Substance abuse affects 21.2 million Americans and only 11% of those individuals ever get the treatment they require. It is not due to a lack of addiction treatment centers but rather due to a lack of knowledge and guidance. One out of every five people struggling with substance abuse claims they don’t know where to go for treatment. Healthcare providers in emergency rooms (ER) have the ability to help people who are looking to enroll in treatment centers. They are the ones who are able to speed up the process of screening, intervention, and referral to treatment. ER doctors can offer patients personal help and guidance. This guide will demonstrate and help the ER doctors to gain a clear understanding of how to get someone admitted to rehab. Read ahead to understand the step-by-step process of referring patients to an addiction treatment facility.
Table of Contents
Chapter #1: Identifying and Confronting Substance Abuse in a Patient
Alcohol and drugs remain a significant problem globally. Moreover, addiction can destroy lives and deteriorate mental and physical health. Therefore, it is highly important not to ignore the signs and symptoms of addiction and seek treatment. Consequently, if a patient comes into an ER and displays signs of addiction, a doctor must know how to get someone admitted to rehab and refer them to a substance abuse treatment plan.
ER Doctors Can Help Patients Struggling With Addiction
ER doctors play a big role when it comes to helping patients seek treatment for addiction. However, one very important subset of commonly abused substances includes prescription medicines. Therefore, health care professionals, especially young doctors, and medical interns should be on the lookout for medicine-seeking behavior.
On duty, if you observe that someone displays signs of substance abuse, you will need to be cautious with your prescriptions. The most commonly sought-after medicines by addicts are painkillers. However, patients may also abuse cough syrups for their sedative properties, and this might be subtler to notice. Patients who abuse substances are knowledgeable about the drugs they abuse and are desperate for another go. Be on the lookout for a vague history, an emphasis on the ‘need’ for very potent painkillers, and being very specific about the class of drug needed for the symptoms to resolve.
a) Identifying Substance Abuse And Dependence: A Fine Line
It is important to understand the distinction between substance abuse and dependence as the latter indicates a progressing problem. Drug dependence is characterized by:
- Tolerance manifests as a need to ‘up’ the dose or uses higher potency drugs.
- Withdrawal symptoms like nausea and vomiting, unexplained headaches, and body pains when the drug is unavailable.
- Constant drug-seeking behavior manifests itself as being absent in important activities and spending unusually long times finding or using drugs.
The Telltale Signs of Addiction
Understanding substance abuse as a behavior instead of as a lifestyle is vital to helping your patients who fall into addictions. Often, the symptoms of addictions are easy to spot and come to light by themselves. These include:
- drug residues on the body
- injection wounds
- abnormal or inappropriate behavior
- loss of impulse control
- unusual sleeping patterns
- unusual tiredness
- tend to skip their schedules
These are red flags and should alert a physician about a potential diagnosis of a mental and/or neurological illness. Above all, if a patient has some or all the above-mentioned signs of addiction, it is a doctor’s job to take the following steps very carefully. An addict should not be treated like any other patient. Rather a doctor should keep in mind that any medicine could trigger their dependence and lead to much bigger problems.
Is your patient addicted to doing drugs? It is time to refer them to addiction rehab. Contact ChoicePoint at 844.445.2563 because we offer a variety of addiction treatment programs that are easily accessible virtually and in person.
When and How to Get Someone Admitted to Rehab: Illness Vs. Choice
If you notice signs of neglect, drug cravings, and unexplained changes in schedule, sleep, and weight in your everyday patients, substance abuse may very well be a culprit. However, due to the ongoing stigma about drug abuse and the overall influence of substances, patients may outright deny or get defensive when confronted about their use of drugs.
It is also essential to recognize that some individuals are more susceptible to addictive behaviors than others. For instance, the following people are more likely to fall into addiction:
- history of physical, sexual, and even emotional abuse
- past trauma
- unaddressed mental illnesses like anxiety and depression
Understanding this gives us a more empathic view of a person ‘suffering’ from addiction.
b) Confronting a Patient With Addiction During an ER Visit – Not as Hard as It Sounds
If you suspect someone is substance-abusing, ask before assuming. Regardless of the outcome, counsel the patient about seeking professional help. Help them to understand that only an addiction specialist can determine whether the patient needs detoxification, psychotherapy, rehabilitation, or all three depending on the patterns of substance abuse. Therefore, it is vital that you carefully plan a confrontation and refer the patients to rehab as soon as possible.
