Prescription Drug Abuse: Loosening the Knot - PowerPoint Presentation

Slide1

Prescription Drug Abuse: Loosening the Knot

J. Patrick

Slifka

, LCSW & George Young, LCSWSlide2

Why We’re HereSlide3

Dealer out of Business?

http://www.youtube.com/watch?v=Cb93lPJB8ywSlide4

Which is More Dangerous?

http://www.youtube.com/watch?v=u_nCqak6mYQSlide5

“Just The Facts”

All of these drugs are available – right now.

They do what they’re “advertised to do.”

If your individuals (particularly your adolescent ones) have not been already, they will soon be in a position to make a choice…to use or not to use. Their choice will carry both a benefit and a consequence. Slide6

“Just The Facts”

Drugs are not

inherently

evil, bad, or good – they’re simply chemicals.The Relationship a person forms with a drug becomes the problem – and the problem gets progressively and significantly worse over time.Remember that not all individuals have the same responses to the same drug or class of drugs. There are idiosyncratic reactions we have to assess and understand.Slide7

Why We’re Here?

Epidemic? Problem?

Attitude is the father of the ActionEthical Obligation and Competent PracticeSlide8

Jeopardy TimeSlide9

Jeopardy Question #1

The Answer is:

Patients leave a doctor’s office with this on 7 out of every 10 visits.

What is a Prescription?Slide10

Jeopardy Question #2

The Answer is:

Medicine Cabinets

Where do a large number of teens who abuse prescription medications get their drugs?Slide11

Jeopardy Question #3

The Answer is:

Dr. Gregory House and American High School Seniors identify this prescription drug as their favorite.

What is Vicodin?Slide12

Trends and Statistics

The LandscapeSlide13

A View of the Landscape

http://www.youtube.com/watch?v=1sdFRJtzI0sSlide14
Slide15

Rates of Rx drug sales, deaths and substance abuse

tx

admissionsSlide16
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1 in 6 TeenagersSlide22
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Most Commonly Abused Medications Among U.S. High School Seniors (2010 Annual Prevalence)

Source: Monitoring the Future, University of Michigan, December 14, 2010Slide24
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Slide26

What is Driving the Prevalence?

Misperceptions about safety.

Increasing e

nvironmental availabilityVaried motivations for their abuse.Slide27

Other Factors Driving Trend: Pill-Taking Society

Rx medications are all around us…and teens notice.

Patients leave the doctor’s office with a prescription in hand in 7 out of 10 visits.

Direct-to-consumer advertising on TV and in magazines.

Many people don’t know how to safely use these medications or ignore their doctor’s instructions.

Slide28

Common Prescription Drugs of Abuse

Signs, Symptoms and

Biopsychosocial

ConsequencesSlide29

Top 10 Most Dangerous Drugs in America (DAWN database of ER visits)

Xanax

Oxycontin

VicodinMethadoneKlonopin

Ativan

Morphine Drugs (opiates)

Seroquel

(Antipsychotic)

Ambien

ValiumSlide30

Most Commonly Abused Classes of Prescription Drugs

Opioid Pain Relievers (Opiates, Narcotics)

CNS Stimulants (primarily those used in the

tx of ADHD)CNS Depressants (Sedatives, Hypnotics, Anxiolytics)Slide31

Key Assessment Point: Effects of Drugs Depend on…

Route of administration

Amount taken at one timeUser’s past drug experience

Circumstances under which the drug is taken (the place, the user’s psychological and emotional stability, the presence of other people, simultaneous use of alcohol and other drugs, etc.)Slide32

Commonly Abused Rx Drugs

How they work

Abused to

Drug names

Strong Pain Relievers

Used to relieve moderate-to-severe pain, these medications block pain signals to the brain

To get high, increase feelings of well being by affecting the brain regions that mediate pleasure

Vicodin

,

OxyContin

,

Percocet,

Lorcet

,

Lortab

,

Actiq

,

Darvon, Codeine, Morphine,

Methadone

Stimulants

Primarily used to treat ADHD type symptoms, these speed up brain activity causing increased alertness, attention, and energy that comes with elevated blood pressure, increased heart rate and breathing

Feel alert, focused and full of energy—perhaps around final exams or to manage coursework, lose weight

Adderall

, Dexedrine

Ritalin,

Concerta

Sedatives or tranquilizers

Used to slow down or “depress” the functions of the brain and central nervous system

Feel calm, reduce stress, sleep

Valium,

Xanax

,

Ativan

,

Klonopin

,

Restoril

,

Ambien

,

Lunesta

,

Mebaral

, Nembutal, SomaSlide33

Opioid Pain Relievers (Opiates/Narcotics)Slide34

What are Opiates?

