Substance Abuse and Co-Morbid Conditions: - PowerPoint Presentation

1. Substance Abuse and Co-Morbid Conditions: What Works?Dr. Ken Robinson

2. Objectives We will discuss and explore the:Prevalence of HIV and substance useRisks of HIV and substance usePrevalence of substance use in pregnancy and womenRisks of chronic substance use with womenComorbidity Treatment options

3. HIV/AIDS, substance abuse disorders, and mental disorders interact in a complex fashion. Each acts as a potential catalyst or obstacle in the treatment of the other two--substance abuse can negatively affect adherence to HIV/AIDS treatment regimens; substance abuse disorders and HIV/AIDS are intertwining disorders; HIV/AIDS is changing the shape and face of substance abuse treatment (Batki and Selwyn, 2008).

4. Chicken or Egg?Substance abuse and HIV have been connected since the beginning of the HIV epidemic. Substance abuse and HIV are both chronic illnesses that often co-occur and exacerbate one another.

5. You can get or transmit HIV only through specific activities. Most commonly, people get or transmit HIV through sexual behaviors and needle or syringe use.Only certain body fluids—blood, semen (cum), pre-seminal fluid (pre-cum), rectal fluids, vaginal fluids, and breast milk—from a person who has HIV can transmit HIV. These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to occur. Mucous membranes are found inside the rectum, vagina, penis, and mouth.Less commonly, HIV may be spread:From mother to child during pregnancy, birth, or breastfeeding. Although the risk can be high if a mother is living with HIV and not taking medicine, recommendations to test all pregnant women for HIV and start HIV treatment immediately have lowered the number of babies who are born with HIV.By being stuck with an HIV-contaminated needle or other sharp object. This is a risk mainly for health care workers.

6. In extremely rare cases, HIV has been transmitted by:Oral sex.Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIVEating food that has been pre-chewed by an HIV-infected person. The contamination occurs when infected blood from a caregiver’s mouth mixes with food while chewing. The only known cases are among infants.Being bitten by a person with HIV. Each of the very small number of documented cases has involved severe trauma with extensive tissue damage and the presence of blood. There is no risk of transmission if the skin is not broken.Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids.Deep, open-mouth kissing if both partners have sores or bleeding gums and blood from the HIV-positive partner gets into the bloodstream of the HIV-negative partner. HIV is not spread through saliva.

7. In the United States, HIV is spread mainly by:Having anal or vaginal sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV. Anal sex is the highest-risk sexual behavior. Vaginal sex is the second-highest-risk sexual behavior.Sharing needles or syringes, rinse water, or other equipment (works) used to prepare drugs for injection with someone who has HIV. HIV can live in a used needle up to 42 days depending on temperature and other factors.Less commonly, HIV may be spread:From mother to child during pregnancy, birth, or breastfeeding. Although the risk can be high if a mother is living with HIV and not taking medicine, recommendations to test all pregnant women for HIV and start HIV treatment immediately have lowered the number of babies who are born with HIV.By being stuck with an HIV-contaminated needle or other sharp object. This is a risk mainly for health care workers.

8. HIV Vulnerable PopulationsGay and bisexual men accounted for 82% of HIV diagnoses among males and 67% of all diagnoses.Black/African American and gay and bisexual men accounted for the largest number of HIV diagnoses, followed by white gay and bisexual men.Heterosexual contact accounted for 24% of HIV diagnoses.Women accounted for 19% of HIV diagnoses. Diagnoses among women are primarily attributed to heterosexual contact (86%) or injection drug use (13%).6% of HIV diagnoses in the United States were attributed to injection drug use (IDU) and another 3% to male-to-male sexual contact and IDU.CDC, 2015, HIV in the United States: At A Glance

9. There are an estimated 50,000 new cases of HIV infection each yearCDC HIV Surveillance Report 2016

10. 1/3 of 1.2 million Americans with HIV currently use drugs or binge on alcohol.Sharing intravenous equipment & impaired judgment which leads to risky sexual behavior and HIV transmission BOTH lead to increased risk of HIV infection.Substance Abuse plays a big part in prevention of HIV

