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Recovery Resident Screening and Admission Back to Course Index

Recovery Resident Screening and Admission

There are specific tasks that a Certified Recovery Residence Administrator must conduct to provide for the residents’ quality of life and safety.  Initial screening and intake procedures determine a client’s eligibility and readiness for a program.  

This course will explore the policies and procedures for admission, the tools utilized to establish criteria for admission, and discuss the rights and requirements of admission.

The screening and admission process used in addiction treatment does not utilize  a single too,  but rather incorporates all the important elements for screening and assessing potential residents for admission into a recovery house.

There are four levels (I, II, III, IV) of support for Certified Recovery Residences, the tools used and information gathered will vary depending on the level and the services being offered.

Certified Recovery Residence Administrators use professional knowledge and skills to determine when and how to conduct assessments and admissions.

The primary goal of the following tasks is to ensure the consistent implementation of policies and procedures that are directly related to resident services and care. All services must be implemented under the guiding philosophies of Quality of Care and Administrative Enforcement.

Tasks for the Recovery Residence Administrator include:

  1. Implement and maintain policies and procedures that identify the residence’s primary population and screening criteria to ensure appropriateness of the applicant to the residence’s level of credentialing or licensure and offered recovery programing.
  2. Ensure resident admission and orientation provides both oral and written explanations of agreements, policies, procedures, rights and requirements before the applicant is admitted/agrees to move-in to the recovery residence, including but not limited to:

-Residence specific recovery support standards, including supervision, house rules and governance, social and leisure activities, arrangements for healthcare, and activities of daily

-Grievance policy and resident

-Initial and on-going screening for communicable disease and/or parasite

-Policy regarding alcohol and illicit drug free living environment and response to resident reoccurrence of

-Food service standards, including dietary standards, food hygiene, and catered food service.

-Medication practice and standards, including self-administered medications; pill organizers, assistance with self-administration; medication administration, records, storage and disposal, labeling and orders; and other the counter products.

  1. 3.  Implement and maintain financial management policy and procedures that fully disclose all anticipated residence and third-party service provider fees, including deposits and/or refund polices for which the resident or responsible payer is/may be accountable.

These tasks were set forth by the Florida Certification Board (FCB).   

 

SCREENING, INTAKE AND ADMISSIONS PROCEDURES

Certified Recovery Residences can look and feel like a family of people in recovery, living together for mutual support understanding what each other is going through. Appropriate admission guidelines ensure that residents are compatible, and that they are united in a goal of recovery from addiction. The application and admission process supports full disclosure to potential residents about their rights and obligations, and establishes a mutual understanding of the recovery and operations goals of the home.

  1. Applicants admitted for residence must suffer from, and be in active recovery from, at least one treatable substance use disorder including alcoholism and/or drug addiction, regardless of other addictions or behavioral health conditions from which they may also
  2. All applicants must be able to engage independently in major life activities including eating, dressing, bathing and other activities consistent with independent
  3. Applicants must have the firm intention of remaining clean and sober, and of actively engaging in a program of
  4. Applicants must be assessed for their ability to become part of a harmonious home environment, taking into consideration the needs of individual residents and the character of the existing resident
  5. Minors may not be admitted as residents in any home which also houses residents over the age of 18, except for minor children of parents admitted as residents of approved parent/child homes
  6. Applicants must be fully informed of all fees and charges for which they will be responsible
  7. Homes must disclose refund policies to applicants in advance of acceptance into the home, and before accepting any applicant
  8. Applicants must be informed about policies regarding abstinence, toxicology testing, recovery participation and other
  9. Applicants must receive a complete written set of house rules and other requirements of residence.
  10. Applications must include the name and contact information for person(s) to be contacted in case of an emergency.
  11. Applicants must be advised of house policies on medications, and must explicitly consent to such policies before being accepted as
  12. Residents must be informed that the home is a family unit, and that they do not have personal property rights in any specific portion of the
  13. Applicants must be informed of their rights to avail themselves of Coalition grievance procedures, including contact information for designated Coalition
  14. The Coalition will review the home’s application and intake documents as part of the inspection process. The Coalition reserves the right to disapprove or request modifications to documents based on policies it publishes and distributes to members. The Coalition will maintain a family of pre-approved intake and related documents for optional use by member homes.
  15. Applicant and resident records are confidential documents, and must be treated as such. All such records must be maintained in a secure and locked location either on or off
  16. Records maintained electronically must not be accessible to residents or others, except for those explicitly delegated with the authority to view such

Screening and admission processes will differ, at least slightly, from on Certified Recovery Residence to another. The tasks listed above will be the common link between all certified residences as maintaining these tasks in all the NARR/FARR domains is necessary in becoming certified and staying that way.

