Transcript “The Ripple Effect of Substance Abuse on Family and Community”

North Dakota Conference on Injury
Prevention & Control
“The Ripple Effect of Substance
Abuse on Family and Community”
October 29, 2008
Mandan, ND
H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM
Director
Center for Substance Abuse Treatment
Substance Abuse Mental Health Services
Administration
U.S. Department of Health & Human Services
“Alcohol addiction and drug
addiction continue to
challenge our Nation.
Addiction to alcohol or
drugs destroys family ties,
friendship, ambition, and
moral conviction, and
reduces the richness of
life to a single destructive
desire.”
President George W. Bush
September 2003
2
Substance Abuse and Mental Health
Services Administration/CSAT
SAMHSA’s Mission:
• To build resilience and facilitate recovery for
people with or at risk for substance abuse and
mental illness.
Center for Substance Abuse Treatment (CSAT)
Mission:
• To improve the health of the nation by bringing
effective alcohol and drug treatment to every
community.
The Impact of Addiction
• Addiction impacts an individual’s behavior,
health, thinking process, quality of life, and
overall functioning.
• Alcohol & other drugs are powerful
reinforcing psychoactive substances that
take on a life of their own.
4
SAMHSA’s Role in Supporting Recovery
from Substance Use Problems &
Disorders
• SAMHSA works to ensure that science, rather
than ideology or anecdote, forms the foundation
for the Nation’s addiction treatment system.
• SAMHSA serves health professionals and the
public by disseminating scientifically sound,
clinically relevant information on best practices
in the treatment of addictive disorders and by
working to enhance public acceptance of that
treatment.
5
SAMHSA/CSAT’s Public Health
Approach
• Population-based
• Comprehensive and holistic
• Incorporates early intervention, treatment,
recovery support, and health promotion
• Works across systems and professions
• Involves people in recovery, the community, the
public and private sectors
• Evidence-based
We Face Multiple Challenges
• Reaching those in need of services
• Providing adequate resources
• Developing culturally-appropriate, evidencebased interventions
• Building and sustaining a qualified workforce
• Integrating substance use disorder services
into the public health paradigm
7
Greater Burden on Public Sector
Projections indicate
that the burden on the
public sector will
continue to increase
Private
50%
Private
23%
50%
Public
1986 All SA = $9.3B
Public = $4.6 B
Private = $4.6 B
Source: Health Affairs, July-August 2007
77%
Public
2003 All SA = $20.7 B
Public = $16.0 B
Private = $4.7 B
8
A Greater Burden & Tighter Budgets
At the same time that a larger percentage of
substance abuse treatment costs are being
placed on the public sector, states are facing
tighter budgets:
• According to the Center on Budget and Policy
Priorities, 29 states face budget shortfalls in
2009 – ranging from $59 Million to $22.2 Billion.
• Funds need to be used effectively for programs
that can show evidence of their success
• All of these factors make the challenges facing
treatment providers even more difficult.
The Challenges Remain
• Despite tightening budgets and changing
populations, the challenges of alcohol and
substance abuse remain. According to the 2007
National Survey on Drug Use and Health
(NSDUH):
– In 2007, an estimated 19.9 million Americans
aged 12 or older were current (past month) illicit
drug users.
– Slightly more than half of Americans (12 and
older) reported being current drinkers of alcohol –
more than a fifth of them participated in binge
drinking at least once in the 30 days prior to the
2007 survey.
Drug Abuse
Past Month Use of Specific Illicit Drugs
among Persons Aged 12 or Older:
2002-2007
Illicit Drugs
Pain Relievers
Marijuana
Cocaine
Psychotherapeutics
Methamphetamine
Percent Using in Past Month
9%
8%
8.0%
7%
6%
5.8%
5%
4%
3%
2.8%
2.1%
2%
1%
0.8%
0.2%
0%
2002
Source: NSDUH, 2007
2003
2004
2005
2006
2007
Past Month Nonmedical Use of Prescription
Drugs (Psychotherapeutics) among Persons
12+: 2002-2007
Percent Using in Past Month
2.0
2
1.9+
1.9
1.8+
2002
2005
2.1 2.1
2003
2006
1
2004
2007
0.8 0.8
0.5 0.5 0.5
0.4
0.5
0.7 0.7 0.7 0.7
0.4
0.2
0.1 0.1 0.1
0.2
0.1
0
Pain Relievers
+
Stimulants
Sedatives
Tranquilizers
Difference between this estimate and the 2006 estimate is statistically significant at the .05 level.
