2007

Mayo Clinic Residential Addiction Treatment Combines Evidence-Based Treatment Strategies

• An estimated 1 in 4 patients seen by primary care physicians has an often-unrecognized substance abuse problem.
• If patients with substance abuse problems relapse after an attempt at outpatient treatment, residential treatment is a helpful and reimbursable option.
• Mayo Clinic has a 28-day residential addiction treatment program and more than 30 years of experience providing physician-directed addiction treatment. The program combines pharmacotherapies for addiction, recovery counseling, and treatment of other psychiatric and medical conditions.
• Research performed at Mayo Clinic's Samuel C. Johnson Genomics of Addiction Program is advancing the understanding of genetic vulnerability to addictions and response to addiction treatments.

The Challenge

Alcohol abuse continues to be a major public health problem. An estimated 15% to 25% of the national health care budget is dedicated to care for patients with alcohol and other drug abuse problems. About 1 in 4 patients consulting primary care physicians has a substance abuse problem. Therefore, primary care physicians play a critical role in detecting substance abuse and counseling patients to pursue treatment. However, alcohol abuse can be difficult to detect and diagnose. Patients are often defensive about their use and tend to deny or minimize the possibility of problems.

Treatment Options

A range of treatment options exists to meet the severity of a given case. After an initial thorough evaluation by an addiction professional, outpatient treatment is usually the first step. During outpatient treatment, the patient continues most of his or her daily routine while receiving counseling. Residential treatment is indicated when outpatient care fails, and it is often covered by medical insurance. Inpatient care is generally appropriate for detoxification only.

Under Mayo Clinic's model of addiction treatment, multiple recovery approaches are used, including cognitive behavioral therapy, motivational enhancement, and 12-step facilitation. Members of the care team are specially trained in addiction medicine, including recent advances in the neuroscience of addiction and use of prescription drugs, such as naltrexone and acamprosate, which have been shown to diminish cravings to drink.

Mayo Clinic also offers services to families of those with addictions. Family programs assist family members in coping with their own reactions to the problem and the changed family dynamics resulting from the addiction.

Residential Treatment

Residential treatment programs range in length from 21 days to several months. Most initiate treatment with a 21- to 28-day program. Two basic forms predominate: free-standing treatment centers and those affiliated with comprehensive medical centers. The free-standing programs are primarily staffed by addiction counselors with referral outside the program for medical or psychiatric care. Programs tend to provide a supportive setting, separating patients from community life and requiring them to stay on campus during the treatment period.

Mayo Clinic has more than 30 years of experience in treatment designed to combine addiction care, psychiatric treatment, and comprehensive attention to health problems. In 2003, Mayo Clinic applied its model of physician-directed care to the development of a residential addiction treatment program. The program has a multidisciplinary team of addiction psychiatrists, nurses, social workers, and addiction counselors. Patients have a full day of programming and live in a residential unit, but they are free to go into the community for meals, exercise, or outings with friends and family. Treatment is individualized to offer the degree of support and structure needed to help establish sobriety. The Mayo Clinic Residential Treatment Program assists patients before discharge in arranging aftercare in their local community. It also provides resources for ongoing self-help groups such as the Alcoholics Anonymous 12-step program. In addition, the Mayo program contacts patients every 3 months by letter and phone call for a full year after discharge to monitor progress during the early months of recovery.

Genes and Alcohol Addiction

The Samuel C. Johnson Genomics of Addiction Program was established at Mayo Clinic with the goal of preventing the onset of addiction to alcohol and other drugs and developing therapies that will be more effective in the treatment of these illnesses. Research performed under the aegis of this program is advancing the understanding of genetic vulnerability to addictions and response to addiction treatments.

Table. Diagnostic Aids To Use in an Office Visit

CAGE is a quick first step toward diagnosis that caregivers can administer during an office visit. Two or more positive responses to the 4-question CAGE assessment indicate a strong likelihood of an alcohol- related problem.

• Cut down: Have you ever felt that you ought to cut down on your drinking?
• Annoyed: Have people annoyed you by criticizing your drinking?
• Guilty: Have you ever felt bad or guilty about your drinking?
• Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

• When patients consent, obtaining a collateral substance use history from family members may be helpful.
• Because alcoholism has a strong genetic component, a thorough family history may include questions about the alcohol habits of parents, grandparents, and siblings.
• A careful medical history can help identify substance abuse by revealing patterns of unexplained accidents, trauma, financial problems, or absenteeism from work or school.
• Referral to advanced treatment centers may be considered. For example, Mayo Clinic offers an Addiction Assessment Center as part of its outpatient services.