On-line Continuing Education. Course Material: Exam Questions Packet

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1 BREINING INSTITUTE 8894 Greenback Lane Orangevale, California USA Telephone (916) Facsimile (916) On-line Continuing Education Course Material and Exam Questions Packet Course No: CE-1521 Course Title: Best Practices for Substance Abuse Treatment Programs Course Objective: An examination of best practices for substance abuse conditions, adapted from the National Quality Forum s consensus standards, which includes suggested practices for screening and brief intervention; initiation, engagement and re-engagement in treatment; therapeutic interventions to treat substance use conditions; business practices for improved client services; and consideration for individualized care. CE Credit Hours: 3.0 hours Course Material: California s Best System Practices (version 2), by the Department of Alcohol and Drug Programs (ADP) in Reprinted within this packet, and also available on-line through ADP s web site at the following URL: Exam Questions: Eleven (11) multiple-choice questions. Answer Sheet: We recommend that you use the on-line Answer Sheet for automatic grading of your exam, and to automatically receive your Certificate of Completion by . If you mail or fax us the attached Answer Sheet, please allow ten days for us to receive and grade your answers, and to send you the Completion Certificate by postal mail. Recommendation: Review the exam questions before you view the course material. The Exam Questions are based upon the information presented in the course material. You should choose the best answer based upon the information contained within the course material. GOOD LUCK! CE-1521 w Breining Institute ( )

2 BREINING INSTITUTE 8894 Greenback Lane Orangevale, California USA Telephone (916) Facsimile (916) CE-1521: Course Exam Questions These Exam Questions are based upon the information presented in the course material. You should choose the best answer based upon the information contained within the course material. A score of at least 70% correct answers is required to receive Course credit. GOOD LUCK! 1. Initiation, Engagement and Re-Engagement in Treatment consists of all of the following, EXCEPT? a. Diagnosis and assessment. b. Withdrawal management. c. Continuing care management. d. Psychosocial interventions. 2. Therapeutic Interventions to Treat Substance Use Conditions consists of all of the following, EXCEPT? a. Psychosocial interventions. b. Services and support planning. c. Adjunct pharmacotherapy for opioid dependence. d. Adjunct pharmacotherapy for nicotine dependence. 3. Screening entails which of the following? a. Feedback on substance use effects on health (and for alcohol, feedback on use relative to norms), increasing motivation to change, and goal setting. b. Referral for a medical and/or psychological exam for individuals with immediate needs, as determined by qualified personnel. c. Use of a validated screening instrument or interview method for substance use, including quantity, frequency, and pattern. d. Implementation of processes or systems that promote flexibility, immediacy / timeliness, continuity, openness and efficiency. 4. Brief Intervention entails which of the following? a. Feedback on substance use effects on health (and for alcohol, feedback on use relative to norms), increasing motivation to change, and goal setting. b. Referral for a medical and/or psychological exam for individuals with immediate needs, as determined by qualified personnel. c. Use of a validated screening instrument or interview method for substance use, including quantity, frequency, and pattern. d. Implementation of processes or systems that promote flexibility, immediacy / timeliness, continuity, openness and efficiency. CE-1521 w Breining Institute ( )

