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Acute Care Model for a Chronic Disease

Acute Care Model for a Chronic Disease. Recovery Oriented Systems of Care OETAS Fall 2009. Past Models of Addiction. All pathology focused Moral Model, Public Health Model, Disease Model. Past Models of Addiction. All based on acute models of care. Acute Care Model of Treatment.

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Acute Care Model for a Chronic Disease

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  1. Acute Care Model for a Chronic Disease Recovery Oriented Systems of Care OETAS Fall 2009

  2. Past Models of Addiction • All pathology focused • Moral Model, Public Health Model, Disease Model

  3. Past Models of Addiction • All based on acute models of care

  4. Acute Care Model of Treatment Services are delivered in a uniform series of encapsulated activities • screening, • admission, • a single point-in-time assessment, • a short course of minimally individualized treatment, • Discharge and brief “aftercare”, followed by termination of the service relationship.

  5. Acute Care Model • Focused on symptom elimination for a single primary problem • A professional expert directs and dominates decision-making throughout this process. • Services transpire over a short period of time. • pre-arranged, time-limited insurance payment designed specifically for addiction disorders and “carved out” from general medical insurance

  6. Acute Care Model • At discharge, “cure has occurred:” long-term recovery is then viewed as self-sustainable without on-going professional assistance. • Evaluation of success occurs at a single point-in-time follow-up, typically just months after treatment. • Post-treatment relapse is viewed as the failure (non-compliance) of the individual, rather than potential flaws in the design of the treatment protocol.

  7. Evidence from Pathology Acute Care Models • Low Treatment Compliance • 50% of outpatients drop out of treatment within one month • 40% of court-ordered patients do not complete treatment (Hubbard, Flynn, Craddock, & Fletcher, 2001); (Watkins, Pincus, Tanielian, & Lloyd, 2003)

  8. Evidence from Pathology Acute Care Models • Relapse Rates are High • About 60% use drugs within six months following treatment discharge • About 45% apply for residential treatment within 12 months (Hubbard, Marsden, Rachal, Harwood, Cavanaugh, & Ginzburg, 1989)

  9. Conclusion of Pathology Acute Care Model: • Public expectations have not been met • Treatment is not very effective; or • We have the wrong model for the illness

  10. Chronic Disease Characteristics • Influenced by genetic inheritance and other personal, family, and environmental risk factors • Can be identified and diagnosed using well validated screening questionnaires and diagnostic checklists

  11. Chronic Diseases • behaviors begin as voluntary choices but become deeply ingrained patterns of behavior that are further exacerbated by neurobiological changes in the brain that weaken volitional control over these contributing behaviors • Are marked by patterns of onset that may be sudden or gradual

  12. Chronic Diseases • Have a prolonged or permanent course that varies from person to person in intensity (mild to severe) and pattern (from constant to recurrent) • Are accompanied by risks of profound pathophysiology, disability, and premature death

  13. Chronic Diseases • Have effective treatments, self-management protocols, peer support frameworks, and similar remission rates, but no known definitive cure • Often generate psychological responses that include hopelessness, low self esteem, anxiety, and depression • Generate excessive demands for adaptation by families and intimate social networks

  14. Outcome in Addiction Treatment McLellan (2003). What's Wrong with Addiction Treatment?

  15. Addiction/Chronic IllnessCompliance Rate Relapse Rate (O'Brien & McLellan, 1996)

  16. Cost/ Benefit Ratio of Acute Care Model vs. Chronic Care Model for Heroin Users $37.72 Value of $ Spent $4.86 (Zarkin, et al, 2005)

  17. Disconnect • If we (the practitioners of addiction treatment) really believed addiction was a chronic disorder, we would not: • view prior treatment as a predictor of poor prognosis (and grounds for denial of treatment admission);

  18. Disconnect • convey the expectation that all clients should achieve complete and enduring sobriety following a single, brief episode of treatment;

  19. Disconnect • punitively discharge clients for becoming symptomatic; • relegate post-treatment continuing care services to an afterthought;

  20. Disconnect • terminate the service relationship following brief intervention; or • treat serious and persistent AOD problems in serial episodes of self-contained, unlinked interventions.

  21. Treatment Renewal Movement • Addiction is best understood as a chronic illness • Addiction requires continuing care over a continuum of care for life

  22. Treatment Renewal Movement • Chronic vs. Acute Model • Continuum of Care vs. Unit or Episode • Performance Measurement vs. Outcomes • Medication Assisted Treatments

  23. Treatment Renewal Movement • Addiction treatment should adhere to proven practices and principles • Treatment is very effective when these ideas/principles are followed NIDA (1999)

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