Treatment Settings for Substance Use Problems

2019 ◽  
pp. 25-32
Author(s):  
Dennis C. Daley ◽  
Antoine Douaihy
Keyword(s):  
Substance Use ◽  
Outpatient Treatment ◽  
Inpatient Treatment ◽  
Treatment Level ◽  
Addiction Medicine ◽  
Levels Of Care ◽  
Substance Use Problems ◽  
Care Approach ◽  
Professional Treatment ◽  
American Society

The American Society of Addiction Medicine (ASAM) outlines levels of care for alcohol or other drug problems in a stepped care approach. The ASAM levels, from least to most restrictive, are Level 1: outpatient treatment; Level 2: intensive outpatient treatment and partial hospitalization; Level 3: medically monitored intensive inpatient treatment (residential); and Level 4: medically managed intensive inpatient treatment (hospital). Clients should use the least restrictive level of professional treatment possible unless they have serious medical complications, such as liver disease or gastritis, or serious psychiatric complications, such as feeling suicidal, persistently depressed, or paranoid. The goals of this chapter are to learn about the different types of professional treatments for substance use problems and for clients to work closely with their therapist or counselor to figure out their specific goals and what steps they can take to reach them.

scholarly journals General practice patients starting treatment for substance use problems: observations from two data sources across levels of care

2020 ◽  
Author(s):  
Nicole Boffin ◽  
Jerome Antoine ◽  
Luk Van Baelen ◽  
Sarah Moreels ◽  
Kris Doggen
Keyword(s):  
General Practice ◽  
Substance Use ◽  
Data Sources ◽  
Treatment Episode ◽  
Specialist Care ◽  
Levels Of Care ◽  
Substance Use Problems ◽  
Stable Housing ◽  
Treatment Demand ◽  
Specialist Treatment

Abstract BackgroundIn Belgium, the incidence of treatment episodes for substance use problems is monitored by the Network of Sentinel General Practices (SGP) and by the Treatment Demand Indicator (TDI) surveillance at higher, specialist care levels. Using both data sources, we examine 1) how patients starting specialist treatment for substance use problems on referral by their GP compare to those that were referred by non-GP caregivers; 2) how patients starting GP treatment for substance use problems without receiving specialist treatment concurrently compare to those who do.MethodsThe same European protocol with common variables was used by both surveillances. Data from 2016 and 2017 were examined using 95% confidence intervals and multivariate regression.ResultsAccording to TDI-data (n=16,543), determinants of being referred by a GP (versus by a non-GP caregiver) for specialist treatment were age ≥ median (OR 1.25; 95% CI 1.13-1.38), education ≥ secondary level (OR 1.27; 95% CI 1.15-1.41), recent employment (OR 1.71; 1.56-1.88), stable housing (3.62; 95% CI 3.08-4.26), first treatment episode (OR 1.72; 95% CI 1.57-1.87), recent daily primary substance use (OR 1.46; 95% CI 1.33-1.59) and mono substance use (OR 1.23; 95% CI 1.04-1.48). Type of substance use was a significant determinant with higher odds of using pharmaceuticals (and alcohol) (OR 1.24; 95% CI 1.04-1.48), and lower odds of using cannabis only/primarily (OR 0.73; 95% CI 0.62-0.86), with reference to street drugs minus cannabis only/primarily. According to SGP data (n=314), determinants of starting GP treatment without concurrent specialist treatment were recent employment (OR 2.58; 95% CI 1.36-4.91), first treatment episode (OR 2.78; 95% CI 1.39-5.55) and living in the Brussels or Walloon region (OR 1.97; 95% CI 1.06-3.66).ConclusionsThis study adds knowledge about the general practice population treated for substance use problems and the consistency of data from the surveillances. Both studies show a relatively favourable profile of general practice patients with substance use problems.

scholarly journals General practice patients starting treatment for substance use problems: observations from two data sources across levels of care

2020 ◽  
Author(s):  
Nicole Boffin ◽  
Jerome Antoine ◽  
Luk Van Baelen ◽  
Sarah Moreels ◽  
Kris Doggen
Keyword(s):  
General Practice ◽  
Substance Use ◽  
Data Sources ◽  
Treatment Episode ◽  
Specialist Care ◽  
Levels Of Care ◽  
Monitoring Centre ◽  
Substance Use Problems ◽  
Treatment Demand ◽  
Specialist Treatment