Some residences, sometimes depending on level (I, II, III or IV) will have an intake and admissions process that will involve getting minimal information from applicants to in-depth detailed information. What is most important is consistency and formalizing the residences intake/admissions process in the residences policies and procedures.

 

Screening Process

The recovery residence is step toward longer term support for recovery.  The initial search begins with an applicant or family member first contacting a recovery residence, often via telephone or a visit to the site of the residence. This contact is the first opportunity for the residence staff to establish rapport with with potential residents and their families. During the initial contact it is important to speak with and answer the questions of not only the potential resident but their family members or loved ones. 

Staff members should be prepared to provide immediate, practical information that helps potential applicants make decisions about the residence as a potential good match, including the approximate length of time from first contact to admission, what to expect during the admission process, and types of services offered. A brief exploration of applicants’ expectations and circumstances can reveal other information they need for considering if the residence is a good match and if the level of support offered is a good match for the applicant’s needs.

After the initial contact, frequently some type of phone screening is conducted to determine the appropriateness of the admission and to begin the process in a more formal way to aide in seizing the opportunity to help the potential resident move forward with the process.  This screening is usually a series of questions to ensure a resident meets admission criterion. The phone screening should be a brief series of 10 or 15 questions that take about 10 minutes. The screening should explore:

  • The desire to be Sober
  • Abstinence from Drugs and Alcohol
  • Mandatory Drug Tests
  • Daily 12-Step meetings
  • Regular in-house meetings
  • Daily meditation and reading Exercise program
  • House Chores
  • Work all 12-Steps of Alcoholics Anonymous
  • Continue after care treatment programs
  • Gain employment (post step-work) or volunteer work

Part of the admissions process will include the financial requirements and arrangements, residence requirements, what residents need to bring with them.  

Once the program rules and regulations have been understood and accepted by the applicant, initial fee payment and travel arrangements must be made.

 

Description of Intake Criteria and Intake Process:

  • A description of intake criteria and specific steps involved in the intake process.
  • A written description of policies regarding resident admission criteria.
  • A policy that resident transfers must leave in good standing. Good standing would include but is not limited to rent, house dues and house violations.

What Residents Need to Bring:

What is suggested or allowed will vary by the recovery residence’s policies but an example of the list should include:

  • Seven days of appropriate clothing
  • Personal hygiene products
  • Cell phones and laptops
  • A notebook and writing utensils
  • Personal cars and/or bikes
  • Items or tools needed to gain and maintain employment (driver’s license, social security card, etc.)
  • A willingness to do whatever it takes to live sober

 

Written policies and Information:

The residence should employ a policy that all staff is aware of and adheres to federal and state regulations on discrimination and confidentiality, strictly limiting disclosure of confidential information.

A written policy promoting non-exploitation of residents including protection from sexual abuse, physical intimidation, financial manipulation or forced labor should also be established and maintained.

A part of the intake and admission process should also include a clear and written procedure for discharge (e.g., positive urine test results, aggressive behavior, etc.).

 

SCREENING AND INTAKE IN PRACTICE

Screening is the process by which the perspective resident is determined appropriate and eligible for admission to a particular residence.

Global Criteria:

  1. Evaluate the psychological, social, and physiological signs and symptoms of active alcohol and other drug
  2. Determine the client’s appropriateness for admission or
  3. Determine the client’s eligibility for admission or
  4. Identify any coexisting conditions (medical, psychiatric, physical, etc.) that indicate the need for additional professional assessment and/or
  5. Adhere to applicable laws, regulations, and agency policies governing certified recovery residences.

The eligibility criteria are generally determined by focus, target population, and funding requirements of the certified recovery residence. Many of the criteria are easily ascertained. These may include the resident’s age, gender, legal status, veteran status, income level, level of AOD recovery and the referral source. Allusion to following agency policy is a minimally acceptable statement. If the client is found ineligible or inappropriate for the program, the counselor should be able to suggest an alternative.

