This Treatment Improvement Protocol (TIP) is intended to examine the physical and psychosocial sequelae associated with the abuse of opioids in combination with cocaine and offer assessment and treatment planning protocols for staff to use in substance abuse treatment programs.

To the extent possible, the document is based on available research information. However, many of the clinical issues facing providers of treatment to concurrently dependent persons have yet to be fully assessed. Few data exist on treating concurrent cocaine abuse, and even less information exists on treating concurrent abuse of other stimulants. This TIP is a reflection of the treatment modalities that are being used in various treatment centers throughout the Nation and should be viewed as such, rather than as a document that purports to have definitive solutions to what has become an extraordinarily difficult problem. Where clinical research is lacking, the TIP makes recommendations for treatment strategies based on clinical models developed by successful treatment programs. These recommendations should be considered guides, and their use should be tailored to the specific needs of an individual program's patient population.

Contents

• What Is a TIP?
• Consensus Panel
• Foreword
• Note From the Chair
• Chapter 1-Overview
  • Methodology for Development of the TIP
  • Critical Issues Deliberated by the Consensus Panel
• Chapter 2-Statement of the Problem
  • Epidemiology
  • Program Interventions
  • Health Consequences
  • Neurochemical and Psychological Effects of Cocaine and Heroin
  • Associated Psychiatric and Psychological Conditions
  • Social and Community Complications
  • Impact on Various Treatment Settings
  • The Needs of Minority Patients
  • Summary
• Chapter 3-Screening, Admission, and Assessment Techniques
  • Screening
  • Admission
  • Assessment
  • Diagnosis and Confirmatory Procedures
  • Preparing the Treatment Plan
  • Patient-Treatment Matching
  • The Multidisciplinary Team
• Chapter 4-Treatment Interventions and Related Issues
  • Treatment Interventions
  • Followup and Continuing Care
  • Special Issues
  • Patient Noncompliance
  • Spiritual Issues
  • Issues for Special Populations
• Chapter 5-Legal and Ethical Issues
  • Informed Consent
  • Confidentiality and Testing for HIV and Other Infectious Diseases
  • The Duty To Warn
  • Release of Information
  • Ethical Issues
• Chapter 6-Evaluating Program Performance
  • Admission
  • Intreatment
  • Posttreatment
  • Data Analysis
  • Analysis of Factors in Program Effectiveness
  • Treatment Variables
  • Program Variables
  • Supplementary Evaluation
• Chapter 7-Consensus Panel Recommendations for Further Research
  • Pharmacotherapies
  • Contingency Management
  • Acupuncture, Electroacupuncture, and Cranial Electrostimulation
  • Amino Acid Therapy
  • Hypnosis
  • Meditation
  • Areas for Further Research
• Appendix A - Glossary
• Appendix B - Levels of Care
• Appendix C - Acronyms
• Appendix D - TB/PPD Testing - Sample Forms
• Appendix E - Multidrug Abuse Patterns
• Appendix F - Diagnostic Assessment Instruments
• Appendix G - DSM-IV Criteria for Substance-Related Disorders
• Appendix H - Psychiatric Disorders
• Appendix I - Internal Trigger Questionnaire and External Trigger Questionnaire
• Appendix J - Self-Help Groups
• Appendix K - Federal Resource Panel
• Appendix L - Field Reviewers
• References

This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. This publication was written under contract number ADM 270-91-0004 from CSAT. Robert Lubran served as the Government project officer. Lynne C McArthur, Yvonne P Goldsberry, Yvonne daSilva, Anita Winters, Rebecca Horton, and Diana Schwartz served as contractor writers.

The opinions expressed herein are those of the Consensus Panel members and do not reflect the official position of the Substance Abuse and Mental Health Services Administration (SAMHSA) or any other part of the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of SAMHSA or DHHS 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.