Rehabilitation Programs and Office Follow-up

Rehabilitation Programs and Office Follow-up Steven R. Ey, M.D. Medical Director Genesis Chemical Dependency Unit South Coast Medical Center Laguna Beach, CA April 14, 2005

Rehabilitation Programs • Inpatient • Residential • Intensive outpatient • Individual counseling • CBT, MET • Sober living

Inpatient Rehab • Highest level of care • Unlikely insurance will cover • Must be able to think clearly, ambulate, and tolerate po’s • Usually lasts a few days then transition to lower level of care

Residential Treatment • Usually 4 to 6 weeks • Insurance will sometimes cover • Medical and psychiatric follow up addressed as indicated • Requires commitment from patient to stay entire treatment

Intensive Outpatient Program • Usually day treatment or evening IOP • Minimum 12 hours per week or more in structured program • Popular level of care that managed care will pay for if patient has the benefits • Can be used as a step down from a higher level of care

Relapse Prevention • Cognitive behavioral approach that facilitates initiation and maintenance of change • Identify and anticipate specific high risk situations (esp. anger, fear, and frustration) • Learn behavioral strategies (e.g., coping skills) • Modify individual’s outcome expectancy

MET, CBT Programs • Motivational Enhancement Therapy • Cognitive Behavioral Therapy • Non 12 step oriented • Effective treatment but those doing best were also going to 12 step meetings

Alcoholics Anonymous • Started in 1935 by a stock broker and physician • Approximately 2 million members worldwide • Over 1000 meetings per week in Orange County • Most successful program to date • Difficult for patients to overcome prejudices and stereotypes • Requires motivated patient to go directly into AA

Individual Counseling • Helpful as adjuvant treatment as compared to primary treatment for Addiction • May serve as starting point for patients who are not willing to do anything else • Therapist can make referrals to psychiatrists and interventionists as indicated

Aftercare • Usually lasts 1 or 2 years after primary treatment • Keeps patient connected to recovery principles, peers, and program • Offers opportunity to set example for newcomers or patients currently in treatment

Office Follow-up • What was your treatment like? • What kind of things did you do there? • How long were you there? • Did you complete their program? • What was their aftercare recommendation? • Did they recommend you attend 12-step meetings?

Office Follow-up (cont.) • Did they give you any paperwork for me? • Did they do any lab tests? • Did they change any of your meds? • Did they refer you to a psychiatrist or therapist?

Office Follow-up (cont.) • What are your plans now? • Did your family participate? • If using prescription pills, have you contacted the pharmacies or other doctors involved? • What can I do to help?

Follow-up Concerns • Missed appointments • No aftercare or 12-step involvement • No family involvement • Requests for prescription substances of abuse • Erratic behavior

What to do if they relapse? • Try to meet with them in person to assess (e.g., were they active in aftercare, taking their meds, family or work support, etc.) • Most programs will consider readmittance to their program but it is important to clarify • They may need a higher level of care

Prescription Use in Recovery • Principal of cross-addiction • Defer non-urgent procedures for minimum three months (including dental) • Create a team approach for post-op narcotic care

Professionals in Recovery • Treatment Recommendations • Diversion Programs • Monitoring • Co-morbidity (Univ. of Washington Study)

Referral Sources • Local hospitals • Internet (residential programs don’t all look alike) • A.A. in the phone book • Treatment Provider Guide located at www.SAMHSA.gov

Rehabilitation Programs and Office Follow-up