1 Addiction Treatment Modalities Peter Banys, MD, MSc Health Sciences Clinical Professor of Psychiatry, UCSF Director, Substance Abuse Programs, VA Medical Center, SF Director, Addiction Psychiatry/Medicine Fellowships, VA/UCSF
2 Disclosures Addiction research support from NIDA. No financial relationships with any commercial interests.
3 Ideology to Evidence Eminence-Based Medicine Evidence-Proof Medicine Evidence-Based Medicine (EBM) Alternatives to Evidence-Based Medicine Seven Alternatives to Evidence-Based Medicine, David Isaacs and Dominic Fitzgerald, BMJ: Vol 319, Dec 1999.
4 Eminence-Based Medicine
5 Evidence-Proof Medicine Opioid Agonist Treatment Needle Exchange Safe Sex Harm Reduction
6 Evidence-Based Medicine Levels of Evidence (U.S. Preventive Services Task Force) Level I: Randomized Control Trials Evidence obtained from at least one properly designed randomized controlled trial. Level II-1: Controlled Trials Evidence obtained from well-designed controlled trials without randomization. Level II-2: Cohort or Case Studies Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group. Level II-3: Uncontrolled o Trials Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. Level III: Expert Opinion Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
7 Evidence-Based Medicine Level 1: Experimental Designs Randomized, controlled trials (RCT s) Systematic Reviews, Meta-Analyses Level 2: Quasi-Experimental Designs Non-randomized controlled trials Matched controls, Cohort comparisons, Correlation studies. Level 3: Expert Consensus/Opinion Case reports, Observational studies, Expert Consensus panels, Best practice guidelines Level 4: Personal Communication American Psychological Association Practice Guidelines, Glasner-Edwards and Rawson, Evidence-based practices in Addiction Treatment, Health Policy, Miller, Zweben, and Johnson, Evidence-based treatment: Why, what, where, and how?, JSAT, 2005.
8 RCT s - Randomized Controlled Trials Adapted from Mark Willenbring MD (ASAM 2006)
9 Efficacy-to to-effectiveness & Implementation The assumption that effectiveness naturally flows from efficacy research is faulty. The tight controls of efficacy studies limit their generalizability. We need more research focus on bench-to-bedside adoption, implementation paradigms, and patient acceptance. Although group modalities are the prevailing clinical model in the addiction field, researchers resist group treatment research because of technical difficulties with controls.
10 NIDA Principles of Treatment 1. Treatment Matching 2. Availability 3. Domains of Care 4. Individualization 5. Retention 6. Psycho-Social Treatment 7. Medications 8. Dual-Diagnosis Treatment 9. Medical Detoxification 10. Coercion 11. Monitoring 12. High-Risk Behaviors 13. Recidivism
11 1. Treatment Matching No single treatment is appropriate for all individuals. Patient-Oriented, not Program-Oriented Chart notes should describe people.
12 Project MATCH (NIAAA) 16 Combinations Studied Final Results: Dec 1996 n = 1,726 subjects Patient Characteristics Gender Alcohol Severity Alcoholic Typology Psychiatric Severity Cognitive Impairment Conceptual Level Meaning Seeking Motivation Sociopathy High v Low Social Support Treatment Modalities TSF - Twelve-Step Facilitation (not AA attendance per se) CBT -Cognitive- Behavioral Therapy MET Motivational Enhancement Therapy
13 Project MATCH (NIAAA) Psych Severity + TSF = Only confirmed match Patients with few or no psychological problems had significantly more abstinent days with TSF than CBT All modalities produced less drinking and fewer consequences. Aftercare Cohort: More aftercare patients (35%) sustained complete abstinence for a year than outpatients (19%). Outpatient Cohort: TSF patients did better (24%) than CBT (15%) or MET (14%). Matching Alcoholism Treatments to Client Heterogeneity: Project MATCH Posttreatment Drinking Outcomes, Journal of Studies on Alcohol, January 1997.
14 Treatment Matching Crisis Intervention SBIRT Detoxification Inpatient Rehabilitation, Minnesota Model 28 Day Programs discredited as a universal intervention (Miller & Hester, Amer Psychologist, 1986) ASAM Patient Placement Criteria: Hospitalization is necessary for some individuals. Outpatient Care Self-Help Programs, Faith-Based Programs Professional Care (Individual + group + monitoring) Adjunctive Medications Opioid agonists, Amethystic medications for alcohol relapse mitigation, Psychiatric meds as indicated)
15 2. Availability Treatment needs to be readily available. Treatment motivation may be fleeting, and reducing barriers to immediate access is essential. Never waste a perfectly good crisis.
