Phases of Treatment
In general, the medical term acute describes phenomena that begin quickly and require rapid response. Acute problems are contrasted with chronic problems. Most commonly, acute stabilization of patients with dual disorders refers to the management of physical, psychiatric, or drug toxicity crises. These include injury, illness, AOD-induced toxic or withdrawal states, and behavior that is suicidal, violent, impulsive, or psychotic.
The acute stabilization of AOD use disorders typically begins with detoxification, such as inpatient detoxification for patients with significant withdrawal or outpatient detoxification for mild to moderate withdrawal, as well as nonmedical withdrawal, such as occurs in social-model detoxification programs. Also, initiation of methadone maintenance can provide outpatient acute stabilization for patients addicted to opioids.
Acute stabilization of psychiatric symptoms more frequently occurs within a mental health or emergency medical setting, but involves a range of treatment intensity. Patients with severe symptoms, especially psychotic, violent, or impulsive behaviors, usually require acute psychiatric inpatient treatment and psychiatric medications, while patients with less severe symptoms can be treated in outpatient or day treatment settings.
Dual disorder programs that provide stabilization to patients with acute needs should have the capability to:
- Identify medical, psychiatric, and AOD use disorders
- Treat a range of illness severity
- Provide drug detoxification, psychiatric medications, and other biopsychosocial levels of treatment
- Provide a range of intensities of service.
These programs should be capable of promoting the patient’s engagement with the treatment system. They should be able to aggressively provide linkages to other programs that will provide ongoing treatment and engagement.
Subacute Stabilization
The medical term subacute describes the status of a medical disorder at points between the acute condition and either resolution or chronic state. The subacute phase of a medical problem occurs as the acute course of the problem begins to diminish, or when symptoms emerge or reemerge but are not yet severe enough to be described as acute.
For example, patients recently detoxified from AODs frequently experience subacute symptoms such as insomnia and anxiety that may linger for a few days or weeks. On the other hand, recently detoxified patients with dual disorders may experience subacute symptoms of insomnia and anxiety either as subacute withdrawal symptoms or as a prelude to relapse with depression. Although the subacute phase is not generally regarded as a period of crisis, ignoring these symptoms and failing to assess and treat them may lead to symptom escalation, decompensation, and relapse.
As AOD-induced toxic or withdrawal symptoms resolve, constant reassessment and rediagnosis is required. During this phase, a psychoeducational and behavioral approach should be used to educate patients about their disorders and symptomatology. During this phase, treatment providers should provide assessment and planning for dealing with long-term issues such as housing, long-term treatment, and financial stability.
Biopsychosocial Assessment Issues From the AOD and Psychiatric Perspectives
____________________________________________________________________________
AOD Psychiatric
____________________________________________________________________________
* Biological: Alcohol on breath Abnormal laboratory tests
Positive drug tests Neurological exams
Abnormal laboratory Using psychiatric
tests medications
Injuries and trauma Other medications,
Toxicity and withdrawal conditions
Impaired cognition
____________________________________________________________________________
* Psychological: Intoxicated behavior Mental status exam: Affect
Withdrawal symptoms mood, psychosis, etc.
Denial and manipulation Stress, situational
Responses to AOD factors
assessments Self-image, defenses, etc.
AOD use history
____________________________________________________________________________
* Social: Collateral information Support systems:
from others Family, friends, others
Social interactions Current psychiatric
and lifestyle therapy
Involvement with other Hospitalization
AOD groups
Family history of AOD
use disorders
Family history
Housing and employment
histories
____________________________________________________________________________
ABC Model for Psychiatric Screening
- Appearance, alertness, affect, and anxiety:
Appearance:
General appearance, hygiene, and dress.
Alertness:
What is the level of consciousness?
Affect:
Elation or depression: gestures, facial expression, and speech.
Anxiety:
Is the individual nervous, phobic, or panicky? - Behavior:
Movements:
Rate (Hyperactive, hypoactive, abrupt, or constant?).
Organization:
Coherent and goal-oriented?
Purpose:
Bizarre, stereotypical, dangerous, or impulsive?
Speech:
Rate, organization, coherence, and content. - Cognition:
Orientation:
Person, place, time, and condition.
Calculation:
Memory and simple tasks.
Reasoning:
Insight, judgment, problem solving.
Coherence:
Incoherent ideas, delusions, and hallucinations?
Last reviewed: By John M. Grohol, Psy.D. on 18 Aug 2007
