Alcohol and Substance Abuse. Tribal Gathering April 2010

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Kristian Bryan
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1 Alcohol and Substance Abuse Tribal Gathering April 2010

2 What is the Issue? Alcohol and Substance Abuse Ranks High at Tribal Gatherings Rank Year to

3 What is the Issue? Alcohol Abuse is a risk factor for many preventable health issues in the Yukon- Kuskokwim Delta including Suicide Unintentional Injuries Domestic Violence Homicide

4 $700 Dx's Occurring in the top 10 of Both Categories 120,000 $ ,000 $500 80,000 $400 60,000 $300 $200 40,000 $100 20,000 $0 Fever Pregnancy LRTI Skin Infections URI Substance Abuse Ear Infection Sore Throat 0 Cost per Dx (Left Axis) Frequency (Rt Axis)

20,000 $0 Fever Pregnancy LRTI Skin Infections URI Substance

5 20% 19% Emergency Department Visits With Alcohol as Primary Diagnosis 18% 16% 16% 15% 15% 16% 14% 14% 12% 10% 8% 6% 4% 2% 0% Total

6 Snap Shot on Saturday, January 30, 2010 at 7:30 am

7 Snap Shot 19 PC s on Friday, March 25 July and October are typically the highest volume months because of the Fourth of July Celebrations and Dividends are dispersed in October.

8 Other Issues About Half the PC s end up in the Emergency Department and the Other Half End Up in the Yukon-Kuskokwim Correctional Center Bethel has the highest per capita rate of inebriates who end up in jail holds in Alaska

Yukon-Kuskokwim Correctional Center Bethel has the

9 Demographics Year to Date 1,129 Visits to Emergency Department Inebriates came from 43 Communities About 50% from Bethel and 50% from Surrounding Communities 60% are Males 18% Youth, one as young as 10 years old

50% from Bethel and 50% from Surrounding Communities

10 Demographics Most Inebriates are One time Offenders In Anchorage Inebriates Use the Transfer Station an Average of 40 Times per Year

11 Other Issues Tend Not to Have an Addiction and are not Dependant Tend to be Binge Drinkers Our Current Clinical Models are Designed to treat Addiction and Dependence

12 The Opportunities Find Alternative Location for Inebriates Find Clinical Model designed and proven to decrease binge drinking

13 Options? With Funding the State of Alaska Build a Facility Designed for Inebriates and more economical than an Emergency Department and Correctional Facility Implement a Clinical Model design to target Binge Drinking known as SBIRT SBIRT = Screening, Brief Intervention and Referral to Treatment

and more economical than an Emergency Department and Correctional

14 BETHEL SOBERING CENTER

15 Floor-plan = Purpose Safe ER relief SBIRT CSP

16 Commercial Zone Location

17 $ Funding $ Design Near 100% Funded Building Cost -$1.5 Million State Funded FFE - $475,000 Request Pending Operating Costs in State and Trust Budgets

18 Timeline Design 100% Building Permits Fire Marshal Review in process Site Work & Building Package Bids Out Construction Begins early summer October 2010 Substantial Completion January Open

20 3 Part tool Screening Brief Intervention and Referral to Treatment Change in philosophy

21 A 10 question survey Takes approx 10 min Administered by a trained provider, nurse, clinician or technician Questions are scored to determine someone s risk for problematic drinking If that person is found to be at increased risk then they are offered brief counseling on the spot and then offered referral to more thorough treatment

23 Historical treatment for alcohol abuse Treated only the worst of the worst alcoholics Was extensive and time consuming Very poor success rates SBIRT is different Targets a broader range of drinkers Attempts to identify problem behaviors before they are life destroying Brief Preventative

24 Yes Numerous studies have shown positive results including: Decreased frequency of alcohol use Reduced risk of trauma Increased utilization of rehab services Decreased Emergency visits Overall cost benefit

25 Ultimately everyone This is how it works best as a screening tool Practically speaking: Starting in the Emergency Department Individuals must be sober at the time of evaluation Those with alcohol related complaints will be targeted first Medical, trauma, psychiatric

26 NO This is a national program that we have adopted for YKHC Recommended by: CDC, SAMHSA, ACS, ACEP, ENA etc. It is now a requirement for all level 1 Trauma centers across the country ANMC, Harborview, Boston Medical Center, many other Hospitals Universities and colleges are also using SBIRT

27 Identify those who have low to moderate alcohol use that slipped through previously Provide education and counseling to all persons screened Allow a stream lined system to refer people to BH for more intensive treatment if needed Ultimate goal is to change behaviors and reduce bad outcomes

Trauma Center Alcohol Screening. Michael Mello, MD, MPH Injury Prevention Center at Rhode Island Hospital /Hasbro Children s Hospital

Trauma Center Alcohol Screening and Intervention Michael Mello, MD, MPH Injury Prevention Center at Rhode Island Hospital /Hasbro Children s Hospital Disclosures I have no affiliations, sponsorship, financial