Treatment and Discharge Planning
Remember the specification from the syllabus and the feedback from previous grading rubrics on these discussions. Remember to use a conversational tone, writing more like you speak than like you would for a test essay. Think out loud and pose unanswered questions that other students can respond to. There is no requirement for you to locate an additional reading or citation. The discussion focuses mainly on the chapter by Phillips, Friedman, Saitz and Samet in the book by Ries, et al. So instead of an outside reading please just make reference to something specific from the other chapters, like Tom McLellan’s.
For this discussion lets look more closely at some of the questions posed by Phillips, Friedman, Saitz and Samet in the book by Ries, et al. Summarizing, they indicate:
Persons with substance use problems are at substantial risk for coexisting medical and mental health problems and often present for treatment in mental health settings. Similarly, patients in addictive disorder treatment settings commonly experience medical and psychiatric problems, which can distract from recovery and increase relapse risk. In both mental health and addictive disorder treatment settings, the provision of comprehensive care for individuals with alcohol and other drug use disorders presents challenges to clinicians who traditionally have been concerned only with issues reflecting their own training and perspectives.
Medical practitioners typically address the toxic effects of a particular substance, such as seizures or cirrhosis, or the health consequences of a high-risk lifestyle, such as viral hepatitis or HIV. Mental health professionals focus on the mental health issues that are prevalent among substance-using patients such as depression or mood disorders, personality disorders. Meanwhile, addiction specialists may focus on the individuals destructive preoccupation with obtaining and consuming a psychoactive chemical substance and the negative consequences of such actions.
For the patient, these problems are inseparable, yet the providers often operate in distinct systems of care, each with its ownoften exclusivefocus. For example, the medical literature contains instances of medical practitioners not attending to the addictive disorders of their patients by failing to screen, intervene, or refer. Similarly, patients in addictive disorder treatment programs report unmet psychological and medical needs. It is as if substance-using patients with psychiatric or medical illnesses sometimes are bounced between systemstold that they must be abstinent before they can receive treatment for their psychiatric and medical problems or that they are too sick (medically or psychiatrically) to get into an addiction treatment programresulting in a clinical Catch-22. What to do?
For this discussion,
Summarize the problems both clinically and systemically, even epidemiologically, that are caused by this fractured and siloed treatment world.
How has the history of the addiction treatment system played into this?
What is a better model? What are some of McLellan’s suggestions?
What is the effect of the Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act of 2010 and how will/is this impacting the discharge planning and referrals across the continuum of care?
Throughout your discussion with each other consider the implications your ideas have for both treatment and discharge planning.
