Addiction Treatment Works! Through Collaboration and Problem Solving amongst all disciplines

Medicaid Costs of Untreated Substance Abuse (Dean Andretta) : For fiscal year : Average medical cost for over age 18 with no A&D Tx was $11,771 – 88 adult patients were over $15,000 and 2 were over $300,000 Average medical cost for over age 18 with A&D Tx was $7,918 Average medical cost for under age 18 with no A&D Tx was $7,918 Average medical cost for under age 18 with A&D Tx was $2,789

Marion County Community Health Assessment Dashboard Population of Marion Co at 315,335 (just under 10% of OR 3.8 million population) 9.9% (312) adult females binge drink 14.4% (454) of adult males binge drink From Hospitalizations due to consumption of alcohol: – 2.8 per 10,000 females = 88 hospitalizations – 5.9 per 10,000 males = 186 hospitalizations Death rate due to Alcohol Consumption: – 7.9 per 10,000 females = 249 deaths – 20.9 per 10,000 males = 658 deaths

Scope of the Problem In Oregonians died from prescription opiate drug overdose. (Oregon State Medical Examiner) In 2011 there were 143 heroin related deaths-a 59% increase over (State Medical Examiner) In the first 8 months of 2012 the Marion County medical examiner investigated 10 heroin related deaths and overdoses compared to a total of five heroin related deaths in all of (County Medical Examiner) Federal Government June 2010 estimates over the previous year that: – 96,000 Oregonians did not receive needed drug treatment – 237,000 Oregonians did not receive needed alcohol abuse treatment

Outcomes of Addiction Treatment Return on Investment OHA/NPC Research 2010 sample study of 606 treatment completed individuals: – 32% showed an increase in employment – 25% showed an increase in median income – 78% showed a decrease in past month arrests – Add percent decrease a decrease in health risks Mental Health Improvements from baseline to 12 month follow up: – 67% decrease in reports of serious depression – 57% decrease in reports of serious anxiety – 50% drop in reports of serious thoughts of suicide

Impact of problem/pathological gambling: In pathological gamblers, the co-morbidity rates are as high as 75% for unipolar depression and 30% for bipolar disorder. 17% to 24% of gamblers will attempt suicide during their life time. The process of pathological gambling can create conditions of chronic stress that will lead to physical consequences: – Hypertension, Cardiovascular Disease, Peptic Ulcer Disease – An exacerbation of already existing medical problems For Treatment Completers: 60.7% report problems never returned 94.3% report no alcohol related problems 98.8% report no drug related problems

OHA Performance Measures and Expectations: State General Funds 1. Access: Alcohol and Drug Services-County shall meet service access targets. Performance in this area will be considered as a factor influencing funding allocations for future funding periods. Contract with CAPS requires access within 14 days from first call. ITRS Target is 134 individualsOPTX Target is 641 individualsDUII Target is 195 individuals 2. Level of Care: At least 80% of all clients who receive services in the time period must receive treatment at the same level as was assessed during intake. 3. Retention: The County will be reviewed each quarter on the standard of actively engaging individuals in alcohol and drug services for 90 calendar days. Counties determined to have met this standard will be eligible for an annual incentive payment established by OHA.

Solutions and Answers: Early identification/strategies with Patient Centered Primary Care Homes – Lie-Bet Screening for Problem Gambling in all settings: – 1. Have you ever had to lie to people important to you about how – much you gambled? – 2. Have you ever felt the need to bet more and more money? – Yes to one or both = refer for further assessment – Screening, Brief Intervention, and Referral to Treatment (SBIRT) – In Primary Care Clinics – In Mental Health Clinics – Screen for Prescription Drug Abuse – Review Multnomah County Health Department Model for response to prescription drug abuse