Innovative Addiction Support and Treatment. > Harold C. Urschel III MD, MMA > Chief Medical Strategist at Enterhealth

Transcription

1 Healing the Addicted Brain: Innovative Addiction Support and Treatment > Harold C. Urschel III MD, MMA > Chief Medical Strategist at Enterhealth

2 For those of you on the call, what is your primary type of practice? > A. Physician / medical prescriber > B. Nurse > C. Therapist (ie PhD, Social work, LPC) > D. Addiction Counselor (ie LCDC) > E. Administrative i ti Function

3 For those of you on the call today, in which type of treatment program do you work? > A. Hospital / detoxification facility > B. Residential > C. IOP (Intensive Outpatient) > D. Supportive Outpatient > E. Some combination of the above

4 Credentials Overview > Chief medical strategist at Enterhealth, LLC > Nationally recognized expert on the disease of addiction and the latest science-based treatment t t options > Author of The New York Times best seller, Healing the Addicted Brain > Board certified in addiction and general psychiatry by the American Board of Medical Specialties > Published work in the areas of opiate dependence, alcohol dependence, cocaine dependence and anti-addiction medications > Education: Cum Laude with a Bachelor of Arts in Neuropsychology from Princeton University it Doctorate of Medicine degree from the University of Texas Southwestern Medical School Clinical research fellowship at the University of Pennsylvania/Veteran's Administration Medical Center Masters of Management Administration degree from Stanford University Graduate School of Business.

5 Enterhealth Overview > Enterhealth is a premier residential rehabilitation facility specializing in addiction disease management located 30 minutes outside of Dallas, Tx. Board Certified doctors, psychiatrists and therapists specializing in addiction treatments are on-site 24 hours-a-day Round-the-clock, specially trained nurses Detox capabilities Neurological testing and treatments Anti-addiction medications Dual diagnosis > Enterhealth offers a comprehensive Continuum of Care: Detox/Stabilization, Residential Rehabilitation, Transitional Living, Intensive Outpatient and Outpatient Support. > Enterhealth treats addiction like a disease, using the latest scientific protocols and medical breakthroughs to block the effects of alcohol and drugs, lessen the affects of withdrawal, and decrease cravings so that the brain s neurological pathways have a chance to heal.

6 All of the Answers > Alcohol and Drug Addiction (and possibly many others) is a chronic, medical disease of the brain. > If you treat it as such, you have up to 90 % chance for staying sober/in recovery. > If you use most traditional methods you currently have about a 30% chance of sobriety. > Most addiction treatment programs are using year old technology. gy > Most treatment programs are treating the WRONG illness

7 The Secrets > Addiction should be treated comprehensively > Addiction is very treatable > You should have a great deal of HOPE that you can beat this devastating illness. > Family and loved ones need education about the illness.

8 The Key is Science > Scientists have effectively studied Addiction for the last 2-3 decades > They have spent hundreds of millions of $$$/year > They have found some really cool and effective treatments > They have revolutionized the field > Most treatment providers are not using this vital information to treat t their patients. t

9 Medical Impact of Alcoholism o Quality of US Medical Care Hypertension Depression Asthma Headache Diabetes Alcohol Dependence % of Recommended Care Delivered

10 Frequent Expectations ti of Alcoholism Treatment > Addiction is an acute condition that should be effectively treated with detoxification > Treatment is expected to produce lasting reduction in symptoms following termination of treatment > Relapse after treatment is often considered a treatment failure > Treatment doesn t work

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12 Alcohol Causes Profound Changes in Brain Metabolism Underside surface 38 y/o, 17 yrs of heavy weekend alcohol use marked overall decreased activity Normal brain Front on surface Right side surface SPECT images courtesy of D.G. Amen, MD.

