Tag Archives: Substance Abuse and Mental Health Services Administration

The Recovery Support that is Available Following Overdose

Posted on February 11, 2018 by Melissa Killeen

What happens to people who experience a drug overdose and are successfully revived through emergency medical intervention?

What is their fate after they leave the hospital or other emergency care setting?

Missing in the media coverage of the unrelenting legions of drug overdose deaths in the United States is an equally important but less heralded story. What happens to people who experience a drug overdose and are successfully revived through emergency medical intervention? What is their fate after they leave the hospital or other emergency care setting? The Connecticut Community for Addiction Recovery (CCAR) and other grassroots recovery community organizations (RCOs) nationwide are influencing positive outcomes to overdose by placing recovery coaches with first responders and doctors in the emergency departments in hospitals to advance recovery options for the revived overdose patients.

The Connecticut Community for Addiction Recovery (CCAR) is one of several hundred recovery advocacy and recovery support organizations (RCOs) rising on the American landscape in the last two decades. One of the first RCOs, CCAR pioneered what have since become standard RCO service fare: recovery-focused professional and public education, legislative advocacy, recovery community centers, recovery celebration walks and conferences, recovery support groups, training for recovery home operators, face-to-face and telephone-based recovery support services, family-focused recovery education and support services, and collaboration with research scientists on the evaluation of the effects of peer support on long-term recovery outcomes. As an example of its reach, CCAR’s Recovery Coach Academy curriculum has been used in the training of more than 20,000 recovery coaches worldwide.

CCAR began piloting an Emergency Department Recovery Coach (EDRC) Program in March of 2017. Through this program, CCAR-trained recovery coaches are on-call for hospital emergency rooms to offer assistance to patients and their families during an emergency room visit resulting from an adverse drug reaction or other alcohol- or another drug-related medical crisis. An evaluation of EDRC services provided between March and November 2017 within four collaborating hospitals revealed the following. CCAR-trained recovery coaches provided recovery support services to 534 patients/families during the 8-month evaluation period with a relatively even distribution of services provided across the four hospitals. Of those served by the EDRC, the majority were in the ER due to an alcohol- or opioid-related condition; 70% were male; and 5% were seen more than once during the evaluation period. Most importantly, of the 534-people interviewed, 528 were assertively linked to a detoxification program, inpatient or outpatient treatment, or community-based recovery support resources.

A more formal and sustained evaluation of the EDRC program is underway in collaboration with Yale University, and the program is now being expanded to an additional four hospitals. Funding support for the EDRC comes from the Connecticut Department of Mental Health and Addiction Services through support of the federal block grant and a Targeted Response to the Opioid Crisis Grant from the Substance Abuse and Mental Health Services Administration.

CCAR’s EDRC program has many distinct features worthy of replication and local refinement. Among the more striking of such features are the following.

  • The EDRC program is governed by a formal agreement between CCAR and each participating hospital that delineates the roles and responsibilities of each party.
  • The EDRC program is currently staffed by one Recovery Coach Manager and 9 full-time Recovery Coaches (RCs).
  • Emergency Department Recovery Coaches (EDRCs) are recruited and screened (2 interviews with background and reference checks) based on desired experience, skills, and a good work history, but also for what our EDRC manager, Jennifer Chadukiewicz, calls “a servant’s heart.”
  • All EDRCs go through more than 60 hours of training and spend the first weeks shadowing tenured EDRCs. The training includes the CCAR Recovery Coach Academy© (30 hours) as well as topical trainings, e.g., Narcan (naloxone administration), medication-assisted recovery, ethical decision-making, crisis intervention, and conflict resolution. Hospital specific training includes such areas as fire/general safety, OSHA, blood borne pathogens, infection control, hazardous materials, and HIPPA regulations.
  • EDRC Recovery Coaches are employed by CCAR rather than the hospitals and enter the hospitals as service vendors and “guests” who defer to leadership of ER staff.
  • The RCs are paid a livable wage ($20-$25/hr. to start plus benefits, health insurance, etc.) that allows them to work full time and support themselves and their families while affording time away for rest and self-care.
  • EDRC coverage is provided from 8 am to 12 midnight, seven days a week, 365 days a year.
  • Patients have the option of enrollment in enhanced Telephone Recovery Support (TRS) program (i.e., patients receive daily support calls for the next 10 days and then weekly if desired).
  • EDRC’s provide assertive linkage and transportation (when needed) to treatment and recovery support resources.
  • The EDRCs spend considerable time with community providers and other stakeholders building collaborative relationships that facilitate this patient referral and service linkage process.
  • CCAR provides each hospital emergency department with “prescription pad” style resource handouts that can be attached to discharge paperwork and given to patient friend/family member.

