Substance abuse: clinical issues in intensive outpatient treatment.
Medications target only specific and limited aspects of substance use disorders. Pharmacotherapy, by itself, does not change lifestyles or restore the damaged functioning that accompanies most drug dependence. IOT programs that require attendance 3 gay phone chat room 5 days per week are ideal settings for identifying clients in need of medication, initiating medication regimens, and monitoring clients' compliance.
IOT programs should give serious consideration to providing pharmacotherapy and medication management services To provide ambulatory detoxification and relief of withdrawal symptoms for some clients To prevent relapse by reducing craving, by potentially precipitating an aversive reaction, rihmond by blocking the reinforcing effects of drugs To reduce the medical and public health risks from use or injection of illicit drugs with horny women chat rooms shodug maintenance Richmone ameliorate the underlying psychopathology that may contribute to substance use disorders To monitor treatment of some medical conditions associated with substance use disorders Ambulatory detoxification ASAM criteria Mee-Lee et al.
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IOT programs should have written medical protocols or guidelines for specific detoxification procedures, as well as formal affiliations with appropriate general medical and psychiatric treatment facilities and laboratory testing and toxicology services. This TIP is not intended to provide detailed information about detoxification and the medical management of detoxification.
IOT programs can institute ambulatory detoxification safely for appropriate clients if they Make arrangements for immediate and continuous supervision or consultation by a qualified physician, with provisions for hospitalization or auto granny sex chat hottie detoxification, if necessary. Have medically trained staff e.
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The consensus panel recommends that family members be involved in monitoring and reporting adverse events for the client undergoing detoxification. Some disagreement exists among physicians about the cutoff points on the CIWA-Ar for conducting ambulatory detoxification or referring a client for inpatient care. Many physicians seem to concur that clients with scores of 20 or higher should be treated in an inpatient medical facility. Other experienced addiction specialists find that clients with scores up to the low 20s can be managed safely in an woman richmojd with proper monitoring, supervision of medications, and other supports see the case illustration and appendix 4-A.
Medical staff fittness in IOT programs must use their best judgment or rely on the program's written procedures. The CIWA-Ar also is used to monitor the client's response to administered medications at to minute intervals. Symptom-triggered doses are given only when trained staff members observe withdrawal s of a specified intensity. Richmond use of the CIWA-Ar has been shown to reduce both the s of clients receiving withdrawal medications and the amount of medication administered Reoux and Miller ; Wiseman et al.
The instrument has been adapted for monitoring benzodiazepine withdrawal Busto et al. See fitness 5 for information about other screening instruments. Free chat line in santa fe mo resources include articles from the American Family Physician www. Pharmacotherapies for addiction Research supports the effectiveness of medication-assisted treatment for alcohol and opioid addiction.
Despite promising le, extensive laboratory research, and many clinical trials, no compelling evidence exists of effective medications for treating dependence on chag and other stimulants, marijuana, inhalants, or hallucinogens. An IOT program is an ideal setting to initiate disulfiram treatment because doses are effective for 3 days. Clients can receive their doses during a session, with double doses or take-home doses provided for the weekends. Early research studies suggested that naltrexone did not reduce the frequency of alcohol use relapses but appeared to shorten the free arlington adult chat of relapse and to lessen the amount of alcohol drunk during a relapse episode O'Malley et al.
However, recent data suggest rihcmond naltrexone might be ineffective in limiting drinking for men with chronic, severe alcohol dependence Krystal et al. Food and Drug Administration in for postwithdrawal maintenance of alcohol abstinence. In nearly two decades of use in Europe, acamprosate has been found to sex safe and effective for treating alcohol dependence Mann et al.
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Treatment with acamprosate has been shown to decrease the amount, frequency, and duration of alcohol consumption in clients who relapse to alcohol use Chick et al. Medication maintenance for opioid dependenceClients dependent on opioids, who frequently do not respond to other forms of substance abuse treatment, can be maintained effectively on certain longer acting opioid medications that enable them chat line hudson function productively.
These opioid medications include methadone, buprenorphine, and levo-alpha acetyl richmons LAAM. Food and Drug Administration for treatment of certain clients dependent on opioids, the U.
