To fully support recovery, providers should “be responsive and respectful to the health beliefs, practices and cultural and linguistic needs of diverse people and groups.”1 Patient engagement is essential to developing a useful care plan and retaining the patient in treatment. Family members can be excellent sources of support and are highly influential in setting attitudes about treatment. Providing education to all on evidence-based approaches and related health issues can be very important.
Active engagement of the patient and family is seen as an essential part of the treatment process. Patients clarify their goals and help develop treatment plans. Providers and other staff communicate information about evidence-based and effective practices and health effects of continued substance use in a way that is accessible and respectful of the cultural and linguistic characteristics of those involved.
How Do You Do It?
Communicate Effectively and Build Relationships
Retention in treatment is key to successful long-term patient outcomes. Patient-provider relationships are critical to keep patients engaged in treatment, particularly in the first few weeks or months when a patient is still stabilizing. Providers need to carefully consider how to build patient-provider relationships to establish trust and a “therapeutic alliance.” Use communication styles or strategies that reinforce the program has an open, honest environment free of judgment, such as2:
- Be empathetic and warm,
- Treat patients with respect and make them feel understood, and
- Do not let personal opinions or feelings influence patient interactions.
For example, as discussed throughout the Playbook, motivational interviewing can help patients make positive changes in their lives. Motivational interviewing is an approach to discussions that can draw out a patient’s reasons for changing and strengthen their motivation. The main principles of motivational interviewing are3:
- Collaboration vs. confrontation— work together to develop a mutual understanding rather than arguing about who is “right.”
- Drawing out vs. forcing ideas about change—do not try to “convince” someone to change, rather try to draw out a person’s own motivations and reasons for change.
- Autonomy vs. authority—recognize that ultimately it is up to the individual to make a change.
- Roll with resistance—resist the urge to correct or argue with people who resist treatment suggestions or other advice. Rather, keep listening and let them come up with their own ideas for change.
The guidance document from the Providers Clinical Support System (PCSS) offers examples of questions to ask when using motivational interviewing techniques.
All staff should also be aware of the language they use and the impact it can have on a patient’s experience in the program. For instance, words such as “addict” or “drug abuser” can reinforce stigma toward those with substance use disorders. Rather, staff should use person-centered language. As discussed in Addressing Organizational Readiness and Culture earlier in this Playbook, staff’s language and attitudes play a large role in how patients perceive the culture and atmosphere of the practice. Patients will be more engaged in treatment if they feel welcome.
Shared decision making is “when a health care provider and a patient work together to make a health care decision that is best for the patient. The optimal decision takes into account evidence-based information about available options, the provider's knowledge and experience, and the patient's values and preferences.”4
Engaging patients in choices about their treatment can help establish trust and build the relationship between patient and provider. Also, when patients take an active role in the decision-making process, they understand better what they need to do and are more likely to follow through.5 Providers do not need to agree with patients’ decisions but it is important to respect them.2
In addition, providers and other staff should communicate with patients, families, and their caregivers in a manner that respects their unique culture, language, and health literacy. Culturally competent services can help improve patient outcomes and minimize health disparities by recognizing how culture influences behaviors and attitudes, including how some may seek and engage in health care. In particular, understanding a patient’s health literacy and tailoring language or materials accordingly can be key to effective communication. The Health Resources and Services Administration offers culture, language, and health literacy resources.
Taking a harm reduction approach to risky patient behaviors can also encourage patients to stay in treatment. Practices should adopt program policies and use strategies to reduce morbidity and mortality associated with opioid use among individuals for whom abstinence is not an immediate or feasible goal. This approach conveys to patients that providers are not judging them for their decisions but rather want to keep them as safe and healthy as possible. Learn more from the Association for Behavioral Healthcare’s Harm Reduction QuickGuide.
