1. FAMILY RECOVERY NETWORK EVENT: What is Substance Abuse Treatment? Patrick Seche, MS, CASAC Strong Recovery Addiction Psychiatry Division Department of Psychiatry UR Medicine

2. WHAT IS ADDICTION?

3. What is Addiction? Drug addiction is a disease of the brain that translates into abnormal behavior……… Drug addiction is a disease of the brain that translates into abnormal behavior………

4. What is Addiction "We now know that addiction is a disease that affects both brain and behavior. We have identified many of the biological and environmental factors and are beginning to search for the genetic variations that contribute to the development and progression of the disease.“ "We now know that addiction is a disease that affects both brain and behavior. We have identified many of the biological and environmental factors and are beginning to search for the genetic variations that contribute to the development and progression of the disease.“ Dr. Nora Volkow, Director of NIDA

5. NEW YORK STATE’S ADDICTION TREATMENT CONTINUUM OF CARE

6. LEVELS OF CARE INPATIENT DETOX(es) INPATIENT DETOX(es) 3-10 days 3-10 days Intoxicated or Acutely ill Intoxicated or Acutely ill Withdrawal symptoms (Severe, Mild to moderate coupled with situational crisis, Hx of past withdrawal complications) Withdrawal symptoms (Severe, Mild to moderate coupled with situational crisis, Hx of past withdrawal complications) Unable to abstain Unable to abstain

7. LEVELS OF CARE Outpatient Detox Outpatient Detox 5-60 days 5-60 days Intoxicated Intoxicated Mild to moderate withdrawal, coupled with a stable environment Mild to moderate withdrawal, coupled with a stable environment Unable to abstain Unable to abstain No Hx of past withdrawal complications No Hx of past withdrawal complications

8. LEVELS OF CARE Inpatient Rehab Inpatient Rehab 2-5 weeks 2-5 weeks Unable to participate in, or comply with, treatment outside of a 24 hour setting: Unable to participate in, or comply with, treatment outside of a 24 hour setting: Failure to remain abstinent in a lower level of care Failure to remain abstinent in a lower level of care Environment is not conducive to recovery Environment is not conducive to recovery Physical or mental complications requiring medical management and 24 hour observation and evaluation Physical or mental complications requiring medical management and 24 hour observation and evaluation Lacks insights and motivation Lacks insights and motivation

9. LEVELS OF CARE Intensive Residential Rehab Intensive Residential Rehab 6-9 months 6-9 months 24/7 treatment 24/7 treatment Structured Environment Structured Environment Substantial social component Substantial social component Case management of additional services Case management of additional services Collaborative agreements with other providers Collaborative agreements with other providers

10. LEVELS OF CARE Community Residence (Halfway House) Community Residence (Halfway House) 6-18 months 6-18 months Transition to abstinent living Transition to abstinent living Require the support of a drug and alcohol-free environment while receiving other services Require the support of a drug and alcohol-free environment while receiving other services Not yet ready for independent living Not yet ready for independent living Ongoing clinical support Ongoing clinical support

11. LEVELS OF CARE Supportive Living Services Supportive Living Services 9-24 months 9-24 months Promote independent living in a supervised setting Promote independent living in a supervised setting No 24/7 staffing on site No 24/7 staffing on site Long-term supportive environment following care Long-term supportive environment following careor Transitional living environment prior to independent community living Transitional living environment prior to independent community living

12. LEVELS OF CARE Outpatient Treatment Programs Outpatient Treatment Programs 12+ months 12+ months Promote achievement and maintenance of recovery Promote achievement and maintenance of recovery Improve functioning and develop necessary recovery management skills Improve functioning and develop necessary recovery management skills Support attainment of economic self- sufficiency Support attainment of economic self- sufficiency Improve quality of life. Improve quality of life. *(Intensive Outpatient Services)

13. LEVELS OF CARE Outpatient Rehab Programs Outpatient Rehab Programs 3-6 months 3-6 months 3-5 days/week for at least 4 hrs/day 3-5 days/week for at least 4 hrs/day Chronic conditions Chronic conditions Therapeutic milieu emphasizing development of basic skills in personal care, nutrition, community competency & prevocational/vocational competencies; etc Therapeutic milieu emphasizing development of basic skills in personal care, nutrition, community competency & prevocational/vocational competencies; etc

14. LEVELS OF CARE Opioid Treatment Programs (Methadone Clinics) Opioid Treatment Programs (Methadone Clinics) Administration of Methadone or other approved medications Administration of Methadone or other approved medications Medical treatment protocols Medical treatment protocols Clinical and Support services Clinical and Support services

15. LEVELS OF CARE CHEMICAL DEPENDENCE RESIDENTIAL REHABILITATION SERVICES FOR YOUTH OUTPATIENT CHEMICAL DEPENDENCY SERVICES FOR YOUTH

16. ACCESS TO CARE DHS DHS CRIMINAL JUSTICE SYSTEM CRIMINAL JUSTICE SYSTEM MEDICAL PROVIDERS MEDICAL PROVIDERS COMMUNITY ORGANIZATIONS COMMUNITY ORGANIZATIONS PEERS PEERS FAMILY MEMBERS FAMILY MEMBERS SELF SELF

17. ACCESS TO CARE Outpatient – direct call to program for an intake Outpatient – direct call to program for an intake Residential and Inpatient – from an outpatient program or higher level of care Residential and Inpatient – from an outpatient program or higher level of care Detox – from ED or lower level of care; or direct call Detox – from ED or lower level of care; or direct call

18. Questions/Remarks