R.  Discontinue Treatment In Specialty Care; Arrange For Transition To Primary Care

OBJECTIVE

Provide appropriate continuity of care to follow up with primary medical or behavioral health care provider.

ANNOTATION

Discuss the impact of changes in substance use on other medical and psychiatric conditions and identify relapse risks for future monitoring.  Arrange for continued monitoring of substance use and co-morbid conditions either in addiction specialty care or by the patient's primary medical or behavioral health care provider.

1.          Schedule primary care follow-up within 90 days to reinforce recovery progress during the post-discharge period of highest risk for relapse (McLellan et al., 1996).

2.          Encourage patients to re-contact addiction-focused treatment providers for additional help as needed in preventing or promptly interrupting relapse.

3.          For DoD active duty patients, addiction-focused treatment follow-up may be mandated for a period of 6-12 months from the time of initial referral (this may be referred to as “aftercare” in the DoD community).

DISCUSSION

Relapse rates in substance use disorders are comparable to those reported for other chronic medical disorders that require behavioral compliance (e.g., hypertension, asthma, and diabetes) (McLellan et al., 2000).  Given the risks of relapse even with successful treatment, primary providers should ask about and discuss with patients any relapses or warning signs during ongoing follow-up.