2. BAF/2014

4. E VERY NURSE IS AN ADDICTIONS NURSE. BAF/2014

6. -Substance use is associated with other health & social problems -Over 40million debilitating injuries or illnesses per year as a result of substance use -Most people who abuse other substances also smoke cigarettes (NIDA, 2011) BAF/2014

7. -Cost to the U.S. is ~$700 billion annually -In 2013, 24.6 million Americans over age 12 used illicit drugs (9.4% of U.S. population) -In 2013, there were ~8,000 new users per day -Opiates remain second only to marijuana use (SAMHSA, 2014) BAF/2014

8. S((SAMHSA, 2014

9. BAF/2014 SAMHSA, 2014

10. -Globally, increases burden of mortality and morbidity -One recent study estimated the effect of substance abuse to be 20 million DALYs, with opiate abuse the highest contributor, at 9.2 million -Highest burden in richer and more advanced countries (Degenhardt et al., 2013) BAF/2014

13. CHRONICPROGRESSIVE, INCURABLE DISEASE CHARACTERIZED BY LOSS OF CONTROL OVER ALCOHOL AND / OR OTHER DRUGS. BAF/2014

14. A primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic impaired control over drinking, preoccupation with the drug, and use of the drug despite adverse consequences and distortions in thinking, most notably denial.

15. BAF/2014

17. O F THE A DDICTED C LIENT BAF/2014

18. 1.No single treatment is appropriate for all individuals. 2. Treatment must attend to multiple needs of the individual, not just drug use. 3. Remaining in treatment for an adequate period of time is critical for treatment effectiveness.

19. BAF/2014

25. 12 fluid ounces of beer (about 5% alcohol) 8 to 9 fluid ounces of malt liquor (about 7% alcohol) 5 fluid ounces of table wine (about 12% alcohol) 1.5 fluid ounces of hard liquor (about 40% alcohol)

26. A GENCY FOR HEALTHCARE RESEARCH AND QUALITY ( AHRQ, 2008) WWW. AHRQ. GOV / CLINIC / POCKETGD. HTM BAF/2014

28. A science-based, preventive care approach used to identify people at high risk for unhealthy alcohol use, tobacco use, and nonmedical or illicit drug use. Offers counseling and referral to appropriate care when needed. SBIRT

29. “H OW MANY TIMES IN THE PAST YEAR HAVE YOU USED AN ILLEGAL DRUG OR USED A PRESCRIPTION MEDICATION FOR NON - MEDICAL REASONS ?” S CORING : A RESPONSE OF 1 OR MORE IS CONSIDERED POSITIVE. BAF/2014

30. I DENTIFY AOD USE THROUGH SCREENING I DENTIFY AOD USE THROUGH SCREENING C ONNECT AOD USE TO PATIENT HEALTH STATUS C ONNECT AOD USE TO PATIENT HEALTH STATUS A PPLY S TAGES OF C HANGE A PPLY S TAGES OF C HANGE A PPLY BRIEF INTERVENTION / M.I. A PPLY BRIEF INTERVENTION / M.I. O FFER REFERRAL IF INDICATED O FFER REFERRAL IF INDICATED BAF/2014

31. Have you ever felt you should Cut down on your drinking?  Have people Annoyed you by criticizing your drinking?  Have you ever felt bad or Guilty about your drinking?  Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)? Scoring: Item responses on the CAGE are scored 0 or 1, with a higher score an indication of alcohol problems. A total score of 2 or greater is considered clinically significant.

32. BAF/2014

34. Annual average reported alcohol use among pregnant women, 2012-2013 (Non-pregnant) 55.4 Current Alcohol Use 9.4% 24.6 Binge Drinking 2.3% 5.3 Heavy Drinking 0.4% NSDUH, 2013

35. BAF/2014

36. * R OUTINE SCREENING PROVEN TO BE EFFECTIVE * E ARLY USE IS ASSOCIATED WITH PROLONGED USE, MEDICAL AND PSYCH. COMORBIDITY, AND MORTALITY * A DOLESCENTS PREFER WRITTEN OR ELECTRONIC EVALUATIONS OVER Q&A * CRAFFT – MOST STUDIED AND APPLIED TOOL BAF/2014

37. CRAFFT Screening 1.”Have you ever ridden in a C ar driven by someone (including yourself) who was high or had been using alcohol or drugs?” 2. “Do you ever use alcohol or drugs to R elax, feel better about yourself, or fit in?” 3. Do you ever use alcohol or drugs when you are by yourself, A lone?” 4. “Do you ever F orget things you did while using alcohol or drugs?”

38. BAF/2014 5. “Do your family or F riends ever tell you that you should cut down on your drinking or drug use?” 6. “Have you ever gotten into T rouble while you were using alcohol or drugs?” Scoring: Each “yes” answer = 1 point. A score of 2 indicates need for SUD assessment. ( Any positive response should be further investigated by health care provider)

39. BAF/2014

42. CSAT, 1998

43. T HE ACA PROVIDES FUNDS FOR INCREASED SUD EDUCATION, SUD TREATMENT IN PRIMARY CARE, AND FOR SBIRT D ESIGNED TO IMPROVE ACCESS TO SUD TREATMENT FOR MILLIONS E NCOURAGES RESEARCH INTO RELATIONSHIP OF SUD AND CHRONIC ILLNESSES, AND PATIENT SELF - CARE P ROMOTES SUD PREVENTION EFFORTS BAF/2014

44. TREATMENT REFERRALS Substance Abuse Treatment Facility Locator (www.findtreatment.samhsa.gov) 1-800-662-HELPwww.findtreatment.samhsa.go Mental Health Services Locator (www.mentalhealth.samhsa.gov/databases)www.mentalhealth.samhsa.gov/databases National Alliance of Advocates for Buprenorphine Treatment – NAABT (www.naabt.org)www.naabt.org Narcotics Anonymous – NA (www.na.org)www.na.org Alcoholics Anonymous – AA (www.aa.org)www.aa.org Local Health Departments

45. BAF/2014