Treatment Team Approaches in Substance Abuse Treatment

PLANT A SEED AND WATCH IT GROW 2

Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria: 1. Taking the substance in larger amounts or for longer than the you meant to 2.Wanting to cut down or stop using the substance but not managing to 3. Spending a lot of time getting, using, or recovering from use of the substance 4.Cravings and urges to use the substance 5.Not managing to do what you should at work, home or school, because of substance use 6.Continuing to use, even when it causes problems in relationships 7. Giving up important social, occupational or recreational activities because of substance use 8.Using substances again and again, even when it puts the you in danger 9.Continuing to use, even when the you know you have a physical or psychological problem that could have been caused or made worse by the substance 10.Needing more of the substance to get the effect you want (tolerance) 11.Development of withdrawal symptoms, which can be relieved by taking more of the substance. (Hartney, 2016) 3

Substance Abuse 4

Substance Abuse 5

Past Year Substance Use Disorder (SUD) and Mental Illness among Adults Aged 18 or Older: 2015 (SAMHSA, 2015) 6

Receipt of Mental Health Care and Specialty Substance Use Treatment in the Past Year among Adults Aged 18 or Older Who Had Past Year Mental Illness and Substance Use Disorders: Percentages, 2015 (SAMHSA, 2015) 7

Need for Substance Use Treatment in the Past Year among Adults Aged 18 or Older, by Substance (in Millions): 2015 (SAMHSA, 2015) 8

Received Substance Use Treatment at a Specialty Facility in the Past Year among Adults Aged 18 or Older Who Needed Substance Use Treatment in the Past Year, by Age Group: 2015 (SAMHSA, 2015) 9

Perceived Need for Substance Use Treatment among Adults Aged 18 or Older Who Needed Substance Use Treatment but Did Not Receive Substance Use Treatment in the Past Year: 2015 (SAMHSA, 2015) 10

Reasons for Not Receiving Substance Use Treatment in the Past Year among Adults Aged 18 or Older Who Felt They Needed Treatment in the Past Year: Percentages, 2015 (SAMHSA, 2015) 11

Costs of Substance Abuse: more than $700 billion annually in costs related to crime, lost work productivity and health care Health Care Overall Tobacco $130 billion $295 billion Alcohol $25 billion $224 billion Illicit Drugs $11 billion $193 billion (NIH, 2015) 12

Treatment Team and Their Roles 13

Treatment Team Specialist and Roles Medical Providers (Psychiatrists, APRNs, PAs) specializing in addiction treatment Psychologists specializing in addiction treatment Registered nurses specializing in drug abuse treatment Licensed alcohol and drug abuse counselors Licensed clinical social workers focusing on addiction Occupational therapists or physical therapists (as needed) Dietitians or nutritionists (as needed) Faith leaders (as needed) Peer Support Specialist 14

Treatment Team Approaches PRINCIPLES AND PRATICES OF EFFECTIVE SUBSTANCE ABUSE TREATMENT 15

Principles of Effective Treatment Based on scientific research since the mid-1970s, the following key principles should form the basis of any effective treatment program: Addiction is a complex but treatable disease that affects brain function and behavior. No single treatment is right for everyone. People need to have quick access to treatment. Effective treatment addresses all of the patient s needs, not just his or her drug use. Staying in treatment long enough is critical. Counseling and other behavioral therapies are the most commonly used forms of treatment. Medications are often an important part of treatment, especially when combined with behavioral therapies. Treatment plans must be reviewed often and modified to fit the patient s changing needs. Treatment should address other possible mental disorders. Medically assisted detoxification is only the first stage of treatment. Treatment doesn't need to be voluntary to be effective. Drug use during treatment must be monitored continuously. Treatment programs should test patients for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as teach them about steps they can take to reduce their risk of these illnesses. (NIH, 2016) 16

(NIH, 2016) 18

TREATMENT PROGRAMS Inpatient Detoxification Inpatient Residential Treatment Intensive Outpatient Treatment Partial Hospital Programs 12 Step Fellowship Outpatient Individual and Group Counseling (SAMHSA, 2016) 19

