Transcript Introducing a New Product - Wales Counseling Center,PLLC

Substance Abuse:
A Social Worker’s Guide
Presented by
Tiffany Egan, LMSW
FACE OF ADDICTS
Substance Abuse - A maladaptive pattern of substance use leading to clinically significant
impairment or distress, as manifested by one (or more) of the following, occurring within a 12‐month
period:
– Recurrent substance use resulting in a failure to fulfill major role obligations at work,
school, or home (e.g., repeated absences or poor work performance related to
substance use; substance‐related absences, suspensions, or expulsions from school;
neglect of children or household
–
Recurrent substance use in situations in which it is physically hazardous (e.g., driving
an automobile or operating a machine when impaired by substance use)
–
Recurrent substance‐related legal problems (e.g., arrests for substance‐related
disorderly conduct)
–
Continued substance use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of the substance (e.g., arguments with
spouse about consequence of intoxication, physical fights)
–
The symptoms have never met the criteria for Substance Dependence for this class of
substance.
DSM-IV–TR
Substance Dependence - A maladaptive pattern of substance use, leading to clinically significant impairment or
distress, as manifested by three (or more) of the following, occurring at any time in the same 12‐month period (emphasis
ours):
– Tolerance, as defined by either of the following:
–
A need for markedly increased amounts of the substance to achieve intoxication or desired effect or
Markedly diminished effect with continued use of the same amount of the substance
–
Withdrawal, as manifested by either of the following:
–
The characteristic withdrawal syndrome for the substance or The same (or a closely related) substance is
taken to relieve or avoid withdrawal symptoms
–
The substance is often taken in larger amounts or over a longer period than was intended
–
There is a persistent desire or unsuccessful efforts to cut down or control substance use
–
A great deal of time is spent on activities necessary to obtain the substance (e.g., visiting multiple doctors
or driving long distances), use the substance (e.g., chain‐smoking), or recover from its effects
–
Important social, occupational, or recreational activities are given up or reduced because of substance use
–
The substance use is continued despite knowledge of having a persistent physical or psychological
problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use
despite recognition of cocaine‐induced depression, or continued drinking despite recognition that an ulcer
was made worse by alcohol consumption)
DSM-IV–TR
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Combines the DSM-IV categories of substance abuse and substance dependence into a
single disorder measured on a continuum from mild to severe
Each specific substance (other than caffeine) is addressed as a separate use disorder
(e.g., alcohol use disorder, stimulant use disorder, etc.),
Cannabis Withdrawal , Caffeine Withdrawal and Tobacco Use Disorder are new disorders
• Caffeine Withdrawal was in DSM-IV Appendix B “for further study”
DSM-5 does not separate abuse and dependence but criteria is provided for Substance
Use Disorder
Drug craving or a strong desire or urge to use a substance added
Problems with law enforcement eliminated
The chapter also includes gambling disorder as the sole condition in a new category on
behavioral addictions
No Apparent Category for Individuals with Co-Occurring Mental Illness and Substance
Abuse
DSM V –
SUBSTANCE-RELATED AND ADDICTIVE DISORDERS
Which category of substances was added as a
substance related disorder?
QUESTION
The substance-related disorders are divided into
two groups:
Substance-Induced Disorder
Substance-Use Disorder
Criteria is provided for substance use disorder, accompanied by criteria for
intoxication, withdrawal, substance/medication-induced disorders, and
unspecified substance-induced disorders, where relevant.
DSM V
Substance – Induced Disorder
It includes…
• Intoxication
• Withdrawal
• Other substance/medication-induced mental disorders
(e.g., substance-induced psychotic disorder, substance-induced depressive
disorder).
• Criterion for substance intoxication are included within the substance-specific sections
• Does not apply to tobacco
DSM V
Substance-Use Disorder: includes a cluster of cognitive, behavioral, and
physiological symptoms indicating that the individual continues using the substance
despite significant substance-related problems.
• The diagnosis of a substance use disorder is based on a pathological pattern of
behaviors related to use of the substance.
