Medication Assisted Treatment

Suboxone is the first opioid medication approved under DATA 2000 for the treatment of opioid dependence in an office-based setting. Suboxone can also be dispensed for take-home use, just as any other medicine for other medical conditions. The primary active ingredient in Suboxone is buprenorphine. Because buprenorphine is a partial opioid agonist, its opioid effects are limited compared to those produced by full opioid agonists, such as Oxycodone or heroin. Suboxone also contains naloxone, an opioid antagonist. The naloxone is there to discourage people from dissolving the tablet and injecting it. When Suboxone is placed under the tongue, as directed, very little naloxone reaches the bloodstream, so what the patient feels are the effects of the buprenorphine. However, if naloxone is injected, it can cause that person to quickly go into withdrawal.

Suboxone at the appropriate dose may be used to:

• Suppress symptoms of opioid withdrawal
• Decrease cravings for opioids
• Reduce illicit opioid use
• Block the effects of other opioids
• Help patients stay in treatment

• An interview (either face-to-face or on the phone) will be conducted to complete the pre-screening form to decide appropriateness of potential admission.
• If the person has the potential for admission, he/she is given an appointment to complete the initial assessment/intake process.
• The assessment will occur face-to-face and include:
  • An assessment tool that will assist in diagnosis and placement criteria
  • A bio-psycho-social assessment
  • Other information required by regulation and/or funding source (i.e., insurance)
• Intake assessments are performed on a walk-in and appointment basis.
• If an individual is found ineligible for services, the individual and the referring facility will be notified and offered alternative referrals for admission.
• If the individual is eligible for services, he/she will proceed through the intake process, including
  • Intake physical/assessment with the doctor
  • Nursing assessment
  • Lab-work
  • Clinical intake process

Please note: Information collected is used in the development of individual treatment plan.

• The facility will complete an eligibility screening, which includes:
  • A drug screen
  • A comprehensive bio-psycho-social assessment
  • Payment source to enroll in services
• The initial assessment will be completed within 48 hours and psychosocial evaluation process will be initiated within 7 days of admission.
• The bio-psycho-social will elicit:
  • Medical status
  • Vocational/employment and support
  • Alcohol, tobacco and other drug use
  • Legal status
  • Family/social status
  • Psychiatric status
  • Co-occurring disorders history
  • Behavioral risk factors for HIV and hepatitis
• All client assessments will result in:
  • A DSM diagnosis for alcohol, tobacco, and other substance uses
  • An identified co-occurring disorder(s)
  • Documentation of level of care determination
• If the bio-psycho-social assessment indicates the client should be referred to another treatment program or level of care, the program will coordinate the client’s referral to another program and document the referral in a progress note.
• If transfer to another program or level of care is indicated, interim services at current level of care will be provided until the transfer is actualized or the individual chooses alternate care.
• A bio-psycho-social assessment will include:
  • • Presenting issues from the client’s perspective and documented in their words
    • Medical, alcohol, tobacco, drug, and intervention history
    • History of psychological and/or psychiatric treatment (including previous admissions to psychiatric facilities)
    • History of suicidal/homicidal ideation and attempts
    • History of psychiatric treatment and/or psychotropic medications
    • Information of treatment by a psychiatrist or other licensed mental health clinician for clients diagnosed with co-occurring mental health disorders
    • Family and relationships, including relationships showing co-dependency and the client’s current living situation
    • Social assessment, including any legal proceedings involving the client.
    • Recreational assessment, including the client’s interests and physical abilities and limitations
    • Vocational and educational assessment of the client’s current work or vocational skills, employment status, and potential for improving those skills or developing new ones
    • Educational status and skills
    • Aptitudes, interests, and motivation
    • Physical abilities and any handicaps or disabilities
    • Relationships with co-workers and supervisors
    • Prior and current work or school related problems, including but not limited to those related to substance abuse
    • Urgent needs, including but not limited to:
      • Suicide risk
      • Personal safety
      • Risk to others
    • Personal strengths, needs, abilities/interests, and preferences
    • Previous behavioral health services, including diagnostic and treatment histories
    • Mental status
    • Medication profile
      • Medication history and current use
      • Effectiveness of current or previously used medications
      • Medication allergies or adverse reactions
    • Health history and current health needs
    • Co-occurring disorders, diagnosis and medical conditions
    • Current level of functioning
    • Pertinent current and historical life situation information
      • Age
      • Gender, sexual orientation, and gender expression
      • Culture and spiritual beliefs
      • Education
      • Employment
      • Legal involvement
      • Family history
      • Relationships and support network
      • History of experienced and/or witnessed trauma involving abuse, neglect, violence and/or sexual assault
• Risk taking behaviors
• Literacy level
• Need for assertive devices
• Advance directives
• Psychological and social adjustment to disabilities and/or disorders
• Resultant diagnosis, if identified