Opiates are a group of drugs that are used for treating pain. They are derived from opium which comes from the poppy plant.

Opiates

go by a variety of names including opiates, opioids, and narcotics. The term opiates is sometimes used for close relatives of opium such as codeine, morphine and heroin, while the term opioids is used for the entire class of drugs including synthetic opiates such as Oxycontin

.

But

the most commonly used term is opiates

.Slide35

Dried Opium PoppySlide36

Commonly Used & Abused Opiates

Opium

Codeine …anybody you’re working with taking any of these?

MorphineTramadol (Ultram)MethadoneBuprenorphine (Subutex)Propoxyphene (Darvocet)

Pethidine

(Demerol)

Hydrocodone (

Lortab

/

Vicodin

)

Oxycodone (Percocet,

Oxycontin

)

Hydromorphone

(

Dilaudid

)

Oxymorphone

(

Opana

)

Fentanyl

Heroin (diacetylmorphine)Slide37

Most Rx’d

Opiate in AmericaSlide38

OxycontinSlide39

Opiates

Opiates are highly effective in controlling moderate to severe pain, but they also have a downside. Opiates are highly

addictive…and

once a person starts abusing them he/she generally becomes dependent (addicted) to them.Slide40

Opiate Effects

Feelings of Euphoria

Suppression of Pain

Depressed Respiratory RateLowered Heart Rate and Blood PressureLethargy/Drowsiness

Clouded Mental Functioning

Nausea/Vomiting

Lowered Body Temperature

Muscle and Bone Pain

Physical/Psychological Dependence

Severe Withdrawal Symptoms

Mood Swings

Severe Constipation

Unconsciousness

Coma

Death by OverdoseSlide41

Opiates: Long Term Effects

Cause significant changes to the nerochemical, molecular and cellular levels.

Changes brain structure and functioning that lasts well beyond the substance use.

These changes are part of what can trigger drug cravings years after last use.Slide42
Slide43

How Do Opiates Work?

Opiates

elicit their powerful effects by activating

opiate receptors that are widely distributed throughout the brain and body. Once an opiate reaches the brain, it quickly activates the opiate receptors that are found in many brain regions and produces an effect that correlates with the area of the brain involved.Slide44

How Do Opiates Work?

Two important effects produced by opiates, such as

morphine, are pleasure (or reward) and pain relief. The brain itself also produces substances known as

endorphins that activate the opiate receptors. Research indicates that endorphins are involved in many things, including respiration, nausea, vomiting, pain modulation, and hormonal regulation.Slide45

Opiate Agonists

Opiate agonists are drugs that

stimulate the opioid receptors in the brain

, leading to the high associated with opiate drugs. They include Heroin, Vicodin, Morphine, Codeine and Methadone.They mimic the effects of naturally-occurring endorphins in the body, and produce an opiate effect by interacting with the opioid receptor

sites.Slide46

Opiate Antagonists

Opiate antagonists block the brain’s opioid receptors, making it impossible for opiate drugs to stimulate them. For example, drugs like

Naloxone

and Naltrexone make it so that, if the user were to take a drug like heroin afterwards, there would be no high. These medications are often used to combat the overdose effects of an opiate or to help break an addiction.Slide47

Partial Opiate Agonists

Partial opiate agonists are drugs that have a “ceiling effect.” In other words, they can only stimulate the opioid receptors to a certain extent.

Buprenorphine,

the main ingredient in Suboxone, is one of these. No matter how much Suboxone you take, its effects are limited.Slide48

Sedatives, Hypnotics, and AnxiolyticsSlide49

Sedatives, Hypnotics and Anxiolytics

Drugs that reversibly depress the activity of the central nervous system.

Barbiturates, Benzodiazepines

, and other sedative-hypnotics have diverse chemical and pharmacological properties that share the ability to depress the activity of all excitable tissue, especially in the arousal center of the brainstem.Barbiturates (Sedatives): Amytal, Nembutal,

Seconal

and Phenobarbital.

