Referral To Treatment for Drug & Alcohol Part I

Size: px

Start display at page:

Download "Referral To Treatment for Drug & Alcohol Part I"

Regina Poole
8 years ago
Views:

1 Referral To Treatment for Drug & Alcohol Part I Geneva Sanford, MSW, LSW, LICDC Substance Abuse Coordinator Grant Medical Center 111 S. Grant Ave, 2nd FL. Columbus, Ohio (614) gsanford@ohiohealth.com May 15, 2013

2 Objectives To explore where patients commonly seek treatment interventions To present common barriers of why patients do not receive treatment services To examine how to identify patients who need a referral for further evaluation and/or treatment To point out essential collaborative efforts between medical and treatment providers within communities To identify ASAM treatment levels of care To examine treatment options for specific patient populations 2

3 SBIRT Screening Brief Intervention Referral Treatment Comprehensive, integrated, public health approach to the identification of, and early intervention for, persons who are misusing substances 5-15 minutes (plus) 3

4 Settings/Locations Hospitals (ER, Trauma Centers, Medical floors, CCU, ICU) Primary Care Physician Healthcare Clinics Specialty Providers (Neuro, Ortho, Plastics, etc) Skilled Nursing Facilities Rehab Facilities Home Healthcare Dentist Office Schools Older Adult Providers 4

5 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Age: 2010 NSDUH 5

6 Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older: NSDUH 6

7 Past Year Perceived Need for and Effort Made to Receive Specialty Treatment among Persons Aged 12 or Older Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use: 2011 NSDUH 7

8 8

9 NASW Standards: Clients with Substance Use Disorder Standard 3. Screening, Assessment and Placement Social workers shall screen clients for SUDs When appropriate, complete a comprehensive assessment If needed, development of a service plan for recommended placement into an appropriate txp program. NASW 9

10 SCREENING 10

11 Identification of Risk Factors Alcohol & Drug Labs Clinical indications (biomarkers) Nursing Triage/Admission Assessment Quick Screen ER documentation OARRS Report H&P documentation Purpose for referral Consultation Note Family/Friend concerns 11

12 What does toxicology testing not tell us? Patterns of use Use, abuse, physical dependence, addiction, legitimate prescribed medications Heroin falls under opiate category Use of substances not tested Alcohol, tobacco, newer illicit drugs 12

13 homedrugtestingkit.com 13

14 McLellan & Dembo, 1992, Tarter, Ott & Mezzich,

15 Screening Basics Screening Assessment/Diagnosis Opportunity to prevent, identify and intervene Screening assessment/diagnosis if criteria is indicated/met To provide more intensive services where specifically needed 15

16 DSM IV-TR Substance Use Disorders Substance Intoxication Substance Withdrawal Substance Abuse Substance Dependence 5/17/2013 DSM IV-TR 16

17 Screening Tools 17

18 Substance Use Screening Tools Tool Format Administer/Time Training ASSIST 1 item for lifetime use, 6 items for each of 10 substances used, and 1 item on injection use Depends on number of substances used Yes AUDIT-C AUDIT 3-item screening questionnaire 10-item screening questionnaire Less than 1 minute to administer and score 2 minutes to administer/ 1 minute to score CAGE (alcohol) 4 yes/no questions Less than 1 minute/ not scored CAGE-AID (drugs) DAST 4 yes/no questions Less than 1 minute/ not scored 20 yes/no questions about current and past use 1-2 minutes to administer / not scored MAST 24 yes/no questions 10 minutes to administer/ 5 minutes to score Yes Yes No No No No 18

19 CRAFFT CRAFFT Scoring: Each yes response in Part B scores 1 point. A total score of 2 or higher is a positive screen, indicating a need for additional assessment. JAMA 19

20 Case example: Melanie 17 yo, single white female, level II trauma, MVC (multiple car rollover), broken leg, head trauma, BAC =.157, 18 yo friend died at the scene, parent unsure what to do, family history of alcohol and drug addiction in the family (mother, father, grandparents): CRAFFT = 4/6 Drinks on weekends, 6 pack or more on each occasion, sometimes 2 to 3 shots Injury directly related to alcohol consumption, friend was driving Family history of addiction, mother in recovery Prior legal 16 yo (underage consumption) I do not have a problem, get me out of here so I can go to my boyfriend s funeral Results: Validated desire to attend funeral, expressed concern of use in relation to prescription medications needed for current injury Supported father who has been in recovery for over 10 years (Al-Anon) Helped father access insurance provider to initiate referral for evaluation GMC 20

21 AUDIT SCORE: ZONE I 0-7 (Education) ZONE II 8-15 (Advice) ZONE III (Counseling) ZONE IV (Referral for evaluation) NIAAA 21

