Table 2.

Principles for Managing Health Care Relationships With Substance-Using Patients

Establish a climate of mutual respect

Maintain a professional approach that reflects the aim of enhancing patients’ well being; avoid creating an atmosphere of blame or judgment

Educate patients about their medical status, proposed treatments, and their side effects

Include patients in decision making

If possible, establish a multidisciplinary team consisting of primary care physicians, HIV specialists, psychiatrists, social workers, and nurses

Have a single primary care provider coordinate the care delivered by such a team to maximize consistency and continuity

Define and agree on the roles and responsibilities of both the health care team and the patient

Set appropriate limits and respond consistently to behavior that violates those limits

Minimize barriers to participation (penalties for missed visits, and so forth)

Recognize that patients must set their own goals for behavior change and work with patients to achieve commitment to realistic goals for healthier behaviors

Acknowledge that abstinence is not always a realistic goal; emphasize risk- reduction measures for patients who continue to use drugs

Acknowledge that sustaining abstinence is difficult and that success may require several attempts

Be familiar with local resources for the treatment of drug users

Pitfalls to avoid

Unrealistic expectations

Frustration

Anger

Moralizing

Blame

Withholding therapy

Data from O’Connor et al.,45Batki and Sorensen,46Wartenberg,47and Selwyn and O’Connor.48