Substance Abuse & Addiction in the Mid Coast Region

1. Substance Abuse&Addictionin the Mid Coast Region July 18, 2012 Tom Kivler, LCPC;CCS Director of the Division of Behavioral Health at Mid Coast Hospital

2. Region Snapshot:2011 Maine Youth Survey for Sagadahoc

3. Region Snapshot- Adult:2009-2010 Health Snapshots

4. Rx Drug Abuse in Maine Maine is one of the worst states in the nation for Rx drug abuse: • 4.7% of all Mainers, 6% of 12-17 year olds, and 13% of 18-25 year olds report abusing painkillers in the past year (2009). • In 2010 162 Mainers died from Rx drug overdoses versus 34 deaths in 1997. • Nearly 1400 deaths in the past decade. • Unintentional poisoning deaths rose 210% from 1999-2004. • Substance abuse in Maine is estimated to cost $1.8 billion a year - $900 for every Mainer. • Opiate abuse = 30,451 ED and outpatient hospital visits in 2008 – a 28% increase from 2007. • As of July 1, 2012 26 Maine Pharmacies robbed. Exceeds 2011 in which 24 were robbed.

5. Admissions to substance abuse treatment for opiate abuse Maine: 1999-2008

6. Access to prescription drugs Where do 18-25 year olds most often get prescription drugs to misuse? “a friend or relative for free” Source: The NSDUH Report, 2009

7. The Aerial View of Behavioral Health Services at MCH

8. The Addiction Resource Center • Brunswick, Damariscotta • Adult, Adolescent, Family • Outpatient and Intensive Outpatient • Lincoln County Outreach • Healthy Generations • Affected Other treatment • For screening or an appointment call 373-6950

9. The latest Research on Addiction: • Drug and alcohol addiction is a chronic disease characterized by changes in the brain which result in a compulsive desire to use a drug. • The new science of addiction considers biology, genetics, as well as behavior and family dynamics in the treatment of addiction.

10. Neurobiological Theory: The synapse and synaptic neurotransmission Neuro-chemicals, including dopamine, endorphins, serotonin, and endogenous opioids interact to allow us to feel good, to engage with others, and to naturally medicate pain.

11. The interplay of these neurotransmitters and endorphins create “hedonic tone” • All Drugs of abuse and all behavioral addictions use this process • Addiction hi-jacks executive functioning

12. What is the Adverse Childhood Experiences (ACE) Study? Decade long. 17,000 people involved. Looked at effects of adverse childhood experiences over the lifespan. Largest study ever done on this subject.

15. “The Origins of Addiction”Dr. Vincent Felitti • “The neurobiology theory of addiction confuses mechanism with cause” • “…the basic cause of addiction is predominanty experience-dependent during childhood and not substance dependent” • ACEs findings imply that the basic causes of addiction “lie within us and how we treat each other” and not due to genetics, or moral weakness, peer pressure or drug dealers

16. ACE Study & Addiction • “….compulsive use of nicotine, alcohol and injected street drugs increases proportionally in a strong, graded, dose-response manner that closely parallels the intensity of adverse experiences during childhood.” • This study suggests a significant re-prioritizing of dollars toward prevention

17. Adverse Childhood Experiences and Current Smoking %

18. Childhood Experiences and Adult Alcoholism 4+ 3 2 1 0

19. ACE Score and Intravenous Drug Use N = 8,022 p<0.001

20. Treatment for SA & Addiction • Initially Cognitive Behavioral, Skill based, motivational enhancement • 12 Step • Anti-craving medications • Longer term treatment to address trauma, couples, parenting, other mental health related issues

21. Rx Drug Abuse National, State and Community Intervention • Education & Physician Prescribing Practices • Disposal • Prescription Monitoring • Enforcement/Diversion Alert

22. Resources • Maine Office of Substance Abuse • www.maine.gov/dhhs/osa • National Institute of Drug Abuse • www.nida.nih.gov • Substance Abuse & Mental Health Services Administration • www.samhsa.gov • www.cdc.gov/nccdphp/ace • www.acestudy.org

23. Thank You !