For confrontation, these are the most commonly used practices in any ER:
If a doctor is worried or notices that a patient is displaying signs of substance abuse, they must incorporate questions like:
- How many glasses of alcohol do you drink in one day?
- Is there anyone in your family that suffers from drug or alcohol addiction?
- When was the first time you started abusing drugs or alcohol?
- Which drugs do you mostly abuse?
- Did you ever seek addiction treatment for your condition?
Once the issue is identified and confronted, it is time to start the process of SBIRT (read ahead to understand its meaning). Addiction treatment referring professionals can understand the need for a patient to attend rehab for their own good. So if you are one of the addiction treatment referring professionals and want to know how to get someone admitted to rehab, read this quick guide or simply call us at 844.445.2563 as ChoicePoint offers rehab referral services for ER Doctors who want to refer their patients to a rehab facility.
Chapter #2: Understanding SBIRT
Substance abuse is a public health issue that impacts people of all ethnicities, which is why many healthcare providers employ SBIRT in their daily practice. SBIRT is an efficient approach to managing substance abuse problems. Undoubtedly, significant decreases in substance usage have been seen in patients who went through the process of SBIRT. SBIRT is a tool used by ER doctors to quickly identify patients at risk of or suffering from Substance Abuse Disorder, intervene in an emergency, and refer patients requiring comprehensive care.
SBIRT stands for:
- Screening for Substance Abuse –evaluates the history, severity, and frequency of substance abuse and identifies the appropriate level of treatment.
- Brief Intervention – compromises bringing about behavioral change by increasing the patient’s self-awareness. The patient’s subjective insight and perception of drug use are targeted to motivate them to change their habits.
- Referral to treatment- provides access to specialized care, especially to those who have been identified as needing more extensive treatment.
SBIRT is a collection of questionnaires that can easily be administered to patients on an outpatient basis. Clinicians can simply download a relevant questionnaire or SBIRT form from the SBIRT website. Questions on the forms are to be answered by patients suspected or at risk of Substance Misuse Disorder. Patients’ answers reflect their history with various addictive substances and, if significant, guide a clinician to make an appropriate decision of intervening or referral.
SBIRT is part of the routine and can help patients who suffer from substance abuse navigate their options regarding treatment. Therefore, it is important to identify and help such patients as early as possible. Thus SBIRT provides opportunities for early intervention with at-risk substance users before more severe consequences occur to:
- Primary care hospitals
- medical emergencies
- trauma centers
Chapter #3: Screening for Substance Abuse
Now breaking down the SBRIT; first, we have “screening for substance abuse.”
Substance abuse often goes undetected in ER patients. The most widely used method in hospitals to find out people who use alcohol and other drugs at harmful levels is called screening. It is also the first step in SBIRT that follows brief intervention and referral to treatment.
Here is how to screen a patient that came into your ER with the use of a drug use screening test;
Steps for Diagnostic Evaluation
- History collection
- Mental, physical, and neurological examination
- Interviews and Questionnaires
- Lab tests
People who have ongoing medical issues may also take a lot of prescription medications, which can lead to difficulties when coupled with alcohol and other substances. Undoubtedly, a doctor can use questions like these to test for prescription medication use and to gain more insight into a patient’s level of dependence:
- Do you frequently see many healthcare professionals? Why? Have you lately changed doctors? Why?
- What prescription medications do you take?
- Do you encounter any issues with them?
- What pharmacy do you use to fill your prescriptions?
- Do you frequently visit many pharmacies?
- Do you take any more over-the-counter medicines?
- If so, how long have you been taking them for and what, why, how much?
- Alcohol Use Disorder Identification Test (AUDIT):
- Alcohol, Smoking, and Substance Abuse Involvement Screen Test (ASSIST)
- Drug Abuse Screening Test (DAST-10)
Pregnant Women Screening
- Tolerance, Annoyance, Cut Down, Eye Opener (T-ACE):
- Tolerance, Worried, Eye Opener, Amnesia, K/Cut Down (TWEAK)
A toxicological test (sometimes known as a “drug test” or “tox screen”) searches for signs of drug use in your saliva, perspiration, hair, urine, or other bodily fluids. Most of the time, either blood or urine is tested for confirmation of alcohol or drugs such as Central nervous system depressants and stimulants, Opiates and Opioids, Hallucinogens, and Marijuana. Other lab tests such as Renal Function tests, Liver function tests, electrocardiograms, and serum electrolytes are also conducted.
