Addictionologist Guidelines?

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I work for a pain management clinic & surgery center. We are bringing in a addictionologist provider to provide counseling to some of our patients. I am currently on the hunt for any information or guidelines to give out to our current providers to aid them in deciding which patients would benefit from this service the most. Is there such a set of guidelines or is it just something that is at their discretion? Thank you for your input!
 
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This is a toughie... If I understand you correctly, this provider would only be seeing some patients, not all, correct? If so, that's where it becomes a little sticky. Obviously there are patients who likely need the assistance, but what about those who don't and end up getting referred for counseling anyway? Think about it from a patient's perspective. There's a fairly significant risk for putting patients on the defensive if it's not played out correctly.

The addictionologist is (or should be) trained to handle the evaluations and counseling if necessary. Personally, I don't think it's the best course of action to place the decision as to whether not a patient should be counseled on the shoulders of the other providers. That's a lot of pressure for them, especially if they're on the fence about it. Not to mention the risk of losing a patient's trust in that provider. I can tell you from personal experience that there are very few things in life that come close to what it feels like as a patient with a provider who thinks you're abusing drugs and subsequently referring you to such a specialist when you honestly have no problems whatsoever. It's forever in your medical record and the stigma or cloud of doubt that's placed over your head never goes away. It's absolutely horrible. Beyond horrible.

IMO, there is nothing specific that a provider could look for, generally speaking. Some drug addicts are incredibly good at appearing just fine; others are not. Some people may exhibit a behavior that could be interpreted as a sign of addiction when it's really not. If you create a list of possible indicators, then who's to say that the providers won't become hyper-aware of them and make false assumptions?

Here are my thoughts and suggestions, which may be skewed since I'm not exactly impartial. I'd have every patient make one initial visit to them when the addictionologist gets there. This has a high probability of creating an "open door" policy if it's approached from the perspective that the addictionologist just wants to get familiar with the patients, ask them some questions, let them know he/she's there if they need to talk to someone, etc. Make it a routine for any new patients to make that initial visit. If the addictionologist is good at their job, they'll be able to pick up on patients who may need some additional help. Integrating that Q&A into the initial visits lets the addictionologist do a semi-evaluation of sorts, if that makes sense. Then the addictionologist can advise the providers on the patients to keep an eye on, so to speak. This takes the pressure off the providers to try figuring it out on their own.

If it's normal practice to see the addictionologist (at least) once, then it becomes routine and expected, sort of like a BP check or taking a patient's weight. No hostility is created, or at least kept to a minimum. Not to mention that "open door" policies are invaluable in the long run. The addictionologist should also be able to provide some advice for the providers; that's what they're trained to do after all.
 
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