Other Admission Criteria

Intake person must utilize subjective criteria to determine:

  • whether or not substance use disorder is currently present\active requiring treatment prior to acceptance into the residence
  • the resident’s level of daily recovery practices
  • the resident’s level of dysfunction in other areas, i.e. mental health, medical issues, education and vocational requirements, employment issues, legal issues and any family related issues
  • key issues and problem areas
  • degree of resident’s awareness and insight into their own recovery and wellbeing

 

Establishing Rapport

Screening is the first step in establishing rapport with a potential

  • May be resident’s first attempt to seeking recovery continued care
  • An opportunity to provide needed emotional support and guidance

Skills which help establish rapport include:

  • Warm tone of voice
  • Encouraging prompts;  “tell me more about that”
  • Non-threatening questions; questions which do not appear to confront, attack or judge the resident
  • Appropriate self-disclosure; sharing some small piece of personal information which will invite openness without shifting the focus away from the resident
  • Clarifying confusing information; asking clarifying or follow-up questions to insure that the resident’s response is clear.

Screening Information

Screening forms generally ask for:

  • resident data (age, sex, residence, )
  • referral source
  • presenting issues
  • financial eligibility \insurance availability (for levels III & IV)
  • whether to accept into the program or refer elsewhere

Screening Tasks for the Admissions Person

  • Assemble screening forms
  • Collect and analyze information from referral sources
  • Interview the prospective resident, with specific questions about:
    • general resident date
    • presenting statement of goals from recovery residence living
    • previous recovery residence efforts
    • outside support available
    • level of commitment to change

Making the Admission Determination

  • Analyze all information to determine resident’s appropriateness for recovery residence. Apply criteria from Sections B and
  • If resident is appropriate, begin arrangements for intake
  • If resident is inappropriate, investigate referral options and discuss with resident

Referral

  • Screening process sometimes ends in referral if resident is not appropriate
  • Admissions person needs to be well-informed about other appropriate programs\residences.

 

Intake includes the administrative and initial assessment procedures for admission to a residence.

The intake usually becomes an extension of the screening, when the decision to formally admit is documented. Much of the intake process includes the completion of various forms. Typically, the new resident and the resident administrator fill out an admission or intake sheet, document the initial assessment, complete any appropriate releases of information collect financial data, sign consent for treatment to collect urine analysis screenings and possibly assign a senior resident as the buddy\orienteer.

Global Criteria:

  • Complete the required documents for admission to the
  • Complete the required documents for program eligibility and
  • Obtain appropriately signed consents when soliciting information from, or providing information to, outside sources to protect client confidentiality and rights.

Tasks

  • Intake is an extension of the screening process; it occurs after a resident is accepted into residence
  • The intake interview is instrumental in engaging a resident in the continuing recovery process and beginning to develop a relationship between resident and recovery residence administrator\recovery residence
  • The intake interview consists primarily of the completion of admission forms
  • The information collected during the intake will form the basis of the resident’s on-going recovery plan
  • The admission’s person and resident discuss confidentiality at this point

General Types of Forms

  • Admission/intake form
    • basic information: name, address, employer, family composition, who to contact in an emergency,
  • Initial assessment form
    • brief statement about the presenting problems and immediate resident needs, i.e. detox, rehab, outpatient
  • Consent for treatment form
    • the resident’s agreement to the general terms of the services and treatment, i.e., level of support, psycho-social assessment, cost,
  • Financial form
    • summary of the resident’s financial status, generally used to determine the cost and for any necessary billing to insurance companies
  • Release of information forms
    • the required written permission of a resident for the release of information to a specific outside party or to receive any information from an outside party, i.e., former treatment provider or therapist, probation or parole officer, family physician,

Confidentiality 

  • State and federal regulations protect the resident’s identity and the content of any counseling sessions
  • Confidentiality is a therapeutic, ethical and legal issue
  • The resident is often anxious about “who will find out”; this anxiety should be addressed during both the screening and intake process and anytime the resident needs reassurance in order to:
    • reduce resident’s anxiety
    • build rapport and trust
  • The rules, regulations and residence policies should be explained to the resident in the intake process and in writing; should be presented in a way that lets the resident know that they are in his/her best
  • The federal regulations:
    • Cover any program providing alcohol/drug abuse diagnosis, treatment or referral for treatment which is directly or indirectly federally assisted
    • Allow disclosure of information about a resident only under certain circumstances:
      • when the resident has consented in writing
      • in a medical emergency
      • when the resident commits or threatens to commit a crime on residence premises or against residence personnel
      • to qualified persons conducting audit, research, or residence evaluation
      • if required by court order
    • Even under these circumstances, the requirements are strict regarding the re- disclosure of resident information
    • there are criminal penalties for violation of the regulations