Can ER Doctors Perform The Screening?
Screenings can be conducted by doctors, counselors, family doctors, coworkers, relatives, friends, and even addicts themselves. A therapist, counselor, or family doctor will want to undertake a diagnostic interview to ascertain if and to what degree the individual’s drug usage fulfills accepted criteria for abuse when the screening suggests a possible issue.
What Happens During Screening for Substance Abuse?
Structured and semi-structured interviews are the two forms that can be used during the evaluation phase in the ER. This is followed by laboratory tests for confirmation.
Screening ER patients for substance abuse can be divided into two parts:
- Pre screens
- Full screens
Chapter #4: Brief Intervention
Now we will help you understand the second part of SBRIT, i.e., “Brief Intervention.”
Interventions are a great way to put your feelings and opinions across to someone. As an ER doctor, there will come a time when a patient will come to you with symptoms of addiction that are hard to ignore. This is the time when you intervene and tell them they can sober up by going to an addiction rehabilitation program. However, your patients may need convincing, but it is your job to help convince them politely so they can get better.
Interventions Could Potentially Save Someone’s Life
It is not a hidden reality that being addicted to alcohol or drugs harms physical health and mental health. ER Doctors should not hesitate and intervene when they see a patient struggling because:
- Being addicted to alcohol or drugs may destroy the addict’s intellect, decision-making power, behaviors, and priorities.
- An addict is unable to make rational decisions.
- They can not recognize the harmful effects of drugs even though he is suffering from the harmful consequences of the drug.
- They go into a denial phase about the harm that drugs have caused him.
Now, as a doctor who has access to patients in the ER, it is your responsibility to convince your patient who is suffering from addiction to visit rehab for professional help. Help them see the need to quit drug or alcohol addiction. Because if you don’t intervene on time, it could lead someone to lose their life.
Here are the top 5 tips that may help ER doctors how to get someone admitted to rehab;
a. Get Into The Mind of an Addict
The first step to convincing an addict is to understand how an addict’s mind works. With this in mind, most addicts do not understand that they need the help of an addiction specialist. Therefore, get yourself educated to the extent that you could easily convince your patient that addiction is a disease and requires proper medical treatment. In order to get yourself educated about the dangers of addiction, you should:
- read literature about the harmful effects of addiction
- meet and talk to addiction specialists
- arrange meetings with support groups and listen to what they talk about
- be equipped with knowledge about every aspect of substance abuse so that you can answer every question of your patient to convince him to proper treatment
b. Intervene Professionally
If a patient is brought to the ER (emergency room) and you notice the signs of addiction, here are some tips for intervening professionally:
- Discuss how much dangerous it can be if they don’t quote substance abuse
- Walk them through the hazards of continuous substance abuse and how it can affect their health
- Mention how much helpful a rehab can be for recovery from substance abuse
- Tell them about some admirable recovery stories
Being an ER doctor, patients look up to you and will listen to you. So, keep your tone friendly while intervening and convince them they can start their new life by seeking help from a rehabilitation center.
c. Don’t Be Judgemental, and Control Your Own Emotions
Your ultimate goal is to educate an addict on how important it is for them to attend an addiction rehab instead of asking them questions that could make them feel nervous while sharing how they got into such a situation. Therefore, make them realize that you only want to help them as you want to see them happy and healthy. Here are some tips you can try while you try to help a patient:
- approach them with kindness
- try to talk politely to convince your patient
- leave all your emotions behind and talk to an addict calmly
- be compassionate
- make them realize that you are intervening because you care about them
- tell them you are worried about their well-being
- don’t blame them
- tell your patient that you want to see them enjoying a normal life with a healthy body and healthy mind.
d. Encourage Your Patient to Seek addiction Treatment As Early As Possible.