22 I don t drink everyday A 31 yo single white male, level II trauma, ATV accident, head trauma, multiple facial fractures, pt. appears intoxicated AUDIT = 19 Drinks 3 times weekly, 8 or more beers on each occasion Patient acknowledges that injury is related to his alcohol use Parents, particularly mother, has voiced great concern of his drinking Results: Pt willing to seek further evaluation Pt had insurance, instructed him on how to access his insurance for substance abuse services GMC 22

23 It was my birthday 70 yo divorced white male, level ll trauma, fall (lost balance on sidewalk), head injury, facial abrasions, pt reports that he went to the bar to celebrate his 70 birthday, BAC =.27, adult children are very concerned about incident, pt resides alone: AUDIT = 21 Drinks twice monthly(?), consuming 6 to 8 mixed drinks on each occasion Reports past history of excessive drinking, cut down due to medical problems Past legal charges (3 OVI) Medical problems HBP, COPD, Arthritis, taking meds as prescribed Results: Monitor for alcohol withdrawal (CIWA) Resistant to referral for further evaluation BUT willing to further discuss alcohol use with his primary care physician due to medical hx and medications GMC 23

24 January 2012 SBIRT Results GMC 24

25 Past Year Initiates of Specific Illicit Drugs among Persons Aged 12 or Older: 2011 NSDUH 25

26 January 2012 SBIRT Results GMC 26

27 I am in PAIN 20 yo, single female, level II trauma, MVC passenger, boyfriend driving under the influence, pelvic fracture AUDIT = 3, rarely drinks History of abusing prescription medications Completed inpatient treatment program in Florida within the year, did not complete aftercare Now resides in OH Mental health diagnosis (Bi-polar, OCD), has not been on medications for a month Major tension and conflict with mother I do not need anymore txp, get me out of here!! Results: Pain Management Consult due to opioid tolerance and withdrawal (COWS) provided support to patient during her hospital stay, addressed hx of abusing prescriptions medications due to current injury and course of txp, identified potential txp providers, medication monitoring/management post d/c Supported mother while maintaining pt confidence (Al-Anon) GMC 27

28 Brief Intervention Treatment Improvement Protocol 34 (SAMHSA) Hazelden Publications 28

29 Brief Intervention Model (FRAMES) Feedback Responsibility of Patient Advice to Change Menu of Strategies Empathetic Counseling Style (Motivational Interviewing) Self-Efficacy (Optimism of Patient) Treatment Improvement Protocol- 34, SAMHSA 29

30 FRAMES Component Feedback Responsibility of Pt Advice to Change Menu of Strategies Empathetic Counseling Self-Efficacy Explanation reason for testing, lab/screening results, recommendations, explore pts response to findings Honesty related to substance use, prior txp interventions, follow-up care, abstinence of AOD while taking medications, willingness to sign release of information Referral for further evaluation, consult primary care physician, therapist, take meds as prescribed Treatment levels of care, medication assisted txp, community resources, legal, insurance provider, strategies to cut down drinking Compassion, supportive, encourage, validate potential fear, honor decision plan of action Non-traditional attempts to address substance use, confidence scale (0-10 scale) 30

31 Five A s Model 5 A s Description ASK Screening is the first A because it asks one or more questions related to drug use. ADVICE ASSESS ASSIST ARRANGE The second A involves strong direct personal advice by the provider to the patient to make a change, if it is clinically indicated. The third A refers to determining how willing a patient is to change his or her behavior after hearing the provider s advice. The fourth A refers to helping the patient make a change if he/she appears ready. The final A is to refer the patient for further assessment and treatment, if appropriate, and to set up follow-up appointments. US Public Health Service 31 31

32 Motivational Interviewing (Clinical Approach) Patient centered communication style that enhances motivation for change by helping the patient clarify & resolve ambivalence about behavior change. Patient-centered Collaborative Focus on motivation Explore ambivalence Individual feedback Elicit reasons to change Rollnick, Miller, Butler 2008 Listen, Listen, Listen 32

33 Grimley 1997 and Prochaska

34 January 2012 SBIRT Results GMC 34

35 Educational Material NIAAA 35

36 36

Vermont Department of Health. Substance Abuse Prevention and Intervention Programs for Adolescents

Vermont Department of Health. Substance Abuse Prevention and Intervention Programs for Adolescents Substance Abuse Prevention and Intervention Programs for Adolescents Alcohol and Drug Abuse Programs December 20, 2013 School-Based Substance Abuse Services (SBSAS) Grants Awarded to 21 Supervisory Unions,