RECOMMENDATIONS FOR STATES

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1 Ending Addictin Changes Everything RECOMMENDATIONS FOR STATES RECOMMENDED STATE ACTIONS TO IMPROVE HEALTH OUTCOMES AND REDUCE COSTS OF RISKY SUBSTANCE USE AND ADDICTION TO GOVERNMENT OCTOBER 2013

2 There are 4 types f cmplementary actins that states can take t avid r reduce the annual burden f substance use and addictin t gvernment: Preventin and early interventin Treatment and disease management Tax and regulatry plicies Targeted research Preventin and Early Interventin The mst significant ways t avid the cstly cnsequences f risky substance use and addictin are t make significant investments in preventin and early interventin thrugh public educatin and awareness and in screenings and brief interventins t catch the prblem early. Preventin and early interventin strategies shuld include: Public Health Infrmatin. Cnsistent with ther successful public health effrts t educate the public abut little understd diseases including depressin r HIV/AIDS, state and lcal gvernments shuld: Get the facts ut thrugh ppulatin-wide public health campaigns and fund independent evaluatins f these campaigns. Such campaigns shuld: Educate the public abut the nature f addictin that it is a preventable and treatable disease, risk factrs that increase vulnerability, preventin strategies and treatment ptins Clarify the difference between risky substance use a behaviral chice that is amenable t change and addictin a medical cnditin that requires evidence-based treatments and recvery supprts and respnd t each accrdingly Ensure that all preventin effrts address all addictive substances, including tbacc, alchl and ther drugs, in a cmprehensive manner Cmprehensive Preventin Messages and Prgrams. Preventin is the crnerstne f any public health initiative. Preventin initiatives shuld be fcused n children: a child wh reaches age 21 withut smking, drinking, misusing prescriptin drugs r using ther drugs is unlikely ever t becme addicted. Preventin strategies shuld fcus n curbing the human and scial csts f substance use and addictin and c-ccurring prblems thrugh cmprehensive messages and appraches that are prvided early and are reinfrced in families, schls and cmmunities Ensure that preventin initiatives are targeted t grups mst likely t influence children and teens, are tailred t age, gender and cultural grups, and are evaluated t ensure efficacy Schl-based preventin prgrams shuld: Begin early in a student s academic career and cntinue in similar intensity thrughut a student s educatin, with age-apprpriate mdificatins 2

3 Be based in science, implemented with fidelity t the tested prgram, carried ut by trained preventin specialists and cnnected with the schl curriculum rather than relegated t islated events r lessns Address all the key factrs influencing a student s likelihd f engaging in substance use, including persnal challenges, family and scial pressures, mental health stressrs and pr-substance use media messages Be designed t fster an envirnment where substance use is understd as a health-risk behavir that is f critical cncern t teens, their parents, schls and the larger cmmunity Screenings, Brief Interventins and Referrals t Treatment. Because the csts f untreated addictin are s high and the human cnsequences s great, gvernments shuld use the pprtunities inherent in their funded prgrams t lk fr substance prblems and address them early. Intervening early is essential t prevent risky substance use and addictin and their cnsequences: In each area f gvernment spending n the burden f substance use and addictin, screen fr risky substance use. Thse wh screen psitive shuld receive a diagnstic evaluatin. Individuals wh are risky users but d nt meet clinical criteria fr addictin shuld receive brief interventins and be reevaluated at regular intervals. Thse wh are diagnsed with addictin shuld receive a cmprehensive assessment and effective and apprpriate treatment. Venues fr screenings and brief interventins include publicly funded prgrams and services such as: emergency departments, health clinics, trauma centers and dctrs ffices; schls and clleges; welfare and child welfare; mental health and develpmental disabilities services; and traffic safety, juvenile justice and adult crrectins prgrams. Public services shuld nt be denied t individuals wh screen psitive fr risky substance use r have the disease f addictin Train wrkers in publicly funded prgrams t prvide screenings, brief interventins and referrals t treatment Encurage expansin and reimbursement f medical billing cdes fr screenings and brief interventins in private health insurance plans and encurage health care prviders t rutinely screen all patients fr risky substance use Implement standardized wrkplace assistance prgrams cvering tbacc, alchl and ther drugs 3

4 Treatment and Disease Management Since apprximately 16% f the U.S. ppulatin already has addictin, quality treatment and disease management services are essential. Currently, nly 11% f peple wh meet the criteria fr addictin receive any treatment, and mst wh d receive treatment d nt get evidence-based care. Failure t prvide these services is just as unacceptable as it wuld be if ur health care system failed t prvide treatment fr diabetes, depressin, hypertensin r asthma. Treatment. As with any ther health cnditin, it is essential t lk fr signs f risk, prperly diagnse addictin and prvide effective treatment and disease management t thse wh have the disease. Gvernment prgrams prvide excellent pprtunities t cnnect peple wh have addictin t the treatments they need, and have the leverage t keep them in treatment lng enugh t make a difference. In prviding services thrugh public systems, it is imprtant t understand that relapse is frequently a part f the recvery prcess as it is with treatment fr ther chrnic diseases Assure that all treatment prgrams and services that receive gvernment funds ffer a full range f evidence-based treatments and that treatment prviders are prperly trained and licensed. T d this, gvernments wrking with prfessinal rganizatins will have t create and imprve standards f practice fr treatment services and assure that prviders meet apprpriate licensing and certificatin requirements Assure access t the full range f psychscial and pharmaceutical treatment ptins and scial supprts, tailred t the gender, age and life circumstances f patients. Successful treatment als requires effective services fr the health prblems that frequently c-exist with addictin, including mental health prblems Assure the availability f detxificatin services and effective linkages t treatment. While ften an imprtant prerequisite t treatment, detxificatin alne is nt sufficient Where pssible, divert individuals frm juvenile and adult crrectins thrugh expanded, evidence-based treatment and aftercare prgrams (alternative sentencing) and thrugh drug treatment curts Eliminate mandatry sentencing laws fr substance-invlved ffenders t enable prsecutrial and judicial discretin in treatment referrals and mnitring, particularly fr nn-vilent ffenders Wrk with existing treatment prviders and the medical cmmunity t integrate addictin treatment int the medical system. Prviding effective treatments will require significant training f medical and ther health prfessinals in preventin and treatment. This is particularly imprtant because addictin treatment has been largely divrced frm ther medical care State and lcal gvernments shuld subject all addictin treatment facilities and prgrams t the same mandatry licensing prcesses as ther health care 4

