Making Treatment Decisions

Abstract

The role of the non-specialist, with particular reference to the general psychiatrist, in treating substance misuse problems is examined. Two models, the Model of Change and of Relapse Prevention, that inform clinical treatment decision-making are described. Emphasis is given to non-specialists combining existing skills with a knowledge of assessment technique to develop so called minimal interventions fitting their own style of practice. While minimal interventions may be adequate for the ‘uncomplicated case’, more intensive treatment will be required where high levels of dependence are present. Psychopathology will be a complicating factor in 30–60% of patients but is not necessarily a reason to refer on to a specialist service. The specific function of the specialist service is seen to be the treatment of dependence, although it is argued that co-existing substance related harm should so far as possible be treated under the one roof. Training, information, consultancy and support from the specialist unit should enable non-specialists to take on more patients but work with them in a familiar and rewarding way.