1. WWW.GOSNOLD.ORG 800-444-1554 Addiction: Current Trends in Substance Use Disorder, Treatment Innovation and Prevention GOSNOLD ON CAPE COD NEW ENGLAND’S ADDICTION TREATMENT PROVIDER

2. WWW.GOSNOLD.ORG 800-444-1554 POPULATION PREVALENCE In Treatment: 2.5 million Total Addicted: 25 Million Harmful Use: 60 Million Little or No Use U.S. Population: 312 Million Addicted: 25 Million--8% Abusers: 60 Million--19% Family of Addicted: 95 Million--30% Total Affected: 180 Million--58%

3. WWW.GOSNOLD.ORG 800-444-1554  18 Million addicted to alcohol  7 million addicted to to other drugs ( 5 million to opiates)  9.5 % are adults  2.5 % are adolescents GOSNOLD ON CAPE COD NEW ENGLAND’S ADDICTION TREATMENT PROVIDER Scope of Addiction in the USA

4. WWW.GOSNOLD.ORG 800-444-1554 Prescription Opioid Patterns in USA  17% of all scripts written are for an opioid  5% of world’s population; consume 80% of pain meds  79.5 million opioid scripts in 2009  Most prescribed med in America is Vicodin

5. WWW.GOSNOLD.ORG 800-444-1554  Philosophy of Pain Treatment  No One Should Suffer  Subjective Assessment of Pain  Defensive Medicine  Ignorance about Addiction How Did this Happen?

6. WWW.GOSNOLD.ORG 800-444-1554 How Did Opioid Users Start?  36% with a Legitimate Doctors Script  68% Medicine Cabinet or Friend  93% of those not starting with heroin ended up using it  Profile: 32 years, 75% white, gender parity, started in High School

7. WWW.GOSNOLD.ORG 800-444-1554 Overdose Deaths Exceed DWI Deaths

8. WWW.GOSNOLD.ORG 800-444-1554  7,000 a day in Emergency Rooms  Overdose deaths exceed Drinking Driver Deaths  Since 1998, 117% increase in ODs  53% of OD deaths re: to pharmaceuticals  80% of 42,000 OD deaths in 2012 were unintentional Impact of Opiate Crisis

9. WWW.GOSNOLD.ORG 800-444-1554  Use & procurement behaviors despite negative events  Return to use after periods of abstinence  Inability to consistently control use  Preoccupation with use/procurement  Cognitive changes (over-valuation, de-valuation, minimization/denial) What is Addiction?

10. WWW.GOSNOLD.ORG 800-444-1554 Addiction is a Brain Disease Caused primarily by neurochemical dysregulation of the dopamine system:  Genetic vulnerability  Exposure to a drug

11. WWW.GOSNOLD.ORG 800-444-1554 W e would not: ➢ View prior tx failure as a poor prognostic indicator ➢ Convey the expectation that patients should achieve enduring sobriety following single, brief treatment episode ➢ Punitively d/c for becoming symptomatic ➢ Relegate continuing care to an afterthought ➢ Treat the condition in episodes of self-contained and unlinked interventions What if we REALLY Believed Addiction was a Chronic Disorder? White and Kelly (2011)

12. WWW.GOSNOLD.ORG 800-444-1554 ➢ “ Addict” or “User” vs. Addiction Patient ➢ “Dirty” urine vs. Positive Lab Test ➢ “Clean & Sober” vs. Remission ➢ “Relapse” vs. Recurrence of Acuity or Regression ➢ Substance Abuser (cf eating disorder, not food abuser) ➢ Behavioral Health implying that “bad behavior” is responsible ➢ Talk of “graduation”. ➢ Challenge Patient Motivation (“he/she’s not ready”) ➢ If patient “uses” in treatment, we “kick them out” We Wouldn’t Talk the Way We Do 12

13. WWW.GOSNOLD.ORG 800-444-1554 ➢ Admit Discharge Admit Discharge ➢ A fixed treatment duration can resolve the problem ➢ Clinical aim is to place patients in a “program” & get them to “complete” treatment ➢ Reinforces Perception that Treatment Doesn’t Work Addiction Treatment Paradigm 13

14. WWW.GOSNOLD.ORG 800-444-1554  Diagnosable, Predictable, Treatable  A Course and Pattern Similar to Other Chronic Illnesses (Diabetes, Arthritis, Hypertension)  Characterized by Alternating Periods of:  Stabilization  Symptom Activation (Relapse) Addiction--A Chronic Illness

15. WWW.GOSNOLD.ORG 800-444-1554  Effects of treatment do not last very long after care stops  Patients who stop receiving treatment are at an elevated risk for a return to the acute stage GOSNOLD ON CAPE COD NEW ENGLAND’S ADDICTION TREATMENT PROVIDER In Chronic Illnesses..