16 3. Domains of Care Effective treatment attends to multiple needs of the individual, not just his or her drug use. McLellan et al. have identified 7 domains in the Addiction Severity Index (ASI) ASI Domains: Alcohol, Drugs, Medical, Psychological, Family, Employment, Legal. Smoking is the major comorbidity in addicts.
17 4. Individualization An individual s treatment and services plan must be assessed continually and modified as necessary to ensure that the plan meets the person s changing needs. Trends in Addiction Health Care: Reimbursement tied to evidence-based practices, Reimbursement tied to downstream outcomes Potential lists of approved or effective interventions. Joint Commission Measurable goals, Specific objectives, Individualized id d interventions. ti
18 5. Retention Remaining in treatment for an adequate period of time is critical for treatment effectiveness. Dropout Intervention and F/U Good retention predicts good outcomes. Compliance is repeatedly a predictor of good outcome even in medication studies.
19 6. Psycho-Social Treatment Counseling (individual and/or group)and other behavioral therapies are critical components of effective treatment for addiction. Twelve-Step Programs (AA) and Twelve-Step Facilitation (TSF) Cognitive-Behavioral-Therapies (CBT) Group and Individual Counseling/Psychotherapy
20 PSYCHOSOCIAL TREATMENTS Interventions (alphabetical) Behavioral Couples Therapy Cognitive Behavioral Coping Skills Training FIRST LINE TREATMENTS at least as effective as other bona fide active interventions or treatment as usual (TAU) Alcohol Opioids Stimulants / Mixed ADDED EFFECTIVENESS AS ADJUNCTIVE INTERVENTIONS in combination with pharmacotherapy and/or other first line psychosocial treatments Cannabis Alcohol Opioids Stimulants / Mixed Cannabis +++ N/A? N/A +/- +? N/A +++ N/A ? ++ Community Reinforcement Approach +++ N/A + N/A N/A N/A + N/A Contingency N/A N/A N/A N/A N/A N/A Management / Motivational Incentives Motivational Enhancement Therapy (MET) Twelve-Step Facilitation (TSF) +++ N/A N/A? +++? +/ N/A N/A N/A + N/A + N/A Slide: Daniel Kivlahan, PhD from VA/DoD Guideline (a work-in-progress) +++ Based on meta analysis / systematic review of comparisons with bona fide alternative interventions. + or ++ Based on one (+) or more (++) individual trials in comparison with bona fide alternatives. +/- Evidence inconsistent across outcomes.? Benefit questionable. N/A Evidence not available.
21 Twelve-Step Groups Myths Only AA can treat alcoholics Only a recovering individual can treat an addict 12-Step groups are intolerant of prescription medication Groups are more effective than individuals because of confrontation
22 Twelve-Step Groups Facts Available 7days/week, 24 hrs/day Work well with professionals Primary treatment modality is fellowship (identification) Safety and acceptance predominate over confrontation o o Offer a safe environment to develop intimacy
23 7. Medications Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral al therapies. Alcohol: Opiates: Stimulants: Nicotine: Naltrexone, Disulfiram, Acamprosate, Topiramate? Naltrexone, Methadone, LAAM, Buprenorphine [None to date,?modafinil?,?topiramate?,?disulfiram?] Nicotine replacement (gum, patches, spray), bupropion, varenicline
24 Myth of Self-Medication Doctors seek to treat deeper, more fundamental disorders. (Koch s postulates) Patients are sure they drink or use drugs to cope better. (Common sense) Logical Theory and appealing to all, but unsupported by outcomes/evidence Shared pursuit of deeper cause = Therapeutic Misalliance
25 8. Dual-Diagnosis Diagnosis Treatment Addicted or drug-abusing individuals with co-existing mental disorders should have both disorders treated in an integrated way. Depression, Suicidality Psychoses, Paranoia Pain Disorders & Analgesic Rx s Violence, Domestic Abuse V-Codes (homelessness unemployment V-Codes (homelessness, unemployment, legal problems, family disorders)
26 9. Medical Detoxification Medical detoxification is only the first stage of addiction treatment and by itself does little l to change long-term drug use. High post-detoxification relapse rates Not a definitive intervention, a preparatory intervention for further care
