Transcript Prescription Drug Abuse: Loosening the Knot

Prescription Drug Abuse:
Loosening the Knot
J. Patrick Slifka, LCSW & George Young, LCSW
Why We’re Here
Dealer out of Business?
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http://www.youtube.com/watch?v=Cb93lPJB8yw
Which is More Dangerous?
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http://www.youtube.com/watch?v=u_nCqak6mYQ
“Just The Facts”
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All of these drugs are available – right now.
They do what they’re “advertised to do.”
If your individuals (particularly your adolescent ones)
have not been already, they will soon be in a position to
make a choice…to use or not to use. Their choice will
carry both a benefit and a consequence.
“Just The Facts”
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Drugs are not inherently evil, bad, or good – they’re simply
chemicals.
The Relationship a person forms with a drug becomes the
problem – and the problem gets progressively and
significantly worse over time.
Remember that not all individuals have the same
responses to the same drug or class of drugs. There are
idiosyncratic reactions we have to assess and understand.
Why We’re Here?
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Epidemic? Problem?
Attitude is the father of the Action
Ethical Obligation and Competent Practice
Jeopardy Time
Jeopardy Question #1
The Answer is:
Patients leave a doctor’s office with this on
7 out of every 10 visits.
What is a Prescription?
Jeopardy Question #2
The Answer is:
Medicine Cabinets
Where do a large number of teens who
abuse prescription medications get their
drugs?
Jeopardy Question #3
The Answer is:
Dr. Gregory House and American High
School Seniors identify this prescription
drug as their favorite.
What is Vicodin?
Trends and Statistics
The Landscape
A View of the Landscape
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http://www.youtube.com/watch?v=1sdFRJtzI0s
Rates of Rx drug sales, deaths and
substance abuse tx admissions
1 in 6 Teenagers
Most Commonly Abused Medications Among U.S.
High School Seniors (2010 Annual Prevalence)
Vicodin
Cough Medicine
Amphetamines
Ritalin
Tranquilizers
OxyContin
Sedatives
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Source: Monitoring the Future, University of Michigan, December 14, 2010
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What is Driving the Prevalence?
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Misperceptions about safety.
Increasing environmental availability
Varied motivations for their abuse.
Other Factors Driving Trend:
Pill-Taking Society
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Rx medications are all around us…and teens notice.
 Patients leave the doctor’s office with a prescription in
hand in 7 out of 10 visits.
 Direct-to-consumer advertising on TV and in
magazines.
Many people don’t know how to safely use these
medications or ignore their doctor’s instructions.
Common Prescription Drugs of Abuse
Signs, Symptoms and Biopsychosocial Consequences
Top 10 Most Dangerous Drugs in
America (DAWN database of ER visits)
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Xanax
Oxycontin
Vicodin
Methadone
Klonopin
Ativan
Morphine Drugs (opiates)
Seroquel (Antipsychotic)
Ambien
Valium
Most Commonly Abused Classes of
Prescription Drugs
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Opioid Pain Relievers (Opiates, Narcotics)
CNS Stimulants (primarily those used in the tx of ADHD)
CNS Depressants (Sedatives, Hypnotics, Anxiolytics)
Key Assessment Point: Effects of Drugs
Depend on…
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Route of administration
Amount taken at one time
User’s past drug experience
Circumstances under which the drug is taken (the place,
the user’s psychological and emotional stability, the
presence of other people, simultaneous use of alcohol
and other drugs, etc.)
Commonly Abused Rx Drugs
How they work
Abused to
Drug names
Strong Pain Relievers
Used to relieve
moderate-to-severe pain,
these medications block
pain signals to the brain
To get high, increase
feelings of well being by
affecting the brain
regions that mediate
pleasure
Vicodin, OxyContin,
Percocet, Lorcet, Lortab,
Actiq, Darvon, Codeine,
Morphine,
Methadone
Stimulants
Primarily used to treat
ADHD type symptoms,
these speed up brain
activity causing increased
alertness, attention, and
energy that comes with
elevated blood pressure,
increased heart rate and
breathing
Feel alert, focused and
Adderall, Dexedrine
full of energy—perhaps
Ritalin, Concerta
around final exams or to
manage coursework, lose
weight
Sedatives or
tranquilizers
Used to slow down or
“depress” the functions
of the brain and central
nervous system
Feel calm, reduce stress,
sleep
Valium, Xanax, Ativan,
Klonopin, Restoril,
Ambien, Lunesta,
Mebaral, Nembutal,
Soma
Opioid Pain Relievers (Opiates/Narcotics)
What are Opiates?