• The more neutral term substance use disorder is used to describe the wide range
of the disorder, from a mild form to a severe state of chronically relapsing,
compulsive drug taking.
• Some clinicians will choose to use the word addiction to describe more extreme
presentations, but the word is omitted from the official DSM-5
• Applied to all 10 classes of drugs (except caffeine)
DSM V
The substance-related disorders encompasses 10 separate classes of drugs:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Alcohol
Caffeine
Cannabis
Hallucinogens
• separate categories for phencyclidine [or similarly acting
rylcyclohexylamines] and other hallucinogens]
• Examples: LSD, Mushrooms, Ecstasy
Inhalants
• solvents, aerosols, gases, and nitrites
Opioids
• heroin, morphine, oxycontin
• Sedatives, Hypnotics, and Anxiolytics
Stimulants
• amphetamine-type substances, cocaine, and other stimulants
Tobacco
Other or unknown substances
DSM V – Drug Classes
Alcohol Related Disorders
Alcohol Use Disorder
Alcohol Intoxication
Alcohol Withdrawal
Other Alcohol-Induced Disorders
Unspecified Alcohol-Related Disorder
Caffeine-Related Disorders
Caffeine Intoxication
Caffeine Withdrawal
Other Caffeine-Induced Disorders
Unspecified Caffeine-Related Disorder
Cannabis-Related Disorders
Cannabis Use Disorder
Cannabis Intoxication
Cannabis Withdrawal
Other Cannabis-Induced Disorders
Unspecified Cannabis-Related Disorder
DSM V – Drug Classes
Hallucinogen-Related Disorders
Phencyclidine Use Disorder
Other Hallucinogen Use Disorder
Phencyclidine Intoxication
Hallucinogen Persisting Perception Disorder
Other Phencyclidine-Induced Disorders
Other Hallucinogen-Induced Disorders
Unspecified Phencyclidine-Related Disorder
Unspecified Hallucinogen-Related Disorder
Inhalant-Related Disorders
Inhalant Use Disorder
Inhalant Intoxication
Unspecified Inhalant Related Disorder
Opioid-Related Disorders
Opioid Use Disorder
Opioid Intoxication
Opioid Withdrawal
Other Opioid-Induced Disorders
Unspecified Opioid-Related Disorder
DSM V – Drug Classes
Sedative-, Hypnotic-, or Anxiolytic-Related Disorders
Sedative, Hypnotic, or Anxiolytic Use Disorder
Sedative, Hypnotic, or Anxiolytic Intoxication
Sedative, Hypnotic, or Anxiolytic Withdrawal
Other Sedative-, Hypnotic-, or Anxiolytic-Related Disorder
Stimulant-Related Disorders
Stimulant Use Disorder
Stimulant Intoxication
Stimulant Withdrawal
Other Stimulant-Induced Disorders
Unspecified Stimulant-Related Disorder
DSM V – Drug Classes
FAMOUS ADDICT
Among individuals who have used cannabis regularly during
some period of their lifetime, up to one-third report having
experienced cannabis withdrawal (i.e. irritability, anger or
aggression ; nervousness or anxiety ; sleep difficulty ;
decreased appetite ; restlessness ; depressed
mood)(physical symptoms; abdominal pain,
shakiness/tremors, sweating, fever, chills, or headache)
- American Psychiatric Association, 2013
STATISTIC
How many drug classes are there for substance
related disorders according to DSM V?
QUESTION
Severity Scale DSM-5:
The severity of each Substance Use Disorder is based on:
- 0-1 criteria: No diagnosis
- 2-3 criteria: Mild Substance Use Disorder
- 4-5 criteria: Moderate Substance Use Disorder
- 6 or more criteria: Severe Substance Use Disorder1
Criteria:
1. Taking the substance in larger amounts or for longer than the you meant to
2. Wanting to cut down or stop using the substance but not managing to
3. Spending a lot of time getting, using, or recovering from use of the substance
4. Cravings and urges to use the substance
5. Not managing to do what you should at work, home or school, because of substance use
6. Continuing to use, even when it causes problems in relationships
7. Giving up important social, occupational or recreational activities because of substance use
8. Using substances again and again, even when it puts the you in danger
9. Continuing to use, even when the you know you have a physical or psychological problem that
could have been caused or made worse by the substance
10. Needing more of the substance to get the effect you want (tolerance)
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.