27 Co-Dependency Withdrawal Syndrome When will he be able to sit up and take criticism?
28 10. Coercion Treatment does not need to be voluntary to be effective. Court-Ordered Probation, Proposition 36 in California Family or Employer Sanctions Medical Consequences & Physician Advice
29 11. Monitoring Possible drug use during treatment must be monitored continuously. Lapses to drug use can occur during treatment. t t Body Fluid Toxicology Testing Randomization Frequency Feedback Alcohol Metabolite Testing (EtG, etc) Breathalyzer Prescription Medication Call-Back Collateral Information (family, etc)
30 Outcomes & Measurement-Based Care Know the difference between Efficacy and Effectiveness Establish standardized baseline measures Include non-drug factors such as family life, employment, etc. Cost-offset measures Assess treatment response periodically Initial vs interim vs completion vs long-term followup Need releases of information completed for collaterals. Poor initial treatment response Change plan Quality improvement interventions for consistently mediocre results.
31 BAM: Brief Addiction Monitor (A Work-In-Progress) 17 items - 5 minutes to complete Pilot study in Philadelphia, administered to 150 patients at intake Repeated 3 months later Initial analyses indicate: Sensitive to change Composed of 3 reliable factors: Substance use Risk factors for use Pro-recovery behaviors,
32 Brief Addiction Monitor (BAM) Items Substance Risk Protective Use Factors Factors Any alcohol use Physical health Self-efficacy Heavy alcohol use Sleep problems Self-help Drug use Mood/Angry/Upset Religion/spirituality Craving Risky situations Work, school Family/social conflict Satisfied with Recovery Income/Housing Social supports for recovery
33 12. High-Risk Behaviors Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, and counseling to help patients modify or change behaviors that place themselves or others at risk of infection. Education & Assessment High Risk Sexual Behavior Needle-Sharing Behaviors Environmental Exposure Risks Medical Followup Hepatitis serologies in needle-users Smoking cessation!
34 13. Recidivism Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment. Relapses Precede Stable Recovery Natural History of Alcoholism (Vaillant) Harm-Reduction Approaches Doing Research
35 This problem warrants more research.
36 Relapse Prevention Triggers, Cues Abstinence Violation Effect (Marlatt) Slips vs. Relapses The Wish that Never Dies When I am strong enough I will be able to drink/use in control like other normal people. p
37 Self-Control Addicts seek control, not abstinence
38 Prochaska s Stages of Change Model Precontemplation Contemplation Preparation Action Maintenance
39 Eminence-Based Practice Full Disclosure The more senior the colleague, the less importance he or she placed on the need for anything as mundane as evidence. Experience, it seems, is worth any amount of evidence. These colleagues have a touching faith in clinical experience, which has been defined as making the same mistakes with increasing confidence over an impressive number of years. The eminent physician's white hair and balding pate are called the halo effect. Seven Alternatives to Evidence-Based Medicine, David Isaacs and Dominic Fitzgerald, BMJ: Vol 319, Dec 1999.
41 Passage Through Phases Progression Attendance Regression Non attendance leads to termination Task-completion, Incomplete not time requirements = phase stasis Relapse prevention Ti Triggers People, places, things Relapse Slip vs. relapse question
42 Phase 0 - CRISIS A Wet or Drug-Using Phase Problem-Solving and Alliance-Building Formulate the psychosocial crisis Assist the patient in getting out of trouble (for the price of compliance) Detoxification Structure is key element Your drugs or mine, not both
43 Phase 1 - ABSTINENCE Illusion of/wish for Self-Control Cognitive-Behavioral Interventions Relapse Prevention Compliance and Imitation Task Completion, not Motivation Structured Program Requirements AA, Twelve-Step Groups Education Groups Specialized Groups (Seeking Safety, Anger Management, PTSD, etc.) Homework
44 Abstinence Strictly speaking, abstinence is developed, not recovered It is an abnormal condition, signifying an internal defect (disease) Addicts want to be normal, that is,,, using drugs in control
45 Phase 2 - SOBRIETY Tolerance of Feelings Grief and loss Depression Self-Hatred, Self-Disgust Remorse and Guilt
