree to which they are associated with the SUD.  The ASI and other information from the biopsychosocial assessment (e.g., lab results, physical exam, mental status exam, and patient report) and integrated summary can be used to make this evaluation.

When problems are identified, and their severity and relationship to the SUD determined, the provider and treatment team should then address the optimal timing and setting of interventions (e.g., whether the patient needs immediate or delayed referral to a specialized program for a chronic co-morbid psychiatric condition, family therapy, or vocational rehabilitation).  When unavailable through the primary treatment team, patients may need referral to other clinics in order to access needed services, such as primary medical care or psychiatric evaluation, housing placement, family counseling, and/or vocational training.  Providing these services in a single setting (one-stop service) may be more effective than usual procedures (Umbricht-Schneiter et al., 1994).  Other facilities will need to develop referral resources and feedback mechanisms.  Either way, ongoing communication and coordination between service providers is essential to quality care.

In addition to the standard addiction-focused services, programs should address psychiatric, medical, family/social, employment, legal, or other problems that exist in association with the SUD.  Treatment services directed toward these additional problems, when they exist, are associated with improvement, while problems show little improvement if services are not provided.

 

EVIDENCE TABLE

 

 

Recommendations

Sources of Evidence

QE

 

R

1

Treat concurrent psychiatric disorders, including concurrent pharmacotherapy.

Mason et al., 1996

Nunes et al., 1995

Nunes et al., 1998

U. S. DHHS, 1994

I

 

A

2

Target specific services to address other coexisting biopsychosocial problems.

McLellan et al., 1993

McLellan et al., 1994

McLellan et al., 1998

I

 

A

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