3 BREINING INSTITUTE 8894 Greenback Lane Orangevale, California USA Telephone (916) Facsimile (916) Diagnosis and Assessment entails which of the following? a. Feedback on substance use effects on health (and for alcohol, feedback on use relative to norms), increasing motivation to change, and goal setting. b. Referral for a medical and/or psychological exam for individuals with immediate needs, as determined by qualified personnel. c. Use of a validated screening instrument or interview method for substance use, including quantity, frequency, and pattern. d. Implementation of processes or systems that promote flexibility, immediacy / timeliness, continuity, openness and efficiency. 6. Engagement in Treatment entails all of the following, EXCEPT: a. Multidimensional assessment that identifies potential barriers to participating in treatment. b. Provision of, or referral to, supportive services. c. Plan developed with client input that is responsive to the individual s culture, language and health literacy. d. Generalized support and reassurance. 7. Services and Supports Planning can be summarized as which of the following? a. Providing information on the efficacy of pharmacotherapy and supported in making an informed choice best suited to the individual client s needs. b. Offering clients long-term, coordinated management of care for their substance use disorder and any co-occurring conditions, which should be adapted based upon ongoing monitoring of the client s progress. c. Empirically validated psychosocial treatment interventions which should be initiated for all persons with substance use problems or dependency. d. Collaboration with clients and their identified support systems to develop a multidimensional services and supports plan that is client-centered, and is periodically re-evaluated to support engagement and progress in treatment. 8. Continuing Care Management can be summarized as which of the following? a. Providing information on the efficacy of pharmacotherapy and supported in making an informed choice best suited to the individual client s needs. b. Offering clients long-term, coordinated management of care for their substance use disorder and any co-occurring conditions, which should be adapted based upon ongoing monitoring of the client s progress. c. Empirically validated psychosocial treatment interventions which should be initiated for all persons with substance use problems or dependency. d. Collaboration with clients and their identified support systems to develop a multidimensional services and supports plan that is client-centered, and is periodically re-evaluated to support engagement and progress in treatment. CE-1521 w Breining Institute ( )

4 BREINING INSTITUTE 8894 Greenback Lane Orangevale, California USA Telephone (916) Facsimile (916) Psychosocial Interventions can be summarized as which of the following? a. Providing information on the efficacy of pharmacotherapy and supported in making an informed choice best suited to the individual client s needs. b. Offering clients long-term, coordinated management of care for their substance use disorder and any co-occurring conditions, which should be adapted based upon ongoing monitoring of the client s progress. c. Empirically validated psychosocial treatment interventions which should be initiated for all persons with substance use problems or dependency. d. Collaboration with clients and their identified support systems to develop a multidimensional services and supports plan that is client-centered, and is periodically re-evaluated to support engagement and progress in treatment. 10. Target outcomes for Adjunct Pharmacotherapy for Opioid Dependence include which of the following? a. Cessation of non-medical use of opioids. b. Retention in treatment. c. Both A and B above. d. Neither A nor B above. 11. For whom should Adjunct Pharmacotherapy for Nicotine Dependence be performed? a. All clients, whether or not there is an indication of nicotine dependence. b. All clients who appear to use nicotine or have nicotine dependence, whether or not they have articulated a desire to quit using nicotine. c. All clients with nicotine dependence, who have a goal of abstinence from nicotine use. d. None of the above. This is an eleven-question examination. Answer Questions 1 through 11 for full CE credit in this course. Questions 12 through 21 have been omitted. CE-1521 w Breining Institute ( )

5 BREINING INSTITUTE 8894 Greenback Lane Orangevale, California USA Telephone (916) Facsimile (916) Course No. CE-1521: Answer Sheet SECTION 1. Please use this sheet only if you have not already submitted your answers on-line. First Name Middle Name Last Name Address (Number, Street, Apt or Suite No.) City State (or Province) USA Zip Code Country (other than USA) Country Code Primary Telephone Number (including Area Code) Facsimile Number (including Area Code) Address SECTION 2. Credit Card Payment information if paying by credit card: Circle which card used - VISA or MasterCard Credit card number Expiration date Full name on credit card. Breining Institute is authorized to charge Twenty-nine dollars ($29.00) to this card. Authorized signature Date SECTION 3. Course Title: CE-1521 / Best Practices for Substance Abuse Treatment Programs Circle correct answer Signature: Date: Return Answer Sheet, with $29 Course examination fee, by mail or facsimile to: BREINING INSTITUTE w 8894 Greenback Lane, Orangevale, California USA w Facsimile (916) CE-1521 w Breining Institute ( )