46 Insight True insight is a relapse risk Inventory of damage done Emotional turmoil Despair Self-Hatred Acted out Projected onto therapist, who, in turn acts it out as harsh confrontation or contempt
47 How useful is insight? All addicts seek the underlying causes of their addiction in therapy Their unconscious fantasy is that insight will reestablish normality Normal people, normies, drink or use drugs in moderation
48 Phase 3 - RECOVERY First Fully Interactional and Psychodynamic Phase of Treatment Emphasis on Relationships Impediments to Intimacy Personal Integrity
49 Elements of Treatment Safe Detoxification Engagement in Recovery Relapse Prevention Treatment of Co-Morbidities Harm-Reduction Services
DrugFacts: Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please
Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call the
National Institute on Drug Abuse SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK U.S. Department of Health and Human National Institutes of Health SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK The goal
National Institute on Drug Abuse SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK U.S. Department of Health and Human National Institutes of Health SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK The goal
MOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT June, 2014 Dean L. Babcock, LCAC, LCSW Associate Vice President Eskenazi Health Midtown Community Mental Health Centers Why is Evidence-Based
Evidence Based Practice in the Treatment of Addiction Treatment of Addiction Steve Hanson History of Addiction Treatment Incarceration Medical Techniques Asylums What We Learned These didn t work Needed
County Public Health ADDICTION RECOVERY CENTERS (ARC) www.countyarc.org We offer some of the best evidence-based outpatient treatment services for men, women, and teens in the State of Colorado. We offer
Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call 1-800-662-HELP(4357)
Addiction Psychiatry Fellowship Rotation Goals & Objectives Table of Contents University Neuropsychiatric Institute (UNI) Training Site 2 Inpatient addiction psychiatry rotation.....2 Outpatient addiction
Health Care Service System in Thailand for Patients with Alcohol Use Disorder Health Care Service System In Thailand Screening for alcohol use disorder and withdrawal syndrome AUDIT MAST CAGE CIWA or AWS
FRN Research Report January 2012: Treatment Outcomes for Opiate Addiction at La Paloma Background A growing opiate abuse epidemic has highlighted the need for effective treatment options. This study documents
BUPRENORPHINE TREATMENT: A Training For Multidisciplinary Addiction Professionals Module VI: Myths About the Use of Medication in Recovery Patients are still addicted Buprenorphine is simply a substitute
Effectiveness of Treatment The Evidence The treatment programme at Castle Craig is based on the 12 Step abstinence model. This document describes the evidence for residential and 12 Step treatment programmes.
Culturally Competent Substance Abuse Treatment for Veterans with Spinal Cord Injuries or Multiple Sclerosis Marsha N. Sargeant, Ph.D. University of Southern California and Linda R. Mona Ph.D. VA Long Beach
The Federation of State Medical Boards 2013 Model Guidelines for Opioid Addiction Treatment in the Medical Office Adopted April 2013 for Consideration by State Medical Boards 2002 FSMB Model Guidelines
Outline Drug and Alcohol Counseling 1 Module 1 Basics of Abuse & Addiction About Substance Abuse The Cost of Chemical Abuse/Addiction Society's Response The Continuum of Chemical Use Definitions of Terms
Overview of Chemical Addictions Treatment Psychology 470 Introduction to Chemical Additions Steven E. Meier, Ph.D. Listen to the audio lecture while viewing these slides 1 Background Treatment approaches
Recovery Outcomes for Opiate Users FRN Research Report November 2013 Introduction Opiate use in America is at epidemic levels. The latest surveys show 4.5 million Americans using prescription painkillers
American Society of Addiction Medicine Public Policy Statement on Treatment for Alcohol and Other Drug Addiction 1 I. General Definitions of Addiction Treatment Addiction Treatment is the use of any planned,
What is Addiction Treatment? During 2000, almost 300,000 people entered addiction treatment services in New York State. On any given day, about 110,000 individuals are enrolled in New York State programs,
