CREATING THE BEST SYSTEM CREATING THE BEST SYSTEM FOR ASSESSMENT, REFERRAL FOR ASSESSMENT, REFERRAL

AND TREATMENT OF METH AND TREATMENT OF METH ADDICTION ADDICTION

Patrick Fleming, MPA, LSACPatrick Fleming, MPA, LSACDirector, Salt Lake County Division of Substance AbuseDirector, Salt Lake County Division of Substance Abuse

801 468-2025801 468-2025pfleming@slco.orgpfleming@slco.org

Tim Whalen, LCSWTim Whalen, LCSWAssociate Director, Salt Lake County Division of Substance Associate Director, Salt Lake County Division of Substance

AbuseAbuse801 468-2009801 468-2009

twhalen@slco.orgtwhalen@slco.org

OUTLINEOUTLINE

Utah Prevalence DataUtah Prevalence Data AssessmentAssessment SupervisionSupervision TreatmentTreatment Working TogetherWorking Together

PREVALENCEPREVALENCE

2005 PRIMARY SUBSTANCE 2005 PRIMARY SUBSTANCE BY GENDER IN UTAHBY GENDER IN UTAH

males males females females AlcoholAlcohol 37% 22% 37% 22% CocaineCocaine 6% 6% 7% 7% MarijuanaMarijuana 18% 13% 18% 13% OpiatesOpiates 15% 15% 15% 15% MethMeth 21% 38%21% 38%

11,742 7,24311,742 7,243

2005 PRIMARY SUBSTANCE 2005 PRIMARY SUBSTANCE BY AGE IN UTAHBY AGE IN UTAH

18 18-25 26-3518 18-25 26-35 36-45 46-65 >65 36-45 46-65 >65 AlcoholAlcohol 472 1213 1326 1568 1298 38 472 1213 1326 1568 1298 38 CocaineCocaine 44 231 339 436 172 0 44 231 339 436 172 0 Marijuana 1343 904 495 229 89 0Marijuana 1343 904 495 229 89 0 Opiates 36 808 851 653 472 3Opiates 36 808 851 653 472 3 Meth 187 1624 1998 1126 291Meth 187 1624 1998 1126 291 0 0

Number of Adults who Need Treatment Compared to the Current Public Treatment Capacity

0

5,000

10,000

15,000

20,000

Bea

r R

iver

Centra

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h

Davi

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ehav

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l Health

Fou

r Cor

ner

s

Northe

aste

rn

Sal

t Lake

Coun

ty

San

Juan

Coun

ty

Sou

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est

Cen

ter

Sum

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Cou

nty

Too

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oun

ty

Uta

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ount

y

Wasa

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County

Webe

r H

S

Nu

mb

er o

f A

du

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X

Need Capacity

(38,769)

Number of Youth (Age 12-17) who Need Treatment Compared to the Current Public Treatment Capacity

0

2,000

4,000

6,000

8,000

Bea

r R

iver

Cen

tral

Uta

h

Dav

is B

ehav

iora

lH

ealth

Fou

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orne

rs

Nor

thea

ster

n

Sal

t Lak

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ount

y

San

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ount

y

Sou

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nty

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Cou

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Uta

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ount

y

Was

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Cou

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Web

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Nu

mb

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f Y

ou

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X

Need Capacity

METH AND WOMENMETH AND WOMEN

Methamphetamine is the primary or Methamphetamine is the primary or secondary drug of choice among Utah secondary drug of choice among Utah women of childbearing age who use and women of childbearing age who use and abuse illegal drugsabuse illegal drugs

In Salt Lake County two-thirds (68%) of In Salt Lake County two-thirds (68%) of these women have young, dependent these women have young, dependent childrenchildren

AP&P reports that 90% of women AP&P reports that 90% of women supervised for drug violations began using supervised for drug violations began using drugs given to them by their male partnersdrugs given to them by their male partners

