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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. Enacted in the Code of Virginia § 2.2-2696 to advise: The Executive Branch Members of the Virginia General Assembly

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substance abuse services council

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

legislative purpose
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
sas council members
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
mandates
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;
mandates cont
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
sas council 2006 annual report plan
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
implementation of medicaid
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
what is substance abuse
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
what is substance abuse1
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

bio psycho effects
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
social effects
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
social effects cont
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
effects on parenting
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
impact of substance use disorders on society
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
fiscal burden of untreated sud in va
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.

fact or fiction
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
critical elements of treatment
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
critical elements of treatment cont
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
types of treatment programs
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
types of treatment programs cont
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
outpatient counseling
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
detoxification services
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
residential treatment
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
special population treatment issues
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
drug treatment courts
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
why provide drug treatment
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
because
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
challenges and barriers to treatment
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
challenges and barriers to treatment cont
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
engagement in treatment
Engagement in Treatment
  • Motivational Enhancement Therapy
  • Contingency Management
  • Cognitive Behavioral Therapy
  • Supports and other services
  • Symptom relief
sas treatment capacity and funding
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
in conclusion
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
contact information
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