11. Alcohol. Excessive alcohol consumption, notably binge drinking, can be an important risk factor for HIV because it is linked to risky sexual behaviors and, among people living with HIV, can hurt treatment outcomes.Opioids. Opioids are associated with HIV risk behaviors such as needle sharing when infected and risky sex, and have been linked to a recent HIV outbreak.Methamphetamine. “Meth” is linked to risky sexual behavior that places people at greater HIV risk. It can be injected, which also increases HIV risk if people share needles and other injection equipment.Crack cocaine. Can create a cycle in which people quickly exhaust their resources and turn to other ways to get the drug, including trading sex for drugs or money, which increases HIV risk.Inhalants. Use of amyl nitrite (“poppers”) has long been linked to risky sexual behaviors, illegal drug use, and sexually transmitted diseases among gay & bisexual men. (Center for Disease Control and Prevention, 2016)Commonly Used Substances & HIV Risk

12. HIV & Co-MorbidityThe HIV Cost and Services Utilization study conducted a survey : According to the study of HIV-positive patients:48% reported significant symptoms of depression, anxiety or panic38% reported using illicit drugs in the previous year19% reported heavy alcohol use (Shapiro et al, 1999).

13. Trends in HIV: CDCHIV among PWID (persons who inject drugs) annual diagnoses dropped almost 50% during 2008-2014.However, the prescription opioid and heroin epidemics pose new challenges for preventing HIV, amongst other viral infections and STDs.22 cities show that many PWID share injection equipment, putting them at high risk for HIV and hepatitis B and C infection. Last year, 40% of new PWID (those who have been injecting for 5 years or less) reported sharing syringes, and only 1 in 4 got all their syringes from sterile sources, such as syringe services programs (SSPs).

14. Women & Substance UseResearch shows physical and sexual trauma (PTSD) is more common in drug abusing women than in men seeking treatment( NIDA).Among pregnant women age 15 to 17 the current illicit drug use rate is 14.6%. Among pregnant women age 18 to 25 the current illicit drug use rate is 8.6%Among pregnant women age 26 to 44 the current illicit drug use rate is 3.2%

15. Women & Alcohol2012-2013 SAMHSA reported among pregnant women aged 15 to 44 an annual average of 9.4% report alcohol use.2.3% report binge drinking0.4% report heavy drinking

16. The Effects of Substance of Abuse on Behavior and Parenting Alcohol :  A parent may forget or neglect to attend to parenting responsibilities.  A parent may stay out all night and leave children alone due to intoxication. A parent may have rages and depressive episodes, creating an unstable environment for children. Cocaine: After prolonged use, cocaine also increases irritability and aggression in the user. Cocaine can result in psychotic distortions of thought such that the user imagines and acts on projections to others of his or her own aggression. A child's crying, which may be only a mild annoyance to a non-using parent, is magnified in its intensity to the parent on cocaine.

17. The Effects of Substance of Abuse on Behavior and Parenting Crack/Crack Cocaine A parent addicted to crack can leave an infant or toddler alone for hours or sometimes days at a time to pursue the drug.  CPS workers frequently investigate maltreatment reports in homes barren of furniture and appliances that have been sold to purchase crack and other drugs. Some parents will do whatever it takes to pursue their habit, even if it means sacrificing the health and well-being of loved ones. Crack can contribute to a significant increase in sexual abuse of young children.Heroin A parent may forget or neglect to attend to parenting responsibilities. Parents may leave children alone while seeking, obtaining, or using the drug. Parents may "nod out" while under the influence of heroin and be unable to supervise or protect their children.  Parents may expose their children to heroin dealers, other users, and hence unsafe and dangerous situations.

18. The Effects of Substance of Abuse on Behavior and Parenting MarijuanaA parent may forget or neglect to attend to parenting responsibilities. Parents may leave children alone while seeking, obtaining, or using the drug.  Parents may fall asleep while under the influence of depressants and be unable to supervise or protect their children. MethamphetamineIs an increasing problem among parents in the child welfare system. Parents may not supervise children or provide for their basic nutritional, hygienic, or medical needs. Violence, aggression, and paranoia may lead to serious consequences for children of meth abusers. Additional risks to children can be quite extreme if the drug is being "cooked" in their residence. These risks include fire and explosions as well as unintentional absorption of the drug from the home

19. Journal of PediatricsIN 1999 35% OF US HIGH SCHOOL STUDENTS SMOKED 27% OF GIRLS & 28% BOYS IN 1991.20% OF ADOLESCENCE.SMOKERS 4 TIMES MORE LIKELY TO DEVELOP DEPRESSION WITHIN A YEAR. BOTH MAY HAVE COMMON PATHWAY.October 2000

20. Percentage of Young Adults With Anxiety Disorders, by Amount of Cigarettes Smoked During AdolescenceSource: Adapted by CESAR from Johnson J.G., Cohen P., Pine D.S., Klein D.F., Kasen S., Brook J.S., “Association Between Cigarette Smoking and Anxiety Disorders During Adolescence and Early Adulthood,” Journal of the American Medical Association 284(18):2348-2351, 2000.

