Your gatekeeper role as a primary care physician or counselor will likely require you to refer one or more patients to an addiction treatment center.  Doctors and counselors may be ill-equipped to do this, but as addiction problems continue to expand with drugs like prescription painkillers, you will need to improve and refine this skill.


Addiction Treatment Options

First, you need to familiarize yourself with addiction treatment centers that can accept your patients and effectively treat their addiction problems, both within and outside of your geographic area. Don’t be afraid to question addiction treatment centers on their treatment specialties and the insurance they’ll accept, how they plan and coordinate their patients’ schedules, how they plan and administer treatment, and what they do once a patient is discharged. You should know what type of paperwork each center needs to admit a patient and what kind of updates you’ll receive on a patient’s progress. Because so many addicted patients experience relapse, you should pay attention to post-discharge care that various centers will offer.


Understanding addiction treatment options provides a foundation for your referrals of clients to those centers. The more difficult step is convincing your addicted patients (or their loved ones) to enroll in an addiction treatment program without alienating them and driving them away from a recovery. Substance abuse is increasing across all patient populations and it is incumbent on you, as a primary care physician or counselor, to recognize the symptoms of substance abuse in your patients and to recommend the best addiction treatment program for them.


You can uncover some evidence of substance abuse through simple question-answer screening techniques and observations of your patient’s overall health during physical exams. A patient who is reluctant to discuss these issues with you can still benefit from your services if you approach the exam without judging the patient or his or her actions. Brief or abbreviated interventions can frequently be as effective as in-depth actions because they are less likely to confront or antagonize the patient, but they instead provide motivation for a patient to take his or her own steps toward more in-depth addiction treatment.


Handling Addiction with Patients

Some counselors use an approach that emphasizes feedback, personal responsibility by the patient, advice on making changes and a menu of options to help with those changes, empathy without judgment, and self-efficacy with follow-up treatment.  This addiction treatment referral approach places more responsibility on your patient to take affirmative steps to treat his or her addiction problems. If your addicted patients are older, this emphasis on personal responsibility may produce better results than hard commands or directions to your patients to stop using addictive drugs.


You might implement this approach by changing your hard commands to questions.  For example, rather than demanding that a patient stop his cocaine use, consider asking him if he thinks his chest pains or other discomforts would go away if he stopped using cocaine. Placing responsibility on a patient and allowing him to make decisions and take action on his own accord will enhance the success of your referrals into addiction treatment programs.


You can’t make a patient change his or her addictions by demanding that he follow your advice and enroll in an addiction treatment program. You can, however, gently but firmly push him in that direction while giving him the tools to make that decision himself. You can then best fulfill your role as a primary gatekeeper by working with him or her to get into the best treatment facility that can address his or her problems.   


Treatment Now offers advice and assistance to primary care physicians. 

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