Chemical Dependency Screening and Referral

By the End of this Session You will be able to: Define substance abuse & related terms Define “disease” as related to substance abuse & describe its characteristics Recognize the progression/stages of substance abuse Utilize the GAIN-SS tool Describe how to partner with providers

A two parent family had their three children removed because they were chronically failing to supervise them. Both parents used drugs and alcohol. One parent has been engaging in treatment for 6 months and has clean UA’s since the start of treatment. The other parent has engaged less frequently in treatment and provided few UA’s. Are the children safe to return home?

After being involved with a family for several months, the FVS worker meets with a single mother to discuss closing her case. She has maintained her home in an adequately sanitary fashion and engaged in outpatient treatment for alcohol abuse. The mother discloses that she’s pregnant, and is very afraid of her boyfriend. She states that he has threatened her and her child, and that she doesn’t know what to do. Should the case be kept open? How can the child, and the parent, be protected?

An intake comes in after a mother is arrested driving drunk with her children in the car. The children remain with the other parent while the investigation occurs. The mother completes a drug and alcohol assessment which recommends participation in their education program, but not treatment. Per the evaluation the mother is not alcohol dependent. Can the children safely resume their custodial time with their mother?

Substance Abuse Statistics Approximately 18 million persons abuse or are addicted to alcohol. 11 million persons abuse tranquilizers & other psychotropic drugs. 5.5 million get high on marijuana more than once a week.

Substance Abuse Statistics At least 2 million are addicted to cocaine or crack. Up to 1 million individuals use heroin. 1% of population over 12 (400,000) people use methamphetamines Higher rate then heroin. Half the rate of cocaine.

Definitions

Addiction

Characteristics of a Disease

Elements of Disease

Symptoms Associated with Stages

Stages of Substance Abuse

Levels of Substance Use and Risk of CA/N General categorization of substance use is as follows: – Substance use – Abuse – Dependence. Any level of substance use by a parent can place a child in imminent harm, create present danger or create impending danger of physical abuse and/or neglect. It is important to determine if substance use is a factor in an unsafe situation for a child.

Impact of Drugs on the Brain Causes significant changes in brain chemistry Disrupts normal communication between neurons. Continued use can impact the ability to experience pleasure. Engaging in a compulsive behavior, even in the face of negative consequences. Inability to limit intake of the addictive substance Long lasting or permanent changes to the brain

Brain Scan

Screening for Substance Use Required for all parents and caregivers How do you gather this information?

Asking About Pre-Natal Exposure Ask about use of drugs and alcohol during pregnancy Impacts can be: – large or small – temporary or long term Alcohol and nicotine are most common & have significant and profound long term effects

Asking about Pre-Natal Exposure Provide context for the question Open ended prompts Presume use in substance abusing women – Ask what, when and how much Follow up with currently pregnant women to support treatment Follow up with non-pregnant women to discuss screening of children

Pre-natal Exposure birth Fetal Growth Strong Effect Effect No EffectEffect Birth defects Strong Effect ?No Effect Long Term GrowthStrong Effect ?No Effect ? BehaviorStrong Effect Effect ? CognitionStrong Effect Effect? ?? LanguageEffect ?No Effect??

Fetal Alcohol Spectrum Disorder Often includes: Physical markers like growth problems and facial differences Intellectual disability Poor executive functioning (planning, anticipating, learning from experience)

FASD: Assessment and Treatment Children under 3: Early Intervention Services Children 3 and over: School District 10X more prevalent in children in care

Neonatal Abstinence Syndrome Related to opiate use only Increased symptoms and discomfort as time passes Often requires hospitalization and treatment More significant from methadone than heroin

Plan of Safe Care For Substance Exposed Newborns Case Note – Medical care – Safe housing/sleep – Child care plan – Emergency numbers – Resources – Referrals

CHEMICAL DEPENDENCY AND TREATMENT

Treatment Works Periods of abstinence, or reduced substance use are a result of effective intervention and treatment Treatment outcomes show a decrease in negative outcomes for addicts Relapse is part of recovery. Increased and/or continued support and interventions assist in regaining abstinence.

Types of Treatment Acute detox Sub-acute detox Intensive Inpatient Recovery House Long Term Intensive Outpatient Outpatient Aftercare.

Opiate Substitution Treatment Client receives medication : o To assist in stabilizing brain chemistry o In conjunction with outpatient counseling. Effective ONLY with opiate class drugs Pregnant mothers generally are prescribed this modality as a way of remaining free from illegal substances and maintaining their pregnancy o - Infant will likely need to detox after its birth as a result of this method of treatment Of a number of treatment options methadone is the most commonly used modality.

Referral Options/Issues Treatment access Obtaining Funding Knowing the Resources

Certified Chemical Dependency Provider Directory A directory that includes chemical dependency service providers certified by the Division of Behavioral Health and Recovery (DBHR). Certified agencies are listed alphabetically within each county.

Utilizing UAs UAs are a tool to be used in monitoring levels of a substance (decreasing/increasing levels) in a person’s system UA Best Practice will be discussed in more depth during 2 day training Random, observed UA’s are the most accurate type of testing UAs are a tool and can be augmented by the client. UAs should not be the basis in deciding permanency – such as reunification Other methods for collecting information on a person’s level of usage are hair follicle testing, oral swabs and blood tests – these tend to be less utilized due to increased cost of testing

UA’s What they tell us: A particular drug or class of drugs was used General time frame this happened What they can’t: Exactly when a drug was used How much of the drug was used Overall skill acquisition

PARTNERING WITH TREATMENT PROVIDERS

Treatment Referral and Initial Conversations Provide the sequence of events around the problem Share the safety plan Share the consensus on the Family and Individual Level Objectives (Case Plan) Describe how evidence of change will be noticed Follow-up the referral with a conversation

Service Expectations for Implementing and Sustaining Change Deliver services within the family developmental context Ensure that the service produces a product (specific action plan) Assist family members learn the details of their behavior patter Assist clients in practicing small steps of change Documentation of behavior change

Need for Collaboration Expected family outcomes may differ based on perspective – CA looks at safely reunifying children with parents – CDPs are working with the client to address addiction CA concerns about the family need to be shared with the CDPs It is critical the CDP and CA Social Worker understand the very different roles each have with the family Talk early and often Share lapses Invite providers to meetings