13 Other Chronic Medical Diseases > Asthma > Diabetes > Hypertension > Compare: > Heritability Estimates > Compliance Issues

14 Chronic Medical Diseases Similarities to Alcohol/Drug Dependence > Similarities to other chronic diseases: > Less than 50% take medications as prescribed > Less than 30% of patients comply with prescribed behavioral change > Relapse rates of 40% - 60% per year > Re-emergence emergence of symptoms following discontinuation of treatment

15 Implications of the Chronic Disease > Model for Alcoholism: Treatment should be expected to improve symptoms while the treatment is being administered i d Evaluating treatment after it has been discontinued may not be appropriate Continuing care approach: Need for ongoing monitoring Integration into broader spectrum of health services

16 Psychiatric i Comorbidities > Depression (50 75% of alcoholics) > Anxiety Disorders > Bipolar Disorders > Schizophrenia > Substance Abuse

17 A Complex Disorder Neurobiological dysregulation should be treated with pharmacotherapy Nutritional deficits should be treated with dietary improvements and supplementation Substance Dependence Dysfunctional behavior should be addressed with psychosocial interventions

18 Alcohol Dependence - Neuroscience fmri images of brain s reward system Social drinkers Neutral cues vs Alcohol cues Alcohol dependent (non-treatment seeking) Social drinkers Alcohol Dependent Individuals Myrick, Anton, Li et al., Archives of General Psychiatry, April 2008

19 Comprehensive e e Alcohol o Dependence Treatment Cortex Rl Role: Decision making Thinking Reasoning Rationalizing Psychosocial treatments 12-step fellowships Faith-based Fithb d support

20 Comprehensive Alcohol Dependence Treatment Psychosocial Treatment and Medication Cortex Rl Role: Decision making Thinking Reasoning Rationalizing Psychosocial treatments 12-step fellowships Faith-based Fithb d support Limbic Region Role: Drive generation

21 Questions?

22 Th R l f Ph l i The Role of Pharmacology in A Comprehensive Approach to Addiction

23 Medications for Alcohol Dependence Antabuse ReVia Campral VIVITROL (disulfiram) 1 (naltrexone) 2 (acamprosate) 3 (naltrexone for extended- d release injectable suspension) 4 30 tabs/month* (1 tab/day) 30 tabs/month* (1 tab/day) 180 tabs/month* (2 tabs, 3x/day) 1/month

24 Vivitrol

25 Plasma Concentrations

26 Vivitrol Significantly Reduces Drinking Days 1,2 Results are from a post hoc subgroup analysis of a 6 month multicenter, double blind, placebo controlled clinical trial of alcohol dependents who were abstinent for 4 or more days prior to treatment initiation. h l f Vi i l b d b f i h bl b i f d i The approval of Vivitrol was based on a subset of patients who were able to abstain for 7 days prior to treatment initiation.

27 Vivitrol Reduced Holiday Drinking1 Results are from a post hoc subgroup analysis of a 6 month multicenter, double blind, placebo controlled clinical trial of alcohol dependents who were abstinent for 4 or more days prior to treatment initiation.

28 New Medications to Facilitate Alcoholic Recovery > Vivitrol* (380 mg/month) > Campral* (2gm/day) > Naltrexone (50mg/day) > Antabuse (250mg/day) > Baclofen > Ability (10-15mg/day) > Topomax ( mg/day) > Ondansetron > *Highly recommended for every alcoholic

29 What Are the Benefits of Suboxone for Opiate Addiction Treatment? > Removes Cravings within 3 days > If you use heroin or pain pills you can t feel their effects > If you take too much you are punished > Safer: Less likelihood of overdose > The perfect solution for Narcotic addiction when used with a comprehensive treatment program > Now in a new film delivery system dissolves faster, safer (10% cheaper)

30 Buprenorphine p e Binding Opioid OpodReceptors Zubieta et al., 2000 Buprenorphine 16mg completely blocks opioid ligand binding

31 Vivitrol it for Opiate Dependence > Vivitrol approved in October 2010 for Opiate Dependence by FDA > All of the same benefits as in Alcohol Dependence Reduces urge to drink Blocks euphoria Decreases severity of relapse > Need to be off opiates for days before first injection

32 Questions?

33 At your particular treatment t t program, what is the primary focus of your treatment approach? > A. AA-12 Steps > B. Psychiatric medications and treatment > C. Individual and group therapy > D. MAT- anti-addiction medications > E. Comprehensive approach

34 Strategy to Achieve a Science- Based Continuum of Care Residential Outpatient LifeCare

35 Question: What does science-based addiction treatment look like in the real world in 2011? Answer: A continuum of care that integrates all of the key treatment components needed for long term sobriety success.

