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

Rehabilitation Programs Inpatient Residential Intensive outpatient Individual counseling CBT, MET Sober living

Inpatient Rehab Highest level of care Unlikely insurance will cover Must be able to think clearly, ambulate, and tolerate po’s Usually lasts a few days then transition to lower level of care

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

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

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 individual’s outcome expectancy

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

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

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

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

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?

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?

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?

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

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

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

Professionals in Recovery Treatment Recommendations Diversion Programs Monitoring Co-morbidity (Univ. of Washington Study)

Referral Sources Local hospitals Internet (residential programs don’t all look alike) A.A. in the phone book Treatment Provider Guide located at