There are critical windows of vulnerability and opportunity within addiction and recovery careers that serve to plunge one deeper into addiction or mark the catalytic beginning of a recovery process. The reversal of a drug overdose or treatment of other drug-related medical crises can constitute a recovery tipping point.

The emergency room is not the only critical point of potential intervention to reduce the risk of drug-related deaths and to promote addiction recovery. For persons with a history of addiction, the days and weeks immediately following release from a correctional facility, release from an inpatient or residential detoxification/treatment program without medication support, or cessation of medication-assisted treatment, and even transfer from one medication-assisted treatment provider to another all constitute a zone of heightened risk for re-initiation of risky drug use and death. Altering such risks and tipping the scales toward recovery stabilization, recovery maintenance, and enhanced quality of personal/family life in long-term recovery should be the goals of every community. Recovery community organizations like CCAR are showing us how this can be done.

This blog was written by William White, Rebecca Allen & Phil Valentine. It was originally posted on the William White web site: www.williamwhitepapers.com on January 18, 2018

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Substantial R.O.I. from Funding Recovery Programs

Posted on August 27, 2015 by Melissa Killeen
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Melissa Killeen

“Most crucially, everyone must be aware of how logical and smart treatment is from a purely financial standpoint.” – Dr Richard Juman, president of the New York State Psychological Association

Can there be a substantial R.O.I. (return on investment) from government-funded recovery programs? How can funding recovery programs provide high returns on the funding investment when a new report from the CDC says opioid use is at epidemic proportions? When heroin deaths nearly quadrupled from 2000 to 2013? And the trend is worsening: heroin-related
deaths, grew a staggering 39.3% from 2012 to 2013. There were about 44,000 drug drug-addiction-9847058overdose deaths in the U.S. in 2013, more than 16,000 of them involving powerful prescription painkillers such as Vicodin and OxyContin. [i] Each day, 44 people in the United States die from overdose of prescription painkillers.[ii] How much funding can the government forecast to pump into this epidemic? Addressing the impact of substance use alone is estimated to cost hundreds of billions each year. Is there enough government money to make a dent? We have to, at least, try.

Substance abuse is costly to our nation, exacting over $600 billion annually in costs related to healthcare, lost work, lower productivity and crime. Research from the Massachusetts Opioid Task Force and Department of Public Health established that mental and substance use disorders are among the top conditions that result in significant costs to families, employers, and publicly funded health systems. In 2012, an estimated 23.1 million Americans aged 12 and older needed treatment for substance use. By 2020, mental and substance-use disorders will surpass all physical diseases as a major cause of disability worldwide. [iii]

In June 2006, the Washington State Institute for Public Policy, whose mission is to carry out practical, non-partisan research on issues of importance to Washington State, was directed by the Washington Legislature to estimate whether treatment for people with alcohol, drug, and mental health disorders offers economic advantages, or a R.O.I. (return on investment). By reviewing “what works,” literature, and estimating monetary value of benefits, they reached these conclusions:

  1. The average substance use treatment program can achieve roughly a 15 to 22 percent reduction in the incidence or severity of these disorders.
  2. Treatment of these disorders can achieve about $3.77 in benefits per dollar of treatment costs. This is equivalent to a 56 percent rate of return on investment.
  3. Estimated that a reasonably aggressive implementation policy could generate $1.5 billion in net benefits for people in Washington with $416 million in net taxpayer benefits, and the risk of losing money is small.[iv]

But still, state and federal legislators are hesitant to fund intervention, treatment, and recovery programs.

“Together we must challenge individuals, communities, cities, counties, regions, states, and the nation to be accountable for the outcomes of the justice systems at every level of government.”
— James Bell

Approximately one-quarter of those people held in U.S. prisons or jails have been convicted of a drug offense.[v] The United States incarcerates more people for drug offenses than any other country. With an estimated 6.8 million Americans struggling with drug abuse or dependence, the growth of the prison population continues to be driven largely by incarceration for drug offenses.[vi] Where does this spiral of incarceration instead of treatment stop?

