Integrated Summary and Screening Tools for Substance Use Disorders

Integrated Summary Purpose

• To communicate the individual's story (Executive Summary) between providers.
• To synthesize information for diagnostic support and level of care determination.
• To drive the treatment plan by identifying:
  • The problems faced by the patient.
  • The impact of these problems.
  • Strategies to meet physical, social, emotional, and behavioral needs.

Parts of the Integrated Summary

• Summary includes:
  • The presenting problem and evidence of impairments.
  • The diagnosis and supporting evidence.
  • Treatment recommendations using ASAM guidelines.
  • Focus of treatment and how current strengths and needs will be addressed:
  • What will be addressed.
  • Why it is necessary.
  • How it will be addressed.
  • Family involvement, if exists.
• Preliminary Relapse Prevention Plan included.

Presenting Problem & Evidence

• Assessment initiation can occur through:
  • Referral or self-initiated assessment.
  • Summarize the evolution and impact of the problem on the individual’s life (social, emotional, physical, occupational).
• If collateral sources are unavailable, gather insights from patient on what significant others would say about the problem.

Summary Insights

• The integrated summary should:
  • Summarize factual data while supporting subjective opinions.
  • Substantiate the diagnosis and recommendations for treatment.
  • Identify initial treatment goals collaboratively with the patient.
  • Establish a preliminary relapse prevention plan.
• The IS aims to:
  • Clearly outline issues.
  • Justify insurance reimbursement for the recommended level of care.
  • Define how to assist the patient in meaningful improvement of functioning in diverse aspects.

Screening Overview

• General Definition: Methodical evaluation to assess suitability for a particular purpose.
• Medical Definition: Examination of typically asymptomatic individuals for disease probability detection and initial treatment suitability evaluation.
• Reality Consideration: Weighing the benefits of early diagnosis against potential treatment harms.

Screening Tool Characteristics

• A good screening tool is characterized as:
  • Universal within the facility.
  • Suitable across different caregiver levels.
  • Easy to administer, valid, reproducible, and patient-friendly.

Various Screening Tools

• TAPS: For tobacco, alcohol, prescription medication, and other substance use.
• CRAFFT: Adolescent-focused, assesses past year substance use and related risk.
• DAST-10: Drug-focused screening, excluding alcohol and tobacco.
• CAGE (AID): Alcohol and drugs, designed to identify potential substance use disorder.
• 5 Ps: For use in pregnant individuals regarding substance use history.

ASAM Levels of Care

• Level 0.5: Early intervention for individuals at risk of SUD.
• Level 1-2: Outpatient treatment and intensive outpatient services are available.
• Level 3: Various residential treatment options depending on specific needs.
• Level 4: Medically managed intensive inpatient services for severe cases.

Co-Occurring Disorders and Prevalence Rates

• Significant prevalence of co-occurring mental health disorders in patients with substance use disorders (SUD).
• Notable numbers include:
  • 40% of AUD patients have mood disorders.
  • Anxiety is prevalent in 33% of SUD cases.
  • Heavy cannabis users exhibit higher rates of psychiatric diagnoses.

Treatment Insights

• Treatments primarily focus on the disease of addiction, addressing co-occurring mental health issues as necessary.
• Medications for Opioid Use Disorder (MOUD) may be included in the treatments if applicable.
• The process of treatment referrals may require time, with close monitoring acceptable during that period.
• Not all facilities cater to inpatient needs or co-occurring concerns, with outpatient services being sufficient for many individuals.