new treatment resources for substance use disordernew treatment resources for substance use disorder...
TRANSCRIPT
New Treatment Resources for Substance
Use Disorder
James MatneyWV Bureau for Behavioral Health & Health Facilities
July 9-10, 2018 July 16-17, 2018
WV CIP Cross Training Conference
Learning Objectives
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1. Addiction as a disease, not a choice
2. Extent of the opioid epidemic in WV
3. Array of community based treatment and recovery services – what’s new
Disease Addiction is a primary, chronic disease of brain
reward, motivation, memory and related circuitry. It is characterized by one or more of the following (ABCDE):
Inability to consistently abstain
Impairment in behavioral control
Craving
Diminished recognition of problems
Dysfunctional emotional response
Cycle of relapse and remission
This disease is often progressive and fatal
Contain vs. Cure
Two main goals:
Keep alive
Increase quality of life ASAM Public
Policy Statement
What Science Says About Addiction
Brain Pathways
BiologicalDysregulation
Cultural
Environmental
Genetic
Social
Psychological
SUBSTANCE
USE
DISORDER
Addiction is a Multifactorial Disease
What Complicates Recovery?
•Poverty
•Single parent
•Minority
•Gender
•Religion
•Treatment method
• Co-Occurring
• Co-dependency
• Unemployment
• Domestic violence
• Living situation
• Family or lack of
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Geographic Analysis
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Accidental Rx Drug Overdose Death Rates Reach New Highs(WV resident deaths occurring in WV)
2001 2015Preliminary
2.0 and under
Accidental Rx Drug Overdose Deaths per 100,000 residents (Crude)
2.1 – 14.4
14.5 – 24.4
24.5 – 34.4
34.5 – 44.4
44.5 and higher
The statewide death rate from accidental overdoses involving prescription drugs rose from 5.7 in 2001 to 22.2 in 2015.
McDowell County had the state’s highest death rate in 2001 at 38.0. Wyoming County had the highest in 2015 at 94.8. Raleigh, Boone and Webster counties’ rates also fall in the 44.5 and higher range.
Source: West Virginia Health Statistics Center, Vital Statistics System
Clinical/Treatment Context
• Move to community-based care system
• SAMHSA – “many paths to recovery”
• Advancements in brain science and mental/SUD health treatments
• Move to integrated health care
• Move to person-centered care and stigma reduction
• ACEs (Adverse Childhood Experiences) strongly related to prevalence of SUDs; move to trauma-informed care and avoiding re-traumatization.
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Clinical/Treatment Context, cont’d.
• Medication Assisted Treatment (MAT) – combining psychosocial therapy and medication
• Related issues: medication assisted withdrawal therapy, medication assisted treatment, medication assisted recovery
• Relapse prevention and harm reduction – esp. for PWID
• Stop/reduce withdrawal symptoms, including drug cravings (no euphoria)
• Improve health and social function;
• Additional medications, e.g., naloxone (brand name: Narcan)
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Continuum of Care (Surgeon General’s Report)
Enhancing Health Primary
Prevention Early Intervention Treatment Recovery Support
Promoting optimum physical and mental health and well-being, free from substance misuse, through health communications and access to health care services, income and economic security, and workplace certainty.
Addressing individual and environmental risk factors for substance use through evidence-based programs, policies, and strategies.
Screening and detecting substance use problems at an early stage and providing brief intervention, as needed.
Intervening through medication, counseling, and other supportive services to eliminate symptoms and achieve and maintain sobriety, physical, spiritual, and mental health and maximum functional ability.Levels of care include: Outpatient services; Intensive Outpatient/ Partial Hospitalization Services; Residential/Inpatient Services; and Medically Managed Intensive Inpatient Services.
Removing barriers and providing supports to aid the long-term recovery process. Includes a range of social, educational, legal, and other services that facilitate recovery, wellness, and improved quality of life.
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SUD Resource Development
BBHHF provides support to the full continuum of behavioral health care, from prevention and early intervention, to treatment and recovery support.
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HANCOCK
BROOKE
OHIO
MARSHALL
WETZEL
MONONGALIA
TYLER
MARION PRESTON
TAYLOR
HARRISONDODDRIDGE
MINERAL
HAMPSHIRE
JEFFERSON
MORGAN
BERKELEY
HARDYGRANT
TUCKER
LEWIS
BARBOUR
RANDOLPH
PENDLETONBRAXTON UPSHUR
POCAHONTAS
WEBSTER
NICHOLAS
GREENBRIER
FAYETTE
WYOMING
McDOWELL
MERCER
RALEIGH
SUMMERS
MONROE
BOONE
MINGO
LOGAN
LINCOLN
KANAWHA
WAYNE
CABELL
PUTNAM
CLAY
PLEASANTS
WOOD
MASONJACKSON
ROANE
WIRT
RITCHIE
CALHOUNGILMER
Catchment Areas
EastRidge
Healthways
Potomac Highlands
Southern Highlands
FMRS
Seneca
Valley
Northwood
Logan
Mingo
Prestera
WESTBROOK
APPALACHIAN
United
Summit
West Virginia Community Behavioral Health Centers
FY 2016
Provider Resources beyond CBHCs
• WV has 97 Licensed Behavioral Health Centers (LBHC’s) providing outpatient services
• The Growing Role of Federally Qualified Health Centers in WV (FQHCs) • approximately half of WV’s FQHCs across 108 sites employ a
behavioral health provider• the option to employ a behavioral health provider is open to all
FQHCs
• Additional Licensed Behavioral Health individual providers offer assessments, as well as individual, group, family and crisis services to West Virginia Medicaid members across the state:• 9 licensed social work (LICSW) practices• 164 psychiatric practices• 219 psychological practices
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Statewide Prevention Structure: Opportunities for Partnership
BBHHF funds 6 Prevention Lead Organizations: Represent all 6 regions of WV
Partner and provide leadership for county-level coalitionsCounty Coalitions serving all 55 counties
Provide evidence-based prevention programming, presentations, & materialsProvide prescription take-back initiatives
Stigma reduction and media campaigns
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Prevention, cont’d.
