Substance Use Disorders

1. Substance Use Disorders Identifying and Referring to Treatment Community Health Institute/JSI RekhaSreedhara, MPH

2. Objectives 1. Understand how to universally ask if a patient needs support related to alcohol and/or drugs 2. Identify appropriate terms to destigmatize addiction 3. Become familiar with the different levels of care and recognize the importance of encouraging patients to obtain an evaluation/assessment 4. Understand how to navigate the NH Alcohol and Drug Treatment Locator as one resource to identify treatment and recovery support services

3. What Do We Know? • Drug (opioid)-related emergency room visits, emergency medical service calls for drug overdose, and drug-related deaths have dramatically increased1.

4. What Do We Know?

5. What Do We Know? • State prevalence rates for substance misuse indicators among 18 to 25 year old young adults have been and remain some of the highest in the country based on data reported by the National Survey on Drug Use and Health (NSDUH).

6. What is Addiction? • Addiction to alcohol and/or drugs is a complex biopsychosocial disease that is chronic in nature and is often characterized by periods of relapse and recovery • Addiction does not have a face. This chronic disease can affect ANYONE at ANYTIME – socioeconomic status, race, gender, age, etc. • There are risk factors which can predispose a person to an alcohol and/or drug problem: • Family history of addiction; • Abuse, neglect, or other traumatic experiences in childhood; • Mental disorders such as depression and anxiety; • Early use of drugs; and • Substance used and method of administration—smoking or injecting a drug may increase its addictive potential. 

7. How can you ask if a person needs help related to alcohol and/or drugs?How can you provide support and refer to treatment?

8. 1. Universalize Identification of an Alcohol/Drug Problem Ask the same question of everyone 2. Destigmatize Addiction Use accurate and sensitive language 3. Refer to Treatment Recommend next steps and help access services as needed

9. Universalize Identification of an Alcohol/Drug Problem “Given the current opioid (heroin, fentanyl, prescription pain relievers, and other drugs) problem in our state, do you or someone you know have a problem with alcohol and/or drugs in which you would like help with? I am asking this question of all of my clients in an effort to be available to provide support and information as may be needed.” Ask the Same Question of EVERYONE

10. Destigmatize Addiction Use Accurate & Sensitive Language

11. Destigmatize Addiction • Substance misuse – improper and harmful use of substances (alcohol and/or drugs) for non-medical purposes where a person is not physically and/or psychologically dependent on the substance used but can affect the person’s ability to follow through with responsibilities (e.g. work, school), cause relationship problems, involvement with criminal issues, etc. • Substance use disorder - repetitive use of substances (alcohol and/or drugs) where a person physically and/or psychologically depends on the substance used which affects the person’s health, ability to follow through with responsibilities (e.g. work, school), cause relationship problems, involvement with criminal issues, etc. • OPIOIDS -refers to entire family of opiates including natural and synthetic (man-made); morphine, hydrocodone, oxycodone, methadone, heroin, fentanyl • OPIATES - refers to drugs derived from opium (not man-made); heroin, morphine, OxyContin, codeine

12. Refer to Treatment • Active Referral and Warm Handoff • understand patient-specific needs including barriers such as transportation, insurance and childcare • identify appropriate treatment services based on these needs • coordinate access to the services needed • Follow Up Recommend Next Steps & Access Treatment

13. Considerations • Insurance coverage • Language/cultural competence • Location/transportation: Can the patient and their family easily access the treatment facility? • Family support • Treatment history: How many past treatment episodes? Which levels of care were received?

14. Levels of Care • Withdrawal Management (Detoxification) – Service aimed at managing acute substance dependence as defined by the presence of intoxication and withdrawal. This service helps stabilize and prepare an individual with a substance use disorder to enter treatment and may be delivered within an inpatient or outpatient setting. • Outpatient Counseling • Individual Outpatient Counseling – Service provided by a clinician to assist an individual to achieve treatment objectives through the exploration of substance use disorders and their effects, including an examination of attitudes and feelings, and considering alternative solutions and decision making with regard to alcohol and other drug related problems. • Group Outpatient Counseling – Service provided by a clinician to assist two or more individuals and/or their families/significant others to achieve treatment objectives through the exploration of substance use disorders and their effects, including an examination of attitudes and feelings, and considering alternative solutions and decision-making with regard to alcohol and other drug related problems. • Intensive Outpatient Programs – Structured individual and group alcohol and/or drug treatment services and activities that are provided at least 3 hours a day and at least 3 days a week according to an individualized treatment plan.

