Management of Adults Recovering From Alcohol or Other Drug Problems
Patients recovering from substance use disorders are commonly seen in the primary care setting, and relapse is a serious long-term problem for these patients.
Extrapolating from therapeutic strategies effective in specialty addiction treatment settings, this article outlines a practical approach to relapse prevention in the primary care setting.
Working within a supportive patient-physician relationship, the primary care physician can help recovering patients decrease their susceptibility to relapse, recognize and manage high-risk situations, and use available self-help, pharmacological, and specialty resources.
Drawing on the therapeutic relationship and skills they already possess, primary care physicians can have an important, productive, and satisfying role in the long-term management of patients in recovery from alcohol or other drug problems.
RELAPSE, a return to the use of alcohol or other drugs, is a serious problem for patients recovering from substance use disorders. Despite the effectiveness of addiction treatment for initiating recovery, only 20% to 50% of patients remain abstinent during the first year.
Specialty aftercare may lessen relapse, but addiction treatment duration and access to aftercare have decreased in recent years, resulting in earlier return of recovering patients to the care of their primary care practitioners. Primary care physicians are poorly prepared for the long-term management of patients with substance use problems. To help these patients avoid relapse, generalist physicians need skills in the support and maintenance of recovery.
Consensus statements recommend that primary care physicians routinely screen all patients for substance use disorders. Recent publications provide the primary care physician with brief, effective approaches to motivate patients to recognize and address their substance use problems.
Based on the theoretical model of the stages of behavioral change, these approaches are designed for the management of patients with current, active substance use problems who either do not recognize the problem (ie, the precontemplation stage) or are considering change (ie, the contemplation stage), but provide little guidance about how to work with patients who have stopped using alcohol or other drugs (ie, the maintenance stage).
This article focuses on the care of patients in recovery from substance use disorders.
For primary care physicians aware of their recovering patients’ struggles, we outline a practical approach to the support of a substance-free lifestyle. Our discussion centers on patients who are early in recovery and at highest risk for relapse, although many of these principles also apply to longer-term recovery.
The full article includes sections on the following topics;
- IDENTIFY PATIENTS IN RECOVERY
- ESTABLISH A SUPPORTIVE PATIENT-PHYSICIAN RELATIONSHIP
- SCHEDULE REGULAR FOLLOW-UP
- MOBILIZE FAMILY SUPPORT
- FACILITATE INVOLVEMENT IN 12-STEP RECOVERY GROUPS
- HELP RECOVERING PATIENTS RECOGNIZE AND COPE WITH RELAPSE PRECIPITANTS AND CRAVING
- ADVISE RECOVERING PATIENTS TO DEVELOP A PLAN TO MANAGE EARLY RELAPSE
- FACILITATE POSITIVE LIFESTYLE CHANGES
- MANAGE DEPRESSION, ANXIETY, AND OTHER COMORBID CONDITIONS
- CONSIDER ADJUNCTIVE PHARMACOTHERAPY
- COLLABORATE WITH ADDICTION SPECIALTY PROFESSIONALS
CONCLUSIONS
The primary care physician can have a central, productive, and satisfying role in the long-term management of patients in recovery from substance use problems. Generalist physicians already possess many of the skills necessary for relapse prevention. Specific recommendations and counseling strategies, extrapolated from therapeutic modalities effective in other settings, are feasible in the primary care physician’s office. Future research should examine the effectiveness and cost of relapse prevention in the primary care setting. Given current knowledge about relapse prevention and the effectiveness of physician involvement with their patients’ substance use problems, primary care physicians should begin the important work of supporting, monitoring, and maintaining patients in recovery from alcohol or other drug problems.
Research report; Peter D. Friedmann, Richard Saitz, Jeffrey H. Samet. Management of Adults Recovering From Alcohol or Other Drug Problems; Relapse Prevention in Primary Care; JAMA. 1998;279:1227-1231.
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