Transcript Building a Recovery-Oriented System of Care

High prevalence of co-morbidity between
substance use disorders and other mental
illnesses does not mean that one caused
the other
 Establishing causality or directionality is
difficult due to
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› Diagnosis of a mental disorder may not occur
until symptoms have progressed to a specified
level
› subclinical symptoms may also prompt drug use,
and imperfect recollections of when drug use or
abuse started can create confusion as to which
came first.
Drugs of abuse can cause abusers to
experience one or more symptoms of
another mental illness. The increased risk of
psychosis in some marijuana abusers has
been offered as evidence for this possibility.
 Mental illnesses can lead to drug abuse.
Individuals with overt, mild, or even
subclinical mental disorders may abuse
drugs as a form of self-medication
 Both drug use disorders and other mental
illnesses are caused by overlapping factors
such as underlying brain deficits, genetic
vulnerabilities, and/or early exposure to
stress or trauma.
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Overlapping Genetic Vulnerabilities
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A particularly active area of co-morbidity research involves the
search for genes that might predispose individuals to develop
both addiction and other mental illnesses, or to have a greater
risk of a second disorder occurring after the first appears.
Estimated 40-60 percent of an individual's vulnerability to
addiction is attributable to genetics.
Most vulnerability arises from complex interactions among
multiple genes and from genetic interactions with environmental
influences.
Genes can also act indirectly by altering how an individual
responds to stress or by increasing the likelihood of risk-taking and
novelty-seeking behaviors, which could influence the
development of drug use disorders and other mental illnesses.
Several regions of the human genome have been linked to
increased risk of both drug use disorders and mental illness,
including associations with greater vulnerability to adolescent
drug dependence and conduct disorders.
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Involvement of Similar Brain Regions
› Some areas of the brain are affected by both drug use disorders
and other mental illnesses.
 Example, the circuits in the brain that use the neurotransmitter
dopamine are typically affected by addictive substances and may
also be involved in depression, schizophrenia, and other psychiatric
disorders.
› Some antidepressants and essentially all antipsychotic
medications directly target the regulation of dopamine in this
system, whereas others may have indirect effects.
› Dopamine pathways have also been implicated in the way in
which stress can increase vulnerability to drug addiction.
 Stress is also a known risk factor for a range of mental disorders and
therefore provides one likely common neurobiological link between
the disease processes of addiction and those of other mental
disorders.
› The overlap of brain areas involved in both drug use disorders
and other mental illnesses suggests that brain changes stemming
from one may affect the other.
 Example, drug abuse that precedes the first symptoms of a mental
illness may produce changes in brain structure and function that
kindle an underlying propensity to develop that mental illness.
 If the mental disorder develops first, associated changes in brain
activity may increase the vulnerability to abusing substances by
enhancing their positive effects, reducing awareness of their negative
effects, or alleviating the unpleasant effects associated with the
mental disorder or the medication used to treat it.
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Estimated one-third of all people experiencing
mental illnesses and about half of people living with
severe mental illnesses also experience substance
abuse.
› These statistics are mirrored in the substance abuse
community, where about a third of all alcohol abusers and
more than half of all drug abusers report experiencing a
mental illness.
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Men are more likely to develop a co-occurring
disorder than women.
Other people who have a particularly high risk of
dual diagnosis include individuals of lower
socioeconomic status, military veterans and people
with more general medical illnesses.
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Burke Recovery: Morganton, NC
 Substance Abuse Assessment; Outpatient Treatment;
Adolescent, Adult & Family Services
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The Cognitive Connection: Morganton, NC
 Substance Abuse Assessment; Outpatient Treatment,
Suboxone Treatment, DWI Services
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Archway Counseling: Morganton, NC
 Substance Abuse Assessment; Outpatient Treatment
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Catawba Valley Behavioral Healthcare:
Morganton, NC
 Mental Health Counseling, Psychiatric Medication
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FOCUS Behavioral Health Services:
Morganton, NC
 Mental Health Counseling
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A Caring Alternative: Morganton, NC
 Mental Health Counseling
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Christ Centered Recovery Program:
Morganton, NC
 Mental Health Counseling; Substance
Abuse Services
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Mimosa Christian Counseling Center:
Morganton, NC
 Mental Health Counseling
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One Love Services:
Morganton, NC
 Outpatient Therapy, Clinical Assessments, In-home
services
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Crossroads Counseling Center
Hickory, NC
 Mental Health Counseling
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Catawba Valley Behavioral Healthcare
Hickory, NC
 Mental Health Counseling, Psychiatric Medication
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Identified Gaps in Service
› 1. Communication related to the availability
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of outpatient services and appointment
timeliness.
2. The availability of bilingual outpatient
services.
3. Inpatient psychiatric bed availability for
adolescents.
4. Access to opioid services.
5. Access to comprehensive substance
abuse outpatient treatment programs.
› 6. Mental Health and substance use fields
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have different historical roots and traditions
7. Differences lead to two distinct groups of
practitioners who have little to do with other
specialty
8. Mental Health providers are not readily
trained to identify signs of substance use
9. Substance Use providers are not readily
trained to identify psychiatric symptoms.
