Counseling Points - September 2007 - (Page 8)

• Level 3: Heavy problem/early addiction with the development of medical complications as a result of use. The individuals may have already become dependent, or may be experiencing tolerance and withdrawal. • Level 4: Clearly addicted individuals show symptoms of classic addiction syndrome. Table 2. DSM-IV-TR Criteria That Suggest Signs of Drug or Alcohol Addiction Any combination of three or more of the following criteria in the past 12 months is considered diagnostic of dependency: • Preoccupation with obtaining, using, and recovering from Consultation and Referral Local treatment resources are important to the success of each individual’s recovery. Community resource directories can be relied upon to identify treatment programs. The health care team should keep a list of names and numbers with the types of services offered and make contact with treatment providers and establish referral agreements if appropriate. It is also necessary to become familiar with other resources and to remember that it is the responsibility of the assessing clinician to refer patients for the most appropriate treatment and to then follow-up on their patients’ care. Once the signs and symptoms of drug use have been evaluated, the nurse will be able to determine what type of recommendations or referrals will be needed to address the severity of the problem. The presence of three of the DSM-IV-TR criteria for addiction within the past 12 months (Table 2) may be appropriate for recommending medication-assisted treatment. Special populations (those with psychiatric and/or medical comorbidities, patients with pain, pregnant women, neonates, adolescents, geriatric patients, polysubstanceusing patients, health care professionals, and those involved with the criminal justice system) warrant referral to a specialty practice. the effects of the chemical • Using more of the chemical than had been anticipated • The development of tolerance to the chemical in question • A characteristic withdrawal syndrome when the person stops or decreases the use of the chemical • Repeated efforts to cut back or stop the drug use • A reduction in social, occupational, or recreational activities in favor of further substance use • Continuation of chemical use in spite of having suffered social, emotional, or physical problems related to drug use only provide methadone, a full agonist opioid, for the management of withdrawal symptoms and cravings, but also offer counseling and frequent monitoring for adherence. Unfortunately, even operating at full capacity, methadone clinicis are currently able to treat less than 25% of the opioid-addicted population. It was the plight of the remaining 75% of untreated patients that inspired new legislation at the turn of this century, DATA 2000, to begin to bridge the gap.This has led to the use of buprenorphine as an office-based, medication-assisted treatment for opioid addiction. Other options for addiction treatment include: • Narcotics Anonymous (NA), which offers the famous 12-step, abstinence-based treatment model. NA has successfully ushered a small percentage of people into a lifetime of recovery through frequent meetings and use of sponsors who serve as compassionate role models to their peers. • Detoxification treatment programs, which offer either inpatient or outpatient, rapid or prolonged treatment. The highly controversial ultra-rapid Available Addiction Treatments The Harrison Narcotic Act of 1914 prohibited physicians from prescribing opioids to treat addiction. Nearly 60 years ensued with no treatment options, until methadone became available in the 1970s (albeit only at specialty clinics). Ideally, these outpatient clinics not 8 COUNSELING POINTS™

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Welcome Office-Based Medication-Assisted Treatment of Opioid Dependence Summary Continuing Education Posttest Postest Answer and Program Evaluation Form

Counseling Points - September 2007

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