Substance Abuse Issues

1. Substance Abuse Issues A training for Human Service Providers {Enter Date Here}

2. Ground Rules for the Day • Start and Stop on Time • Maintain Confidentiality • Participate fully and encourage participation of others • Respect others’ viewpoints, opinions and needs • OK to voice concerns and questions • Make comments in a constructive manner • Silence cell phones

3. Welcome Substance use impacts many families Consider mental health, trauma, basic needs Safety among home-visitors Safety among families Actions that can and should be taken Building relationships Identifying help and helping

4. Presentation Goals Review local data on substance use prevalence Introduce issues related to substance use Reduce stigma associated with substance use Identify signs and symptoms of substance use Screen and referral/intervention tools Increase participant ability to match client needs with eligible services Identify Substance Use Disorder Treatment Services in our community

5. Substance use in {Greater Lansing} Data from Tri-County Metro Data from ISAP Coalition Alcohol is the most commonly used and abused drugs Getting more common: marihuana (medical), heroin Equally bad in all of our community

6. Alcohol is the Most Common Drug of Abuse Binge Drinking Defined Women: more than 3 drinks on any single day AND more than 7 drinks per week. Men: more than 4 drinks on any single day AND more than 14 drinks per week

7. Percentage of Adults Who Report Binge Drinking in the Past 30 Days

8. Students Who Report Binge Drinking in the Past Two Weeks

9. Percentage of Students Who Have Had At Least One Drink of Alcohol

10. Students Who Report Ever Smoking Cigarettes

11. Marijuana use continues to rise among U.S. teens, while alcohol use hit historic lows • Marijuana use among teens rose in 2011 for the fourth straight year—a sharp contrast to the considerable decline that had occurred in the preceding decade. Daily marijuana use is now at a 30-year peak level among high school seniors. • “Synthetic marijuana,” which until earlier this year was legally sold and goes by such names as “K2” and “spice,” was added to the study’s coverage in 2011; one in every nine high school seniors (11.4%) reported using that drug in the prior 12 months. • Alcohol use—and, importantly, Binge drinking—continued a long-term gradual decline among teens, reaching historically low levels in 2011. • Energy drinks are being consumed by about one third of teens, with use highest among younger teens.

12. Regional Illicit Drug Forfeitures 2011 Narcotic Seizure Value: $4,046,431 Tri-County Metro Narcotics (MSP) Heroin & Pills (opiates)  Marihuana (Marijuana) Methamphetamine Alcohol Tobacco

13. Prescription Drug Abuse Taking medicine that was not prescribed to you, or us being take for non-medical use • 60% from a friend or relative • 8% purchased from a friend or relative • 4% taken from a friend or relative • 17% physician prescribed

14. Addiction The use of substances as a means to cope with difficult experiences is common Use of substances can lead to addiction, in which the need for the alcohol or drugs is physical & becomes the most important thing in someone’s life People who are using have a harder time keeping themselves and their families safe

15. How is having an Addiction like having Cancer? Biologically pre-disposed Most likely addicted before adulthood Family history and normalization of use Trying to find a “normal” brain function (self-medication) Some brain responds stronger to drug use Power/Control Dynamics Victims are by-products of wealthy suppliers

16. Drug Use – Why? Mental Health Diagnosis (50% use drugs) Trauma (Seeking Safety) Family inter-generational use Genetic and Biological Factors Escape from the pain of reality Medical or Disease Model is Most Effective Use / Abuse /Dependence

17. Substance using behaviors • Sexual assault • Childhood or current • Physical assault • Domestic violence

18. Addiction Pathology Child of a substance abuser Child of an alcoholic becomes an alcoholic Substance abuses -Phases Recovery Relapse

19. Addiction in the Brain

20. Addiction in the Brain Neurotransmitters are chemicals in the brain that relay, intensify and alter signals between neurons and other cells. When someone takes an addictive drug, whether it be alcohol, cocaine, nicotine, heroin, or Valium, just to name a few, the brain gets flooded with a neurotransmitter called dopamine. This neurotransmitter is related to feelings of pleasure and excitement, and is associated with the reward center of the brain. In a normal brain, dopamine is released when the person experiences pleasure. However, chronic use of addictive substances means that the brain begins producing less dopamine on its own since it’s so used to getting flooded with dopamine as a result of the addiction. This leads to the abuser being unable to experience pleasure from his normal life, thus creating a dependency on the drug to feel pleasure.

