where are we going?
DESCRIPTION
Where Are We Going?. William Frank Barker, LPC, MAC Diane Diver, LMSW, CAC II. The Perfect Storm. The Field. Key Forces. WORKFORCE. Healthcare. Healthcare. $ 28 Billion spent in 2010 to treat addiction which affects 40 million people Versus - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/1.jpg)
Where Are We Going?
William Frank Barker, LPC, MAC
Diane Diver, LMSW, CAC II
![Page 3: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/3.jpg)
The FieldPhysician’
sOffice
Mental Health
Institutions
Alcoholics Anonymo
us
Minnesota Model
Outpatient
Legal System &
Jail
![Page 4: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/4.jpg)
Key ForcesHealth Care
Reform
Clinical Trends
WORKFORCE
![Page 5: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/5.jpg)
Healthcare
![Page 6: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/6.jpg)
Healthcare $ 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
![Page 7: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/7.jpg)
Relapse Rates Are Similar for Drug Addiction & Other Chronic Illnesses
100
Type I Diabete
s
Drug Addiction
0102030405060708090
Hypertension Asthma
40 t
o 60
%
30 t
o 50
%
50 t
o 70
%
50 t
o 70
%
Perc
ent
of P
atie
nts
Who
Rel
apse
McLellan et al., JAMA, 2000.
Healthcare
![Page 8: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/8.jpg)
Healthcare
Parity
![Page 9: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/9.jpg)
HealthcareEstimated U.S. Economic Cost to Society Due to Substance Abuse and Addiction
Illegal Drugs - $181 billion/yearAlcohol - $185 billion/yearTobacco - $158 billion/year
Total - $524 billion/year
Source: Surgeon General’s Report, 2004; ONCP, 2004; Harwood, 2000.arwood, 2000. Surgeon General’s Report, 2004; ONDCP, 2004; Harwood, 2000.
![Page 10: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/10.jpg)
Healthcare
How Its Funded
![Page 11: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/11.jpg)
Healthcare
17%
20%
14%
45%
5%
Current Spending on Substance Abuse Treat-
mentPrivate FundingMedicaidOther FederalOther State and LocalMedicare
![Page 12: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/12.jpg)
Healthcare
More people with 3rd party insurance Shifts cost and focus: deductibles, reimbursement
rates, outcome orientation, primary care physician
![Page 13: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/13.jpg)
Healthcare
Shift from management and administration of block grants to focus on “best practices,” grants, and outcome measurements.
![Page 14: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/14.jpg)
Healthcare
![Page 15: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/15.jpg)
Healthcare
![Page 16: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/16.jpg)
Healthcare
![Page 17: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/17.jpg)
Healthcare
![Page 18: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/18.jpg)
Healthcare
![Page 19: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/19.jpg)
Healthcare 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 2011. Rockville, MD.
![Page 20: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/20.jpg)
Healthcare/Medical
52.00%
24.00%
13.00%
10.00%
2010 Emergency Department Visits Involving Buprenorphine by Type
Nonmedical Use of PharmaceuticalsSeeking Detoxifica-tion/Treatment ServicesAdverse ReactionOther
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.
![Page 21: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/21.jpg)
Clinical Trends
![Page 22: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/22.jpg)
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.
Clinical Trends
![Page 23: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/23.jpg)
Clinical TrendsNIDA’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
![Page 24: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/24.jpg)
Clinical Trends
“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
![Page 25: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/25.jpg)
Clinical Trends 1900s “Being on the wagon”
1930s “Not drinking alcohol”
1980 Sober is being totally chemically free
1990-2000 Relapse is a part of recovery
![Page 26: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/26.jpg)
Clinical Trends
Audrey Kishline
2000 Evidence based practices• Moderate drinking• Fewer drinking days
![Page 27: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/27.jpg)
ASAM Definition of Addiction 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.
![Page 28: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/28.jpg)
ASAM Definition of Addiction 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.
![Page 29: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/29.jpg)
What is different about this definition? 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.
![Page 30: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/30.jpg)
Clinical TrendsDetoxification
Residential Treatment
Day Treatment
Intensive Outpatient Treatment
General Outpatient Treatment
More Severe
Less Severe
The Acute Model Vs. ASAM Levels of Care
![Page 32: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/32.jpg)
Concerns About DSM-5 Changes
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.
![Page 34: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/34.jpg)
Clinical TrendsACCOUNTABILITY COURTS
![Page 36: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/36.jpg)
Implications for Clinicians
Health Care
Reform
Clinical Trends
WORKFORCE
Peer Recover
y Support
s
HighlyTrained
![Page 37: Where Are We Going?](https://reader036.vdocument.in/reader036/viewer/2022070500/5681685f550346895ddea819/html5/thumbnails/37.jpg)
CONCLUSIONS 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