SYNOPSIS
The assessment of suicide risk is a daunting, but increasingly frequent task for the outpatient practitioner. Guidelines for depression screening identify more individuals at risk for treatment and mental health resources are not always easily accessible. For those patients identified as in need of a formal risk assessment, this article reviews established risk and protective factors for suicide and provides a framework for the assessment and management of individuals at risk of suicide. The assessment should be explicitly documented with a summary of the most relevant risk/protective factors for that individual with a focus on interventions that may mitigate risk such as means restriction, psychotherapy and pharmacotherapy for psychiatric disorders or substance use, hospitalization, and safety planning.
Background
Opioid use disorder (OUD), a chronic disease, is a major public health problem. Despite availability of effective treatment, too few people receive it and treatment retention is low. Understanding barriers and facilitators of treatment access and retention is needed to improve outcomes for people with OUD.
Objectives
To assess 3-month outcomes pilot data from a patient-centered OUD treatment program in Iowa, USA, that utilized flexible treatment requirements and prioritized engagement over compliance.
Methods
Forty patients (62.5% female: mean age was 35.7 years, SD 9.5) receiving medication, either buprenorphine or naltrexone, to treat OUD were enrolled in an observational study. Patients could select or decline case management, counseling, and peer recovery groups. Substance use, risk and protective factors, and recovery capital were measured at intake and 3 months.
Results
Most participants reported increased recovery capital. The median Assessment of Recovery Capital (ARC) score went from 37 at enrollment to 43 (p < 0.01). Illegal drug use decreased, with the median days using illegal drugs in the past month dropping from 10 to 0 (p < 0.001). Cravings improved: 29.2% reported no cravings at intake and 58.3% reported no cravings at 3 months (p < 0.001). Retention rate was 92.5% at 3 months. Retention rate for participants who were not on probation/parole was higher (96.9%) than for those on probation/parole (62.5%, p = 0.021).
Conclusion
This study shows preliminary evidence that a care model based on easy and flexible access and strategies to improve treatment retention improves recovery capital, reduces illegal drug use and cravings, and retains people in treatment.
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