Substance Abuse Evaluation Modell in Käpylä Rehabilitation Center

1. Substance Abuse Evaluation Modell in Käpylä Rehabilitation Center VAPA-Project 2001-2004 Seija Savolainen 2003 HDI 1

2. A Presentation of VAPA project 2001-2004 • VAPA=Developing substance abuse services for people with disabilities • Consists of 4 sub-project and a coordinative function • A-clinic Foundationtarget group are people with hearing impairments • The Kalliola Clinic target groups are the visually impaired ( blind and blind deaf) • Helsinki Deaconess Institute target groups are clients with brain damage and clients with spinal injuries • The Finnish Blue Ribbon works with mentally challenged / retarded/ physically handicapped people and is responsible of the coordination of VAPA project Seija Savolainen 2003 HDI 2

3. The main object of the project is to develope a comprehensive and united network of services suitable for the disabled and with an emphasis of the integration to both substance abuse services and services for the disabled • The project includes training for substance abuse workers in how to address the unique needs of the disabled client • Training for other professionals who work with the disabled in how to recognize a substance abuse problem A Presentation of VAPA project 2001-2004 Seija Savolainen 2003 HDI 3

4. The Objectives • To increase the readiness of the disability workers to meet the disabled client with an substance abuse problem • To create a comprehensive servicesupply which includes the special needs of the disabled • To develop treatment to disabled substance abusers that are equal • To give tools to the substance abuse workers to meet the disabled client and to recognise the problem Seija Savolainen 2003 HDI A presentation of VAPA project 2001-2004 4

5. To increase the readiness of workers to meet the sci client with an substance abuse problem • Specialised RN with Drug Abuse Counselling skills is mentoring Nurses on daily basis at ward • Substance abuse specialist is one of the rehabilitation team members • Group discussions in multi professional teams • Work Shops with written assignments for RNs as a part of continuing education plan • Continuing supervision of work in groups ( case) • Individual consulting with empowering evaluation is part of development process Seija Savolainen 2003 HDI SAE in SCI Nursing 5

6. Approaches to screening for substance abuse • It should be within the context of the entire client/patient evaluation – routine screening • clients behavioral styles and participation may be as important as the answers they give – professional documentation • need to be followed by more detailed evaluations to confirm and to assess severity of alcohol,drug abuse and/ or dependency • Signs of drug-seeking behaviors Seija Savolainen 2003 HDI SAE in SCI Nursing 6

7. Signs of drug-seeking behavior • Feigning psychological distress by specific medications are sought to treat anxiety, insomnia,fatigue or depression • Deception – lost or stolen medication,requests for premature refills,alteration or forgery of prescription • pressuring the physician • The client is disinterested in following throw evaluation or unconcerned with dg • The manipulative client – you my sense a client’s efforts to manipulate you Seija Savolainen 2003 HDI SAE in SCI Nursing 7

8. Alcohol Screening • First ask : Do you drink alcohol ? If the response is ”yes” proceed with the four CAGE questions. • Have you ever felt you ought to Cut down on your drinking? • Have people Annoyed you by criticizing your drinking? • Have you ever felt bad or Guilty about your drinking? • Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? Eye-opener Questions for nondrinker: Did you drank in the past ?when drinking stopped? What did you used to drink and how much? J.Ewing:Detecting alcoholism,1984 8 Seija Savolainen 2003 HDI SAE in SCI Nursing

9. Trauma Scale • Have you had any fractures or dislocations to your bones or joints? • Have you been injured in a road traffic accident? • Have you injured your head? • Have you been injured in an assault or fight ( excluding injuries during sports )? • Have you been injured after drinking ? • Two or more positive answers are the criteria for a positive test. • To pick up non-normative drinking, abuse or dependence. Skinner HA;Holt S;Sculler R;Roy J;Israel Y 1984 Seija Savolainen 2003 HDI 9 SAE in SCI Nursing

10. Substance Abuse Evaluation in SCI Nursing • Do you use/have youtried • cannabis-marijuana-hash ? • amphetamine or other stimulants ? • cocaine, crack? • LSD, other hallucinogens? • Opiates –morphine, heroin? • Ecstacy, other dance drugs? • Gamma-hydroxy butyric acid (gamma)? • Subutex? ?”Street meds” • Do you combine alcohol and medicine? • Do you use for someone else prescribed medications? • Do you use over-the-counter medication? Seija Savolainen 2003 HDI SAE in SCI Nursing 10

11. Substance Abuse Evaluation in SCI Nursing • Ask how do you take drugs iv,sc,im ,po smoking,inhaling,other way? • Do you know how to protect yourself from Hepatitis B,C, HIV? • What substances you have used in past 24 hours,48hours,7 days,month,year? • Have your substance abuse habits changed after accident / hospitalization / since you were admitted to ward? • Traumatized client do need time and space bee discreet Seija Savolainen 2003 HDI 11 SAE in SCI Nursing

12. Substance Abuse Evaluation in SCI Nursing AUDIT The Alcohol Use Disorders Identification Test 10 questions as a screening tool identifying heavy drinkers or at-risk drinkers( WHO project 1993) Brief MAST A shortened version of Selzers (1971)The Michigan Alcoholism Screening Test ,10 questions used as a structured interview and for self administration ( Pokorny,Miller,Kaplan1972) DAST The Drug Abuse Screening Test 28 questions(Skinner 1982) ALCOMETER Laboratory methodes, Urin sample: amphetamine, benzodiatzepin, cocaine, opiates, propoksifen,cannabis, methadone,LSD, bubrenorfin, gamma. Blood Alcohol Determination and Drug Testing Seija Savolainen 2003 HDI 12 SAE in SCI Nursing

13. Substance Abuse Evaluation in SCI Nursing • Data collection is continual and systematic • Setting short and long terms Goals while at ward • Substance abuse evaluation and dependency evaluation • Physical status assessment, health issues • Psychological status assessment • Social work perspective with individuals and families • Motivation evaluation,how to reach goals • Substance Abuse Treatment care plan while at ward • Referral to drug abuse councelling as support for sobriety t.ex A-clinic • Choose a suitable treatment center t.ex relapse • Assessment results are professionally documented (MEDIATRI) Seija Savolainen 2003 HDI SAE in SCI Nursing 13

14. Pathway • Clients SAE is done prior to admission for rehabilitation at Käpylä Rehabilitation center • Client has a relevant substance abuse treatment plan including referral addresses in case of relapse at ward. Possibility for re-admission at ward. • Client signs a written agreement recarding sobriety, while at ward. • Multi-professional rehabilitation team together with family members and client with support from professional network are planning together continuing care plan as part of rehabilitation plan. Follow up is recommended. Seija Savolainen 2003 HDI 14 SAE in SCI Nursing