Diagnosis: Substance use

Treatment: Inpatient admission, monitoring

The insurer denied the inpatient admission. The denial was reversed.

This patient was admitted to inpatient substance residential treatment for rehabilitation of substance use. He reportedly was smoking 2-3 blunts of cannabis per day. He had a past inpatient substance detoxification and rehabilitation residential treatment and past substance outpatient treatment. He lacked coping skills and a sober support, needed to have better motivation for change, needed to improve coping skills, relapse triggers, and relapse prevention skills. He reportedly was unable to remain abstinent on his own, and his motivation was external due to being mandated by parole for positive toxicology. He was discharged with referral to outpatient substance treatment.

The American Psychiatric Association (APA) Practice Guidelines for the Treatment of Patients with Substance Use Disorders reports that residential treatment is indicated for individuals who do not meet clinical criteria for hospitalization but whose lives and social interactions have come to focus exclusively on substance use and who currently lack sufficient motivation and/or substance-free social supports to remain abstinent in an ambulatory setting. According to the Level of Care for Alcohol & Drug Treatment Referral (LOCADTR), he met criteria for substance residential treatment, as he continued to use substances despite a past inpatient substance detoxification and rehabilitation treatments and substance outpatient treatment. He used substances despite negative consequences and could not stop on his own, so outpatient substance treatment was not considered to be safe and effective. He was unable to stop substance use without being in a sober and supervised therapeutic inpatient substance residential setting.