An introduction from Addiction Professional's
This is the fourth in a series of six articles designed to provide you with the latest information on the use of medications in alcohol dependence treatment. Medications (pharmacotherapy) used as adjuncts to counseling techniques and biopsychosocial, educational, and spiritual therapies are an increasingly important part of a comprehensive treatment approach for alcohol dependence.
Expanding knowledge of how medications may interact with and complement counseling techniques will help the addiction counseling community optimally coordinate care of patients with other treatment providers. Thus, the article series Pharmacotherapy: Integrating New Tools Into Practice will not only provide the latest efficacy and safety data on these medications, it will also explore how we can build better relationships among addiction professionals and medication prescribers. The series will also examine the current barriers to medication use in treatment while offering potential solutions.
The first three articles in this series, which began in the January/February 2007 issue, addressed the topics of facilitating the process of change through medication use; examining recent study results on the approved medications for alcohol dependence; and overcoming biases against greater use of medications in treating alcohol dependence. In this fourth article, Gerald Shulman, MA, MAC, FACATA, describes how nonprescribing clinicians can integrate medication into their treatment planning efforts. The next article, in the September/October issue, will discuss the importance of building cooperative relationships between addiction treatment professionals who provide counseling and medication prescribers.
Successful treatment of individuals dependent on alcohol requires having a treatment plan that is jointly developed by the clinician and patient. This plan must precisely state the individual's problems, goals for treatment, specific measurable objectives, and treatment interventions. Such a plan provides the link between the results of the individual's assessment, which begins at intake, and the actual treatment, which is updated as the individual progresses through treatment. It can help determine the level of care and facilitate appropriate referrals to other treatment providers, such as physicians or others who prescribe medications.
Although they do not prescribe, addiction counselors involved in patient care need to be aware of the goals of pharmacotherapies and be prepared to collaborate in monitoring and supporting them. Counselors need to develop an understanding of the role and action of pharmacotherapies, ensure that the treatment plan details the processes for how they will be used and managed during treatment, and support their use with the patient.
This article describes the key components and steps in treatment planning for alcohol-dependent individuals, with a focus on how counselors and other nonprescribers of medication can integrate medication into their treatment plans and their practices.
Creating a treatment plan
A well-constructed treatment plan first requires comprehensive assessment of the individual. The
American Society of Addiction Medicine (ASAM) Patient Placement Criteria, Second Edition-Revised (PPC-2R) details six dimensions by which patients can be assessed. These categories are: 1) the individual's potential for intoxication and withdrawal; 2) co-occurring medical conditions; 3) emotional, cognitive, or behavioral complications; 4) the individual's readiness to change; 5) the potential for relapse or continued use; and 6) the individual's living and recovery environment.
1 Clinicians can use the ASAM PPC-2R as a guide to evaluate their patients' strengths and the severity of their problems, and to determine the nature and intensity of treatment.
Identifying the severity of an individual's problems and his or her particular needs in recovery is particularly important because this process allows the patient and clinician to create an individualized treatment plan. A “one-size-fits-all” plan does not address specific patient treatment issues or account for all of the biopsychosocial or spiritual factors that affect each person's situation. Additionally, individualized treatment plans, when developed collaboratively with the patient, may make it easier for the clinician and the patient to develop a rapport—the patient who participates in such a plan is likely to be more engaged and stay in treatment longer, which increases the likelihood of treatment success.2,3