21. 21Why Do People Take Drugs in The First Place?To feel goodTo have novel:feelingssensationsexperiencesANDto share them To feel betterTo lessen:anxietyworriesfearsdepressionhopelessness

22. Frequency of use by High School Seniors – CSAT 2002 Children under 21 25% of Alcohol 27 billion 5 million or 31% binge 1 x monthDrinking 80%Smoking 70%Marijuana 47%Other Drugs 29%Huffing 2 million age 12- 17 tried

23. 2016 Monitoring the Future StudyDrug Prevalence Alcohol 58.2% Marijuana/Hashish 34.9% Hookah 19.8% Small cigars 15.9% Amphetamines* 7.7% Adderall®* 7.5% Snus 5.8% Narcotics o/t Heroin* 5.4%

24. Substance Abuse and APDKessler, et. Al. Archives of General Psychiatry. 1994Rates of Alcoholism and Substance DependenceOver Previous 12 Months2.8% of Population Dependent on Drugs7.2% of Population Dependent on AlcoholOverlap: The bulk of substance dependent persons are also diagnosable as having APD. While about half of alcoholics who enter treatment also have APD, less than half of all alcoholics have APD. Almost all APDs who enter institutions or programs show some form of chemical abuse.

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27. MarijuanaA study published in The Journal of Clinical Psychiatry April 2016 found that marijuana was more addictive than alcohol but less so than tobacco. Among weekly users, the study found a 25 percent risk of dependence for marijuana compared with 16 percent for alcohol and 67 percent for tobacco.

28. Marijuana on College CampusesThe most startling trend is the number who smoke daily: One in every 22 college students surveyed said they smoke at least 20 times in a month.And two-thirds say they believe a little weed every now and then is safe."Something has changed dramatically," said principal investigator Lloyd Johnston, a distinguished senior research scientist at University of Michigan. "We've been asking the same question for years, and their answers are changing."

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30. 25% of adult population experience a mental health issue every year.60% receive no treatment68% have at least one medical condition50% of care delivered by primary care physicians29% of those with medical condition have a mental health condition.Source Nami and Comorbidity surveyMind and Body

31. How Prevalent are Mental Disorders?19% general adult population in U.S. have a mental disorder & 4% SMI in past year SMI includes schizophrenia, bi-polar disorder, major depression, andOther disorders that cause significant impairmentSAMHSA, National Survey on Drug Use & Health, 2013

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33. Two million teens report feelings of depression and loss of interest in daily activities during the past year.Depressed teens are twice as likely as their peers to abuse or become dependent on marijuana.Teens who smoke marijuana as least once a month are 3x more likely to have suicidal thoughts than non-users.The percentage of depressed adults and percentage of depressed teens is equal, but depressed teens are more likely to use marijuana and other drugs.Teen Marijuana Use Worsens Depression

34. Anxiety disorders are among the most common mental, emotional, and behavioral problems to occur during childhood and adolescence. The estimated lifetime prevalence of any anxiety disorder is over 15%, while the 12-month prevalence is more than 10%. Most anxiety disorders are more prevalent in women than in men.About 13 of every 100 children and adolescents ages 9 to 17 experience some kind of anxiety disorder; girls are affected more than boys.1 About half of children and adolescents with anxiety disorders have a second anxiety disorder or other mental or behavioral disorder, such as depression. SAMSHA Information Center

35. APD More Common Among AddictedJournal of Clinical Psychiatry (June, 2005)An epidemiological study of 43,000 adults found a significant association between abuse or addiction and apd, conduct disorder, and adult apd behavior.This assoc. was higher for women than men.Dependence on tranquilizers, sedatives, marijuana, inhalants, or hallucinogens were more likely APD.Abuse of cocaine, alcohol, amphetamines, sedatives, or hallucinogens more likely to have adult apd behavior.We need need to treat APD syndromes to reduce abuse.By Nora Volkow – Director of NIDA.

