Though as school psychologists and teachers, we will likely not be undergoing a large amount of actual treatment for substance abuse disorders, it is important to know what the evidence-based treatments and interventions are.
The National Quality Forum published a document (link below) called “Evidence Based Treatment Practices for Substance Use Disorders” outlining recommended practices, background, and much more, which may serve as a starting point for research on the topic.
This document recommends that treatment for SUDs is part of a continuum of services that includes screening and assessment, active treatment, and continued engagement as part of a long-term plan
Important recommendations included in this document include:
- Screening: whenever there is an opportunity
- Initial Brief Intervention: and then referral as needed
- Treatment Plans: written recommendations for further care and the quantity/time/etc of the service
- Psychosocial interventions: motivational interviewing, motivational enhancement therapy, CBT, structured family/couples therapy, contingency management, community reinforcement therapy, and/or 12 step facilitation therapy
- Pharmacotherapy: in addition to psychosocial, if needed for withdrawal/detox
- Patient Engagement and Retention: both of which are crucial
- Recovery/Post-care: on-going follow-up and management is also crucial
An “Initial Brief Intervention” may be the extent of our role as school psychologists in many cases. This involves (p. 6):
- Give feedback about screening results, relating the risks of negative health effects to the patient’s presenting health concerns.
- Inform the patient about safe consumption limits and offer advice about change.
- Offer to involve family members in this process to educate them and solicit their input (consent is required).
- Assess the patient’s degree of readiness for change (e.g.,“How willing are you to consider reducing your use at this time?”).
- Negotiate goals and strategies for change.
- Schedule an initial follow-up appointment in two to four weeks.
- Monitor changes at follow-up visits by asking patient about use, health effects, and barriers to change.
- If the patient declines referral to specialty evaluation or treatment, continue to encourage reduction or cessation of use and reconsider referral to specialized treatment at subsequent visits.
Specific DON’Ts include:
- Detox as a standalone
- Acupuncture, relaxation therapy, didactic group education, or biological monitoring as a standalone treatment (and may not be very helpful at all).
- Individual psychodynamic therapy
- Unstructured group therapy
- Discharge from treatment in response to a relapse