DSM V – Severity Scale
Criterion A criteria can be considered to fit within overall groups of impaired control, social
impairment, risky use, and pharmacological criteria.
Impaired control over substance use is the first criteria grouping (Criteria 1-4).
• Impaired Control: The individual may take the substance in larger amounts or over a longer
period than was originally intended (Criterion 1 - #s 1-4)
• Social Impairment: The individual may express a persistent desire to cut down or regulate
substance use and may report multiple unsuccessful efforts to decrease or discontinue use
(Criterion 2 - #s 5-7).
• Risky Use: The individual may spend a great deal of time obtaining the substance, using the
substance, or recovering from its effects (Criterion 3 - #s 8-9).
• Pharmacological: Craving (Criterion 4 - #s 10-11) : an intense desire or urge for the drug that may occur
at any time but more likely when in an environment where the drug previously was obtained/used.
• Craving has also been shown to involve classical conditioning and is associated with activation of
specific reward structures in the brain.
• Craving is queried by asking if there has ever been a time when they had such strong urges to
take the drug that they could not think of anything else.
• Current craving is often used as a treatment outcome measure because it may be a signal of
impending relapse.
DSM V
For Substance Use Disorders…
• Specify criteria
• Specify if:
• Early remission: at least 3 months, but less than 12 months without substance
use disorder criteria (except craving)
• Sustained remission: at least 12 months without criteria (except craving)
• Specify if:
• In a Controlled Environment. This additional specifier is used if the individual is
in an environment where access to alcohol and controlled substances is
restricted.
• Examples of these environments are closely supervised and substance-free
jails, therapeutic communities, and locked hospital units
• On Maintenance Therapy. Taking prescribed agonist medications (i.e. methadone,
buprenorphine, oral naltrexone, & no other criteria met)
DSM V
People with drug problems might act differently than they used to. They might:
• Spend a lot of time alone
• Lose interest in their favorite things
• Get messy—for instance, not bathe, change clothes, or brush their teeth
• Be really tired and sad
• Be very energetic, talk fast, or say things that don't make sense
• Be nervous or cranky (in a bad mood)
• Quickly change between feeling bad and feeling good
• Sleep at strange hours
• Miss important appointments
• Have problems at work
• Eat a lot more or a lot less than usual
People with an addiction usually can't stop taking the drug on their own. They want and need
more. They might try to stop taking the drug and then feel really sick. Then they take the drug
again to stop feeling sick. They keep using the drug even though it's causing terrible family,
health, or legal problems. They need help to stop using drugs.
Signs of Abuse & Addiction
FAMOUS ADDICT
Cocaine indicators have decreased over time, but the DEA
Field Divisions report availability is higher than in the past.
STATISTIC
What are some signs of
abuse/addiction?
QUESTION
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CAGE AID Substance Abuse Screening Tool
DAST – Drug Abuse Screening Test ; DAST 10
The NIDA (National Institute on Drugs Abuse) Quick Screen
Simple Screening Instrument for Substance Abuse SelfAdministered Form
Addiction Severity Index (ASI)
SASSI
Audit C (for alcohol)
CAGE (for alcohol)
Screening & Assessment Tools
Substance abuse and behavioral disorder counselors typically do the following:
• Assess and evaluate clients’ mental and physical health, addiction or problem
behavior, and readiness to treatment
• Help clients develop treatment goals and plans
• Review and recommend treatment options with clients and their families
• Help clients develop skills and behaviors necessary to recover from their addiction or
modify their behavior
• Work with clients to identify behaviors or situations that interfere with their
recovery
• Teach families about addiction or behavior disorders and help them develop
strategies to cope with those problems
• Refer clients to other resources and services, such as job placement services and
support groups
• Conduct outreach programs to help people identify the signs of addiction and other
destructive behavior, as well as steps to take to avoid such behavior
Social Work Role
These standards were developed to broadly define the scope of services that social workers
shall provide to clients with substance use disorders, that clients & their families should
expect, and that program administrators should support.
