Getting It Right: Why Accurate Diagnosis and Tailored Treatment Plans Matter in Opioid Care

By Jamelia Hand MHS CADC CODP I

Early in my career, I had the privilege of working with a gentleman who changed the way I view diagnosis and treatment planning forever. His name was Mr. James, a 67 year old African-American man with a quiet strength and a gentle spirit. He had worked many years on the railroad and now lived alone in a retirement community. His pension provided financial stability, but the emotional weight of his wife’s passing after nearly 50 years of marriage was a heaviness he carried each day.

His sadness was palpable. His children were distant after years of strained communication had taken a toll. To manage his grief and loneliness, Mr. James found comfort in the company of a few women in the community, women who also used heroin. Their presence made the days a little less lonely, even if the coping strategy wasn’t healthy.

When he came to our agency, he was diagnosed with Opioid Use Disorder (OUD) and placed into treatment. But as I got to know Mr. James better, his story didn’t quite fit the standard mold. He wasn’t engaging in compulsive drug-seeking behavior. He wasn’t selling belongings or engaging in risky behavior to sustain his use. He was grieving. He was lonely. And he had developed a physical dependence on opioids, not a full-blown substance use disorder.

With more listening and less assumption, I worked with our team to revisit his intake assessment. His diagnosis was changed from OUD to opioid dependence, and that distinction made all the difference. His treatment plan was adjusted to reflect his emotional needs, not just his physical symptoms. We addressed his grief. We helped him process the pain of his wife’s death and supported him in reconnecting with his children. Within months, he had improved significantly. His mood stabilized, his use decreased, and for the first time in a long time, he began to feel hopeful.

Why These Distinctions Matter

Opioid Use Disorder (OUD) and opioid dependence are not the same. Yet they’re often used interchangeably, leading to misdiagnoses and treatment mismatches. Here’s how they differ:

• Opioid Dependence is a physiological condition that occurs when the body adapts to a drug and develops withdrawal symptoms when the drug is stopped. This can happen even when taking prescribed opioids.

• Opioid Use Disorder (OUD) involves a behavioral component. It includes compulsive use, cravings, an inability to control use, and continued use despite negative consequences.

Mr. James didn’t have OUD, he had opioid dependence related to grief and social isolation. If we hadn’t slowed down, asked more questions, and remained open to being wrong, he might still be misdiagnosed and receiving the wrong care.

Medication- Assusted Treatment (MAT) vs. Medications for Opioid Use Disorder (MOUD)

The language we use matters. So does understanding treatment options:

• MAT refers to the broader strategy of combining medication (like methadone, buprenorphine, or naltrexone) with behavioral therapies to treat substance use disorders.

• MOUD specifically refers to medications used for treating OUD. It emphasizes the role of medication in stabilizing brain chemistry, reducing cravings, and preventing relapse.

Some patients need long-term MOUD; others, like Mr. James, may benefit more from short-term medication support and counseling focused on the emotional drivers of their use.

OTP’s vs. OBOT’s: Choosing the Right Setting

Treatment setting matters, too:

• Opioid Treatment Programs (OTPs) are structured, federally regulated programs that provide daily medication (like methadone), counseling, and wraparound services. These are often best for patients with moderate to severe OUD.

• Office-Based Opioid Treatment (OBOTs) allow providers to prescribe medications like buprenorphine in a regular medical office. These are more flexible and less intensive, which can work well for patients with mild to moderate OUD or opioid dependence.

In Mr. James’ case, OBOT services, coupled with grief counseling, were more appropriate than the higher-intensity structure of an OTP.

Intake and Diagnosis: Getting it Right from the Start

Mr. James’ story highlights the critical role of accurate intake and diagnosis. The intake process shouldn’t be treated as a one-and-done formality. It’s an opportunity to get to know the patient, not just collect data. And diagnosis should never be final, it should evolve as new information emerges.

Too often, providers get tunnel vision, clinging to initial assessments even when the patient’s story begins to diverge. But good care demands humility. It requires providers to say, “I may have been wrong,” and to prioritize the patient over their own ego.

As Mr. James taught me, the willingness to revisit and revise a diagnosis can mean the difference between ineffective treatment and lasting recovery.

Treatment Planning is an Ongoing Process

A treatment plan isn’t a static document. It should change as the patient changes. Regular check-ins, open dialogue, and the flexibility to adjust goals and services are all essential.

For Mr. James, our team’s willingness to change course led to a better outcome. That’s the kind of care every patient deserves thoughtful, dynamic, and centered on their lived experience.

How Vantage Clinical Consulting Can Help

At Vantage Clinical Consulting, we help providers and organizations strengthen their ability to:

• Conduct thorough, person-centered intake assessments

• Make accurate distinctions between OUD and opioid dependence

• Match patients to the right level of care, whether that’s OBOT or OTP

• Deliver training on MOUD, MAT, and best practices in treatment planning

• Build clinical teams grounded in humility, integrity, and patient-centered care

By improving diagnostic accuracy and tailoring treatment plans to real-life stories (not assumptions) we help ensure no one like Mr. James is ever overlooked again.

Let’s get it right, because patients deserve better.

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