Recovery is a Reality 76-83% lifetime remission rate Addiction skews choice but does not erase free will Purpose and incentives: Vietnam and Rat Park Thankful so many employers are considering how to connect people who are struggling or have struggled with substance use to the important incentive that is employment.

Source: “An Employer’s Guide to Workplace Substance Abuse: Strategies and Treatment Recommendations”

Source: “An Employer’s Guide to Workplace Substance Abuse: Strategies and Treatment Recommendations”

SBIRT Express empathy through reflective listening. Develop discrepancy between clients' goals or values and their current behavior. Avoid argument and direct confrontation. Adjust to client resistance rather than opposing it directly. Support self-efficacy and optimism.

Source: “An Employer’s Guide to Workplace Substance Abuse: Strategies and Treatment Recommendations”

3 Phases of Relapse 1. Emotional 2. Mental 3. Physical Here are some risk factors that increase the likelihood of relapse. (Read off the risk factors). These risk factors can cause a relapse regardless of how long ago a person might have stopped using drugs. Addiction is a pattern in a person’s brain-let’s think about this pattern for a second as an unwelcome roommate. In recovery, people build a house to contain this unwelcome roommate. But an untended house will start to deteriorate even if it doesn’t fall apart. (Point to the screen to draw attention to the risk factors). And when a storm comes, it can threaten to knock the whole house down and let the unwelcome roommate out. So before, during, and after these storms people need to reflect on where the house they have built has deteriorated. Where do they need renovations? How do they keep their house strong and ensure their safety? And just like when our homes needs renovations we usually can’t make all the renovations or notice all the areas that need improving all by ourselves. And that’s where you (referring to the staff) all come in.

Factors That Increase the Likelihood of Relapse Challenges managing stress or negative emotional states Interpersonal conflicts with family or others Difficulty sticking to the recommendations of doctors and counselors Negative thinking Low motivation to change Here are some risk factors that increase the likelihood of relapse. (Read off the risk factors). These risk factors can cause a relapse regardless of how long ago a person might have stopped using drugs. Addiction is a pattern in a person’s brain-let’s think about this pattern for a second as an unwelcome roommate. In recovery, people build a house to contain this unwelcome roommate. But an untended house will start to deteriorate even if it doesn’t fall apart. (Point to the screen to draw attention to the risk factors). And when a storm comes, it can threaten to knock the whole house down and let the unwelcome roommate out. So before, during, and after these storms people need to reflect on where the house they have built has deteriorated. Where do they need renovations? How do they keep their house strong and ensure their safety? And just like when our homes needs renovations we usually can’t make all the renovations or notice all the areas that need improving all by ourselves. And that’s where you (referring to the staff) all come in.

3 questions to guide relapse prevention (Gabor Mate) “What did it offer you?” “What did you like about it?” “What in the short-term did it give you that you craved or liked so much?” Asking these questions helps individual identify what underlying perceived benefits influence their use of opioids and in turn helps to facilitate discussions about alternatives that could provide the same perceived benefits. “It helped me escape emotional pain… helped me deal with stress… gave me peace of mind… a sense of connection with others… a sense of control.”

Write down and share personal early warning signs/behaviors that relapse is likely. “I will not do my homework”, “I will start hanging out with _____”, “I will stop attending meetings” This is a valuable practice to perform with clients who are in any stage of recovery especially early recovery. This is also a valuable practice to repeat on a regular basis. By writing down and sharing their personal warning signs or behaviors that relapse is likely, both of you will be able to notice and respond to when a storm is brewing, the house is at risk, and renovations are needed.

Talk with person about what they think should be done if warning signs/behavior appear. Write it down/make a contract. If you are still in treatment, make the contract in treatment before treatment is over. When you and your (client, patient, etc.) exhaust warning signs/behaviors move on to planning a response to these indicators. Focus on what the person thinks should be done if these signs/behaviors appear. This focus on the individuals solutions are important for two reasons. One when an individual chooses and is invested in their solutions they are more likely to follow through. Second, when and if the house starts to crumble or fall apart completely, the actions you take will not be you doing something to the individuals but you doing what you agreed to do with the individual when they were in a sound state of mind. (Wrap up with Q & A and/or organization specific information).

211. Pregnant women- extension 6. All others- extension 5 211 Pregnant women- extension 6 All others- extension 5 http://211maine.org/opiate-helpline-getting-help-is-a-sign-of-strength Text zip code to: 898211 While anyone connecting to the Opiate Helpline will speak with a Call Specialist to identify treatment options and other resources in their area, 2-1-1 provides additional assistance to pregnant women. Treatment (detox short-term/long-term, programs, hard without insurance-look for sliding feeds), fuel/transportation, basic necessities (i.e. food), housing (programs and properties), recovery

Resources Substance Abuse and Mental Health Services (SAMHSA) Drug Free Workplace Programs https://www.samhsa.gov/workplace National Business Group on Health- Center for Prevention & Health Services “An Employer’s Guide to Workplace Substance Abuse: Strategies and Treatment Recommendations” https://www.businessgrouphealth.org/pub/?id=f3151957-2354-d714-5191- c11a80a07294 SBIRT Colorado https://www.youtube.com/channel/UCCB4xnHTyWMRT_HFJhO0BAQ/feed SBIRT App https://itunes.apple.com/us/app/sbirt/id877624835?mt=8

Under the Influence and On the Clock: Opioid Misuse and the Impact on the Workplace http://hospitalsbirt.webs.com/opioids-and-workplace Small Business Wellness Initiative http://nrepp.samhsa.gov/ProgramProfile.aspx?id=1228#hide1 Workplace Wellness Approach for Prescription Misuse Prevention https://www.youtube.com/watch?v=ZpTv-M-RVwI&feature=youtu.be National Safety Council "The Proactive Role Employers Can Take: Opioids in the Workplace“ http://safety.nsc.org/rxemployerkit

Heath Myers Bangor Public Health and Community Services heath Heath Myers Bangor Public Health and Community Services heath.myers@bangormaine.gov 949-9961 Od Prevention- scope of who it concerns- sleep/911- offer to help