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Assessment and Treatment Planning for Cocaine-Abusing Methadone-Maintained Patients
Treatment Improvement Protocol (TIP) Series10

[Tables and Figures]

Figure 1: Sample Substance Use History Form

CLINICAL RECORD				Admission Assessment
SUBSTANCE USE HISTORY
Drug	Current use (x)	Current rank	Past use only (_)	Year of 1st use	Date of last use	Typical pattern of use, including amount of daily use	Mode
Alcohol
Cocaine
Heroin
Methadone
Other opioids
Methamphetamine
Other amphetamine
Benzodiazepines
Barbiturates or other sedatives
Cannabis
LSD
Other psychedelics
PCP
Other (specify)

Cigarettes		- - -
Other nicotine		- - -
Caffeine		- - -
Additional comments on history and pattern of use of primary substances: (use reverse side of page if more space is required)
Patient Identification
Clinician:
Date:

Table 1. Commonly encountered psychiatric disorders among cocaine and heroin abusers

Table 1. Commonly encountered psychiatric disorders among cocaine and heroin abusers
Disorder Category	Disorder
Axis I	Affective disorders Major depression Dysthymic disorder Bipolar disorder
Axis I	Anxiety disorders Panic disorder Agoraphobia Social phobia Posttraumatic stress disorder
Axis I	Attention deficit hyperactivity disorder
Axis I	Schizophrenia
Axis II	Antisocial personality disorder Narcissistic personality disorder Borderline personality disorder

Table 1. American Society of Addiction Medicine adult patient placement criteria for the treatment of psychoactive substance use disorders

Table 1. American Society of Addiction Medicine adult patient placement criteria for the treatment of psychoactive substance use disorders
Levels of care
Criteria dimensions	Level I Outpatient treatment	Level II Intensive outpatient treatment	Level III Medically monitored intensive inpatient treatment	Level IV Medically managed intensive inpatient treatment
1 Acute intoxication and/or withdrawal potential	No withdrawal risk	Minimal withdrawal risk	Severe withdrawal risk but manageable in Level III	Severe withdrawal risk
2 Biomedical conditions and complications	None or very stable	None or nondistracting from addiction treatment and manageable in Level II	Requires medical monitoring but not intensive treatment	Requires 24-hour medical, nursing care
3 Emotional and behavioral conditions and complications	None or very stable	Mild severity with potential to distract from recovery	Moderate severity needing a 24-hour structured setting	Severe problems requiring 24-hour psychiatric care with concomitant addiction treatment
4 Treatment acceptance and resistance	Willing to cooperate but needs motivating and monitoring strategies	Resistance high enough to require structured program, but not so high as to render outpatient treatment ineffective	Resistance high despite negative consequences and needs intensive motivating strategies in 24-hour structure	Problems in this dimension do not qualify patient for Level IV treatment
5 Relapse potential	Able to maintain abstinence and recovery goals with minimal support	Intensification of addiction symptoms and high likelihood of relapse without close monitoring and support	Unable to control use despite active participation in less intensive care and needs 24-hour structure	Problems in this dimension do not qualify patient for Level IV treatment
6 Recovery environment	Supportive recovery environment and/or patient has skills to cope	Environment unsupportive but with structure or support, the patient can cope	Environment dangerous for recovery necessitating removal from the environment; logistical impediments to outpatient treatment	Problems in this dimension do not qualify patient for Level IV treatment
SOURCE: Center for Substance Abuse Treatment. Intensive Outpatient Treatment for Alcohol and Other Drug Abuse. Treatment Improvement Protocol (TIP) Series, No. 8. DHHS Pub. No. (SMA) 94-2077. Rockville, MD: Center for Substance Abuse Treatment, 1994b.

Table 2. CSAT model for comprehensive alcohol and other drug (AOD) abuse treatment

Table 2. CSAT model for comprehensive alcohol and other drug (AOD) abuse treatment
A model treatment program includes the following:
Assessment including a medical examination, drug use history, psychosocial evaluation, and where warranted, psychiatric evaluation, as well as a review of socioeconomic factors and eligibility for public health, welfare, employment, and educational assistance programs
Same-day intake to retain the patient's involvement and interest in treatment
Documentation of findings and treatment to enhance clinical case supervision
Preventive and primary medical care provided on site
Testing for infectious diseases at intake and at intervals throughout treatment, for infectious diseases, such as hepatitis, retrovirus, tuberculosis, HIVAIDS, syphilis, gonorrhea, and other sexually transmitted diseases
Weekly random drug testing to ensure abstinence and compliance with treatment
Pharmacotherapeutic interventions by qualified medical practitioners, as appropriate for those patients having mental health disorders, those addicted to opiates, and those who are HIV seropositive
Group counseling interventions to address the unique emotional, physical, and social problems of HIVAIDS patients
Basic substance abuse counseling including psychological counseling, psychiatric counseling, and family or collateral counseling provided by persons certified by State authorities to provide such services. Staff training and education are integral to a successful treatment program
Practical life skills counseling including vocational and educational counseling and training, frequently available through linkages with specialized programs
General health education including nutrition, sex and family planning, and HiV/AIDS counseling, with an emphasis on contraception counseling for adolescents and women
Peer/support groups particularly for those who are HIV positive or who have been victims of rape or sexual abuse
Liaison services with immigration, legal aid, and criminal justice system authorities
Social and athletic activities to retrain patients' perceptions of social interaction
Alternative housing for homeless patients or for those whose living situations are conducive to maintaining the addicted lifestyle
Relapse prevention which combines aftercare and support programs, such as Alcoholics Anonymous and Narcotics Anonymous, within an individualized plan to identify, stabilize, and control the stressors that trigger and promote relapse to substance abuse
Outcome evaluation to enable refinement and improvement of service delivery

Table of Contents

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