Continuity of Treatment and Dual Disorders Services
Most service providers recognize that recovery for people with substance use and mental health disorders is an ongoing, lifelong process. But how can providers assess their commitment to this process? Here are a few key areas of inquiry.
Some people feel that next to choosing a partner for marriage, the most important choice we make in life is in choosing a therapist. Although this may strike some as hyperbole, few would argue that the attachment patients make with a treatment provider is a critically important and potentially enduring one. Having developed trust in a treatment provider, patients soon learn that moving on is a necessary part of the treatment process.
Nonetheless, particularly in outpatient settings, continuity of care is possible and time-unlimited treatment is an option. Even in hospital or residential settings, where such a level of continuity of care with the patient's existing treatment provider may be less realistic, clearly defined linkage to the next level of care is imperative. There may be some realistic limitations to the amount of contact a patient has with his or her former therapist based on managed care, staff caseload, or other considerations, but recovery checkups may be considered routine care.
Co-occurring Disorders Program:
Clinical Administrator's Guidebook
Softcover, 192 pp., with CD-ROM
Published Year: 2008
Online Price: $85.00 Each
This guidebook provides an overview of the Hazelden Co-occurring Disorders Program and an introduction to integrated treatment.
Some residential programs have built in return visits for patients. These can include peer support group meetings, alumni weekends, or events to reinforce continuity. Other residential programs have developed or are connected to outpatient components and have some clinical staff, such as a physician or psychologist, who work in both the outpatient and inpatient, hospital or residential, levels of care. This common staff denominator provides a nice sense of continuity for patients who are making a transition from a structured to an unstructured environment.
To evaluate continuity of care, service providers need to consider their treatment policies around co-occurring disorders. What is the policy for patients who become psychiatrically symptomatic during the course of addiction treatment? Are these patients treated within the addiction treatment program until stabilized? Are they referred for psychiatric care, and once stabilized are they accepted back into the addiction treatment program? Or once they become psychiatrically symptomatic are they forever "blacklisted" from the mental health treatment program once they exhibit a substance use disorder?
Also consider the policy for substance use relapse in mental health treatment programs. How does the mental health treatment program respond to substance use? Are these patients treated within the mental health treatment program until stabilized? Are they referred for addiction treatment and once stabilized are they accepted back into the mental health program? Or are they barred from re-entering the mental health treatment program? Continuity of care is important to consider not only with respect to recovery from addiction but also in psychiatric recovery.
You can learn about your program's approach to continuity of care by reviewing your procedures for providing consistent follow-up care for both disorders. Ask if your program's overall goal is co-occurring disorder illness management. Programs that provide addiction services only often discharge a patient with a co-occurring disorder who develops acute psychiatric symptoms. Similarly mental health services-only programs may discharge a patient with a co-occurring disorder who returns to alcohol or other drug use.
To move to providing integrated dual-disorders services, programs must develop procedures for dealing with changing levels of psychiatric symptoms as well as relapses where the patient returns to alcohol or drug use. Typically programs that provide full dual-disorders services evaluate the changing symptoms of both disorders. If the patient is sufficiently stable, the patient will be allowed to remain in the current program. If a referral is required-preferably within the same agency or to a mental health agency or addiction treatment program with which there is a memorandum of understanding (or a charter agreement) -the program will accept the patient back once he or she is stabilized. Programs must provide in-house services to deal effectively with changing levels of psychiatric and substance use systems.
Additional questions to ask when considering your program's continuity of treatment for co-occurring disorders: Does your program focus on ongoing recovery issues for both mental health and substance use disorders? Does your program facilitate the connection to peer recovery support groups beyond the patient's treatment episode and out in their home community? Does your program have a sufficient supply of prescription medications for needs beyond the treatment episode and an adequate medication adherence plan?