Expectations of Admission Person Attitudes during Screening and Intake Processes

  • Recognition of personal biases, values, and beliefs and their effect on communication and the treatment
  • Willingness to establish
  • Appreciation of the value of data-gathering
  • Willingness to be respectful toward the resident in his or her presenting
  • Appreciation of the importance of empathy in the face of feelings of anger, hopelessness, or suicidal or violent thoughts and
  • Appreciation of the importance of legal and administrative
  • Respect for the resident’s perception of his or her
  • Acceptance of non-readiness as a stage of
  • Appreciation that motivation is not a prerequisite for
  • Recognition of the importance of the resident’s self-assessment.
  • Recognition of one’s own recovery
  • Appreciation of various recovery
  • Willingness to link to resident with a variety of helping
  • Recognition of personal and professional limitations of practice, based on knowledge and
  • Willingness to base recovery recommendations on the resident’s best interest and preferences.
  • Willingness to work collaboratively with the resident and
  • Willingness to renegotiate

Person-centered Screening and Admission Processes

Person-centered processes emphasizes that the focus of initial contact is not on filling out a form or answering several questions or on establishing residence fit, but rather on finding out what the resident\applicant wants, in terms of his or her perception of their need, their recovery process, what he or she wants to change, and how he or she thinks that change will occur.

Sensitivity to Culture, Gender, and Sexual orientation

An important component of a person-centered process is the continual recognition that culture plays a significant role in determining the resident’s view of addiction, the recovery process and continuing wellness. With regard to co-occurring disorders, admission\screening staff must remember that ethnic cultures may differ significantly in their approach to substance use disorders, recovery and mental disorders, and that this may affect how the resident presents.

Cultural sensitivity also requires recognition of one’s own cultural perspective and a genuine spirit of inquiry into how cultural factors influence the resident’s request for help.

During the screening\intake\admission process, it is important to ascertain the individual’s sexual orientation as part of the admission staff person’s appreciation for the resident’s personal identity, living situation, and relationships. Admission staff also should be aware that women often have family-related and other concerns that must be addressed to help keep them engaged in their on-going recovery process, such as the need for child care.

Trauma sensitivity

The high prevalence of trauma in individuals with co-occurring disorder requires that the admission staff consider the possibility of a trauma history even before the screening begins. Trauma may include early childhood physical, sexual, or emotional abuse; experiences of rape or interpersonal violence as an adult; and traumatic experiences associated with political oppression, as might be the case in refugee or other immigrant populations. This pre-interview consideration means that the approach to the applicant must be sensitive to the possibility that the applicant has suffered previous traumatic experiences that may interfere with his or her ability to be trusting of the screening\admissions person. Admission staff who observes guardedness on the part of the applicant should consider the possibility of trauma and try to promote safety in the screening\intake through providing support and gentleness, rather than trying to “break through” evasiveness that erroneously might look like resistance or denial. All questioning should avoid “re-traumatizing” the applicant\resident.

It is important to emphasize that in screening for a history of trauma or in obtaining a preliminary diagnosis of PTSD, it can be damaging to ask the applicant to describe traumatic events in detail. To screen, it is important to limit questioning to very brief and general questions, such as:

“Have you ever experienced childhood physical abuse? Sexual abuse? A serious accident? Violence or the threat of it? Have there been experiences in your life that were so traumatic they left you unable to cope with day-to-day life?”