Benzodiazepines

(Anti-Anxiety):

Ativan, Halcion, Librium, Valium, Xanax, and Rohypnol.

Other Sedative-Hypnotics

(Sleep Inducers):

Lunesta

, Sonata, Ambien.Slide50

Barbiturates

In therapeutic doses, barbiturates are effective and are typically used for seizure disorders and anesthesia. Using them to “get high” is extremely dangerous because there is a relatively small difference between the desired dose and an overdose.

A small miscalculation, which is easy to make, can lead to coma, respiratory distress (breathing slows or stops) and death.

Withdrawal from barbiturates is similar to, and sometimes more severe than, alcohol withdrawal. Seizures are possible and can also lead to death.Slide51

Common Barbiturates

Amytal

NembutalSeconal

Phenobarbital Seconal 100mgA barbiturate may be prescribed for a variety of reasons, the list is extensive, but the most common use today is as an anesthesia for surgery. This form is hardly ever abused because they cause almost immediate unconsciousness.

Other

forms like Phenobarbital are used in treating various seizure disorders as an anticonvulsant. Other uses of this form of barbiturate along with

mephobarbital

include treating anxiety, insomnia, epilepsy and delirium tremens. Slide52

Benzodiazepines

The

benzodiazepine family of depressants is used therapeutically to produce sedation, induce sleep, relieve anxiety and muscle spasms, and to prevent seizures. In general, benzodiazepines act as

hypnotics in high doses, anxiolytics (anti-anxiety) in moderate doses, and sedatives in low doses.

Of

the drugs marketed in the United States that affect central nervous system function, benzodiazepines are among the most widely prescribed

medications.

Compared to barbiturates,

benzodiazepines

are much safer. They cause sedation but rarely stop a person’s breathing or lead to death (unless combined with other CNS depressants).Slide53

Common Benzodiazepines

Ativan

HalcionLibrium

RestorilValiumXanaxRohypnol (not marketed in U.S.)Slide54

Other Sedative-Hypnotics: Sleep Aids

This is a newer class of drugs that is used for the short-term treatment of insomnia. They cause the onset of sleep to occur faster and allows for a longer sleep period throughout the night

.

These non-benzodiazepines have a short half-life and have less chance of causing dependency, tolerance, and impairment of daytime activities due to carry-over effects

.

Again, combining any of these drugs or using them with alcohol (and other depressants) can lead to dangerous effects.Slide55

Common Sleep Aids/Hypnotics

Ambien/Ambien CR

SonataRozerem

PrecedexLunestaSlide56

CNS StimulantsSlide57

CNS Stimulants

CNS Stimulants are a class of drugs that elevate mood, increase feelings of well-being and increase energy and alertness. Examples include:

Caffeine *Amphetamines Cocaine

Methamphetamine

“Bath Salts”Slide58

Amphetamines

Synthetic psychoactive CNS stimulant drugs including amphetamine,

dextroamphetamine and methamphetamine

Medications containing amphetamines are prescribed for narcolepsy, obesity and ADHD (including Adderall, Dexedrine, DextroStat, and Desoxyn). The basic molecule of amphetamine can be modified to emphasize specific actions (e.g., appetite suppressant, CNS stimulant, cardiovascular actions) for certain medications…including methylphenidate (Ritalin and

Concerta

).Slide59

DexedrineSlide60

RitalinSlide61

AdderallSlide62

Adderall: The “Study Pill”

http://www.youtube.com/watch?v=1gQNg2f15dkSlide63

Amphetamines

Cause release of the neurotransmitters dopamine and norepinephrine – and their reuptake is inhibited.

This influx causes the buildup of NTs at synapses in the brain.

