Substance use relapse monitoring

The manuals converge on close monitoring for relapse and other substance use during ketamine-assisted treatment, using repeated checks rather than one-off assessment. Across the extracts, this includes timeline follow-back or Time Line Follow Back methods, urine drug testing or urine drug screening, and attention to changes in opioid use, other illicit drug use, or ketamine use at each visit or during follow-up. They also agree that worsening substance use or illicit ketamine use is a meaningful clinical signal. The sources describe referral for ongoing substance abuse care when new or worsening use appears, and one manual states that participants who report illicit ketamine use between sessions are withdrawn and referred for substance abuse treatment. Another source adds that facilitators remain alert to emerging interest in ketamine outside the therapeutic context, and address misuse, diversion, or escalation promptly within the treatment team. The manuals differ mainly in emphasis and scope. The opioid-focused protocols stress opioid recurrence, abstinence, collateral reports from relatives or colleagues, and physical signs such as injection marks, with monthly follow-up extending up to 12 months. The methamphetamine protocol places more emphasis on non-medical use liability, measured with the DEQ-5, and on balancing therapeutic engagement with clear boundaries around prescribed ketamine use, while still tracking other drug use with Timeline Follow Back.