Substance abuse slides

SUBSTANCE ABUSE:

PREVALENCE, TREATMENT AND RESOURCES

SUSAN SPINA, LCSW-R

32.00%

19.60%

24.10%

11.90%

10.50%Total Patients 2,569

Alcohol PrimaryHeroin PrimaryMarijuana PrimaryCocaine PrimaryOther Rx and OTC Primary

SUBSTANCE USE DATA

SECONDARY SUBSTANCE

15.60%

4.20%

19.40%

14.70%

0.90%

Total patients 2,569

Alcohol Secondary

Heroin Secondary

Marijuana Secondary

Cocaine Secondary (includes crack)Other Rx/OTC

GENDERPERCENTAGE OF 2,569 PATIENTS

69.40%

30.60%

MaleFemale

EMPLOYMENT STATUSPERCENTAGE OF 2,569 PATIENTS

58.10%

18.90%

23.00%

Column1

UnemployedEmployedNot in Labor Force (dis-abled)

HISTORY OF MENTAL HEALTH TREATMENTPERCENTAGE OF 2,569 PATIENTS

57.30%

42.70%

Prior MH Treatment

YesNo

EMERGENCY DEPARTMENT VISITS

PERCENTAGE BASED ON 2,569 PATIENTS

ED Visits

73.10%

16.00%9.30%

3.50%

0 Visits1 Visit2 to 4 Visits5 to 9 Visits

ADDICTION Defined as repeated behavior in spite of

negative consequences. Your patients drug of choice is his

lifeline Your patient uses because it is the only

way that he/she feels normal It is the only way that he/she feels ok Preprogrammed to addiction?

DRUGS OF CHOICE Heroin: Opioid drug synthesized from

Morphine Marijuana Bath Salts: 1 or more synthetic chemicals

related to Cathihone, amphetamine like stimulant found in the KHAT plant (similar properties to Ecstasy or MDMA.)

OCD: Narcotics, Adderal, Concerta, sleep meds.

Cocaine Alcohol

SCREENING Various tools available

SBIRT

CAGE

SBIRTSCREENING, INTERVENTION AND REFERRAL TO TREATMENT:

SBIRT is a comprehensive, integrated, public health approach that provides opportunities for early intervention before more severe consequences occur.

Evidence-based tools that are demonstrated to be valid and reliable in identifying individuals with problem use or at risk for a Substance Use Disorder (SUD) must be used.

Based on implementation of this model nationally, of 459,599 patients screened, 22.7 percent screened positive for a spectrum of use (risky/problematic, abuse/addiction). Of those who screened positive 15.9 percent were recommended for a brief intervention with a smaller percentage recommended for brief treatment (3.2 percent) or referral to specialty treatment (3.7 percent).

NYS Office of Alcoholism and Substance Abuse Services

SBIRT BENEFITS Prevent disease, accidents and injuries

related to substance use, resulting in better patient outcomes.

SBIRT reduces costly healthcare utilization. SBIRT is reimbursable, billing codes are

available in New York State. Many payers reimburse for SBIRT services. Complete resource tool for screening,

training certification.

NYS Office of Alcoholism and

Substance Abuse Services

SCREENING CAGE : adapted for both alcohol and/or

drug use.1.Have you ever felt that you should cut

down on your drinking or drug use?2. Have people annoyed you by criticizing

your drinking or drug use?3. Have you felt bad about your drinking or

drug use?

4. Have you ever had a drink or used drugs first thing in the morning to steady your nerves or get rid of a hangover?

ALCOHOL GUIDELINES Moderate: 1 drink per day for women/2

drinks for men Binge: BAC. 0.08 4 drinks women/ 5 drinks

men in 2 hours at least 1 day in 30 days Heavy: 5+ drinks in a day for 5+ days in 30 Low Risk: No more than 3 drinks 1 day and

no more than 7 drinks in 1 week for women No more than 4 drinks in single day and no

more than 14 drinks in one week. NIUAA Research shows 2/100 have Alcohol

Use Disorder

•

MENTAL HEALTH SCREENING

Important to evaluate family history, mental health history/current Mental Health Provider and psychosocial issues that contribute to addiction.

PHQ 9 patient health questionnaire/Geriatric Depression scale

Higher risk of substance abuse and self injury when positive on scales.

