TIP 20:  Matching Treatment to Patient Needs in Opioid Substitution Therapy: Treatment Improvement Protocol (TIP) Series 20

Disclaimer

This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. All material appearing in this volume except quoted passages 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 ADM 270-91-0007 from the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration (SAMHSA). Sandra Clunies, M.S., served as the CSAT Government project officer. Robert A. Lubran, M.S., M.P.A., was the Government content advisor. Writers were Carolyn Davis, Alan Gambrell, Constance Gartner, M.A., Linda Harteker, Randi Henderson, and Deborah Shuman.

The opinions expressed herein are the views of the consensus panel members and do not reflect the official position of CSAT or any other part 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 proffered in this document should not be considered as substitutes for individualized patient care and treatment decisions.

What Is a TIP?

CSAT Treatment Improvement Protocols (TIPs) are prepared by the Quality Assurance and Evaluation Branch to facilitate the transfer of state-of-the-art protocols and guidelines for the treatment of alcohol and other drug (AOD) abuse from acknowledged clinical, research, and administrative experts to the Nation's AOD abuse treatment resources.

The dissemination of a TIP is the last step in a process that begins with the recommendation of an AOD abuse problem area for consideration by a panel of experts. These include clinicians, researchers, and program managers, as well as professionals in such related fields as social services or criminal justice.

Once a topic is selected, CSAT creates a Federal resource panel, with members from pertinent Federal agencies and national organizations, to review the state of the art in treatment and program management in the area selected. Recommendations from this Federal panel are then communicated to the members of a second group, which consists of non-Federal experts who are intimately familiar with the topic. This group, known as a non-Federal consensus panel, meets in Washington for 5 days, makes recommendations, defines protocols, and arrives at agreement on protocols. Its members represent AOD abuse treatment programs, hospitals, community health centers, counseling programs, criminal justice and child welfare agencies, and private practitioners. A Chair (or co-Chairs) for the panel is charged with the responsibility for ensuring that the resulting protocol reflects true group consensus.

The next step is a review of the proposed guidelines and protocol by a third group whose members serve as expert field reviewers. Once their recommendations and responses have been reviewed, the Chair approves the document for publication. The result is a TIP reflecting the actual state of the art of AOD abuse treatment in public and private programs recognized for their provision of high quality and innovative treatment.

This TIP, Matching Treatment to Patient Needs in Opioid Substitution Therapy, offers guidelines to providers who are working to deliver the best treatment possible to opiate-addicted persons. Patients in this population often need a broad range of services in addition to opioid substitution therapy, and research has shown that providing these services as part of the therapy program greatly increases retention in treatment and improves outcomes. The TIP provides a model for matching patients to services that takes into account the changing needs of patients at different phases of treatment. The TIP outlines a comprehensive assessment process for identifying patient needs and describes core treatment elements for addressing those needs. Because evaluation and self-monitoring are important ways to ensure that programs stay responsive to patient needs, the TIP presents step-by-step guidelines to assist programs in designing and implementing evaluation studies.

The TIP includes a chapter on costs of opioid substitution therapy that reviews several approaches to determining the costs and benefits of matching patients to needed services.

This TIP represents another step by CSAT toward its goal of bringing national leadership to bear in the effort to improve AOD abuse treatment.

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.