Offer Education About Medication-Assisted Treatment for Opioid Use Disorder
Stigma may be one of the biggest barriers to engaging patients in treatment. While staff will have already received training about substance use disorders and MAT to help dispel stigma, it is important that providers offer basic education to patients, families, and caregivers as well. Support of family and friends can be very important to sustaining one’s recovery. This education can help build support among family and friends and can help patients and their families advocate for themselves and their loved ones.
Practice staff need to be proactive in dispelling myths or misunderstandings about MAT or addiction when they hear them2 and educate patients and family members about what to expect at each stage of the treatment and recovery process. This education should emphasize these points:
- Medication is an effective treatment for opioid use disorder.
- Addiction is a chronic, relapsing brain disease.
- Recovery is an achievable goal.
- Staying in MAT long term leads to better patient outcomes.
It should also cover topics such as how medications for opioid use disorder work, their side effects, the risk of setbacks and recurrence of use, overdose interventions (i.e., administration of naloxone), and related topics. Learn more about Recovery Plans for Recurrence of Use later in the Playbook.
It is important to identify patient- and family-oriented educational materials that are consistent with the practice’s approach to patient care. These materials can be a good source of information for patients who want to learn more on their own. Examples of resources that providers can use for this education include the following:
- How Buprenorphine Works (PDF—365 KB) (National Alliance for Advocates of Buprenorphine Treatment [NAABT])
- What Is Buprenorphine Treatment Like? (NAABT)
- Medication-Assisted Treatment for Opioid Addiction (Partnership for Drug-Free Kids)
- Common Questions and Concerns About Medication Assisted Treatment (MAT): A Handout for Family Members of a Person With Opioid Use Disorder (PDF—58 KB) (PCSS)
- Common Questions and Concerns About Medication Assisted Treatment (MAT): A Handout for Ambivalent Patients (PDF—75 KB) (PCSS)
- The Facts About Buprenorphine for Treatment of Opioid Addiction (PDF—750 KB) (SAMHSA)
- The Facts About Naltrexone for Treatment of Opioid Addiction (PDF—581 KB) (SAMHSA)
- Why Do Our Brains Get Addicted? (TEDMED)
Providers should also consider providing a wallet-sized card to patients and their families that includes information about their treatment plan (including the prescribed medications) as well as contact information for the provider or MAT program. These cards can help promote care coordination and may be particularly helpful if the patient is ever hospitalized.6
What Not To Do
- Don’t expect patients or their families to have well-formed or accurate information about substance use disorders or their treatment. Providing education grounded in evidence and experience is important.
- Don’t fail to appreciate cultural and linguistic differences in patients and their families and the need to adapt communication styles to be effective with your audience.
- Don’t underestimate the central importance of building and sustaining relationships to the process of recovery.
Describes the key principles of motivational interviewing and provides examples for how to use these techniques.
- Substance Abuse and Mental Health Services Administration. Recovery and Recovery Support. Last updated May 2019. https://www.samhsa.gov/find-help/recovery. Accessed June 6, 2019.
- Substance Abuse and Mental Health Services Administration. Treatment Improvement Protocol 63: Medications for Opioid Use Disorder. Part 4: Partnering Addiction Treatment Counselors With Clients and Healthcare Professionals. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2018. Publication No. SMA18-5063PT4. https://store.samhsa.gov/product/SMA18-5063PT4. Accessed June 6, 2019.
- Providers Clinical Support System. Motivational Interviewing: Talking With Someone Struggling with Opioid Addiction. October 2017. https://pcssnow.org/resource/motivational-interviewing-talking-with-someone-struggling-with-opioid-addiction/
- Agency for Healthcare Research and Quality.The SHARE Approach—Achieving Patient Centered Care With Shared Decisionmaking: A Brief for Administrators and Practice Leaders. Rockville, MD: Agency for Healthcare Research and Quality; 2014. https://www.ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/tools/tool-9/index.html. Accessed June 6, 2019.
- Shared Decision Making. Washington, DC: National Learning Consortium; 2013. https://www.healthit.gov/sites/default/files/nlc_shared_decision_making_fact_sheet.pdf