Code of Maine Rules › 14 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 118 - OFFICE OF SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES (SAMHS) › Chapter 2 - DRIVER EDUCATION AND EVALUATION PROGRAMS PROCEDURE MANUAL › Section 118-2-L - DEEP COMPLETION OF TREATMENT GUIDELINES

Current through 2024-29, July 17, 2024
Statement of purpose
This document sets forth a common framework within which
				  Community-based Service Providers of DEEP approved substance abuse services can
				  evaluate, treat and recommend completion of treatment of persons suspended for
				  operating under the influence. It presents criteria for classifying clients
				  according to their degree of progression and recommends appropriate treatment
				  requirements. Consistent use of this framework should result in a uniform
				  approach to the DEEP evaluation, referral and treatment process.
DEEP clients include both offenders who are addicted and
				  those who are not. The needs of both groups are different. Also, although
				  addicted persons share the characteristics of loss of control, they differ in
				  the degree to which they have progressed and may also have different
				  needs.
DEEP affirms that addiction is a disease that requires
				  abstinence from alcohol and other drugs. DEEP also recognizes that the current
				  DSM manual provides the accepted standard for diagnosis of behavioral disorders
				  but is not intended to diagnose addiction as a disease. Thus, the DEEP
				  guidelines have been revised to be consistent with the both DSM standards and
				  the Prevention Research Institute Phases of use, which reconciles the concepts
				  of Dependence and Addiction. In these guidelines, Phase Two and Three refers to
				  clients who may qualify for the DSM IV diagnosis of "Abuse" or of "Dependence
				  Without Physiological Dependence," but are not yet addicted. Phase Four refers
				  to clients who are addicted to alcohol or other drugs. People in Phase Four
				  usually qualify for DSM IV Diagnosis of "Dependence with Physiological
				  Dependence."
We need to acknowledge the presence of Phase One, although
				  individuals who display drinking choices identified as Phase One will very
				  likely not be involved in services unless they progress into Phase Two. Phase
				  One is characterized by consistent low-risk drinking choices. That is to say
				  that individuals will either abstain or drink 0 to 2 drinks if daily and no
				  more than 0 to 3 if less than daily, depending on their guidelines, and never
				  more than one drink per hour. Individuals in Phase One do not use other drugs
				  to get high since this leads to impairment and any impairment is high-risk.
				  Unless a pattern of high- risk choices develops that would put the individual
				  in Phase Two, it is appropriate for individuals to continue to enjoy alcohol in
				  low-risk quantities for the rest of their lives.
A number of physical, psychological and social experiences
				  characterize each group. The number, severity and frequency of negative
				  consequences increase as the individual progresses.
The client's needs and thus the appropriate treatment
				  response differ according to the client's stage in the progression. That is, a
				  treatment approach that might be effective with an abuser may be completely
				  ineffective with a person who is physically dependent. Conversely, treatment
				  options thatmight be appropriate for a physically dependent person might be too
				  intensive and restrictive for a person who is not addicted.
Clinical experience and knowledge of published studies
				  generated the categories mentioned above. Clients' needs are defined and
				  matched to those general types of treatment most suited to meeting those needs.
				  This establishes a guideline for the practitioner's use during the initial
				  client clinical substance abuse evaluation. It also provides DEEP with a
				  reference point for assessing evaluations.
Obviously, eliciting sufficient information about multiple
				  areas of an individual's life is not always easy, especially when the
				  individual may be consciously or unconsciously denying or minimizing the extent
				  of the individual's involvement with substances. It is critical to supplement
				  information obtained from the substance abuser with information obtained from
				  significant others. Thus the true extent of the person's involvement with
				  substances may only emerge after a series of interviews. This information may
				  then be used to clarify the client's degree of involvement with
				  substances.
This formula for classifying every client describes general
				  patterns of behavior that are usually associated with a given degree of
				  progression into addiction. It provides a set of reference points for gauging a
				  client's degree of harmful involvement with substances. Based on these
				  reference points, a suitable intensity and modality of treatment may be
				  recommended.
DEEP recommends that each client complete the DEEP
				  educational program plus additional evaluation/treatment, if required. All
				  clients respond differently to treatment and may have different treatment
				  needs. Some clients may respond readily to recommended treatment. If the client
				  completes treatment prior to the recommended threshold, the reason for
				  recommending early completion must be justified on forms provided by DEEP.
				  Other clients may not respond to treatment for a significant period of time,
				  resulting in the continued need for treatment beyond the recommended number of
				  clinical hours and time lines. When the clinician decides there is a need for
				  continued treatment that may go beyond thresholds established by the Completion
				  of Treatment Guidelines, the clinician is required by regulation to request and
				  obtain an extension of treatment from DEEP.
The rest of this document is given over to delineating the
				  typical problems and behaviors experienced by individuals in each of the
				  identified groups. Associated with each phase is the treatment approach
				  recommended by the Driver Education and Evaluation Programs (DEEP) as having
				  the highest probability of successful outcome, without being overly
				  restrictive. The guidelines represent the recommended number of clinical hours
				  within a time period and the modality of treatment for significant client
				  improvement in each phase.
Salient Characteristics/Symptoms
1. Substance Abuse/Phase Two
The most important distinguishing characteristic of this
				  phase is frequent engagement in high-risk alcohol and/or drug use in spite of
				  repeated negative consequences. Persons in this group are focused on the short
				  term and artificial benefits substance use appears to bring them. Typically,
				  use is fostered by social pressure or by internal needs. The person may have
				  turned to substance use to dull feelings of pain and insecurity, or may simply
				  be using for fun. They may use chemicals as substitutes for other forms of
				  satisfaction. People in this group will qualify for a DSM IV Abuse diagnosis,
				  but not a DSM IV Dependence diagnosis.
Interventions in this stage typically do not require
				  intensive treatment approaches. Generally, individuals may require motivational
				  enhancement and increased skills inorder to better withstand peer pressure, and
				  to inject more intrinsic satisfaction into their lives. These persons should
				  also receive objective information on the effects of substance abuse and the
				  long-term risks of continuing their pattern of use. Some individuals may have
				  co-occurring issues that may require intensive treatment, possibly including
				  referral to specialized programs.
The recommended treatment interventions can usually be
				  accomplished in 6 - 8 outpatient clinical hours spread over a 60-day
				  period.
a. PHYSICAL
(1) Does not qualify for a DSM IV Dependence
				diagnosis
(2) Risk of physical
				injury as a result of abuse
(3) May
				be experiencing physical difficulties as a result of abuse
(4) No physical addiction
(5) Repeated impairment as a result of
				substance abuse
(6) Increased
				Tolerance