Presented by. 13 Principles 10/27/09. Principles of Drug Addiction Treatment: A Research Based Guide

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1 Presented by Principles of Drug Addiction Treatment: A Research Based Guide Rick Moldenhauer, MS, LADC, ICADC, LPC Treatment Services Consultant, Alcohol and Drug Abuse Division PO Box 64977, St Paul, Minnesota P) F) richard.moldenhauer@state.mn.us Notice of Copyright and Limitations on Use and Liability "Copyright 2008, State of Minnesota, Department of Human Services" "This curriculum was written by the Minnesota Department of Human Services for use in its training regarding effective principles of substance abuse treatment. The curriculum was designed for the specific purposes that may or may not apply to other locations, and may require modifications of content and/or form before it can be used in other jurisdictions. The Minnesota Department of Human Services makes no representations and accepts no liability on its use or results. This curriculum is made available free as part of training provided by the Minnesota Department of Human Services and is available for personal use by a single requestor for a nominal fee, which covers the cost of making, certifying, compiling and copying the materials. Any use of this curriculum for other than personal use requires a licensing agreement with the department. This curriculum may not be sold, used, or reproduced for profit or financial gain. Those accessing or copying this document agree to be bound by the aforementioned limitations on its use. " 13 Principles NIH Publication No , reprinted February 2008 Available at: PODATIndex.html No single treatment is appropriate for all individuals 1

2 Matching treatment settings, interventions, and services to each individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society. In Minnesota, we have about 301 licensed tx programs (Rule 31); some specialize in gender, age, drug of choice, culture, co-morbidity, provide room and board, client with children, etc. List available in.pdf or csv format at: IdcService=GET_DYNAMIC_CONVERSION&R evisionselectionmethod=latestreleased&redir ected=true&ddocname=id_ Treatment needs to be readily available Because individuals who are addicted to drugs may be uncertain about entering treatment, taking advantage of opportunities when they are ready for treatment is crucial. Potential treatment applicants can be lost if treatment is not immediately available or is not readily accessible. 2

3 All 87 Counties, 11 Tribes and 9 Managed Care Organizations (MCOs) offer a Rule 25 assessment at a designated point of contact List of these contacts available from ADAD If meet FPG, State can pay for tx Effective treatment attends to multiple needs of the individual, not just his or her drug use To be effective, treatment must address the individual's drug use and any associated medical, psychological, social, vocational, and legal problems. 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 3

4 A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient at times may require medication, other medical services, family therapy, parenting instruction, vocational rehabilitation, and social and legal services. It is critical that the treatment approach be appropriate to the individual's age, gender, ethnicity, and culture. Required tx services in Additional tx services Subpart 1. Treatment services offered by license holder. A. A license holder must offer the following treatment services unless clinically inappropriate and the justifying clinical rationale is documented: (1) individual and group counseling to help the client identify and address problems related to chemical use and develop strategies to avoid inappropriate chemical use after discharge; (2) client education strategies to avoid inappropriate chemical use and health problems related to chemical use and the necessary changes in lifestyle to regain and maintain health. Client education must include information concerning the human immunodeficiency virus, according to Minnesota Statutes, section 245A.19, other sexually transmitted diseases, drug and alcohol use during pregnancy, hepatitis, and tuberculosis; (3) transition services to help the client integrate gains made during treatment into daily living and to reduce reliance on the license holder's staff for support; (4) services to address issues related to co-occurring mental illness, including education for clients on basic symptoms of mental illness, the possibility of comorbidity, and the need for continued medication compliance while working on recovery from substance use disorder. Groups must address co-occurring mental illness issues, as needed. When treatment for mental health problems is indicated, it is integrated into the client's treatment plan; and (5) service coordination to help the client obtain the services and to support the client's need to establish a lifestyle free of the harmful effects of substance use disorder. B. Treatment services provided to individual clients must be provided according to the individual treatment plan and must address cultural differences and special needs of all clients. Subp. 2. Additional treatment services. A license holder may provide or arrange the following additional treatment services as a part of the individual treatment plan: A. relationship counseling provided by a qualified professional to help the client identify the impact of the client's substance use disorder on others and to help the client and persons in the client's support structure identify and change behaviors that contribute to the client's substance use disorder; B. therapeutic recreation to provide the client with an opportunity to participate in recreational activities without the use of mood-altering chemicals and to learn to plan and select leisure activities that do not involve the inappropriate use of chemicals; C. stress management and physical well-being to help the client reach and maintain an acceptable level of health, physical fitness, and well-being; D. living skills development to help the client learn basic skills necessary for independent living; E. employment or educational services to help the client become financially independent; F. socialization skills development to help the client live and interact with others in a positive and productive manner; and G. room, board, and supervision provided at the treatment site to give the client a safe and appropriate environment in which to gain and practice new skills. Remaining in treatment for an adequate period of time is critical for treatment effectiveness 4

