Dancing with the Addict

Transcription

1 Substance Use Disorders in the Clinic: How to talk to the Addict and keep the relationship Dancing with the Addict Oyen Hoffman, LMFT, LAC, MAC

2 Objectives: By the end of this short talk you will understand how to identify, assess, monitor, and especially how to talk to a patient with a Substance Use Disorder (SUD) You will be able to follow this illness in all phases of its pathology You will know what to say and when to say it You will know when to refer to higher level of SUD care You will leave with a cheat sheet to use in your office and exam rooms You will have exposure to evidenced based measures and protocols

3 Some Basic Statistics 38 Million adults drink too much 88,000 alcohol related deaths per year Another 64,000 drug related deaths per year $244 Billion in costs Only 1 in 6 patient have discussed their drinking with their PCP Even less about their drug use Center for Disease Control, 2014

4 First Line assessment for Drug/EtOH Use NIDA 1 question measure Can also include Cannabis in your questions Cannabis is our new normal

5 AUDIT-C

6 First line interventions for EtOH AUDIT-C Full Audit

7 DAST-10

8 Possible Social Indicators Locked up recently DUIs Relationship issues (family, SO, professional, DV) Recent loss or death Recent employment problems (e.g. another job loss) Accidents and Injuries Secondary reports Patient seen around town don t underestimate the word on them streets What are you doing to take the edge off all your stress? What are you doing to cope?

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10 Brief Education & Intervention Substance Use Disorders are real and very much a medical issue, I think we should monitor this When you, or others who know you, have a concern about your substance use, there could be a real problem It s not about how much you use/take/drink, it s what happens when you do If you find it hard to stop once you have started you could have an issue You don t have to keep living this way; you can decide to deal with this

11 Brief Interventions Raise the Subject Let s talk a little bit about your alcohol / drug use. (Don t ask) Tell me about your drinking / drug use. What does a typical day drinking or using look like? How does your use get in the way of your overall life goals? Provide Feedback I recommend that all my patients drink less than or even abstain from alcohol and drugs altogether Most people who drink or use at high levels (males 4 daily & females 3 daily) have trouble cutting back and repeatedly experience negative consequences. This is why I recommend that people cut down

12 Valuable questions to KEEP asking your patients with SUD Enhance Motivation What do you like about your drinking / drug use? What do you not like about it? What are your concerns? Has anyone else expressed concern about your use? On a scale of 0 to 10, how ready are you to cut back or receive help for this? Why that number and not (lower number)?

13 Negotiate a Plan Summarize the conversation (if patient is ready to change): What steps can you take to reach your goal? Can we schedule a future appointment to see how it s going? Usually there are people, places, or things that can get in the way; what are some of yours? I d like to refer you to behavioral health or to specialized care if you have trouble abstaining or reaching your goals Would you like to discuss medications for help with this? e.g. Naltrexone, buprenorphine, etc

14 Follow-up, Reassess, and persevere Patients with SUD are necessarily dishonest, manipulative, evasive, and very challenging to treat Their illness requires these unfortunate behaviors in order to stay alive and well This illness has just a few goals Isolate the host body (the addict) Destroy the healthy relationships (because they get in the way) Kill the addict Move on to another host

15 Evidence Base: Clinical & Financial Talking about Substance Use in the clinical setting works! Can reduce drinking by 25% in people who drink too much Improves health outcomes Reduction in risky behaviors associated with drinking (e.g., unprotected sex, injection drug use) (Centers for Disease Control, 2014) Decreased medical use and system costs Healthcare cost savings can range from $3.81 to $5.60 for each $1.00 spent (Fleming et al., 2000)

16 Review Don t ever give up, especially on your SUD patients! Continue to reassess and reevaluate their SUD illness Use the exam room interventions Refer the experts who can treat and/or make appropriate referral Congratulate any progress (no matter how small) make it a BIG deal When someone can do this (get, or try to get, clean and sober) they can do anything!

17 Discussion, Questions, Feedback This would be the time for us to actually TALK Colin Joshua Beth