 William Frank Barker, LPC, MAC Diane Diver, LMSW, CAC II

Physician’s Office Mental Health Institutions Alcoholics Anonymous Minnesota Model Outpatient Legal System & Jail

Health Care Reform Clinical Trends WORKFORCE

 $ 28 Billion spent in 2010 to treat addiction which affects 40 million people Versus  $107 Billion to treat heart disease which affects 27 million people

Relapse Rates Are Similar for Drug Addiction & Other Chronic Illnesses 100 Type I Diabetes Drug Addiction Hypertension Asthma 40 to 60% 30 to 50% 50 to 70% Percent of Patients Who Relapse McLellan et al., JAMA, 2000.

Parity

Estimated U.S. Economic Cost to Society Due to Substance Abuse and Addiction Illegal Drugs-$181 billion/year Alcohol-$185 billion/year Tobacco-$158 billion/year Total-$524 billion/year Source: Surgeon General’s Report, 2004; ONCP, 2004; Harwood, arwood, Surgeon General’s Report, 2004; ONDCP, 2004; Harwood, 2000.

How Its Funded

 More people with 3 rd party insurance  Shifts cost and focus: deductibles, reimbursement rates, outcome orientation, primary care physician

 Shift from management and administration of block grants to focus on “best practices,” grants, and outcome measurements.

 2 Million people in US dependent/abuse opioids  18,582 Physicians are certified to prescribe buprenorphine.  9% of SA facilities are Opioid Treatment Programs (OTP) in 2011  Individuals receiving buprenorphine prescriptions in 2010 was 800,000 with only 5% coming from treatment programs  Emergency department visits involving buprenorphine increased from 3,161 in 2005 to 30,135 visits in 2010 as availability of the drug increased. Source: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (April 23, 2013). The N-SSATS Report: Trends in the Use of Methadone and Buprenorphine at Substance Abuse Treatment Facilities: 2003 to Rockville, MD.

Source: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (January 29, 2013). The DAWN Report: Emergency Department Visits Involving Buprenorphine. Rockville, MD.

NIDA’s Principles of Treatment No single treatment is appropriate for all individuals. Treatment needs to be readily available. Treatment must attend to multiple needs of the individual, not just drug use. Multiple courses of treatment may be required for success. Remaining in treatment for an adequate period of time is critical for treatment effectiveness.

NIDA’s Principles of Treatment Behavioral Therapies:  Cognitive Behavioral Therapy  Contingency Management Interventions/Motivational Incentives  Community Reinforcement Approach Plus Vouchers  Motivational Enhancement Therapy  The Matrix Model  12-Step Facilitation Therapy  Family Behavior Therapy  Behavioral Therapies

“You can’t do cognitive therapy from a manual any more than you can do surgery from a manual.” -Aaron T. Beck, New York Times

 1900s“Being on the wagon”  1930s“Not drinking alcohol”  1980 Sober is being totally chemically free  Relapse is a part of recovery

Audrey Kishline  2000Evidence based practices Moderate drinking Fewer drinking days

 Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

 Addiction is characterized by the inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or death.

 The focus in the past has been generally on substances associated with addiction.  The new definition clarifies that addiction isn't about drugs, it’s about brains.  It is not the substance or the quantity or frequency of use that makes them an addict. Addiction is about what happens in the reward circuitry of the brain when exposed to a rewarding substance or behavior.

Detoxification Residential Treatment Day Treatment Intensive Outpatient Treatment General Outpatient Treatment More Severe Less Severe The Acute Model Vs. ASAM Levels of Care

1. Would significantly increase the number of people being diagnosed with addiction. 2. The APA has not allowed enough discussion regarding these changes (secondary gain). 3. It could create false epidemics and medicalication of everyday behavior. 4. Possible boundary issues between DSM panel members and the pharmaceutical companies.

ACCOUNTABILITY COURTS

USE OF TECHNOLOGY

Health Care Reform Clinical Trends WORKFORCE Peer Recovery Supports Highly Trained

 Medication Assisted Treatment  Physician Office/Counselor Embedded Treatment  Technology becomes a major tool  Increased qualifications for workforce  Serve More people  Prison/Drug courts may become converted to one payer