5 The appropriate duration for an individual depends on his or her problems and needs (see pages 11-49). Research indicates that for most patients, the threshold of significant improvement is reached at about 3 months in treatment. After this threshold is reached, additional treatment can produce further progress toward recovery. Because people often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment. Consider step down Flexibility with new Rules 31 and 25 Counseling (individual and/or group) and other behavioral therapies are critical components of effective treatment for addiction In therapy, patients address issues of motivation, build skills to resist drug use, replace drug-using activities with constructive and rewarding nondrug-using activities, and improve problem-solving abilities. Behavioral therapy also facilitates interpersonal relationships and the individual's ability to function in the family and community. 5

6 Medications, not drugs Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies Methadone and levo-alpha-acetylmethadol (LAAM) are very effective in helping individuals addicted to heroin or other opiates stabilize their lives and reduce their illicit drug use. Naltrexone is also an effective medication for some opiate addicts and some patients with co-occurring alcohol dependence. For persons addicted to nicotine, a nicotine replacement product (such as patches or gum) or an oral medication (such as bupropion) can be an effective component of treatment. For patients with mental disorders, both behavioral treatments and medications can be critically important. Additional requirements in , and OTPs certified under Any Rule 31 can contract with an MD/DO and build cost into bundled rate for CCDTF; Medication Assisted Therapy rev code 0944, HCPCS code H0020 (daily charge) Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way 6

7 Because addictive disorders and mental disorders often occur in the same individual, patients presenting for either condition should be assessed and treated for the co-occurrence of the other type of disorder. Additional requirements under id= MOA with Rule 29 clinic Mental health practitioner/professionals on staff ( ) Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use Medical detoxification safely manages the acute physical symptoms of withdrawal associated with stopping drug use. While detoxification alone is rarely sufficient to help addicts achieve long-term abstinence, for some individuals it is a strongly indicated precursor to effective drug addiction treatment Minnesota has 24 detoxes, list available at: ProgramLists/pdf/flds.pdf Governed by to Also some hospital based programs 7

8 Treatment does not need to be voluntary to be effective Strong motivation can facilitate the treatment process. Sanctions or enticements in the family, employment setting, or criminal justice system can increase significantly both treatment entry and retention rates and the success of drug treatment interventions. Jails and prisons have tx programs, e.g. Triad at Lino lakes, CIP at Togo, Rule 31 in county jails The Whiz Quiz Possible drug use during treatment must be monitored continuously 8

9 Lapses to drug use can occur during treatment. The objective monitoring of a patient's drug and alcohol use during treatment, such as through urinalysis or other tests, can help the patient withstand urges to use drugs. Such monitoring also can provide early evidence of drug use so that the individual's treatment plan can be adjusted. Feedback to patients who test positive for illicit drug use is an important element of monitoring. OBSERVED drug screens Do not use results in a vacuum, 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 Counseling can help patients avoid highrisk behavior. Counseling also can help people who are already infected manage their illness. HIV Minimum standards, 245A , Subpart 1. Treatment services offered by license holder. A. A license holder must offer the following treatment services unless clinically inappropriate and the justifying clinical rationale is documented: (2) client education strategies to avoid inappropriate chemical use and health problems related to chemical use and the necessary changes in lifestyle to regain and maintain health. Client education must include information concerning the human immunodeficiency virus, according to Minnesota Statutes, section 245A.19, other sexually transmitted diseases, drug and alcohol use during pregnancy, hepatitis, and tuberculosis; 9

10 Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment As with other chronic illnesses, relapses to drug use can occur during or after successful treatment episodes. Addicted individuals may require prolonged treatment and multiple episodes of treatment to achieve long-term abstinence and fully restored functioning. Participation in self-help support programs during and following treatment often is helpful in maintaining abstinence. 10