36. Lifetime Prevalence of SUD in Persons with Axis I Mental Disorders – Regier et al. 1990 Alc/Drug Alcohol Other Drug_________________________________________Major Dep 27.2% 16.5% 18.0%Bipolar I 60.7% 46.2% 40.7%Schizophrenia 47.0 33.7% 27.5%Anx Disorder 23.7% 17.9% 11.9%

37. Lifetime Prevalence of Severe Mental Illness in Persons with Substance Use/Abuse - Buckley, 2006Adults using Ill Drugs w/MI 18.1%Adults not using Ill Drugs w/MI 7.8%Adults w/Sub Use Disorder w/MI 21.6%Adults w/o Sub Use Disorder w/MI 8.0%

38. Rates of APD, MDD and Anxiety Disorders by Drug Dependency - DATOSDrug Depend APD MDD Anxiety DisAlcohol Only 34.7% 17.8% 5.5%Heroin Only 27.0% 7.0% 2.0%Heroin & Alc 46.3% 13.2% 3.2%Cocaine Only 30.4% 8.4% 2.7%Coc & Alcohol 47.0% 13.6% 4.7%Coc & Heroin 44.0% 10.8% 2.2%Coc Her & Alc 59.8% 17.1% 6.3%__________________________________________Overall 39.3% 11.7% 3.7%

39. Lifetime Prevalence of Substance Abuse Disorders and APDThe 2001-2002 National Epidemiologic Survey of Alcohol and Related Conditions addressed lifetime prevalence of alcohol and substance abuse disorders.The survey showed that the lifetime prevalence was:30.3% of the population had an alcohol use disorder. 10.3% of the population had a drug use disorder.PopulationLifetime Prevalence of Drug Abuse Disorder10.3%Lifetime Prevalence of Alcohol Disorder30.3%APD3.9%

40. Is Treatment Effective?Many do not complyMany relapse There is no cureRates are similar to other diseasesI.e. diabetes, heart disease, obesity40

41. Relapse Rates Are Similar for Drug Dependence And Other Chronic Illnesses0102030405060708090100Drug DependenceType I DiabetesHypertensionAsthma40 to 60%30 to 50%50 to 70%50 to 70%Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, 2000.Percent of Patients Who RelapseAddiction Treatment Does Work

42. Rates of Medication AdherenceBipolar Disorder Schizophrenia Cardiovascular OsteoporosisOver 6 to 12 mos34% to 80%11% to 80%Beta 46% Cholesterol 44%43% to 53%

43. Popular Treatment ApproachesWhat’s PopularGeneral CounselingLectures/FilmsConfrontationRelaxationMilieu TherapyGroup psychotherapyMiller et al, 1995How Effective Are They?

44. APD More Common Among AddictedAn epidemiological study of 43,000 adults found a significant association between abuse or addiction and APD, conduct disorder, and adult APD behavior.This assoc. was higher for women than men.Dependence on tranquilizers, sedatives, marijuana, inhalants, or hallucinogens were more likely APD.Abuse of cocaine, alcohol, amphetamines, sedatives, or hallucinogens more likely to have adult APD behavior.We need need to treat APD syndromes to reduce abuse.Nora Volkow – Director of NIDA.Journal of Clinical Psychiatry (June, 2005)

45. What About an Intervention!?

46. What Works?Framework and interventions based on theory.Influencing behavior of individuals requires an individual or intrapersonal level theory. Behavior is directly related to what people know and think.Knowledge is necessary but usually doesn’t produce behavior change.Beliefs, motivations, skills, and social factors are major influences on behavior.Contemporary Health Behavior Theories are “Cognitive Behavioral”

47. Why Use a Cognitive Behaviorally Based Intervention?

48. Characteristics of Cognitive Behavioral Treatment (CBT) CBT Approaches Are Based On Scientific Learning Principles.CBT Approaches Focus On Changing How A Client Thinks And Acts. CBT Interventions Obviously And Directly Relate To The Client’s Difficulties and Problems.CBT Approaches Are Systematic.

