Transcript Desipramine versus Placebo in Treating Cocaine Dependence

Wellness Is Where It’s At
Douglas Ziedonis, M.D., M.P.H.
Professor and Chairman
Department of Psychiatry
UMass Memorial Medical Center/
University of Massachusetts Medical School
Wellness & Health Promotion
for Everyone
Why now?
– National, State, Local Awareness and
Commitment
We each must do our part as individuals
and as teams
UMass Department of Psychiatry
– Wellness Interest Group
– Wellness Initiative
Need Personal & Organizational Change
Plan
Massachusetts DMH Data:
Clinical Research in Our Clinical Programs
26 years shorter life
Leading causes of death:
– Cardiovascular
– Cancer
Many other health risks
Need to link with wellness and recovery
Address obesity, nutrition, exercise, stress
management, mood management, vocational
rehabilitation, relationship building, and
significant other risk factor reduction
Why address tobacco addiction in
Mental Health Settings?
44% of all cigarettes consumed in the US are by
smokers with a psychiatric disorder
Most individuals with mental illness are tobacco
dependent & 50% are heavy smokers (>25 cigs/day)
Increased health consequences, death, medication &
discretionary costs, housing issues, and other
addictions
Treatment can work – more intensive motivation
based treatments & organizational change
– Watch psychiatric medication side effects with abstinence
Helping Staff who smoke: Adverse
Employment Outcomes Associated with
Smoking
Involuntary turnover
Accidents
Injuries
Discipline problems
Mean Absence Rates
17 workdays dedicated to smoke-breaks
per year
Economic Benefits to Employers
Reduced Absenteeism
On-the-Job Productivity
Reduced Life Insurance
Reduced Medical Expenditures
– workers, retirees, medicare, other
Benefit to Cost Ratio
– 1:1 3rd year & 5:1 10th year
Stigma
Misinformation / lack of information about
General Health Implications for this population
– Little data on why this group dies
– Myths: “health risks exaggerated, just manipulating
statistics, people are living longer, I don’t know anyone
who died of smoking caused diseases”
Stigma, rationalization, and minimization:
– “other than increase morbidity and mortality why should
we address tobacco?”
– OR “You are taking away their only pleasure in life What else are they going to do?”
Behavioral Risk Factors
– Heart disease & Stroke & Diabetes
Alcohol, tobacco smoking, other substance
abuse, exercise, obesity, and diet
– Cancer
Tobacco smoking, alcohol dependence,
obesity, diet
– Respiratory diseases
Tobacco smoking and other substance abuse
– Traumatic injuries from Accidents
Alcohol and other substance abuse
Centers for Disease Control (www.cdc.gov/nccdphp/burdenbook2002/01_tables.htm)
WELLNESS
ACADEMIC INTEREST GROUP
UMASS DEPARTMENT OF PSYCHIATRY
CONTACTS
Betsy Austin –[email protected],
Paula Nims –[email protected]
Marie [email protected]
Complete Wellness:
Mental and Physical Health
Mental
Health &
Recovery
Plan
Healthy
Food Choices
Regular
Checkups
Complete
Wellness
Addressing
Addictive
Behaviors
Daily
Physical
Activity
Balancing
Relaxation
& Stress
Wellness Initiative
Targets for Intervention
Diet - Nutrition
Exercise
Stress Management
Smoking cessation
Improving integration with primary care
and specialty providers
– Minimizing drug interactions and side effects
& medications
– Statins and other tools
Current Projects
Interests of AIG Participants
Caregiver and student health and
wellness
Tom Hopkins and Valerie Wedge- EAP,
Brian Szetela, Mathieu BerminghamPhysician Wellness, Mai- Lan RogoffMedical Student Wellness
Decreasing Morbidity and Mortality for
Individuals with Serious Mental Illness
Sally Reyering- DMH Healthy Changes Initiative,
investigating “Fit Together” model health club in Hadley.