Welcome. This presentation is designed for people working in criminal justice and drug abuse treatment settings. It provides an overview of drug abuse treatment principles for individuals involved in the
Treatment of opioid use disorders Gerardo Gonzalez, MD Associate Professor of Psychiatry Director, Division of Addiction Psychiatry Disclosures I have no financial conflicts to disclose I will review evidence
Beyond SBIRT: Integrating Addiction Medicine into Primary Care Community Clinic Association of Los Angeles County 14 th Annual Health Care Symposium March 6, 2015 Keith Heinzerling MD, Karen Lamp MD; Allison
Treatment of Alcoholism Why is it important Prevents further to body by getting people off alcohol. Can prevent death. Helps keep health insurance down. Provides assistance so alcoholics don t t have to
Special Populations in Alcoholics Anonymous J. Scott Tonigan, Ph.D., Gerard J. Connors, Ph.D., and William R. Miller, Ph.D. The vast majority of Alcoholics Anonymous (AA) members in the United States are
The Clinical Level of Care Guidelines contained on the following pages have been developed as a guide to assist care managers, physicians and providers in making medical necessity decisions about the least
Youth Residential Treatment- One Step in the Continuum of Care Dave Sprenger, MD Outline Nature of substance abuse disorders Continuum of care philosophy Need for prevention and aftercare Cost-effectiveness
Alcohol Dependence and Motivational Interviewing Assessment of Alcohol Misuse Checklist Establish rapport patients are often resistant Longitudinal history of alcohol use Assess additional drug use Establish
Substance Misuse Treatment Framework (SMTF) Guidance for Evidence Based Psychosocial Interventions in the Treatment of Substance Misuse ISBN 978 0 7504 6272 3 Crown copyright 2011 WG-12567 F9161011 Contents
National Survey of Substance Abuse Treatment Services The N-SSATS Report January 28, 2010 Overview of Opioid Treatment Programs within the United States: 2008 In Brief In 2008, a total of 1,132 (8 of all
A Drug Policy for the 21st Century October 18, 2014 International Nurses Society on Addictions Health Care Reform & Its Impact on Addictions Nursing: Navigating Change through the Rapids David K. Mineta,
Topics In Addictions and Mental Health: Concurrent disorders and Community resources Laurence Bosley, MD, FRCPC Overview Understanding concurrent disorders. Developing approaches to treatment Definitions
Minimum Insurance Benefits for Patients with Opioid Use Disorder By David Kan, MD and Tauheed Zaman, MD Adopted by the California Society of Addiction Medicine Committee on Opioids and the California Society
Personal Experience as a Dentist in the California Dental Diversion Program History of Treatment Early AA meetings, both the alcoholic and the wives attended meetings AA began in Treatment centers Hospitals
UNDERSTANDING CO-OCCURRING DISORDERS Frances A. Campbell MSN, PMH CNS-BC, CARN Michael Beatty, LCSW, NCGC-1 Bridge To Hope November 18, 2015 CO-OCCURRING DISORDERS What does it really mean CO-OCCURRING
West Virginia University School of Medicine BEHAVIORAL MEDICINE & PSYCHIATRY Morgantown, WV Carl R. Sullivan, M.D. Professor and Director Addictions Program firstname.lastname@example.org Disclosure Reckitt Benckiser
Smoking Cessation in People with Severe Mental Illness Lisa Dixon, M.D., MPH and Melanie Bennett, Ph.D. University of Maryland School of Medicine Smoking and Severe Mental Illness Smoking is a MAJOR problem
Re-Considering Addiction Treatment Have We Been Thinking Correctly? Part I FDA standards of effectiveness Do substance abuse treatments meet those standards? An FDA Perspective A Drug is Approved for An
BREINING INSTITUTE 8894 Greenback Lane Orangevale, California USA 95662-4019 Telephone (916) 987-2007 Facsimile (916) 987-8823 On-line Continuing Education Course Material and Exam Questions Packet Course
Treatment of Prescription Opioid Dependence Roger D. Weiss, MD Chief, Division of Alcohol and Drug Abuse McLean Hospital, Belmont, MA Professor of Psychiatry, Harvard Medical School, Boston, MA Prescription
UPDATED 4.6.2015 PERSPECTIVES ON DRUGS The role of psychosocial interventions in drug treatment Psychosocial interventions are structured psychological or social interventions used to address substance-related
Putting Addiction Treatment Medications to Use: Lessons Learned George E. Woody, M.D. Laura McNicholas, M.D., Ph.D. Department of Psychiatry, University of Pennsylvania School of Medicine and Philadelphia