Abstract Background In Belgium, the incidence of treatment episodes for substance use problems is monitored by the Network of Sentinel General Practices (SGP) and by the Treatment Demand Indicator (TDI) surveillance at higher, specialist care levels. Using both data sources, we examine 1) how patients starting specialist treatment for substance use problems on referral by their GP compare to those that were referred by non-GP caregivers; 2) how patients starting GP treatment for substance use problems without receiving specialist treatment concurrently compare to those who do. Methods Both surveillances are based on the TDI protocol for reporting data to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) on persons starting treatment as a result of their substance use. Data from 2016 and 2017 were examined using 95% confidence intervals and multivariate logistic regression. Results According to TDI-data (n=16,543), determinants of being referred by a GP (versus by a non-GP caregiver) for specialist treatment were age ≥ median (OR 1.25; 95% CI 1.13-1.38), education ≥ secondary level (OR 1.27; 95% CI 1.15-1.41), recent employment (OR 1.71; 1.56-1.88), stable housing (3.62; 95% CI 3.08-4.26), first treatment episode (OR 1.72; 95% CI 1.57-1.87), recent daily primary substance use (OR 1.46; 95% CI 1.33-1.59) and mono substance use (OR 1.23; 95% CI 1.04-1.48). Type of substance use was a significant determinant with higher odds of using pharmaceuticals (and alcohol) (OR 1.24; 95% CI 1.04-1.48), and lower odds of using cannabis only/primarily (OR 0.73; 95% CI 0.62-0.86), with reference to street drugs minus cannabis only/primarily. According to SGP data (n=314), determinants of starting GP treatment without concurrent specialist treatment were recent employment (OR 2.58; 95% CI 1.36-4.91), first treatment episode (OR 2.78; 95% CI 1.39-5.55) and living in the Brussels or Walloon region (OR 1.97; 95% CI 1.06-3.66). Conclusions This study adds knowledge about the general practice population treated for substance use problems. It shows that both surveillances consistently found a relatively favourable profile of general practice patients with substance use problems.

scholarly journals General practice patients starting treatment for substance use problems: observations from two data sources across levels of care

2020 ◽  
Author(s):  
Nicole Boffin ◽  
Jerome Antoine ◽  
Luk Van Baelen ◽  
Sarah Moreels ◽  
Kris Doggen
Keyword(s):  
General Practice ◽  
Substance Use ◽  
Data Sources ◽  
Treatment Episode ◽  
Specialist Care ◽  
Levels Of Care ◽  
Monitoring Centre ◽  
Substance Use Problems ◽  
Treatment Demand ◽  
Specialist Treatment

Abstract Background In Belgium, the incidence of treatment episodes for substance use problems is monitored by the Network of Sentinel General Practices (SGP), and at higher, specialist care levels by the Treatment Demand Indicator (TDI) surveillance. Using both data sources, we examine 1) how patients starting specialist treatment for substance use problems on referral by their GP compare to those that were referred by non-GP caregivers; 2) how patients starting GP treatment for substance use problems without receiving concurrent specialist treatment compare to those who did. Methods Both surveillances are based on the TDI protocol for reporting data to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) on individuals starting treatment as a result of their substance use. Data from 2016 and 2017 were examined using 95% confidence intervals and multivariate logistic regression. Results According to TDI-data (n=16,543), determinants of being referred by a GP (versus by a non-GP caregiver) for specialist treatment were age ≥ median (OR 1.25; 95% CI 1.13-1.38), education ≥ secondary level (OR 1.27; 95% CI 1.15-1.41), recent employment (OR 1.71; 1.56-1.88), recent stable accommodation (3.62; 95% CI 3.08-4.26), first treatment episode (OR 1.72; 95% CI 1.57-1.87), recent daily primary substance use (OR 1.46; 95% CI 1.33-1.59) and mono substance use (OR 1.23; 95% CI 1.04-1.48). Type of substance use was a significant determinant with higher odds of using pharmaceuticals (and alcohol) (OR 1.24; 95% CI 1.04-1.48), and lower odds of using cannabis only/primarily (OR 0.73; 95% CI 0.62-0.86), with reference to street drugs minus cannabis only/primarily. According to SGP data (n=314), determinants of starting GP treatment without concurrent specialist treatment were recent employment (OR 2.58; 95% CI 1.36-4.91), first treatment episode (OR 2.78; 95% CI 1.39-5.55) and living in the Brussels or Walloon region (OR 1.97; 95% CI 1.06-3.66). Conclusions This study provides a useful insight into the general practice population treated for substance use problems. It shows that both surveillances consistently found a relatively favourable profile of general practice patients with substance use problems.

scholarly journals General practice patients starting treatment for substance use problems: observations from two data sources across levels of care

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nicole Boffin ◽  
Jerome Antoine ◽  
Luk Van Baelen ◽  
Sarah Moreels ◽  
Kris Doggen
Keyword(s):  
General Practice ◽  
Substance Use ◽  
Data Sources ◽  
Levels Of Care ◽  
Substance Use Problems

scholarly journals General practice patients starting treatment for substance use problems: observations from two data sources across levels of care

2020 ◽  
Author(s):  
Nicole Boffin ◽  
Jerome Antoine ◽  
Luk Van Baelen ◽  
Sarah Moreels ◽  
Kris Doggen
Keyword(s):  
General Practice ◽  
Substance Use ◽  
Data Sources ◽  
Treatment Episode ◽  
Specialist Care ◽  
Levels Of Care ◽  
Monitoring Centre ◽  
Substance Use Problems ◽  
Treatment Demand ◽  
Specialist Treatment