36 A Comprehensive Treatment Approach to Alcohol/Drug Addiction Science-based Anti-Addiction Medications Very strong 12 step and spiritual component Dual Diagnosis i Evaluation and Treatment t Innovative Family and Relational Therapy Wellness ess and Nutrition Psychotherapy to teach new, healthy coping skills to effectively manage stress Neuroevaluation and therapy Personalized Treatment Plan for each patient Ongoing g Monitoring and support

37 Enterhealth s Continuum of Care > 60% of people who successfully complete treatment t t will relapse within the first year after leaving a facility. > The leading cause for relapse is failure to follow the prescribed continuing care plan set up at discharge. > Enterhealth is meeting that challenge by developing a science-based treatment model that provides consistent touch points in the patient s recovery journey. We call it Enterhealth s Continuum of Care.

38 Enterhealth s ea Continuum of Care More Structured Less Structured Enterhealth Ranch Residential Rehab Facility Here s how it works Transitional Living Intensive Outpatient Outpatient Support > As the patient progresses from one phase of treatment to the next, he/she is not taken from one support system and then dropped into another, and another. The patient maintains a consistent continuum of care within the Enterhealth comprehensive treatment options. > This enables Enterhealth to: build a continuing relationship/trust Monitor the patient based on their unique needs/situation build on and/or modify therapies over time as needed Maintain a consistent, science-based comprehensive approach to the client over their lifetime.

39 Traditional Treatment Model 12-Step Spiritual Family Therapy (group) Group and/or Individual Therapy Patient

40 Science-Based Treatment Model Life Care Tools and Support Withdrawal Stabilization/ Detox Neurological Testing & Treatments Wellness and Nutrition 12- Step/Spiritual Patient Psychiatric Dual Diagnosis Co-Occurring Medical Disease Family Therapies (group & individual) Group & Individual Therapy Anti-Addiction Medications

41 Residential Treatment t for Alcohol and Drug Addiction

42 Residential Science-based Program > Safe, high quality Withdrawal Stabilization > Comprehensive Multi-faceted Evaluation both client and family > Personalized Treatment Plan Individualized per client > Anti-Addiction Medications > Dual Diagnosis Treatment > 12 step/ Spiritual approach > Family Therapy

43 Residential Science-based Program > Wellness/ Nutrition optimal building blocks > Neuropsychiatric Screening, neurocognitive therapy when appropriate it is a brain disease! > Didactic Program > Stress Management Program > Contingency Management Program > Online Elessons- Advanced Recovery Lesson

44 Residential Science-based Program > Discharge Planning Process > Life Care Program Continuity for practicing the coping skills that they learned at the Ranch Ongoing Recovery Support and coaching components for clients and families Life Care therapy groups post discharge Ongoing g Monitoring > Outcome measurements Addiction Severity Index

45 Residential Personalized Treatment Plan > Treatment team approach > Most important and yet the most difficult > Individualized to specific situation > Different types of alcoholics/addicts > Includes discharge plan > Involves family > Evolves overtime

46 Residential Anti-addiction Medications > Alcohol Vivitrol, Campral, Antabuse, Baclofen > Opiates Suboxone including maintenance > Stimulants Provigil, Baclofen, others > Benzodiazepines Seroquel, Vistaril, Neurontin > Marijuana Seroquel, Vistaril > Don t be scared to use them very powerful tools to enhance any treatment program > Caffeine and Nicotine Free Program

47 Residential Dual Diagnosis Treatment > Critical to get psychiatric evaluation and recommendations for all alcohol and drug addicted clients. > 50-75% of all clients have some psychiatric i disorderd > Treat both diseases at the same time > Psychiatrist knowledgeable in Addiction (full time) twice per week minimum > Address sleep and anxiety early in treatment program > Complicated by post acute withdrawal symptoms

48 Residential 12-step/Spiritual Approach > Critical to any successful program > Introduction to 12 step model and begin to work steps > Outside sponsors visit during stay > Discharge planning key > Not sufficient by itself to treat chronic disease > Religious services on campus > Bible studies available > Explore spritual issues in therapy