 

Safety Screening

Safety screening requires that early in the screening process the admission staff person specifically ask the applicant if he or she has any immediate impulse to engage in violent or self-injurious behavior, or if the applicant is in any immediate danger from others. These questions should be asked directly of the applicant and of anyone else who is providing information. If the answer is yes, the admission staff person should obtain more detailed information about the nature and severity of the danger, the client’s ability to avoid the danger, the immediacy of the danger, what the client needs to do to be safe and feel safe, and any other information relevant to safety; following the guidelines and procedures set forth by the residence’ policies and procedures. Once this information is gathered, if it appears that the applicant\resident is at some immediate risk, the admission staff person should arrange for a more in-depth risk assessment by the residence supervisor or a mental-health-trained clinician (licensed), and the applicant\resident should not be left alone or unsupervised.

 

DOCUMENTATION AND RECORD KEEPING

Documentation and the appropriate maintenance of resident documents is an important aspect of the screening process. Earlier in this course we talked about reviewing the laws and limits of confidentiality with applicants and residents. Many of the same guidelines apply to any document that contains any form of a person’s Personal health Information (PHI), which is basically of the documents used in the both the screening and admission process.

Applicants and residents have a right to expect that not only what they say during individual and group counseling and any support group but also what they put in writing by the act of answering questions, completing self-assessments or signing agreements for urine drug screenings.

It is true that when a person is in alcohol and other drug treatment there is significantly more documentation involved. However, despite the limited amount of documentation required in a certified recovery residence it carries the same level of importance and federal and state mandates.

The seven key purposes of clinical and procedural documentation include:   

 1.  Document professional work:

  • to record what was done, by whom, with, to, for, and/or on behalf of whom, when, where, why, and with what results
  • to document assessment, psychosocial needs, risk assessment and other services provided,

2.  Serve as the basis for organization and continuity of care of the resident by the residence staff:

  • to record meaningful information that the residence staff can later rely on to refresh his or her memory of crucial events, the resident’s response to treatment and other services, problems experienced in treatment, key historical facts and details of substantive collateral contacts
  • to create a longitudinal record of the history of the resident’s complaints, symptoms, co- morbidities, assessments, recovery progress and other services provided.

3.  Serve as the basis for subsequent continuity of care of the resident by recording for use by other practitioners\staff who may serve the resident in the future meaningful data regarding the resident’s:

  • assessment, treatment and other services provided, progress and response to treatment and other services.
  • trends, crises and problems in recovery and in living environment, so that they may have sufficient data based upon which they can provide meaningfully informed continuity of care to the resident.

4.  Risk management purposes to protect against malpractice lawsuits and professional discipline complaints, and to aid in defending effectively against any such lawsuits or complaints; (in this regard, be aware that if you didn’t document something of importance contemporaneously in the resident’s record and that becomes the subject of contention in a legal or disciplinary proceeding against you, it can be treated by a court or administrative body as if it did not happen or you missed it or you ignored it or you did not address it, etc., all of which may well ensure to your detriment in such proceedings)

  • Document informed consent (i.e., for treatment, disclosure of information) and the nature and extent of the professional relationship and of duty owed with regard to the resident
  • Explain, detail and justify professional decision-making, problems encountered in working with the resident, and the response to crises and other special or problem situations
  • Record the details of supervision/consultation obtained in relation to the assessment and treatment of the resident, particularly with regard to crises or other special or problematic situations that arise
  • Recovery Residence Administrators who supervise, provide oversight of the screenings and intakes, any treatment and other services rendered by their staff under their supervision in order to enable them to defend the quality and appropriateness of their supervision and the quality of their supervisee’s professional work against any malpractice lawsuit alleging negligent supervision or malpractice by them or their supervisee
  • Record information that will support the adequacy of the intake decision, the appropriateness of the treatment/on-going recovery plan and the application of professional/peer skills and knowledge in the provision of certified recovery residence services

5.  Comply with legal, regulatory and institutional requirements

  • Assure compliance with resident documentation and record-keeping requirements imposed by federal and state (including licensing boards) laws, regulations and rules.
  • Fulfill clinical documentation and record-keeping requirements of various third-party payers (i.e. Medicare, Workmen’s Compensation, Medicaid, insurance, managed care plans)

6.  Facilitate coordination of professional and peer efforts by fostering communication and collaboration between members of the residence team

  • Assure coordinated rather than fragmented service delivery
  • Assure appropriate utilization of team members from multiple disciplines in order to bring to bear collaboratively in an interdisciplinary/transdisciplinary manner the particular competencies of team members from various disciplines and/or who have specific specialties to maximize the quality of services to clients.