Addiction Psychiatry Program Site Specific Goals and Objectives Addiction Psychiatry (ADTU) Goal: By the end of the rotation fellow will acquire the knowledge, skills and attitudes required to recognize
Concurrent Disorder Comprehensive Assessment: Every Interaction is an Intervention Presented by: Kristin Falconer, Gillian Hutton & Stacey Whitman November 12, 2015 Disclosure Statement We have not received
Identification, treatment and support for individuals with Alcohol & Drug Addiction in the Community Dr David Jackson Clinic Medical Officer The Hobart Clinic Association Drugs In tonight s context, drugs
Psychology Externship Program The Washington VA Medical Center (VAMC) is a state-of-the-art facility located in Washington, D.C., N.W., and is accredited by the Joint Commission on the Accreditation of
YOUNG ADULTS IN DUAL DIAGNOSIS TREATMENT: COMPARISON TO OLDER ADULTS AT INTAKE AND POST-TREATMENT Siobhan A. Morse, MHSA, CRC, CAI, MAC Director of Fidelity and Research Foundations Recovery Network YOUNG
THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES PURPOSE: The goal of this document is to describe the
Category: Heroin Title: Methadone Maintenance vs 180-Day psychosocially Enriched Detoxification for Treatment of Opioid Dependence: A Randomized Controlled Trial Authors: Karen L. Sees, DO, Kevin L. Delucchi,
Factors Influencing the Effectiveness of Substance Abuse Treatments Stephen Jurd Area Medical Director Drug and Alcohol Services Northern Sydney Health Patient Factors Social Stability - education, marital
University of Massachusetts Medical School MASSACHUSETTS TOBACCO TREATMENT SPECIALIST TRAINING Course Description Goals and Learning Objectives 1 2012 55 Lake Avenue North, Worcester, MA 01655 www.umassmed.edu/tobacco
Comprehensive Addiction Treatment A cognitive-behavioral approach to treating substance use disorders Brief Treatment Eric G. Devine Deborah J. Brief George E. Horton Joseph S. LoCastro Comprehensive Addiction
ORGANIZATION OF AMERICAN STATES INTER-AMERICAN DRUG ABUSE CONTROL COMMISSION FIRST INTER-REGIONAL FORUM OF EU-LAC CITIES: PUBLIC POLICIES IN DRUG TREATMENT April 2 5, 2008 Santo Domingo, Dominican Republic
Alcohol and Prescription opiate abuse: Responsibilities of Stakeholders to reduce the problem Thomas Kosten MD Waggoner Chair & Professor of Psychiatry & Neuroscience Baylor College of Medicine Past-President,
information for service providers Schizophrenia & Substance Use Schizophrenia and Substance Use Index 2 2 3 5 6 7 8 9 How prevalent are substance use disorders among people with schizophrenia? How prevalent
Treatment of Methamphetamine Dependence: A brief overview Richard A. Rawson, Ph.D Adjunct Associate Professor Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine University
REVISED SUBSTANCE ABUSE GRANTMAKING STRATEGY The New York Community Trust April 2003 1 I. INTRODUCTION Substance Abuse is defined as the excessive use of addictive substances, especially narcotic drugs,
Contact: IBADCC PO Box 1548 Meridian, ID 83680 Ph: 208.468.8802 Fax: 208.466.7693 e-mail: email@example.com www.ibadcc.org Page 1 of 9 Twelve Core Functions The Twelve Core Functions of an alcohol/drug
Track Director: Justin Enggasser, Ph.D. Psychology Service (116B) 940 Belmont Street Brockton, MA 02301 Telephone: (774) 826-1380 Email: firstname.lastname@example.org Dual Diagnosis Location: VA Boston Healthcare
Resources for the Prevention and Treatment of Substance Use Disorders Table of Contents Age-standardized DALYs, alcohol and drug use disorders, per 100 000 Age-standardized death rates, alcohol and drug
Using Drugs to Treat Drug Addiction How it works and why it makes sense Jeff Baxter, MD University of Massachusetts Medical School May 17, 2011 Objectives Biological basis of addiction Is addiction a chronic
Web-based Interventions for the Prevention and Treatment of Substance Use Disorders Lisa A. Marsch, Ph.D. Director, Center for Technology and Health (CTH), National Development & Research Institutes (NDRI)
Session 2: Introduction to Drug Treatment Today s Topics Level of care determination How to know when treatment works What does treatment include Description of treatment modalities Naomi Weinstein, MPH
African American Women and Substance Abuse: Current Findings Based on the work of Amelia Roberts, Ph.D. Assistant Professor, UNC School of Social Work and Iris Carleton-LeNay, Ph.D. Professor, UNC School