Source Where Pain Relievers Were Obtained
for Most Recent Nonmedical Use among Past
Year Users Aged 12 or Older: 2007
Source Where Respondent Obtained
Bought on
Drug Dealer/ Internet
0.5%
Stranger
More than 4.1%
One Doctor
2.6%
One Doctor
18.1%
Bought/Took
from Friend/Relative
14.1%
Source Where Friend/Relative Obtained
Other 1
4.2%
Free from
Friend/Relative
56.5%
More than One Doctor Free from
2.9%
Friend/Relative
6/6%
Bought/Took
from
One
Friend/Relative
5.9%
Doctor
Drug Dealer/
81.0%
Stranger
1.8%
Other 1
1.8%
Bought on
Internet
0.1%
Note: Totals may not sum to 100% because of rounding or because suppressed estimates are not shown.
1
The Other category includes the sources: “Wrote Fake Prescription,” “Stole from Doctor’s
Office/Clinic/Hospital/Pharmacy,” and “Some Other Way.”
Estimated numbers of new nonmedical
users in past year by type of drug, US,
1990-2007
Pain relievers
Tranquilizers
Cocaine
Stimulants
Heroin
3000
Numbers in Thousands
2500
2000
1500
1000
500
0
90
91
92
93
94
95
Source: SAMHSA NSDUH, 2006 and 2007
96
97
98
99
00
01
02
03
04
05
06
07
Mean Age at First Use for Specific Drugs
among Past Year Initiates Aged 12 to 49:
2007
21.9
Stimulants
24.2
24.5
Tranquilizers
21.8
Heroin
LSD
20.2
21.2
Pain
Relievers
Marijuana
20.2
Ecstacy
17.6
Inahalants
20
Cocaine
16.4
17.1
18.3
PCP
Age in Years
25
Sedatives
30
15
10
5
0
Source: SAMHSA NSDUH 2007
Illicit Drug Use in Past Month among Persons Aged 12 or Older, by State:
Percentages, Annual Averages Based on 2005-2006 NSDUHs
Percentage of
Persons
9.40 – 11.21
8.36 - 9.39
7.89 – 8.35
7.20 – 7.88
5.66 – 7.19
Illicit Drug Dependence or Abuse in Past Year among Persons Aged 12 or
Older, by State: Percentages, Annual Averages Based on 2005 and 2006
NSDUHs
Percentages of
Persons
3.11-4.25
2.92-3.10
2.82-2.91
2.57-2.81
2.10-2.56
Alcohol Misuse
Past Month Alcohol Use - 2007
• Any Use:
51% (127 million)
• Binge Use:
23% (58 million)
• Heavy Use:
7%
(17 million)
(Current, Binge, and Heavy Use estimates are
similar to those in 2002-2006)
Source: NSDUH 2007
Alcohol Use in past Month among Persons Aged 12 or Older, by State:
Percentages, Annual Averages Based on 2005 and 2006 NSDUHs
Percentages of
Persons
57.86-63.14
54.04-57.85
51.52-54.03
44.86-51.51
32.40-44.85
Binge Alcohol Use in Past Month among Persons Aged 12 or Older, by
State: Percentages, Annual Averages Based on 2005 and 2006 NSDUHs
Percentages of
Persons
25.47-30.32
23.84-25.46
21.80-23.83
20.72-21.79
17.38-20.71
Alcohol Dependence or Abuse in Past Year among Persons Aged 12 or
Older, by State: Percentages, Annual Averages Based on 2005 and 2006
NSDUHs
Percentages of
Persons
8.78-10.81
8.15-8.77
7.52-8.14
6.81-7.51
6.30-6.80
Perceptions of Great Risk of Having Five or more Drinks of an Alcoholic
beverage Once or Twice A Week among Persons Aged 12 or Older, by
State: Percentages, Annual Averages Based on 2005 and 2006 NSDUHs
Percentages of
Persons
44.24-47.63
42.06-44.23
39.10-42.05
36.97-39.09
32.86-36.96
Alcohol Related Deaths
•
•
There are approximately 79,000 deaths
attributable to excessive alcohol use each year
in the United States
This makes excessive alcohol use the 3rd
leading lifestyle-related cause of death for the
nation.
Source: Centers for Disease Control
Alcohol-Related Emergency Room Visits
• According to the Drug Abuse Warning Network
(DAWN), in 2005 approximately 492,655
Emergency Department (ED) visits involved
alcohol alone or in combination with another
drug – 34% of all drug misuse/abuse ED visits.
– Approximately 145,759 of these were
alcohol-related ED visits for patients under
the age of 21.
