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Minnesota Health Technology Advisory Committee  SAMHSA/CSAT Treatment Improvement Protocols29 . TIP 29: Substance Use Disorder Treatment For People With Physical and Cognitive Disabilities Title Page Substance Use Disorder Treatment For People With Physical and Cognitive Disabilities Treatment Improvement Protocol (TIP) Series 29 Dennis Moore, Ed.D. Consensus Panel Chair U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Rockwall II, 5600 Fishers Lane Rockville, MD 20857 DHHS Publication No. (SMA) 98-3249 Printed 1998 This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. All material appearing in this volume except that taken directly from copyrighted sources is in the public domain and may be reproduced or copied without permission from the Center for Substance Abuse Treatment (CSAT) or the authors. Citation of the source is appreciated. This publication was written under contract number 270-95-0013 with The CDM Group, Inc. (CDM). Sandra Clunies, M.S., I.C.A.D.C., served as the CSAT government project officer. Rose M. Urban, M.S.W., J.D., C.S.A.C. served as the CDM TIPs project director. Other CDM TIPs personnel included Jonathan Gilbert, M.A., managing editor, Y-Lang Nguyen, copy/production editor, Raquel Ingraham, M.S., project manager, Mary Smolenski, Ed.D., C.R.N.P., former project director, and MaryLou Leonard, former project manager. Special thanks go to consulting writers Jeff Allen, Ph.D., A.B.P.P., Janet Dickinson, Ph.D., Debra Guthmann, Ed.D., and Elizabeth Villalobos, M.S.W., for their contributions to this document. The opinions expressed herein are the views of the Consensus Panel members and do not reflect the official position of the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT or DHHS for these opinions or for particular instruments or software that may be described in this document is intended or should be inferred. The guidelines in this document should not be considered substitutes for individualized patient care and treatment decisions. CSAT Treatment Improvement Protocols (TIPs) are best practice guidelines for the treatment of substance use disorders. CSAT's Office of Evaluation, Scientific Analysis and Synthesis draws on the experience and knowledge of clinical, research, and administrative experts to produce the TIPs, which are distributed to a growing number of facilities and individuals across the country. The audience for the TIPs is expanding beyond public and private treatment facilities for substance use disorders as these disorders are increasingly recognized as a major problem. The TIPs Editorial Advisory Board, a distinguished group of substance use disorder experts and professionals in such related fields as primary care, mental health, and social services, works with the State Alcohol and Drug Abuse Directors to generate topics for the TIPs. Topics are based on the field's current needs for information and guidance. After selecting a topic, CSAT invites staff from pertinent Federal agencies and national organizations to a Resource Panel that recommends specific areas of focus as well as resources that should be considered in developing the content for the TIP. Then recommendations are communicated to a Consensus Panel composed of non-Federal experts on the topic who have been nominated by their peers. This Panel participates in a series of discussions; the information and recommendations on which they reach consensus form the foundation of the TIP. The members of each Consensus Panel represent substance use disorder treatment programs, hospitals, community health centers, counseling programs, criminal justice and child welfare agencies, and private practitioners. A Panel Chair (or Co-Chairs) ensures that the guidelines mirror the results of the group's collaboration. A large and diverse group of experts closely reviews the draft document. Once the changes recommended by these field reviewers have been incorporated, the TIP is prepared for publication, in print and online. The TIPs can be accessed via the Internet on the National Library of Medicine's home page at the URL: http://isis.nlm.nih.gov. The move to electronic media also means that the TIPs can be updated more easily so they continue to provide the field with state-of-the-art information. While each TIP strives to include an evidence base for the practices it recommends, CSAT recognizes that the field of substance use disorder treatment is evolving, and research frequently lags behind the innovations pioneered in the field. A major goal of each TIP is to convey "front-line" information quickly but responsibly. For this reason, recommendations proffered in the TIP are attributed to either Panelists' clinical experience or the literature. If there is research to support a particular approach, citations are provided. This TIP, Substance Use Disorder Treatment for People With Physical and Cognitive Disabilities, is intended to enhance treatment providers' knowledge concerning people who have a physical or cognitive disability in addition to their substance use disorder. Treatment programs for substance use disorders already see many individuals with coexisting disabilities, but many providers fail to accommodate these individuals either because they are unaware of the disability or how accommodations can improve treatment outcomes (even though such accommodations are legally mandated). The first chapter defines and explains the issues involved in treating people with coexisting disabilities. Chapter 2 discusses how to screen for coexisting disabilities and how to adapt substance use disorder screenings for clients who have a disability. Chapter 3 discusses treatment planning and counseling; it also describes how treatment can be modified to meet the particular needs of people with coexisting disabilities. Forming linkages with other service providers is the topic of Chapter 4, and Chapter 5 presents material for program administrators. In Appendix B, there is a comprehensive list of resources. Appendix C discusses the proper language to use when referring to people with disabilities. Alcohol and Drug Programs and the Americans With Disabilities Act, a pamphlet from the Pacific Research and Training Alliance, is reproduced in Appendix D. Other TIPs may be ordered by contacting the National Clearinghouse for Alcohol and Drug Information (NCADI), (800) 729-6686 or (301) 468-2600; TDD (for hearing impaired), (800) 487-4889.
Chair
The Treatment Improvement Protocol (TIP) series fulfills SAMHSA/CSAT's mission to improve treatment of substance use disorders by providing best practices guidance to clinicians, program administrators, and payors. TIPs are the result of careful consideration of all relevant clinical and health services research findings, demonstration experience, and implementation requirements. A panel of non-Federal clinical researchers, clinicians, program administrators, and patient advocates debates and discusses its particular areas of expertise until it reaches a consensus on best practices. This panel's work is then reviewed and critiqued by field reviewers. The talent, dedication, and hard work that TIPs panelists and reviewers bring to this highly participatory process have bridged the gap between the promise of research and the needs of practicing clinicians and administrators. We are grateful to all who have joined with us to contribute to advances in the substance use disorder treatment field.
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Overview of Treatment Issues