15. Levels of Care • Partial Hospitalization – Combination of 20 or more hours per week of group and individual sessions in conjunction with, either directly or through referral, medical and psychiatric services, psychopharmacological services, addiction medication management, recovery support services and 24-hour crisis services. • Residential Services – Program providing 24-hour support and services where an individual lives full-time at the program and receives individual and/or group counseling, educational sessions and introduction to self-help groups. • Recovery Support Services – Services provided to individuals and/or their families to help stabilize and support recovery. Services may include employment services, anger management, recovery mentoring/relapse prevention management, peer recovery coaching, care coordination, childcare, transportation, sober housing, and other supports. • Medication Assisted Treatment – Treatment that includes medication prescription, supervision, and management paired with counseling or other treatment services. Common medications include buprenorphine (Suboxone), Methadone, Naltrexone, Acamprosate, and Disulfiram.

16. How do you know which level of care is the most appropriate?

17. EVALUATION/ASSESSMENT An assessment involves the careful evaluation of biopsychosocial factors of an individual which is conducted by a professional (usually a Licensed Alcohol and Drug Counselor (LADC) / Master’s Alcohol and Drug Counselor (MLADC)).

18. Evaluation Resources • Refer to the evaluation filter on the NH Alcohol and Drug Treatment Locator to access a list of providers who conduct evaluations. • Any outpatient treatment program • Private LADCs/MLADCs • Southeastern NH Services, Dover • Serenity Place, Manchester

19. Identify if the person has been assessed/evaluated to determine the level of care that is most appropriate If an assessment has been conducted…. If an assessment has not been conducted… Help patient connect with appropriate level of care. Help patient connect with an outpatient counseling program to help assess what type of care would be most appropriate for them. Outpatient Counseling Intensive Outpatient Counseling Partial Hospitalization Residential Recovery Support Services Medication Assisted Treatment Use the NH Alcohol and Drug Treatment Locator, www.nhtreatment.org as a resource to identify appropriate services based on needs.

20. www.nhtreatment.org

21. How to use Nhtreatment.org? • Type your address or zip code in the Address field. You may also indicate a range within 10 to 250 miles. • Filter by clicking on the Service Types, Populations/Specialties Served, and/or Payerradio buttons. • Click on the points on the map within the location of interest to obtain provider contact information. • Scroll down the page for a full list of providers specific to the service type(s) selected.

22. Follow-Up: Monitor Treatment Progress • Participation in treatment • Knowledge gained about substance use disorders • Participation in support systems • Compliance with plan • Interpersonal relationships • Abstinence from substances

23. What if treatment is not readily available? • Encourage participation in 12 step meetings (provide a list of local meetings) • Encourage participation in other recovery support programs and recovery centers • Hope for NH Recovery, Manchester • Keene Serenity Center, Keene • Connect patient with a recovery coach • Hope for NH Recovery, Manchester • Establish frequent phone/in-person check-ins • Suggest group and/or individual counseling

24. Resources • NH Alcohol & Drug Treatment Locator, www.nhtreatment.org, Resources Page • National Center on Substance Abuse and Child Welfare, https://www.ncsacw.samhsa.gov/training/toolkit/Default.aspx?id=home, Child Welfare Training Toolkit

25. Questions?

26. Thank You! Rekha Sreedhara rsreedhara@jsi.com

27. References 1 NH Information and Analysis Center, Drug Monitoring Initiative Report, December 2015 2 Behavioral Health Barometer, New Hampshire, 2014, retrieved from http://www.samhsa.gov/data/sites/default/files/State_BHBarometers4_2/BHBarometer-NH.pdf