what is enough "behavioral medicine"

Buprenorphine Post
Posts: 1404

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

Maybe create a Psychotherapy Form, or add to your existing form. You could even have catagories, you could check off boxes reflecting what was done.

For example:

1. Supportive counseling
2. Stress management
3. Cognitive behaviorial therapy- facing fears head on
4. Relapse provention therapy
5. Disease management and education
6. Problems solving
7. Crisis management
8. Dietary control
9. Smoking cessation
10. Insight oriented therapy
11. Couples therapy
12. Family therapy
13. Goals and future planning

Some things like that, maybe with a space to write specifics after each catagory. No one could ever than say, you didn't do the therapy component.

You could also join and seek certification with The American Psychotherapy****ociation- for a little more "street cred."

Hope this helps.


Posts: 571

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

entjwb, thanks for info on ohio (where i grew up and went to med school and wish cavs could win) law,....i didnt finish
chris Hedges quote, next part of it is "....and then we let it go". so i think we carry out the good for pts until regs catch up w us and stop us from carrying out that good, and then then we let it go per wisdom of Reinhold Niebhur re things we can no longer change...ps also as noted in thread on street bup, just got called by woman who for 9 years cant get better w counselling but bup 4/d keeps her well, point being - your program record is good but i remember ohio as a smart strong place that would not force a person into just anything w/o even knowing what it is going to end up doing or not to the person

Posts: 180

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

In Ohio we have to refer to a certified drug counsellor. If you are a Psychiatrist or board certified addictionologist you can fulfill that role. I prefer to send to a drug counsellor as well as spending some time with the patient. I have a good retention rate and 1-5 people a month completing the program. I have patients that have been referred by other patients.

Posts: 571

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

... studies have been reported showing success is just as good w an experienced bupdoc doing the counselling as w formal counsellors....formal counselling adds expense and time out of work...formal counselling most often ends up w pt being asked when they are going to get off that stuff .... i know i am not as good at it as Dr Passer and other good psychs on this Board and i cant ask my pts pay for additional 30-60 min of my time....but my pts let me know how much cousnelling help they get from me in the length of time spent in our regular bup appts...and i have no doubts in this regard....andit is fun....very fun to me to have read the article "elements that define recovery" by Kaskutis and others including Alexandre Laudet in JCSAD as linked from asam weekly news this week and exploring such succinctly w my clients....and i am not going to give such up to trembling over what authorities will do to me...w Chris Hedges, i say " we are called to carry on the good in so far as we can determine what the good is"...or (to myself)...Man up. Just do it!

Posts: 70

Postby mack86 » Tue May 26, 2015 11:57 am

Thank you Dr. Passer, for suggesting that. I spend 30-90 min with my patients. I'm not a psychiatrist, but all physicians are counselors, almost by definition. I would like to think I could do at least as well as a social worker. Wouldn't it make sense that there must be a way doctors like me could become qualified for counseling? At least at the social worker level?

Posts: 1404

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

As a "Shrink," I do my own therapy. I allow at least 30 minutes/visit. I am also big on family therapy.

There must be a legitimate way, for non behavioral medicine physicians, to perform the therapy part, especially if one is interested in doing so.

Posts: 70

Postby mack86 » Tue May 26, 2015 11:57 am

The DEA is not who you need to worry about. They are benign. It is your state medical board that is going to cause trouble, and their rules can be arbitrary and change without notice.

Posts: 137

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

Still, would be interested in knowing what people are doing in their respective practices, whether or not the dea agent cares.

Posts: 101

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

Same here. No questions about counseling during my DEA inspection. It was seriously benign from start to finish. Don't sweat it.

Posts: 104

Postby jmosby1469 » Tue May 26, 2015 11:57 am

In my own practice, Medicaid and some other third party payers will not cover Suboxone costs unless the member is in formal Behavioral Health counseling. Adversely, it has become difficult to find such services which will accept patients using Suboxone. My DEA examiners seem to have no interest in whether or not such counseling is actually taking place.

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