6 Caal liforrni iaa ss Beesst t Prraacct ticceess forr f Subsst taanccee Ussee Conditionss AAddaappt tteedd ffr froom tthhee t NNaat tti iioonn aal ll QQuuaal lli iit ttyy FFoor ruum ss NNaat tti iioonnaal ll CCoonnsseennssuuss SSt ttaannddaar rddss ffoor f r tthhee t TTr reeaat ttmeennt oof ff SSuubbsst ttaannccee UUssee CCoonnddi iit tti iioonnss Screening and Brief Intervention for Substance Use Conditions Screening During new encounters and anuual check-ups, patients in healthcare settings should be screened for at-risk drinking and substance use problems and dependency, including tobacco use. Brief Intervention All persons identified by screening to be at risk of problems related to substance use should receive a brief motivational counseling intervention by a healthcare provider trained in this technique. Initiation, Engagement and Re-Engagement in Treatment Diagnosis and Assessment Persons with an indication of a substance use problem or illness should be further assessed to confirm that a problem exists and to determine a diagnosis. Persons diagnosed with a substance use disorder should receive a validated multidimensional, biopsychosocial assessment to guide client-centered treatment planning for substance use disorders and any co-occurring conditions. Engagement in Treatment Counties and treatment providers should systematically promote initiation of care and engagement in treatment for substance use disorders. Persons with substance use problems or dependency should receive supportive services to facilitate their participation in ongoing treatment. Withdrawal Management Based on a systematic assessment of the symptoms and risk of serious adverse consequences related to the withdrawal process, support (including pharmacotherapy where indicated) should be provided to manage the symptoms and adverse consequences of withdrawal. Withdrawal management alone does not constitute treatment for dependence and should be linked with ongoing treatment for substance use disorders. Services and Supports Planning Service providers should collaborate with clients and their identified support systems to develop a multidimensional services and supports plan that is client-centered, and is periodically re-evaluated to support engagement and progress in treatment. Continuing Care Management Clients with substance use illness should be offered long-term, coordinated management of care for their substance use disorder and any co-occurring conditions, and this care management should be adapted based on ongoing monitoring of their progress. Therapeutic Interventions to Treat Substance Use Conditions Psychosocial Interventions Empirically validated psychosocial treatment interventions should be initiated for all persons with substance use problems or dependency. Adjunct Pharmacotherapy for Opioid Dependence All clients diagnosed with opioid dependence should be provided with information on the efficacy of pharmacotherapy (e.g. methadone, buprenorphine) and supported in making an informed choice best suited to their needs. Pharmacotherapy, if prescribed, should be provided in addition to and directly linked with psychosocial treatment and support. Adjunct Pharmacotherapy for Alcohol Dependence All clients diagnosed with alcohol dependence should be provided with information on the efficacy of pharmacotherapy (e.g. naltrexone, acamprosate) and supported in making an informed choice best suited to their needs. Pharmacotherapy, if prescribed, should be provided in addition to and directly linked with psychosocial treatment and support. Adjunct Pharmacotherapy for Nicotine Dependence All clients diagnosed with nicotine dependence should be provided with information on the efficacy of pharmacotherapy (e.g. nicotine replacement therapy, bupropion, varenicline) and supported in making an informed choice best suited to their needs. Pharmacotherapy, if prescribed, should be provided in addition to and directly linked with psychosocial treatment and support. Page 1 of 13

7 In Support of Recovery Health Care Family Strengthening Transitional and Supportive Living Crisis Intervention Literacy, Education and Work-Related Supports Nutrition and Exercise Assistance with Legal Issues and Bureaucracy Business Practices For Improved Client Services Coordination of Changes in Levels of Care Clinical Supervision Quality Improvement Staff Development Child Care Tele-health Considerations for Individualized Care Programs should assure that all personnel have an adequate understanding of the individuals they are likely to encounter, and that they provide appropriate supports with empathy and respect, in order to positively influence initiation, engagement and re-engagement (as needed) in treatment. Women / Perinatal Co-Occurring Problems and Disorders Adolescents Elderly Trauma LGBTQ and Gender Minorities Recipients of Public Assistance Programs Criminal Justice Referrals Diverse Cultures Page 2 of 13