 

HIPAA and 42CFR Part 2

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is the law that regulates the use and disclosure of Protected Health Information (PHI) held by “covered entities” such as health plans. In addition to HIPAA there are special privacy protections afforded to alcohol and drug abuse patient records by 42 Code of Federal Regulations (“CFR”) Part 2.

The privacy provisions in 42 CFR Part 2 were motivated by the understanding that stigma and fear of prosecution might dissuade persons with substance use disorders from seeking treatment. To add an extra layer of protection on these records, the regulations outline under what limited circumstances information about a patient’s treatment may be disclosed with and without the patient’s consent. Who and what are covered can be confusing, though.Just about anyone who has ever received medical care has heard of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the law that regulates the use and disclosure of Protected Health Information (PHI) held by “covered entities” such as health plans. But far fewer are familiar with the special privacy protections afforded to alcohol and drug abuse patient records by 42 Code of Federal Regulations (“CFR”) Part 2.Just about anyone who has ever received medical care has heard of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the law that regulates the use and disclosure of Protected Health Information (PHI) held by “covered entities” such as health plans. But far fewer are familiar with the special privacy protections afforded to alcohol and drug abuse patient records by 42 Code of Federal Regulations (“CFR”) Part 2.

The Legal Action Center has developed some handy-dandy FAQ’s for the Substance Abuse and Mental Health Services Administration. Here is the summary of them:

  • 42 CFR Part 2 applies to any individual or entity that is federally assisted and holds itself out as providing, and provides, alcohol or drug abuse diagnosis, treatment or referral for treatment (42 CFR § 2.11). Most drug and alcohol treatment programs are federally assisted. For-profit programs and private practitioners that do not receive federal assistance of any kind would not be subject to the requirements of 42 CFR Part 2 unless the State licensing or certification agency requires them to comply. However, any clinician who uses a controlled substance for detoxification or maintenance treatment of a substance use disorder requires a federal DEA registration and becomes subject to the regulations through the DEA license.
  • The regulations restrict the disclosure and use of alcohol and drug patient records which are maintained in connection with the performance of any federally assisted alcohol and drug abuse program (42 CFR § 2.3(a)). The restrictions apply to any information disclosed by a covered program that “would identify a patient as an alcohol or drug abuser …” (42 CFR §2.12(a) (1)). In laymen’s terms, the information protected by 42 CFR Part 2 is any information disclosed by a covered program that identifies an individual directly or indirectly as having a current or past drug or alcohol problem, or as a participant in a covered program.
  • With limited exceptions, 42 CFR Part 2 requires patient consent for disclosures of protected health information even for the purposes of treatment, payment, or health care operations. Consent for disclosure must be in writing.

 

 

MEDICATION MANAGEMENT 

Each recovery residence should establish and clearly communicate its policy and procedures around both OTC and prescription medications. These policies and procedures are designed to maintain a safe living environment and support the recovery of everyone in the home, including the resident(s) taking medication. There are 4 different types of recovery residences, each offering a different Level of Support in both services and staffing. Level 4 offers clinical services, whereas Levels 1, 2, and 3 do not. While laws can vary from state to state, they generally restrict the dispensing and managing of medications to licensed professionals, like the ones you would find in a Level 4 recovery residence. That being said, most residents taking medication do not live in a Level 4 recovery residence. Although they cannot provide medication management, Levels 1, 2, and 3 can use policies and procedures around the self-management of medications and the eligibility of individuals taking specific medications to live in the house. These policies and procedures are used to maintain a safe, recovery supportive living environment for a specific population within the scope of service the recovery residence is qualified to provide. For example, the use of methadone, buprenorphine, and other medication-assisted recovery pharmaceuticals are allowed in some RRs, but not in others. This is in part due to the logistics, staffing, and cost of managing these types of medications, but it also may reflect philosophical differences within the recovery community and consumer choices. There is a demand for both RRs designed for individuals using medically assisted products in their recovery and for those that dis-allow medically assisted recovery.

 

SIGNS AND SYMPTOMS OF INTOXICATION AND WITHDRAWAL 

The client seeking admission to a recovery residence needs the support of a clean and sober environment.  It is crucial for the staff at a recovery residence be able to recognize the signs and symptoms of intoxication and withdrawal.  