ASSESSMENTASSESSMENT

THE IDEAL ASSESSMENT THE IDEAL ASSESSMENT PROCESSPROCESS

ObjectiveObjective Two to three hours of face to face contactTwo to three hours of face to face contact Addiction Severity IndexAddiction Severity Index Clinical interviewClinical interview ASAMASAM Collateral informationCollateral information Completed by an appropriately licensed Completed by an appropriately licensed

individualindividual

ASIASI Not meant to be a stand alone comprehensive assessmentNot meant to be a stand alone comprehensive assessment Choice by the State of Utah and all federal substance Choice by the State of Utah and all federal substance

abuse facilitiesabuse facilities Provides severity indices in each of the following areas:Provides severity indices in each of the following areas:

MedicalMedical AlcoholAlcohol Other DrugOther Drug PsychiatricPsychiatric Legal Legal Family/Social Family/Social

Should be combined with other form of assessment such Should be combined with other form of assessment such as clinical interview – and redundancy eliminatedas clinical interview – and redundancy eliminated

Comprehensive biospsychosocial assessment for youthComprehensive biospsychosocial assessment for youth

American Society of AddictionAmerican Society of AddictionMedicine Medicine

Placement, Continued Stay and Placement, Continued Stay and Discharge CriteriaDischarge Criteria

Intoxication or Withdrawal PotentialIntoxication or Withdrawal Potential Biomedical Conditions or ComplicationsBiomedical Conditions or Complications Emotional/Behavioral Conditions and Emotional/Behavioral Conditions and

ComplicationsComplications Readiness for ChangeReadiness for Change Relapse/Continued use PotentialRelapse/Continued use Potential Recovery EnvironmentRecovery Environment

TREATMENTTREATMENT

TYPES OF TREATMENTTYPES OF TREATMENT

DetoxificationDetoxification General Outpatient TreatmentGeneral Outpatient Treatment Intensive Outpatient Treatment (Intensive Outpatient Treatment (>>9 9

hours per week)hours per week) Residential TreatmentResidential Treatment Medically Managed TreatmentMedically Managed Treatment SupervisionSupervision

INTERIM GROUP SERVICESINTERIM GROUP SERVICES Began in December of 2001Began in December of 2001 Monies initially provided by the State Monies initially provided by the State

Division of Substance Abuse and Mental Division of Substance Abuse and Mental HealthHealth

Contract transferred to Salt Lake County Contract transferred to Salt Lake County Division of Substance AbuseDivision of Substance Abuse

Provides interim services for individuals Provides interim services for individuals awaiting treatmentawaiting treatment

Groups take place at the same times six Groups take place at the same times six days per weekdays per week

INTERIM GROUP SERVICESINTERIM GROUP SERVICES

Groups are conducted by supervised Groups are conducted by supervised graduate students from social work graduate students from social work and psychology, and psychiatry and psychology, and psychiatry residentsresidents

Group FormatGroup Format SupportSupport Harm reductionHarm reduction Motivation InterviewingMotivation Interviewing

INTERIM GROUP SERVICESINTERIM GROUP SERVICES

Bus tokens are providedBus tokens are provided Light snacks are servedLight snacks are served All groups are freeAll groups are free Clients can just show upClients can just show up Clients can attend as often as they’d likeClients can attend as often as they’d like Agencies require attendance twice per Agencies require attendance twice per

week to maintain status on wait listweek to maintain status on wait list AP&P requires attendance twice per AP&P requires attendance twice per