16. WWW.GOSNOLD.ORG 800-444-1554 Successful Outcome for Chronic Disease?  Patient has increasingly extended remission periods  When acute symptoms recur, intervention occurs, the patient is re-stabilized & care plan is modified  Patient engaged in a program to manage the disease  Patient experiences overall improved functionality (health, family, etc.)

17. WWW.GOSNOLD.ORG 800-444-1554 WE CAN DO BETTER

18. WWW.GOSNOLD.ORG 800-444-1554 Moving from focus on acute emergency care to prevention, early intervention, primary care and extended engagement It’s Time to Invert the Triangle 18

19. WWW.GOSNOLD.ORG 800-444-1554  Prevention, Identification and Early Intervention  Integration with General Medical Care (PCPs, hospital, etc.)  Extended Patient Engagement (Recovery Coaching)  Whole Family Involvement  Anti-Craving Medications  Technological Monitoring  Tele-Health The New Paradigm

20. WWW.GOSNOLD.ORG 800-444-1554 ➢ Screening and Brief Interventions (SBIRT, PHQ-9, GAD) ➢ Factors related to stress, non-compliance, coping style, sleep, diet, exercise, social supports ➢ Emphasis on prevention and self ‐ management approaches ➢ Partner with patient to build resiliency ➢ Consultation and co ‐ management of psychiatric disorders I. The Behavioral Health Clinician in PCP Office

21. WWW.GOSNOLD.ORG 800-444-1554 ➢ Care doesn’t End at “Graduation” ➢ For Patient & Family ➢ Improve Treatment Compliance ➢ Help Patient Integrate into a Recovery World ➢ Improve Life Functioning— Social Determinants ➢ Rapid Re-stabilization if Acute Symptoms Recur II. Extended Engagement-Recovery Management

22. WWW.GOSNOLD.ORG 800-444-1554 ACHESS—measures progress, educates, maintains engagement, networks patients. My Strength- Sober Grid Steps Away III. Self Management Tools 37

23. WWW.GOSNOLD.ORG 800-444-1554 GOSNOLD ON CAPE COD Extended Engagement Outcomes

24. WWW.GOSNOLD.ORG 800-444-1554 GOSNOLD ON CAPE COD ◦  Naltrexone/Vivitrol  Suboxone  Methadone Medication Assisted Treatment

25. WWW.GOSNOLD.ORG 800-444-1554 Psychiatric consult during the clinical visit Tele-Psychiatry

26. WWW.GOSNOLD.ORG 800-444-1554 GOSNOLD ON CAPE COD NEW ENGLAND’S ADDICTION TREATMENT PROVIDER Prevention- Community Approach

27. WWW.GOSNOLD.ORG 800-444-1554  Law Inforcement  Academia  Medical  Community  Legistlators/Government GOSNOLD ON CAPE COD NEW ENGLAND’S ADDICTION TREATMENT PROVIDER Coalitions and Partnerships

28. WWW.GOSNOLD.ORG 800-444-1554 GOSNOLD ON CAPE COD NEW ENGLAND’S ADDICTION TREATMENT PROVIDER Gosnold Prevention Division  Clinicians Integrated in Medical Practices  School Based Counseling  Overdose Intervention Program  Clergy Education  Physician & Prescriber Education  Charlie Wilkerson Memorial Community Lecture Series  Dental Society Education  National Prescription Drug Take Back Day  Project Sticker Shock  Lock Your Meds Campaign- Ongoing  Community Forums  Compliance Checks – Falmouth (twice annually)  Playing Above the Influence-A Collaboration with the Cape Cod Baseball League Teams  Collaborative Partnerships

29. WWW.GOSNOLD.ORG 800-444-1554 Thank You! LORI J. MCCARTHY NATIONAL DIRECTOR OF CLINICAL OUTREACH LADC, CAI LJMCCARTHY@GOSNOLD.ORG GOSNOLD ON CAPE COD NEW ENGLAND’S ADDICTION TREATMENT PROVIDER