When mixed with other drugs (including alcohol), the effects of prescription amphetamines are enhanced. When the drug is snorted, effects occur within 3-5 minutes. When ingested orally, effects occur within 15 to 20 minutes.Slide64

Amphetamines: Short-Term Effects

Increased activity/talkativeness

Decreased fatigue/drowsiness

Heightened sense of well-beingHeightened alertness/energyEuphoriaRelease of social inhibitionsAltered sexual behaviorUnrealistic feelings of cleverness, great competence, and powerHostility or paranoia

Increased body temperature

Irregular or increased heart rate

Increased diastolic/systolic BP

Decreased appetite

Dry mouth

Dilated pupils

Increased respiration

Nausea

Headache

Palpitations

Cardiovascular system failure

Twitching/Tremor of small musclesSlide65

Amphetamines: Long-Term Effects

Toxic psychosis

Physiological and behavioral disorders

DizzinessPounding heartbeatDifficulty breathingMood/Mental changesUnusual tiredness/weaknessCardiac arrhythmiasRepetitive motor activity

Ulcers

Malnutrition

Mental Illness

Skin disorders

Vitamin deficiency

Flush or pale skin

Loss of coordination and physical collapse

Convulsions, coma and death.Slide66

Amphetamines: Potential for Abuse

Rx amphetamines are taken orally and in low doses, drug abuse and addiction are not serious risks.

Abuse of amphetamines can lead to tolerance and physical/psychological dependence characterized by consuming increasingly higher dosages and by the “binge and crash” cycle.

When the binge episode ends, the abuser “crashes” and is left with severe depression, anxiety, extreme fatigue, and a craving for more drugs. The chronic abuse of amphetamines is characterized by erratic (sometimes violent) behavior – as well as a psychosis similar to schizophrenia.Slide67

Screening and EvaluationSlide68

Screening & Assessment: 3 Primary Goals

1. To Obtain Information/Collect a Database

2. To Determine Eligibility for a Particular Service

3. To Engage the Individual/Family in the Treatment

ProcessSlide69

The Clinical Assessment Interview: Basic Elements

Only

One

part of a multimodal evaluationFormally arranged meetingHas specific purposeInterviewer chooses topic/broad contentDefined relationships

Interviewer attuned to ALL aspects of interaction - Affect, Behavior, Style (Process) and Content

Questioning techniques/strategies employed to direct the flow of conversation

Acceptance of client's expressions of feelings and factual information without casting judgment

Interviewer makes explicit what otherwise be left unstated

Assessor follows guidelines for confidentiality and disclosure of info.Slide70

What a Clinical Assessment Interview is NOT...

Ordinary Conversation

"Counseling" Session

Forensic InterviewSurvey InterviewSlide71

The Assessment Interview: Assumptions

1. Need for Multiple Data Sources:

There is no gold standard for assessing people's functioning. The key to good assessment is to find the conceptual links and relationships between methods and modalities of the assessment. Each form of indirect and direct methods contributes unique elements to solving the puzzle (Wheel of Fortune).Slide72

Assumptions (Cont.)

2. Situational Variability:

Individuals' behaviors are likely to vary across situations and relationships. Good assessment requires identifying patterns of behavior that DIFFER across situations and relationships as well as patterns that REMAIN CONSISTENT, despite variations in situations and relationships.

Slide73

Assumptions (Cont.)

3. Limited Cross-Informant Agreement:

There is likely to be only low-to-moderate agreement between informants who are in different situations or in different relationships with the same person (esp. children). Low agreement does not mean that one is right and one is wrong or that one has a "truer" picture. The challenge is to put all these pieces together to form a meaningful picture of the person's functioning under the given circumstances.Slide74

Assumptions (Cont.)

4. Variations in Interview Structure and Content:

The structure and content of clinical interviews should vary in relation to the informant and the goals of the interview. Structured, semi-structured, direct observation, indirect data collection, age/role appropriateness, etc. Clinical interviews need to be tailored to particular informants. The content and questioning strategies are shaped by the kind of informant interviewed and the kind of information sought.Slide75

Interview Content and Questioning Strategies

1.

Semi-Structured:

Questions used to query client (and others) about many aspects of functioning. Format is relatively open-ended and flexible to stimulate a natural flow of conversation. MI strategies are used (empathy, reflective listening, summarizing). Probe questions can then be used to obtain more detailed information.

2.

Structured:

Appropriate for querying individuals/family members about symptoms and criteria for psychiatric disorders. Structured diagnostic interviews have a standardized set of questions and probes focusing on specific problems relevant to diagnoses.Slide76

Interview Content and Questioning Strategies (Cont.)

3.

