Transcript Substance Abuse Training – February 16, 2016

SUBSTANCE USE DISORDERS
Identifying and Referring to Treatment
Community Health Institute/JSI
Rekha Sreedhara, MPH
Objectives
1. Understand how to universally ask if a patient needs support related to
alcohol and/or drugs
2. Identify appropriate terms to destigmatize addiction
3. Become familiar with the different levels of care and recognize the
importance of encouraging patients to obtain an evaluation/assessment
4. Understand how to navigate the NH Alcohol and Drug Treatment Locator
as one resource to identify treatment and recovery support services
What Do We Know?
• Drug (opioid)-related emergency room visits, emergency medical service calls for drug
overdose, and drug-related deaths have dramatically increased1.
What Do We Know?
Drug Deaths vs. Traffic Deaths by Year
Data Sources: NH Medical Examiner's Office / NH State Police
450
399
400
325
350
# of Deaths
300
250
200
205
177
193
164
150
100
135
128
90
50
108
95
114
0
2010
2011
2012
All Drug Deaths
2013
2014
2015*
Traffic Crash Fatalities
*2015 Drug Death numbers are based on analysis completed as of 28 Jan 2016 - many cases are still
pending analysis; 2015 Traffic Death numbers were reported on 26 Jan 2016 - the 2015 total is still
pending until 1/31/16
What Do We Know?
• State prevalence rates for substance misuse indicators among 18 to 25 year old young
adults have been and remain some of the highest in the country based on data
reported by the National Survey on Drug Use and Health (NSDUH).
What is Addiction?
• Addiction to alcohol and/or drugs is a complex biopsychosocial disease that is chronic
in nature and is often characterized by periods of relapse and recovery
• Addiction does not have a face. This chronic disease can affect ANYONE at ANYTIME –
socioeconomic status, race, gender, age, etc.
• There are risk factors which can predispose a person to an alcohol and/or drug
problem:
• Family history of addiction;
• Abuse, neglect, or other traumatic experiences in childhood;
• Mental disorders such as depression and anxiety;
• Early use of drugs; and
• Substance used and method of administration—smoking or injecting a drug may
increase its addictive potential.
How can you ask if a person needs
help related to alcohol and/or
drugs?
How can you provide support and
refer to treatment?
1. Universalize Identification of an Alcohol/Drug Problem
Ask the same question of everyone
2. Destigmatize Addiction
Use accurate and sensitive language
3. Refer to Treatment
Recommend next steps and help access services as needed
Universalize Identification of an
Alcohol/Drug Problem
“Given the current opioid (heroin, fentanyl, prescription pain
relievers, and other drugs) problem in our state, do you or
someone you know have a problem with alcohol and/or drugs
in which you would like help with?
I am asking this question of all of my clients in an effort to be
available to provide support and information as may be
needed.”
Destigmatize Addiction
Incorrect Terms
Preferred Terms
Addict, Alcoholic, Abuser, User, Junkie, Drug -Person experiencing an alcohol/drug
Seeker
problem
-Person with a substance/alcohol use
disorder
Recovering Addict
Person in recovery, addiction survivor
Substance Abuse, Alcohol Abuse
-Substance misuse/alcohol misuse
-Substance use disorder/alcohol use
disorder
-Addiction
Clean, Dirty
Replacement or Substitution Therapy
Negative, substance-free, positive
Medication assisted treatment, medication
Destigmatize Addiction
• SUBSTANCE MISUSE – improper and harmful use of substances (alcohol and/or drugs) for
non-medical purposes where a person is not physically and/or psychologically dependent on
the substance used but can affect the person’s ability to follow through with responsibilities
(e.g. work, school), cause relationship problems, involvement with criminal issues, etc.
• SUBSTANCE USE DISORDER - repetitive use of substances (alcohol and/or drugs) where a
person physically and/or psychologically depends on the substance used which affects the
person’s health, ability to follow through with responsibilities (e.g. work, school), cause
relationship problems, involvement with criminal issues, etc.
• OPIOIDS - refers to entire family of opiates including natural and synthetic (man-made);
morphine, hydrocodone, oxycodone, methadone, heroin, fentanyl
• OPIATES - refers to drugs derived from opium (not man-made); heroin, morphine, OxyContin,
codeine
Refer to Treatment
 Active Referral and Warm Handoff
 understand patient-specific needs including barriers such as
transportation, insurance and childcare
 identify appropriate treatment services based on these needs
 coordinate access to the services needed
 Follow Up
Considerations
• Insurance coverage
• Language/cultural competence
• Location/transportation: Can the patient and their family easily access the
treatment facility?
• Family support
• Treatment history: How many past treatment episodes? Which levels of
care were received?
