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AFH 1 · Chapter 22 · Section 22.24

Substance Use Assessment and Treatment

Part of Force Development · 2 sections · ~661 words · WAPS PFE study material

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Substance Use Assessment — Nonclinical and Clinical Services

Purpose of the Assessment

Assessment Central Purpose
The central purpose of the substance use assessment is to determine the patient's need for treatment and level of care required.

7-Day Review Window

7-Day Review
ADAPT program managers conduct required reviews of medical records and all documentation within seven calendar days of notification to determine:
  • Diagnosis
  • Treatment planning
  • Delivery of substance use services

Two Service Types

Two Service Types
Substance use treatment is divided into two services:
  • Nonclinical
  • Clinical

Nonclinical Services

Nonclinical Eligibility
Members who do NOT meet diagnostic criteria for a substance use disorder will receive targeted prevention and education services tailored to the individual based on a thorough assessment and determination of risk.

Follow-Up

Follow-up appointments and review will be conducted to reassess the need for continued services.

Additional Counseling
Additional counseling addressing bio-psychosocial issues identified in the assessment may be prescribed.

Length of Involvement

Length Determined
Length of involvement will be determined based on the patient's presenting problems and agreed-upon services or behavioral contract.

Separation Process

Separation Care
Individuals being processed for separation are provided appropriate medical care (including but not limited to detoxification) prior to separation.
ADAPT Doesn't Postpone
Separation action is NOT postponed because of a member's participation in ADAPT.

Clinical Services

Clinical Eligibility
Those who meet the diagnostic criteria for a substance use disorder will be entered into substance use treatment with the level and intensity of care determined by the ADAPT program manager.

Variable Treatment Settings

Depending on the member's needs, variable lengths of stay or duration of treatment are provided within an array of treatment settings that reflect a multidisciplinary approach to assist the patient to achieve full recovery, free of the negative effects of substance use.

Detoxification Setting

Outpatient Preferred
To the greatest extent possible, patient detoxification will be managed on an outpatient basis.
Inpatient When Required
Individuals assessed as requiring medically managed (inpatient) detoxification will be entered into an appropriate medical facility.

Family Involvement

Family Involvement
Family involvement is strongly encouraged.

Abstinence and Self-Help

Abstain During Treatment
Individuals diagnosed with a substance use disorder will refrain from the use of alcohol during the initial phase of treatment and are strongly encouraged to continue to abstain during aftercare.
Self-Help Encouraged
Involvement in self-help recovery groups is encouraged as an adjunct to treatment.

Frequency of Self-Help Attendance

Frequency Determined
The frequency of attendance is determined by the treatment team with the patient.

Successful Completion and Failing the Program

Successful Completion

Aftercare Required
Patients will not be considered to have successfully completed treatment until the patient has completed treatment AND continuing care (aftercare).

Clinical Reference Standards

Treatment Reference Sources
Decisions are based on:
  • Veterans Affairs/Department of Defense Clinical Practice Guidelines for Management of Substance Use Disorders
  • Current Diagnostic and Statistical Manual of Mental Disorders criteria
  • American Society of Addiction Medicine criteria

How Progress Is Determined

Treatment Team Determination
The treatment team determines:
  • Patient progress toward agreed-upon goals and issues as stated in the treatment plan
  • When the patient is effectively in recovery and no longer requires program resources

Failing the Program

Failure Triggers
The treatment team may determine failure of a patient's participation in the program based on:
  • A demonstrated pattern of unacceptable behavior
  • Inability or unwillingness to comply with their treatment plan
  • Involvement in alcohol or drug-related incidents after receiving initial treatment

Consequence of Failure

Administrative Separation
An individual who has failed ADAPT will be considered for administrative separation by his or her commander.

Aftercare Decisions Following Failure

Aftercare After Failure
Decisions regarding aftercare services will be based on a current assessment of status and will include establishment of an aftercare treatment plan identifying:
  • Specific goals
  • Interventions
  • Means to assess interventions

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