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Opiates are a group of drugs that are used for treating
pain. They are derived from opium which comes from the
poppy plant.
Opiates go by a variety of names including opiates,
opioids, and narcotics. The term opiates is sometimes
used for close relatives of opium such as codeine,
morphine and heroin, while the term opioids is used for
the entire class of drugs including synthetic opiates such
as Oxycontin. But the most commonly used term is
opiates.
Dried Opium Poppy
Commonly Used & Abused Opiates
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Opium
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Codeine
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Morphine
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Tramadol (Ultram)
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Methadone
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Buprenorphine (Subutex)
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Propoxyphene (Darvocet)
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Pethidine (Demerol)
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Hydrocodone (Lortab/Vicodin)
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Oxycodone (Percocet, Oxycontin)
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Hydromorphone (Dilaudid)
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Oxymorphone (Opana)
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Fentanyl
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Heroin (diacetylmorphine)
…anybody you’re working with taking any of these?
Most Rx’d Opiate in America
Oxycontin
Opiates
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Opiates are highly effective in controlling moderate
to severe pain, but they also have a downside. Opiates
are highly addictive…and once a person starts abusing
them he/she generally becomes dependent (addicted)
to them.
Opiate Effects
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Feelings of Euphoria
Suppression of Pain
Depressed Respiratory Rate
Lowered Heart Rate and
Blood Pressure
Lethargy/Drowsiness
Clouded Mental Functioning
Nausea/Vomiting
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Lowered Body Temperature
Muscle and Bone Pain
Physical/Psychological
Dependence
Severe Withdrawal
Symptoms
Mood Swings
Severe Constipation
Unconsciousness
Coma
Death by Overdose
Opiates: Long Term Effects
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Cause significant changes to the nerochemical, molecular
and cellular levels.
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Changes brain structure and functioning that lasts well
beyond the substance use.
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These changes are part of what can trigger drug cravings
years after last use.
How Do Opiates Work?
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Opiates elicit their powerful effects by activating opiate
receptors that are widely distributed throughout the brain and
body. Once an opiate reaches the brain, it quickly activates the
opiate receptors that are found in many brain regions and
produces an effect that correlates with the area of the brain
involved.
How Do Opiates Work?
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Two important effects produced by opiates, such as
morphine, are pleasure (or reward) and pain relief.
The brain itself also produces substances known as
endorphins that activate the opiate receptors.
Research indicates that endorphins are involved in
many things, including respiration, nausea, vomiting,
pain modulation, and hormonal regulation.
Opiate Agonists
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Opiate agonists are drugs that stimulate the opioid
receptors in the brain, leading to the high associated with
opiate drugs. They include Heroin, Vicodin, Morphine,
Codeine and Methadone.
They mimic the effects of naturally-occurring endorphins
in the body, and produce an opiate effect by interacting
with the opioid receptor sites.
Opiate Antagonists
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Opiate antagonists block the brain’s opioid receptors,
making it impossible for opiate drugs to stimulate them.
For example, drugs like Naloxone and Naltrexone make
it so that, if the user were to take a drug like heroin
afterwards, there would be no high.
These medications are often used to combat the
overdose effects of an opiate or to help break an
addiction.
Partial Opiate Agonists
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Partial opiate agonists are drugs that have a “ceiling
effect.” In other words, they can only stimulate the
opioid receptors to a certain extent. Buprenorphine,
the main ingredient in Suboxone, is one of these. No
matter how much Suboxone you take, its effects are
limited.
Sedatives, Hypnotics, and Anxiolytics
Sedatives, Hypnotics and Anxiolytics
