Rehabilitation Programs and Office Follow-up

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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

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Rehabilitation Programs

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

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Inpatient Rehab

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

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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

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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

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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 individuals outcome expectancy

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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

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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

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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

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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

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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?

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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?

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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?

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Follow-up Concerns

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

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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

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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

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Professionals in Recovery

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

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Referral Sources

• Local hospitals
• Internet (residential programs dont all look
  alike)
• A.A. in the phone book
• Treatment Provider Guide located at www.SAMHSA.gov