Abstract Background In Belgium, the incidence of treatment episodes for substance use problems is monitored by the Network of Sentinel General Practices (SGP), and at higher, specialist care levels by the Treatment Demand Indicator (TDI) surveillance. Using both data sources, we examine 1) how patients starting specialist treatment for substance use problems on referral by their GP compare to those that were referred by non-GP caregivers; 2) how patients starting GP treatment for substance use problems without receiving concurrent specialist treatment compare to those who did.Methods Both surveillances are based on the TDI protocol for reporting data to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) on individuals starting treatment as a result of their substance use. Data from 2016 and 2017 were examined using 95% confidence intervals and multivariate logistic regression.Results According to TDI-data (n=16,543), determinants of being referred by a GP (versus by a non-GP caregiver) for specialist treatment were age ≥ median (OR 1.25; 95% CI 1.13-1.38), education ≥ secondary level (OR 1.27; 95% CI 1.15-1.41), recent employment (OR 1.71; 1.56-1.88), recent stable accommodation (3.62; 95% CI 3.08-4.26), first treatment episode (OR 1.72; 95% CI 1.57-1.87), recent daily primary substance use (OR 1.46; 95% CI 1.33-1.59) and mono substance use (OR 1.23; 95% CI 1.04-1.48). Type of substance use was a significant determinant with higher odds of using pharmaceuticals (and alcohol) (OR 1.24; 95% CI 1.04-1.48), and lower odds of using cannabis only/primarily (OR 0.73; 95% CI 0.62-0.86), with reference to street drugs minus cannabis only/primarily. According to SGP data (n=314), determinants of starting GP treatment without concurrent specialist treatment were recent employment (OR 2.58; 95% CI 1.36-4.91), first treatment episode (OR 2.78; 95% CI 1.39-5.55) and living in the Brussels or Walloon region (OR 1.97; 95% CI 1.06-3.66).Conclusions This study provides a useful insight into the general practice population treated for substance use problems. It shows that both surveillances consistently found a relatively favourable profile of general practice patients with substance use problems.

Recognition and Management of Iatrogenically Induced Opioid Dependence and Withdrawal in Children

2018 ◽  
pp. 109-112
Author(s):  
Jeffrey Galinkin ◽  
Jeffrey Lee Koh
Keyword(s):  
Substance Use ◽  
Pain Relief ◽  
Opioid Dependence ◽  
Pediatric Population ◽  
Single Source ◽  
Pain Medicine ◽  
Addiction Medicine ◽  
Or Management ◽  
Acute Injuries ◽  
American Society

Opioids are often prescribed to children for pain relief related to procedures, acute injuries, and chronic conditions. Round-the-clock dosing of opioids can produce opioid dependence within 5 days. According to a 2001 Consensus Paper from the American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine, dependence is defined as “a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.” Although the experience of many children undergoing iatrogenically induced withdrawal may be mild or goes unreported, there is currently no guidance for recognition or management of withdrawal for this population. Guidance on this subject is available only for adults and primarily for adults with substance use disorders. The guideline will summarize existing literature and provide readers with information currently not available in any single source specific for this vulnerable pediatric population.

Treatment Settings for Substance Use Problems

2019 ◽  
pp. 35-40
Author(s):  
Dennis C. Daley ◽  
Antoine Douaihy
Keyword(s):  
Substance Use ◽  
Early Intervention ◽  
Substance Use Disorder ◽  
Continuum Of Care ◽  
Continuing Care ◽  
Inpatient Hospital ◽  
Levels Of Care ◽  
Rehabilitation Programs ◽  
Substance Use Problems ◽  
Residential Rehabilitation

A continuum of care is needed to meet the needs of clients with substance use problems. The least restrictive level of treatment should be used unless the severity of the diagnosed substance use disorder (SUD) and related medical, psychiatric, and social problems are such that medically managed or monitored treatment is needed. Levels of care include early intervention, outpatient and aftercare or continuing care programs, non-residential addiction rehabilitation programs, and inpatient hospital and residential rehabilitation programs.

Overview of Substance Use Disorder Treatment

2020 ◽  
pp. 29-42
Author(s):  
Darius A. Rastegar
Keyword(s):  
Substance Use ◽  
Drug Use ◽  
Behavioral Therapy ◽  
Psychosocial Treatment ◽  
Addiction Medicine ◽  
Patient Centered ◽  
Therapeutic Modalities ◽  
Disorder Treatment ◽  
American Society ◽  
Self Help Groups

Treatment of substance use disorders (SUD) has traditionally been program-centered, but patient-centered models hold the promise of care that is more ethical and effective. Most SUD treatments can be roughly divided into two types of modalities: psychosocial treatment, which includes brief interventions, self-help groups, counseling, cognitive–behavioral therapy, and analytic psychotherapy; and pharmacotherapy, which includes drug antagonists or agonists and other agents. These treatments are not mutually exclusive, and the best approach in many cases is a combination of therapeutic modalities. The American Society of Addiction Medicine has developed placement criteria to help determine the optimal treatment setting. Harm reduction is an approach that focuses on reducing the harms of drug use without necessarily targeting drug use itself.

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