Overview
Medical Group typically consists of 8-12 membersmeeting with the prescriber, therapist, case manager and occasionally a peer recoverysupport specialist. Priorto the session, each patientis checked in by the medical assistant. The medical group discussion typically consists of:
- Medication issues including dosage adjustments, side effects, film/tablet etc.
- Number of days abstinent
- Results of Urine Drug Screen
- Review of communitypeer support group meeting attendance and progress e.g. home group, sponsor, step work etc.
- Basic psychiatric, social,employment and legal progress are discussed
- Treatment of co-morbid psychiatric conditions are typically not conducted in this group.If patients have co-existing psychiatric needs a separate psychiatric evaluation is scheduled.
- Treatment for other medical conditions are typically not provided.
Therapy Group consists of the same 8-12 members as in the medical groupand follows immediately afterwards. (The therapist attends the Medical Group). The therapy group’s goals are to:
- Help build a solid,sustainable recovery program
- Develop strategies for relapse prevention
- Promote peer support and a supportive social network
- Develop an understanding of the disease of addiction
- Discuss how the medication works to assist the process of recovery
- Review attendance and experience at community peer support groups
- Develop healthy interpersonal relationships
COAT Treatment Phases
- Orientation (weekly) Group: Most patients entering the COAT program will start in an Orientation Group (exceptions are made for recent re-admissions, etc.). Patients attend this group until they have demonstrated understanding of the COAT policies and procedures. On average patients attend Orientation Group for 1 to 3 weeks.
- Beginner (weekly) Group: All patients entering the COAT program must start in a weekly group. Patients attend this group until they have 90 consecutive days of abstinence from all drugs, alcohol, and no missed urine drug screens. The patients are encouraged to attend community peer support group meetings.
- Intermediate (bi-weekly) Group: This group is for patients with more than 90 days of continuous abstinence and meets every other week. Individuals continue in the bi-weekly group until they have one year of continuous abstinence from drugs, alcohol, and no missed urine drug screens. The patients are encouraged to attend community peer support group meetings.
- Advanced (monthly)Group: This group is for patients with more than 365 days of continuous abstinence and meets every 28 days. The patients are encouraged to attend community peer support group meetings. Patients may continue to attend this group indefinitely.
- Maintenance (bi-monthly) Group: This group meets every other month for medication management only and is for patients with more than three years of continuous abstinence who choose to only attend the medical group. Patients continue in a recovery oriented lifestyle and some become peer mentors themselves. Patients may continue to attend this group indefinitely for maintenance.
Not every patient advances through all the various phases. Some patients require the program to be flexible enough so that they may receive the structure that is appropriate for them. The program is fluid bi-directionally based on the patients’ needs.
Example: A patient who is currently attending a monthly group may move to a bi-weekly group because they felt the need for higher care, or the current care does not suffice. The patient is able to drop down a level and can re-graduate once they reached the required number of days abstinent.
In addition to the regular, phase-based COAT programming above, two additional outpatient programs exist to provide the highest levels of care. The philosophy behind these programs is to provide more frequent visits and accountability for those who have been unsuccessful in the regular COAT program. These are listed in increasing levels of care as follows:
Applied Coat (aCOAT)
The second highest level of COAT programing for patients referred from the Beginner COAT groups. This program consists of two sessions per week. This includes a 30-minute check-in session with a medical assistant followedby an hour-long Group Therapysession (e.g. Mondays). There is also a 30-minute check-in session with a medical assistant followed by a 30-minute Medical Management session (e.g. Wednesdays). Patients remain in aCOAT for a28-day evaluation period. When the 28-day evaluation period ends, if eligible, the patient may return to a Beginner COAT group.If not eligible, the patientwill then be referred to a higherlevel of care (e.g. Residential Treatment Center (RTC),iCOAT or daily dosing Opioid Treatment Programs (OTP).
Intensive COAT (iCOAT)
The highestlevel of COAT programing consistsof three sessionsper week. This includes a 30- minute check-in session with a medical assistant followed by an hour-long Group Therapy session (e.g. Mondays). There is also a 30-minute check-in session with a medical assistant followed by a 30-minute Medical Management session (e.g. Wednesdays). Finally, there is a 30- minute Case Management Session (e.g. Fridays). Patients remain in iCOAT for a minimum of a 28-day evaluation period. When the 28-day evaluation period ends, if eligible, the patient may return to a Beginner COAT group. If not eligible, the patient will then be referred to a higher level of care. [(e.g. Residential Treatment Center (RTC), or daily dosing Opioid Treatment Programs (OTP)].
Specialized Groups
Thought COAT
This is a weekly specialized COAT group for those patients who have co-occurring psychiatric disorders, such as, Schizophrenia, Schizoaffective Disorder, and Psychosis (not substance induced). The group therapy component of this group takes place first to allow more time for adjustment after check in stimulation and has a more life skills and resource focused approach. The medication portion of the group is still 30 minutes but also handles psychiatric medication for these patients. Group capped at 8 or 10 based on acuity of patients in group.
Dual COAT
This is a weekly specialized COAT group for those patients who have struggled in the traditional COAT model due to co-occurring psychiatric disorders, such as, MDD, GAD, PTSD, and Bipolar. The medication portion of this group is 60 minutes to allow time for management of those co-occurring diagnoses to help with overall medication compliance and reducing the need for any additional appointments in early recovery.
THC COAT
This is a weekly COAT Group specifically for patients who have struggled in the traditional COAT model due to the continued use of THC alone. This group focuses on decreasing THC use overall while patients understand they will remain in this weekly group until they are abstinent. The group has the traditional 30 min medical assistant check in followed by the 30-minute med check and 60 min group therapy component.
Pain COAT
This is a weekly COAT group specific for patients who struggle with pain control as a primary concern and this groups allows for additional medications for pain regulation that are not permitted in the traditional COAT model. This group focuses on best practices for management of pain that are unique to that population and then have the option to transition to our other pain management programing upon graduation. The group has the traditional 30 min medical assistant check in followed by the 30-minute med check and 60 min group therapy component.
Cannabis as Medicine Policy
The Medical Cannabis Act, signed into law in 2017, allows WV residents to apply for a card from a licensed physician to obtain cannabis if they qualify as having specific medical conditions. As such, there is much confusion among the public regarding the lack of scientific rigor to support designating cannabis as medication as well as the demonstrable health risks associated with cannabis. The WVU Department of Behavioral Medicine and Psychiatry is aligning their policies to reflect the position of both the American Medical Association (AMA) and the American Psychiatric Association (APA) on the use of cannabis for medical indications, considering the current evidence base and statements from other medical organizations as well.
It is important to note that cannabis use is associated with clear physical and mental health impacts.These include a defined increased risk of:
- cannabis hyperemesis syndrome
- chronic bronchitis (if smoked)
- cannabis withdrawal syndrome
- cannabis use disorder/addiction
- worsening of symptoms related to depression, anxiety, PTSD, bipolar disorder, and schizophrenia.
- psychosis and suicidality
Therefore, patients enrolled in our Comprehensive Opioid Addiction Treatment (COAT) Clinic are not permitted to use cannabis, regardless of whether they are certified by a medical provider to do so. If you are currently using cannabis as a result of having the “medical marijuana card,” you are instructed to contact the physician who authorized the card and begin the discontinuation process. If you have previous history of complicated withdrawal from cannabis or any other substance, please alert your medical prescriber and your COAT Treatment Team.