5 facilities. As a cnditin f licensure, state and lcal gvernments shuld stipulate that all facilities and prgrams prviding addictin treatment adhere t established natinal minimum standards fr accreditatin Use all available tls including quality assurance measurements, pay-frperfrmance cntracting and ther incentives in publicly funded health care prgrams t encurage participating prviders and facilities t adpt evidencebased practices, institute quality-imprvement measures and assess patient utcmes Require as a cnditin f receipt f public funds that prgrams that receive gvernment grants, cntracts and nn-insurance reimbursement fr addictin treatment services: Emply a multidisciplinary team f health prfessinals with a trained physician crdinating addictin care, alng with individuals wh can prvide auxiliary services and arrange fr peer supprt Utilize evidence-based preventin and treatment appraches, including pharmaceutical therapies (prvided r managed by a physician demnstrating the cre cmpetencies f addictin medicine r addictin psychiatry) and psychscial therapies (prvided by medical prfessinals r graduate-level clinical mental health prfessinals trained and licensed in the cre cmpetencies f addictin treatment), as indicated Generate psitive and measurable lng-term patient utcmes Disease Management. T address the lng-term disease management needs f thse with addictin in publicly funded prgrams, gvernment shuld: Assure access t lng-term medical management that is cnsistent with the access prvided fr any ther chrnic disease, including management f cccurring medical (including psychiatric) prblems Assure access t auxiliary supprt services including educatin, vcatinal training, emplyment; life, parenting and ther family skills; childcare, husing and transprtatin supprt; and mutual supprt thrugh such prgrams as AA, NA, Smart Recvery Train publicly-funded staff t help clients access aftercare services and mutual supprt prgrams 5

6 Taxatin and Regulatin Gvernments shuld adpt a brad range f tax and regulatry plicies t prevent underage initiatin f substance use, decrease risky use and increase access t effective treatments. Tax Plicy Initiatives Include: Increase taxes n tbacc (including e-cigarettes) t help eliminate use and n alchl t prevent underage initiatin and reduce adult excessive drinking. Increases in bth taxes wuld help generate revenues t fund preventin and treatment services Regulatry Plicy Initiatives Include: Eliminate tbacc (including e-cigarettes), alchl and marijuana (in states where marijuana is legal fr persnal use) advertisements and marketing that are accessible t yuth audiences Enact/increase enfrcement f laws restricting the sale f tbacc (including e- cigarettes) and alchl t minrs, including minimum legal drinking age laws, rutine retailer cmpliance checks, keg registratin and eliminatin f cigarette vending machine sales. In states that have legalized marijuana fr persnal use, enact strng laws restricting access t persns under age 21 Increase use f sustained sbriety check-pints and stricter license suspensin laws fr driving while intxicated Prhibit direct t cnsumer marketing f cntrlled prescriptin drugs Enact/expand cmprehensive clean indr air laws and ther smking bans (including e-cigarettes and marijuana in states where marijuana use is lawful) Require that all state-funded insurance prgrams cver and require as a cnditin f receiving funds the fllwing services prvided by health care prviders trained in evidence-based addictin care: patient educatin; screenings and brief interventins; diagnstic evaluatin, cmprehensive assessment and treatment planning; stabilizatin/withdrawal management in a range f levels/settings; the full range f evidence-based pharmaceutical and behaviral treatments in a range f levels/settings; and mnitring, supprt and cntinuing care Ablish state Unifrm Accident and Sickness Plicy Prvisin Laws that limit insurers medical liability if individuals are injured while they are intxicated, since these laws prvide dctrs with disincentives t screen patients fr substance prblems r dcument substance-invlved injuries Implement a cmprehensive prescriptin drug mnitring prgram and cllabrate with ther states 6

7 Supprt zning laws that restrict the density f alchl utlets (and marijuana utlets in states where marijuana is legal fr persnal use), including stres and bars Research and Evaluatin Research that increases ur understanding f risky substance use and addictin is key t quality assurance and will help t develp and guide future cst-saving initiatives. Such activities shuld include: Establish a baseline against which t measure prgress and dcument impact at regular intervals Fund research n best-practices fr preventin and treatment f risky substance use and addictin and c-ccurring health cnditins Dcument the benefits f preventin, treatment, taxatin and regulatry initiatives cmpared with the csts f failing t d s 7

8 Ending Addictin Changes Everything 8

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