There will always be care for chronic addiction so why not do it more compassionately and efficiently. Factors to consider when deciding who should have CMCA include past treatment history, motivation level and goals, ability to participate in rehabilitation, available programming to match patient needs, and prognosis of coexisting conditions. The goals of CMCA include engaging the patient, coordinating care, reducing suffering, treating complications, improving motivation to change, inducing remission whenever possible, preventing or limiting relapse, slowing the rate of deterioration or extending meaningful life, reducing use of expensive, and ineffective services. This is an active treatment where an ideal goal is abstinence. In many people this is an unrealistic proximal goal, but CMCA tries to move people in that direction.
Some patients refuse treatment except when in crisis.
If so, then provide episodic care, crisis intervention, case management, and continue attempts to engage the patient. Involuntary treatment or asset management may be needed in extreme circumstances. Periodically it is also necessary to reassess goals and refer to rehab when goals change. One study showed that a group receiving a one-hour intervention by a nurse was more likely to be improved a year later. Another studied a sample of middle- aged Swedish men who had been drinking heavily.