Levels of Care
 Withdrawal Management (Detoxification) – Service aimed at managing acute substance
dependence as defined by the presence of intoxication and withdrawal. This service helps stabilize
and prepare an individual with a substance use disorder to enter treatment and may be delivered
within an inpatient or outpatient setting.
 Outpatient Counseling

Individual Outpatient Counseling – Service provided by a clinician to assist an individual to achieve treatment
objectives through the exploration of substance use disorders and their effects, including an examination of
attitudes and feelings, and considering alternative solutions and decision making with regard to alcohol and
other drug related problems.
 Group Outpatient Counseling – Service provided by a clinician to assist two or more individuals and/or their
families/significant others to achieve treatment objectives through the exploration of substance use disorders
and their effects, including an examination of attitudes and feelings, and considering alternative solutions
and decision-making with regard to alcohol and other drug related problems.
 Intensive Outpatient Programs – Structured individual and group alcohol and/or drug
treatment services and activities that are provided at least 3 hours a day and at least 3 days a
week according to an individualized treatment plan.
Levels of Care
 Partial Hospitalization – Combination of 20 or more hours per week of group and individual sessions in
conjunction with, either directly or through referral, medical and psychiatric services, psychopharmacological
services, addiction medication management, recovery support services and 24-hour crisis services.
 Residential Services – Program providing 24-hour support and services where an individual lives full-
time at the program and receives individual and/or group counseling, educational sessions and introduction
to self-help groups.
 Recovery Support Services – Services provided to individuals and/or their families to help stabilize and
support recovery. Services may include employment services, anger management, recovery
mentoring/relapse prevention management, peer recovery coaching, care coordination, childcare,
transportation, sober housing, and other supports.
 Medication Assisted Treatment – Treatment that includes medication prescription, supervision, and
management paired with counseling or other treatment services. Common medications include
buprenorphine (Suboxone), Methadone, Naltrexone, Acamprosate, and Disulfiram.
How do you know which level of
care is the most appropriate?
EVALUATION/ASSESSMENT
An assessment involves the careful
evaluation of biopsychosocial factors of an
individual which is conducted by a
professional (usually a Licensed Alcohol and
Drug Counselor (LADC) / Master’s Alcohol and
Drug Counselor (MLADC)).
Evaluation Resources
• Refer to the evaluation filter on the NH Alcohol and Drug
Treatment Locator to access a list of providers who
conduct evaluations.
• Any outpatient treatment program
• Private LADCs/MLADCs
• Southeastern NH Services, Dover
• Serenity Place, Manchester
Identify if the person has been
assessed/evaluated to determine the level of care
that is most appropriate
If an assessment has been
conducted….
Help patient connect with
appropriate level of care.
Outpatient Counseling
Intensive Outpatient Counseling
Partial Hospitalization
Residential
Recovery Support Services
Medication Assisted Treatment
If an assessment has not been
conducted…
Help patient connect with an
outpatient counseling program to help
assess what type of care would be
most appropriate for them.
Use the NH Alcohol and Drug
Treatment Locator,
www.nhtreatment.org as a
resource to identify appropriate
services based on needs.
www.nhtreatment.org
How to use Nhtreatment.org?
• Type your address or zip code in the Address field. You may also indicate
a range within 10 to 250 miles.
• Filter by clicking on the Service Types, Populations/Specialties Served,
and/or Payer radio buttons.
• Click on the points on the map within the location of interest to obtain
provider contact information.
• Scroll down the page for a full list of providers specific to the service
type(s) selected.
Follow-Up: Monitor Treatment Progress
• Participation in treatment
• Knowledge gained about substance use disorders
• Participation in support systems
• Compliance with plan
• Interpersonal relationships
• Abstinence from substances
What if treatment is not readily
available?
• Encourage participation in 12 step meetings (provide a list of local
meetings)
• Encourage participation in other recovery support programs and
recovery centers
•
•
Hope for NH Recovery, Manchester
Keene Serenity Center, Keene
• Connect patient with a recovery coach
•
Hope for NH Recovery, Manchester
• Establish frequent phone/in-person check-ins
• Suggest group and/or individual counseling
Resources
•
NH Alcohol & Drug Treatment Locator, www.nhtreatment.org, Resources Page
•
National Center on Substance Abuse and Child Welfare,
https://www.ncsacw.samhsa.gov/training/toolkit/Default.aspx?id=home, Child
Welfare Training Toolkit
Questions?
Thank You!
Rekha Sreedhara
[email protected]
References
1 NH Information and Analysis Center, Drug Monitoring Initiative Report, December 2015
2 Behavioral Health Barometer, New Hampshire, 2014, retrieved from
http://www.samhsa.gov/data/sites/default/files/State_BHBarometers4_2/BHBarometerNH.pdf