8 Screening and Brief Intervention for Substance Use Conditions - DRAFT Screening During new encounters and anuual check-ups, patients in healthcare settings should be screened for at-risk drinking and substance use problems and dependency, including tobacco use. Target Outcome: Identification of persons with alcohol use in excess of NIAAA guidelines for the relevant population, and/or with any illicit drug use, and/or with any tobacco use. Use of a validated screening instrument or interview method for substance use, including quantity, frequency, and pattern (preferably validated in the relevant population). Following a positive screen with a brief intervention and a referral for further assessment if warranted. For Whom It Is Indicated: Persons 10 years of age and older, upon new patient encounters and at least annually thereafter. Any type of healthcare worker with the appropriate training. Where It Should Be Implemented: All appropriate settings (for example, primary, inpatient, urgent, and emergency healthcare; criminal justice healthcare; occupational healthcare; and school-based healthcare settings). Substance use disorder treatment settings should screen for tobacco use. Page 3 of 13

9 Screening and Brief Intervention for Substance Use Conditions - DRAFT Brief Intervention All persons identified by screening to be at risk of problems related to substance use should receive a brief motivational counseling intervention by a healthcare provider trained in this technique. Target Outcome: Cessation or reduction of alcohol and/or illicit drug use and/or tobacco use, and acceptance of treatment when indicated. 5 to 15 minute advice/motivational counseling session. Provided in one to multiple contacts. Includes feedback on substance use effects on health (and for alcohol, feedback on use relative to norms), increasing motivation to change, and goal setting. Multi-contact interventions are more effective and also include further assistance (e.g., recommendations for treatment when indicated) and follow-up monitoring and support. For Whom It Is Indicated: Persons identified with alcohol use in excess of NIAAA guidelines and/or illicit drug use and/or tobacco use. A healthcare provider trained in brief motivational counseling intervention. Any appropriate healthcare setting (for example, primary, inpatient, urgent, and emergency care; criminal justice healthcare; occupational healthcare; and school-based healthcare settings). Specialty treatment settings for substance use disorders should address tobacco use. Page 4 of 13

10 Initiation, Engagement and Re-Engagement in Treatment - DRAFT Diagnosis and Assessment Persons with an indication of a substance use problem or illness should be further assessed to confirm that a problem exists and to determine a diagnosis. Persons diagnosed with a substance use condition should receive a validated multidimensional, biopsychosocial assessment to guide client-centered treatment planning for substance use disorders and any co-occurring conditions. Target Outcomes: Establishment of a diagnosis. Initiation of, or referral for, treatment. Identification of initial and ongoing individualized treatment needs, including co-occurring conditions. Confirmation of a substance use problem or illness. Assessment of all substance use. Use of validated instruments or interview methods (preferably validated in the relevant population). For diagnosed substance use disorders, a multidimensional bio-psycho-social assessment (one that includes, for example, substance use; presence of co-existing general medical and mental health conditions; psychosocial functioning; social factors such as living environment, employment, and support system; and client motivation, preferences, and cultural values as they relate to treatment for substance use illness). Referral for a medical and/or psychological exam for individuals with immediate needs, as determined by qualified personnel. For Whom It Is Indicated: All persons identified through screening or who present with clinical indications or red flags for probable substance use problems or illnesses (for example, a marked change in physical health, deteriorating performance in school or job, dramatic change in personality, involvement in crimes or trauma accidents, needle track marks). Healthcare workers authorized to initiate and guide the treatment of persons with substance use illness. Diagnosis may be performed in general healthcare settings or in county diagnostic facilities. Detailed assessment of treatment needs for substance use illness should be performed in AOD treatment facilities. Page 5 of 13