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Drugs that reversibly depress the activity of the central
nervous system. Barbiturates, Benzodiazepines, and other
sedative-hypnotics have diverse chemical and pharmacological
properties that share the ability to depress the activity of all
excitable tissue, especially in the arousal center of the
brainstem.
Barbiturates (Sedatives): Amytal, Nembutal, Seconal and
Phenobarbital.
Benzodiazepines (Anti-Anxiety): Ativan, Halcion, Librium,Valium,
Xanax, and Rohypnol.
Other Sedative-Hypnotics (Sleep Inducers): Lunesta, Sonata,
Ambien.
Barbiturates
In therapeutic doses, barbiturates are effective and are typically
used for seizure disorders and anesthesia. Using them to “get
high” is extremely dangerous because there is a relatively small
difference between the desired dose and an overdose.
A small miscalculation, which is easy to make, can lead to coma,
respiratory distress (breathing slows or stops) and death.
Withdrawal from barbiturates is similar to, and sometimes more
severe than, alcohol withdrawal. Seizures are possible and can
also lead to death.
Common Barbiturates
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Amytal
Nembutal
Seconal
Phenobarbital
Seconal 100mg
A barbiturate may be prescribed for a variety of reasons, the list is extensive,
but the most common use today is as an anesthesia for surgery. This form is
hardly ever abused because they cause almost immediate unconsciousness.
Other forms like Phenobarbital are used in treating various seizure disorders
as an anticonvulsant. Other uses of this form of barbiturate along with
mephobarbital include treating anxiety, insomnia, epilepsy and delirium
tremens.
Benzodiazepines
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The benzodiazepine family of depressants is used therapeutically to
produce sedation, induce sleep, relieve anxiety and muscle spasms, and to
prevent seizures. In general, benzodiazepines act as hypnotics in high doses,
anxiolytics (anti-anxiety) in moderate doses, and sedatives in low doses.
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Of the drugs marketed in the United States that affect central nervous
system function, benzodiazepines are among the most widely prescribed
medications.
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Compared to barbiturates, benzodiazepines are much safer. They cause
sedation but rarely stop a person’s breathing or lead to death (unless
combined with other CNS depressants).
Common Benzodiazepines
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Ativan
Halcion
Librium
Restoril
Valium
Xanax
Rohypnol (not marketed in U.S.)
Other Sedative-Hypnotics: Sleep Aids
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This is a newer class of drugs that is used for the short-term
treatment of insomnia. They cause the onset of sleep to occur
faster and allows for a longer sleep period throughout the
night.
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These non-benzodiazepines have a short half-life and have less
chance of causing dependency, tolerance, and impairment of
daytime activities due to carry-over effects.
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Again, combining any of these drugs or using them with
alcohol (and other depressants) can lead to dangerous effects.
Common Sleep Aids/Hypnotics
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Ambien/Ambien CR
Sonata
Rozerem
Precedex
Lunesta
CNS Stimulants
CNS Stimulants
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CNS Stimulants are a class of drugs that elevate mood,
increase feelings of well-being and increase energy and
alertness. Examples include:
Caffeine
*Amphetamines
Cocaine
Methamphetamine
“Bath Salts”
Amphetamines
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Synthetic psychoactive CNS stimulant drugs including
amphetamine, dextroamphetamine and methamphetamine
Medications containing amphetamines are prescribed for
narcolepsy, obesity and ADHD (including Adderall,
Dexedrine, DextroStat, and Desoxyn).
The basic molecule of amphetamine can be modified to
emphasize specific actions (e.g., appetite suppressant,
CNS stimulant, cardiovascular actions) for certain
medications…including methylphenidate (Ritalin and
Concerta).
Dexedrine
Ritalin
Adderall
Adderall: The “Study Pill”
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http://www.youtube.com/watch?v=1gQNg2f15dk
Amphetamines
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Cause release of the neurotransmitters dopamine and
norepinephrine – and their reuptake is inhibited.
This influx causes the buildup of NTs at synapses in the brain.
When mixed with other drugs (including alcohol), the effects
of prescription amphetamines are enhanced. When the drug is
snorted, effects occur within 3-5 minutes. When ingested
orally, effects occur within 15 to 20 minutes.
Amphetamines: Short-Term Effects
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Increased activity/talkativeness
