Continuum of Care
Substance abuse and dependency services are viewed as a continuum of prevention, intervention, treatment, and aftercare. As with all continuums, the boundaries are not always clearly drawn. A comprehensive substance abuse continuum combines many programs, policies and practices, in order to reduce substance abuse in communities. A local continuum of care may include local services ranging from prenatal parenting classes, student assistance programs, outpatient and residential treatment and community-based relapse prevention and ongoing recovery support services.
Although the P-I-T-A continuum may appear to be a sequential process, in fact, an individual may enter or leave at any point. The ultimate goal is to reduce the need for treatment related services through successful community prevention strategies and programs.
The goal of prevention is to foster a climate in which:
- Alcohol use is acceptable only for those of legal age and only when the risk of adverse consequences is minimal, and tobacco and illegal drugs are not used at all.
- Prescription and over-the-counter drugs are used only for the purposes for which they are intended.
- Substances such as gasoline or aerosols are used only for their intended purposes.
- Pregnant and women who may become pregnant do not use alcohol, tobacco, or other drugs.
What does prevention look like?
Prevention programs fall into three categories: Universal, Selective, and Indicated.
Universal prevention programs/strategies reach the general population, such as all students in a school or all parents of middle school students.
Selective prevention programs target groups at risk or subsets of the population, such as children of drug users or poor school achievers.
Indicated prevention programs identify individuals who are showing early signs of problem behavior(s) and targets them with special programs to prevent further onset of difficulties.
The goal of intervention is to reduce the risk of harm and decrease problem behaviors that result from continued use of substances. The intent of the intervention is to take action that decreases risk factors related to substance use, abuse or dependency; enhance protective factors; and provide ongoing services, as appropriate.
The specific goal of each individual client is determined by his or her consumption pattern, the consequences of his or her use, and the setting in which the intervention is delivered.
Intervention techniques vary based on the specific population being served and may be delivered to participants throughout the P-I-T-A continuum. For example, early intervention programs may include a student assistance program that provides assessments of individual students beginning to use drugs and to experience problem behaviors. Intervention may also include case management for chronic public inebriates focused on harm reduction.
Intervention services include but are not limited to:
- School intervention - pre-assessment, screening, information/education and referral
- Service assessments
- Brief intervention and referral to treatment
- Case management to facilitate referral to treatment.
The goal of treatment is to improve social functioning through complete abstinence from alcohol and drugs for individuals diagnosed with chemical dependency. Treatment is the use of any planned, intentional intervention in the health, behavior, personal and/or family life of an individual suffering from alcoholism or from another drug dependency designed to help that person achieve and maintain sobriety, physical and mental health and a maximum functional ability.
Treatment therapies are linked to the Diagnostic and Statistical Manual, IV-Text Revision (DSM-IV TR) under the diagnosis of Substance Use Disorder. The diagnosis may be one of three levels beginning with Substance Use, progressing to Substance Abuse, and may conclude with Substance Dependence.
Substance Use Disorder
Use of a substance, whether legal or illegal, does not constitute a substance use disorder even though it may be unwise and strongly disapproved of by family, friends, employers, religious groups, or society at large.
Substance use is not considered a medical disorder. For a medical disorder to be present, substance use must occur more frequently; occur at high doses; and/or result in a number of problems.
The term substance abuse or substance misuse is sometimes used to refer to any substance use by adolescents, because their use of substances is illegal and poses developmental and physical risks associated with substance use at an early age.
Substance Use Disorders are separated into two categories:
- Substance abuse (may also be referred to as misuse)
- Substance dependence
The DSM-IV TR defines substance abuse as problematic use without compulsive use, significant tolerance, or withdrawal. A diagnosis for substance abuse is made when one or more of the following occur within a 12-month period:
- Repeated substance use resulting in a failure to fulfill major role obligations
- Repeated substance use in situations that are physically hazardous
- Substance-use related legal problems
- Substance use despite having persistent or recurrent social or interpersonal problems.
Related substance abuse treatment services include but are not limited to:
- Alcohol Drug Information School
- Outpatient treatment.
Substance Dependence (also referred to as Chemical Dependency)
The DSM-IV TR defines substance dependence as a syndrome involving compulsive use, with or without tolerance and withdrawal. A diagnosis for substance dependence is made when three or more of the following occur within a 12-month period:
- Tolerance, withdrawal, use in larger amounts or over a longer period than intended
- Persistent desire or unsuccessful efforts to cut down
- Great deal of time spent in activities necessary to obtain the substance
- Reduction in social, occupational, or recreational activities because of substance use
- Substance use continues despite knowledge of problems.
Related treatment services for individuals diagnosed with substance dependence disorder include but are not limited to:
- Detoxification service
- Outpatient treatment/intensive outpatient treatment
- Intensive inpatient treatment
- Recovery House services
- Opiate substitution treatment.
Assisting the individual to establish the recovery process is the goal of treatment.
The goal of aftercare and continuing care is to support the person's abstinence through relapse prevention after primary care and throughout their recovery. Aftercare is the stage following more intensive services.
Related aftercare and relapse prevention services for individuals who are part of a treatment continuum include but are not limited to:
- Periodic outpatient aftercare
- Relapse/recovery groups
- Recovery support group
- Oxford House
- Access to Recovery wrap around.