11 Initiation, Engagement and Re-Engagement in Treatment - DRAFT Engagement in Treatment Counties and treatment providers should systematically promote initiation of care and engagement in treatment for substance use disorders. Persons with substance use problems or dependency should receive supportive services to facilitate their participation in ongoing treatment. Target Outcome: Initiation of treatment after first contact. Continuation of treatment beyond the admission/intake assessment and upon transfer from one level of care to another. Attendance at treatment settings for a sufficient length of time and with an adequate number of sessions per week. Organizational level: Identification of organizational system barriers to the initiation of treatment after first contact/injury/criminal justice diversion and continuation of treatment beyond the admission/intake assessment and upon transfer from one level of care to another. Implementation of processes or systems that promote flexibility, immediacy/timeliness, continuity, openness, and efficiency. Client level: Multidimensional assessment that identifies potential barriers to participating in treatment (for example, living environment, employment, support system, readiness for treatment, coexisting general medical and mental health conditions). Provision of, or referral to, supportive services (for example, housing, legal, employment, child care, medical, or mental health services). Plan developed with client input that is responsive to the individual's culture, language and health literacy. Empathic supportive approach. Active promotion of involvement with community support (some examples include family, 12-step support groups, spiritual support). For Whom It Is Indicated: All persons with substance use problems or dependency. AOD treatment providers and/or certified and licensed counselors authorized to initiate and guide the treatment of persons with substance use disorders. All treatment settings for substance use disorders. Page 6 of 13

12 Initiation, Engagement and Re-Engagement in Treatment - DRAFT Withdrawal Management Based on a systematic assessment of the symptoms and risk of serious adverse consequences related to the withdrawal process, support (including pharmacotherapy where indicated) should be provided to manage the symptoms and adverse consequences of withdrawal. Withdrawal management alone does not constitute treatment for dependence and should be linked with ongoing treatment for substance use disorders. Target Outcome: Control of withdrawal symptoms. Prevention of serious adverse consequences of withdrawal. Engagement in ongoing treatment for substance use dependence. Generalized support and reassurance. Systematic assessment and reassessment of acute withdrawal symptoms and risk of severe symptoms to determine need for medication (e.g., use of a validated instrument). Medications and/or tapering protocols proven to be effective for managing substance use withdrawal, provided in adequate doses to control symptoms and timely adjustments of doses when indicated, with monitoring of response and side effects. Ongoing support and monitoring of medical status including coexisting conditions and medications. Provision of, or referral to, ongoing treatment for dependence. Opioid Withdrawal: Examples of medications proven to be effective for managing opioid withdrawal methadone or buprenorphine tapering. Alcohol withdrawal: Examples of medications proven to be effective for managing alcohol withdrawal benzodiazapenes. For Whom It Should Be Performed: Substance-dependent individuals who desire to withdraw and/or who are in acute phase withdrawal regardless of intent to withdraw (e.g., when incarcerated or hospitalized). Healthcare workers licensed to prescribe medication. Certified counselors who are trained to guide the withdrawal process for substance-dependent individuals. Licensed healthcare personnel who provide medical monitoring and support. AOD detoxification programs. Inpatient or outpatient treatment settings with adequate ongoing medical monitoring capabilities. If dispensing medications, must meet statutory and regulatory requirements at the State and federal levels. Page 7 of 13

13 Initiation, Engagement and Re-Engagement in Treatment - DRAFT Services and Supports Planning Service providers should collaborate with clients and their identified support systems to develop a multidimensional services and supports plan that is client-centered, and is periodically re-evaluated to support engagement and progress in treatment. Target Outcome: A strengths-based plan, informed by assessment and evaluation, that addresses the client s needs and builds upon her/his unique abilities and assets. A working alliance between the client, supportive significant others, and providers of services. Engagement, progress, and retention in treatment. Document assessed needs. Develop reasonably achievable goals in collaboration with the client that address problems identified during assessments. Develop objectives with the client. What action steps will he/she take toward achieving those goals? Identify interventions. What will staff do to assist the client in achieving the desired goal? Identify follow-up times to review the plan. Adjust the plan when ongoing assessments indicate that a more effective intervention is needed, or if there is a change in the need for supportive services. Adjust the plan when goals important to the client have been met or have changed significantly. For Whom It Should be Performed: Every client admitted to treatment for substance use disorders. AOD treatment counselors. AOD treatment settings. Suggested Reference: Treatment Planning M.A.T.R.S Page 8 of 13