The main point of professional intervention is not to highlight the urgent need for addiction treatment. But make them believe that they need to get themselves admitted to addiction rehab otherwise it could have fatal results. Therefore, it is very important to repeatedly mention to the patient that they require addiction treatment. For a successful rehabilitation process, a doctor should not wait for the patient to hit rock bottom. Hitting rock bottom means that the patient has become too addicted to be treated. Here are some things you can say to them in order to convince them to start addiction treatment as soon as possible:
- It is important to seek rehab help as early as possible before it is too late
- Medical treatment can help you to gain sobriety
- Addiction rehabs focus on the betterment of your mental and physical health
e. Be Prepared to Receive Some Angry Reaction
While speaking to addicts about attending addiction rehab, be prepared to receive a negative response as well. As mentioned before, addicts don’t see the need to attend an addiction rehab as they don’t see anything wrong with being addicted, or sometimes they don’t even know if they are abusing drugs.
So, if you receive a negative reaction, here are some things to tell yourself in order to get the most out of this situation:
- Know that you can not understand the pain and challenges that go into an addict’s life.
- Judgment can cease conversation
- Be sympathetic
- Your patient needs you to be empathetic with them, regardless of how they react
- Anger cannot result in anything good
Chapter #5: Referral to Treatment
The last and main part of SBRIT is “Referral to treatment” and How to get someone admitted to rehab.
After it has been established that the patient sitting in front of you needs the assistance of a professional addiction specialist, it is time to refer them to one of the addiction specialists or a rehabilitation center. Even though the ER has long been acknowledged as a front door to the hospital. However, only recently have the emergency room (ER) visits been acknowledged as a chance to identify and connect patients to care for substance abuse disorders and provide crucial access to the health care system for many.
Can You Commit Someone to Rehab?
If you are a doctor and notice signs of substance abuse, then yes, you can refer your patient to addiction rehab.
How to Get Someone Admitted to Rehab – Referring a Patient
The Diagnostic and Statistical Manual of Mental illness was revised in the early 2000s to classify Substance Misuse as a mental disorder. What’s more, the classification underlines the perception of addiction and addicted people as not just a series of bad decisions but a buildup of many social, psychological and physical issues into a larger addiction problem.
Understanding this on a deeper level should guide healthcare providers on how to refer a patient to an addiction rehab facility.
a. Build Rapport
Building a strong patient-doctor relationship is important. Especially when you are about to say something that will change the course of someone’s life. People suffering from substance abuse disorder and mental illness, in general, are more cynical than the average patient and, therefore, less likely to be honest. Letting a patient know that it is a safe space to share their problem is key to making them open up.
b. Take Initiative
In order to get a patient into an addiction treatment center, a patient may be asked to fill out a form. Instead of filling out a referral form and handing it out to the patient, do it yourself. Reach out to a rehab facility and brief them on your patient details. Making the referral look like part of your treatment plan not only makes it a smooth process but also ensures that most patients will follow through on your advice.
c. Do Not Be Blunt but Don’t Lie Either
Unsurprisingly, the stigma of addiction can make many patients dishonest and deny having a problem. It is your job to make your patient realize if they need help, why they need it, the extent of their problem, and how long it will take. Think honesty with a dash of optimism.
A truly remarkable clinician follows through with his patients. Despite a ‘successful’ referral, check in on your patient. They aren’t luggage, to begin with, so treat them like you care instead of dumping them to rehab.
e. Online Referral Form
Many addiction treatment centers provide ER doctors a chance to refer their patients simply by filling out an online form. The form asks for basic information about the patient and why they are being referred to rehab. ChoicePoint in New Jersey is an addiction treatment rehab that provides a safe place for people suffering from addiction to start a new addiction-free life. You can refer your patients simply by filling out this form.
Chapter #6: Selecting an Addiction Rehab to Refer Your Patient
As a doctor, you can also assist your patients in selecting and locating the best drug rehabilitation facility. Given the wide variety of rehab facilities available today, it can be challenging for patients to determine which option will best serve their needs.
What to Look for in an Addiction Treatment Center?
The ASAM (American Society of Addiction Medicine) Levels of Care assist patients in understanding the different levels of care they require and in comprehending the treatment they will receive. From least to most intensive, the ASAM Levels of Care describe five major kinds of treatment. Addiction treatment referring professionals can use these categories to better understand which care levels are best for their patients.
a) Ambulatory detox (ASAM Level I-D and II-D)
For those who need to detox from drugs and alcohol, the ambulatory detox program is an outpatient model.