1980s Early studies focused on providing integrated treatment for individuals who have dual diagnosis (adding SA counseling to community MH treatment) Early studies also showed that clients did not readily
Governor s Cabinet Opiate Action Team Promoting Wellness and Recovery John R. Kasich, Governor Tracy J. Plouck, Director Opiate Addiction in Ohio: An Update on Scope of Problem Ashland Ohio November 14,
Medication-Assisted Addiction Treatment Molly Carney, Ph.D., M.B.A. Executive Director Evergreen Treatment Services Seattle, WA What is MAT? MAT is the use of medications, in combination with counseling
Considerations in Medication Assisted Treatment of Opiate Dependence Stephen A. Wyatt, D.O. Dept. of Psychiatry Middlesex Hospital Middletown, CT Disclosures Speaker Panels- None Grant recipient - SAMHSA
Tobacco Treatment Specialist Certification (CTTS) Program Workshop Manual Accredited by: Council for Tobacco Treatment Training Programs (CTTTP) Association for the Treatment of Tobacco Use and Dependence
FRN Research Report March 2011: Correlation between Patient Relapse and Mental Illness Post-Treatment Background Studies show that more than 50% of patients who have been diagnosed with substance abuse
Alcohol intervention programs in other countries Assist. Prof. Dr. Suttiporn Janenawasin Siriraj Hosp. Mahidol Univ. A Major Task for Drug Treatment is Changing Brains Back! The Most Effective Treatment
California Addiction Training and Education Series Jeanne L. Obert, MFT, MSM Executive Director, Matrix Institute on Addictions Methamphetamine Behavioral Treatments Behavioral Treatment: Contingency Management
Delivery of Tobacco Dependence Treatment for Tobacco Users with Mental Illness and Substance Use Disorders (MISUD) Learning Objectives Upon completion of this module, you should be able to: Describe how
Neurobiology and Treatment of Opioid Dependence Nebraska MAT Training September 29, 2011 Top 5 primary illegal drugs for persons age 18 29 entering treatment, % 30 25 20 15 10 Heroin or Prescription Opioids
CBTx Community Based Treatment and Care for Drug Use and Dependence Information Brief for Southeast Asia Community Based Treatment refers to a specific integrated model of treatment for people affected
EDITORIAL Have we evaluated addiction treatment correctly? Implications from a chronic care perspective The excellent reviews of alcohol treatment outcomes and methods for evaluating and comparing treatment
Use of Pharmacotherapies by Substance Abuse Treatment Facilities Cathie E. Alderks, PhD Substance Abuse and Mental Health Services Administration Department of Health and Human Services November 2007 1
Addiction Medicine for FP / GP Dr. Francisco Ward, DABPMR/PM SetonPainRehab.com email@example.com S Disease of Chemical Addiction Short Definition of Addiction (ASAM): Addiction is a primary, chronic disease
H-SOAP STUDY Hospital-based Services for Opioid- and Alcohol-addicted Patients Meldon Kahan, Anita Srivastava, Kate Hardy, Sarah Clarke Canadian Society of Addiction Medicine 2014 October 17, 2014 1 Few
John R. Kasich, Governor Orman Hall, Director 2 3 Epidemics of unintentional drug overdoses in Ohio, 1979-2011 1,2,3 1800 1600 1400 1200 1000 800 Prescription drugs are causing a larger overdose epidemic
VA/DoD Clinical Practice Guideline for Management of Substance Use Disorder Toolkit Training Key Concepts for Providers July 27, 2012 Audience: Providers in Defense Department and Veterans Administration
Co-occurring Disorder Treatment for Substance Abuse and Compulsive Gambling Midwest Conference on Problem Gambling and Substance Abuse 2006 Problem Gambling and Co-occurrence: Improving Practice and Managing
The National Community Detoxification Pilot Aoife Dermody, Progression Routes Initiative NDCI, 2011 Community Detoxification Protocols Guidelines for outpatient detoxification from methadone or benzodiazepines
Handout for DUAL DIAGNOSIS: An Integrated Model for the Treatment of People with Co-occurring Psychiatric and Substance Disorders in Managed Care Systems Kenneth Minkoff, M.D. A Videotaped Lecture Produced
Conceptualizing and Integrating Medication Assistant Treatment into your Court s Armamentarium Ted Parran JR. M.D. FACP Carter and Isabel Wang Professor of Medical Education CWRU School of Medicine firstname.lastname@example.org
Free Additional Resources Substance Abuse and Mental Health Services Administration Treatment Improvement Protocols The Substance Abuse and Mental Health Services Administration (SAMHSA) offers free Treatment