49. Carl Jung said,“ I am not whathappened to me.I am what I chooseto become.”

50. Major Categories for TreatmentA. MotivationB. InsightC. Skills

51. Therapeutic Changes in Addiction/Six AreasBehaviorPhysiology/HealthAffective/EmotionSocial/FamilyCognitiveSpiritual

52. What Works Best? Evidence Based Practices!Interventions based on scientifically sound research studies:Experimental designSufficient sample sizeMatched groupsControl groupSpecific performance indicatorsAbility to generalize to the field when implemented with fidelity

53. WHY HAVE WE NOT BEEN SUCCESSFULWE HAVE NOT FOCUSED ON THE CORE ISSUES.WE HAVE FOCUSED ON WHAT WORKS FOR US - NORPSWE INVESTED IN DRUG TREATMENT ONLYWE DID NOT TAKE INTO ACCOUNT THE PERSONALITY HOW WE SEE THE WORLD - PERCEPTION

54. Moral Reconation Therapy-MRT, but WHY?Cognitive behavioralEvidence basedCurriculum based

55. Moral Reconation Therapy-MRTResearch shows increased life purpose, increase in medication adherence, increased adherence to treatment protocol, and decrease in risk behaviorIt address social, moral, and behavioral elements of the person’s perception with the major emphasis on improving decision making.It promotes the importance and need to adhere to a person’s individualized treatment plan.

56. Moral Reconation Therapy™MRT seeks to move clients from egocentric, hedonistic (pleasure vs. pain) reasoning to levels where concern for social rules and others become important. Research of MRT has shown that as clients pass steps, moral reasoning increases in adult and juvenile clients.

57. MRT FocusConfrontation of beliefs, attitudes, and behaviorsAssessment of current relationshipsReinforcement of positive behavior and habitsPositive identity formationEnhancement of self-conceptDecrease in hedonismDevelopment of frustration toleranceDevelopment of higher stages of moral reasoning

58. ConationA term derived from the philosopher Rene DeCartes to describe the point where body, mind and spirit are aligned in decision making. Reconation refers to altering the process of how decisions are made.

59. 1.Pleasure vs. PainKohlberg’s Theory of Moral Development2. Back Scratching3. Approval Seeking4. Law is the Law5.Social Contract6. Social ContractPost ConventionalConventional Pre Conventional

60. Program Goals for MRTDecrease high program dropout ratesImprove program completion ratesIncreased treatment adherenceProvide integration of programming across the continuum of treatment levelsReduction of relapse/recidivismDecrease technical violations

61. MRT Client Group Process MRT typically has groups of 5-15 client participants with one facilitator or co-facilitators where desired.Groups are designed to last approximately one and one half to two hours. Depending on client and site characteristics, groups are usually held at least once or twice weekly. Institutional settings typically have two or more meetings per week with community-based sites having one or two meetings per week.Clients in MRT typically prepare step exercises and tasks prior to group attendance and process their exercises in group or exercises are given to the facilitator for review and approval.  

62. MRT Client Group ProcessMRT is designed to be completed by the average client in 20-30 sessions.  Completion is defined when the client successfully passes MRT's 12th Step.MRT is specifically designed for clients with open-ended groups where participants can enter at any time and work at their own pace.

63. The delivery of MRT is both highly structured and directive, which gets clients engaged and keeps them on track.Achievements of each step in the program are clearly understood and client progress can be documented at every stage of the program.Clients quickly establish ownership of their participation in the program because the program emphasizes feedback and client reflection. Why MRT™ Works

64. Each step in the program involves completing specific assignments and reporting on how they completed the step.The program is culturally neutral and gender sensitive. Standardized curriculum and facilitator training ensures consistent program delivery and quality assurance.Finally, MRT is extremely cost-effective compared to other programs.Why MRT Works

65. DAY 18:30-10:00 AM: Introductory Remarks-On the cutting edge of treatment; Introduction and History of MRT™; Criminal Justice Statistics10:00 AM – 10:15 AM: Break10:15 AM – 12:00 PM: Characteristics of Effective Client Interventions; Introduction to MRT-Problems in Treating Sociopaths and Other Treatment Resistant Groups; Historical background of Antisocial Personality Disorder. 1:00 PM- 3:00 PM Evolution of APD treatment3:00 PM- 4:30 PM Cognitive-Behavioral TreatmentDAY 28:30-10:00 Moral reasoning as an essential treatment variable. Moral reasoning as the “missing element.” Dr. Lawrence Kohlberg’s moral reasoning levels.Methods of measuring moral reasoning. 10:00 a.m.- 12:00 p.m. MRT® Personality Theory. How the personality forms. Attitudes, Habits, Beliefs. The concept of the “Inner Self”. Defense mechanisms-insulators of the Inner Self. Identity formation: good and bad. Happiness as a measurable construct.1:00 p.m. – 2:00 p.m. Research on MRT. Effect on Recidivism & Rearrests. Relationship of Moral Reasoning to Recidivism.            MRT™ TRAINING OUTLINE