– Two-thirds of the alcohol-related ED visits for
minors involved alcohol alone.
Immediate Health Risks from
Inappropriate Drinking
•
•
•
Unintentional injuries.
•
•
Alcohol poisoning
Risky sexual behaviors.
Miscarriage and stillbirth among pregnant
women, and a combination of physical and
mental birth defects among children that last
throughout life.
Violence, including intimate partner violence and
child maltreatment.
Source CDC: Alcohol-Attributable Deaths Report, Average for United States 2001-2005
Unintentional Injuries
•
•
•
Falls
– An average of 5,532 deaths per year are related
to alcohol
Drownings
– An average of 868 deaths per year are related
to alcohol
Traffic injuries
– An average of 13,819 deaths per year are
related to alcohol-related motor vehicle traffic
crashes
– An average of 183 deaths per year are related
to motor-vehicle non-traffic crashes
Source CDC: Alcohol-Attributable Deaths Report, Average for United States 2001-2005
Intimate Partner Violence & Child
Maltreatment
•
About 35% of victims report that offenders are under
the influence of alcohol.
•
Alcohol use is also associated with 2 out of 3
incidents of intimate partner violence.
•
Studies have also shown that alcohol is a leading
factor in child maltreatment and neglect cases, and
is the most frequent substance abused among these
parents.
•
An average of 168 children die every year as a
result of alcohol related child maltreatment
Source CDC: Alcohol-Attributable Deaths Report, Average for United States 2001-2005
Alcohol Impaired Driving: 2004-2006
• In 2006, approximately 30.5 Million persons
aged 12 or older drove under the influence of
alcohol at least once during the past twelve
months.
• North Dakota – at 24.9% -- reported the second
highest rate of drivers 18 and older who reported
driving under the influence of alcohol during the
past year – only Wisconsin (at 26.4%) reported
more.
Source: OAS, NSDUH 2007, combined data 2004-2006
Other Unintentional Injuries
Other annual deaths related to alcohol include:
• An average of 1,158 deaths related to burns
• An average of 123 unintentional firearm deaths
• An average of 370 poisoning deaths related to
alcohol poisoning
• An average of 5,416 deaths per year related to
alcohol related poisoning (not alcohol)
• An average of 269 deaths per year related to
hypothermia
• An average of 7,787 homicide deaths
Source CDC: Alcohol-Attributable Deaths Report, Average for United States 2001-2005
Alcohol-related Suicide
•
Suicide
–
Alcohol related suicide has been related to
an average of 7,235 deaths per year
–
Another 31 deaths per year have been
attributed to suicide by and exposure to
alcohol
Source CDC: Alcohol-Attributable Deaths Report, Average for United States 2001-2005
Substance Misuse can:
Lead to:
• Worsened medical conditions (e.g. diabetes,
hypertension, dental) and
• Worsened brain disorders (e.g. depression,
psychosis, anxiety & sleep disorders)
• Unintentional injuries & violence
Result in:
• Dependence, which may require multiple treatment
services
• Low birth weight, premature deliveries, and
developmental disorders, child abuse & neglect
Substance Misuse can:
Contribute to or be associated with :
• Homelessness
• Criminal justice involvement
• The effect and abuse of prescribed medications
• Unemployment
• Gambling
• Bankruptcy
• Legal Issues (e.g. DUI, DWI, domestic violence)
• Dropping out of school
Substance Misuse can:
Induce or facilitate:
• Medical diseases (e.g. Stroke, dementia,
hypertension, cancers, dental)
• Acquiring Infectious diseases & infections (e.g.
HIV, Hepatitis C)
• Suicide attempts or tendencies
Impact of Addiction on the Family
• Addiction is a developmental and inter-generational
disease
– Majority of persons who abuse or are dependent on
psychoactive substances begin alcohol and drug use
as teens
– Children of parents who use are more likely to use
themselves
• Children of substance abusing and dependent parents
are at increased risk for
– Abuse and neglect
– Poor academic, health and psycho-social outcomes
– Genetic propensity to addiction
Drug Use and Criminal Activities
• An annual average of 1.2 Million adults (18
years & older) were arrested for serious violent
or property offenses from 2002 to 2004.
• An annual average of 60.1% of adults who were
arrested from 2002 to 2004 for any serious
offense were more likely to have used an illicit
drug in the past 12 months than those who were
not arrested (13.6%).
