AODA RECOVERY. How to support those in recovery, and those not yet ready to commit

Transcription

1 AODA RECOVERY How to support those in recovery, and those not yet ready to commit

2 YOUR PRESENTER TODAY Robin Lickel is a psychotherapist and addictions specialist at Journey Mental Health Center in Madison, WI. Robin has worked at the Salvation Army of Dane County s Single Women s Shelter for 9 years. Robin specializes in opiate dependence, medication assisted treatment and co-occurring mental health and substance use disorders. Robin.lickel@journeymhc.org

3 OBJECTIVES Discuss current issues and shifts in thinking about AODA, treating it, and supporting a recovery lifestyle. Develop a resource toolbox to have at the ready to respond to clients with substance abuse issues, or identify as being in recovery.

4 WHAT S NEW CLINICALLY? DSM-V diagnosis Substance Use Disorder on a continuum. Mild, moderate, severe Brain imaging understanding that addiction is a brain disorder. Adaptations to the brain that result in uncontrollable behavior can be seen. Dopamine system is significantly affected Post-Acute Withdrawal Syndrome symptoms can last up to 1.5 years. Anti-depressants can be helpful to help balance brain chemistry.

5 Functional MRI: The brain s response to cocaine cues:arrows point to the anterior cingulate area, which is activated (yellow) in cocaine-addicted patients (left) but not in healthy volunteers (right) (Wexler et al., 2001).

6 AMBIVALENCE Levels of motivation for behavior change will wax and wane. Stopping use of a chemical that reliably met a need (like nothing else) is difficult to do until the negative consequences become unbearable. The scale that weighs reasons to use and reasons to quit tends to move back and forth. Even in recovery, it is normal to have urges to use. It is normal to have ambivalence about permanent abstinence, because there are pros and cons to both a using lifestyle and a recovery lifestyle. Recovery is hard! Understanding ambivalence and rolling with resistance are helpful tools to maintain a trusting relationship with a client who is struggling with substance use. (These are principles of Motivational Interviewing)

7 UNDERSTANDING WITHDRAWAL Absence of a chemical of which the body has adapted to accommodate large quantities. Symptoms are typically the opposite of the effect. Alcohol early withdrawal tremor, sweaty, anxiety. Seizures, DTs this is a lifethreatening medical emergency. Opiates early withdrawal anxiety, sneezy, goosebumps, watery eyes, sweaty. Develops into diarrhea, vomiting, involuntary muscle movement ( kicking it ). Opiate withdrawal is not life threatening, but a person often would rather be dead due to the discomfort. Withdrawal becomes feared. Marijuana psychological withdrawal symptoms irritability, poor sleep, high anxiety. Emotional discomfort.

8 STAGES OF CHANGE Pre-contemplation Don t talk to me about this problem, because there is no problem. Contemplation Well, maybe it s starting to cause problems for me Preparation I feel like I want to try. I m going to do a few things to get myself ready. Early Action Look at me! I m doing it! It s precarious, but I m doing it! Sustained Action This is getting much more comfortable. I m getting skillful! Episode of use/relapse Oh no! I ve used! Do I get back on track or keep going down the slippery slope?

9 HOW CAN YOU BE HELPFUL? Be ready with resources. When someone expresses interest in getting help, give them information better yet, help facilitate referral. Don t wait until the next appointment. The window of motivation can be short. Know and have all the info needed about: Treatment programs available Community based meetings in the area Options for obtaining medication assisted treatment Recovery coaches/peer Supports Online resources Consider harm reduction approaches

10 MEDICATION ASSISTED TREATMENT Medication can be used to as a tool to support recovery. Specific medications have been developed to support abstinence from alcohol use. Disulfram (Antabuse) daily administration. Causes illness when alcohol is taken. Advantages (can help be motivator), and disadvantages (must be taken to be effective, hard on the liver) Naltrexone (ReVia and Vivitrol) works as a blockade at receptor site Advantages (not much payoff for use, episode of use is reduced, Vivitrol is a monthly shot) and disadvatages (also hard on the liver, Vivitrol is about $1000/month) Acamprosate Sodium (Campral) reduces the desire to drink Advantages (safe for liver, helpful for people with some periods of abstinence) and disadvantages (must take 3 times per day, must have some abstinence)

11 MEDICATION ASSISTED TREATMENT Some medications have been found to be helpful in supporting alcohol recovery, and are prescribed off-label. Gabapentin (Neurontin) anti-convulsant. Helps manage anxiety, helps with sleep, seems to take the edge off of cravings. Topamax (Topiramate) anti-convulsant. Has been shown to reduce cravings and over time, led to reduced alcohol use to the point of eventual eliminating. Medications for opiate dependence Methadone Has been used for 50 years to treate opiate dependence. Full opiate agonist fills receptor site: no withdrawal, no physiological cravings, no high. Advantages very effective at reducing and eliminating opiate use. Stops the chase. Gold standard for women who become pregnant and are opiate dependant. Disadvantages must be dispensed at licensed methadone clinic. Requires an investment in time and recovery to be most successful.

12 MEDICATION ASSISTED TREATMENT Buprenorphine (Suboxone) partial opiate agonist, sublingual strips Better safety profile than methadone, doctors (with some training) can prescribe it from their offices. Can get 30 day prescription. More street diversion than expected. Still need about 2 years for maximum benefit. Naltrexone (Vivitrol shot) opioid blockade. can be helpful after a methadone/suboxone taper to maintain recovery. Studies underway to determine efficacy for people being released from a jail stay.

13 A WORD ABOUT NARCAN Naloxone (Narcan) injectable opioid antagonist. Used to reverse an overdose. Currently primarily in ERs, also some needle exchange programs offer pre-loaded Narcan syringes. Narcan saves lives. Wisconsin legislation awaiting governor s signature would eliminate criminal charges for use of Narcan on an overdosing person, including first responders. (Currently it is obtained by prescription). Wisconsin legislation on the governor s desk also provides some immunity from possession charges if someone calls 911 to report an overdose.

14 MULTIPLE PATHWAYS TO RECOVERY For many years, the sole recovery model was the 12 Steps. Today there are many different models with different features. SMART Recovery CBT approach to recovery, focuses on motivation, relapse prevention skills. ( Online meetings Women for Sobriety I have a life-threatening problem that once had me. Women-focused support. Avoids concepts of powerlessness, emphasizes mutual support of other women. My name is Robin and I m a competent woman Steps for Discovery and Empowerment Women-focused support model based on 16 steps. ( Stresses empowerment through healing of mind, body, spirit

15 MULTIPLE PATHWAYS TO RECOVERY Secular Organization for Sobriety Formed as a secular alternative, shifting emphasis from powerlessness to empowerment. LifeRing Secular alternative. Organized to support individual recovery pathways through mutual support. 12 Step AA, NA, CA, Tobacco Anonymous, Gambler s, Overeater s Follows 12-step model. Sponsorship. Service work. Fellowship.

16 THANK YOU FOR JOINING ME! Please let me know if you have any questions. Enjoy the first day of spring (it s really here)!