Engaging Young People with Addiction in Treatment

Transcription

1 Engaging Young People with Addiction in Treatment James McKowen, Ph.D. Addiction Recovery Management Service (ARMS) Orlando, FL 2016

2 Disclosures Neither I nor my spouse/partner has a relevant financial relationship with a commercial interest to disclose.

3 Goals of Talk Scope of Problem in Youth Developmental Challenges in Youth Adapting Traditional Models of Care Addiction Recovery Management Service

4 Percentage of sample Substance Use By Age Severity Category Light Alcohol Use Only Any Infrequent Drug Use Regular AOD Use Abuse 10 Dependence Age NSDUH 2007;

5 Percentage of sample Substance Use By Age Severity Category Light Alcohol Use Only Any Infrequent Drug Use Regular AOD Use Abuse 10 Dependence Age NSDUH 2007;

6 Percentage of sample Substance Use By Age Severity Category Light Alcohol Use Only Any Infrequent Drug Use Regular AOD Use Abuse 10 Dependence Age NSDUH 2007;

7 Impact of Psychological Distress on Use NSDUH 2014;

8 Very few young adults engage in treatment 21% of youth need treatment for a substance use disorder (SAMHSA, 2009) 96% do not perceive the need to attend treatment (SAMHSA, 2009) Only 10% of youth with substance use disorders enter treatment (NSDUH, 2013) Only half finish treatment with mean length of time in treatment is 50 days (Dennis, 2005)

9 WHY ARE YOUTH SO AT RISK?

10 Cognitive Development WHY SO AT RISK?

11 Cognitive Development Social Influences WHY SO AT RISK?

12 Cognitive Development Social Influences WHY SO AT RISK? Access & Availability

13 Cognitive Development Social Influences WHY SO AT RISK? Family Factors Access & Availability

14 Traditional Treatment Models of Care Age 18 Traditional Treatment Pediatric Adult Age 15 to 25 New Approach Pediatric Transitional Age Youth (TAY) Adult 14

15 Why Rethink Traditional Treatment Models of Care? Youth with addiction differ from adults: Less physical & psychological dependence than older adults Fewer negative consequences & severity More likely to relapse due to social factors More dependent on family More likely to drop out of care

16 Different Use Profiles

17 Support Effective Individuation Understand Contextual Factors Newer Models of Care For TAY Understand Emerging Executive Control Novel Engagement Opportunities Different Reinforcement of Use and Change

18 Newer Models of Care: ARMS Recovery Management Philosophy Established in 2007 Focuses on year olds and their parents Patient centered care: motivational model Evidence-based psychosocial treatments Medication Management

19 Treatment at ARMS: Flow of patient engagement Parent Engagement Initial Youth Engagement: - Call/text - Meet & Greet Evaluation Not ready for sobriety Ready for Sobriety - Readiness Group - Motivational Therapy - Medication -Intensive Outpatient Program - Therapy - Medication Long-term Recovery Group

20 Engaging Youth at ARMS Referral Rapidly engage capitalize on motivational window Risk Adjusted Intake Process Meet and greet option Modify intake length/content Treatment Evidence-base youth treatments ACRA/ACC Contingency Management Family Engagement - CRAFT Match treatment to readiness Support functional goals not just substance outcome Consider Shorter Sessions and Adapt Frequency

21 Programmatic Adaptations Supporting TAY Clinician Adaptations Educate staff on unique aspects to TAY Accept waxing/waning readiness Individuation issues experiential learning Risk Rounds Consider overall reduced caseload Other Considerations Transparent consent for communication Care Coordination: school, college, court Peer facilitators link to mutual help Recognize markers of goal attainment Voic is dead! Provide snacks!

22 Further ARMS Goals with TAY Data collection on TAY Predictors of Engagement & Retention Community Linkage to Recovery Supports Recovery Coaches Technology Social media Location of engagement

23 Take Homes Early intervention reduces morbidity and mortality Traditional models of care are inadequate Different risk factors, neurodevelopmental issues, substance use profiles, and motivators of change Novel strategies are needed to foster engagement and retention

24 Thank You Contact: James McKowen, Ph.D.