Lunch & Learn 11/29/17. Brent Cummins MA, LPC, CADC, ATE, GCE Director of Adult Substance Use Services Chestnut Health Systems

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2 Lunch & Learn 11/29/17 Brent Cummins MA, LPC, CADC, ATE, GCE Director of Adult Substance Use Services Chestnut Health Systems

3 Physical Signs of Opioid Use Persistent and hacking cough Sudden weight loss Loss of appetite Dry Mouth Extremely small pupils

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5 Physical Signs of Opioid Use (cont d) Limbs that are heavy/droopy Cuts, bruises, scabs Itching skin Abscesses or infections Nosebleeds

6 Physical signs of Opioid Use Sores/burns on mouth or fingers Dark circles under eyes Flu like symptoms Constant sniffing Needle marks on arms/legs

7 Behavioral Signs of Opioid Use Poor school/work performance Slow/uncoordinated movement Being disoriented Alert/jittery..followed by nodding off

8 Behavioral Signs of Opioid Use Sleeping a lot Slurring speech Lack of motivation No interest in activities they used to enjoy Hostile toward others Lying/Acting Deceptive

9 Behavioral Signs of Opioid Use Avoiding Eye Contact Lack of hygiene Withdrawal from family/friends All new friends Long sleeves/long pants Sunglasses when not needed

10 Indirect Signs of Opioid Use Missing pills in medicine cabinet Mileage on car Missing money or valuables Asking to borrow money often Syringes or needles (in drawers) Tiny orange caps from syringes

11 Indirect Signs of Opioid Use Spoons with burn marks Missing shoelaces Rubber straps or bands Straws Bottle caps

12 Indirect Signs of Opioid Use Rolled up dollar bills Razor blades, IDs, Credit Cards Empty capsules Q tips

13 Signs of Withdrawal Severe muscle aches Diarrhea Nausea/Vomiting Extreme Sweating Intense Cravings Fever Insomnia Chills

14 What works with Opioid Use Disorder?

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17 Meeting Opioid Users Where They Are

18 How We Engage Opioid Users Nonjudgmental and Collaborative Gently persuasive More supportive than argumentative Listen rather than tell Communicate respect for clients and their feelings

19 How We Engage Opioid Users Explore perceptions without labeling or correcting Resistance is met with reflection Change arises from within, than imposed from without Use discrepancies to enhance motivation Elicit change strategies from the client.

20 Substance Use Treatment for Opioid Use Disorder Contingency Management Encouraging positive behavior by providing positive reinforcement when patient progresses. Privileges, Prizes, Vouchers * Certificates, Gift Cards, etc.

21 Substance Use Treatment for Opioid Use Disorder 12 step approaches Aims to provide support, practical help, and care for group members. Helps to reinforce/maintain changes being worked on in treatment. Not enough evidence to support the effectiveness of 12 step programs as stand alone interventions. Supportive of MAT? (Hazelden, 2013).

22 Substance Use Treatment for Opioid Use Disorder - Evidence supports best approach pairing counseling with Medication Assisted Treatment (MAT) - Outcomes for counseling without MAT aren t encouraging.

23 Substance Use Treatment for Opioid Use Disorder Cognitive Behavior Therapy Focus on skills building. Managing negative moods. Preparing for emergencies. Coping with cravings and relapses

24 What is the Community Reinforcement Approach (CRA/A-CRA) An evidence-based series of cognitive-behavioral interventions developed by Robert Myers, Ph.D. and Jane Ellen Smith, Ph.D. The Therapist s Role in CRA/A-CRA Focus on the positives Teach and practice new skills Help the client find ways to make abstinence more rewarding than using Help the client discover motivation for change and see how use is interfering with important areas of life

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36 Medication Assisted Treatment (MAT)? MAT is the use of pharmacological medications, in combination with counseling and behavioral therapies, to provide a whole patient' approach to the treatment of substance use disorders.

37 Goals of MAT Abstinence (or reduction) of compulsive nonmedical opioid use and alcohol use. Treat or prevent withdrawal symptoms Reduce urges/cravings Minimize relapse time and intensity Increase retention in treatment Decrease deaths due to overdose Treat comorbid disorders

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41 What else? Behind the Walls - Aims to provide MAT and other treatment services while individuals are still incarcerated. - One study in Massachusetts > 82% stayed out of jail. Madison County Jail - Medical and Clinical Screening Assessments - Referral to treatment Medicaid Help - Post- Release Planning Recovery Coaching - Vivitrol education/dosing Overdose/Naloxone Education

42 What else? Outreach/Linkage Program - Aims to locate individuals in our community that are struggling with opioid use disorder and get them in to MAT/Treatment as rapidly as possible. (wherever that may be) - Screened over 100 individuals in the last 90 days. - Bethany Place, Law Enforcement, Seed Cards

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44 What else? Enhanced Treatment for Women that are Pregnant/Postpartum with Opioid Use Disorder - New 5 year SAMHSA grant in collaboration with Queen of Peace and Wish Clinic in St. Louis. - Clients will receive residential treatment at Queen of Peace and MAT at the Wish Clinic. - Wrap around services at Chestnut (Parenting Education, Doula Services)

45 Other thoughts For each client we assess: - Have we educated everyone about the continued risks of opioid use/misuse? - Have we educated individuals about Naloxone/locations where they can receive it? - Have we educated each client about MAT available?

46 Behavioral Health Services Adult Substance Abuse Treatment Belleville Outpatient, intensive outpatient, assessment and screening Bloomington Medically monitored detox, crisis residential (short-term), outpatient, intensive outpatient, gender specific residential, assessment and screening, recovery support services (32 beds) Granite City Medically monitored detox, medication assisted treatment, crisis residential (short-term), outpatient and intensive outpatient, assessment and screening, recovery support services Calendar Year 2016 # of Patients Central Region Granite City Total * Adult CD 1,972 1,609 3,581 CSU Detox

47 Chestnut: Adult Residential Treatment Bloomington, IL

48 Behavioral Health Services Adolescent Substance Abuse Treatment Providing services to adolescents since 1985 Bloomington Outpatient, intensive outpatient, assessment and screening Joliet Outpatient, assessment and screening Maryville Outpatient, intensive outpatient, youth recovery home for young men (ages 15-20), gender specific residential, assessment and screening (43 beds) Calendar Year 2016 # of Patients Central Region Southern Region Total * Adolescent CD ,238

49 Chestnut Youth Residential & Recovery Home Maryville, IL

50 Chestnut: Youth Residential & Recovery Home Maryville, IL

51 Chestnut Youth Residential & Recovery Home Maryville, IL

52 Chestnut Youth Residential & Recovery Home Maryville, IL

53 Chestnut Youth Residential & Recovery Home Maryville, IL