To qualify for inpatient treatment,  the adolescent must meet the DSM criteria for Substance Use Disorder, all of the dimensions for outpatient treatment, plus at least two of the following dimensions:

A.  The risk of withdrawal is present.

B.  Continued use places the patient at imminent risk of serious damage to health; or biomedical condition requires medical management.

C.  History reflects cognitive development of at least 11 years of age and significant impairment in social, interpersonal, occupational, or educational functioning as evidenced by one of the following:

1.  Current inability to maintain behavioral stability for more than a 48-hour period.
2.  Mild to moderate risk to self or others. Current suicidal/homicidal thoughts with no active plan or history of suicidal/homicidal gestures.
3.  Behaviors sufficiently chronic and/or disruptive to require separation from current environment.

D.  Patient is having difficulty acknowledging an alcohol or a drug problem and is not able to follow through with treatment in a less intense environment.
E.  The patient is experiencing an intensification of addiction symptoms despite interventions in a less intense level of care; or, patient has been unable to control use as long as alcohol or drugs are present in the patient’s environment; or, if abstinent, the patient is in crisis and appears to be in imminent danger of using alcohol or drugs.
F.  One of the following:
1.  Environment is not conducive to successful treatment at a less intense level of care.
2.  The parents or legal guardians are unable to provide consistent participation necessary to support treatment in a less intense level of care.
3.  Accessibility to treatment precludes participation in a less intense level of care.
4.  There is a danger of physical, sexual, or emotional abuse in the patient’s current environment.

Sharing the diagnosis
You should discuss your findings with the patient and, if possible, with the patient’s family. If you are in recovery yourself, this is not a good time to share much of your story because it may frighten patients and make them wonder about your own state of health. Patients need a stable, well-adjusted counselor.  You can tell a patient that you are recovering,  but don’t get into specifics about your drinking and using days.

As you share the diagnosis with the patient, make sure you take the time to encourage and reinforce him or her for having the courage to come into treatment. Check out how the patient feels. It is not good to be suffering, and your patient has been in misery for a long time. It was scary to come into treatment, but he or she made it. You are proud of the individual. Most people who complete their first inpatient treatment ultimately achieve a stable recovery. They might have to come into treatment again, even again and again, but the first treatment is a major turning point. Patients learn things in the first treatment that they never forget. They learn that there is a disease called chemical dependency, there is treatment for it, treatment doesn’t hurt, and people can live happy, sober lifestyles.

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Robert R. Perkinson,  PHD
Helping Your Clients Find the Road to Recovery

Alcoholism - Treatment.  I.  Title.
RC565.P375 - 2004
616.86’10651- dc22