11
Table 4. Risk Stratification and Adherence Monitoring
Action Low Risk Moderate Risk High Risk
Risk
stratification
a
• No history of
alcohol abuse or
drug abuse
• No family
history of
alcohol or drug
abuse
• No history of a
major psychiatric
disorder
• Older age
• No smoking
• Stable social
support
• Remote history of
alcohol or drug abuse
• History of addiction
with a sustained
period of recovery
and a strong system to
help sustain recovery
• Questionable family
history of alcohol or
drug abuse
• History of major
psychiatric disorder
that has been
managed effectively
• Younger age
• Smoking
• History of physical or
sexual abuse
• Lack of social support
• Involvement with
others engaging in
drug abuse
• Recent history,
or multiple
episodes, of
alcohol or drug
abuse
• History of
addiction with
limited or no
system to sustain
recovery
• Strong family
history of alcohol
or drug abuse
• History of major
psychiatric
disorder
Adherence
monitoring
and
mitigation
• At least annual
adherence
monitoring
• At least semiannual
adherence monitoring
(more frequent
at higher levels of
assessed risk)
Adherence
monitoring at least
every 2-3 months
and more frequent
visits
Monitoring should
usually include:
• detailed
interviewing
about drug-
related behavior
• questioning of
family member
and record
review from
other treating
physicians
• check of
prescription
monitoring
program
• urine drug screen
• pill counts
Monitoring should usually include:
• detailed interviewing about drug-related
behavior
• questioning of family member and record
review from other treating physicians
• check of prescription monitoring program
• urine drug screen
