Substance Abuse Services Council

1. Substance Abuse Services Council Presentation for the Judicial Conference Patty L. Gilbertson, R.N.,C., Chair Mellie Randall, DMHMRSAS Joseph Battle, SAARA August 16, 2007

2. Enacted in the Code of Virginia§ 2.2-2696 to advise: The Executive Branch Members of the Virginia General Assembly State DMHMRSAS Board Make recommendations regarding Statewide Policies related to Substance Use Disorders Goals for SA Prevention and Treatment Coordination of public and private efforts to control alcohol and other drug use Legislative Purpose

3. SAS Council Members The SA Council consists of 30 members appointed by Governor Mark Warner: • 6 Legislators • Senators Mark R. Herring and Roscoe Reynolds • Delegates Clifford Athey, C. Todd Gilbert, David E. Poisson and Beverly Sherwood • 13 State Agency Heads or designees • 9 Association Representatives • 2 Consumer/Advocacy Representatives

4. Mandates • Recommend policies and goals to the Governor, the General Assembly, and the Board; • Coordinate agency programs and activities, to prevent duplication of functions, and to combine all agency plans into a comprehensive interagency state plan for substance abuse services; • Review and comment on annual state budget requests regarding substance abuse and on all applications for state or federal funds or services to be used in substance abuse control programs;

5. Mandates (cont.) • Define responsibilities among state agencies for various programs for persons with substance abuse problems and to encourage cooperation among state agencies; and • Make investigations, issue annual reports to the Governor and the General Assembly and make recommendations relevant to substance abuse upon the request of the Governor

6. SAS Council 2006 Annual Report & Plan Recommendations for 2007 General Assembly Session focused on three issues • Underage drinking in Virginia • Expansion of Medicaid coverage to include treatment of substance use disorders • Evaluation of agency administered SA Treatment Programs to comply with § 2.2-2696 B

7. Implementation of Medicaid • $5.2 million in nonfederal funds has been appropriated • Expanded Medicaid coverage will include all clinically appropriate treatment for substance use disorders for all persons eligible for Medicaid who need treatment • Will generate $5.2 million in federal match funds • Total new funds = $10.4 million

8. What is Substance Abuse? • Legal definition • Substance abuse or addiction is the chronic use of any chemical substance used with the intention of alteringstates of body or mind for other than medically warranted purposes • Alcoholism, drug abuse and addiction are chronic, relapsing, and treatablediseases

9. What is Substance Abuse? Medical Definition Physical Emotional Behavioral Chemical Drug Change Any use of a chemical licit or illicit which results in physical, mental/emotional, social or behavioral impairment

10. The Bio/Psycho/Social View

11. Biological Effects Alcoholism Cirrhosis and other liver problems Hypertension, diabetes, pancreatitis, cardiac problems Brain damage Other drugs HIV/AIDS, Hepatitis C and TB Infections at injection sites Liver damage Attention deficits Perinatal issues Physiological Effects Cognitive Impairments Inability to focus or concentrate Changes in time and spatial perception Impaired ability to employ reasonable “problem solving skills” Memory deficits or loss Emotional Impairments Blunted or heightened emotional responses Severe mood swings Low frustration tolerance Irritability Bio/Psycho Effects

12. Social Effects • Values/Legal Issues • Drug of choice assumes control • Mismanagement of funds/stealing from friends and family • Participation in illegal activity to acquire drugs • Prostitution, drug dealing, shoplifting, robbery, etc. • DUI’s • Work/Productivity • Inability to maintain employment or education • Increased accidents at the workplace • Failure to acquire or loss of work/employment skills

13. Social Effects (cont.) • Economics/Money • Erratic work history ► erratic financial circumstances • Inability to provide for basic medical care and shelter for self and family members • Homelessness • Relationships • Subjects allfamily members, friends and employers to fear and stress • Family members are exposed to physical and emotional abuse and neglect • Legal issues affect family members

14. Effects on parenting • Disorganization and Inability to Impose Structure • Inability to establish “normal” family routines • Inability to follow “simple” instructions • Inability to schedule or comply with appointments • Social Services, medical, court appearances, etc. • Emotional distancing from family members • Inability to provide for and protect their children • Family role reversals

15. Impact of Substance Use Disorders on Society • Abuse of alcohol and/or other drugs is the number one cause of preventable illness and death in the United States • Each year, more than 500,000 deaths (or over one in four deaths) in the United States are attributable to abuse of alcohol, tobacco or other drugs • The cost of substance abuse is devastating to the U.S. economy • Total economic cost of alcohol and drug abuse: $245.7 billion in 1992

16. Fiscal Burden of Untreated SUD in VA From a study conducted by the National Center on Addiction and Substance Abuse (CASA) at Columbia University that analyzed the budgets of 45 states to determine the impact of untreated substance use disorders.

