what is enough "behavioral medicine"

Buprenorphine Post
Posts: 35

Postby compchat57 » Tue May 26, 2015 11:57 am

Any books recommended for addiction counseling ?

Posts: 111

Postby fishdoc » Tue May 26, 2015 11:57 am

Entjwb, the Ohio law does not limit counselling to Certified Addictionologists or psychiatrists. Certified drug counsellors and 12 step programs are also included. Most important, as has been pointed out here, you, as a physician, can provide the counselling. I do that for all my patients, but require them to attend their required 3 meetings per week unless a private counsellor prescribes fewer meetings. I feel extra cannot hurt and should I get audited, I have the records. I do know many other Ohio docs not doing their own counselling, some of whom were OB-Gyns, internists, and emergency physicians. The Ohio law will be discussed at the OHSAM meeting (7 hours free CME) in Columbus next month. Hope to see you there!

Posts: 183

Postby MChaplin » Tue May 26, 2015 11:57 am

what i have done is use the 2mg strip and have the patient cut it in half and take one full strip one day and one half the next- so they are getting 3/4 strip daily- then it is only a 25% drop- when they have habituated to this dose- they can go to 1/2 strip daily- then i have them alternate 1/2 and 1/4, then go to 1/4, then 1/4 every other day- then 1/4 every third day then every 4th then once weekly. though i haven't done this with alot of patients the ones i did do it with it did work.

Jeremy K
Posts: 109

Postby Jeremy K » Tue May 26, 2015 11:57 am

Good topic, thanks for everyone's input.
Like other posters, most of the welfare third party payors in KY require specific counseling documentation.
I tell my patients they have to see a licensed addiction counselor at least monthly, more if the counselor requires it. I require documentation of their visits logged in the chart. I'm pretty OC about it, too.
I do allow an alternative: pastoral counseling under two conditions:
1. The pastor is willing (not all are)
2. The patient is an actual member of the pastor's congregation (speaks to accountability)

Posts: 137

Postby deegee » Tue May 26, 2015 11:57 am

Hi entjwb,
Maybe I wasn't clear in my post. You referred above to "1-5 people a month completing the program". Are you referring to patients? Or are you talking about docs becoming drug counselors?
It sounds like you send your patients to an outside counselor, but in your state, you have the option of doing counseling yourself? How does that get billed? Aren't counseling charts required to be separate from medical charts?
Anyway, I just wasn't sure what you meant in your post.

Posts: 180

Postby entjwb » Tue May 26, 2015 11:57 am

Degree, if you are board certified in any specialty. The ABAM will allow you to take courses to qualify to take the boards if you have one year equivalent patient care in addiction and get 50 hours CME in addiction. I will try to post here later.

Posts: 137

Postby deegee » Tue May 26, 2015 11:57 am

I must say, this is the most civil discussion board I've ever participated in.

Posts: 571

Postby kcairns » Tue May 26, 2015 11:57 am

DeeGee u r right of course and i withdraw my manup, and again Kevin has got us on top of the issue both w his above post and also reference to new asam guidelines which spells it out in part 7

Posts: 137

Postby deegee » Tue May 26, 2015 11:57 am

Thanks to all for contributing more to this topic. I don't think it's an issue of whether or not we "man up". I'm sure we all do counseling in our own way. Unfortunately, if we want to be around to help patients, we also need to know what is expected of us. Often, the hoops we jump through don't do $*** but we have to jump through them anyway. I'm not a big fan of na/aa for everyone, but that's all some people are offered. I think I can do some effective counseling in my office even though I'm not a "shrink" but I don't think anyone would acknowledge it and I sure as heck don't get paid for it. Sadly, I don't think care exists if there is no reimbursement. Everything must have it's code.
I do like Kevin's idea of the checklist and I will incorporate it. But does it qualify? I think Mack86 makes a good point in his post. We should somehow seek clarification on this.
@entjwb, what do you mean by "completing the program"? What does the program consist of and what happens next?
Anyway, I'm bothered by the vague advise that we have the ability to offer counseling. It seems like we are all just as much in the dark. Ultimately, I wonder if my checklist would be acceptable to the powers that be, whomever they are.

Posts: 571

Postby kcairns » Tue May 26, 2015 11:57 am

beautiful i typed mine immediately

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