Decreased fatigue/drowsiness
Heightened sense of well-being
Heightened alertness/energy
Euphoria
Release of social inhibitions
Altered sexual behavior
Unrealistic feelings of cleverness,
great competence, and power
Hostility or paranoia
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Increased body temperature
Irregular or increased heart rate
Increased diastolic/systolic BP
Decreased appetite
Dry mouth
Dilated pupils
Increased respiration
Nausea
Headache
Palpitations
Cardiovascular system failure
Twitching/Tremor of small muscles
Amphetamines: Long-Term Effects
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Toxic psychosis
Physiological and behavioral
disorders
Dizziness
Pounding heartbeat
Difficulty breathing
Mood/Mental changes
Unusual tiredness/weakness
Cardiac arrhythmias
Repetitive motor activity
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Ulcers
Malnutrition
Mental Illness
Skin disorders
Vitamin deficiency
Flush or pale skin
Loss of coordination and physical
collapse
Convulsions, coma and death.
Amphetamines: Potential for Abuse
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Rx amphetamines are taken orally and in low doses, drug
abuse and addiction are not serious risks.
Abuse of amphetamines can lead to tolerance and
physical/psychological dependence characterized by
consuming increasingly higher dosages and by the “binge
and crash” cycle.
When the binge episode ends, the abuser “crashes” and is
left with severe depression, anxiety, extreme fatigue, and a
craving for more drugs.
The chronic abuse of amphetamines is characterized by
erratic (sometimes violent) behavior – as well as a
psychosis similar to schizophrenia.
Screening and Evaluation
Screening & Assessment: 3 Primary Goals
1. To Obtain Information/Collect a Database
2. To Determine Eligibility for a Particular Service
3. To Engage the Individual/Family in the Treatment
Process
The Clinical Assessment Interview:
Basic Elements
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Only One part of a multimodal evaluation
Formally arranged meeting
Has specific purpose
Interviewer chooses topic/broad content
Defined relationships
Interviewer attuned to ALL aspects of interaction - Affect, Behavior, Style
(Process) and Content
Questioning techniques/strategies employed to direct the flow of
conversation
Acceptance of client's expressions of feelings and factual information
without casting judgment
Interviewer makes explicit what otherwise be left unstated
Assessor follows guidelines for confidentiality and disclosure of info.
What a Clinical Assessment Interview is
NOT...
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Ordinary Conversation
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"Counseling" Session
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Forensic Interview
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Survey Interview
The Assessment Interview: Assumptions
1. Need for Multiple Data Sources:
There is no gold standard for assessing people's
functioning.
The key to good assessment is to find the conceptual
links and relationships between methods and modalities
of the assessment. Each form of indirect and direct
methods contributes unique elements to solving the
puzzle (Wheel of Fortune).
Assumptions (Cont.)
2. Situational Variability:
Individuals' behaviors are likely to vary across
situations and relationships.
Good assessment requires identifying patterns of
behavior that DIFFER across situations and relationships
as well as patterns that REMAIN CONSISTENT, despite
variations in situations and relationships.
Assumptions (Cont.)
3. Limited Cross-Informant Agreement:
There is likely to be only low-to-moderate
agreement between informants who are in different
situations or in different relationships with the same
person (esp. children).
Low agreement does not mean that one is right and one
is wrong or that one has a "truer" picture. The challenge
is to put all these pieces together to form a meaningful
picture of the person's functioning under the given
circumstances.
Assumptions (Cont.)
4. Variations in Interview Structure and Content:
The structure and content of clinical interviews
should vary in relation to the informant and the goals
of the interview.
Structured, semi-structured, direct observation, indirect
data collection, age/role appropriateness, etc. Clinical
interviews need to be tailored to particular informants.
The content and questioning strategies are shaped by the
kind of informant interviewed and the kind of information
sought.
Interview Content and Questioning
Strategies
1. Semi-Structured: Questions used to query client (and
others) about many aspects of functioning. Format is relatively
open-ended and flexible to stimulate a natural flow of
conversation. MI strategies are used (empathy, reflective
listening, summarizing). Probe questions can then be used to
