PRINCIPLES OF DRUG DEPENDENCE TREATMENT. part 2

PRINCIPLE 2: SCREENING, ASSESSMENT, DIAGNOSIS AND TREATMENT PLANNING

Description and Justification

Patients affected by drug use disorders often have multiple treatment needs across a range of personal, social and economic areas that cannot be addressed when taking into consideration only their addictive symptoms in a standardized way. As for any other health care problems, diagnostic and comprehensive assessment processes are the basis for a personalized and effective approach to treatment planning and engaging the client into treatment.

Components

•  Screening is a useful assessment procedure to identify individuals with hazardous or harmful drug use, or drug dependence, as well as associated risk behaviors (viral transmission via needle sharing and/or unprotected sexual activity, potentially violent behavior, suicide risk). There are standardized tools to assess drug use and its severity in an individual that help to consider the degree of help required. These tools can be applied in different environments (primary health care system, school health and counseling services, and employee assistance programmes at workplaces).

•  Assessment and diagnosis are core requirements for treatment initiation. Diagnostic criteria commonly used in the mental health field are the references to reach a diagnosis of a drug use disorder. Diagnosis of comorbid psychiatric disorders is ideally made and followed-up by a psychiatrist, while with adequate training, other health care professionals can successfully identify and manage drug use disorders and associated psychiatric co-morbidity.

•  A comprehensive assessment takes into account the stage and severity of the disease, somatic and mental health status, individual temperament and personality traits, vocational and employment status, family and social integration, and legal situation. It further considers environmental and developmental factors, including childhood and adolescent history, family history and relationships, social and cultural circumstances, and previous treatment attendance. An adequate assessment process creates the environment for the development of a therapeutic alliance to engage the patient into treatment.

• The treatment plan, developed with the patient, establishes goals based on the patient’s identified needs and sets interventions to meet those goals. A care or treatment plan is a written description of the treatment to be provided and its anticipated course. Care plans set the specific needs of the individual patient and how they are going to be met by the service. The plan is then monitored and revised periodically as required to respond to the patient’s changing situation. While current research results do not support matching patient profiles to specific treatment approaches, there is evidence that matching responses and interventions to client needs following a serious diagnostic process and extensive assessment improves the treatment outcomes.

Actions to promote this principle

Ensure that:

1. primary health care staff, as well as employee assistance programmes and health/counseling staff in social services, at schools and in the criminal justice system are aware of the benefits of screening, early identification of drug use and brief interventions and are trained to administer such screening tools and associated interventions packages.

2. patient risk behaviors associated with drug use disorders are assessed at all relevant venues (primary health care, outreach services, emergency services, social services, etc) and responses planned in consequence.

3. accurate diagnosis of drug dependence and other co-morbid conditions is established before initiating drug dependence treatment, in particular, pharmacological treatment.

4. clinical protocols specify requirements for comprehensive patient assessment and the treatment plan development, patient progress monitoring and revision of written care plans, and the relevant staff is trained to fulfill these tasks.

5. documentation and standardization of all treatment steps are required from all staff involved in the treatment plan in order to ensure quality treatment for all patients

ABSCESS ANONG INJECTING DRUG USERS.

Abscess is a localized collection of pus and infected material in a body part. Whenever any germs or other materials enter the body, the body recognizes them as ‘foreign bodies’. As a reaction,the body deploys the white blood cells and other cells in its attempt to get the foreign body out. This results in collection of pus (which is generally made up of dead tissues, germs and white cells) in and around the foreign body, leading to formation of abscesses. Abscesses often take between two and five days to develop but sometimes can develop instantaneously. 

The affected part may be hot, red, swollen, tender and fluctuant (indicating pus formation).

Abscesses can occur in any part of the body. However, a majority of the IDUs have abscesses on the skin due to unsafe injecting practices. These are called cutaneous abscesses. This SOP addresses issues and management of cutaneous abscesses. Cutaneous abscesses are usually caused by common skin bacterium (Staphylococcus Aureus).

Abscesses can be of two types:

1. Exploding: where infection breaks out onto the outer skin surface.

2. Impounding: where the pus formation takes place under the skin and infection      keeps spreading under the skin, without breaking out onto the skin surface.

Why Abscesses Occur in IDUs? ( IDU- Injecting Drug User )

Abscesses are caused by germs, such as bacteria and foreign substances entering the body through needles piercing the skin and contaminating the injection site. An area of tissue becomes infected and initially looks like a hard boil. If ignored, white blood cells move into the infected area and collect within the damaged tissue and pus forms. If further ignored, the infected area could increase and break/ breach the skin leading to formation of an ulcer. If overlooked, the site could become infested with maggots after which gangrene could set in. This could result in amputation of the limb or infected part. In IDUs, abscesses occur because of a number of factors – from the drugs being injected to the unsafe injecting practices followed by the IDU. Finally, the physical status of the IDU may play a role in the formation of abscesses.