Melanie Cotter, M.A., LPC, CCM Medical Liaison; Behavioral Health Case Manager, Subject Matter Expert (SME) SUD-Managed Care Organization MelanieCotterDallas@Gmail.com
Welcome to Texas!!! Grammar Lesson: Pronouns
DSM criteria for Opioid Use Disorder (SUD is) Misconceptions about SUD (SUD is not) Challenges of working CM with SUD members CM Interventions SBIRT Motivational Interview Referrals Support Groups Cognitive Behavioral Therapy
In the past the DSM split this into 2 categories 1)Substance Abuse 2)Substance Dependence All combined into one category: S.U.D.
10. Tolerance defined by either: a. Needing increased amounts to achieve high/intoxication (desired effect). b. Diminished Effect with use of same amount. **note-this is not considered to be met for those taking opioids under medical supervision. 11. Withdrawal as manifested by either: a. Characteristic Opioid withdrawal SX s b. b. Opioids or closely related substance taken to relieve or avoid withdrawal SX.
Specifiers you may notice In early remission = 3-12 months In sustained remission = 12 months + On maintenance therapy (on Rx for their recovery) In a controlled environment (if they are locked up)
Yay You know what SUD is!!! Now what SUD isn t: COMMON MISCONCEPTIONS.
It is not a moral failing and/or a bad set of choices. It is not the same as physical dependence and/or tolerance but these are symptoms. It is not something that must be long in term to be considered a disorder. (2 SX w/in last 12 mo) Addiction Medication/ Therapies are not substitutes for the drug of abuse.
It is not the result of, or the same as, Depression, Bi-Polar or other mental health disorders. SUD isn t the same but can co-exist with them & often does & exacerbates them. (Co-Occurring Disorders) The idea that someone can t be addicted because they have a job, family, health, wealth, intelligence, youth is not correct. The belief that law enforcement should intervene and that addiction is a criminal, not a medical matter. The #1 misconception: IT S NOT TREATABLE!
Overlook screening and referrals of patients with possible SUD. (Bias Error, rationalization) These misconceptions can cause providers to under/over treat chronic pain* (37% of the 44,000 drug overdoses in 2013 were due to Rx opioid medication). Lack of training in screening and referral leads medical providers to avoid it altogether. (Training Error- I don t know what to do?) *New England Journal of Medicine March 31, 2016 Opioid Abuse in Chronic Pain
Removing Barriers
Challenges in working with SUD Members Lack of motivation (family may be done as well and lacking in motivation) Denial & Rationalization Lack of understanding of Disease process Fears of judgement of admitting SUD (Fear of rejection, shame, getting rejected, fired, jailed) Inability to reach them on the phone. While using: unstable living environments, poor support system. Once in recovery they may change their number to avoid drug dealers, seek sober living situation.
Challenges in working with SUD Members Finances (they can t afford TX or basic needs) Information (they don t know how to get help) Negative perceptions of the treatment process ( It doesn t work won t work for me It s too religious It s not religious enough I m not crazy/weak/needy like those people ) Cultural & Socioeconomic differences Lack of social support (can t go to treatment because there s no one to take care of the kids) Legal/Other barriers (can t attend due to child support, probation payments, incarceration, loss of income, punitive workplace)
When you are working with a client you suspect has a SUD your tone is important. Make sure you engage in a conversation rather than an interrogation. The member will be less defensive if they feel comfortable. Use the Motivational Interview in these situations it is efficacy based!
Keep in mind Addicts TRULY think they are the only ones whose lives are affected by their use. This is part of the disease. Denial is the Hallmark of Addiction
1) HAVE A PRINTED LIST OF RESOURCES 2) EXPLAIN THE LEVELS OF RESOURCES PATIENTS DON T KNOW THE DIFFERENCE BETWEEN: Impatient * Residential Treatment * Partial Hospitalization * Intensive Outpatient * OP Therapy * Support Groups * Sober Living * Addiction Psychiatrist * Pain Management * PCP *A counselor/psychologist and a psychiatrist (many people don t know!!!)
Alcoholics Anonymous Narcotics Anonymous Celebrate Recovery Smart Recovery AA.org NA.org CelebrateRecovery.com SmartRecovery.org Dual Diagnosis: NAMI.org National Alliance for the Mentally Ill (NAMI)
Cognitive Behavioral Therapy Can change physical response brain has to stress (pain) by altering neurochemical messengers. Teaches stress reduction and offers SKILLS to change negative thought patterns. Puts the discomfort in a better context. Control studies show that it is as good as or better than other treatments
The successful CBT patient will: Have an open mind (believe it will work) Do CBT homework, be an active participant (you can even self study CBT) Practice the new skills Complete the learning process Like the therapist personally (studies show that connection is the best predictor of success) http://www.webmd.com/pain-management/features/cognitive-behavioral#3