Cedar Mountain CenterCedar Mountain Center

Trends and Developments in Trends and Developments in Substance Abuse TreatmentSubstance Abuse Treatment

Kim FletcherMarketing Director

Personal and Professional Personal and Professional ImplicationsImplications

• Criminal Justice System jammed

• Epidemic Proportions

• No Socioeconomic Boundaries

Disease or Moral WeaknessDisease or Moral Weakness

• Science is clear on disease

• Stigma attached which is a barrier to treatment

• Mandated treatment does work– Drug Courts– Prisons – Department of Family Services

#1 Abused Drug#1 Abused Drug

Alcohol

Cost to SocietyCost to SocietyHalf a Trillion DollarsHalf a Trillion Dollars

• Crime Related Costs

• Loss in Productivity

• Break Down:– Alcohol-185 Billion– Illicit Drugs-181 Billion– Tobacco-168 Billion

Cost to SocietyCost to Society(Billions of Dollars)(Billions of Dollars)

155

160

165

170

175

180

185

Alcohol Drugs Tobacco

Monitoring the future Monitoring the future Survey of 50,000 Survey of 50,000

8, 10, and 12 graders by NIDA8, 10, and 12 graders by NIDA

• Decline in use

• Exception are Ecstasy, Oxycotin, Vicodin and inhalants

• Report by NIDA – monitoringthefuture.org

Addiction: Bio-psycho-social Addiction: Bio-psycho-social diseasedisease

• Biological - Genetic Tendency

• Psychological – Beliefs

• Social – Drinking culture– Learned behavior– Environment

Brain ImagingBrain Imaging

• Exposure to psychoactive chemicals cause changes in the brain that can be seen with brain imaging

• Changes in critical areas:– Decision making– Learning and memory– Behavior control

• Cravings and triggers – choose drug despite catastrophic consequences

Culture of Substance AbuseCulture of Substance Abuse

• Parental modeling– Adolescents want to mimic adults– Will use substances to cope with problems

• Parental indifference– We used and we turned out alright– Today's drugs are more potent

• Best place to find beer– In the fridge right next to the milk

Co-dependencyCo-dependency

• Making excuses for the user• Covering up for the user enabling their use to continue

Co-dependents develop their own self-destructive behaviors for coping

Victims of child abuse/neglect due to substance use often go on to become CHINS and delinquency cases

Diagnostic Manual of Mental Diagnostic Manual of Mental Disorders – Psychiatric Assoc.Disorders – Psychiatric Assoc.

• Differentiates between Substance Abuse and Substance Dependence

• Relies on the pattern and duration of drug use

• The negative impact of drugs on the social and occupational functioning of the user, and the pathological effects to confirm a diagnosis of addiction or dependence

Physical vs Psychological Physical vs Psychological DependenceDependence

• Misconception that an addict uses everyday

• Binge use

• Causing significant life problems

• Compulsively seeking and using despite

negative consequences

Addiction Severity IndexAddiction Severity Index

• Most Comprehensive

• 186 criteria for diagnosis of Chemical Dependency

Screening ToolsScreening Tools

• CAGE – 4 questions, highly reliable for alcohol have you ever felt you should CUT DOWN on your

drinking? have people ANNOYED you by criticizing your

drinking? have you ever felt bad or GUILTY about your

drinking? EYE OPENER: have you ever had a drink first thing in

the morning to steady your nerves or

to get rid of a hangover?

Does treatment work?Does treatment work?

Research shows that when appropriate treatment is given and when clients follow the prescribed program, treatment does work.

In 1999 the National Institute of Health published “Principles of Drug Addiction Treatment, 13 principles of effective treatment.”

National Institute of Health National Institute of Health 13 Principles of Effective Treatment13 Principles of Effective Treatment

#1 No single treatment is appropriate for all;

match treatment settings and

interventions to the individual

Principles of Effective TreatmentPrinciples of Effective Treatment

#2 Treatment needs to be readily available

potential applicants can be lost if treatment is not immediately available

Principles of Effective TreatmentPrinciples of Effective Treatment

#3 Effective treatment attends to the

multiple needs of the individual

Principles of Effective TreatmentPrinciples of Effective Treatment

#4 Treatment and service plan must be

assessed continually and modified as

necessary

Principles of Effective TreatmentPrinciples of Effective Treatment

#5 Remain in treatment for an adequate period of time

Principles of Effective TreatmentPrinciples of Effective Treatment

#6 Counseling (individual and/or group) and

other behavioral therapies are critical

components

Principles of Effective TreatmentPrinciples of Effective Treatment

#7 Medications are an important element of

treatment

Principles of Effective TreatmentPrinciples of Effective Treatment

#8 Dual disorders should be addressed in

in integrated way

Principles of Effective TreatmentPrinciples of Effective Treatment

#9 Detox is only the first state and does

little to change long term use

Principles of Effective TreatmentPrinciples of Effective Treatment

#10 Treatment doesn’t need to be voluntary

to be effective

Principles of Effective TreatmentPrinciples of Effective Treatment

#11 Drug use during treatment must be

monitored continuously

Principles of Effective TreatmentPrinciples of Effective Treatment

#12 Treatment programs should provideassessment for HIV/AIDS, Hepititis Band C, tuberculosis, and otherinfectious diseases as well as counseling to help patients modify orchange behaviors that place

themselves at risk of infection

Principles of Effective TreatmentPrinciples of Effective Treatment

#13 Recovery from drug addiction can be a

long-term process and frequently

requires multiple episodes of treatment

ResourcesResources

• Most current information available from:– National Institute on Drug Abuse (NIDA)– National Institute on Alcohol Abuse and

Addiction (NIAAA)

• Cedar Mountain Center’s 30 years of treatment experience

• Personal Experience – 50 years