Shatterproof National Principles of Care
The Shatterproof National Principles of Care for addiction treatment are science-based practices which improve outcomes for individuals with a substance use disorder.
#1: Routine screenings in every medical setting
During check-ups and in the ER, no matter how old you are, you need to be screened for a substance use disorder. This should be as common as getting your blood pressure taken.
What this means: Screening for substance use disorders should be routine in primary care and other medical and behavioral health settings, such as emergency, obstetric, geriatric, and pediatric care. Screening should be followed by:
- guidance on reducing substance use,
- family education to support lifestyle changes, and
- regular check-ins with healthcare providers.
If you show symptoms of a substance use disorder, you should receive a diagnosis and personalized treatment plan from a healthcare provider.
Why it matters: Screening for substance use disorders should be a part of routine primary care visits, similar to screening for other chronic diseases, such as diabetes. Screening is proven to help prevent, treat, and sustain recovery from substance use disorders. Also, it’s critical that discussions about substance misuse in medical and behavioral health settings become part of the normal routine.
#2: A personal plan for every patient
Treatment facilities should consider your unique needs. One-size treatment does not fit all.
What this means: Treatment facilities should give you a personalized and thorough evaluation before creating your treatment plan. Your provider should ask about your substance use disorder and other physical and mental health concerns. During this first step, you also should be asked to identify concerns—such as those related to family, social situations, housing, and transportation—which could affect your care and long-term recovery. In addition, treatment should include frequent check-ins and personalized adjustments from your healthcare provider.
Why it matters: No single treatment approach works for everyone. Personalized care is used to treat other chronic illnesses and has been shown to help people with addiction stay engaged, follow their treatment plan, and have better health results.
#3: Fast access to treatment
You should be able to get treatment as soon as you’re ready.
What this means: Treatment facilities should provide quick access to services that meet your immediate needs and set you up for long-term success. This could mean allowing walk-ins for outpatient treatment or starting the process for getting you into a residential treatment program.
Why it matters: Addiction is a condition that alters your brain. Addiction can affect areas of your brain that control what motivates you, what prevents you from taking action, and your ability to handle stress. Starting treatment as soon as you’re ready can lead to more successful results.
#4: Long-term disease management
Addiction treatment should include long-term management and follow-up, not just one-time treatment.
What this means: Local, long-term outpatient care—or care you receive in a regular medical office where you do not stay overnight, like a checkup—helps you manage your substance use disorder over time. Even when you don’t start treatment in this setting, when you’re ready you should be connected to these services through what’s called a “cascade of care.” A cascade of care includes:
- Prevention
- Identification (diagnosing substance use disorder)
- Treatment
- Recovery
Why it matters: Some individuals with more severe substance use disorders may need intensive services, such as withdrawal management or residential treatment. But this type of care is not the way that everyone starts treatment or maintains recovery.
For individuals who do require these intensive services, lower levels of outpatient care should always follow to support lasting recovery. Other individuals may start and remain in care in the outpatient setting. Because your needs may change over the course of recovery, checking in with your healthcare provider is important to track your progress and adjust your care as needed.
#5: Coordinated care for every illness
Your treatment plan should include treatment for other illnesses you may have, such as mental health (like depression or anxiety) and physical health conditions (like diabetes or hepatitis).
What this means: Addiction treatment should consider the whole person. Treatment facilities should offer comprehensive physical and mental health services along with addiction treatment. If a treatment facility cannot provide all of the health services you need, they should work with other healthcare systems and providers to connect you with these services.
Why it matters: It’s very likely that people entering treatment for substance use disorder are also dealing with other mental or physical health concerns. Common mental health concerns include depression, anxiety, and post-traumatic stress disorder (PTSD). Common physical health concerns include pain, sleep disorders, infectious diseases such as HIV/AIDS, hepatitis C, or tuberculosis (TB), diabetes, and high blood pressure.
The best way to improve your overall health is to be treated for all your concerns at the same time in a coordinated manner.
#6: Behavioral health care from legitimate providers
Certain behavioral health therapies, such as cognitive behavioral therapy and family behavior therapy, are proven to help manage and treat addiction effectively.
What this means: Treatment facilities should offer proven behavioral therapies. Some behavioral therapies shown to successfully change problematic behaviors and relationships include: Cognitive Behavioral Therapy, Individual Supportive Psychotherapy, Families and Couples Therapy, and Motivational Enhancement Therapy.
Why it matters: Proven behavioral health therapies have been shown to help individuals
- recognize and accept their substance use disorder,
- increase their motivation to stick with treatment, and
- sustain long-term recovery.
These approaches are most effective when delivered by trained healthcare providers.
#7: Medications for addiction treatment
Treatment providers should work with you to find out if a medication, which is approved by the Food and Drug Administration (FDA), may be the best choice for treating your substance use disorder.
What this means: Treatment facilities should help you understand all of your treatment options—including FDA-approved medications—and help you get the right medications if needed.
Why it matters: Not all people with substance use disorders will need medications. Also, FDA-approved medications are not available for every substance use disorder. But when medications are prescribed correctly and checked from time to time, they’ve been shown to prevent overdose and support positive health results.
Medications work best when they’re part of a larger treatment plan that includes:
- behavioral health therapies,
- check-ins with healthcare providers to make sure you’re taking your medications correctly and that they’re working without negative side effects, and
- other health and support services.
#8: Support for recovery outside the doctor’s office
Treatment is more successful when other circumstances also are addressed, such as housing, employment, and personal relationships.
What this means: Treatment is more successful when other circumstances—such as housing, employment, and personal relationships—also are addressed. Treatment facilities should connect you with recovery support services that offer emotional and practical support throughout your recovery. This might include peer services (such as mutual aid or support groups) and community services (such as housing, education, employment, and family support).
Why it matters: It’s hard for individuals to stay in recovery if they’re having housing issues, are unemployed, or are in complicated relationships. Treatment is more successful if your living and job situations and relationships support your treatment goals. Some treatment facilities may not be able to directly offer services to address these issues, but they should be able to help you find and access these services.