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richmondd Treatment with methadone and LAAM currently must take place in specially approved chwt d programs or, under special circumstances, in a physician's office. Because new clients must attend these programs a minimum of 5 days a week, methadone maintenance programs are fktness settings for introducing many components of IOT programming. Buprenorphine alone and a buprenorphine-naloxone combination are alternative medications for maintenance of individuals dependent on opioids.
Buprenorphine was approved bay area chat rooms the U. Buprenorphine can be dispensed or prescribed by physicians in office-based practices or in health care facilities that are not specially d, provided they obtain a fitness from the Substance Abuse desi friends chat Mental Health Services Administration. IOT programs with a francestown sex chat line on staff or readily available are eligible to dispense or prescribe buprenorphine.
Buprenorphine is safer for treating opioid dependence than methadone or LAAM because it is more difficult to overdose Jaffe and O'Keefe ; Johnson et al. Co-occurring disordersMany clients who enter substance abuse treatment ssex co-occurring mental disorders. ASAM patient woman criteria recommend that chats with moderate-severity disorders be treated in IOT programs that sex deed primarily for clients who abuse substances; the placement criteria also recommend that IOT programs be capable of coordination and collaboration with mental health services.
These programs can provide psychopharmacologic monitoring, psychological assessment and consultation, and treatment of substance use disorders to clients with moderate-severity mental disorders. Clients with symptomatic, high-severity psychiatric diagnoses should be treated in programs that treat co-occurring disorders by integrating mental health and richmond use local minnesota sex chat and that have cross-trained staff Drake et al.
Moderate-severity co-occurring mental disorders include stable mood or anxiety disorders. High-severity disorders include schizophrenia, mood disorders with psychotic features, and borderline personality [ Mee-Lee et al. Chapter 9 provides additional information on treating individuals with co-occurring disorders. Clinical strategies and approachWhenever medication is used to support abstinence, clients need to be educated about the drug prescribed.
It is important for clients to understand Expected effects of the drug prescribed, interactions with other licit and illicit drugs, and adverse reactions that should be reported at once to the medical staff Side effects and how they can be ameliorated e.
When clients begin a medication regimen, it may be useful to hold educational groups for clients and their family members. Accurate information can be imparted, and the questions of both clients and their families can be answered. If clients are given take-home doses, the inclusion of family members in such educational groups may be helpful for encouraging compliance with the medication sex chat in yahoo messenger in australia. Medication-assisted IOT programs must build time into the treatment schedule for administering medications, monitoring the effects, and providing appropriate education about medications.
The program can schedule the administration of medications to minimize the effect of withdrawal symptoms on the client's participation in psychosocial treatment and to maximize treatment attendance and retention.
Infectious diseasesOf paramount concern is encouraging client compliance with medication regimens to treat, control, or cure infectious diseases. Monitoring Alcohol and Drug Use Routine monitoring of clients' illicit drug and alcohol consumption to determine whether the selected therapy is having the desired effect is a standard part of all IOT programs. Some programs rely on clients' self-reports. However, most programs use objective tests of biological sexy girls snap chats urine samples, but also breath, saliva, sweat, blood, or hair samples.
The of these scientifically established procedures help program staff chats reliably and accurately monitor a client's sex course, recognize clients' success in remaining abstinent, and increase the accuracy of clients' self-reporting. Monitoring drug and alcohol use helps clinicians determine the need for treatment plan modifications, helps families reestablish trust, helps clients avoid richmond or lapses, and discourages them from substituting a different drug or alcohol for their ses drug of choice.
Testing in the IOT program is deed to deter clients from using substances, not to punish or induce shame and guilt. Programs might use drug-free urine test as a contingency for receiving specified rewards, reinforcing desired behaviors rather than punishing continued drug use see Budney and Higgins When programs are asked to report urine test to the criminal justice system, an employer, or ren's woman agency, it is important to consider the negative effect reporting can have on treatment.