weekweek

CRIMINAL/SUPERVISION MODEL CRIMINAL/SUPERVISION MODEL FOR CRIMINAL JUSTICE SYSTEM FOR CRIMINAL JUSTICE SYSTEM

INVOLVED CLIENTSINVOLVED CLIENTS

Tra

ined

Sta

ff

Low Criminality

Medium Criminality

High Criminality

Outpatient

Lic

ense

d M

enta

l H

ealth

The

rapi

sts

Intensive Outpatient

Day Treatment

Transitional Housing

Low Intensity

Residential

Medium Intensity

Residential

High Intensity

Residential

Levels of Supervision

Low High Intensity

Low High Intensity

Criminality Assessment

LSI Criminal History

Legal History Treatment History

Marlowe’s Variables

Clinical Assessment

ASI/ASAM Criteria Clinical Interview/MH Evaluation

DSM-IV Based Diagnosis Treatment Plan

Level of Care

Tra

ined

Sta

ff

Outpatient

Lic

ense

d M

enta

l H

ealt

h T

hera

pist

s

Intensive Outpatient

Day Treatment

Transitional Housing

Low Intensity

Residential

Medium Intensity

Residential

High Intensity

Residential

Levels of Supervision

Low High Intensity

Low High Intensity

No Supervision MIJD CORA County DRC DORA

Specialty Courts Prison/Jail

Criminality Assessment

LSI Criminal History

Legal History Treatment History

Marlowe’s Variables

Clinical Assessment

ASI/ASAM Criteria Clinical Interview/MH Evaluation

DSM-IV Based Diagnosis Treatment Plan

Level of Care

Outpatient

Lic

ense

d M

enta

l H

ealt

h T

hera

pist

s

Intensive Outpatient

Day Treatment

Transitional Housing

Low Intensity

Residential

Medium Intensity

Residential

High Intensity

Residential

Levels of Supervision

Low High Intensity

Low High Intensity

No Supervision MIJD CORA County DRC DORA Drug Court

Clinical Assessment

ASI/ASAM Criteria Clinical Interview/MH Evaluation

DSM-IV Based Diagnosis Treatment Plan

Level of Care

Prison/Jail

Clinical/Supervision Model in Action with Drug Court

Supervision stays the same.

Outpatient

Lic

ense

d M

enta

l H

ealt

h T

hera

pist

s

Intensive Outpatient

Day Treatment

Transitional Housing

Low Intensity

Residential

Medium Intensity

Residential

High Intensity

Residential

Levels of Supervision

Low High Intensity

Low High Intensity

No Supervision MIJD CORA County DRC DORA Drug Court

Clinical Assessment

ASI/ASAM Criteria Clinical Interview/MH Evaluation

DSM-IV Based Diagnosis Treatment Plan

Level of Care

Prison/Jail

Clinical/Supervision Model in Action with Drug Court

Supervision stays the same.

Outpatient

Lic

ense

d M

enta

l H

ealt

h T

hera

pist

s

Intensive Outpatient

Day Treatment

Transitional Housing

Low Intensity

Residential

Medium Intensity

Residential

High Intensity

Residential

Levels of Supervision

Low High Intensity

Low High Intensity

No Supervision MIJD CORA County DRC DORA Drug Court

Clinical Assessment

ASI/ASAM Criteria Clinical Interview/MH Evaluation

DSM-IV Based Diagnosis Treatment Plan

Level of Care

Prison/Jail

Clinical/Supervision Model in Action with Drug Court

Supervision stays the same.

INITIAL TREATMENT INITIAL TREATMENT CONCERNSCONCERNS

Treat any medical illnessesTreat any medical illnesses

Provide vitaminsProvide vitamins

Advise to avoid stimulantsAdvise to avoid stimulants

PSYCHOTHERAPYPSYCHOTHERAPY

provide evidence based treatmentprovide evidence based treatment (e.g., motivational interviewing, coping (e.g., motivational interviewing, coping

and social skills training)and social skills training) coordinate other care (e.g., housing, coordinate other care (e.g., housing,

voc rehab, DCFS, childcare, etc.)voc rehab, DCFS, childcare, etc.) expect resistance to weight gainexpect resistance to weight gain expect relapse as part of recoveryexpect relapse as part of recovery

