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Clinical Issues in Intensive Outpatient Treatment PDF Substance Abuse: Clinical Issues in Intensive Outpatient Treatment A Treatment Improvement Protocol TIP 47 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment www.samhsa.gov INTENSIVE OUTPATIENT TREATMENT Substance Abuse: Clinical Issues in Intensive Outpatient Treatment Robert F. Forman, Ph.D. Consensus Panel Chair Paul D. Nagy, M.S., LCAS, LPC, CCS Consensus Panel Co-Chair A Treatment Improvement Protocol TIP 47 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment 1 Choke Cherry Road Rockville, MD 20857 Acknowledgments considered substitutes for individualized cli- ent care and treatment decisions. Numerous people contributed to the develop- ment of this Treatment Improvement Protocol (TIP) (see pp. xi–xiv as well as appendixes C, Public Domain Notice D, and E). This publication was produced by JBS International, Inc. (JBS), under the All materials appearing in this volume except Knowledge Application Program (KAP) those taken directly from copyrighted sources contract numbers 270-99-7072 and 270-04- are in the public domain and may be repro- 7049 with the Substance Abuse and Mental duced or copied without permission from Health Services Administration (SAMHSA), SAMHSA/CSAT or the authors. Do not repro- U.S. Department of Health and Human duce or distribute this publication for a fee Services (DHHS). Christina Currier served as without specific, written authorization from the Center for Substance Abuse Treatment SAMHSA’s Office of Communications. (CSAT) Government Project Officer, and Andrea Kopstein, Ph.D., M.P.H., served as Electronic Access and Copies Deputy Government Project Officer. Lynne MacArthur, M.A., A.M.L.S., served as the JBS of Publication KAP Executive Project Co-Director. Barbara Copies may be obtained free of charge from Fink, RN, M.P.H., served as the JBS KAP SAMHSA’s National Clearinghouse for Managing Project Co-Director. Other KAP Alcohol and Drug Information (NCADI), (800) personnel included Dennis Burke, M.S., M.A., 729-6686 or (301) 468-2600; TDD (for hearing and Emily Schifrin, M.S., Deputy Directors for impaired), (800) 487-4889; or electronically Product Development; Patricia A. Kassebaum, through www.ncadi.samhsa.gov. M.A., Senior Writer; Elliott Vanskike, Ph.D., Senior Writer/Publication Manager; Candace Baker, M.S.W., Senior Writer; Wendy Caron, Recommended Citation Editorial Quality Assurance Manager; Frances Center for Substance Abuse Treatment. Nebesky, M.A., Quality Assurance Editor; Substance Abuse: Clinical Issues in Leah Bogdan, Junior Editor; and Pamela Intensive Outpatient Treatment. Treatment Frazier, Document Production Specialist. In Improvement Protocol (TIP) Series 47. DHHS addition, Sandra Clunies, M.S., ICADC, served Publication No. (SMA) 06-4182. Rockville, as Content Advisor. Dixie M. Butler, M.S.W., MD: Substance Abuse and Mental Health and Paddy Shannon Cook were writers. Services Administration, 2006. Disclaimer Originating Office The opinions expressed herein are the views of Practice Improvement Branch, Division of the consensus panel members and do not nec- Services Improvement, Center for Substance essarily reflect the official position of CSAT, Abuse Treatment, Substance Abuse and SAMHSA, or DHHS. No official support of or Mental Health Services Administration, 1 endorsement by CSAT, SAMHSA, or DHHS Choke Cherry Road, Rockville, MD 20857. for these opinions or for particular instru- ments, software, or resources described in this DHHS Publication No. (SMA) 06-4182 document is intended or should be inferred. NCADI Publication No. BKD551 The guidelines in this document should not be Printed 2006 Contents What Is a TIP? .............................................................................................................................. ix Consensus Panel .......................................................................................................................... xi KAP Expert Panel and Federal Government Participants ........................................................xiii Foreword ......................................................................................................................................xv Executive Summary .................................................................................................................. xvii Chapter 1—Introduction ............................................................................................................... 1 Forces Affecting IOT and the Contents of This TIP .................................................................................. 2 Terminology and Definitions ....................................................................................................................... 3 Summary of This TIP .................................................................................................................................... 5 Chapter 2— Principles of Intensive Outpatient Treatment ...........................................................7 Principle 1: Make Treatment Readily Available ........................................................................................ 8 Principle 2: Ease Entry ................................................................................................................................. 9 Principle 3: Build on Existing Motivation ................................................................................................. 9 Principle 4: Enhance Therapeutic Alliance ............................................................................................. 10 Principle 5: Make Retention a Priority .................................................................................................... 10 Principle 6: Assess and Address Individual Treatment Needs .............................................................. 11 Principle 7: Provide Ongoing Care ............................................................................................................ 11 Principle 8: Monitor Abstinence ............................................................................................................... 12 Principle 9: Use Mutual-Help and Other Community-Based Supports ................................................12 Principle 10: Use Medications if Indicated .............................................................................................. 13 Principle 11: Educate About Substance Use Disorders, Recovery, and Relapse .................................14 Principle 12: Engage Families, Employers, and Significant Others .................................................... 14 Principle 13: Incorporate Evidence-Based Approaches .........................................................................15 Principle 14: Improve Program Administration ...................................................................................................15 Chapter 3—Intensive Outpatient Treatment and the Continuum of Care ................................. 17 Overview of a Continuum of Care ............................................................................................................. 17 Conceiving of a Continuum of Care ........................................................................................................... 18 Key Aspects of IOT (Level II) ...................................................................................................................... 19 iii Key Aspects of Outpatient Treatment (Level I) ........................................................................................ 23 Continuing Community Care ..................................................................................................................... 24 Chapter 4—Services in Intensive Outpatient Treatment Programs ........................................... 27 Core Services ................................................................................................................................................ 27 Enhanced IOT Services ............................................................................................................................... 44 IOT Services: A Case Illustration ............................................................................................................... 46 Appendix 4-A. A Case Study of Intensive Outpatient Treatment .......................................................... 48 Appendix 4-B. Induction Protocol for Disulfiram ................................................................................... 56 Chapter 5—Treatment Entry and Engagement .......................................................................... 59 Elements of Engaging the Client in IOT ................................................................................................... 60 Collect Screening Information ................................................................................................................... 62 Assessing Barriers to Treatment ................................................................................................................ 64 Crises and Emergencies .............................................................................................................................. 67 Components of the IOT Admission Process ............................................................................................. 67 Sample Treatment
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