For example, the average cost for a year of an offender treatment program is $5,000, whereas a year of imprisonment costs over $31,000, and far more in areas like New York City where the average annual cost per inmate was $167,731 in 2012. Court ordered addiction treatment programs can seriously reduce prison costs.[vii]

The Pennsylvania Commission on Crime and Delinquency (PCCD) examined the return-on-investment for seven programs (e.g. Big Brothers and Big Sisters, Strengthening Families, and Multisystemic Therapy programs) that are supported by the state’s Commission and Department of Public Welfare. It was concluded that these programs represent a potential $317 million return to the Commonwealth in terms of reduced correctional costs, lessened welfare and social services burden, and increased employment and tax revenue. The researchers estimated that the programs produced returns of $1 to $25, for every dollar invested, and could generate cost savings as great as $130 million for a single program.[viii] Are these facts overlooked by legislators in state and federal government?

Maryland voters believe by a five-to-one margin that the drug problem is getting worse. The same poll showed that voters believe by a two-to-one margin that there are too many people in prison, and 86% of respondents favor judges having the option to order drug treatment rather than prison for some offenders. [ix] Have the voters spoken?

“Recovery with justice allows us to bury the ghosts of the past and to live with ourselves in the present.” — William White

So in this election year, I urge you to contact your local state representatives, contact your state senators and congressmen/women and urge them to increase funding for substance-addiction treatment and implement reforms that will send addicts to treatment programs like Drug Court or COPS, (Office of Community Oriented Policing Services) versus prison.

William White just posted an excellent letter to our presidential candidates that outlines the impact opioid addiction has on individuals, families, and communities. White requests a policy statement by the candidates in the 2016 Presidential campaign. Copy this letter and send it to the candidates you support: http://www.williamwhitepapers.com/blog/

And remember:

There are 23 million people in long-term recovery, and we vote.

 

References used in this blog

[i] The American Association for the Treatment of Opioid Dependence (AATOD) March 18, 2015 10:51 AM, Accessed on August 23, 2015 at: http://finance.yahoo.com/news/only-1-9-substance-abuse-145129124.html

[ii] Understanding the Epidemic, Center for Disease Control, access on August 23, at: http://www.cdc.gov/drugoverdose/epidemic/index.html

[iii] Massachusetts Opioid Task Force and Department of Public Health Recommendations on Priorities for Investments in Prevention, Intervention, Treatment and Recovery, http://www.mass.gov/eohhs/docs/dph/substance-abuse/opioid/report-of-the-opioid-task-force-6-10-14.pdf  Accessed August 23, 2015

[iv] Washington State Institute for Public Policy, accessed on August 23, 2015 at: http://www.wsipp.wa.gov/ReportFile/945/Wsipp_Evidence-based-Treatment-of-Alcohol-Drug-and-Mental-Health-Disorders-Potential-Benefits-Costs-and-Fiscal-Impacts-for-Washington-State_Full-Report.pdf

[v] Number of people in federal or state prison for drug offenses: Harrison, Paige, and Allen J. Beck. Prisoners in 2005. Washington, DC: Bureau of Justice Statistics. Estimate of jail inmates held on drug offense derived from James, Doris J. 2004. Profile of jail inmates, 2002. Washington, DC: Bureau of Justice Statistics.

[vi] U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. 2005 National Survey on Drug Use & Health: Detailed Tables. Table 5.1A Online at www.drugabusestatistics.samhsa.gov/NSDUH/2k5NSDUH/tabs/Sect5peTabs1to82.htm#Tab5.1A

[vii] The American Association for the Treatment of Opioid Dependence (AATOD)March 18, 2015 10:51 AM, Accessed on August 23, 2015 at: http://finance.yahoo.com/news/only-1-9-substance-abuse-145129124.html

[viii] EpisCenter, Penn State University, Cost-benefit Assessment of Pennsylvania’s Approach to Youth Crime Prevention Shows Dramatic Return on Investment access on August 23, 2015 at: http://www.episcenter.psu.edu/sites/default/files/Fact%20Sheet%20-%20Cost%20Benefit%20of%20PA%20Prevention.pdf

[ix] Justice Policy.org accessed on August 23, 2015 at: http://www.justicepolicy.org/uploads/justicepolicy/documents/04-01_rep_mdtreatmentorincarceration_ac-dp.pdf

[ix] Maryland Voter Survey. (December, 2003). Bethesda, Maryland: Potomac Incorporated.

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Alcohol Kills One Person Every Ten Seconds.

Posted on July 2, 2015 by Melissa Killeen
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Melissa Killeen

The misuse and abuse of alcohol affect the lives, health and well-being of billions of people. A World Health Organization 2014 report stated the consumption of alcohol led to 3.3 million deaths around the world. In essence, the report says that alcohol kills 1 person every 10 seconds.