Treatment Modalities http://adai.uw.edu/ebp/matrix.pdf 20

RELAPSE PREVENTION Recovery Process Abstaining from alcohol and other drugs Separating from people, places, and things that promote the use of alcohol or drugs, and establishing a social network that supports recovery Stopping self-defeating behaviors that prevent awareness of painful feelings and irrational thoughts Learning how to manage feelings and emotions responsibly without resorting to compulsive behavior or the use of alcohol or drugs Learning to change addictive thinking patterns that create painful feelings and selfdefeating behaviors Identifying and changing the mistaken core beliefs about oneself, others, and the world that promote irrational thinking. Relapse Process Have a mistaken belief that causes irrational thoughts Begin to return to addictive thinking patterns that cause painful feelings Engage in compulsive, selfdefeating behaviors as a way to avoid the feelings Seek out situations involving people who use alcohol and drugs Find themselves in more pain, thinking less rationally, and behaving less responsibly Find themselves in a situation in which drug or alcohol use seems like a logical escape from their pain, and they use alcohol or drugs. (SAMSHA, 1996) 21

Medications to help re-establish normal brain function and decrease cravings in Relapse Prevention. Opioids: Methadone (Dolophine, Methadose ), buprenorphine (Suboxone, Subutex, Probuphine ), and naltrexone (Vivitrol ) are used to treat opioid addiction. Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone blocks the effects of opioids at their receptor sites in the brain and should be used only in patients who have already been detoxified. All medications help patients reduce drug seeking and related criminal behavior. (NIH, 2016) 22

Alcohol: Three medications have been FDA-approved for treating alcohol addiction and a fourth, topiramate, has shown promise in clinical trials (large-scale studies with people). The three approved medications are as follows: Naltrexone blocks opioid receptors that are involved in the rewarding effects of drinking and in the craving for alcohol. It reduces relapse to heavy drinking and is highly effective in some patients. Genetic differences may affect how well the drug works in certain patients. Acamprosate (Campral ) may reduce symptoms of long-lasting withdrawal, such as insomnia, anxiety, restlessness, and dysphoria (generally feeling unwell or unhappy). It may be more effective in patients with severe addiction. Disulfiram (Antabuse ) interferes with the breakdown of alcohol. Acetaldehyde builds up in the body, leading to unpleasant reactions that include flushing (warmth and redness in the face), nausea, and irregular heartbeat if the patient drinks alcohol. Compliance (taking the drug as prescribe. Tobacco: Nicotine replacement therapies have several forms, including the patch, spray, gum, and lozenges. These products are available over the counter. The U.S. Food and Drug Administration (FDA) has approved two prescription medications for nicotine addiction: bupropion (Zyban ) and varenicline (Chantix ). They work differently in the brain, but both help prevent relapse in people trying to quit. The medications are more effective when combined with behavioral treatments, such as group and individual therapy as well as telephone quitlines.d) can be a problem, but it may help patients who are highly motivated to quit drinking. (NIH, 2016) 23

Resources for Treatment Team Members National Agencies: 1. National Institute on Alcohol Abuse and Alcoholism (NIAAA) 2. National Institute on Drug Abuse (NIDA) 3. National Institute of Mental Health (NIMH) 4. Center for Substance Abuse Treatment (CSAT) 24

REFERENCES ADAI, U. o. (2013). Evidence-Based Practices for Treating Substance Use Disorders: Matrix of Interventions. Retrieved from University of Washington Alcohol and Drug Abuse Institute: http://adai.uw.edu/ebp/matrix.pdf Hartney, E. (2016, April 15). DSM 5 Criteria for Substance Use Disorders. Retrieved from Very Well: https://www.verywell.com/cannabis-use-disorder-22295 NIH. (2016, July). Treatment Approaches for Drug Addiction. Retrieved from National Institute on Drug Abuse: https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drugaddiction NIH, N. I. (2015, August). Trends & Statistics. Retrieved from National Institute of Drug Abuse: https://www.drugabuse.gov/related-topics/trends-statistics SAMHSA, S. A. (1996). Counselor's Manual for Relapse Prevention With Chemically Dependent Criminal Offenders. Retrieved from http://lib.adai.washington.edu/clearinghouse/downloads/tap- 19-Counselors-Manual-for-Relapse-Prevention-with-Chemically-Dependent-Criminal-Offenders- 109.pdf SAMHSA, S. A. (2016, September). Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health. Retrieved from Reports and Detailed Tables From the 2015 National Survey on Drug Use and Health (NSDUH) : https://www.samhsa.gov/data/sites/default/files/nsduh-ffr1-2015/nsduh-ffr1-2015/nsduh- FFR1-2015.htm 25