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What to do When a Person Uses Substance While in Treatment


David Mee-Lee explained that doctors that work in addiction may not agree as much as one would think on a multitude of issues in treatment. In this issue he is specifically speaking on how we manage those who use while in treatment. He reports, “It was fascinating to see how this group of committed physicians, all of whom firmly believe addiction is a disease needing chronic disease management, varied in their views on what to do when a patient has a flare-up of addiction and uses substances while in treatment.” He explained that a zero tolerance policy “is not consistent with viewing addiction as a chronic disease characterized by loss of control of use, and prone to relapse or acute exacerbation of addiction illness.”

According to Andrea Barthwell, M.D. and William E.McAuliffe treatment is complete when:

(a) the patient acknowledges addiction,

(b) commits to recovery, and

(c) reduces or eliminates inducements to use.

So if these steps have not happened, have our client’s truly relapsed, or are they simply continuing their use?

David Mee-Lee Recommends: TIP 1

Consider these steps when a person uses substances while in treatment:

1. View such a flare-up as a poor outcome, which needs assessment and a change in the treatment plan.

2. Collaborate with the patient to discover: What went wrong? What is s/he willing to do differently in their treatment plan that is in a positive direction?

3. Call a crisis patient community meeting. Highlight the dangers of use in the treatment community and address any triggering or even actual use by others.

4. Work with any patients affected by their fellow patient’s flare-up. Help them learn from this and change their treatment plan accordingly.

5. Discharge the person who used only if s/he is not interested in treatment and just wants to “do time” in a treatment program and continue using trying not to get caught.

So what do we think? What is the belief on our teams and how will we agree to manage those who have a disease “flare-up” ? Please discuss this topic at your team meetings and send your answers to:

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