Shekhar Saxena, head of the World Health Organization’s Mental Health and Substance Abuse department, reports that there are roughly 3.25 billion people in the world that drink, and these drinkers consume an average of 4.5 gallons of pure alcohol a year. China is estimated to increase it’s per person, per year alcohol consumption ratio by an additional 1.5 liters of pure alcohol by 2025.

According to SAMHSA’s National Survey on Drug Use and Health (NSDUH), more than half of all U.S. adult citizens drink alcohol, with 6.6% meeting criteria for an alcohol-use disorder.

One in 10 deaths among working-age adults aged 20-64 years are due to excessive alcohol use.

A CDC study, published in June of this year, found that nearly 70% of deaths due to drinking involved working-age adults, and about 70% of those deaths involved males. Nearly 88,000 people die in the U.S. from alcohol-related causes annually, making it the third most preventable cause of death in the United States. In 2013, fatal accidents involving an alcohol-impaired driver accounted for 10,076 deaths or 30.8 % of all driving fatalities.

Men are more likely than women to experience alcohol-related deaths. Although more women are drinking today as compared to 2012, of the 88,000 alcohol related deaths, approximately 62,000 were men and 26,000 were women. This study proclaims that excessive alcohol use can shortened the lives of working-age adults by about 30 years.

Alexandra Sifferlin for Time Magazine reported that harmful alcohol use not only leads to addiction, but it can put people at a higher risk of over 200 disorders like liver disease, tuberculosis and pneumonia.

Binge drinking can damage the frontal cortex and other areas of the brain

The CDC report shows that 16% of drinkers partake in binge drinking, which is the most dangerous form of alcohol consumption. Some of the risks associated with binge drinking are well known. It increases the risk for sexual assault, violence and self-harm. But the physical effects of such behaviors on the body are often not discussed. According to the National Institutes of Health (NIH), there’s strong evidence to suggest that regular binge drinking impacts executive functioning and decision making by damaging the frontal cortex and other areas of the brain.

According to the 2013 The National Survey on Drug Use and Health (NSDUH), approximately 5.4 million people (about 14.2%) in the age range of 12-20 years, were binge drinkers (15.8% of males and 12.4% of females).

One in every four families are impacted by alcoholism

More than 10% of U.S. children live with a parent with alcohol problems, according to a 2012 study.

According to Herma Silverstein, author of the book; Alcoholism, one of every four families has problems with alcohol.

The CDC study also found that about 5% of the alcohol related deaths in the U.S. involved people younger than age 21.

In 2012, 58.3% of people who tried alcohol for the first time were younger than 18.

Drinking during pregnancy can cause brain damage to the infant, leading to a range of developmental, cognitive, and behavioral problems, otherwise called Fetal Alcohol Spectrum Disorders (FASD). People/children with difficulties in the following areas may have FASD or alcohol-related birth defects:

  • Coordination
  • Emotional control
  • Learning challenges
  • Socialization skills
  • Focus in class, holding down a job

These statistics are over powering and most definitely build an excellent argument to stop drinking, especially over this Fourth of July long holiday weekend. Please share these statistics with a friend, post on your social media pages, re-publish in your blog, or newsletter.

References used in this blog:

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is one of the 27 institutes and centers that comprise the National Institutes of Health (NIH). NIAAA supports and conducts research on the impact of alcohol use on human health and well-being. http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. The mission of PCD is to promote the open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention. http://www.cdc.gov/features/alcohol-deaths/

The National Survey on Drug Use and Health (NSDUH) provides national and state-level data on the use of tobacco, alcohol, illicit drugs (including non-medical use of prescription drugs) and mental health in the United States https://nsduhweb.rti.org/respweb/homepage.cfm

Substance Abuse and Mental Health Services Administration (SAMHSA), is an agency of the U.S. Public Health Service in the U.S. Department of Health and Human Services. http://www.samhsa.gov/

Alexandra Sifferlin, (2015) What Drinking Does to Your Body over Time, Time Magazine, http://time.com/author/alexandra-sifferlin/

And

Alexandra Sifferlin, (2014) Alcohol Kills 1 Person Every 10 Seconds, Report Says, Time Magazine, http://time.com/96082/alcohol-consumption-who/

Silverstein, Herma. (1990), Alcoholism. New York: Franklin Watts http://allpsych.com/journal/alcoholism/#.VZQkhWPH_VI

 

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