Integration & Aftercare

Integration is a clinical phase, not an afterthought

Under the Readiness Standard, preparation and screening earn most of the attention because they gate whether treatment happens at all. But the Common Outcome Protocol's own minimum dataset runs a full 2-week → 4-week → 3-month → 6-month → 12-month follow-up arc — longer than the screening and dosing phases combined. That schedule exists because the question that actually matters to your patient is not "did the session go well," it's "am I still better in six months." Integration is the clinical phase where that answer gets made — or doesn't.

Define it precisely for your practice: integration is the structured process of helping a patient process, make meaning of, and behaviorally act on material that came up during a dosing session, paired with systematic monitoring for delayed adverse effects and symptom change. It is not a wellness add-on. It is where continuity of care, outcome measurement, and safety surveillance all converge.

The integration window: what to actually do, and when

• Day-of to 72 hours: acute monitoring per the modality annex (vitals, adverse-event log). For ibogaine specifically, cardiac risk does not end when the session ends — QTc effects and the drug's long elimination half-life mean clinically meaningful prolongation can persist for days. Established
• Daily/weekly check-ins: brief, two-sided — patient reports mood/sleep/cravings/side effects and a since-last-visit suicide-risk screen (C-SSRS); clinician logs observed function, adverse events, vitals/cardiac notes where indicated, medication changes, and integration support delivered. Any positive safety screen triggers immediate escalation — it is never just a data point.
• 2 weeks: first formal check-in against baseline; confirm the integration plan is actually being used, not just handed out.
• 4 weeks: repeat brief symptom and function check; this is typically your first real signal of trajectory.
• 3 months: repeat the full primary outcome measure, function/disability scale, and wellbeing scale; review medication list for changes.
• 6 and 12 months: repeat the same battery. This is the window where you find out whether an early response held, partially faded, or reversed — durability cannot be assessed at any earlier timepoint.

Measuring outcomes with the Common Outcome Protocol

The Common Outcome Protocol asks every provider to repeat the same core battery at every follow-up milestone, using the same validated instruments used at baseline, so an individual patient's trajectory and the field's pooled evidence are built from comparable data:

• Primary condition outcome — PCL-5 for PTSD, PHQ-9 for depression, or GAD-7 for anxiety, matched to the patient's presenting condition. All three are validated, published instruments with strong psychometric support in treatment-seeking veteran and first-responder populations. Established
• Function — WHODAS 2.0 or the Sheehan Disability Scale. Symptom reduction without functional improvement is an incomplete result; track both.
• Wellbeing — WEMWBS. Captures the positive side of recovery, not just symptom absence.
• Adverse events and new medications at every follow-up, including delayed or persistent effects.
• Loss-of-diagnosis (no longer meeting criteria) where applicable — an adjunct, patient-meaningful marker, not a required core measure.

Durability is not guaranteed — grade the claim honestly

This is the point where CE content most often drifts into overpromising, so be precise with your patients and yourself. Short-term efficacy data for several of these modalities is real: a randomized, placebo-controlled phase 3 trial of MDMA-assisted therapy for severe PTSD showed a significant reduction in CAPS-5 scores at its primary endpoint. But that endpoint was measured roughly two months after the final session — it is evidence of acute-to-medium-term response, not durability, and MDMA-assisted therapy remains without FDA approval as of the most recent regulatory action. Established (short-term) / Hypothesis (durability)

Longer follow-up data exists but is thinner: a small (n=39) LSD-assisted therapy trial for anxiety reported sustained anxiety-scale improvement out to roughly 12–18 months in an open-label extension — encouraging, but a single small study is not proof that durability is the norm across patients, modalities, or clinics. Plausible

• Tell patients plainly: an acute response is not a promise of a lasting one. Relapse or partial fade-out is a real, expected possibility your follow-up schedule is designed to catch — not a sign that something went wrong or that they failed.
• Long-term persistence-of-effect studies for these modalities are actively enrolling and reporting precisely because durability is an open question, not a settled one — this is exactly why your repeat measurements at 6 and 12 months matter clinically, not just for the registry.

Continuity of care and referral

• Named receiving clinician for every escalation path before treatment day: psychiatry/crisis services for safety-screen positives, cardiology for delayed cardiac symptoms (especially post-ibogaine), addiction medicine for craving/relapse or dependence concerns (ketamine, kratom), and the patient's primary prescriber for any medication reconciliation change.
• Warm handoff, not a referral slip. A positive C-SSRS screen or a serious adverse event should trigger a direct, documented contact with the receiving clinician — the same standard the daily check-in design already requires.
• Document the clear-to-treat packet's continuation: the same file that carried screening, consent, and contraindication review should carry the follow-up battery results, adverse-event log, and any referrals made, so the next clinician who sees this patient — including you, eleven months from now — has the full course, not just the dosing note.
• Close the loop on medication changes. Any taper done pre-treatment (e.g., serotonergic agents before MDMA or ibogaine) needs an explicit, prescriber-owned decision about resumption timing during integration — this is not something to leave to patient discretion.

Post-session red flags: what should make you stop and escalate

What this module is — and isn't

This is a framework for structuring integration, measurement, and escalation — it does not certify that any psychedelic, ibogaine, or detox protocol is safe or effective, and it does not set your clinical thresholds for you. The Readiness Standard and Common Outcome Protocol certify a preparation and follow-through process; every go/no-go decision, every threshold, and every clinical judgment call remains the treating clinician's alone.