21. Human Needs: Brain Tricks

22. The Illness Brings with it Frustrating Behavior Deceptive, lying, secretive Passive-Aggressive Characteristics, failure to follow-through with responsibilities Failure of priorities, chronic tardiness, money problems, lack of judgment, anxiety, depression Disregard for themselves or values of those they love, poor boundaries Legal implications

23. Blanket Activity Strengths/Assets Social Justice Balance/Independence Intimacy: closest Friendship: community Participation: clubs/groups Exchange: paid help

25. Marihuana:most common illegal drug Signs & Symptoms Animated behavior, sleepy, dilated pupils, bloodshot eyes, loss of coordination, odor, paranoia, fragmented thought. Usage Smoked in joints, pipes, bongs, or blunts. Can be mixed in food or brewed in tea. Change lasts 3-5 hours or until the next day. Slang Mary Jane, pot, reefer, skunk, weed, yerba, bluns, dope, ganja, grass, herb, hydro, kif, bud, boom, and 420.

26. Marihuana:Michigan Medical Marihuana • Federal Law trumps State Law • Caregiver and Patient Cards Issued by State of Michigan, Licensing And Regulatory Affairs • Caregivers may grow up to 72 plants in an enclosed, locked facility • Patient limit is 12 plants per Patient • Safety in homes is primary concern • Marihuana is active in the body for 7 hours • Impaired Driving is increasing

27. Marihuana

28. K2/Spice:alternative to marihuana Signs & Symptoms Rapid heart rate, high blood pressure, hallucinations, delusions, paranoia, changes in perceptions and behavior, seizure and death. Usage Leafy herbs with psychoactive chemicals sprayed on and then smoked. Chemical changes make some forms illegal, some legal. Slang Incense, potpourri, Spice, K2, K3, fake pot, Chemical Compound is JWH-018 and not THC.

29. Methamphetamine:One Pot Meth Labs urban/rural Signs & Symptoms Dilated pupils, euphoria, rapid speech, depression, violent, nasal congestion, insomnia, weight loss, dry mouth, lack of interest in food and sleep. Skin abscess, paranoia, volatile mood, movement disorders, lead poisoning, and meth-mouth. Usage Smoked, snorted, taken orally or injected. Ingestion produces euphoria for 12 or more hours. The One-Pot Meth Lab has increased use, and brought meth into cities. Pacifiers and glow lights supplement use at Raves. Slang Speed, chalk, crank, ice, glass, meth, shards, speed, stove top, tweak, yaba, yellow bam, glass, crystal, go-fast, ecstasy, rollin’, E, X.

30. Methamphetamine:Manufacturing Products • Signs & Symptoms Chemical smell in home and on person. Multiple chemicals - together in kitchen or garage used for cooking meth. • Combination of several household products may indicate Cooking Meth Batteries, camp fuel/gasoline, lye, drain cleaner, allergy medicine containing pseudoephedrine or ephedrine, plastic bottles, tubing, match heads

31. Prescription Drug Abuse:Pills not prescribed to you Signs & Symptoms Pinpoint pupils, nausea, drowsy, confused, relaxed, blood pressures high or low, heart rate and respiration high or low. Anxiety, euphoria, depression, irritable, shaky, trouble sleeping, coma. Tolerance Usage Pills can be swallowed, crushed, snorted & injected. Pain patches. Pharm Parties/Skittle Parties: mix stimulants, narcotics and depressants. Pain pills should not be combined with alcohol, antihistamines or benzodiazepines. Medication Suppliers Most Prescription Drugs come from your medicine cabinet. Properly dispose of all expired, un-used and un-wanted medications. Visit www.michigan.gov/deqreswastecontacts for local collection programs. ADD medications, pain pills and OTC pills are often combined with unknown outcomes.

32. Inhalants • Signs & Symptoms Drunk or disoriented appearance, paint or other stains on face, hands, or clothing, hidden empty spray paint or solvent containers, chemical soaked rags or clothing, slurred speech, strong chemical odors on breath or clothing, nausea or loss of appetite, red or runny nose, sores or rash around nose or mouth. Hidden empty containers. Nail polish, nail polish remover, perfume samples • Usage Sniffed or Inhaled. Local deaths have occurred with first time use. • Slang Huffing, bagging, buzz-bomb, laughing gas, poor man’s pot, poppers, rush, snappers, and whippets.