1. Ethics & Values
2. Qualifications
3. Assessment
4. Intervention
5. Decision Making & Practice Evaluation
6. Record Keeping
7. Workload Management
8. Professional Development
9. Cultural Competence
10. Interdisciplinary Leadership & Collaboration
11. Advocacy
12. Collaboration
NASW Social Work Standards
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1
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FAMOUS ADDICTS
Name that Star!
8
9
Alprazolam was the primary benzodiazepine
that was misused, based on treatment
admission and toxicology laboratory data.
STATISTIC
What is the common name for alprazolam
and what does it treat?
QUESTION
The National Institute on Drug Abuse (NIDA) created a list of guiding principles that characterize the
most effective treatments.
The principles include the following:
1. No single treatment approach is appropriate for all individuals.
2. Treatment needs to be readily available. Effective treatment attends to the multiple needs of the individual,
not just his or her substance use.
4. An individual’s treatment plan needs to be assessed continually and modified as necessary.
5. Remaining in treatment for an adequate time is critical for effectiveness.
6. Counseling and other behavioral therapies are critical components of effective substance abuse treatment.
7. Medications are an important element of treatment for many people, especially when combined with
behavioral therapies.
8. Substance-abusing individuals with coexisting medical disorders should have the disorders treated in an
integrated way.
9. Medical detoxification is only the first stage of substance abuse treatment and by itself does little to change
long-term drug and alcohol use.
10. Treatment does not need to be voluntary to be effective.
11. Possible substance use during treatment must be monitored continuously.
12. Treatment programs should provide assessment for HIV, hepatitis B, hepatitis C, tuberculosis, and other
infections and provide counseling to help people change their risk for infection.
Treatment
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Motivational Enhancement Therapy
Cognitive behavioral therapy
Twelve-Step Facilitation
Structured family and couples therapy
Community reinforcement therapy
Contingency Management
Pharmacological therapies
(According to NIDA and the National Institute on Alcohol Abuse and Alcoholism)
Evidence Based
Treatments
Motivational Enhancement Therapy is a program based on the principles and practices of
motivational interviewing, an approach to helping people make behavior change that is based
on a client-centered, goal-oriented way of increasing a person’s intrinsic motivation to change,
capitalizing on his or her readiness.
• Motivational Interviewing (MI) is a client‐centered, directive method for enhancing intrinsic
motivation to change (by exploring and resolving ambivalence) that has proven effective in
helping clients clarify goals and commit to change. MI has been modified to meet the
special circumstances of clients with COD, with promising results from initial studies to
improve client engagement in treatment.
Cognitive behavioral approaches help people recognize, avoid, and cope with situations in
which they are likely to use substances by using awareness raising and skill-building activities.
Evidence Based
Treatments
Twelve-Step
Facilitation is a structured, individualized approach to introducing a person to a Twelve-Step
program that typically helps the person have a better understanding of his or her role in
therapy and what is expected.
Structured family and couples therapy such as Multidimensional Family Therapy, addresses a
variety of influences on the substance-abusing patterns of the person and includes family
members in the therapy sessions so as to treat people within their natural
social environment.
Community reinforcement therapy is an approach of connecting a person who has
substance abuse problems with a range of services within his or her community.
Evidence Based
Treatments
Contingency management, also known as motivational incentives, is an approach that uses
positive reinforcement (e.g., special rewards such as gift certificates) to increase positive
behaviors (e.g., not using substances for a specified period of time).
• Contingency Management (CM) maintains that the form or frequency of behavior can be
altered through the introduction of a planned and organized system of positive and negative
consequences. It should be noted that many counselors and programs employ CM principles
informally by rewarding or praising particular behaviors and accomplishments. Similarly, CM
principles are applied formally (but not necessarily identified as such) whenever the
attainment of a level or privilege is contingent on meeting certain behavioral criteria.
Demonstration of the efficacy of CM principles for clients with COD is still needed.
