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Chapter 33. Community-Based Treatment

Jonathan I. Ritvo, M.D.; Harvey L. Causey, M.D.
DOI: 10.1176/appi.books.9781585623440.353945

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Excerpt

In this chapter we discuss community-based substance abuse treatment from two perspectives. The first perspective, the community's role in treatment, encompasses substance abuse identification and intervention, ranging from noncoercive brief interventions in medical care settings to coercive interventions through social service agencies and criminal and civil courts. The second perspective, specific non-hospital-based treatment services, encompasses outpatient treatment programs, community residential facilities, detoxification centers, and case management approaches.

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TABLE 33–1. Treatment episodes by referral source, 2003a
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TABLE 33–2. Components of a typical brief intervention
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TABLE 33–3. Judicial strategies for the "hardcore" drunk driver
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TABLE 33–4. Standard features of the drug-court model
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TABLE 33–5. Case management activities
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TABLE 33–6. Persons who may perform case management functions
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TABLE 33–7. Features of assertive community treatment
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Brief intervention has proved effective for reducing drinking and/or its consequences in primary care, emergency care, and college settings and with depressed first-time driving while intoxicated (DWI) offenders.

Specialized programs for drug-abusing mothers improve outcomes such as treatment completion and maintenance of custody.

The substance-abusing patient with chronic mental illness may be best managed by an assertive community treatment case management approach, with the case manager serving as payee for the patient's benefits.

Treatment mandated through drug courts and through sentencing for DWI reduces recidivism in the criminal justice system.

Treatment participation in community residential facilities and "graduation" from an intensive outpatient program predict positive outcome.

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Sample questions:
1.
Among community sources for referrals to substance abuse treatment, which of the following is the most common source?
2.
Which of the following is not part of a typical brief intervention for substance abuse, according to Fleming and Manwell (1999)?
3.
Problematic alcohol use at colleges and universities is a significant societal and even public health problem. Marlatt et al. (1998) described a university-based program to address this problem. Which of the following is not part of this program?
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