Reference guide to assist clinical psychologists in dealing with the opioid

It can be difficult for physicians who haven't had training in substance use disorders to figure out how to handle the situation when it arises with patients.

12/21/20224 min read

Three APA divisions have collaborated to create a reference guide to assist clinical psychologists in dealing with the opioid crisis. A cross-divisional work committee of representatives from APA's Div. 12 (Society of Clinical Psychology), Div. 28 (Psychopharmacology and Substance Abuse), and Div. 50 (Psychopharmacology and Substance Abuse) wrote "The Opioid Guide: A Resource Guide for Practicing Psychologists" (Society of Addiction Psychology).

According to R. Kathryn McHugh, PhD, a psychologist in McLean Hospital's substance use disorders division, assistant professor of psychology at Harvard Medical School, and a co-author of the resource guide, "the guide is meant to be a practical guidebook." She explains, "So many psychiatrists want to know, 'What do I do when...?'" "We intended to make a truly useful primer for psychologists working with this demographic," says the author.

From knowing different forms of opioids and recognizing their overuse to discovering evidence-based treatments and resources for family members of persons with opioid use disorder, the book covers a lot of ground. The following are some major points from the guide.

Recognizing the dangers of an overdose. "Opioid use disorder is extremely lethal," says Sharon Walsh, PhD, a behavioral science professor at the University of Kentucky College of Medicine and one of the guide's co-authors. "People may appear to be doing well when they enter care, but one lapse can be fatal." Reduced tolerance owing to recent reductions in use, mixing drugs, a history of overdose, physical illness, taking multiple opioids of varying strengths, moving to injecting opioids, and using drugs alone are all risk factors for overdose. Naloxone is an opioid overdose reversal medicine. It has no potential for misuse and little adverse effects. A prescription is necessary for the medicine in some areas. Clinicians should explore formal naloxone training, and family members of opiate users should seek training as well (see Training front-line psychologists).

Detecting and preventing abuse. Prescription opioid abuse frequently leads to opioid use disorder. The earlier opiate usage is detected, the better the prognosis in the long run. Clinical psychologists should ask all patients about opioid use with a simple screening question: "How many times in the last year have you used an illegal drug or a prescription medication for nonmedical reasons (for example, because of the experience or feeling it caused)?" according to the authors of the guide. Anyone who claims to have done so even once should be subjected to a thorough screening to determine whether or not they are abusing substances.

Treatment regimens that are based on scientific evidence. Outpatient treatments for opioid use disorder that involve buprenorphine, methadone, or naltrexone are the most successful. In addition to medicine, behavioral treatments such as contingency management and cognitive-behavioral therapy may enhance drug adherence and address issues that medication does not address, such as interpersonal difficulties and stress. Patients should be referred to a drug use disorder treatment specialist by psychologists who can help establish the appropriate degree of therapy depending on the patient's needs and the severity of the problem. Treatment programs that are certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by the Joint Commission or the Commission on Accreditation of Rehabilitation Facilities offer medication-assisted treatment, provide family support, and are accredited by the Joint Commission or the Commission on Accreditation of Rehabilitation Facilities. The book provides information on how to find and evaluate local providers and initiatives.

Families can use these resources. Family involvement in therapy has been shown to be beneficial for people with substance use problems, but finding family-based treatments can be difficult. Whether a person with an opioid use disorder gets treatment or not, his or her family might suffer significantly. Psychologists can assist individuals in dealing with issues such as guilt, anger, humiliation, fear, financial troubles, and a lack of understanding about setting boundaries. Family members can also benefit from the assistance of psychologists in finding support groups.

Groups that provide social support. Mutual aid organizations may be beneficial to persons suffering from opioid addiction. These groups can offer social support, reaffirm recovery goals, educate recovery skills, and provide structure and drug-free activities. However, because the use of drugs is sometimes stigmatized, certain groups are hostile to patients undergoing medication-assisted therapy. Psychologists can assist patients by directing them to groups that are most likely to be a good fit by becoming familiar with support groups in their area.

Cultural awareness. Disparities in health-care delivery have ramifications for the diagnosis and treatment of opioid use disorder. To address the interplay of race, ethnicity, socioeconomic status, cultural context, and geography, psychologists must first get a working understanding of potential treatment barriers among racial/ethnic minorities, taking into account health-care system, provider, and patient characteristics. Second, doctors should evaluate their patients' expectations and beliefs about therapy for opioid use disorder. Finally, doctors should provide opioid use disorder treatment that is culturally appropriate.

Adolescents abuse the system. Youth who abuse prescription opioids are at a significant risk of developing a heroin addiction. All kids with a severe opioid use disorder should be offered pharmacological treatment in addition to behavioral counseling, according to the American Academy of Pediatrics. Their relatives should, ideally, be included in the therapeutic process.

Taking care of chronic pain Opioids are prescribed to millions of people for chronic pain. Several techniques for assessing the risk of opioid misuse and dependency are available. Patients with chronic pain who are seeking long-term opioid medication should use these tools. People with persistent pain should also consider nonpharmacological therapy. Cognitive-behavioral therapy, acceptance and commitment therapy, exposure to feared movements, exercise, physical therapy, and interdisciplinary rehabilitation are some of the most well-studied and effective therapies for chronic pain.

Clinicians must have certain abilities. According to McHugh, many clinical psychologists have little training in substance use disorders, so it's understandable if they're hesitant to treat people who are addicted to opioids. Clinicians do not, however, need to be experts to make a difference. "It's absurd to expect the entire psychology workforce to specialize in this field or feel qualified to provide these therapies," she says.

However, anyone working in mental health should be able to accomplish two basic things, according to McHugh. "It's vital that people understand how to recognize opioid use disorder and where to refer them for evidence-based therapy if they can't manage it on their own. That would be a significant improvement over where we are now if we could tick those two boxes."