Behavior-Specific:

Questions can be used to query family members parents, teachers, PO's, etc. regarding their current concerns about the individual. More narrow in scope than semi-structured because the focus is on a limited number of specific problem areas. Typically, the main purposes

are:

a) identify and define problems of concern of others (

problem identification

)

b) examine antecedents and consequences that surround the identified problems (

problem analysis

)

Assessors can also use behavior-specific questions to elicit from individuals their views of particular problems and their understanding of the consequences around the problems.Slide77

Interview Content and Questioning Strategies (Cont.)

4.

Problem-Solving:

Focus on others' current concerns with the goal of developing interventions for identified problems. In initial clinical interviews, assessors can use problem-solving questions to explore and gauge others' receptivity to different kinds of interventions prior to implementing any interventions.

Can also use problem-solving questions to explore individual’s views of different interventions and to find out which approaches are acceptable to them.Slide78

Preparation: Master Your Material

Preparation and Mastery increase your confidence and competence. Your goals include...

Understanding and applying all aforementioned material

Learning and knowing intimately all sections (and the purpose for each) of the assessment formsMastering the art of Motivational InterviewingReading, Studying, Understanding DSM-IV/DSM-5 diagnostic criteria - and applying structured interviewing strategies to rule out and rule in dx

Knowing what you don't know - and learning itSlide79

Preparation and Mastery: Conceptualizing Your Case

Guided by: Observing, Questioning, Thinking

(repeat ad

nauseum)Study your prelim. Info (Screening Form, etc.) and apply the above...Begin your studies/researchGenerate Questions

Formulate Hypotheses (not conclusions)

Prepare, Prepare, Prepare...

Slide80
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Key Terms

Tolerance:

(a) a need for markedly increased amounts of the

substance to achieve intoxication or desired effect. (b) markedly diminished effect with continued use of the same amount of the substance (DSM-IV TR).

Potentiation:

Potentiation occurs when two drugs are taken together and one of them

intensifies

the action of the other.

This

could be expressed by

a +b= B.

As an example, - an

antihistamine, when given with a painkilling

narcotic

such as

Percocet ,intensifies

its

effect thereby

cutting down on

the

amount of the narcotic needed.

Slide82

Key Terms

Cross Tolerance and Cross Dependence:

Cross

tolerance refers to the fact that if a person has developed a tolerance to a drug in a certain classification, such as the depressants, that person is more likely to develop tolerance with another drug in that classification.

As

an example, people who are dependent upon alcohol show an increased tolerance to barbiturates, synthetic and natural opiate narcotics, and anesthetics. This, of course, means that the person must have a higher dose of the new drug for it to be effective.

In

cross dependence

, the withdrawal symptoms from one drug in a classification can be relieved by another

.

As an example, many alcoholics are given barbiturates and tranquilizers to prevent withdrawal symptoms. However, the person may soon develop a dependency on the other drug as well.Slide83

Key Terms

Synergism:

Synergism

is similar to potentiation. If two drugs are taken together that are similar in action, such as barbiturates and alcohol, which are both depressants, an effect exaggerated out of proportion to that of each drug taken separately at the given dose may occur. This could be expressed by 1+1= 5. An

example might be a person taking a dose of alcohol and a dose of a barbiturate. Normally, taken alone, neither substance would cause serious harm, but if taken together, the combination could cause coma or death

.Slide84

Key Terms

Withdrawal:

Withdrawal

is a term referring to the feelings of discomfort, distress, and intense craving for a substance that occur when use of the substance is stopped. These physical symptoms occur because the body had become metabolically adapted to the substance. The withdrawal symptoms can range from mild discomfort resembling the flu to severe withdrawal that can actually be life threatening. Withdrawal from particular substances can be

extremely serious

and

dangerous

(potentially life-threatening). Refer to the DSM-IV TR and or DSM-5 for drug-specific withdrawal profiles.Slide85

Interventions/Best PracticesSlide86

Treatment: Key Components

Established Clinical Model that is evidence-based

Individualized assessment and

person-centered treatment planningFull array of integrated services (MH and SA, etc.)Individual, Family and Group TherapiesPsychoeducationMotivational Interviewing/Motivational Enhancement (strengths-based)

Cognitive-Behavioral Interventions

Relapse and Recovery Planning

Connection and Collaboration with Community Resource and Associated Professionals (wrap-around)