14 Initiation, Engagement and Re-Engagement in Treatment - DRAFT Continuing Care Management Clients with substance use illness should be offered long-term, coordinated management of care for their substance use disorder and any co-occurring conditions, and this care management should be adapted based on ongoing monitoring of their progress. Target Outcomes: Client receives care for all conditions that affect recovery. Stabilization of co-occurring conditions. Retention in treatment. Engagement in long-term monitoring. Prevention of relapse or delayed time to relapse. Coordinating administrative, clinical and evaluative activities that bring the client, treatment services, community agencies, and other resources together to focus on issues and needs identified in the assessment(s) and subsequent treatment plan(s), according to the client s preferences. Sharing of diagnostic and treatment information with other service providers, with client s consent. Monitoring the response to treatment and ensuring that when indicated, the treatment plan is modified with client input. Continuing care with an emphasis on providing support and skills for self-management, as for any chronic health condition. Long-term monitoring to identify early signs of relapse. For Whom It Should be Performed: Clients in AOD treatment programs, especially those with co-existing general medical and mental health conditions. Healthcare workers authorized to initiate and/or guide general medical, mental health, or treatment for substance use disorders. Wherever the person is in the care system: Specialty treatment settings when clients are receiving services. General medical and mental healthcare settings when clients are not in specialty treatment. Care management may shift from the specialty setting to the general healthcare setting as clients move into stabilized recovery. Page 9 of 13

15 Therapeutic Interventions to Treat Substance Use Conditions -- DRAFT Psychosocial Interventions Empirically validated psychosocial treatment interventions should be initiated for all persons with substance use problems or dependency. Target Outcome: Cessation or reduction of substance use. Improved psychological and social functioning. Prevention of relapse or delayed time to relapse. Retention in treatment. Varied approaches include motivational enhancement therapy, cognitive behavioral therapies, community reinforcement therapy, 12- step facilitation therapy, structured family and relationship therapies, and contingency management. An empathic, supportive approach may be as important as the specific psychosocial technique. Delivered in various ways, such as individually or in groups, or as brief treatment, as stand-alone treatment or in combination. The manner of delivery is guided by a treatment plan that is responsive to the client s individual needs. Session topics should include problem-solving skills, impulse control, strategies for coping with cravings, development of a supportive environment, and re-assessment and re-evaluation of needs. Involvement with community support is actively promoted. Examples include family (recognized as support by the client), 12-step or other mutual support groups, and spiritual support. For Whom It Should Be Performed: All clients in treatment for substance use disorders. Certified counselors who have been trained in the specific psychosocial intervention and who have appropriate, ongoing supervision. AOD treatment settings. Page 10 of 13

16 Therapeutic Interventions to Treat Substance Use Conditions - DRAFT Adjunct Pharmacotherapy for Opioid Dependence All clients diagnosed with opioid dependence should be provided with information on the efficacy of pharmacotherapy (e.g. methadone, buprenorphine) and supported in making an informed choice best suited to their needs. Pharmacotherapy, if prescribed, should be provided in addition to and directly linked with psychosocial treatment and support. Target Outcome: Cessation of non-medical use of opioids. Retention in treatment. Medications that have been proven to be effective for ongoing treatment of opioid dependence (e.g., methadone, buprenorphine). Provided in adequate doses to control craving. Controlled dispensing of doses. Regular biologic monitoring for illicit drug use. Monitoring of response and side effects. Timely adjustment of doses when indicated. Monitoring of medical status, including co-existing conditions and medications. Provision of empirically validated psychosocial treatment or psychosocial support (including medical management). For Whom It Should be Performed: All adult (and adolescents 16 and older) patients diagnosed with opioid dependence who meet clinical indications and regulatory requirements; may consider for adolescents under 16 as clinically indicated. Special consideration should be given before using pharmacotherapy with selected populations: those with medical contraindications, pregnant or breastfeeding women, adolescents, and the elderly. Healthcare workers licensed and qualified to prescribe medication to treat opioid dependence. Healthcare workers authorized to initiate and guide the treatment of opioid dependent patients should recommend pharmacotherapy. Providers who do not prescribe pharmacotherapy should have formal arrangements to refer patients for pharmacotherapy treatment. Substance use disorder treatment specialty settings. Healthcare settings where patients are treated for substance use illness. If dispensing medications, must meet statutory and regulatory requirements at the State and Federal levels. Page 11 of 13