Ambulatory detoxification without extended onsite monitoring. Qualified clinicians who offer medically supervised evaluation, detoxification, and referral services in accordance with a planned schedule may deliver them in an office setting, healthcare facility, or patient’s home. These services are offered during sessions that have set schedules.
Ambulatory detoxification with extended onsite monitoring. In this, availability of suitably qualified and licensed nurses who supervise patients for several hours each day of service. On the other hand, this stage of detoxification is also a scheduled outpatient treatment. In this level of care, detoxification services are offered in regularly scheduled sessions and are carried out following a predetermined set of rules and medical protocols.
b) Outpatient Treatment (ASAM Level I)
For those with demanding schedules and a strong network of personal supporters, level 1 care is suitable. Medical appointments, family therapy sessions, psychotherapy, and employment counseling may be assisted by outpatient programs. The regularly scheduled sessions are conducted by addiction specialists or qualified clinicians at a nonresidential treatment facility or a practitioner’s office. An examination, treatment, and recovery follow-up services are all included in overall care.
c) Intensive Outpatient Treatment (ASAM level of care 2.1)
Adults receiving Level 2.1 Intensive Outpatient Treatment (IoT) may get services for nine or more hours per week. Depending on the severity of the addiction, Intensive Outpatient Treatment could also last for 90 days or more. People with addiction and associated illnesses are treated to address their multifaceted needs. The program is open to participants throughout the day (before or after work), in the evening, on weekends, or both.
d) Medication-Assisted Treatment (Suboxone ®, Vivitrol ® )
Medication-assisted therapy (MAT), which helps treat opioid use disorders (OUD) and may help some people maintain recovery, involves using drugs in combination with counseling and behavioral treatments. MAT drugs treat the psychological urges and withdrawal symptoms that lead to chemical imbalances in the body. The major drugs used to treat opioid addiction are Suboxone and Vivitrol. They prevent the effects of opioid medications, such as pain alleviation or positive moods, which might cause the overuse of opioids.
e) Addiction Therapy Services (CBT, DBT, Group and Individual Therapy)
There are several sorts of addiction rehabilitation services accessible, and each one has advantages and disadvantages of its own.
CBT (Cognitive Behavioral Therapy)
The goal of cognitive behavioral therapy is to alter the automatic negative ideas that cause and exacerbate emotional problems, sadness, and anxiety. The mood is negatively impacted by these uncontrollable, unpleasant thoughts.
DBT (Dialectical Behavior Therapy)
A modified form of cognitive-behavioral therapy is dialectical behavior therapy (DBT). Its major objectives are to educate individuals on how to be present, create healthy coping mechanisms for stress, control their emotions, and enhance interpersonal connections.
There are obvious contrasts between solo and group treatment. One client and one counselor work together in individual therapy. Numerous clients and occasionally multiple counselors participate in group therapy. A group therapy session typically involves at least five individuals and a maximum of fifteen.
Group and Individual Therapy
Group therapy has benefits that include a strong support system and the inclusion of different perspectives.
f) Dual Diagnosis Program for Co-occurring Disorders
Dealing with underlying mental health problems that a person with a drug use disorder may have in addition to the addiction is referred to as dual diagnosis therapy. You can receive the support you require for both drug misuse and mental health difficulties through dual-diagnosis therapy. This is crucial since one might worsen the other.
ER Doctors Looking for How to Get Someone Admitted to Rehab – Final Words
People frequently visit a healthcare provider to get treatment for some ailment. However, some patients also have some degree of substance abuse problem that is not addressed in ERs. They might not be aware, but their use of illicit substances may be having an impact on some of their medical conditions. SBIRT is therefore extremely adaptable and global. This implies that a wide range of healthcare providers may utilize it with any client who seeks their assistance, regardless of whether the client is particularly searching for assistance with harmful alcohol or drug use.
To summarize it all, SBIRT helps doctors in identifying and then referring patients to proper addiction treatment facility centers. Screening, intervention, and referral to treatment are important steps when referring someone to addiction rehab. If you want to commit someone to addiction rehab by referring them, simply fill out this form.