Outpatient Treatment
Ideally, outpatients who currently abuse drugs should be enrolled in a drug rehabilitation program; however, patients with advanced medical illnesses may
not be able to be enrolled. The health care provider may outline for the
patient the role of the treatment team, what is expected of the patient, and
the consequences to the patient should he or she continue to abuse drugs while
receiving treatment for medical illness. Patients must receive detailed
instructions for taking prescribed drugs responsibly. They must be seen
frequently so symptom control may be maintained and drug abuse may be
monitored. Frequent visits also avoid the need to prescribe large amounts of
drug at one time, and may help the patient stay on the treatment schedule and
attend appointments with the physician. Some patients may find that a "twelve-step" program is helpful in stopping illegal drug use while they are receiving
treatment.
Outpatients may be required to undergo periodic drug testing. The patient
should be informed in advance of the consequences of a positive test. A urine test that indicates the patient is using illegal drugs may result in the need
to visit the outpatient department more frequently, smaller quantities of
prescribed drugs, referral to a drug rehabilitation program, or other
restrictions.
If the patient lives with family members who are substance abusers, the family
members can be encouraged to enroll in a drug treatment program to help the
patient avoid illegal drugs and alcohol. The patient should also be aware that
friends and family members may attempt to buy or steal the prescribed drugs.
It is very helpful to identify people who will be supportive of the patient.
A treatment team that includes a specialist in addiction medicine may be able
to provide more effective treatment for the outpatient with a progressive
medical disease and a history of substance abuse than can a single physician.
Patients who have successfully stopped abusing drugs or alcohol may be
reluctant to begin using prescribed drugs for their medical illness for fear of
developing an addiction. They may fear rejection from friends and family
members who will object to their use of prescribed drugs, and they may fear
that others will attempt to buy or steal the drugs. The health care provider
should help the patient resolve these concerns and assure the patient that use
of opioids to control symptoms of progressive disease does not result in the
euphoria experienced by opioid abusers who do not have a medical illness.
If the patient is very reluctant to begin opioid therapy, the physician may
develop strict guidelines for use of the prescribed drug to provide the patient
with a sense of control. The patient may also be provided with counseling to
help identify situations in which he or she is likely to abuse drugs or
alcohol, and to develop strategies for avoiding future abuse of illegal or
prescribed drugs.
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