Pharmacological therapies include the use of medications like naltrexone (Rivia, Dapade,
Vivitrol), disulfiram (Antabuse), methadone, and buprenorphine (Suboxone, Subutex, Zubsolv) to
help stabilize a person’s life during treatment.
Evidence Based
Treatments
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Brief Interventions/Therapies
Client Engagement
Johnson Model Intervention
Resistance in Treatment
Stages of Change Model
Other Interventions
FACE OF ADDICTS
In 2010, 8.9% percent of persons 12 years of age and over
had any illicit drug use in the past month
STATISTIC
Name two evidence based treatment
models for working with addiction?
QUESTION
SAMHSA's 2002 report to Congress defines co-occurring disorders as:
• Individuals who have at least one mental disorder as well as an alcohol
or drug use disorder. While these disorders may interact differently in
any one person (e.g., an episode of depression may trigger a relapse
into alcohol abuse, or cocaine use may exacerbate schizophrenic
symptoms), at least one disorder of each type can be diagnosed
independently of the other.
• refers to an individual having co-existing mental health and substance
use disorders.
Co-Occurring Disorders
Some of the most common psychiatric disorders seen in patients with co-occurring
addiction issues include:
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schizophrenia
bipolar disorder
borderline personality disorder
major depression
anxiety and mood disorders
post traumatic stress disorder
pathological gambling
sexual and eating disorders
conduct disorders
attention deficit disorder
Co-Occurring Disorders
Whatever the relationship between mental health problems and problematic substance
use, the research shows that their co-existence is likely to worsen a range of outcomes
for service users.
These include:
•• Increased rates of violence.
•• Increased rates of suicide.
•• Higher levels of mental health symptoms.
•• Increased relapses, numbers of hospitalizations and time spent in hospital.
•• Poorer general health, including increased rates of hepatitis C and HIV.
•• Higher rates of offending and incarceration.
•• Unstable housing and homelessness.
•• Loss of family supports.
•• Financial problems.
•• Financial costs to treatment services.
Co-Occurring Disorders
The 12-Step Assessment Process (by SAMHSA)
• 1. Engage the client
• 2. Upon receipt of appropriate client authorization(s), identify and contact collaterals
(family, friends, other treatment providers) to gather additional information
• 3. Screen for and detect COD
• 4. Determine severity of mental and substance use disorders
• 5. Determine appropriate care setting (e.g., inpatient, outpatient, day-treatment)
• 6. Determine diagnoses
• 7. Determine disability and functional impairment
• 8. Identify strengths and supports
• 9. Identify cultural and linguistic needs and supports
• 10. Identify additional problem areas to address (e.g., physical health, housing,
vocational, educational, social, spiritual, cognitive, etc.)
• 11. Determine readiness for change
• 12. Plan treatment
Social Work Assessment
• Motivational Interviewing (MI)
• Contingency Management (CM)
• Cognitive‐Behavioral Therapy (CBT) is a general therapeutic approach that seeks to modify
negative or self‐defeating thoughts and behaviors, and is aimed at achieving change in both.
CBT uses the client's cognitive distortions as the basis for prescribing activities to promote
change. Distortions in thinking are likely to be more severe with people with COD who are, by
definition, in need of increased coping skills. CBT has proven useful in developing these coping
skills in a variety of clients with COD.
• Relapse Prevention (RP) has proven to be a particularly useful substance abuse treatment
strategy and it appears adaptable to clients with COD. The goal of RP is to develop the client's
ability to recognize cues and to intervene in the relapse process, so lapses occur less
frequently and with less severity. RP endeavors to anticipate likely problems, and then helps
clients to apply various tactics for avoiding lapses to substance use. Indeed, one form of RP
treatment, Relapse Prevention Therapy, has been specifically adapted to provide integrated
treatment of COD, with promising results from some initial studies.
Co-Occurring Disorders
Evidence Based Treatments
8
Integrated
Dual
Disorders
Treatment
Co-Occurring Disorders
Evidence Based Treatments
8
FACE OF ADDICTS
• Over 8.9 million persons have co-occurring disorders; that is
they have both a mental and substance use disorder.