33. Mandatory Reporters Physicial Neglect E. If the allegations involve parental drug use: • How do you know the parents are using drugs? • What kind of drugs are they using? • Do the parents use drugs in front of the child? • Are the parents selling drugs out of the home? Are the parents allowing other people to use drugs in the home or to sell drugs out of the home? Mandated Reporters Resource Guide (http://www.michigan.gov/documents/dhs/Pub-112_179456_7.pdf) Medical Neglect Improper Supervision Abandonment Failure to Protect Abuse Physical/Sexual

34. Continuum of Services: Continuum of Need

35. Case Study #1 Father of baby (FoB) lives with Mother of Baby (MoB) in a rural community. FoB was previously shot in the leg, is disabled, and uses a wheel chair. He reports that he suffers from chronic pain, but refuses opiate painkillers. FoB has a medical marihuana card for his pain and grows his own marihuana. He does not provide caregiver services for others. The plants are kept in a locked closet and there is a water bong on top of the refrigerator. The home visitor has reported no smell of marihuana in the home at any time. MoB has recently delivered her baby. She entered prenatal care at six months, and had received home visiting services to assist with medical coverage, transportation to medical appointments, and tangible needs. MoB has a history of substance use (heroin), but is in recovery and reports that she does not use drugs.

36. Case Study #2 Mother of Baby (MoB) is four-months pregnant and has three other children in the home (ages 12, 8, and 6). She receives food assistance, and lives with her boyfriend. He is on SSI and pays the rest of the bills. MoB has participated in two previous home visits. Today, she enters the home visitors car with red glassy eyes and a light smell of marihuana. The home visitor asks if MoB is doing ok, since her eyes are red. MoB states that she was at Michigan Works all day looking at the computer screen.

37. Case Study #3 This same MoB is now requesting assistance in obtaining a birth certificate for one of her children. At the next visit, MoB gets in the car and says that she can’t live with her boyfriend because he drinks alcohol and takes Vicodin daily. MoB reports that the boyfriend is a mean drunk and is verbally abusive towards her. She reports that he steals her money to buy alcohol, even when it means that she can’t take the bus to go to Michigan Works. MoB states that she probably should not judge him since she has a medical marihuana card for carpal tunnel syndrome. MoB braids hair to make pocket money and uses marihuana to ease the pain that it causes. MoB reports that she only uses marihuana if she is going to braid hair, and does not use it when the kids are around. MoB states that she has not used marijuana during the four months of this pregnancy. She asks you for help finding other housing so she can leave her boyfriend.

38. Authentic Messages get Results: non-violent communication (NVC) Empathetically listening Observations Feelings Needs Requests Honestly Expressing Observations Feelings Needs Requests Both sides of the NVC Model: Empathetically listening and honestly expressing; use of the four steps of the model: Observations, Feelings, Needs, Requests

39. Small Changes can make a Big Difference Keeping Track Counting and Measuring Setting Goals Pacing and Spacing Avoid “Triggers” Planning to Handle Urges Knowing your “NO” Find Safe Support

40. Best Practices: Assess/ReferEvery Encounter Varied Resources Offered Genuine Concern and Care Authentic Relationship Motivational Interviewing Capitalize on the Moment Follow the Client’s Lead – it’s their life and their priority and readiness

41. Assessment and Interventions CAGE Assessment C Have you every tried to Cutback on your use? A Have you ever been Annoyed/Angered when questioned about your use? G Have you ever felt Guilt about your use? E Have you ever had a Eye-opener to get started in the morning?

42. Local Collaboration Power of We http://powerofwe.org/ ISAP Coalition www.drugfreeingham.org Ingham Great Start Collaborative www.inghamgreatstart.org Care Coordination Center www.ceicmhca.org (888) 230-7629 or (517) 346-8458

43. Continuum of local services: Home visitation • Capital Area Community Services • Early Head Start • Community Mental Health • Parent Infant Program (PIP) • Parent Young Child Program (PYC) • Ingham County Health Department • Family Outreach Services (FOS) • Public Health Nursing • Ingham Intermediate School District • Early On ® • Great Parents-Great Start

44. Continuum of local services: Recovery meetings • Central Alcoholics Anonymous • http://www.aalansingmi.org/ • Narcotics Anonymous • www.na.org • Smart Recovery • www.smartrecovery.org • Celebrate Recovery • www.celebraterecovery.com • Al-anon and Alateen (family/friend support) • www.al-anon.alateen.org

45. Continuum of local services: Treatment options Community Mental Health www.ceicmhca.org  Toll Free: 1.888.230.7629 Local Calls: (517) 346-8458 Hours: 8:30- 4:30 (M-F)

46. Care Coordination Center Responsibilities • Screening, Referral, Follow-Up • Warm Transfers • Utilization Review • Next Day Openings • Care Management • List of Care Coordination Center providers • Resource Consulting

47. Care Coordination CenterEligibility • Medicaid, Adult Benefit Waiver (ABW), or MiChild Requirements • Resident of one of the following Counties: • Clinton, Eaton, Gratiot, Hillsdale, Ingham, Ionia, Jackson, or Newaygo

48. Thank you! {Name Agency Email address}