obtain more detailed information.
2. Structured: Appropriate for querying individuals/family
members about symptoms and criteria for psychiatric
disorders. Structured diagnostic interviews have a
standardized set of questions and probes focusing on specific
problems relevant to diagnoses.
Interview Content and Questioning
Strategies (Cont.)
3. Behavior-Specific: Questions can be used to query family members
parents, teachers, PO's, etc. regarding their current concerns about the
individual. More narrow in scope than semi-structured because the focus is
on a limited number of specific problem areas.
Typically, the main purposes are:
a) identify and define problems of concern of others (problem
identification)
b) examine antecedents and consequences that surround the identified
problems (problem analysis)
Assessors can also use behavior-specific questions to elicit from individuals
their views of particular problems and their understanding of the
consequences around the problems.
Interview Content and Questioning
Strategies (Cont.)
4. Problem-Solving: Focus on others' current concerns with
the goal of developing interventions for identified problems. In
initial clinical interviews, assessors can use problem-solving
questions to explore and gauge others' receptivity to different
kinds of interventions prior to implementing any interventions.
Can also use problem-solving questions to explore individual’s
views of different interventions and to find out which
approaches are acceptable to them.
Preparation: Master Your Material
Preparation and Mastery increase your confidence and
competence. Your goals include...
 Understanding and applying all aforementioned material
 Learning and knowing intimately all sections (and the
purpose for each) of the assessment forms
 Mastering the art of Motivational Interviewing
 Reading, Studying, Understanding DSM-IV/DSM-5
diagnostic criteria - and applying structured interviewing
strategies to rule out and rule in dx
 Knowing what you don't know - and learning it
Preparation and Mastery:
Conceptualizing Your Case
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Guided by: Observing, Questioning, Thinking
(repeat ad nauseum)
Study your prelim. Info (Screening Form, etc.) and apply
the above...
Begin your studies/research
Generate Questions
Formulate Hypotheses (not conclusions)
Prepare, Prepare, Prepare...
Key Terms
Tolerance:
(a) a need for markedly increased amounts of the
substance to achieve intoxication or desired effect.
(b) markedly diminished effect with continued use of
the same amount of the substance (DSM-IV TR).
Potentiation:
Potentiation occurs when two drugs are taken together and one of them
intensifies the action of the other. This could be expressed by a +b= B.
As an example, - an antihistamine, when given with a painkilling
narcotic such as Percocet ,intensifies its effect thereby cutting down on
the amount of the narcotic needed.
Key Terms
Cross Tolerance and Cross Dependence:
Cross tolerance refers to the fact that if a person has developed a tolerance to
a drug in a certain classification, such as the depressants, that person is more
likely to develop tolerance with another drug in that classification. As an
example, people who are dependent upon alcohol show an increased
tolerance to barbiturates, synthetic and natural opiate narcotics, and
anesthetics. This, of course, means that the person must have a higher dose of
the new drug for it to be effective.
In cross dependence, the withdrawal symptoms from one drug in a classification
can be relieved by another. As an example, many alcoholics are given
barbiturates and tranquilizers to prevent withdrawal symptoms. However, the
person may soon develop a dependency on the other drug as well.
Key Terms
Synergism:
Synergism is similar to potentiation. If two drugs are taken together that are
similar in action, such as barbiturates and alcohol, which are both depressants,
an effect exaggerated out of proportion to that of each drug taken separately
at the given dose may occur. This could be expressed by 1+1= 5.
An example might be a person taking a dose of alcohol and a dose of a
barbiturate. Normally, taken alone, neither substance would cause serious
harm, but if taken together, the combination could cause coma or death.
Key Terms
Withdrawal:
Withdrawal is a term referring to the feelings of discomfort,
distress, and intense craving for a substance that occur when use
of the substance is stopped. These physical symptoms occur
because the body had become metabolically adapted to the
substance. The withdrawal symptoms can range from mild
discomfort resembling the flu to severe withdrawal that can
actually be life threatening.
Withdrawal from particular substances can be extremely serious and
dangerous (potentially life-threatening). Refer to the DSM-IV TR and
or DSM-5 for drug-specific withdrawal profiles.
Interventions/Best Practices
