反差系列

American Society of Addiciton Medicine

Engagement and Retention of Nonabstinent Patients in Substance Use Treatment

https://downloads.asam.org/sitefinity-production-blobs/docs/default-source/guidelines/asam_engagement-and-retention-of-nonabstinent-patients_final_082624.pdf?sfvrsn=b01862ba_1

Clinical Consideration

Engagement and Retention of Nonabstinent Patients in Substance Use Treatment

Clinical Consideration for Addiction Treatment Providers

Engagement and Retention of Nonabstinent Patients in Substance Use Treatment

Clinical Consideration for Addiction Treatment Providers

 

Background

Initiation, engagement, and retention in treatment are critical factors that impact long-term outcomes for substance use disorders (SUDs); early treatment engagement and longer durations of treatment predict better clinical outcomes. Despite this, patients are regularly dissuaded from initiating treatment until they commit to full sustained abstinence from all intoxicants, and too frequently are administratively discharged from SUD treatment programs during instances of substance use recurrence. This document was developed to provide SUD treatment programs and providers with guidance and support to: 1) address the complexities of patient nonabstinence during treatment; 2) reduce administrative discharges; and 3) implement strategies focused on lowering barriers to care to improve engagement and retention of nonabstinent patients in the continuum of care.

This project is funded by the California Department of Health Care Services.

Summary of Recommendations

  1. Cultivate patient trust by creating a welcoming, nonjudgmental, and trauma-sensitive environment
  2. Do not require abstinence as a condition of treatment initiation or retention
  3. Optimize clinical interventions to promote patient engagement and retention
  4. Only administratively discharge patients from treatment as a last resort
  5. Seek to re-engage individuals who disengage from care
  6. Build connections to people with SUD who are not currently seeking treatment
  7. Cultivate staff acceptance and support
  8. Prioritize retention of front-line staff
  9. Align program policies and procedures with the commitment to improve engagement and retention of all patients, including nonabstinent patients
  10. Measure progress and strive for continuous improvement of engagement and retention

 

 

Literature Review and Funding

Funding for this project was provided by the California Department of Health Care Services. The Expert Committee members, listed below, applied and were selected by ASAM’s Quality Improvement Council (members listed below). A targeted literature review was conducted on the evidence regarding engagement and retention in addiction treatment and was used to inform the deliberations of the committee. The final document was reviewed and approved by the ASAM Quality Improvement Council and Board of Directors.

 

Expert Committee 

Eman Gibson, MBA, LCSW, LCADC 
Jackie Lien, LPC 
Samuela Manages, MD, FAAFP 
Sarah Mohr, MA, LCSW, CADC-II 
Colleen Ryan, MD, FASAM 

Gary Tsai, MD, DFAPA, FASAM

 

ASAM Quality Improvement Council

Itai Danovitch, MD, MBA, FAPA, DFASAM 
Kenneth I. Freedman, MD, MS, MBA, FACP, AGAF, DFASAM (co-chair)
Michael P. Frost, MD, DFASAM, FACP 
R. Jeffrey Goldsmith, MD, DLFAPA, DFASAM 
Margaret A. Jarvis, MD, DFASAM (co-chair)
Navdeep Kang, PsyD 
Tiffany Y. Lu, MD, MS 
Tami Mark, PhD, MBA 
Stephen Martin, MD, FASAM 
Melissa B. Weimer, DO, MCR, FASAM 

 

 

 

Field Reviewers

Ford Baker, LCSW 
Matt Boyer, MD, FASAM 
G. Malik Burnett, MD, MBA, MPH
Nathaniel Kratz, MD
David Lawrence, MD, FASAM
Joshua Leiderman, MD, FASAM
Jessica Northcott-Brillati, MSW, LCSW
Jason Powers, MD, MAPP, FASAM, DABAM, FABFM
Kate Roberts, MA, MSW, LCSW
Sarah C. Spencer, DO, FASAM
Mary Wiltshire-Fields

 

Staff and Author Contribution

Literature Search and Evidence Summary: Dawn Lindsay, PhD and Maureen Boyle, PhD
First Draft: Annabel Sibalis, PhD, Sam Sibalis, MBA, Maureen Boyle, PhD, and Amanda Devoto, PhD
Revisions: Expert Committee, Maureen Boyle, PhD, Annabel Sibalis, PhD, and Sacha K. Song, MD
Final Approval: Quality Improvement Council and Board of Directors

 

 

 

Supplemental Materials

A description of the methodology and disclosures of interest is available for download.