Rob Karr - DMH/ Community Partnerships in areas of
diet, physical activity, and smoking cessation
Colleen McKay / Doug Ziedonis / Greg Seward Smoking cessation groups at Genesis Club- using the
“Learning about Healthy Living” . Legacy Foundation
funding to study and disseminate information.
More Projects
Marie Hobart , Sarah Guzofski- Wellness Intervention in
Assertive Community Treatment
Alan Brown/ Rosalie Torres Stone CMHS - Addressing
Health Care Disparities – proposed joint project with
psychiatric providers and primary care in the Worcester
area. Cross Cultural issues. To look for new source of
funding
Mike Archambault- CHL residential staff- Solutions for
Wellness- training for 50 staff to implement program.
Many already starting.
Improving health behaviors in those
with chronic medical conditions
Betsy Austin and Jennifer Lauretti
Health Psychology
Improving Health Status for those with
Developmental Disabilities
Carol Curtin and colleagues at the Shriver
Center- Health U- a group model for teens
with Down’s syndrome and family
members. The focus is on healthy diet
and physical activity.
Managing Chronic Illness and
Addiction
Monika Kolodziej- ADCARE- Group
treatment for those in recovery from
addiction with co-occurring Hepatitis C
infection.
Obesity and ADHD
Sherry Pagoto
PCA tracking health measures, use of
pedometers in outpatient mental health
Mary Innis, Phyllis Wood- UMMHC OPD
Smoking Cessation/ Prevention in
Adolescents, Improving Health
Behaviors in Teens
Mathieu Bermingham- Child Psychiatry,
Anne Lutz- CHL,
Carolyn McGrath- Westboro State Hospital
Promoting Healthy Lifestyles at Genesis Club
•Structured and independent exercise:
• Assumption College's Plourde Recreation Center
• Daily walks and Team Genesis the club’s running team
•Tobacco Cessation (Organizational Change, Learning About
Healthy Living and CHOICES)
•Nutrition meetings are held weekly to discuss meals and food
choices, and research and write articles regarding nutrition.
•Dual Recovery Anonymous (D.R.A.) meetings:
An independent, self-help organization that help men and
women who have a dual diagnosis of mental illness and
substance misuse achieve dual recovery
Wellness Initiative
Targeted Outcomes
Wellness goals will be a standard part of
all treatment plans.
Wellness resources will be readily
available for all
Routine measurement of weight, waist
circumference, blood sugar, lipids, and
other lab indices as appropriate to care will
be obtained.
Personalized feedback: what
mattered
Carbon Monoxide Meter
score and feedback (like an
alcohol breathalyzer)
– Big impact on patients
– Short & long term benefits
to quit
Cost of Cigarettes for the
year
Medical conditions affected
by tobacco
Links with other substances,
relapses, etc
Wellness Initiative
Targeted Outcomes
Culturally relevant resources regarding
affordable healthy diet and accessible exercise
options in the community will be available at
each site.
Intervention focusing on health, wellness,
smoking cessation and exercise will be available
at all sites. This may include patient and family
education, group programs or access to
specialty services.
Wellness Initiative
Targeted Outcomes
Clinical research studies will be ongoing
addressing the effectiveness of
interventions, education and practice
standards.
Moving Toward Healthier Behaviors
Model healthy behavior
Health belief model: weigh benefits
and risks1
Most people move through
predictable stages in their efforts to
change2
The stages-of-change model can
be applied to most health related
behaviors2
Match clinician strategies to stage
of change3
1. Rosenstock
I, Strecher V, and Becker, M. (1998). Health Education Quarterly, 11, 403-418.