• Only 7.4 percent of individuals receive treatment for both
conditions with 55.8 percent receiving no treatment at all.
STATISTIC
Name 2 common co-occurring disorders
Co-Occurring Disorders
Susan presents to you asking for help for her heroin
addiction. She has been using drugs off and on for 4 years
(from pills to heroin) and is currently using about $60/day by
IV drug use. Susan does not have stable housing and lives
with her boyfriend sometimes. Susan has one child (age 4)
who is with her mother due to CPS involvement (open case).
Susan also feels some anxiety and sadness, but has never
been diagnosed. She has many physical withdrawals when
she does not use (sweating, cramps, nausea). Susan relies on
the bus for transportation and her boyfriend will give her
money sometimes. How do we help her?
Treatment Plan EXAMPLE
• Problems
•
The problems must be specific, not vague. A problem is a brief clinical statement of a condition of the patient that
needs treatment.
• Long Term Goals
•
A goal is a brief clinical statement of the condition you expect to change in the patient or in the patient’s family.
Goals usually are abstract statements that you cannot actually see happen.
• Short Term Objectives
•
An objective is a specific skill that the patient must acquire to achieve a goal. The objective is what you really set
out to accomplish in treatment. It is a concrete behavior. Objectives must be measurable.
• Therapeutic Interventions
•
Interventions are what you (as the clinician) do to help the patient complete the objective. Interventions also are
measurable and objective. There should be at least one intervention for every objective.
• Diagnostic Suggestions
Treatment Plan
Components
Susan presents to you asking for help for her heroin addiction. She has been using drugs off
and on for 4 years (from pills to heroin) and is currently using about $60/day by IV drug use.
Susan does not have stable housing and lives with her boyfriend sometimes. Susan has one
child (age 4) who is with her mother due to CPS involvement (open case). Susan also feels
some anxiety and sadness, but has never been diagnosed. She has many physical
withdrawals when she does not use (sweating, cramps, nausea). Susan relies on the bus for
transportation and her boyfriend will give her money sometimes. How do we help her?
LIST PROBLEMS
Treatment Plan EXAMPLE
Susan presents to you asking for help for her heroin addiction. She has been using drugs off
and on for 4 years (from pills to heroin) and is currently using about $60/day by IV drug use.
Susan does not have stable housing and lives with her boyfriend sometimes. Susan has one
child (age 4) who is with her mother due to CPS involvement (open case). Susan also feels
some anxiety and sadness, but has never been diagnosed. She has many physical
withdrawals when she does not use (sweating, cramps, nausea). Susan relies on the bus for
transportation and her boyfriend will give her money sometimes. How do we help her?
LIST LONG TERM GOAL(S)
Treatment Plan EXAMPLE
Susan presents to you asking for help for her heroin addiction. She has been using drugs off
and on for 4 years (from pills to heroin) and is currently using about $60/day by IV drug use.
Susan does not have stable housing and lives with her boyfriend sometimes. Susan has one
child (age 4) who is with her mother due to CPS involvement (open case). Susan also feels
some anxiety and sadness, but has never been diagnosed. She has many physical
withdrawals when she does not use (sweating, cramps, nausea). Susan relies on the bus for
transportation and her boyfriend will give her money sometimes. How do we help her?
LIST SHORT TERM OBJECTIVE(S)
Treatment Plan EXAMPLE
Susan presents to you asking for help for her heroin addiction. She has been using drugs off
and on for 4 years (from pills to heroin) and is currently using about $60/day by IV drug use.
Susan does not have stable housing and lives with her boyfriend sometimes. Susan has one
child (age 4) who is with her mother due to CPS involvement (open case). Susan also feels
some anxiety and sadness, but has never been diagnosed. She has many physical
withdrawals when she does not use (sweating, cramps, nausea). Susan relies on the bus for
transportation and her boyfriend will give her money sometimes. How do we help her?
LIST THERAPEUTIC INTERVENTION(S)
Treatment Plan EXAMPLE
Susan presents to you asking for help for her heroin addiction. She has been using drugs off
and on for 4 years (from pills to heroin) and is currently using about $60/day by IV drug use.
