Understanding the Disease of Addiction & the Process of Recovery
Transcript of Understanding the Disease of Addiction & the Process of Recovery
![Page 1: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/1.jpg)
Understanding the Disease of Addiction &
the Process of Recovery for Healthcare
Clinicians and Staff
Presented by
John G. Gardin II, Ph.D., A.C.S.
Chief Clinical Officer, ADAPT, Inc./SouthRiver CHC
![Page 2: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/2.jpg)
![Page 3: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/3.jpg)
Basic Definition
…if it causes a problem, it’s a problem…
![Page 4: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/4.jpg)
Drug use continuum
Non-use Use Risky Use Abuse Dependency
![Page 5: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/5.jpg)
Risk of Addiction
Risk
Tobacco 32%
Meth 31%
Heroin 23%
Cocaine 17%
Alcohol 15%
Cannabis 9%
Anxiolytics/Analgesics 9%
Psychedelics 9%
Inhalants 4%
![Page 6: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/6.jpg)
? Genetics
Upbringing
Drug
Psychopathology
Neurological issues
Cultural issues
Trauma/Abuse
Age of first use
Criminal history
Friends
![Page 7: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/7.jpg)
A substance use disorder is an
extremely complex disease
![Page 8: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/8.jpg)
SUDs as chronic diseases
• Early acquisition with late onset of symptoms
• Individualized progression
• Complex causes
• Effectiveness of behaviorally-oriented care
• Comparable relapse rates
• Poor treatment compliance
• Psychiatric co-morbidities
![Page 9: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/9.jpg)
Relapse Comparison
![Page 10: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/10.jpg)
Substance dependency is a chronic
disease
![Page 11: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/11.jpg)
How big a problem is it?
• 6% of those 12 or older abuse illicit drugs*
• 16% of those 12 or older abuse alcohol*
• Less than 25% of those needing treatment get
treatment**
*National Household Survey on Drug Abuse, SAMHSA, 2009
**Institute on Health Policy, 1993
![Page 12: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/12.jpg)
Assessing burden
Problem Drinkers Alcohol Dependent Daily Drug Use
Primary Care 42% 56% 43%
Criminal Justice 41% 24% 39%
Alcohol TX Clinics 4% 9% 3%
Drug TX Clinics 2% 2% 3%
Mental Health
Clinics 3% 3% 3%
![Page 13: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/13.jpg)
Why Bother with SUD in Primary
Care? • <10% of those with SUD seek treatment
• Perhaps 25% of all patients in primary care with a
diagnosable ETOH and/or drug problem
• Patients with SUDs complicate medical care
• Patients with SUDs disrupt practices
![Page 14: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/14.jpg)
![Page 15: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/15.jpg)
Substance use disorders are wide-
spread and significant factors
in the lives of our patients
![Page 16: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/16.jpg)
Drug Abuse Treatment – The Simple
Way
Drug Problem
Drug Treatment
No Drug Problem
![Page 17: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/17.jpg)
Where is treatment provided?
Setting Percent
Self-help Groups 80%
Outpatient SUD clinic 56%
Residential treatment 33%
Outpatient mental health clinic 33%
Inpatient hospital 23%
Outpatient medical practice 22%
Emergency Room 16%
Jail/Prison 11%
![Page 18: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/18.jpg)
Pacific Coast Consulting
![Page 19: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/19.jpg)
Effective treatment for SUDs
• Use of Evidence-based Treatments (CBT, CRA)
• Tailor the treatment to the patient
• Adaptive (stepped) care
• Involve the patient in setting clear goals
• Involvement of significant others
• Attention to controllable co-factors (work, healthcare,
psychiatric issues)
• Use of medications
![Page 20: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/20.jpg)
Substance use disorder treatment –
like the treatment of all chronic disease
- involves behavior change
and behavior change is hard
![Page 21: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/21.jpg)
Next Steps
Contact your local addiction treatment
agency
![Page 22: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/22.jpg)
Integration
• Integration vs collaboration
• Integration model – SBIRT or SBIrT
• Integration Issues
• Clinical (What care is called for?)
• Operational (How eill the care be provided?)
• Financial (Is the care a good value?)
![Page 23: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/23.jpg)
Clinical Issues
• Controlled substances and medication contracts
• Screening tools or brief interview?
• Pain patients
• Providing addiction, mental health, behavioral medicine
• Non-compliant patients
• Use of EBPs
![Page 24: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/24.jpg)
Operational Issues
• Who is the BHC?
• Coordinated vs co-located vs integrated care
• Targeted vs non-targeted
• Specified vs non-specified
• Medical staff training
• Scheduling and “meet and greets”
• Charting and confidentiality
![Page 25: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/25.jpg)
One example of outcomes
• Screened approx. 2,000 pts/yr (20% of total)
• Provided treatment to 15% (50% Medicaid)
• 25% SUD; 35% MH; 40% COD
• 30% of Medicaid provided 70% of utilization
• 64% showed significant improvement
• Overall medical utilization by Medicaid decreased 13%
• “Frequent flyer” Medicaid patients decreased medical
utilization by 33%
![Page 26: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/26.jpg)
What we learned
• Medical assistants drive it
• Overbooking necessary
• Increased appropriate use of psychotropics
• Better management of pain patients
• Sessions of 15-20 minutes
• Use of Behavioral Medicine billing codes (96150-
96154)
![Page 27: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/27.jpg)
Continuing Challenges
• Constant retraining of medical assistants
• Training issues with providers
• Scheduling challenges
• Unable to use same-day appointments for Bmed
• Poor penetration of SUD involved patients
• eMR and confidentiality
• Billing issues
![Page 28: Understanding the Disease of Addiction & the Process of Recovery](https://reader035.fdocuments.in/reader035/viewer/2022071523/613d0da9736caf36b758c258/html5/thumbnails/28.jpg)