10. Lack of LPCs and LCASs.
 Identified
Needs
› 1. Assess to providers
› 2. Examine true cost of care by examining
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gaps in funding
3. Further examination of the Mental Health
and Substance Use continuum of care
4. More licensed mental health and
substance use clinicians
5. Dually trained clinicians
6. Easier access to simultaneous Mental
Health and Substance Use providers for
consumers
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A ROSC is a coordinated network of
community-based services and supports
that is person-centered and builds on
the strengths and resilience of
individuals, families, and communities to
achieve abstinence and improved
health, wellness, and quality of-life for
those with or at risk of alcohol and drug
problems.
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Person-centered approach:
› Centered around the needs, preferences and strengths of
individuals. There are many pathways to recovery such as
treatment, mutual aid groups and faith-based recovery. ROSC
offers flexibility and supports that are designed to meet each
individual’s specific needs.
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Self-directed approach:
› Exercising the greatest level of choice over their service and
support options and responsibility for their recovery.
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Strength-based approach:
› Identifying and building upon the assets, strengths, resources,
and resiliencies of the individual, rather than the needs, deficits
and pathologies.
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Participation of family members, caregivers, significant
others, friends, and the community:
› Acknowledging the role that others play in the recovery process.
These individuals are incorporated in recovery planning and
recovery support.
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Collaborative decision-making:
› By empowering individuals to make their own decisions
regarding their care. This helps individuals to direct their own
recovery to the greatest extent possible.
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Individualized and comprehensive services and supports:
› Offering a variety of supports to meet the needs to the
individuals, the services are designed to support an individual’s
recovery across the lifespan. Services and supports are to be
gender-specific, culturally relevant, trauma-focused, and
appropriate to the person’s stage of life and stage of recovery.
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Community-based services and supports:
› Offering a wide array of services and supports that draw upon
the strengths, resilience, and services of the community.
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Continuity of services and supports:
› Coordinating services and supports to ensure ongoing
connections among various organizations for as long as the
individual needs them.
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Multiple stakeholder involvement:
› A ROSC involves all segments of the community –
including treatment and recovery professionals,
policy-makers, administrators, people in recovery,
family members, representatives from allied health
and social service agencies, community leaders, and
others with concern for substance use disorder
recovery. It promotes trust and transparency in the
design and delivery of services and supports.
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Recovery community/peer involvement:
› A ROSC includes members of the recovery community in
the design of systems, services, and supports. People in
recovery have a meaningful role in service design,
provision, and quality improvement. Peer-to-peer recovery
support services are also included.
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Outcomes-driven:
› A ROSC measures outcomes to improve the systems of
care.
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Consumer and Family-Driven
› Requires people in recovery be involved in all
aspects and phases of the care delivery
process, from the initial framing of questions, the
delivery and ongoing monitoring of care, and
development of new services and supports.
› Person-centered care is not by itself sufficient
› Changes are required at the system level to
make sure the right types of services and
supports are available to be included in
individualized recovery plans
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Timely and Responsive
› Optimal to foster wellness, enhance
protective factors, and promote healthy
living
› Access to care involves facilitating swift and
uncomplicated entry into care
› Engagement into services involves making
contact with the person rather than the
diagnosis, building trust over time, attending
to stated needs, providing a range of
services
› Timeliness of services such as waiting times as
well as perceptions of inadequate care and
unmet needs
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Person-Centered
› Base care on the person’s own goals and life
circumstances
› Identifying and building on the person’s
resources and strengths
› Orienting care and supports to the
community arenas in which the person
wishes to participate
› Services and supports based on an
individualized, multidisciplinary recovery plan
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Effective, Equitable, and Efficient
› Services and supports offered are the best
available for the person being served at any
given time
› Care being provided to all those who will benefit
from it and in such a way that it does not vary in
quality or effectiveness depending upon
gender, ethnicity, race, sexual orientation,
religious affiliation, geographic location, or
socioeconomic status
› Intensity, location, duration, and timeliness of
care offered based on the suggestion that
people will derive the most benefit from being
able to access the services and supports
needed at the time and for as long as they are
needed, with emphasis in care shifting from
acute, institutional-basis services to more natural
and community-based supports over time
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Safe and Trustworthy
› Practitioners to identify and address
elements and characteristics of stigma and
discrimination within the current service
system and broader community the
unwittingly contribute to the exacerbation of
symptoms in persons with mental health and
substance use conditions
› Research consistently demonstrates a
trusting relationship with a practitioner is one
of the most important predictors of a positive
outcome; more so than any particular
theoretical approach or evidenced-based
technique
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Maximizes Use of Natural Supports and
Settings
› Adequate knowledge of the local
community, including opportunities,
resources, and potential barriers
 AA meetings, NA meetings, Celebrate
recovery, Food Banks, Transportation, Housing,
Employment
 A comprehensive understanding of
community resources and supports available
to address the range of a person’s needs is
essential to the recovery planning process
across the continuum of care
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