HOW TREATMENT WORKS
The purpose of the Intake interview is to collect information about the client, share information with the client about the program, screen the client for appropriate placement within the program, and obtain signatures on all legal and financial intake forms.
During the Intake interview the counselor will determine the client’s stage of readiness, motivation to change, other program involvement (probation, parole, domestic violence, treatment court, etc…). Screening instruments may be used to assist with the next step; assessment. Client’s generally receive information about the program, expectations, rights, and forms. Forms generally include: Informed Consent, Release of Information (for appropriate organizations), and financial responsibility.
An assessment may include the coordination of a urinalysis, blood test and/or breathalyzer if it is part of the treatment centers policy. A treatment center may also coordinate a physical exam for the client, if the client has not had one in the preceding 12-months, including a TB test, HIV/AIDS testing and Hepatitis C testing.
3 Treatment Plan
The purpose of a treatment plan is to provide a roadmap of treatment developed with the client, for the client and clinical team to follow; treatment planning includes identifying a problematic pattern of substance use, leading to clinically significant impairment.
Treatment plans are based upon information obtained through intake assessments, and progress through treatment. Treatment plans are generally reviewed and updated no less than every 90-days, unless required more frequently based upon client’s progress.
Treatment Plans contain the following:
- A statement of problem to be addressed
- Goals to be reached which address each problem statement
- Action steps (intervention descriptions) which will be taken by the assigned counselor and/or case manager
- Target dates for the accomplishment of goals
- A description of the services, including type and frequency of counseling, to be provided
- Client’s diagnosis
- Physical exam if client has not had one within the previous 12-months
- If the documentation of the client’s physical exam, which was performed within the 12-month period prior to treatment, indicates any significant medical illness, then a goal that the client obtain appropriate treatment for said illness will be included in the treatment plan
- Include the names of the assigned primary therapist/counselor/physician
Treatment Goals have the following elements:
- Level of care
- Type of counseling and frequency
4 MAT- Medication-Assisted Treatment
MAT is most commonly used to treat the addiction of opioids. They are a class of drugs that include prescription pain relievers, including oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, synthetic opioids including fentanyl, methadone, pethidine, tramadol and carfentanil, and the street drug heroin. MAT is also used to treat alcohol addiction.
Prescribed MAT medications operate to normalize the brain chemistry blocking the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative effects of the substance used. Prescription opioids are meant to be used to treat acute pain (such as recovering from injury or post-surgery), chronic pain, active-phase cancer treatment, palliative care and end-of-life care.
All MAT medications must be FDA approved and MAT programs are clinically driven and tailored to meet each patient’s needs. Combining medications used in MAT with anxiety treatment medications can be fatal (visit SAMHSA for more information)
Types of anxiety treatment medications include derivatives of Benzodiazepine, such as Xanax or valium.
MAT has proved to be a clinically effective treatment and to significantly reduce the need for inpatient detoxification services for many individuals struggling with opiate and alcohol addiction. MAT works on the receptors in the brain. Opiates work by crossing the blood-brain barrier and attaching to receptors on brain cells, which trigger the release of neurotransmitters and brain activity which produce the feelings associated with the drug.
MAT will work in one of three ways; as an agonist, partial agonist or an antagonist. An agonist is a chemical that binds to a receptor in the brain and activates the receptor to produce a biological response. An agonist causes an action. An antagonist may bind to the same receptor, but does not produce a response; instead it blocks that receptor to a natural agonist. The antagonist blocks the action of the agonist and an inverse agonist causes an action opposite to that of the agonist. Partial agonists are drugs that bind to and activate a given receptor, but have only partial efficacy at the receptor relative to a full agonist.
MAT medications can be prescribed to give a person opiates that activate the same receptors but are absorbed into the blood over a longer period of time. This will reduce and stave off withdrawal symptoms, helping to break the psychological link between taking a drug and immediately feeling the effects. A prescription could also be given for an opioid antagonist, a non-opioid drug that sits on those same receptors and blocks them, so that if the user relapses, they will not feel the effects of the drug. HOWEVER, a person’s tolerance for the drug decreases after long periods of sobriety AND especially after antagonist treatment. Therefore they are at an increased risk of overdose or death if they relapse.
The purpose of counseling is to help clients achieve their personal goals, as identified in their treatment plan, and gain greater insight into their lives. Counselors work with clients on strategies to overcome obstacles and personal challenges that they are facing.
The purpose of group counseling is to encourage group members to share stories and experiences. Through the group dynamic individuals will learn different coping mechanisms and strategies for healthier living and decision making choices. The group therapist/counselor will share and practice coping skills and techniques with the clients, to help them practice better life-management skills.
6 Drug Testing
The purpose is to utilize testing as a valuable tool to help clients become abstinent and actively participate in their recovery process. Testing is generally utilized in helping the client learn that many tools may be necessary for recovery and to regain control of their lives. Drug testing is another means of helping clients impose structure and awareness of their own behaviors. Additionally the purpose of drug testing may include:
- Deterring clients from resuming substance use
- Providing counselors’ with objective information about a client’s substance use
- Providing the in denial-client, objective evidence of use
- Identifying patterns of use which may warrant residential or hospital-based treatment
7 Case Management
The purpose of case management is to improve the quality of life for the client, through the assistance, guidance and referrals from the case manager. This includes working with the client to prevent life situations and problems from getting worse.
The case manager will help the client identify strengths and assets to address current issues and barriers to success. Case manager will also refer clients to appropriate community service providers, organizations and/or agencies.