Substance Use Disorder Assessment Notes

Substance Use Disorder (SUD) Overview

• Definition: Chronic disease that disrupts healthy body function and increases health risks.
• Stigma: Negative perceptions prevent individuals from seeking care, leading to untreated conditions.

Managing SUD

• Connection to Care: Primary Care Providers (PCPs) are crucial in identifying and addressing substance misuse with a non-judgemental, compassionate approach.
• Language Use: Shift from stigmatizing terminology (e.g., 'addict') to more compassionate terms (e.g., 'person with SUD').
• Education and Diversity: Clinics should offer education and recruit culturally diverse healthcare providers, including peers with personal recovery experience.

Roles of Medical Care Providers

• Primary Care Providers (PCPs):

  • Conduct motivational interviews to gather patient information.
  • Continuous assessment during follow-up visits and referral to specialists as needed.
  • Collaborate with behavioral specialists to develop treatment plans and provide pharmacotherapy if necessary.

• Case Managers & Community Health Workers:

  • Maintain patient records, connect patients to care, and navigate healthcare systems.

• Medical Assistants/Nurses:

  • Administer screenings and report concerning responses.

• Behavioral Health (BH) Specialists:

  • Investigate unhealthy substance use, adjust treatment plans, and conduct motivational interviews.
  • May provide behavioral therapy.

• Peer Support Specialists:

  • Assist patients with goal setting and navigating recovery.

Patient Approach

• Important Approaches:
  • Be forthright about privacy, genuine in communication, and available to answer patient questions.
  • Maintain confidentiality of patient records.

Screening Tools for At-Risk Patients

• Assessment Tools: Use evidence-based screening tools to identify at-risk patients (e.g., AUDIT, CAGE, DAST-10).
  • Men: “How many times in the past year have you had five or more drinks in a day?”
  • Women: “How many times in the past year have you had four or more drinks in a day?”
• Risk Categories:
  • Low Risk: AUDIT scores 0-6 for women and men >65 or 0-7 for men 18-65.
  • Risky: AUDIT scores 7-15 or DAST scores 1-2.
  • Harmful/Severe: AUDIT scores 16-40 or DAST scores 3-10.

Treatment Approaches

• Individualization: Tailored treatment plans based on patient needs and willingness.
• Integrated Health Model: PCPs assess initial needs; BH specialists undertake comprehensive assessments.

Levels of Care (ASAM)

1. Early Intervention: Provided by PCPs; brief interventions and self-management support.
2. Outpatient Services: Includes pharmacotherapy and behavioral therapy.
   • Medications for Alcohol Use Disorder:
     • Acamprosate: Prevents relapse post-detox.
     • Disulfiram: Discourages drinking through unpleasant effects.
     • Naltrexone: Blocks euphoric effects of alcohol.
   • Medications for Opioid Use Disorder (MOUD):
     • Buprenorphine: Partial opioid receptor agonist.
     • Methadone: Full agonist; requires monitoring.
     • Naloxone: Reverses opioid overdose.
3. Intensive Outpatient Program (IOP) / Partial Hospitalization Program (PHP): Short-term intensive care.
4. Residential/Inpatient Services: 24-hour support for severe cases.
5. Medically Managed Intensive Inpatient Services: Medical detoxification.

Treatment Duration

• Tailored Plans: Reviewed and adjusted after initial weeks based on individual needs. Regular follow-ups (monthly or quarterly) ensure progress.

Evidence-Based Assessment

• Approach: Involves integrating various data to enhance clinical outcomes for individuals with SUD. Key factors include:
  • Criteria for DSM-5 Diagnosis: Involves recurrent substance use leading to impairment or distress.
  • Limitations: Lack of focus on the etiological aspects of SUD.

Comorbidity and Developmental Life Course of SUD

• Prevalence: 1.6% in ages 12-17; 10.1% in ages 18+.
• Developmental Trends: Substance use peaks between ages 18-22, declines thereafter.
• Pathways to SUD:
  • Deviance Proneness: Higher impulsivity leads to riskier behavior.
  • Stress: Coping mechanisms through substance use.
  • Pharmacological Sensitivity: Individual differences in substance response.

Assessment Process**

• Stigma Awareness: Use of a person-centered approach that fosters empathy and understanding.
• Flexibility in Timing: Adjust assessments based on physical and emotional readiness.
• Comorbidity: Evaluating common features across disorders aids in comprehensive treatment planning.