Susan does not have stable housing and lives with her boyfriend sometimes. Susan has one
child (age 4) who is with her mother due to CPS involvement (open case). Susan also feels
some anxiety and sadness, but has never been diagnosed. She has many physical
withdrawals when she does not use (sweating, cramps, nausea). Susan relies on the bus for
transportation and her boyfriend will give her money sometimes. How do we help her?
LIST DIAGNOSTIC SUGGESTIONS
DSM V
Opioid use Disorder
Specify if: early remission or sustained
remission
Specify if : on maintenance therapy,
in controlled environment S
Specify if:
305.50 (F11.10) - Mild
304.00 (F11.20) - Moderate
304.00 (F11.20) - Severe
Opioid Intoxication
292.89
Without perceptual disturbances
w/use disorder – F11.129
w/use disorder, severe/moderate – F11.229
w/out use disorder – F11.929
With perceptual disturbances
w/use disorder – F11.122
w/use disorder, severe/moderate – F11.222
w/out use disorder – F11.922
Opioid Withdrawal
292.0 (F11.23)
Unspecified Opioid
Related Disorder
292.9 (F11.99)
Treatment Plan EXAMPLE
Accountability App
TARRANT COUNTY:
• Call Recovery Resource Center (RRC) - #877-332-6329
DALLAS COUNTY:
• Detox:
• Homeward Bound (Oak Cliff) - #214-941-3500
• Nexus (women only) - #214-321-0156
• Treatment:
• Nexus ; Homeward Bound
• Solace #214-522-4640
• Turtle Creek #214-871-2496
• Insurance: NorthSTAR 1-888-800-6799
JOHNSON COUNTY:
• Star Council: 817-645-5517 (Cleburne)
OTHER AREAS:
• Partners for a Drug Free Texas (Dept of Health) - 1-866-378-8440
Local Treatment
Costs of Substance Abuse
Abuse of tobacco, alcohol, and illicit drugs is costly to our
Nation, exacting over $600 billion annually in costs related
to crime, lost work productivity and healthcare
STATISTIC
FAMOUS ADDICT
Guess Who?
1. American Psychiatric Association. (2013). Substance Related Addictive Disorders. Retrieved March 1,
2014 from http://www.dsm5.org/Documents/Substance%20Use%20Disorder%20Fact%20Sheet.pdf
2. Villanova University. Drug Classifications. Retrieved March 1, 2014 from
https://www1.villanova.edu/villanova/studentlife/health/promotion/goto/resources/drugclassifications.html
3. National Institute on Drug Abuse. (2012). Drug Facts: Inhalants. Retrieved March 1, 2014 from
http://www.drugabuse.gov/publications/drugfacts/inhalants
4. Maxwell, Jane. Substance Abuse Trends in Texas: June 2012. Retrieved March 1, 2014 from
http://www.utexas.edu/research/cswr/gcattc/documents/CurrentTrends2012.pdf
5. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition,
Substance Abuse and Behavioral Disorder Counselors,
on the Internet at http://www.bls.gov/ooh/community-and-social-service/substance-abuse-andbehavioral-disorder-counselors.htm (visited March 10, 2014).
6. Co-Occurring Center for Excellence. (2006). Screening, Assessment, and Treatment Planning for
Persons With Co-Occurring Disorders. Retrieved March 1, 2014 from
http://store.samhsa.gov/shin/content/PHD1131/PHD1131.pdf
7. Nelson, Anna. (2012). Social Work with Substance Users. Sage Publications.
8. Jongsma, A., Peterson, M.L., & Bruce, T. (2006). The Complete Adult Psychotherapy Treatment Planner
(4th Ed.). (2006). Hoboken, NJ: John Wiley & Sons.
9. NASW. (2013). NASW Standards for Social Work Practice with Clients with Substance Use Disorder.
10. Images used from Internet
REFERENCES
1. Center for Substance Abuse Treatment. (2005). Substance Abuse Treatment for Persons With CoOccurring Disorders. Treatment Improvement Protocol (TIP) Series 42. DHHS Publication No. (SMA) 053992. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved March 1,
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