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 ID: 157949
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Slide1
Where Are We Going?
William Frank Barker, LPC, MAC
Diane Diver, LMSW, CAC IISlide2
The Perfect StormSlide3
The FieldSlide4
Key Forces
WORKFORCESlide5
HealthcareSlide6
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 peopleSlide7
Relapse Rates Are Similar for Drug Addiction
& Other Chronic Illnesses
100
Type I
Diabetes
Drug
Addiction
0
10
20
30
40
50
60
70
80
90
Hypertension
Asthma
40 to 60%
30 to 50%
50 to 70%
50 to 70%
Percent of Patients Who Relapse
McLellan et al., JAMA, 2000.
HealthcareSlide8
Healthcare
ParitySlide9
Healthcare
Estimated U.S. Economic Cost to Society Due to Substance Abuse and Addiction
Illegal Drugs - $181 billion/year
Alcohol - $185 billion/year
Tobacco - $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. Slide10
Healthcare
How Its FundedSlide11
HealthcareSlide12
Healthcare
More people with 3
rd
party insurance
Shifts cost and focus: deductibles, reimbursement rates, outcome orientation, primary care physicianSlide13
Healthcare
Shift from management and administration of block grants to focus on “best practices,” grants, and outcome measurements.Slide14
HealthcareSlide15
HealthcareSlide16
HealthcareSlide17
HealthcareSlide18
HealthcareSlide19
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.Slide20
Healthcare/Medical
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.Slide21
Clinical TrendsSlide22
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 TrendsSlide23
Clinical Trends
NIDA’s Principles of Treatment
Behavioral
Therapies:
Cognitive Behavioral
Therapy
Contingency Management Interventions/Motivational
Incentives
Community Reinforcement Approach Plus Vouchers
Motivational Enhancement Therapy
The Matrix Model12-Step Facilitation TherapyFamily Behavior TherapyBehavioral Therapies Slide24
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 TimesSlide25
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 recoverySlide26
Clinical Trends
Audrey
Kishline
2000 Evidence based practices
Moderate drinking
Fewer drinking daysSlide27
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.Slide28
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.Slide29
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.Slide30
Clinical Trends
More Severe
Less Severe
The Acute Model Vs. ASAM Levels of CareSlide31
Clinical TrendsSlide32
Concerns About DSM-5 Changes
Would significantly increase the number of people being diagnosed with addiction.
The APA has not allowed enough discussion regarding these changes (secondary gain).
It could create false epidemics and
medicalication
of everyday behavior.
Possible boundary issues between DSM panel members and the pharmaceutical companies.Slide33
Public PerceptionSlide34
Clinical Trends
ACCOUNTABILITY COURTSSlide35
Clinical Trends
USE OF TECHNOLOGYSlide36
Implications for Clinicians
WORKFORCE
Peer Recovery Supports
Highly
TrainedSlide37
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