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<br /> 06/01/2007 10:24 7753542378 LESYMAE F'FGE 37 <br /> Psychiatric Times 1?ag,; 5 o1'G <br /> in primary care settings than psychiatric settings $a. pier; iC <br /> i has no[ been LeSted a5 much, except for asSeC[IV•. <br /> community treatment) (Willenbring et al., 1995; Vii1•:^L•r r!7 <br /> and Olson, 1999), although care management Is a ~ r :n• <br /> sense approach that has virtually no risk and is rnl: ti nn <br /> consuming. Greater Comfort and more effective <br /> communication between physician and patent are Iil:ra, r.. <br /> improve trust, motivation, treatment compliance a. irl, <br /> therefore, outcome. Care management will allow a IU le <br /> t integration of addiction treatment techniques into pep<r iala• c <br /> ` care. How much outcome is improved, or what sferi=u:: <br /> outcomes are most affected, are questions requirmq <br /> I additional research. <br /> { Summary <br /> The frustration many psychiatrists feel when [reaanc <br /> ! substance dependent patients can be reduced by reccg; i::irg <br /> the biological basis for the disorder and Its chronic re i~laiitc <br /> course. I hrs leads to a broader conception of goa s a~?I : • r. <br /> adoption of long-term management techniques s;mi a ~ <br /> j those for other chronic and incurable disorders. Tie :e ri <br /> harm reduction has been used when this palliative ;:Err. <br /> I aDDroach is applied to substance use disorders. Carc <br /> management, as defined in the VA Clinical Practice ;_i.ild :litre <br /> I for the Management of Substance Use Disortler5, is G ra: used <br /> as a more accurate and Less politicized alternative. C:tlrtl <br /> i management is a low-risk, effldant approach that drP I!it! s: <br /> improves the doctor-patient relationship and may leacl t: ~ <br /> improves outcomes as well. <br /> i Dr. Willenbring is director of the addictive disorder,; 6iorl iorr <br /> at the MlnneaOONs Veterans A%airs Medics! Center. <br /> Acknowledgement <br /> Dr. Wlllenbring'S work was supDOrted by the Qua! tp <br /> Enhancement Racearch Initiative of VA Health Saroir. a!: <br /> Research and Development. <br /> i <br /> References <br /> Drucker E (1995), Harm Reduction: a Public Healtt `.Slre~:e,y.. <br /> Current Issues in Public Health 1:64-70. Available at: <br /> • www.lindesmith,erg/liprary/Clotlruck.html. Aocessad 7~ r!. <br /> 2000. <br /> L.eshner AT (1997), Drug abuse and addiction tr®etrn ar:~: <br /> research: the next generation. Arch Gen Psychiab'y 5~~ <br /> (8):691-694. <br /> McHugo GT, Drake RE, Teague GB, Xie H (1999), Fidr'M ~ :c• <br /> assertive community treatment and client outcomes h ~ t t<' <br /> New Hampshire dual disorders study. Psychiatr Sa~rv ii(I <br /> (6):818.824. <br /> i National Institutes of Health (1997), EPFective merilcal <br /> i treatment of opiate addiction. NIH Consensus Staecr^e:ni t.5 <br /> (6):1-38. Available at: <br /> odp.od.nlh.gov/consensuslcons/108/108_statemert.h:r r. <br /> Accessed Jan. 4, 2000. <br /> O'Brien CP, McClellan AT (1996), Myths about the tr:: el:n oa•:I <br /> ` of addiction. Lancet 347(8996):_237-240. <br /> i <br /> RachBelsel J, Stott Dixon L (1999), CO-oaurnn~ ?o•rE <br /> mcntoi illness and substance use disorders: a revie,~r r.~l' <br /> http://www.psychiatrictimes.com/p000255.htm1 S C31 !2007 <br /> <br />