What is Care Management?

• Care management is a clinical approach to the management of chronic SUDs where full remission (e.g., abstinence) is not a realistic goal or one the patient endorses.
• Conceptually, the care management approach is similar to managing other chronic illnesses, such as diabetes or schizophrenia.
• Practically, the care management framework provides specific strategies designed to enhance motivation to change, relieve symptoms and improve function, where possible, and monitor progress towards goals.
• Care management is a flexible approach that may be integrated into medical and psychiatric care in any setting. In some cases, care management will lead to remission of the SUD or referral for specialty care rehabilitation, while in others it serves a more palliative function.

Care Management Components:

1. Monitor and record specific substance use at each contact by patient report (e.g., drinking days during the past month, days of any substance use during the past month, and typical and maximum number of drinks per occasion).
2. Monitor biological indicators (e.g., transaminase levels and urine toxicology screens).
3. Encourage abstinence or reduced substance use.
4. Enhance motivation to change using non-confrontational motivational interviewing techniques.
5. Educate about substance use and associated problems.
6. Recommend self-help groups.
7. Address or refer for social functioning needs.
8. Address or refer for financial or housing needs.
9. Address nicotine use as appropriate.
10. Initiate crisis intervention as needed.
11. Provide care coordination.

To access the complete algorithm for Module C, go to: http://www.healthquality.va.gov/sud/sud_full_601f.pdf