Health Care Provider FAQs
Health Care Provider FAQs
It is recommended that you discuss the following with your patients:
- Adverse consequences of risky use and the nature of addiction—that it is a disease that can be prevented and treated effectively
- Risk factors for substance use, tailoring the information to the patient’s age, gender, mental health history and other relevant medical, social and demographic characteristics
- Times of increased risk for substance use, such as adolescence, key life transitions and stressful life experiences
- Steps they can take to prevent risky use of addictive substances and the onset of addiction. These include delaying initiation of substance use, following guidelines for the safe use of alcohol and controlled prescription medications, being vigilant for signs and symptoms of risk and seeking professional help at the first sign of trouble
Yes. Screening is an effective method of preventive care comparable to yearly Pap smears or colonoscopies to identify cancer indicators. It is recommended that providers routinely screen all patients for use of tobacco/nicotine, alcohol and other drugs.
Screening tools typically include written or oral questionnaires and, less frequently, clinical and laboratory tests. Unfortunately most available screening tools either fail to include all substances and/or do not identify the full range of risky users. CASAColumbia has developed a simple screening tool for patients that identifies risky users of all substances.
All patients who screen positive should receive a diagnostic evaluation to determine whether they have the disease of addiction or are risky users.
Health care providers should use standardized criteria such as those in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association.
Patients who screen positive for risky substance use but do not meet the threshold of clinical addiction may be able to reduce their use and the chances of negative consequences with structured discussions that provide them with advice and motivation. These interventions can be delivered face-to-face or over the phone or computer by a broad range of trained health professionals, including doctors, nurses, physician assistants and clinical mental health counselors.
All patients with a diagnosis of addiction require a complete and comprehensive assessment to determine:
- The form and severity of the addiction
- Any other health (including psychiatric) conditions
- Potential for complications related to withdrawal
- Presence of other factors that may affect treatment outcome, including family and social support
This is a necessary first step in determining a patient’s treatment needs.
More information is available at the American Society of Addiction Medicine website.
The first step in addressing addiction involving nicotine, alcohol or other drugs is cessation of use and, if necessary, medically managing the clearance of toxic substances from the patient’s system, also known as detoxification. While cessation of use can in some cases be a self-managed process, patients typically need professional assistance. For patients who demonstrate physical dependence on a substance, cessation of use on their own may be unsafe and medically supervised detoxification may be required to manage withdrawal symptoms and complications. For those with addiction involving opioids, cessation of use is often accomplished by immediate transition to medications that reduce cravings and withdrawal symptoms and that may be continued over time.
Effective, clinical treatments for addiction include a range of pharmaceutical and/or psychosocial therapies delivered by qualified health professionals. Due to the complex nature of addiction and its physiological, psychological and environmental risk factors, a multi-pronged approach to treatment tailored to each patient that includes a combination of medications and psychosocial therapies typically yields the best results.
Because of the extent to which addiction co-occurs with a broad range of other health problems, effective medically managed treatment protocols also should address both co-occurring disorders, including psychiatric conditions, and nutrition and exercise requirements.
Types of Treatment: Medications
Medications for addiction treatment may work by:
- Reducing cravings for the addictive substance and/or reducing aversive withdrawal symptoms (e.g., acamprosate, bupropion)
- Creating an aversion to the addictive substance or attenuating the rewarding effects of the addictive substance, eventually limiting its appeal (e.g., disulfiram, naltrexone, varenicline)
- Producing moderated effects resembling those of the addictive substance and serving as a less addicting replacement for the substance of addiction (e.g., nicotine replacement therapy, methadone, buprenorphine/naloxone)
Types of Treatment: Psychosocial Therapies
Psychosocial treatments for addiction aim to alter patients’ attitudes and behaviors regarding use of tobacco/nicotine, alcohol and other drugs. These therapies enhance patients’ skills in coping with life challenges, navigating high-risk situations, avoiding substance-use triggers, controlling cravings and coping with lapses. Some therapies focus on enhancing patients’ motivations to change their substance-related behaviors. Other therapies focus on helping patients alter their environments in order to reduce pressures and cues to use, or provide positive or negative reinforcements to help patients change their attitudes and behavior. Examples include cognitive behavioral therapy, community reinforcement approach, contingency management and couples/family therapy.
Ideally, you should consult with and/or refer your patients to addiction specialists for advanced treatment options for addiction.
An addiction specialist can be found through these sites:
- Addiction medicine physicians: find a doctor near you
- Addiction psychiatrists: find a doctor near you
You may also consult with and/or refer your patients to clinical psychologists specializing in addiction for psychotherapies and, in cases where licensing permits, pharmaceutical therapies.
- Addiction psychologists: find a psychologist near you
Note: for "Area of Specialization," select “Addictions/Other or Addictions/Substance”
You may consider further specialization to more effectively assess and treat addiction in your patient population.