BBHHF supports WV SADD (Students Against Destructive Decisions): Youth-led initiatives at the local level feed into statewide network geared to engage youth early to promote positive mental health and decision making and to evolve youth leadership – 350 Chapters statewide with nearly 1000 members www.wvsadd.org
BBHHF supports Screening and Early Intervention around the statePromotion of SBIRT and training with more than 3500 trained statewidePartnered with Bureau for Public Health and the Benedum Foundation to support
Drug-Free Moms and Babies (DFMB) initiative to promote early screening, intervention, behavioral health support, treatment and recovery supports, support sites, and expand.
BBHHF meeting quarterly with WV Board of Education and WV Bureau for Public Health on Prevention Efforts
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Historical Array of SUD Services
• Residential Detoxification Services (“CSUs” and hospital based)
• Outpatient Treatment/Intensive Outpatient Treatment
• Residential Treatment (30-90 days)
• Recovery Residences and Supports
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Crisis Stabilization/Detox and Residential Treatment programs
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TREATMENT BEDSTOTAL Crisis Stablization Services: 171 16
TOTAL SA Short-term Treatment BEDS: 67 0
TOTAL SA Long-term Treatment BEDS: 26 10
TOTAL SA LT Treatment BEDS: PPW 32 0
TOTAL SA LT Treatment BEDS: TY 16 0
Total Crisis Stabilization; Short Term TX; Long Term TX
312 26
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Recovery Beds
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RECOVERY BEDS Op
en
Un
der
D
evel
op
men
t
TOTAL TX PROVIDER RECOVERY BEDS: 211 0
TOTAL PEER RECOVERY HOME BEDS: 235 16TOTAL PEER RECOVERY FACILITY BEDS: 340 100
TOTAL: WV Subtance Use Recovery Capacity - Recovery Beds 786 116
BARBOUR
BERKELEY
BRAXTON
BROOKE
CABELL
CLAY
FAYETTE
GILMER
GRANT
GREENBRIER
HAMPSHIRE
HANCOCK
HARDY
HARRISON
JACKSON
KANAWHA
LEWIS
LINCOLN
MCDOWELL
MARION
MASON
MERCER
MINERAL
MONONGALIA
MONROE
MORGAN
NICHOLAS
OHIO
PENDLETON
POCAHONTAS
PRESTON
PUTNAM
RALEIGH
RANDOLPH
RITCHIE
ROANE
SUMMERS
TUCKER
TYLER
UPSHUR
WAYNE
WEBSTER
WETZEL
WIRT
WOOD
WYOMING
ANTSPLEAS-
RIDGEDODD-
HOUN
CAL-
MARSHALL
JEFFERSON
TAYLOR
MINGO
LOGAN
BOONE
07-06-18
Provider Recovery Operated
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46
78
53
Substance AbuseRecovery Residences
Peer Operated Recovery Facility(60 – 100 beds)
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Peer Operated Recovery Home(8 – 20 beds)
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100
60
60
80
24
11
8
8
15
12
8
20
20
18
26
7
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NEW – Under DevelopmentPeer Operated Recovery Facility(60 – 100 beds)
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New Resources
Medication Assisted Treatment
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New Resources
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Peer Recovery Coaches
• Supported by BBHHF state and federal grant funds
• Extensive training required
• What’s NEW:
Additional coaches in specialized areas of Pregnant and postpartum women (Drug Free Moms
and Babies programs)Offenders re-entering community Overdose survivors who have contact with emergency
responders or Emergency Departments
New Resources
Law Enforcement Assisted Diversion Programs
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New Resources
Quick Response Teams
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New Resources
Collegiate Recovery
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New Resources
Expansion of services for pregnant women and their families
• Additional locations for Drug
Free Moms and Babies
• Additional residential treatment
and recovery services
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New Resources
Ryan Brown Fund – Residential Treatment Services
• House Bill 2428 (2017) mandates that the Secretary of the West Virginia Department of Health and Human Resources (DHHR):
• ensure beds, for purposes of providing substance use disorder (SUD) treatment services in existing or newly constructed facilities, are made available in locations throughout the state
• Administers the newly created Ryan Brown Addiction Prevention and Recovery Fund for the purpose of implementing the provisions of the bill.
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Improving Access: Opportunities for Partnership
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The HELP4WV Call Line launched on September 9, 2016 to provide assistance
to callers seeking assistance with substance abuse or behavioral
health issues.
Since its launch, the hotline has
received
16,690*calls.
Presenter
James Matney, M.S. Clinical Psychology/WV Drug and Alcohol Counselor
Single State Authority/State Opioid Treatment [email protected]
Bureau for Behavioral Health and Health Facilities (BBHHF)WV DHHR
350 Capitol Street, Room 350Charleston, WV 25301
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