Treatment: Key Components
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Established Clinical Model that is evidence-based
Individualized assessment and person-centered treatment planning
Full array of integrated services (MH and SA, etc.)
Individual, Family and Group Therapies
Psychoeducation
Motivational Interviewing/Motivational Enhancement (strengths-based)
Cognitive-Behavioral Interventions
Relapse and Recovery Planning
Connection and Collaboration with Community Resource and Associated
Professionals (wrap-around)
Frequent/randomized drug/alcohol screening
Accountability
Drug Testing
Critical Component of any treatment program
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Urine lab testing
Urine instant
Oral
Hair
Pay Attention! What to “watch” for
when conducting drug screens
All testing needs to be Observed whenever possible.
1.
2.
3.
4.
Dilution – water loading/adding water to samples
Flushing – ingesting Niacin or Golden Seal (or any of
hundreds of other products on the market)
Substituting – synthetic urine or borrowing/storing
urine
Mechanical Devices – the “Wizinator,” small bottles or
tubes
Screening: Other things to Know
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Know where your individuals can get tested (and what
kind of testing they conduct)
Know what medications your individuals are taking
Connect with a therapist or doctor that conducts drug
screens, or make sure you call the lab toxicologist for
specific information
You do not have to be the expert on all information, but
know where to get the information and be willing to
puruse it!
Principles of Effective Treatment
(National
Institute of Drug Abuse, 2012)
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Addiction is a complex but treatable disease that affects
brain function and behavior.
No single treatment is appropriate for everyone.
Treatment needs to be readily available
Effective treatment attends to multiple needs of the
individual, not just his or her substance abuse.
Principles of Effective Treatment (cont.)
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Remaining in treatment for an adequate period of time
is critical.
Behavioral therapies – including individual, family, or
group counseling – are the most commonly used forms
of drug abuse treatment.
Medications are important element of treatment for
many individuals, especially when combined with
counseling and other behavioral therapies.
Principles of Effective Treatment (Cont.)
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An individual’s treatment and services plan must be
assessed continually and modified as necessary to
ensure that is meets his or her changing needs.
Many drug-addicted individuals also have other mental
disorders.
Medically assisted detoxification is only the first stage of
addiction treatment and by itself does little to change
long-term drug abuse
Principles of Effective Treatment (Cont.)
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Treatment does not need to be voluntary to be
effective.
Drug use during treatment needs to be monitored
continuously, as lapses during treatment do occur.
Treatment programs should test individuals for the
presence of HIV/AIDS, hepatitis B and C, tuberculosis
and other infectious diseases as well as provide targeted
risk reduction counseling, linking individuals to
treatment if necessary.
ASAM Criteria: Case Conceptualization
Wherever the treatment location or circumstances, some
guidelines have suggested criteria to consider when treating
substance dependence. The following criteria were developed by
the American Society of Addiction Medicine (ASAM) to consider
in the treatment of dependence:
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1. acute intoxication and/or withdrawal potential
2. biomedical conditions and complications
3. emotional, behavioral, or cognitive conditions and complications
4. readiness to change
5. relapse, continued use, or continued problem potential
6. recovery/living environment
ASAM Levels of Treatment
ASAM Levels
Level 0.5 = Early Intervention Services
Level 1 = Outpatient Treatment Services(3 hours a week
or less)
Level 2 = Intensive Outpatient/Partial Hospitalization (9
hours per week at least)
Level 3 = Residential/Inpatient Services (24 Hours/Day)
Level 4 = Medically Managed Intensive Inpatient Services
Reference: www.asam.org
Opiate Withdrawal and Detoxification
Opiate/Narcotic Withdrawal
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Opiate addicts avoid treatment because they are afraid of
withdrawal, which can be rather unpleasant but rarely
fatal. They crave the drug and experience muscle and
bone pain, insomnia, restlessness, nausea and vomiting,
sweating, involuntary muscle twitches, dry mouth.
Opiate withdrawal will usually peak between 48-72 hours
after the last use. But withdrawal can last much longer,
depending on the individual.
Detoxification and “Maintenance”

