main index

P00: frame around

P01: olicognography

P02: addictions




Graph Start

Core n
Half complex graph








Addictions Clinics

Basic Olicognograph: organicsemio

Not in this introduction nor in the next documents to make you addiction physicians but help you to refer to appropriate structures if emergency does not prevail. Call for emergencies whenever fever, respiratory depression, opiates and cocaine possible overdosis; and also when alcohol withdrawal confusion or alcohol intoxication more than a bottle of wine and/or with any other debilitating factors, suicidal thoughts, psychosis, etcetera.

Out of emergency, recommendations for physicians (adapted since ASPediatricians): 1) They need to become familiar with the patterns of patient nicotine, alcohol, and drug use and the stages of substance abuse. Knowledge of the DSM-IV and DSM-PC criteria. 2) A thorough psychosocial and medical assessment before making a referral. Familiarity with the levels of treatment available and the multidimensional assessment criteria used to determine the intensity of services required. 3) Substance abuse is a potentially fatal disease. Use to the point at which school, activities, home, or workplaces is affected represents symptomatic substance abuse and usually warrants family involvement and a comprehensive interview and assessment. 4) Awareness of the high prevalence of psychiatric disorders. 5) Have the opportunity and obligation to become familiar and communicate well with professionals and programs in their communities that provide education, prevention, and treatment services, including smoking cessation. 6) They can advocate with local managed care organizations to provide quality mental health and substance abuse services that are appropriate for specific ages and developmental stages. 7) Physicians must be familiar with regulations governing confidential exchange of information about substance abuse treatment.

Adolescent Criteria: Crosswalk of Levels 0.5 Through

Levels of Service

level 0.5 early intervention

level I outpatient treatment

level II intensive outpatient treatment

level III medically monitored intensive inpatient treatment

level IV medically managed intensive inpatient treatment

dimension1: acute intoxication and/or withdrawal potential

no withdrawal risk

no withdrawal risk

manifests no overt symptoms of withdrawal risk

risk of with drawal syndrome is present but manageable in level III

severe withdrawal risk

dimension 2 biomedical conditions and complications

none or very stable

none or very stable

none or, if present, does not distract from addiction treat ment, mana- geable ant level II

require medical monitoring but not intensive treatment

requires 24hour medical and nursing care

Dimension3 emotional behavioral conditions and complications

nore or very stable

none or manageable in outpatient structured environment

mild severity, with the potential to distract from recovery efforts

moderate severity, requires a 24hour structure setting

severe problems require 24hour psychiatric care with conco- mitant addiction treatment

Dimension4 treatment acceptance/ resistance

willing to understand how current use may affect personal goals

willing to cooperate but needs motivting and monitoring strategies

resistance high enough to require struc -tured program but not so high as to render out patient treatment ineffective

resistance high despite negative consequences; needs intesive motivating strategies in a 24hour structure setting

problems in this dimension do not qualify patient for level IV treatment

Dimension5 relapse / continued use potential

needs understanding of skills to change current use patterns

able to maintain abstinence and recovery goals with minimal support

intensification of addiction symp -toms; high likelihood of relapse without close monitorin and support

unable to control use despite active participation in less intensive care; needs 24hour structure

problems in this dimension do not qualify patient for level for IV treatment

Dimension6 recovery environment

social support system or significan others increase risks of personal conflict about alcohol / other drug use

supportive recovery environment and/or patient has skills to cope

environment unsupportive but, with structure of support, patient can cope

environment dangerous for recovery, neces -sitating removal from the environ -ment; logistical impediments to outpatients treat.

problems in this dimension do not qualify patient for level for IV treatment

Source: nfm (ASP)

Addictions Treatment Resources 1. Cognitive Behavioral Interventions – involves using awareness and skillbuilding activities with clients. 2. Community Reinforcement – involves connecting the client with other needed agencies and services in the community. 3. Motivational Enhancement Therapy – involves using motivational interviewing strategies and interventions that are based on a “stages of change model”. 4. 12-Steps Facilitation – This is a structured, individualized approach for introducing clients to a 12-step program. This can result in better meeting attendance for a longer period of time. 5. Contingency Management – It includes behavioral contracting where clients have opportunities to earn rewards for specific desirable behaviors. Data demonstrates that stimulant users respond well to this approach, stay in treatment longer, make measurable progress and have better treatment outcomes. 6. Pharmacological Therapies – There is strong evidence that medication like Antabuse, Naltrexone, Methadone and Buprenorphine when used in conjunction with other therapies can help stabilize a person’s life when their alcohol or drug use is out of control. 7. Systems treatment – This term refers to treating clients in their natural social environment. Couples therapy, family therapy, and multi-systemic family therapy are all examples of systems treatment models. There is substantial evidence indicating that clients whose families are engaged in the treatment process show improved outcomes. Systems treatment appears to be especially effective with young people. 8. Integrated Dual Disorders Treatment – This treatment approach helps people recover by offering mental health and substance abuse treatment services together, in one setting. The same clinicians (or team of clinicians) offer an individualized treatment plan, which addresses both the mental health and substance abuse problems. A wide range of services is offered in a stage-wise fashion, as service needs change over the course of treatment.

USA Substance Abuse and Mental Health Services Administration (SAMHSA), and The National Institute of Mental Health (NIMH) offer the following set of evidence-based practices for adults with mental illness and co-occurring disorders. 1. Illness Management and Recovery - Wellness self-management encompasses a number of strategies designed to help consumers manage their symptoms. Psycho-education, social skills training, cognitive behavioral therapy, and coping skills training have been shown to help consumers manage their own mental health, reduce symptoms and relapses, and minimize the adverse effects of psychiatric illness on social and role functioning. 2. Medication Management – The elements of an effective program to optimize the use of medications include: (1) a systematic evidence-based approach to medication selection and use; (2) measurement of treatment response and side effects; and (3) efforts to enhance patient adherence to taking prescribed medications. 3. Assertive Community Treatment (ACT), Intensive Case Management (ICM) Important features of ACT and Intensive case management include the following: a small caseload, provision of services in consumers’ natural living settings, a 24-hour responsibility, and coordination of comprehensive multi-disciplinary services through regular treatment team meetings. 4. Family Psycho-education – Effective family intervention programs provide a combination of education, problem solving, crisis intervention, and support. Family psycho-education has been shown to reduce relapse rates and facilitate recovery of persons who have mental illness and/or co-morbid disorders. 5. Supported Employment – The supported employment model of vocational rehabilitation includes: rapid job searches and placement in competitive employment, on-going followalong supports after placement, integration of vocational and clinical services, and placing consumers in jobs that match their preferences. Supported employment approaches have been proven to help consumers secure and maintain meaningful jobs in the community. 6. Integrated Treatment for Co-Occurring Substance Use and Mental Health Disorders – Substance use treatment that is integrated with mental health treatment and tailored for individuals with mental illness is more effective than separate substance use and mental health services. Effective models also integrate other services such as case management, medications, housing, vocational rehabilitation, and family intervention. 7. Trauma Services - There is a growing body of evidence that early intervention following traumatic incidents can avoid a variety of behavioral disorders. Effective treatment following traumatic events should include individualized counseling taking an historical account of both current and past trauma and providing psycho-educational information about trauma phenomenon. Effective treatment will include concurrent treatment of trauma issues and co-morbid issues including substance abuse when appropriate.

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