Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.
-
Upload
virginia-gallagher -
Category
Documents
-
view
215 -
download
0
Transcript of Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.
![Page 1: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/1.jpg)
Suppose We Try Something New in
Addiction?
Different Perspectives andResearch Implications
![Page 2: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/2.jpg)
1. Build National System of “Prevention Prepared Communities”
2. Train primary care to intervene early with emerging abuse
3. Integrate addiction treatment into mainstream healthcare
4. Smarter, safer management of drug-related offenders
![Page 3: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/3.jpg)
A Nice Simple Rehab Model
NTOMS Sample of 250 Programs
Treatment
Substance Abusing Patient
Non- Substance Abusing Patient
![Page 4: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/4.jpg)
ASSUMPTIONS• Some fixed amount or duration of
treatment will resolve the problem
• Clinical efforts put toward correctly placing patients and getting them to complete treatment
• Evaluation of effectiveness should occur following completion
– Poor outcome means treatment/patient failure
![Page 5: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/5.jpg)
But this hasn’t worked well…
• About 60% of outpatients drop out prematurely (< 1 month).
• Relapse rates are high – 50% @ 6-mos.
![Page 6: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/6.jpg)
Studies show few differences between…
• Brief and Intensive Treatments
• Inpatient and Outpatient Treatments
• Conceptually Different Treatments
• “Matched” and “Mismatched” Trt.
• Gender or Culturally Oriented Trt.
![Page 7: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/7.jpg)
How Do Other
Treatments Work? Chronic Illness & Continuing Care
![Page 8: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/8.jpg)
A Continuing Care Model
PrimaryContinuing Care
Primary Care
Specialty Care
![Page 9: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/9.jpg)
In Chronic Illnesses….
1 – The effects of treatment do not last very long after care stops
2 – Patients who are out of treatment/contact are at elevated risk for relapse
![Page 10: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/10.jpg)
So, For Treatment….1 – One goal is to retain patients at an appropriate level of care and monitoring
2 – Another goal is to prepare patients to do well in the next level of care
3 - The effects of treatment are evaluated during treatment – not post-discharge
![Page 11: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/11.jpg)
• Maybe Results Depend on Perspective
![Page 12: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/12.jpg)
0
2
4
6
8
10
Pre During During During Post
Treatment Research Institute
Outcome In Hypertension
![Page 13: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/13.jpg)
0
2
4
6
8
10
Pre During During During Post
Treatment Research Institute
Outcome In Addiction
![Page 14: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/14.jpg)
Maybe this is why…
![Page 15: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/15.jpg)
Studies show few differences between…
• Brief and Intensive Treatments
• Inpatient and Outpatient Treatments
• Conceptually Different Treatments
• “Matched” and “Mismatched” Trt.
• Gender or Culturally Oriented Trt.
![Page 16: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/16.jpg)
OK, But Could This Work in Addiction?
Several Reasons To Think ofAddiction as a Chronic Illness
![Page 17: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/17.jpg)
Continuing Care In Addiction
RecoverySupport Services
Primary Care
Specialty Care
ScreenInterveneMonitorRefer
Re-InterveneMonitor/Support
StabilizeMotivate/MedicateTrain Self-MgmntRefer
![Page 18: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/18.jpg)
Implications?
1. For Current Addiction TreatmentSystem
2. For Expanding Treatment3. For Evaluation
![Page 19: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/19.jpg)
~ 12,000 specialty programs in US
• 31% treat less than 200 patients per year
• Very Few Doctors • Most of those eligible do not want
care
![Page 20: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/20.jpg)
7. Integrate Addiction Treatment into Federal Healthcare Systems
8. Performance Contracting in State Treatment Systems
9. Consumer Choice Through Vouchers for Recovery Services
![Page 21: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/21.jpg)
How to Evaluate?
1. Model is There2. What are Performance Measures3. When/How to Measure Outcome4. How will public understand
![Page 22: Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.](https://reader035.fdocuments.in/reader035/viewer/2022062500/5697c02d1a28abf838cd9c23/html5/thumbnails/22.jpg)