2. Levels of Care Continuum of Care ASAM Patient Placement Criteria (PPC)
Treatment matching
Qualitative assessment
Multidimensional Risk Profile
Bundling and unbundling of care
Assessment dimensions
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3. Levels of Care The six ASAM dimensions are: Dimension Criterion 1
Acute Intoxication and/or Withdrawal Potential 2
Biomedical Conditions and Complications 3
Emotional, Behavioral, or Cognitive Conditions & Complications 4
Readiness to Change 5
Relapse, Continued Use or Continued Problem Potential 6
Recovery Environment
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4. Levels of Care The ASAM Levels of CARE: # Level ASAM Levels of Care 1
Early Intervention 2
Level I
Outpatient Treatment 3
Level II
Intensive Outpatient or Partial Hospitalization 4
Level III
Residential or Inpatient 5
Level IV
Medically Managed Inpatient Care.
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5. Levels of Care The ASAM Sub-Levels of CARE: Sublevel
Treatment Modality
Level III.1
Clinically Managed Low-Intensity Residential Treatment
Level III.3
Clinically Managed Medium-Intensity Residential Treatment
Level III.5
Clinically Managed High-Intensity Residential Treatment
Level III.7
Medically Monitored Inpatient Treatment
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6. Types of Inpatient Services
Classifications of detoxification
Ambulatory Detoxification with Extended On Site Monitoring
Inpatient Treatment Setting
Clinically Managed Residential Detoxification
Medically Monitored Inpatient Detoxification
Medically Managed Inpatient Detoxification
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7. Clinician Determination
Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Substance Abuse Subtle Screening Inventory (SASSI)
Michigan Alcohol Screening Test (MAST)
Drug Abuse Screening Test (DAST)
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8. Clinician Determination
Screening, Brief Intervention, and Referral to Treatment (SBIRT)
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9. Readiness for Change Motivational Interviewing Stages Stage
Description 1
Pre-Contemplation
No intended change behavior 2
Contemplation
Awareness of problem with no commitment to change 3
Preparation
Intent to change 4
Action
Steps taken to modify behavior 5
Maintenance
Continuing commitment to and action toward change
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10. Motivational Interviewing
Motivational Interviewing (MI)
Is a directive, person centered approach that has been shown to be effective in enhancing intrinsic motivation to change.
Helps assess ambivalence.
Used in conjunction with the Stages of Change model.
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11. Challenges Facing Rehabilitation Centers
Most operate predominately in the specialty sector.
Funding problems
Public perception
Staffing
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12. Client Inpatient Experiences
Most inpatient programs are 28 days in length.
May have a waiting list as long as six months.
Programs are generic in nature.
Most are not fully staffed 24-hours per day or seven days per week.
Program is very structured.
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13. Outpatient Treatment Drug and Alcohol Legislation Affecting Treatment
Temperance Movement
War on Drugs
Anti-Drug Abuse Act of 1986
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14. Incarceration Rates Race/Gender Ratio African American males
4,618 per 100,000
Hispanic males
1,747 per 100,000
Caucasian males
773 per 100,000
African American females
348 per 100,000
Hispanic females
146 per 100,000
Caucasian females
95 per 100,000
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15. Rehabilitation versus Incarceration
The United States has one of the highest, if not the highest incarceration rate in the world.
Incarcerations for substance abuse issues has increased within the last ten years.
Of those incarcerated for substance related issues, only about 11% have received any type of treatment.
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16. Residential Drug Abuse Program
The Federal Bureau of Prisons
Drug Court
Nonresidential drug abuse treatment
Residential Drug Abuse Program (RDAP)
Residential Reentry Centers and in Home Confinement
Community Treatment Services
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17. Residential Drug Abuse Program
Drug Court
Deferred prosecution
Post prosecution
6-12 months in length
Repeated drug testing
Cost ranges from $9,500-$12,000, plus the cost of therapy.
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18. Residential Drug Abuse Program
Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
This law now requires health insurance providers to cover both mental and physical health equally.
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19. SAMHSA Relapse Rates Drug of Choice Relapse Rate Alcohol
86% within 5 years
Heroin
87% after 1 year
Crack Cocaine
Cocaine
55% after 1 year
PCP, inhalants, hallucinogens
43% after 5 years
Methamphetamine
54% after 5 years
Depressants
51% after 5 years
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20. Useful Web Sites
American Society for Addiction Medicine (ASAM) Criteria
Drug and Alcohol Dependence Journal
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