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REFERRAL TO TREATMENT

When a patient reports serious alcohol or drug use (e.g., crack cocaine use, heavy drinking), mental health and/or psychosocial problems (e.g., legal problems, job loss), a critical next step is to make an appropriate referral.

Make Necessary Referrals to Treatment
Determine the right referral(s) based on the information you obtained during the screening and the brief intervention and from collateral sources (e.g., parents). You should consider seeking the support of behavioral health staff (e.g., social worker, case manager) in completing a referral if such staff is available in your medical setting. Some key features of a good referral include:
- Identification of one or more referral options. Provide the patient with referral options prior to the end of the office visit. For example, the American Academy of Child and Adolescent Psychiatrists has a Psychiatrist Finder that can be used to find a psychiatrist who is taking new adolescent patients.
- Administering a "warm hand-off." A warm handoff is a process in which a primary care provider introduces a patient (in-person) to his or her new health care practitioner. This process helps to facilitate the establishment of trust between the patient and the new healthcare practitioner Examples of warm handoffs include walking the patient over to the referral facility, assisting the patient in making the initial call to the referral facility, and staying with him or her when the initial appointment is made. It is important to note that patients with substance abuse problems who were transferred to a specialist using warm handoffs have very high rates of treatment enrollment. (24) Physicians or clinicians might use the following sample language when performing a warm handoff:
  
  "When looking at your overall health, I'm concerned about [insert use of substance and/or problems that have occurred as a result of use]. One of our team members/colleagues specializes in [insert concerns], and I'd like to have him/her help me provide you with the best possible care. His/her office is close by; is it ok if I make an appointment for you to speak with him/her?" (25)
- Addressing and troubleshooting potential barriers to following through on the referral. Examples of barriers are a family's lack of money, insurance, transportation, or time. Research has shown that setting up an integrated system of care that uses culturally competent engagement specialists to cultivate referral sources and engages youth and families in treatment can help improve access to, and retention in, treatment programs. (26) In cases when an integrated system of care is not available, providers should attempt to follow up with patients systematically to help address barriers that may impact following through on treatment. Use of service referral matrices, or an organized patient tracking and follow-up system—which includes multiple, ongoing contacts with the patient, depending upon severity of symptoms, impairment, etc—may be helpful in this process. In addition, providers can distribute pamphlets and handouts for community services as well as self-help and other worksheets/handouts (e.g., for patients to practice/maintain new behaviors).
- Addressing your patient's resistance to seeking additional help and following through with a referral. When a patient is ambivalent to changing their substance use behavior or resistant to seeking help, it may be helpful to use motivational interviewing strategies such as validating concerns with empathy, reflecting back the patient's concerns, talking through the pros and cons, and addressing potential barriers or concerns. Consult the NIDAMED Clinician's Resource Guide for recommendations on how to address resistant patients.
Additional Resources:

To help patients and their families identify the right drug abuse treatment program, NIDA developed the Seeking Drug Abuse Treatment brochure, which lists key questions to ask when seeking a treatment program. In addition, NIDA has developed a one-page Treatment Options handout for patients seeking treatment, and a low reading-level website—Easy-to-Read Drug Facts—that includes a section on drug treatment.