Bipolar Disorder: - 56% had experienced drug or alcohol addiction in their

lifetime.- 46% had abused alcohol or were addicted to alcohol- 41% had abused drugs and were addicted to drugs- Alcohol is more commonly used in Bipolar individuals (Dual diagnosis.org)

MENTAL HEALTH TREATMENTPSYCHOTHERAPY

Cognitive Behavioral Treatment evidenced based addresses dysfunctional emotions,

maladaptive behaviors Problem focused/goal oriented

MENTAL HEALTH TREATMENTPSYCHOTHERAPY

Dialectical Behavior Therapy ( DBT) Change patterns of behavior that are

not effective Develop coping behaviors in sequence

of events: thoughts, feelings, behaviors that lead to negative behaviors

Individual and Group therapy

MENTAL HEALTH TREATMENTPSYCHOTHERAPY

CBT VS DBT

CBT is commonly practiced today DBT is a specific form of CBT builds upon the CBT foundation psychosocial/ relationship

component “how one interacts with others in different

environments and relationships.”Regulates emotions and behaviors in a social

contex

PRESCRIPTION DRUG SCREENING

According to NIDA, addiction varies 3-40%

Based on duration of treatment, develop of drug tolerance, increased pain sensitivity and proponent to addiction.

Check: personal or family hx of addiction

Increased need for pain refills Development of drug tolerance National

Institute of Drug Abuse. org

TREATMENT Research shows that drug abuse is a

brain disease that can be treated effectively.

3 componets: Detoxification Counseling Use of addiction medications

Behavioral vs. Pharmological

National Institute of Drug Abuse. org

TREATMENT Opiate Addiction Treat withdrawal and Cravings Treat overdose Behavioral Therapy

PHARMACOLOGY Heroin/Opioids:NARCAN : acute overdose: complete or

partial reversal of opioid overdose.Naltrexone ( Vivitrol) injectable: Long

acting antagonist, used for alcohol addiction as well.

Methadone: synthetic Opioid Suboxone: antagonist + agonist opioid

receptor

PHARMACOLOGY CNS Depressants/Prescription

Stimulants

No Medication TherapyMedically supervised Detox centerCognitive Behavioral TreatmentSupport Groups

Often seen in combination with alcohol and Cocaine addictions

National Institute of Drug Abuse.org

TREATMENT MarijuanaMust have 3 symptoms in 1 year period.

Tolerance (decreased effects of marijuana over time or a need to increase the amount used to achieve the desired effect)

Withdrawal (characteristic symptoms that occur when the individual abstains from using marijuana for several days)

Often taking marijuana in larger amounts or over a longer period of time than planned

Persistent desire to use marijuana or trouble decreasing or controlling its use Spending significant time either obtaining marijuana (for example, buying or growing it), using it or recovering from its effects

Significant social, educational, occupational or leisure activities are either abandoned or significantly decreased as a result of marijuana use

Marijuana use continues despite being aware of or experiencing persistent or repeated physical or psychological problems as a result of its use

Coalition against drug abuse. org

TREATMENT

Colorado or California?

Outpatient/inpatient Cognitive behavioral therapy

COMMUNITY RESOURCES Addiction Crisis Center: ACC Insight House Beacon Center McPike Milestone

ADDICTION CRISIS CENTER

16 bed, Medically monitored withdrawal service, regulated by Oasas

Screened for severity and presence of chemical dependency, medical and mental health services

Duration of stay varies: Max 14 days LT Treatment = 21 days Free Service if can’t afford to pay

ADDICTION CRISIS CENTER

Needs collaboration with PCP “ativan for ACC only” 1 RN LPN with a stethoscope and blood

pressure cuff Cannot accept .350 BAC, Med and psych stable Alcohol and opiates major withdrawal tx at

facility Benzo addictions : wean and replace with

vistiril Alcohol: gapapentin, wellbutrin and depakote

use Strong relationship with Conifer Park

INSIGHT HOUSE Inpatient and Outpatient treatment

Center No Detox Adults and adolescents ( any age) Intensive Residential Services Outpatient Clinic Services Day Rehabilitation Services Prevention Services and School Program Additional Specialized Services Suboxtone: Dr Kozminski Psychiatric: Dr Jhori

BEACON Intensive Outpatient Program Out Patient Counseling COMPASS Program Women’s Program Mens Program Adolescents/Youth Programs Suboxone Therapy

MILESTONESDUAL RECOVERY PROGRAM NYS OASAS Licensed Outpatient

Treatment Program Shelter Plus Care Supportive Living Dual Recovery Supportive Living Oasas Medicaid Redesign Team

Permanent Supportive Housing Suboxone Therapy

MCPIKE

Tobacco Free Inpatient Treatment Center Integrated Dual Recovery Program Woman’s Program 18 years and older Not based on ability to pay.

QUESTIONS?????