Continuum of Care in a drug/alcohol setting
Abstract
The Continuum of Care for substance abuse treatment is a model that is statewide recognized. This model is meant to intervene with probationers with substance abuse problem. This paper will examine, the Outpatient Treatment in relation to Continuum of Care. It will give the duration, setting, goals and intensity of out patient program and how to determine the outcome of the program.
Introduction
Both alcohol and drug abuse causes dependence. Drug/ abuse dependency causes a disabling addictive disorder which is characterized by uncontrolled and compulsive consumption of alcohol and substance abuse. This has negative impact to the general health of an abuser and in establishing social relationships. Both alcoholism and dug addictions are defined in medical terms as treatable diseases(AMA, 2010). Continuum care denotes the treatment system which clients enroll for treatment either less intense care or more intense care depending on ones needs and the most appropriate level.
Outpatient Treatment and Continuum of Care
An effective continuum care features successful transfer of a client between care levels, efficient transfer of records and similar philosophy of treatment across the levels of care (Mee-Lee and Shuman 2003 p 453–465.). There are five main levels established by the American Society of Addiction Medicine (ASAM). The first level is known as Level 0.5 which deals with early intervention services. This level is then followed by Level I for outpatient services, Level II for partial hospitalization services or the intensive outpatient. Level II has sublevels; II.2 and II.5. There is Level III for inpatient/residential services with levels III.1, III.3, III.5 and III.7. Level IV is for medically managed intensive inpatient service. These are the discrete levels of substance abuse care which work as a continuum.
The treatment settings, philosophy, services and the characteristics of the clients vary at a given level of care because some aspects of treatment may be adjusted to fit the specific needs of a client or a specific population. This can be exemplified from the fact that a residential program meant to treat women who are alcohol dependent differs from an urban residential program for treating men dependent on stimuli. Intensive outpatient treatment tries to ensure that there is continuity and consistency throughout the treatment period. This will ensure that there will be an ease of moving clients through treatment. Further stages of ASAM can be broken down to stage 1 for engagement into treatment, stage 2 is the early discovery phase, stage 3 maintenance, and stage 4 for community support. In developing continuum care, the administrators and clinicians have to have a vision of admitting a client into the session through the available program than to their program (Mee-Lee and Shulamn, 2003, p 456).
This means that the health practitioners are responsible for moving the client along the continuum and to look ahead in the treatment for the clients. This will help clinicians in planning for treatment for transition from one level to the next and for to keep an eye on client’s ongoing care. Intensive outpatient program facilitates continuum care. This program is flexible in terms of intensity, duration and spectrum of service and the setting where the service is delivered. IOT programs are therefore well suited to meets the needs of clients. When the program was first formulated, it was to act as an intermediate level of ambulatory care. IOT program acts as an entry point into substance abuse treatment, step-up the level of care, and step down the level of care. IOT program assist in being part of a seamless continuum of the care levels through moving the client along the treatment. In this process, a program provider has to refer a client from one treatment organization to another. This may result in the internal transfer of some of the components of comprehensive IOT program.
Such a transfer should be handled with outmost care because clients can drop out with any changes of settings, peers or the staff. It is therefore advisable to transfer a client between levels of care within the same organization to avoid chances of drop out. Partial hospitalization services or the intensive outpatient service is the level two of continuum care. This level has aims, specific duration, intensity, stages and a specified setting. The general goals of this stage is to achieve abstinence, to foster behavioral changes that support new lifestyle and abstinence, to assist client in addressing and identifying a wide range of psychological problems, to facilitate active participation in community-based support system, to assists clients in developing positive network of support and to improve client coping strategies and problem solving skills. The intensity of treatment is facilitated by IOT program which provides an increased frequency of services and contact that responds to severity and chronicity of substance use and other disorders. The duration of a client participating in an IOT program varies depending on the needs of a client.
ASAM defines IOT as 9 hours or more than a week spent in treating a client which may go on for three to five days. The recommended duration by consensus panel state that the programming hours to be six to thirty hours depending on the needs of a client. Statistics has shown that the most beneficial programs are those which clients frequently visit short sessions than les frequent longer sessions. Low intensity outpatient treatment that last over longer duration may be more cost-effective. This is because the approach is associated with better social functioning and less substance use to clients(Moos et.al,2001), the increase o the decrease of the duration of treatment is based on client’s psychiatric status, clinical and support system among other factors. The setting for the provision of IOT can be any setting that meets certification criteria or the state license (Mee-Lee et al, 200, p 325–337). The IOT programs can be comprehensive offering various level of care which may differ in services or structure provided. In large hospital setting, IOT programs can provide detoxification services, treatment for other medical conditions, pharmacotherapy and treatment for psychiatric conditions.
IOT programs have also been provided in prison facilities to treat prisoners suffering from drug and alcohol problems and successfully link them with community step-down services after their release. Other IOT programs are located near vocational training sites for welfare recipients to attend training and treatment sessions. The outcome of IOT should be evidence based through practices such as individual assessment. Appropriate treatment should be conducted in suitable settings which are less restrictive. This is because research has shown that recidivism increases when treatment or intensive was applied at low risk. It is therefore important for correction departments, judges and community supervision departments to develop assessment driven progressive sanction and treatment models that incorporate both the state driven and local treatment programs. The first stage deals with treatment engagement. The main goal of this stage is for the clinician and counselors to encourage the client to remain in treatment.
The counselor determines the clients presenting problems which have been caused by substance abuse on psychological, physical and social functioning. The client is then presented with expectations and rules and work he is supposed to carry out. By the time the client is entering the second stage, the client should have developed recovery skills , built substance free lifestyles and address lapses. A successful and effective continuum care include, less intensive, ongoing and tampered contact with treatment system. This transition should encourage the client and his/her active participation, maintain working knowledge, and develop a strong working relation to facility smooth transmission that will ensure the availability of special arrangements. As part of continuing care services, continuing community care can provide checkup and booster counseling sessions at out patients treatment facility. Periodic telephone contact should be available. The community care services can also provide recreational therapy, family therapy vocational training and medical care.
Conclusion
Continuum of Care in a drug/alcohol depends in the willingness of a person to abstain from substance abuse. Establishing a collaborative relationships between the client and the clinician is the start of a successful out come. Health practitioners should aim at providing the least restrictive intensive treatment setting to support recovery effectively.
Reference
AMA (2010) Alcoholism Definition. Retrieved from
http://www.ama-assn.org/ama1/pub/upload/mm/388/alcoholism_treatable.pdf
On June 14, 2010
Moos R, and Moos B. (2003) Long-term influence of duration and intensity of treatment on previously untreated individuals with alcohol use disorders. Addiction, p 325–337.
Mee-Lee, D., and Shulman, G (2003) The ASAM placement criteria and matching patients to treatment. In: Graham, A.W.; Schultz, T.K.; Mayo-Smith, M.F.; Ries, R.K.; and Wilford, B.B., eds. Principles of Addiction Medicine, Third Edition. Chevy Chase, MD: American Society of Addiction Medicine, pp. 453–465.
Mee-Lee, D.; Shulman, G.D.; Callahan, J.F.; Fishman, M.; Gastfriend, D.; Hartman, R.; and Hunsicker, R.J., eds. (2001) Patient Placement Criteria for the Treatment of Substance-Related Disorders: Second Edition-Revised(PPC-2R). Chevy Chase, MD: American Society of Addiction Medicine.
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