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Suppose We Try Something New in Addiction?

Suppose We Try Something New in Addiction?. Different Perspectives and Research Implications. Build National System of “Prevention Prepared Communities” Train primary care to intervene early with emerging abuse Integrate addiction treatment into mainstream healthcare

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Suppose We Try Something New in Addiction?

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  1. Suppose We Try Something New in Addiction? Different Perspectives and Research Implications

  2. Build National System of “Prevention Prepared Communities” Train primary care to intervene early with emerging abuse Integrate addiction treatment into mainstream healthcare Smarter, safer management of drug-related offenders ONDCP Policy Priorities

  3. A Nice Simple Rehab Model Substance Abusing Patient Treatment NTOMS Sample of 250 Programs Non- Substance Abusing Patient

  4. ASSUMPTIONS • Some fixed amount or duration of treatment will resolve the problem • Clinical efforts put toward correctly placing patients and getting them to complete treatment • Evaluation of effectiveness should occur following completion • Poor outcome means treatment/patient failure

  5. But this hasn’t worked well… • About 60% of outpatients drop out prematurely (< 1 month). • Relapse rates are high – 50% @ 6-mos.

  6. Studies show few differences between… Brief and Intensive Treatments Inpatient and Outpatient Treatments Conceptually Different Treatments “Matched” and “Mismatched” Trt. Gender or Culturally Oriented Trt.

  7. How Do Other Treatments Work? Chronic Illness & Continuing Care

  8. A Continuing Care Model Primary Care Specialty Care Primary Continuing Care

  9. In Chronic Illnesses…. 1 – The effects of treatment do not last very long after care stops 2 – Patients who are out of treatment/contact are at elevated risk for relapse

  10. So, For Treatment…. 1 – One goal is to retain patients at an appropriate level of care and monitoring 2 – Another goal is to prepare patients to do well in the next level of care 3 - The effects of treatment are evaluated during treatment – not post-discharge

  11. Maybe Results Depend on Perspective Evaluation Implications

  12. Outcome In Hypertension Pre - During - Post Treatment Research Institute

  13. Outcome In Addiction Pre - Post Treatment Research Institute

  14. Maybe this is why…

  15. Studies show few differences between… Brief and Intensive Treatments Inpatient and Outpatient Treatments Conceptually Different Treatments “Matched” and “Mismatched” Trt. Gender or Culturally Oriented Trt.

  16. OK, But Could This Work in Addiction? Several Reasons To Think of Addiction as a Chronic Illness

  17. Continuing Care In Addiction Screen Intervene Monitor Refer Primary Care Stabilize Motivate/Medicate Train Self-Mgmnt Refer Specialty Care Recovery Support Services Re-Intervene Monitor/Support

  18. Implications? • For Current Addiction Treatment • System • For Expanding Treatment • For Evaluation

  19. ~ 12,000specialtyprograms in US 31% treat less than 200 patients per year Very Few Doctors Most of those eligible do not want care Current System

  20. Integrate Addiction Treatment into Federal Healthcare Systems 8.Performance Contracting in State Treatment Systems 9. Consumer Choice Through Vouchers for Recovery Services Treatment

  21. How to Evaluate? • Model is There • What are Performance Measures • When/How to Measure Outcome • How will public understand

  22. - The End -

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