66. 2:00 PM- 4:30 PM MRT Steps and Personality Stages; Disloyalty-the stage of most clients; low moral reasoning, sociopathic beliefs and behaviors. (Steps 1 & 2) DAY 38:30-10:00 a.m. Opposition-Low moral reasoning, confrontational, manipulative, and hostile. (Step 3) 10:00 AM- 12:00 PM. Uncertainty-indecisive, no direction with rapidly swinging behavior and moral judgments. (Step 4).1:00 PM - 4:30 PM Injury-awareness of injury, feelings of inadequacy, worthlessness, low self-esteem. (Steps 5 & 6) DAY 48:30-10:00 AM Nonexistence-no identity, unsure of control in life, no sense of direction. (Steps 7 & 8)10:00 AM - 12:00 PM. Danger-has a sense of identity and personal goals. (Steps 9 & 10) 1:00 PM – 2:00 PM Emergency-goals not as self-serving and egocentric. Tries to do too much out of commitment. (Step 11) 2:00 PM- 2:45 PM Normal-lives life in a manner that leads to the fulfillment of needs rather easily. (Step 12) 2:45 PM – 3:30 PM Grace-reached by few people; feels at one with things, sees thing in totality. (Steps 13-16)3:30 PM – 4:00 PM MRT Treatment Elements. Confrontation of self explained as a process. Assessment of relationships. Reinforcement of Appropriate Behavior. Building Positive Identity. Enhancement of Self-Concept. Decrease Hedonism-Develop Tolerance of Delay of Gratification. Development of Higher Stages of Moral Reasoning.4:00 PM – 4:30 PM Conclusion, Wrap-up, Questions & Answers.

67. Pharmacological InterventionsGoals – Provide:relief from withdrawal symptoms, prevent drugs from working, reduce craving, aversive reactionsThese actions are helpful in reducing relapse and increasing retention in programs

68. Pharmacological Interventions Methadone – Opiate addiction – reduces craving, mediates withdrawal symptoms, helps restore normal functioning Buprenorphine – similar to methadone, may be prescribed by an MD with special training Acamprosate – reduction of alcohol cravings Antabuse – produces adverse reaction with alcohol use

69. Pharmacological Interventions Naltrexone / Nalmefene – stops opiates from working, changes alcohol action for some – reduction in relapse Neurontin – helps with insomnia in early recovery Clonidine – reduction of withdrawal symptoms – possible reduction in cravings Baclofen – possible reduction in cocaine cravings

70. National GAINS Center70The Case for an Integrated Approach for Co-occurring Disorders Traditional, non-integrated approaches result in poorer outcomesAn integrated, multidisciplinary approach is needed:Incorporates the staff and treatment approaches from the mental health fieldNot addressing their challenges in an integrated fashion means their instability will continue resulting in greater cost of time, energy and resource.

71. National GAINS Center71Consequences For Not Addressing Co-occurring Disorders Difficulty in adjusting to treatment groups, employment, and other program activitiesFrequent hospitalization and other mental health emergenciesHigh rates of dropout from programsRapid cycling to other parts of the criminal justice system – re-arrest, re-incarceration, hospitals, jails and thus never stabilizing.

72. National GAINS Center72What Works? Evidence-Based PracticesMedicationsIllness self-management recovery skillsFamily psychoeducationSupported employmentAssertive Community Treatment (ACT)Integrated services for co-occurring disorders

73. Evaluation

74. Individualized Standardized Assessment Protocol (ISAP)Administer Pre and Post-test:The ISAP assesses medical, HIV/STD/TB risk, substance abuse and treatment history, employment, education, criminal history, family history, psychological, parenting, housing, life skills, community support, and transportation.

