How can I effectively support a patient with a substance use disorder in achieving and maintaining recovery?

Effectively supporting a patient with a substance use disorder in achieving and maintaining recovery involves a comprehensive and person-centred approach, focusing on assessment, tailored interventions, and ongoing support.

• Comprehensive Assessment and Care Planning: When developing a care plan, consider the patient's medical, psychological, social, and occupational needs, their history of drug use, previous treatment experiences, and their personal goals and preferences ². It is crucial to involve the patient in developing and reviewing their care plan ¹. Staff in mental health and criminal justice settings should routinely ask about recent legal and illicit drug use, including type, quantity, and frequency ². In primary care, consider asking about drug use if symptoms suggest it, such as acute chest pain in a young person, acute psychosis, or mood and sleep disorders ². Biological testing (e.g., urine or oral fluid samples) can be used as part of a comprehensive assessment but should not be the sole method ².
• Establishing Supportive Relationships and Engagement: It is essential to establish and sustain a respectful and supportive relationship with the patient ². A major focus of the care plan should be maintaining the patient's engagement with services ². Help the patient identify situations or states where they are vulnerable to drug misuse and explore alternative coping strategies ². Ensure the patient has full access to a wide range of services and maintain effective collaboration with other care providers ².
• Psychosocial Interventions: A range of psychosocial interventions should be available, including contingency management, behavioural couples therapy, and cognitive behavioural therapy (CBT) ². Contingency management involves offering incentives for positive behaviours like abstinence or reduced illicit drug use, and participation in health-promoting interventions ¹. Services should encourage and facilitate participation in self-help groups ². For patients with comorbid depression and anxiety disorders, evidence-based psychological treatments, particularly CBT, should be considered in line with existing NICE guidance, especially for those misusing cannabis or stimulants, or stabilised on opioid maintenance treatment ².
• Addressing Co-occurring Conditions: If a patient has coexisting severe mental illness and substance misuse (dual diagnosis), immediately contact their care coordinator within mental health services if there is a risk of self-harm or suicide, or within 24 hours for existing concerns ¹. Residential treatment may be considered for patients seeking abstinence who have significant comorbid physical, mental health, or social problems (e.g., housing), especially if they have completed detoxification and have not benefited from previous community-based psychosocial treatment ².
• Family Involvement: If the patient's family has not benefited from guided self-help or support groups and continues to experience significant problems, consider offering individual family meetings ². These meetings should provide information and education about drug misuse, help identify stress sources, and promote effective coping behaviours, typically consisting of at least five weekly sessions ².
• Relapse Prevention and Urgent Assessment: A relapse is a return to substance misuse ¹. If a patient relapses to opioid use during or after treatment in an inpatient or residential setting, offer an urgent assessment ². Consider offering prompt access to alternative community, residential, or inpatient support, including maintenance treatment ².
• Brief Interventions: Brief interventions can be used opportunistically in various settings (e.g., mental health, general health, emergency departments, community pharmacies) for patients not in contact with drug services or in limited contact ². During routine contacts, provide information and advice to all people who misuse drugs about reducing exposure to blood-borne viruses ².