2. Prochaska J, DiClemente C, Norcross, J (1992). Amer Psychologist, 47: 1102-1114
3. Miller W. & Rollnick S. (2002). Motivational Interviewing: Preparing People to Change Addictive Behaviors
Learning
About
Healthy
Living
TOBACCO AND YOU
Jill Williams, MD
Douglas Ziedonis, MD, MPH
Nancy Speelman, CSW, CADC, CMS
Betty Vreeland, MSN, APRN, NPC, BC
Michelle R. Zechner, LSW
Raquel Rahim, APRN
Erin L. O’Hea, PhD
Mindfulness in Medicine,
Health Care and Society
Full Catastrophe Living: Using the
Wisdom of Your Body and Mind to Face
Stress, Pain and Illness
MBSR
–Based on intensive training on meditation and yoga
–Notion of a Way (of Being); a Way (of Seeing)
What is mindfulness?
“Mindfulness means paying attention in a
particular way: on purpose, in the present
moment and not judgmentally”
Practicing Mindfulness
The engagement in these stress reduction
techniques provides and/or increase:
clarity of mind,
sense of purpose,
greater self-esteem, and
personal commitment,
All important elements to make necessary
changes in our lives
From Automatic-Pilot to
Intentionality
Dis-Attention
Dis-Connection
Dis-Regulation
Dis-Order
Dis-Ease
“Only that day dawn to which we are awake”
H. Thoreau
UMassMemorial Medical Center
ATTOC: Agency Goals and
Accomplishments Tool
Major goal for ATTOC
–
–
–
–
Staff Training & Improving Clinical Services
Program Development
Supporting Staff Recovery
Implement Policies for Smoke-free grounds
For Staff
For Patients
Performance Measures Metric
Threshold, Target, and Stretch Goals
Importance of Communication (within
organization and with outside network)
Tracking and Sustaining Change
Organizational Change
1. Establish preliminary organizational goals for
change.
– consulting team and “champions”
– articulate the organization’s vision of change, provisional goals
– ensure leaders are supportive
2. Establish a leadership group and prepare for
change.
3. Assess readiness for change
– conduct strengths and needs assessment
4. Develop a draft Change Plan
– Working document
5. Develop and document a communication plan
– determine how to initiate and maintain two-way communication
with stakeholders throughout the change process
– including how to communicate new policies and procedures
Organizational Change
6. Work area: Patients / Clients / Consumers
– The agency identifies opportunities to address wellness and health
promotion, implements selected strategies, tracks and assesses
progress.
7. Work area: Staff / Faculty / Peer Counselors
– Based on an assessment of staff readiness to change, the agency
implements selected strategies to help staff support clients in their
recovery and to assist staff in their own recovery. Progress is
tracked and assessed.
8. Work area: ENVIRONMENT
– Based on its assessment of factors supporting and impeding
environmental change
– EX the agency implements selected strategies to discourage or
end smoking through environmental changes and policies (e.g.,
discouraging or ending smoking on the grounds).
Organizational Change
9. Document changes in policies and
procedures.
– After assessing the success of the intervention, the
agency formally documents changes in policies and
procedures and ensures they are reflected in agency
operations (e.g., training of new staff, performance
review).
10. Support, encourage, and sustain
environmental change.
– The organization sustains change by publicizing
successes, maintaining an ongoing feedback loop,
and ensuring the existing of an infrastructure within
the agency capable of sustaining change.
Psychosocial treatment research
issues:
Cognitive, affective, and motivational issues
How modify and integrate tobacco dependence
psychosocial treatments?
What medication platform?
What length of time for treatment intervention?
– number of sessions, length of session, etc
Adjunct Service versus Integrate
Component analysis of current approaches
Role for Contingency Management? What
rewards?
Involvement of significant others?
Champions
What is a Champion?
Assemble Leadership Team
Facilitate leadership team activities
Can oversee our consultant activities and
motivates the cultural change process.
Criteria:
– Passion and commitment for the topic
– Leader in system
– Knowledge in topic area
Conclusion
The Time is now to focus on Wellness and
Health Promotions – for everyone
Leadership & Organizational Change
Motivation Based Intervention Strategies are
needed
Having the tools – education and training
Program and system changes are critical to
the broad-based success