75. Life Purpose QuestionnairePre and Post TestThe LPQ is a 20-item scale that assesses perceived meaningfulness and purpose. The questionnaire is scored from 0 to 20, with higher scores suggesting greater perceived meaning/life purpose.Increased life purpose yields increased medication adherence and treatment protocol AND decreased risk behavior (unsafe sex and substance use)

76. Reviewing the Facts….

77. REINCARCERATION RATES OF MRT TREATED FELONY OFFENDERS COMPARED TO NON-TREATED CONTROLS ONE TO TEN YEARS AFTER RELEASE(SHELBY COUNTY CORRECTION CENTER, MEMPHIS, TN 1987-1998)YEARS OF RELEASEREINCARCERATION RATE

78. Bonneville County MH CourtBegan in 20021 of 5 National Learning SitesFirst graduate was a Drug Court Drop Out

79. Is MH Court Successful?98% Decrease in Hospitalizations85% Decrease in Jail Days in 3 yearsSix year outcome shows 75% arrest free.

80. WARMLong term residential treatment facility for 80 women exhibiting symptoms of drug and alcohol dependence, with 52 beds designated for those women who are pregnant, post partum, and parenting young childrenWomen are permitted to include their children in the treatment process. Children under the age of six may reside at the facility with their mother.Older children are eligible to visit on the weekend. Research supports the notion that addiction is a family problem. Allowing children to remain connected with their mother during this time assists the family in healing.

81. WARM’s Treatment ApproachUtilizes evidenced-based practices such as Moral Reconation Therapy, amongst others. The women learn healthy coping skills, boundaries in relationships, development of necessary life skills, and enhanced parenting abilities.They also learn to address the devastating traumas that many women have faced throughout their life. In the years since WARM opened in 1999, over 203 children have been born drug free as a result of the opportunity for treatment their mothers were provided. At any given time, WARM is home to several pregnant women and nearly two dozen children.

82. WARM Performance StandardsSuccessful completion rate: 72%Working or in school at time of discharge: 85%Regained or maintained custody of children: 100%Babies born drug-free: 18 (Boys 7/Girls 11)Children who resided at WARM: 72Children who visited WARM on weekends: 88

83. MRT™ -Treated Participants in Virginia Drug Courts Show a Substantively Significant Reduction in Recidivism RiskExcerpted from Virginia Adult Drug Treatment Courts Cost Benefit Analysis October 2012 by Fred L. Cheesman, Ph.D., Tara L. Kunkel, MSW, et. Al., National Center for State Courts , Williamsburg, VA

84. Drug Courts who use MRT™ have a recidivism rate that is 65% lower than Drug Courts who do not employ MRT™Excerpted from Virginia Adult Drug Treatment Courts Cost Benefit Analysis October 2012 by (Fred L. Cheesman, Ph.D., Tara L. Kunkel, MSW, et. Al., National Center for State Courts , Williamsburg, VA.) 2012

85. This study reports on a meta-analysis of moral reconation therapy (MRT). Recipients of MRT included adult and juvenile offenders who were in custody or in the community, typically on parole or probation. The study considered criminal offending subsequent to treatment as the outcome variable. The overall effect size measured by the correlation across 33 studies and 30,259 offenders was significant (r = .16). The effect size was smaller for studies published by the owners of MRT than by other independent studies. A Meta-Analysis of Moral Reconation Therapy by Myles Ferguson and J. Stephen WormithInternational Journal of Offender Therapy and Comparative Criminology, 2012, XX(X) 1–31.

86. Typical Programs RetentionRate is 28% after six monthsTraining And Employment Report Of The Secretary Of Labor ,    Written under the direction of the Department of Labor's Employment and Training Administration (ETA), Office of Research and Policy, 1998 <>

87. Tidewater Community College resultsSUCCESSFUL COMPLETIONS - 77%EMPLOYMENT PLACEMENTS - 94%6 MONTH RETENTION OF JOB - 92%TRANSITION TO LONG TERM - 92%INCREASE IN EMPLOYER - 60% COMMITMENTS

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89. SAMSHA’s Definition of TraumaIndividual trauma results from an event, series of events, or a set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being.

90. MRT Works: Thurston Co, WA Drug Court Program Treating Trauma & DepressionFindings indicate:MRT alone reduced depression 67%Impacted clinically significant self-esteem areas by 24%Reduced traumatic symptoms by 24%

91. Questions?

92. For More Information:Contact CCI901-360-1564www.ccimrt.com