1. Drug Related Issues Questions and Curiosities?

2. Looking at SAMHSA Site Observations? Observations? What does this site tell you about the government’s priorities, agenda, etc. as related to Substance abuse? What does this site tell you about the government’s priorities, agenda, etc. as related to Substance abuse? As a human services professional, how might this site be useful to you? As a human services professional, how might this site be useful to you?

3. Defining key terms Substance Use: Individual has used in a specified period of time or a particular way, e.g. “lifetime” or “past 30 days” or “binge drinking.” Substance Use: Individual has used in a specified period of time or a particular way, e.g. “lifetime” or “past 30 days” or “binge drinking.” Substance Misuse: Often used in re: to prescription meds, but defines inappropriate use that falls short of the criteria for abuse. Substance Misuse: Often used in re: to prescription meds, but defines inappropriate use that falls short of the criteria for abuse. Substance Abuse: Diagnostic term-clinically significant impairment because of use and indicated by at least one problem (legal, school, interpersonal, use in hazardous situation, etc.) within a 12 month period. Substance Abuse: Diagnostic term-clinically significant impairment because of use and indicated by at least one problem (legal, school, interpersonal, use in hazardous situation, etc.) within a 12 month period. Substance Dependence: Diagnostic term-significant impairment, tolerance, withdrawal, lack of control, health issues, etc. Substance Dependence: Diagnostic term-significant impairment, tolerance, withdrawal, lack of control, health issues, etc. Addiction: Use of a substance or behavior over which the individual has no control. Addiction: Use of a substance or behavior over which the individual has no control. Substance abuse/dependence as a disability Substance abuse/dependence as a disability

4. Why do people use substances? There are a variety of reasons why people use; the reasons can be linked to theories-think BioPsychoSocial: There are a variety of reasons why people use; the reasons can be linked to theories-think BioPsychoSocial: 1. Biological theories: genetic predisposition, physiological reaction 2. Psychological theories: self-medication of unmet needs, learned behavior. 3. Sociological theories: anomie, differential association

5. Co-occurring Disorders Definition: A cx has at least one substance related disorder and at least one other mental disorder. Definition: A cx has at least one substance related disorder and at least one other mental disorder. Previously used terms: MICA, dual disorders, dual diagnoses, CAMI Previously used terms: MICA, dual disorders, dual diagnoses, CAMI Approximately 20% of people treated in publicly funded system have COD Approximately 20% of people treated in publicly funded system have COD

6. Which came first? Secondary substance abuse Secondary substance abuse Secondary psychiatric disorder Secondary psychiatric disorder Common factor Common factor Bidirectional Bidirectional

7. Treatment models Sequential Sequential Parallel Parallel Integrated Integrated

8. “Wet Housing,” a Harm Reduction Approach Permanent supported housing Permanent supported housing Sobriety not required, i.e. housing first approach Sobriety not required, i.e. housing first approach Target population: chronic inebriates Target population: chronic inebriates Goals? Goals? –Reduce costs –Reduce illness & injury –Increase well-being of clients –Decrease problems for community –Sobriety

9. Success? Medical expenses down 41% Medical expenses down 41% County jail bookings down 45% County jail bookings down 45% Sobering center usage down 87% Sobering center usage down 87% Shelter usage down 92% Shelter usage down 92% # of days of intoxication reduced by 50% # of days of intoxication reduced by 50% Alcohol related incidents reported by Downtown Seattle Association down by 48% Alcohol related incidents reported by Downtown Seattle Association down by 48%

10. Drug Diversion Court An approach to reducing crime associated with substance use and providing treatment to people with abuse/dependence problems. An approach to reducing crime associated with substance use and providing treatment to people with abuse/dependence problems. Goal of drug court: break the substance abuse/dependence-crime cycle. Goal of drug court: break the substance abuse/dependence-crime cycle. 10 month minimum; average 15 month program. Tx, UAs, appearance before judge. 10 month minimum; average 15 month program. Tx, UAs, appearance before judge. Eligibility criteria- Eligibility criteria- –Lots of details, bottom line: Possession or delivery charges within limits. –Lots of exclusion, both with current crime and crime history.

11. Is it effective? How would you define effectiveness? Between August, 94 and May 5, 2004 (Seattle and Kent sites): Between August, 94 and May 5, 2004 (Seattle and Kent sites): –5,948 defendants have been referred to drug court; –3,071 defendants have opted into the drug court program; –of those that entered treatment, 350 are currently active in the program – 622 have graduated. –Approximately 178 cases have been referred to the Kent Drug Court, with 84 opting-in. The Kent program has been operational since March 1, 2003. –Approximately 178 cases have been referred to the Kent Drug Court, with 84 opting-in. The Kent program has been operational since March 1, 2003.

12. MM Bell, 1998, Outcome Evaluation Study New felony charges after one year: 9% of drug court graduates; 25% of noncompleters and nonparticipants. U of WA. Institute for Alcohol and Substance Abuse, Outcome and Process Evaluation Graduates have zero or near zero rates of imprisonment in the year following graduation from the drug court Increased earnings for graduates as compared with noncompleters and nonparticipants Other studies Show that for every dollar spent on treatment, 2-10 bucks is saved in law enforcement, healthcare, corrections, welfare and lost productivity.

13. Your task Select an approach to addressing substance related problems. Select an approach to addressing substance related problems. Discuss possible ways of measuring success. Discuss possible ways of measuring success. Identify strengths and weaknesses of each. Identify strengths and weaknesses of each.