49 Residential Family Therapy > Family Education alone is critical > Healing the Addicted Brain > Elessons > First 2-3 days, interview family extensively by phone therapeutic, encourage finding therapist NOW. > First 3 weeks, separate family therapy > Thereafter, combinded family therapy > Use phone, video and , do not have to be onsite

50 Residential Online Elessons > Reinforces any standard type of addiction treatment didactic information and customizes it to a client s specific life situation > Engages a different type of brain learning > Technology allows client to connect with others (therapist, spouse, probation officer, etc) to demonstrate effort in their recovery program > Especially attractive for younger clients who enjoy being online

51 Residential LifeCare Program > This is a chronic medical brain disease that is not going to go away > Repetition of concepts in residential plan are key brain injury issue > Needs to have an enjoyable/satisfaction component creating a higher chance of long term adoption > Family/support system key role in understanding these concepts > This is a marathon, not a sprint!!

52 Outpatient Continuum The Urschel Recovery Science Institute (URSI)

53 Outpatient Treatment Continuum of Care > Comprehensive multidimensional assessment > Individualized treatment plan > Science based anti-addiction medications > Dual Diagnosis (daily onsite psychiatric support) > Innovative Family and Relational Therapy > Personalized Treatment Plan for each patient > Very strong 12 step and spiritual component

54 Outpatient Treatment Continuum of Care > Neurotherapy Program It is a Brain Illness! > Personal Wellness and Nutritional Integration into ongoing sober lifestyle > Life Care Program Continuity for practicing the coping skills that they learned in Residential Ongoing Recovery Support and coaching components for clients and families Use the Elessons from

55 Outpatient Treatment Continuum of Care > Utilize a multidimensional treatment team to get this accomplished > Frequently need to use more than one office and one provider > Providers need to work as a team with good communication > Strong family/support system component g y pp y p > Help a client to put their discharge plan into action

56 Outpatient Treatment Continuum of Care > Meet the client where they are in their environment. > Therapeutic interactions don t always need to be in the office. > URSI Post Residential Program 15 days to operationalize the discharge plan from the Enterhealth Ranch > In home or in hotel outpatient withdrawal stabilization better access for clients

57 elessons esso s - What are They? > Web-based - Practical recovery lessons available online > Bite-sized - Each learning modules is brief and easy to complete > Self-paced - Start/stop at whatever point is most comfortable and resume session exactly where left off > Archived - Review / retake lessons as often as desired / required > Real-world - Develop recovery strategies based on common daily challenges > Innovative hours of cognitive therapy, many including dual-diagnosis > Proven - Developed by leaders in the treatment of addiction

58 elessons esso s - Available to Anyone > Anonymity G t h l ith t f f b i l b l d Get help without fear of being labeled > Accessibility Available 24/7 via Internet > Affordability Economically priced

59 el Lessons Brick & Mortar elessons - Continuum of Care suse during all stages of recovery Rehab. Early Prevention (At Risk) Trans. Living Assessment Test (Addiction Severity Index) Advanced Recovery (Qualify Abuser / Addict) Intensive Outpatient Life Care (Completed Treatment) Outpatient Support

60 elessons - Virtual Support Friend Physician Court Therapist Individual Family Member Include any 3 in the network Sponsor Communicate / monitor progress

61 elessons - Many Uses / Users > Compatible with different therapy approaches 12 step Family Group Private >

62 Role of Monitoring Clients Over Time

63 Outpatient Treatment e Continuum of Care > Monitor adherence to treatment plan 12 step meeting attendance Therapy visits Physician visits Family therapy visits Elesson use

64 Questions?

65 Summary Research Results Translated into Clinical Practice

66 Research Results Translated into Clinical Practice > Alcohol and Drug addiction is a chronic medical brain disease > If you treat it as such, your results will skyrocket > Comprehensive Approach is the key research finding. > Family and patient education is critical to successful outcomes > Healing the Addicted Brain and > It is not rocket science

67 Research Results Translated into Clinical Practice > It can be done > Stretch your comfort level > Enhances success rates of treatment > Inspires hope and optimism > Can save lives and families > Step up to the plate your clients are trusting you!!

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69 Web Resources