The Fundamentals of Outpatient Treatment for Addiction and Alcoholism
By Dr. Kimberly s. Benson LMHC,CAC,ICADC,CCTP
Licensed Mental Health Counselor
Certified Addictions Professional
International Certified Alcohol & Drug Counselor
Certified Clinical Trauma Professional
The latest DSM V describes alcohol, drugs and other substance use as Substance Use Disorder AKA also known as SUD.
The American Society of Addiction Medicine defines 5 levels of care to guide practitioners in selecting appropriate treatment for people.
Level 0.5: Early Intervention Services
Level 1: Out-patient services
Level 2: Intensive Out-patient
Level 3: Residential and in-patient services
Level 4: Medically Managed Intensive Inpatient
Sarasota Addiction Specialists offer care for Level 0.5-level 2.
Phase 1: Referral Source
Referrals to an IOP come from:
Professionals such as Physicians, Lawyers, Treatment Centers, as well as Family members of the Addict or the Addict/Substance Abuser themselves.
Phase 2: Evaluation
Evaluating the appropriate level of care is a critical stage in the process of treating addiction. IOP’s are not designed to handle medical problems that may arise as a result of the detox process.
During the evaluation process the intake counselor assesses the physical state of the individual considering treatment, risk factors for relapse and commitment to treatment. Dependent on the above areas a referral may be made to in-patient detox, residential treatment, private therapist or a psychiatrist if a dual diagnosis is suspected that may require psychotropic medication treatment.
If detox is necessary there are remedies, one of which is that a client can do out-patient medical detox through a private addiction psychiatrist affiliated with our services. Of course, there are other ways to detox.
Phase 3: Intake
3 hour ASAM Biopsychosocial Assessment
Bio=of the body
Psych=of the mind
- Dimension 1: Substance Use, Acute Intoxication & or withdrawal potential.
- Dimension 2: Biomedical conditions & complications
- Dimension 3: Emotional, Behavioral, or Cognitive Conditions & Complications
- Dimension 4: Readiness to change
- Dimension 5: Relapse, continued use or continued problem potential
- Dimension 6: Recovery/Living Environment
- Intake paperwork: informed consent to treatment, release of information, HIPA Confidentiality, Limits & Rights, Suicidality, Homicidality, Consents to drug screening.
- Treatment Plan:
- A treatment plan is formulated starting with a schedule of treatment meetings, psychoeducational lectures with interactive group processing.
- The treatment plan will also include connections to support groups, allies, reading materials, podcasts, daily schedule.
- Outside resources include but are not limited to AA, NA, SOS (Secular Organizations for Sobriety), Rational Recovery, & Smart Recovery. There are faith-based recovery support groups as well. Research shows that without support group an individual seeking recovery with has decreased odds of success.
- Orientation to the program, A treatment plan is now implemented and will include education, support groups, allies, reading materials, podcasts. Expectations and responsibilities are clarified. Personal responsibility for participation is paramount We don’t apply treatment, it is an interactive joint partnership.
- Selection of Treatment:
- State of Florida & Department of Children and Families Requires a minimum of 9 hours a week for 6 weeks.
- Options include 6/9/12/16/18 weeks
- In the event of relapse an updated evaluation & treatment plan review is conducted and treatment starts over.
- Tools for Drug and Alcohol Screening
- 1 weekly random urine drug screen
- sober link monitoring
- Early Recovery Skills Examples: How to avoid temptation, liquor stores, convenient stores, using friends/drinking friends, (thought stopping), picking up the phone, having people to call.
- Emotional Recovery Skills. Emotional management is critical to recovery at any level. That means learning how to temper intense emotions, behaviors, thoughts, and having resources to help. Emotional recovery involves values clarification, life principals, and identifying internal and external triggers.
- Relapse Prevention Skills: Daily Plan, Support Network, Resources to interrupt a relapse at any level, we try to teach our patients to ask for help.
- Individual and Family Counseling:
- Available with our staff or in collaboration with outside established compatible resources.
- This is a time when the patient has completed IOP with success we have a graduation ceremony with a Certificate of Completion and a medallion. This is often one of the most moving experiences for both staff and patients.
Aftercare includes the patient leaving with resources in hand, people to call, assurance that they can call us back for support, come back for aftercare groups, re-engage with staff at any time. We try hard to connect our patients to actual people in the community who are connected to recovery
Recovery has an overarching umbrella-like piece that can be spiritual, religious, philosophical, scientific, universal intelligence. Under that umbrella is having a community of other like-minded people in recovery; where ever you find them, reading the literature, continuing their new found skills of health and self-care, physical wellness, connection, personal growth, vocational/occupational skills as indicated, renewal programs, follow up.
Who know about P.A.W.S?
Post Acute Withdrawal Syndrome
There are two stages of withdrawal. The first stage is the acute stage, which usually lasts at most a few weeks. During this stage, you may experience physical withdrawal symptoms. But every drug is different, and every person is different.
The second stage of withdrawal is called the Post-Acute Withdrawal Syndrome (PAWS). During this stage you’ll have fewer physical symptoms, but more emotional and psychological withdrawal symptoms.
Post-acute withdrawal occurs because your brain chemistry is gradually returning to normal. As your brain improves the levels of your brain chemicals fluctuate as they approach the new equilibrium causing post-acute withdrawal symptoms.
Most people experience some post-acute withdrawal symptoms. Whereas in the acute stage of withdrawal every person is different, in post-acute withdrawal most people have the same symptoms.
The Symptoms of Post-Acute Withdrawal
- Mood swings, anxiety, irritability
- Tiredness, variable energy, low enthusiasm
- Variable concentration
- Disturbed sleep
- These are the most common post-acute withdrawal symptoms.
- Post-acute withdrawal feels like a rollercoaster of symptoms.
- Each post-acute withdrawal episode usually last for a few days.
- Post-acute withdrawal usually lasts for 2 years.
H.A.L.T? Are you feeling irritable, restless and discontent?
Hungry, Angry, Lonely, Tired
People need to take ACTION this is NOT a passive process.
https://www.psychiatry.org/psychiatrists/practice/dsm (SUD/Substance Related Disorders)
https://www.asam.org/resources/the-asam-criteria/about (ASAM biopsychosocial assessment and model of treatment)