Support & Advance Effective Treatment

Return to Opioid Top-Level Strategy Map

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Treatment for Substance Use Disorder can take many forms.  In recent years typs of treatment have expanded consistent with more pathways to recovery.  There is no one size fits all.  Often multiple attempts at treatment are required before someone finds what works for them. What is important is that people have access to affordadable treatment when they are willing to seek help.

 

Background

• Substance Use Disorders (SUDs): occur when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home.
  • A diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria.
  • Drug classes for which an individual could be diagnosed with a SUD include: alcohol, cannabis, nicotine, opioids, inhalants, hallucinogens, amphetamine, caffeine, cocaine, and sedatives.
• Opioid dependence is a brain disease with both psychological and physical effects. Medication-assisted treatment combines therapy and medication in recovery to address them.
  • Counseling treats the psychological aspects of addiction and helps teach people effective recovery skills to prevent relapse.
  • Medication targets the physical aspects. Physical effects of the disease occur in the limbic region of the brain and have to do with the way the brain reacts and adjusts to the constant presence of opioids.
• Treatment has a high return on investment--even with success rates lower than ideal.
  • The average cost for 1 full year of methadone maintenance treatment is approximately $4,700 per patient, whereas 1 full year of imprisonment costs approximately $24,000 per person.
  • According to several conservative estimates, every dollar invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft. When savings related to healthcare are included, total savings can exceed costs by a ratio of 12 to 1. 

Current Status

One aspect of improving treatment is reducing treatment dropout rates. Psychiatrist Sally Satel puts the dropout rate during the first few months of addiction treatment at 40-60%.[any empirical studies to support this idea?]

 

Promising Programs

Burlington, Vermont

As part of the Chittenden County Opioid Alliance, the City of Burlington piloted a “hub-and spoke” model that has since been adopted by the entire state of Vermont to organize their provider and treatment-centered response to the opioid epidemic. Following implementation, Vermont now has the highest capacity for treating Opioid Use Disorder (OUD) in the U.S. The model divides Vermont into five regions, organized around an opioid treatment provider with a license to dispense buprenorphine and sufficient staff to assess and treat opioid patients’ medical and psychiatric needs. From this “hub” jut “spokes” of nurse-counselor teams focused on family services, corrections, residential services, in-patient services, pain management clinics, medical homes, substance abuse outpatient treatment and/or mental health services. As a result of this model, Vermont increased the number of opioid patients served more than threefold during its first three years and reduced the length of its treatment waiting lists even as demand increased. A key component of the hub-and-spoke model’s success is the incorporation of the Burlington Police Department, which is transitioning from punishing addiction as a crime to treating it as a disease. The Chittenden County Opioid Alliance tracks its progress using a scorecard, which it provides to the public as an online tool that shares information about the state’s progress. 

Triggr Health

Triggr Health has developed a data-driven, personalized system that helps recovering addicts in part by predicting when they are most likely to suffer a relapse. The company uses a combination of digital tools -- including a mobile app -- and human interaction to help its patients overcome addiction. Trigger Health's tools encourage patients to set and meet goals for curtailing their drug use.

Treatment Options

The following list goes reads from lower intensity interventions to higher intensity interventions

 

• Early Intervention: Assessment and Education
• Acupuncture-based approaches: Detoxification using Acupuncture
• Outpatient Services: Supportive recovery environment. Therapy.
• Intensive Outpatient/Partial Hospitalization Services: Structured supportive environment. Increased therapy sessions. Possible hospitalization for withdrawal or other issues.
• Residential Inpatient Services: 24-hour care, structured setting. May include medical, nursing, or clinical care or monitoring. Increased therapy sessions.
• Medically Managed Intensive Inpatient Services: 24-hour nursing care, daily physician care. Highly structured environment. Therapeutic counseling services available.

Counseling Options

Group Counseling: In group counseling, a person can learn from the experiences of others going through recovery. A counselor, psychiatrist or psychologist guides the group, providing opportunities to discuss issues that led to opioid dependence and ways to stay drug-free. For many people, talking to others with similar problems helps in their recovery and allows them to develop a support network.

Individual Counseling: One-on-one therapy with a counselor, psychiatrist or psychologist could be helpful for someone who prefers a more private setting over a group environment. It provides the opportunity to examine the issues that led to opioid dependence and strategies for change.

Peer Support Group Programs: Like Narcotics Anonymous and Alcoholics Anonymous, 12-step programs help people in recovery by helping support drug-free lifestyles. Meetings are usually led by people who have been through the program and are living successful lives in recovery. See Strengthen Peer Recovery Support Services & Programs for more information

Link to National Acupuncture Detoxification Association Page
 

Referrals

Referral Protocol

For people who walk into law enforcement or mental health services that are struggling with addiction or know others who are. This tool helps analyze financial or other barriers that may exist. Referrals to other groups as well.

 Contact: Stonington Human Services at (860) 535-5015, Stonington Prevention Council [contacted source for resource]
 

 

Tools & Resources

TR - Support & Advance Effective Treatment

 

Sources

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1. https://www.samhsa.gov/disorders/substance-use
2. https://www.samhsa.gov/disorders/substance-use
3. https://www.samhsa.gov/disorders/substance-use
4. http://www.wsj.com/articles/how-to-treat-an-opioid-epidemic-1484323662
5. http://www.endopioiddependence.org/opioid-treatment-options
6. http://www.endopioiddependence.org/opioid-treatment-options
7. http://www.theday.com/policefirecourts/20170114/the-problem-is-everywhere-stonington-fights-opioid-crisis