Includes the presentation of community education programs for community groups, organizations, businesses, and other organizations. These presentations are intended to increase public awareness of the nature of opioid addiction and the services available to treat this disease.

One-on-one therapy with patient and counselor.

Group counseling attempts to provide individuals a safe and comfortable place where they can work out problems and emotional issues. Patients gain insight into their own thoughts and behavior, and offer suggestions and support to others. In addition, patients who have a difficult time with interpersonal relationships can benefit from the social interactions that are a basic part of the group counseling experience.

Groups:

• Provide positive peer support and pressure to abstain from substances of abuse.
• Reduce the sense of isolation that most people who have substance abuse disorders experience.
• Enable people who abuse substances to witness the recovery of others.
• Help members learn to cope with their substance abuse and other problems by allowing them to see how others deal with similar problems.
• Offer family-like experiences. Groups can provide the support and nurturance that may have been lacking in group members’ families of origin.
• Encourage, coach, support, and reinforce as members undertake difficult or anxiety-provoking tasks.
• Offer members the opportunity to learn or relearn the social skills they need to cope with everyday life instead or resorting to substance use. Group members can learn by observing others, being coached by others, and practicing skills in a safe and supportive environment.
• Allow a single treatment professional to help a number of patients at the same time.
• Can add needed structure and discipline to the lives of people with substance abuse disorders, who often enter treatment with their lives in chaos. Groups instill hope, a sense that “if he can make it, so can I”. Process groups can expand this hope to dealing with the full range of what people encounter, overcome or cope with in their lives.

• Provide goal-oriented and individualized supports focusing on improved self-sufficiency for the patients through:
  • Assessment
  • Planning
  • Linkages
  • Advocacy
  • Coordination
  • Monitoring activities
• Successful service coordinator results in community opportunities and increase independence for the individual/patient

• Clinically-intensive treatment services 3 days a week for a total of 9 hours, including patients and their families receiving:
  • Education and information regarding symptoms, effects, and treatment of mental illness, medications, substance abuse, co-dependency, and its effect on substance abuse treatment the implementation of self-care rehabilitation (such as Al-Anon, Nar-Anon, Alateen), and community agencies/resources available during treatment services.
• Services provide individual and group substance abuse counseling, education on the health consequences of substance abuse and dependence, and relapse prevention.
• Specialized services such as life skills, job placement, resume writing, vocational topics, and anger management.
• Psychiatric services and medication monitoring provided for patients who have been diagnosed with co-occurring disorders or need psychiatric intervention and assessment.

Each patient is seen by the Medical Director or other licensed practitioner before admission to assess the individual using ASAM criteria, make a proper DSM IV diagnosis, perform a physical and history examination, and develop appropriate medical orders for induction care.

A licensed nurse will compile a nursing history, which includes assessing risk factors for STDs, HIV, and HVC

• Detoxification is the process of assisting an individuals’ gradual metabolic clearance of a substance through the use of a pharmacological replacement along with applicable supplemental treatment. This process is conducted in a way that minimizes physical and psychological risk and discomfort to the patient and ultimately eliminates their dependence on unhealthy and/or undesired substances.
• A detox is accomplished through the medically-supervised cessation of all opioid and opiate intake by the patient which is then replaced by a medically prescribed, long-acting opioid medication such as Suboxone or Methadone. This medication  will be administered in place of the illicit opioid substance(s) that was discontinued. This medication will be tapered/diminished over the clinically agreed upon time frame until the patient has completely discontinued the use of opioids and/or opiates.