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Assessment and Treatment Planning for Cocaine-Abusing Methadone- Maintained Patients: Treatment Improvement Protocol (TIP) Series 10

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Assessment and Treatment Planning for Cocaine-Abusing Methadone- Maintained Patients: Treatment Improvement Protocol (TIP) Series 10 TIP 10: Assessment and Treatment Planning for Cocaine-Abusing Methadone- Maintained Patients: Treatment Improvement Protocol (TIP) Series 10 A31109 Herbert D. Kleber, M.D. Consensus Panel Chair U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Rockwall II, 5600 Fishers Lane Rockville, MD 20857 DHHS Publication No. (SMA) 94-3003 Printed 1994 Disclaimer This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. The figure on page 6, the table on page 29, appendix G, and appendix I are copyrighted and are reproduced herein with permission of the copyright holders. Further reproduction of these copyrighted materials is permitted only as part of a reprinting of the entire publication. For any other use, the copyright holder's permission is required. All other material appearing in this volume is in the public domain and may be reproduced or copied without permission from the Center for Substance Abuse Treatment (CSAT) or the authors. Citation of the source is appreciated. This publication was written under contract number ADM 270-91-0004 from CSAT. Robert Lubran served as the Government project officer. Lynne C. McArthur, Yvonne P. Goldsberry, Yvonne daSilva, Anita Winters, Rebecca Horton, and Diana Schwartz served as contractor writers. The opinions expressed herein are those of the Consensus Panel members and do not reflect the official position of the Substance Abuse and Mental Health Services Administration (SAMHSA) or any other part of the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of SAMHSA or DHHS is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized patient care and treatment decisions. What Is a TIP? Treatment Improvement Protocols (TIPs) are prepared by the Quality Assurance and Evaluation Branch of the Center for Substance Abuse Treatment (CSAT). Their purpose is to facilitate the transfer of state-of-the-art protocols and guidelines for treating alcohol and other drug (AOD) abuse from acknowledged clinical, research, and administrative experts to the Nation's AOD abuse treatment resources. Disseminating a TIP is the last step in a process that begins with the recommendation of an AOD abuse problem area for consideration by a panel of experts. Panel members include clinicians, researchers, and program managers, as well as professionals in related fields such as social services or criminal justice. Once a topic has been selected, CSAT creates a Federal Resource Panel, composed of members of pertinent Federal agencies and national organizations, to review the state-of-the-art treatment and program management in the area selected. This Federal panel's recommendations are then transmitted to a second group of non-Federal experts who are intimately familiar with the topic. This group, known as a non-Federal Consensus Panel, meets for about 3 days, makes recommendations, defines protocols, and arrives at agreement on protocols. Its members represent AOD abuse treatment programs, hospitals, community health centers, counseling programs, criminal justice and child welfare agencies, and private practitioners. The panel chair is charged with ensuring that the resulting protocol reflects true group consensus. The next step is a review of the proposed guidelines and protocol by a third group-the expert field reviewers. Once their recommendations and responses have been reviewed, the chair approves the document for publication. The result is a TIP reflecting the state of the art of AOD abuse treatment in public and private programs recognized for providing high-quality and innovative AOD abuse treatment. This TIP on assessment and treatment planning for cocaine-abusing methadone-maintained patients represents another step by CSAT toward its goal of bringing national leadership to bear in the effort to improve AOD abuse treatment. Contents Consensus Panel Foreword Note From the Chair Chapter 1-Overview Chapter 2-Statement of the Problem Chapter 3-Screening, Admission, and Assessment Techniques Chapter 4-Treatment Interventions and Related Issues Chapter 5-Legal and Ethical Issues Chapter 6-Evaluating Program Performance Chapter 7-Consensus Panel Recommendations for Further Research Appendix A - Glossary Appendix B - Levels of Care Appendix C - Acronyms Appendix D - TB/PPD Testing - Sample Forms Appendix E - Multidrug Abuse Patterns Appendix F - Diagnostic Assessment Instruments Appendix G - DSM-IV Criteria for Substance-Related Disorders Appendix H - Psychiatric Disorders Appendix I - Internal Trigger Questionnaire and External Trigger Questionnaire Appendix J - Self-Help Groups Appendix K - Federal Resource Panel Appendix L - Field Reviewers References TIP 10: Consensus Panel Peter Banys, M.D. Substance Abuse Programs VA Medical Center San Francisco, CA Addie Corradi Associate Commissioner Health and Planning Services Division New York State Office of Alcoholism and Substance Abuse Services Albany, NY Robert Galea, Ph.D. Chairman Spectrum Addiction Services, Inc. Westboro, MA Elizabeth Khuri, M.D. Medical Director Adolescent Development Program Clinic New York, NY Herbert D. Kleber, M.D., Chair Professor of Psychiatry and Director Division on Substance Abuse College of Physicians and Surgeons Columbia University New York State Psychiatric Institute New York, NY Thomas R. Kosten, M.D. Associate Professor of Psychiatry Division of Substance Abuse Department of Psychiatry Yale University School of Medicine New Haven, CT Frances Levin, M.D., Facilitator Assistant Professor of Psychiatry College of Physicians and Surgeons Columbia University New York State Psychiatric Institute New York, NY Ira J. Marion, M.A. Associate Executive Director Division of Substance Abuse Albert Einstein College of Medicine Bronx, NY Edward Nunes, M.D., Facilitator Research Psychiatrist College of Physicians and Surgeons Columbia University New York State Psychiatric Institute New York, NY J. Thomas Payte, M.D. Medical Director Drug Dependence Associates, Inc. San Antonio, TX Richard Rawson, Ph.D. Executive Director Matrix Institute on Addictions Los Angeles, CA Robert Ruiz, M.D. North Clinic Comprehensive Psychiatric Center Miami, FL Richard Schottenfeld, M.D. Director Substance Abuse Treatment Unit Connecticut Mental Health Center APT Foundation New Haven, CT Edward C. Senay, M.D. Professor of Psychiatry University of Chicago Chicago, IL Merritt Smith, M.D., M.P.H. Medical Director Community Substance Abuse Services Department of Public Health San Francisco, CA Maxine Stitzer, Ph.D. Behavioral Biological Research Center Johns Hopkins School of Medicine Baltimore, MD Barbara Wallace, Ph.D. Department of Health and Nutrition Education Teachers College Columbia University New York, NY Aaron Wells, M.D. Medical Director New York Hospital Adult Methadone Program Cornell Medical Center New York, NY Richard Wiesen, M.D. (deceased) Medical Director Chemical Dependency Programs Milwaukee County Mental Health Complex Milwaukee, WI Joan Ellen Zweben, Ph.D. Executive Director East Bay Community Recovery Project Berkeley, CA TIP 10: Foreword The increasing complexity of the problems of cocaine-abusing patients in the substance abuse treatment system has created pressure on treatment providers to expand the scope of services to meet the complex needs of multidrug users. Narcotic treatment programs (NTPs) have been successful in treating opioid addicts for their narcotic addiction but in many instances have been less successful in treating patients who are also dependent on cocaine. The increasing prevalence of acquired immune deficiency syndrome (AIDS) and multidrug-resistant TB among drug users has further complicated treatment needs and heightened the urgency to provide effective drug treatment services. As the Federal office responsible for providing leadership in improving substance abuse treatment services, the Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration has sponsored the development of this Treatment Improvement Protocol (TIP) to address the treatment needs of patients who are abusing opioids and stimulants, especially cocaine and crack cocaine. CSAT is committed to assisting State policy officials and treatment providers with understanding current treatment issues and improving treatment for all substance abuse patients. This TIP is one of a series written with the assistance of substance abuse treatment experts throughout the United States that serve as guidelines to help substance abuse treatment providers meet treatment challenges of the 1990s. Furthermore, the TIP is intended to assist State alcohol and drug agencies in implementing 45 CFR, § Part 96, which requires States to provide for independent peer review to assess the quality, appropriateness, and efficacy of treatment services by entities that receive State Substance Abuse Prevention and Treatment Block Grant funds. This TIP provides guidelines to assist States in developing criteria for State independent peer review. The TIP was developed as an initiative of CSAT's Methadone Treatment Improvement Project (MTIP), which is designed to assist States and methadone treatment providers in effectively identifying and addressing technical assistance needs. The problem of patients who are dependent on multiple drugs and stimulants has become increasingly
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