Medications have been developed to lessen the impact of
the withdrawal and help addicts rid themselves of the
need to use. Principal among these are Methadone and
Suboxone, both synthetic opiates themselves, but both
act to block the impact of the opiates.
Maintenance Therapy

Maintenance therapy with drugs like methadone or
Suboxone is helpful because it takes away the severe
effects of a heroin or prescription painkiller habit while
easing the symptoms of withdrawal.
APA Guidelines for Opiate Dependence
The American Psychiatric Association (APA) guideline
identified the following 3 treatment modalities to be
effective strategies for managing opioid dependence and
withdrawal:



1. opioid substitution with methadone or buprenorphine,
followed by a gradual taper
2. abrupt opioid discontinuation with the use of clonidine
to suppress withdrawal symptoms
3. clonidine-naltrexone detoxification
Considering Your Options in Dealing
with an Opiate Dependent Individual

Acute opioid-related disorders that require medical
management include opioid intoxication, opioid
overdose, and opioid withdrawal. Issues pertaining to
treatment of chronic opioid abuse include opioid agonist
therapy (OAT), psychotherapy, and treatment of acute
pain in patients already on maintenance therapy.
Intensive Case Management
The Importance of Coordinated
Intervention
We need an integrated, coordinated community response
focused on recovery. This type of approach is more
effective in preventing, treating and managing the chronic
consequences of substance abuse and addiction than a
response that is fragmented or focused primarily on
penalties.
We need a systematic response that is fast, fluid and
flexible…meeting needs as they arise and changing
through the continuum of care.
Intensive Case Management and WrapAround: Who Needs to be Involved?





The prescribing physician
Significant other(s)
Probation or parole (if a part of the case)
Other clinicians (if part of the case)
Other “natural supports” (as part of a high-fidelity wrap
around team)
Please make sure you follow all confidentiality
regulations under 42 CFR Part 2.
Why include these people? What’s the
rational?
1.
2.
3.
Liability
Appropriate Service/Treatment Planning
Best Practice
Case Study Exercise
Case Study: Time to Pick each others’
Brains and Generate some Ideas!
“Dedicated Service To
Those In Need”
Our strong
reputation keeps us
increasingly
committed to
providing high quality
services to youth and
families in the
community.
Additional References and Resources

www.nationalcounselinggroup.com

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.

Johnston, LD, O'Malley, PM, Bachman, JG, & Schulenberg, JE. (2012). Monitoring the Future
National Results on Adolescent Drug Use: Overview of Key Findings, 2011. Ann Arbor: Institute for
Social Research, University of Michigan. Available at http://monitoringthefuture.org.

Levine, DA. (2007). “'Pharming': The abuse of prescription and over-the-counter drugs in
Teens.” Current Opinion in Pediatrics. Vol. 19, No. 3, pages 270-274.

National Institute on Drug Abuse. NIDA InfoFacts: Prescription and Over-the-Counter
Medications. http://www.drugabuse.gov/infofacts/PainMed.html). Bethesda, MD: NIDA, NIH,
DHHS. Published June 2009. Retrieved February 2012.

National Institute on Drug Abuse. NIDA Research Report: Prescription Drugs: Abuse and
Addiction. http://www.drugabuse.gov/ResearchReports/Prescription/Prescription.html. NIH
Publication No. 11-4881. Bethesda, MD: NIDA, NIH, DHHS. Published July 2001. Revised
October 2011. Retrieved February 2012.
References and Resources (Cont.)

http://emedicine.medscape.com/article/1174630-overview

http://www.nytimes.com/interactive/2012/06/10/education/stimulants-student-voices.html

http://www.chesterfieldsafe.org

www.unifiedpreventioncoalition.com

http://www.samhsa.gov/

http://www.nida.nih.gov/nidahome.html

http://www.suboxone.com

http://www.drugalcoholaddictionrecovery.com

http://drugpubs.drugabuse.gov/

http://www.whitehousedrugpolicy.gov/drugfact/juveniles/juvenile_drugs_ff.html

www.erowid.com

http://learn.genetics.utah.edu/content/addiction/

http://www.theantidrug.com/drug-information/default.aspx
Additional References and Resources

http://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/rx_abuse_plan.pdf
“Epidemic: Responding to America’s Prescription Drug Crisis”

http://www.drugabuse.gov/publications/principles-drug-addiction-treatment “Principles of
Drug Addiction Treatment: A Research-Based Guide (3rd Edition)

http://www.drugabuse.gov

http://www.youtube.com/watch?v=E0ihO1KFxkQ “Students Seek Competitive Edge…”

http://www.youtube.com/watch?v=1gQNg2f15dk “Adderall: The Study Pill”

http://www.youtube.com/watch?v=1sdFRJtzI0s “PBS NewsHour Excerpt:Prescription Drug
Abuse (aired 5/2013)

http://www.youtube.com/watch?v=_mgQHSCDswQ&NR=1&feature=fvwp “Prescription Drug
Abuse”

http://www.nytimes.com/interactive/2012/06/10/education/stimulants-studentvoices.html?emc=eta1#/#1 “In Their Own Words: Study Guides.”