Long-term use of even legally prescribed medication can result in withdrawal symptoms, negative physical and psychological symptoms when stopped or reduced.   Withdrawal from can range from mild anxiety and depression to seizures, delusions, hallucinations, coma, seizures and death. 

Many times the psychological withdrawal symptoms are worse than the physical symptoms due to their long-lasting effects and the inability to use drugs to alter thought patterns about the substance. Individuals who have abused substances for a lengthy period of time may come to believe they can’t function normally without the drug. Others fear they will no longer be able to function at school or work, while others are concerned they will lose their self-confidence and ability to interact socially.  Once in recovery these fears have to be processed.

Signs

While symptoms can differ based on the substance used, common symptoms include:

Psychological/Mood:

  • Altered mood state
  • Continued drug use despite the knowledge it is causing or exacerbating a psychological disorder
  • Difficulty making decisions
  • Poor judgment
  • Changes in personality
  • Sudden changes in mood, irritability
  • Angry outbursts
  • Feeling fearful, anxious or paranoid without reason
  • Lack of motivation to pursue any goal-related activity
  • Loss of pleasure in previously enjoyed activities

Behavioral:

  • Neglecting responsibilities at home, work, or school
  • Engaging in risky behavior when under the influence
  • Using the substance in hazardous conditions
  • Continued drug use despite legal problems
  • Much time and effort spent obtaining, using and recovering from the substance
  • Deterioration of physical appearance
  • Hiding drugs in different places =
  • Hiding drug use from others
  • Social withdrawal to avoid negative judgments or pressure to stop using the drug
  • Unexplained financial problems.
  • Illegal acts such as stealing to buy drugs

Lack of participation in previously frequented activities

Physical:

  • Altered perceptual experiences
  • Continued drug use despite knowledge it is causing or exacerbating an illness
  • Tolerance – the need to take more of the substance to produce desired effects
  • Taking the drug to avoid withdrawal symptoms
  • Negative effect on immune system resulting in frequent illnesses
  • Change in appetite
  • Change in sleep patterns

Effects of Drug Abuse

Some common effects of drug abuse include:

  • Accidents and injuries
  • Criminal activity
  • Domestic violence, child abuse and neglect
  • Physical and psychological illness
  • Lost opportunities
  • Reduced productivity
  • Risky sexual behavior and promiscuity
  • Engaging in theft, violence and vandalism which may result in incarceration
  • Drug-related medical emergencies
  • Drug-related death
  • Infectious diseases
  • Homelessness
  • Loss of employment
  • Inability to obtain employment
  • Lack of control, impulsivity
  • Disruptive and antisocial behavior
  • Increased aggression and physical altercations

Withdrawal Symptoms

While withdrawal symptoms depend largely on the substance, common withdrawal symptoms include:

  • Anxiety, nervousness
  • Restlessness, agitation
  • Social withdrawal or isolation
  • Sweating
  • Racing heart
  • Palpitations
  • Muscle tension
  • Tightness in the chest
  • Difficulty breathing
  • Tremor
  • Nausea, vomiting, or diarrhea
  • Seizures
  • Irregular heart beat or heart attacks
  • Strokes
  • Hallucinations
  • Thoughts of death or suicide
  • Feelings of helplessness/ hopelessness
  • Irritability
  • Insomnia, hypersomnia
  • Headaches
  • Inability to concentrate
  • Depression

 

CONCLUSION

Just as in the screening, intake and admissions process for addiction treatment programs, certified recovery residences must have policies, procedures, and screening tools that match the level of support being offered to ensure the wellbeing, safety and recovery goals of their residents. In order to help ensure this, residence staff assigned to complete screenings and\or intakes must be trained in the admissions process and provide the same delivery of services to all applicants and residents.

FARR guidelines and recovery residence guidelines must be strictly adhered to and appropriately documented following federal and state laws and guidelines for documentation and record keeping.

Certified recovery residences were established to help provide meaningful continued support in an individual’s continuing recovery path. First and foremost recovery residence staff must provide support, caring and concern for all applicants and residents alike.

 

REFERENCES

  1. Recovery Residence Administrator Role Delineation Study Formal Report February 2016. The Florida Certification Board. February 29, 2016
  2. The Granite House. http://granitehousesl.com/about/admissions-process/. 2012
  3. Consumer Guide to Sober Housing. Pro-Act Ambassadors for Recovery. August 31, 2010

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