17 Therapeutic Interventions to Treat Substance Use Conditions - DRAFT Adjunct Pharmacotherapy for Alcohol Dependence All clients diagnosed with alcohol dependence should be provided with information on the efficacy of pharmacotherapy (e.g. naltrexone, acamprosate) and supported in making an informed choice best suited to their needs. Pharmacotherapy, if prescribed, should be provided in addition to and directly linked with psychosocial treatment and support. Target Outcome: Reduction of alcohol consumption with the goal of cessation. Retention in treatment. Medications proven to be effective for treating alcohol dependence (for example, naltrexone, acamprosate). Provided in adequate doses to control craving. Regular monitoring for alcohol use. Monitoring of response and side effects. Timely adjustment of doses when indicated. Monitoring of medical status, including co-existing conditions and medications. Provision of empirically validated psychosocial treatment or psychosocial support (including medical management). For Whom It Should be Performed: All nonpregnant adults (18 and older) that are current alcohol dependent patients. Special consideration should be given before using pharmacotherapy with selected populations: those with medical contraindications, pregnant or breastfeeding women, adolescents, and the elderly. Healthcare workers licensed to prescribe medication. Healthcare workers authorized to initiate and guide the treatment of alcohol dependent patients should offer pharmacotherapy. Providers who do not prescribe pharmacotherapy should have formal arrangements to refer patients for pharmacotherapy treatment. Substance use illness treatment specialty settings. Healthcare settings where patients are treated for substance use illness. If dispensing medications, must meet regulatory requirements at the State and Federal levels. Page 12 of 13

18 Therapeutic Interventions to Treat Substance Use Conditions - DRAFT Adjunct Pharmacotherapy for Nicotine Dependence All clients diagnosed with nicotine dependence should be provided with information on the efficacy of pharmacotherapy (e.g. nicotine replacement therapy, bupropion, varenicline) and supported in making an informed choice best suited to their needs. Pharmacotherapy, if prescribed, should be provided in addition to and directly linked with psychosocial treatment and support. Target Outcome: Cessation of tobacco use. Medications proven to be effective for tobacco cessation (for example, nicotine replacement therapy, bupropion, varenicline). Provided in adequate doses to control craving. Regular monitoring for tobacco use. Monitoring of response and side effects. Timely adjustment of doses when indicated. Monitoring of medical status, including co-existing conditions and medications. Provision of empirically validated psychosocial treatment or psychosocial support. For Whom It Should be Performed: All clients with nicotine dependence, who have a goal of abstinence from nicotine use. Special consideration should be given before using pharmacotherapy with selected populations: those smoking fewer than 10 cigarettes/day, those with medical contraindications, pregnant or breastfeeding women, and adolescents. Healthcare workers licensed to prescribe medication (if prescription required). Healthcare workers authorized to initiate and guide the treatment of substance dependent patients should provide or refer for pharmacotherapy for tobacco cessation. Healthcare workers authorized to initiate and guide general and mental healthcare treatment. Substance use illness treatment specialty settings, general and mental healthcare settings (for example, primary, inpatient, urgent and emergency care; criminal justice healthcare, occupational healthcare, and school-based healthcare settings). If dispensing medications, must meet regulatory requirements at the State and Federal levels. Page 13 of 13