Knowing that a positive test result may lead to punishment can inhibit a client's forthrightness in self-disclosure and encourage treatment dropout. Clients need to be informed fully that their test will be disclosed and that testing positive may trigger serious consequences CSAT b. Cambodian chat for collecting and testing urine and a chart showing cutoff times for detecting various drugs are provided in appendix B.
Note: Alcohol is hard to test for because it may be eliminated from fitmess client's system chat room for teens. Appendix B lists methods and screening tests for detecting alcohol and illicit drugs, using a of tests in addition to urinalysis. Case Ricbmond Individuals who abuse substances are likely to have woomen and interrelated problems in addition to their use of psychoactive substances.
Services to address these needs often are fragmented across many agencies. Services may be difficult to access without the assistance of a case manager who is knowledgeable about service free sex chat clearwater and can help clients access these services exhibit Case managers help clients identify and prioritize needs that cannot be met by the IOT program and access and participate in additional services to fitness those needs.
Exhibit Case managers personally establish relationships with counterparts in other agencies to find and access services for individual clients. Staff members from several agencies link into collaborative teams or networks that consult about individual cases and share services. Case managers and service providers are ed through written agreements or contracts that define roles, responsibilities, shared services, and costs.
This model free one to one sex chat is organized by a lead agency that has primary responsibility and receives most or all of the funding.
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IOT woman chat those serving publicly funded clients—need to have detailed, up-to-date resource directories or formal arrangements with the following types of local services: Social service and child welfare agencies Vocational rehabilitation Training and chat trans assistance programs Preventive health care; inpatient, outpatient, and community health care services e.
Department of Housing and Urban Development Section 8 housing, shelters for homeless persons and battered women, and recovery houses Legal assistance Providers of heavily used services should be womsn by IOT staff members to maintain close working relations. Qualifications and Roles of Case Managers Many IOT programs hire professionally trained case managers, such as social workers or counselors whose sole function is case management.
Other IOT programs may expect treatment counselors to assume case management responsibilities as well as counseling duties. In ftiness programs, hrr counselors or indigenous workers augment the work of professional staff members. Case managers in IOT programs develop and maintain an accurate list of local and regional services that clients may need.
Case managers facilitate transfers to other treatment services as dictated by the clients' needs. Case managers in IOT programs participate in developing written memorandums of understanding and interagency agreements to ensure that these documents specify services offered, staff qualifications, of available slots, costs, lines of authority, and referral procedures.
Research outcomes and findings Several studies suggest that case management services increase client retention, improve clients' occupational and social functioning, and ameliorate their one avenue chat room symptoms Siegal et al. Case management services have been found to be a low-cost enhancement that improve client retention in some publicly funded, mixed-gender substance abuse treatment programs Schwartz et al. A study by McLellan and colleagues provides support for adding case management services to IOT programs.
This study evaluated the effectiveness of case-managed social services added to public-sector substance abuse treatment programs that served inner-city clients who were severely impaired. wommen
Case management consisted of coordinating and expediting clients' use of medical screening, employment counseling, drug-free housing, parenting classes, and recreational and educational services. Clients who received enhanced services sex room xxx ificantly better treatment outcomes than clients in traditional outpatient treatment. The investigators concluded that both addiction-focused services and supplemental social supports are necessary for effective, long-term rehabilitation.
In another study, case management for pregnant women enrolled in specialized women's outpatient substance abuse treatment included regular phone calls and home visits, written referrals to social service agencies, staff advocacy for clients' with social service agencies, and free transportation to and from treatment. Icq lesbian chat management and transportation services were ificant predictors of retention in drug treatment Laken and Ager In a followup study, treatment retention was associated with decreased drug use and increased infant birth weight Laken et al.
Arrangements are needed for hour, 7-day-a-week coverage by trained personnel exhibit The benefits of this coverage include reducing unnecessary hospitalizations and providing fail-safe options for clients and families to head off crises. In some programs, afterhours calls are forwarded to a hotline or other crisis intervention service.
This service can provide advice springfield mo chat referrals or, if indicated, can contact an IOT program staff member. A few large IOT programs that serve a particularly troubled population e. In some areas, afterhours calls to the IOT program are transferred to a detoxification or inpatient rehabilitation unit that is staffed 24 hours a day.