TIP 45: Detoxification and Substance Abuse Treatment

SAMHSA has issues a new TIP (Treatment Improvement Protocol) on Detoxification and Substance Abuse Treatment. I haven’t read it yet, so I can’t comment on most of it.

TIPs tend to be hit or miss — a few are terrific (especially when you consider that they are free!) and many are of little value. They’re done by committees and often end up watered down or representing the biases of the committee.

I did glance at the co-occurring section and thought it looked like a mixed bag. (Maybe something for everyone on the committee?) It starts off emphasizing high rates of psychiatric illness in alcoholics and mentions “underlying psychiatric disorders”, but also suggests postponing psychiatric diagnoses several weeks (if possible), discusses substance-induced psych symptoms, and encourages a conservative approach to prescribing psychotropics. Importantly, at first glance, it fails to distinguish between DSM abuse and DSM dependence.

I think highly of the committee chair, Normal Miller. I’m unfamiliar with most of the rest of the committee. It seems heavily skewed towards psychiatrists and other M.D.s. It looks like there are very few practitioners on the panel. Let me know what you think about it.