Frequent/randomized drug/alcohol screening

AccountabilitySlide87
Slide88
Slide89

Drug Testing

Critical Component of any treatment program

Urine lab testingUrine instantOralHairSlide90

Pay Attention! What to “watch” for when conducting drug screens

All testing needs to be

Observed

whenever possible.Dilution – water loading/adding water to samples Flushing – ingesting Niacin or Golden Seal (or any of hundreds of other products on the market)Substituting – synthetic urine or borrowing/storing urine

Mechanical Devices – the “

Wizinator

,” small bottles or tubes Slide91

Screening: Other things to Know

Know where your individuals can get tested (and what kind of testing they conduct)

Know what medications your individuals are taking

Connect with a therapist or doctor that conducts drug screens, or make sure you call the lab toxicologist for specific informationYou do not have to be the expert on all information, but know where to get the information and be willing to puruse it!Slide92

Principles of Effective Treatment (National Institute of Drug Abuse, 2012)

Addiction is a complex but treatable disease that affects brain function and behavior.

No single treatment is appropriate for everyone.

Treatment needs to be readily availableEffective treatment attends to multiple needs of the individual, not just his or her substance abuse.Slide93

Principles of Effective Treatment (cont.)

Remaining in treatment for an adequate period of time is critical.

Behavioral therapies – including individual, family, or group counseling – are the most commonly used forms of drug abuse treatment.

Medications are important element of treatment for many individuals, especially when combined with counseling and other behavioral therapies.Slide94

Principles of Effective Treatment (Cont.)

An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that is meets his or her changing needs.

Many drug-addicted individuals also have other mental disorders.

Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuseSlide95

Principles of Effective Treatment (Cont.)

Treatment does not need to be voluntary to be effective.

Drug use during treatment needs to be monitored continuously, as lapses during treatment do occur.

Treatment programs should test individuals for the presence of HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases as well as provide targeted risk reduction counseling, linking individuals to treatment if necessary.Slide96

ASAM Criteria: Case Conceptualization

Wherever the treatment location or circumstances,

some guidelines

have suggested criteria to consider when treating substance dependence. The following criteria were developed by the American Society of Addiction Medicine (ASAM) to consider in the treatment of dependence:

1. acute intoxication and/or withdrawal potential

2. biomedical conditions and complications

3. emotional, behavioral, or cognitive conditions and complications

4. readiness to change

5. relapse, continued use, or continued problem potential

6. recovery/living environmentSlide97

ASAM Levels of Treatment

ASAM Levels

Level 0.5 = Early Intervention Services

Level 1 = Outpatient Treatment Services(3 hours a week or less)Level 2 = Intensive Outpatient/Partial Hospitalization (9 hours per week at least)

Level 3 = Residential/Inpatient Services (24 Hours/Day)

Level 4 = Medically Managed Intensive Inpatient Services

Reference:

www.asam.org

Slide98

Opiate Withdrawal and DetoxificationSlide99

Opiate/Narcotic Withdrawal

Opiate addicts avoid treatment because they are afraid of withdrawal, which can be rather unpleasant but rarely fatal. They crave the drug and experience muscle and bone pain, insomnia, restlessness, nausea and vomiting, sweating, involuntary muscle twitches, dry mouth.

Opiate withdrawal will usually peak between 48-72 hours after the last use. But withdrawal can last much longer, depending on the individual. Slide100

Detoxification and “Maintenance”

Medications have been developed to lessen the impact of the withdrawal and help addicts rid themselves of the need to use. Principal among these are

Methadone

and Suboxone, both synthetic opiates themselves, but both act to block the impact of the opiates. Slide101

Maintenance Therapy

Maintenance therapy with drugs like methadone or Suboxone is helpful because it takes away the severe effects of a heroin or prescription painkiller habit while easing the symptoms of withdrawal.Slide102

APA Guidelines for Opiate Dependence

The American Psychiatric Association (APA) guideline

identified the following 3 treatment modalities to be effective

strategies for managing opioid dependence and withdrawal:1. opioid substitution with methadone or buprenorphine, followed by a gradual taper2. abrupt opioid discontinuation with the use of clonidine

to suppress

withdrawal symptoms

3. clonidine-naltrexone detoxificationSlide103

Considering Your Options in Dealing with an Opiate Dependent Individual

Acute opioid-related disorders that require medical management include

opioid intoxication,

opioid overdose, and opioid withdrawal. Issues pertaining to treatment of chronic opioid abuse include opioid agonist therapy (OAT), psychotherapy, and treatment of acute pain in patients already on maintenance therapy. Slide104

Intensive Case ManagementSlide105

The Importance of Coordinated Intervention

We need an integrated, coordinated community response focused on recovery. This type of approach is more effective in preventing, treating and managing the chronic consequences of substance abuse and addiction than a response that is fragmented or focused primarily on penalties.

