Archives for October 2017

Outline of an Initial, Evidence-Informed Treatment Plan for Substance Use Disorder

The goal of substance use disorder treatment is to assist individuals with living healthy, functional lives, in connection with others, such that substance use does not result in negative consequences for themselves, others, or society. A treatment plan describes how a person hopes to reach this goal, or to get help with reaching this goal, through specific steps, termed objectives.

Following is a brief outline of evidence-based treatment components for an individual beginning treatment for substance use disorder.  This treatment plan is evidence-informed, not evidence-based, because it, as a stand-alone protocol, has not been subjected to research.

I define evidence-based treatment as what research reports works for most people, most of the time, better than other treatments, and better than no treatment. Specifically, that means the treatment is supported by numerous, peer-reviewed scientific experiments with rigorous methods that include control groups, randomization of subjects to experimental conditions, and bias-free samples, with statistically significant results. Some treatments that are evidence-based to work for groups may not be helpful to a particular individual, however. It is an imperative that counselors and individuals continually monitor an individual’s condition and progress while engaged in treatment.

I contrast research data – the evidence resulting from research experiments – with “anecdotal data.” I define anecdotal data as an individual’s personal experience. Data from a sample size of one does not provide sufficient information from which a generalization can be made about a group or population. Principles believed to account for outcomes from inspirational individual stories, practitioner wisdom, or theories based on logic, cannot be safely applied to others without first subjecting those principles to rigorous research.

The content of this treatment plan is based on a synthesis of extensive literature reviews that I and Laurel Sindewald have conducted on substance use disorders and their treatment. The treatment plan is highly informed by Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, released in November, 2016. (Research data does not support inclusion of 12-step approaches and rehab in the Surgeon General’s report, however.) We link to primary sources reporting research data as available, and authoritative secondary sources that cite multiple primary sources. Our reports are here. Since nearly every word in this post could be linked to a source, I have only linked to sources for terms or concepts that may be unfamiliar to some. Feel free to contact me with questions or feedback.

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Outline of an Initial, Evidence-Informed Treatment Plan for People with Substance Use Disorders

“A substance use disorder is a medical illness characterized by clinically significant impairments in health, social function, and voluntary control over substance use.”
Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health, November, 2016, Page 4-1

“Addiction is a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.”
National Institute on Drug Abuse (NIDA), a division of the National Institutes of Health (NIH), 2014

Treatment Plan Goal: To assist individuals in living healthy, functional lives, in connection with others, such that substance use does not result in negative consequences for themselves, others, or society.

Objectives listed in priority order:

1 – Medical Care

  • Physical exam and diagnostic lab work
  • Assessment for suitability for medications for:
    – Substance use disorders (SUDs), including nicotine replacement therapy
    – Co-occurring mental illnesses
    – Physical illnesses
    – Physical pain
    – Sleep disturbances
    – Nutrition and diet
    – Assessment for neuroatypicality: sensory sensitivity and under-sensitivity (Unbroken Brain, Chapter 4); attention challengesautism spectrum
  • Assessment for suitability for follow-up care, additional treatment, and referrals

2 – Mental Health Care

Mental Health Assessment

  • Trauma (2/3 of all people with SUDs have experienced trauma)
  • Co-occurring mental illnesses (over 1/2 of all people with SUDs have at least one co-occurring mental illness)
  • Current stressors
  • Needs assessment

Counseling

3 – Support Services

  • Connect individuals with social services agencies to assist with current stressors and needs: employment, housing, transportation, child care, legal issues, etc.
  • Income: Assist individuals with finding jobs or applying for disability benefits.

4 – Social Support

  • Interests and preferences assessment
  • Experimentation with diverse interest groups, clubs, religious groups, support groups and/or other sources of social connection based on individual interests and preferences

This report may also be of interest:

A Guide for Clinicians to Initial Treatment for Alcohol Use Disorder

The views expressed are the author’s alone and do not necessarily reflect the positions of the author’s employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.