The Treatment Plan

1 The Treatment PlanThe Treatment plan is the road map that a patient will follow on his or herjourney through Treatment . The best plans will follow the patient for thenext 5 years where the relapse rates drop to around zero (Vaillant, 2003). Notwo road maps will be the same; everyone s journey is different. Treatmentplanning begins as soon as the initial assessments are completed. The patientmight have immediate needs that must be addressed. Treatment planning isa never-ending stream of therapeutic plans and interventions.

2 It is alwaysmoving and changing. I have cowritten a thorough Treatment planning bookand computer program that should make Treatment planning easy: TheAddiction Treatment Planner(Perkinson & Jongsma, 2006a, 2006b). Theplanner comes in two forms, as a book and as computer software. The bookand software help you write your Treatment plan with point-and-click simplic-ity and have been approved by all accrediting Treatment plan is built around the problems that the patient brings intotreatment. Within the Treatment plan is a problem list that details each prob-lem.

3 The problem list comes at the end of the diagnostic summary. It tells thestaff what the patient will do in Treatment . It must take into account all of thephysical, emotional, and behavioral problems relevant to the patient s care,as well as the patient s strengths and weaknesses. It must also address eachof the six dimensions of ASAM that you are Treatment plan details the therapeutic interventions, what is goingto be done, when it is going to be done, and by whom. It must consider eachof the patient s needs and come up with clear ways of dealing with each prob-lem.

4 The Treatment plan flows into discharge planning, which begins fromthe initial Diagnostic SummaryAfter the interdisciplinary team members assess the patient, they meetand develop a summary of their findings. This is the diagnostic summary. Thisis where members of the clinical team the physicians, nurses, counselors,psychologists, psychiatrists, recreational therapists, occupational therapists,physical therapists, dietitians, family therapists, teachers, pastors, pharmacists,575 How to Build aTreatment 11/13/2007 5:25 PM Page 75and anyone else who is going to be actively involved with the patient s care meet and develop a summary of the patient s current state and needs.

5 Theteam members discuss each of the patient s problems and how to best treatit. From this meeting, the diagnostic summary is developed. This details whatthe problems are, where they came from, and what is going to be done aboutthem. It is much better to do this as a team. As you watch your team function,you will see how valuable it is to have many disciplines Problem ListThe Treatment team will continue to develop the problem list as thepatient moves through Treatment . New problems will come up and be addedor modified as conditions change.

6 The problem list and Treatment plan mustbe fluid. The list changes throughout Treatment as different problems comeup and others are to Develop a Problem ListA Treatment plan must be measurable. It must have a set of problems andsolutions that the staff can measure. The problems must be specific, notvague. A problem is a brief clinical statement of a condition of the patient thatneeds Treatment . The problem statement should be no longer than one sen-tence and should describe only one problem statements are abstract concepts.

7 You cannot actually see,hear, touch, taste, or smell the problem. For example, low self-esteem is aclinical phrase that describes a variety of behaviors exhibited by the can see the behaviors and conclude from them that the patient has lowself-esteem, but you cannot actually see low are evidenced by signs (what you see) and symptoms (whatthe patient reports). A problem on the Treatment plan should be followed byspecific physical, emotional, or behavioral evidence that the problem actuallyexists.

8 List the problem, add as evidenced by or as indicated by, and thendescribe the concrete evidence you see that tells you that the problem of a problem list:Problem 1:Inability to maintain sobriety outside of a structured facilityAs evidenced by: Blood alcohol level of .23As evidenced by: The patient s family report of daily drinkingAs evidenced by: Alcohol withdrawal symptomsAs evidenced by: Third DWIAs evidenced by: History of third Treatment for addictionProblem 2:DepressionAs evidenced by: Hamilton Depression Rating Scale score of 29As evidenced by: Psychological evaluationAs evidenced by: Patient s two suicide attempts in the past 3 monthsAs evidenced by: Depressed affectProblem 3:Acute alcohol withdrawalAs evidenced by: Coarse hand tremorsAs evidenced by.

9 Blood pressure 160/100, pulse 104As evidenced by: Restless pacing; self-report of strong cravingAs evidenced by: Profuse sweating; mild visual disturbances76 CHEMICAL DEPENDENCY 11/13/2007 5:25 PM Page 76 Once you have generated a problem list, you need to ask yourself what thepatient needs to do to restore him- or herself to normal functioning. Aperson who has a drinking problem needs to stop drinking and must learnthe skills necessary to maintain a sober lifestyle. A person who is depressedneeds to reestablish normal mood.

10 A person who is dishonest needs to gethonest with himself or herself and others. Writing goals, objectives, and inter-ventions in a Treatment plan is made much easier for counselors by using TheAddiction Treatment Planneror The Addiction Treatment Planner WithDisk(Perkinson & Jongsma, 2006a, 2006b). These plans conform to the high-est standards set by accrediting bodies such as the Joint Commission onAccreditation of Healthcare Organizations (JCAHO, 1988).How to Develop GoalsA goal is a brief clinical statement of the condition you expect to changein the patient or in the patient s family.