DON’T FORGET THE DON’T FORGET THE IMPORTANCE OF RECOVERY IMPORTANCE OF RECOVERY

SUPPORTSUPPORT

NEVER UNDERESTIMATE THE NEVER UNDERESTIMATE THE POWER OF SIMPLY POWER OF SIMPLY

ENGAGING SOMEONE IN ENGAGING SOMEONE IN TREATMENTTREATMENT

THIS IS A POWER THAT EVERY THIS IS A POWER THAT EVERY SINGLE PROFESSIONAL SINGLE PROFESSIONAL

INVOLVED IN THE CASE CAN INVOLVED IN THE CASE CAN USE TO THE DEFENDANT’S USE TO THE DEFENDANT’S

AND THEIR CHIDRENS’ AND THEIR CHIDRENS’ ADVANTAGEADVANTAGE

Percent of improvement in Percent of improvement in psychotherapy as a function of psychotherapy as a function of

therapeutic factorstherapeutic factorsExtratherapeutic ChangeExtratherapeutic Change: : Factors that are part of the client Factors that are part of the client such as ego strength and other such as ego strength and other

homeostatic mechanisms Factors homeostatic mechanisms Factors that are part of the environment that are part of the environment

such as social support or such as social support or fortuitous/catastrophic events.fortuitous/catastrophic events.

Expectancy (placebo Expectancy (placebo effects):effects):

Clients knowledge/belief that Clients knowledge/belief that he/she is being treated by qualified he/she is being treated by qualified

professionals with effective professionals with effective techniquestechniques

Techniques: Techniques: Factors unique to Factors unique to specific therapies such as CBT, MI, specific therapies such as CBT, MI,

Hypnosis, Therapeutic CommunitiesHypnosis, Therapeutic Communities

Common Factors: Common Factors: Include a Include a host of variables that are found in a host of variables that are found in a

variety of therapies regardless of variety of therapies regardless of the therapists theoretical the therapists theoretical

orientation: such as empathy, orientation: such as empathy, warmth, acceptance, warmth, acceptance,

encouragement of risk taking, et encouragement of risk taking, et cetera.cetera.

Techniques15%

Expectancy (placebo Effect)

15%

Extra-therapeutic

Change40%

Common Factors

30%

BOTTOM LINEBOTTOM LINE

Focus should be on the individual’s Focus should be on the individual’s strengths, social systems, energies strengths, social systems, energies and abilities.and abilities.

Focus should be on the alliance, Focus should be on the alliance, engagement and retentionengagement and retention

Maximizing the Effort Maximizing the Effort Between Judges/Treatment Between Judges/Treatment

Professionals/ Professionals/ Probation/Parole/DCFS/Drug Probation/Parole/DCFS/Drug

Court StaffCourt Staff Give up the turf issuesGive up the turf issues Understand one another’s roles Understand one another’s roles

(including time lines)(including time lines) Share information (e.g., urinalyses, Share information (e.g., urinalyses,

ASIs, progress, etc.)ASIs, progress, etc.)

““Telling (someone with an Telling (someone with an addiction) to stop, is like addiction) to stop, is like

telling someone with telling someone with Parkinson’s Disease not to Parkinson’s Disease not to

tremor.”tremor.”Glen Hanson Glen Hanson

Acting Executive Director, Acting Executive Director, NIDANIDA

RESOURCESRESOURCES

Center for Substance Abuse Prevention: Center for Substance Abuse Prevention: www.samhsa.govwww.samhsa.gov

Substance Abuse Information for Parents: Substance Abuse Information for Parents: www.drugfacts.comwww.drugfacts.com

Partnership for a Drug Free America: Partnership for a Drug Free America: www.drugfreeamerica.orgwww.drugfreeamerica.org

American Academy of Addictive Psychiatry: American Academy of Addictive Psychiatry: www.aaap.orgwww.aaap.org

American Society of Addiction Medicine: American Society of Addiction Medicine: www.asam.orgwww.asam.org

RESOURCESRESOURCES

Utah State Division of Substance Abuse: Utah State Division of Substance Abuse: www.hsda.state.ut.uswww.hsda.state.ut.us

Salt Lake County Division of Substance Abuse: Salt Lake County Division of Substance Abuse: www.slcosubstanceabuse.orgwww.slcosubstanceabuse.org

Edward G. Callister Foundation: Edward G. Callister Foundation: www.hopetoday.comwww.hopetoday.com

National Institute on Drug Abuse: National Institute on Drug Abuse: www.drugabuse.govwww.drugabuse.gov

National Clearinghouse for Alcohol and Drug National Clearinghouse for Alcohol and Drug Information: Information: www.health.orgwww.health.org