We need a systematic response that is fast, fluid and flexible…meeting needs as they arise and changing through the continuum of care.Slide106

Intensive Case Management and Wrap- Around: Who Needs to be Involved?

The prescribing physician

Significant other(s)

Probation or parole (if a part of the case)Other clinicians (if part of the case)Other “natural supports” (as part of a high-fidelity wrap around team)Please make sure you follow all confidentiality regulations under 42 CFR Part 2.Slide107

Why include these people? What’s the rational?

Liability

Appropriate Service/Treatment Planning

Best PracticeSlide108

Case Study ExerciseSlide109

Case Study: Time to Pick each others’ Brains and Generate some Ideas!Slide110

“Dedicated Service To Those In Need”

Our strong reputation keeps us increasingly committed to providing high quality services to youth and families in the community

.Slide111

Additional References and Resources

www.nationalcounselinggroup.com

American Psychiatric Association. (2000).

Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.American Psychiatric Association. (2013).

Diagnostic and statistical manual of mental disorders

(5

th

ed.). Washington, DC: Author.

Johnston, LD, O'Malley, PM, Bachman, JG, &

Schulenberg

, JE. (2012).

Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings

, 2011. Ann Arbor: Institute for Social Research, University of Michigan. Available at

http://monitoringthefuture.org

.

Levine, DA. (2007). “'Pharming': The abuse of prescription and over-the-counter drugs in Teens.”

Current Opinion in Pediatrics.

Vol. 19, No. 3, pages 270-274

.

National Institute on Drug Abuse. NIDA

InfoFacts

: Prescription and Over-the-Counter Medications.

http://www.drugabuse.gov/infofacts/PainMed.html

). Bethesda, MD: NIDA, NIH, DHHS. Published June 2009. Retrieved February 2012

.

National

Institute on Drug Abuse. NIDA Research Report: Prescription Drugs: Abuse and Addiction.

http://www.drugabuse.gov/ResearchReports/Prescription/Prescription.html

. NIH Publication No. 11-4881. Bethesda, MD: NIDA, NIH, DHHS. Published July 2001. Revised October 2011. Retrieved February 2012.Slide112

References and Resources (Cont.)

http

://emedicine.medscape.com/article/1174630-overview

http://www.nytimes.com/interactive/2012/06/10/education/stimulants-student-voices.htmlhttp://www.chesterfieldsafe.orgwww.unifiedpreventioncoalition.comhttp://www.samhsa.gov/http://www.nida.nih.gov/nidahome.htmlhttp://www.suboxone.com

http://www.drugalcoholaddictionrecovery.com

http://drugpubs.drugabuse.gov/

http://www.whitehousedrugpolicy.gov/drugfact/juveniles/juvenile_drugs_ff.html

www.erowid.com

http://learn.genetics.utah.edu/content/addiction/

http://www.theantidrug.com/drug-information/default.aspxSlide113

Additional References and Resources

http

://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/rx_abuse_plan.pdf

“Epidemic: Responding to America’s Prescription Drug Crisis”  http://www.drugabuse.gov/publications/principles-drug-addiction-treatment “Principles of Drug Addiction Treatment: A Research-Based Guide (3rd Edition) http://www.drugabuse.gov

http://www.youtube.com/watch?v=E0ihO1KFxkQ

“Students Seek Competitive Edge…”

http://www.youtube.com/watch?v=1gQNg2f15dk

“Adderall: The Study Pill

”

http://www.youtube.com/watch?v=1sdFRJtzI0s

“PBS

NewsHour

Excerpt:Prescription

Drug Abuse (aired 5/2013)

http://www.youtube.com/watch?v=_mgQHSCDswQ&NR=1&feature=fvwp

“Prescription Drug Abuse”

http://www.nytimes.com/interactive/2012/06/10/education/stimulants-student-voices.html?emc=eta1#/#1

“In Their Own Words: Study Guides.”