17. Faces of Addiction

18. Fact or Fiction? • Drug addiction is voluntary behavior • More than anything else, drug addiction is a character flaw • You have to wantdrug treatment for it to be effective. • Treatment for drug addiction should be a one-shot deal • We should strive to find a "magic bullet" to treat all forms of drug abuse

19. Screening and evaluation Assessment Comprehensive, client-centered treatment Culturally and gender specific treatment Therapeutic relapse prevention Case Management Although treatment should include an array of modalities, with individualized levels of intensity to serve the needs of each participant, all modalities should share these common goals Developing insight regarding factors related to the onset of substance abuse disorders Promoting personal responsibility for changing behaviors related to the abuse of alcohol and/or other drugs Critical Elements of Treatment

20. Critical Elements of Treatment (cont.) • Like other health disorders, effective treatment for substance abuse: • Must begin with a careful examination of the causes and symptoms of the condition • Must be conducted by a qualified substance abuse professional or therapist • Must be individualized and comprehensive • Must have an aftercare and relapse prevention component

21. Types of Treatment Programs • There are several types of drug abuse treatment programs. • Short-term methods last less than 6 months • Drug-free outpatient therapy • Intensive outpatient or partial • Medical Detoxification • Ambulatory Detoxification • Medication therapy • Residential treatment

22. Types of Treatment Programs (cont.) • There are several types of drug abuse treatment programs. • Longerterm treatment may include • Methadone maintenance outpatient treatment (Opioid Replacement) for people addicted to opiates • Residential therapeutic community treatment • Drug Treatment Court Programs, Family Dependency Courts • Self Help Recovery Groups • AA, NA, Al/Nar Anon, Faith based recovery programs

23. Outpatient Counseling • Encompasses variety of programs for patients who visit a clinic at regular intervals. • Intensive Outpatient at least 3X weekly • Partial Hospitalization 5 X weekly • Most of the programs involve short term cognitive behavioral therapy, individual or group counseling. • Patients entering these programs are abusers of alcohol, illicit drugs and prescription drugs other than opiates

24. Detoxification Services • Medical detoxification • Inpatient care • High risk for complicated withdrawal symptoms • Influenced by other medical problems • Ambulatory detoxification • Done in a clinic setting • Is medically supervised • Protocols vary by drugs of abuse

25. Residential Treatment • Encompasses variety of residential settings for patients who require structured settings • Traditional “28” day treatment • Long term residential (60 – 90 days) • Halfway House/Group Home

26. Special Population Treatment Issues • Effective treatment for juveniles requires: • A multi-disciplinary approach • Involves more systems of care • Developmental issues • Sexual abuse • Primary health care • Treatment that duplicates the adult model will not be successful for juveniles

27. Drug Treatment Courts • Special court docket for dealing with non-violent criminal matters committed by drug addicted offenders • Combines the power of intensive judicial supervision with comprehensive substance abuse treatment and case management to assist non-violent offenders to achieve recovery

28. Why Provide Drug Treatment? • Do“these people” really deserve to be treated? • Didn't they just do it to themselves? • Why should we coddle people who cause so much social disruption? • Shouldn't they be punished, rather than treated? • Even many people who recognize addiction as a disease, still get hung up on whether or not it is a "no-fault" illness

29. Because… • Treatment reduces drug use and increases productivity • Treatment works • Alcoholics and addicts need treatment • Over the last 25 years, studies have shown that treatment works to reduce drug intake and crimes committed by drug-dependent people • Every $1 spent to treat substance use disorders generates a savings of between $5 and $7 in funds not spent on public safety, health, social services and resources generated by employment

30. Challenges and Barriers to Treatment • Lack of capacity for treatment slots • Funding for public treatment ↓ • Disparities in insurance/medical coverage • Nature of the disease • Chronic and relapsing • Stigma • Shame and guilt • Denial • Family denial of problems

31. Challenges and Barriers to Treatment (cont.) • Fear of legal consequences • Powerful and compelling nature of the drugs of abuse • Lack of transportation to engage in treatment • Child care issues • Work obligations • Fear of termination • Lack of trust

32. Engagement in Treatment • Motivational Enhancement Therapy • Contingency Management • Cognitive Behavioral Therapy • Supports and other services • Symptom relief

33. SA Treatment Services in Virginia

34. SA Treatment Services in Virginia

35. SAS Treatment Capacity and Funding • Local funding for SAS to CSBs varies significantly • The CSBs receive most referrals from criminal justice system • Funding for criminal justice population has declined or been eliminated • Access to private insurance is limited

36. In conclusion… • Shift the focus to the treatment and prevention of substance use disorders • Recognize that substance use disorders are a public health issue • Accept that substance use disorders are a chronic, relapsing disease with devastating medical consequences • Recovery is possible with comprehensive ongoing, integrated treatment and management

37. Faces of Recovery

38. Contact Information • Mellie Randall, Manager, Community Planning and Standards • DMHMRSAS OSAS • mellie.randall@co.dmhmrsas.virginia.gov • Julie Truitt • DMHMRSAS OSAS • julie.truitt@co.dmhmrsas.virginia.gov • Patty Gilbertson, Chair, SA Services Council • H-NN CSB • pattyg@hnncsb.org

39. Questions?