Motivation is key to substance use behavior change. Counselors can support clients' movement toward positive changes in their substance use by identifying and enhancing motivation that already exists. Motivational approaches are based on the principles of person-centered counseling. Counselors' use of empathy, not authority and power, is key to enhancing clients' motivation to change. Clients are experts in their own recovery from SUDs. Counselors should engage them in collaborative partnerships. Ambivalence about change is normal. Resistance to change is an expression of ambivalence about change, not a client trait or characteristic. Confrontational approaches increase client resistance and discord in the counseling relationship. Motivational approaches explore ambivalence in a nonjudgmental and compassionate way.

This Treatment Improvement Protocol (TIP) reviews the use of the three Food and Drug Administration (FDA)-approved medications used to treat opioid use disorder (OUD)—methadone, naltrexone, and buprenorphine—and provides guidance for healthcare professionals and addiction treatment providers on appropriate prescribing practices for these medications and effective strategies for supporting the patients utilizing medication for the treatment of OUD. The goal of treatment for opioid addiction or OUD is remission of the disorder leading to lasting recovery. Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. This TIP also educates patients, families, and the general public about how OUD medications work and the benefits they offer. Related products: Medication-Assisted Treatment of Opioid Use Disorder: Pocket Guide A Shared Burden: The Military and Civilian Consequences of Army Pain Management Since 2001 Click our Alcoholism, Smoking & Substance Abuse collection to find more resources on this topic.

Treatment Improvement Protocols (TIPs) are developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and HumanServices (HHS). Each TIP involves the development of topic-specific best practice guidelines for the prevention and treatment of substance use and mental disorders. TIPs draw on the experience and knowledge of clinical, research, and administrative experts of various forms of treatment andprevention. TIPs are distributed to facilities and individuals across the country. Published TIPs can be accessed via the Internet at http: //store.samhsa.gov. Although each consensus-based TIP strives to include an evidence base for the practices it recommends, SAMHSA recognizes that behavioral health is continually evolving, and research frequently lags behind the innovations pioneered in the field. A major goal of each TIP is to convey "front-line" information quickly but responsibly. If research supports a particular approach, citations are provided.

Presents information on identifying, screening, and assessing adolescents who use substances. This report focuses on the most current procedures and instruments for detecting substance abuse among adolescents, conducting comprehensive assessments, and beginning treatment planning. Presents appropriate strategies and guidelines for screening and assessment. Explains legal issues concerning Federal and State confidentiality laws. Provides guidance for screening and assessing adolescents in juvenile justice settings. Summarizes instruments to screen and assess adolescents for substance and general functioning domains.

EXECUTIVE SUMMARY AND RECOMMENDATIONS: The goal of this TIP is to recommend guidelines for primary care clinicians to follow in caring for patients with alcohol and other drug use disorders. These guidelines were developed by a Consensus Panel of clinicians, researchers, and educators who work on the prevention and treatment of substance use disorders. Protocols are based partly on research evidence, partly on Panel members' clinical experience. The algorithm to the left follows a patient with substance use problems who presents in a primary care setting. The chart will serve as a guide or road map through screening, brief assessment, brief intervention, assessment, referral, specialized treatment, and followup care as they are detailed in the TIP. Since substance use disorders are often chronic conditions that progress slowly over time, primary care clinicians, through their regular, long-term contact with patients, are in an ideal position to screen for alcohol and drug problems and monitor each patient's status. Futhermore, studies have found that primary care clinicians can actually help many patients decrease alcohol consumption and its harmful consequences through office-based interventions that take only 10 to 15 minutes (Kahan et al., 1995; Wallace et al., 1988). This potential, however, is largely untapped: Saitz and colleagues found that of a sample of patients seeking substance abuse treatment, 45 percent reported that their primary care physician was unaware of their substance abuse (Saitz et al., in press). Yet even though screening and limited treatment of substance use disorders do not require a large time investment, the Consensus Panel that developed this TIP recognized that many primary care clinicians are already overwhelmed by the demands imposed by expanded gatekeeper functions. The Panel realized that a practical approach to addressing patients' substance abuse problems was needed: one that recognized the time and resource limitations inherent in primary care practice and offered a series of graduates approaches that could be incorporated into a normal clinic or office routine. Biological, medical, and genetic factors as well as psychological, social, familial, cultural, and other environmental features all bear on substance abuse. Addressing the condition effectively requires a team effort, especially when it has progressed beyond the early stage. For this reason, in addition to screening and intervention treatment options, these guidelines include information about viable referral for assessment and treatment, as well as followup. Readers will notice that the TIP contains more information on alcohol use and abuse than on use of illicit drugs. This reflects both the scope of the problems and the research literature available about them. It is estimated that about 18 million people with alcohol use problems and 5 million users of illicit drugs need treatment. Although the Panel recognizes that tobacco is an addictive substance with a major public health impact, it is not included in this TIP because the topic falls outside CSAT's purview. Readers are referred to "Smoking Cessation: a Guide for Primary Care Clinicians," published by the Agency for Health Care Policy and Research (Agency for Health Care Policy and Research, 1996). The Consensus Panel's recommendations are based on a combination of clinical experience and research-based evidence. In the list below, the summary guidelines supported by the research literature are followed by (1); clinically based recommendations are marked (2). Citations supporting the former are referenced in the body of the document. Screening and assessment instruments mentioned below are reproduced and discussed in Chapters 2 and 4 and Appendix C. The guidelines are presented in more detail in Chapter 6.

Written for clinicians this guide provides an easily understood framework in which to set formalised goals, establish treatment objectives and learn diagnostic techniques. Professional forms are included in sample form for insurance purposes.