1. Cedar Mountain Center Trends and Developments in Substance Abuse Treatment Kim Fletcher Marketing Director

2. Personal and Professional Implications Criminal Justice System jammed Epidemic Proportions No Socioeconomic Boundaries

3. Disease or Moral Weakness Science is clear on disease Stigma attached which is a barrier to treatment Mandated treatment does work –Drug Courts –Prisons –Department of Family Services

4. #1 Abused Drug Alcohol

5. Cost to Society Half a Trillion Dollars Crime Related Costs Loss in Productivity Break Down: –Alcohol-185 Billion –Illicit Drugs-181 Billion –Tobacco-168 Billion

6. Cost to Society (Billions of Dollars)

7. Monitoring the future Survey of 50,000 8, 10, and 12 graders by NIDA Decline in use Exception are Ecstasy, Oxycotin, Vicodin and inhalants Report by NIDA – monitoringthefuture.org

8. Addiction: Bio-psycho-social disease Biological - Genetic Tendency Psychological – Beliefs Social – Drinking culture –Learned behavior –Environment

9. Brain Imaging Exposure to psychoactive chemicals cause changes in the brain that can be seen with brain imaging Changes in critical areas: –Decision making –Learning and memory –Behavior control Cravings and triggers – choose drug despite catastrophic consequences

10. Culture of Substance Abuse Parental modeling –Adolescents want to mimic adults –Will use substances to cope with problems Parental indifference –We used and we turned out alright –Today's drugs are more potent Best place to find beer –In the fridge right next to the milk

11. Co-dependency Making excuses for the user Covering up for the user enabling their use to continue Co-dependents develop their own self-destructive behaviors for coping Victims of child abuse/neglect due to substance use often go on to become CHINS and delinquency cases

12. Diagnostic Manual of Mental Disorders – Psychiatric Assoc. Differentiates between Substance Abuse and Substance Dependence Relies on the pattern and duration of drug use The negative impact of drugs on the social and occupational functioning of the user, and the pathological effects to confirm a diagnosis of addiction or dependence

13. Physical vs Psychological Dependence Misconception that an addict uses everyday Binge use Causing significant life problems Compulsively seeking and using despite negative consequences

14. Addiction Severity Index Most Comprehensive 186 criteria for diagnosis of Chemical Dependency

15. Screening Tools CAGE – 4 questions, highly reliable for alcohol  have you ever felt you should C UT DOWN on your drinking?  have people ANNOYED you by criticizing your drinking?  have you ever felt bad or GUILTY about your drinking?  EYE OPENER: have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

16. Does treatment work? Research shows that when appropriate treatment is given and when clients follow the prescribed program, treatment does work. In 1999 the National Institute of Health published “Principles of Drug Addiction Treatment, 13 principles of effective treatment.”

17. National Institute of Health 13 Principles of Effective Treatment #1 No single treatment is appropriate for all; match treatment settings and interventions to the individual

18. Principles of Effective Treatment #2 Treatment needs to be readily available potential applicants can be lost if treatment is not immediately available

19. Principles of Effective Treatment #3Effective treatment attends to the multiple needs of the individual

20. Principles of Effective Treatment #4 Treatment and service plan must be assessed continually and modified as necessary

21. Principles of Effective Treatment #5 Remain in treatment for an adequate period of time

22. Principles of Effective Treatment #6 Counseling (individual and/or group) and other behavioral therapies are critical components

23. Principles of Effective Treatment #7 Medications are an important element of treatment

24. Principles of Effective Treatment #8 Dual disorders should be addressed in in integrated way

25. Principles of Effective Treatment #9 Detox is only the first state and does little to change long term use

26. Principles of Effective Treatment #10 Treatment doesn’t need to be voluntary to be effective

27. Principles of Effective Treatment #11 Drug use during treatment must be monitored continuously

28. Principles of Effective Treatment #12 Treatment programs should provide assessment for HIV/AIDS, Hepititis B and C, tuberculosis, and other infectious diseases as well as counseling to help patients modify or change behaviors that place themselves at risk of infection

29. Principles of Effective Treatment #13 Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment

30. Resources Most current information available from: –National Institute on Drug Abuse (NIDA) –National Institute on Alcohol Abuse and Addiction (NIAAA) Cedar Mountain Center’s 30 years of treatment experience Personal Experience – 50 years