Source: Illicit Drug use among Persons Arrested for Serious Crimes, NSDUH Report,
December 16, 2005
Drug Use and Criminal Activities
• The rate of substance abuse or dependence
among adult offenders on probation or parole
supervision is more than four times that of the
general population1 (38.5% vs. 9%)
• Nearly 3/4ths of state prison inmates are in need
of some substance abuse intervention:
– 31.5% of male inmates and 52.3% of all
female inmates require intensive services
such as residential treatment programs.2
1 NSDUH
Report (2006)
2 Belenko and J. Peugh, Estimating drug treatment needs among state prison inmates, Drug and
Alcohol Dependence (2005),
Criminal Justice, Substance Abuse and
Mental Health: The Impact on Society
• 72% of persons under justice supervision •
•
•
•
•
jail/prison/probation/parole have a Co-Occurring
Substance Abuse Disorder
More than 60% of male arrestees have tested positive
for at least 1 illegal drug
670,000+ offenders return to the community from
State prison each year
Almost 70% recidivate within 3 years of release
69% have Substance Abuse disorder
Less than 10% receive treatment
Source: US Department of Justice, Office of Justice Programs, The Bureau of Justice Statistics
Past Year Perceived Need for and Effort Made to Receive
Specialty Treatment among Persons Aged 12 or Older
Needing But Not Receiving Treatment for Illicit Drug or
Alcohol Use: 2007
Did Not Feel
They Needed
Treatment
(19.5 Million)
93.6%
4.6%
Felt They Needed
Treatment and Did
Not Make an Effort
(955,000)
1.8%
Felt They Needed
Treatment and Did
Make an Effort
(380,000)
20.8 Million Needing But Not Receiving
Treatment for Illicit Drug or Alcohol Use
Reasons for Not Receiving Substance
Use Treatment: Persons Aged 12+
Those who Needed & Made the Effort to Get Treatment
But Did Not Receive Specialty Treatment
Did Not Know Where to Go for
Treatment
6.9%
Might Have Negative Effect on Job
7.0%
8.1%
No Program Having Type of Treatment
Might Cause Neighbors/Community to
Have Negative Opinion
8.9%
No Transportation/Inconvenient
10.5%
Able to Handle Problem without
Treatment
12.5%
Not Ready to Stop Using
26.6%
No Health Coverage and Could Not
Afford Cost
0%
Source: NSDUH, 2004-2007 combined
35.9%
10%
20%
30%
Percent Reporting Reason
40%
North Dakota State Indicators
North Dakota
Needing Treatment for
Illicit Drugs But Not
Receiving It
National Average
2.67
2.04
Needing Alcohol
Treatment, But Not
Receiving It
7.35
9.49
Alcohol/Drug
Dependence/Abuse in
Last Year
9.25
10.86
8.02
6.16
Any Ilicit Drug use in
the Past Month
22.7
Binge Alcohol Use in
Last Month
31.52
0
Source: NSDUH 2004-2005 average
5
10
15
20
Percent Reporting...
25
30
35
Special Populations:
Underage Drinkers &
Adolescents
Underage Drinking
• According to the 2007 National Survey on Drug
Use and Health (NSDUH), 10.7 million persons
aged 12 to 20 reported drinking alcohol in the
past month.
• Approximately 18.6% of them were binge
drinkers, and 6% were heavy drinkers.
• 56.3% of current underage drinkers reported
that their last use of alcohol in the past month
occurred in someone else’s home (vs. 29.4%
who reported it occurred in their own home).
Underage Drinking
• 30.2% of underage drinkers paid for the alcohol
the last time they drank – 8.2% bought it
themselves.
• Among those who had someone else pay for the
alcohol, 37.2% got it from an unrelated person
aged 21+, 20.7% from another person under 21,
and 19.5% got it from a parent, guardian, or
other adult family member.
Source: 2007 NSDUH
Adolescents Drink Less Frequently
than Adults But More Per Occasion
12 to 17
18 to 25
Adult 26 and older
10
8
8.7
7.5
6
4
4.7
4.3
2
4.5
2.5
0
Average Drinking
Days/Month
Average # Drinks/Day
Source: SAMHSA National Survey on Drug Use and Health 2007
Alcohol Use and Binge Drinking Rise
Rapidly Over Ages 12 to 20
Past Month Use
Past Month Binge
Past Month Heavy
70
60
Percent
50
40
30
20
10
0
12
13
14
15
16
Age
Source: SAMHSA National Survey on Drug Use and Health 2007
17
18
19
20
Alcohol use in Past Month among Persons Aged 12 to 20, by State:
Percentages, Annual Averages Based on 2005 and 2006 NSDUHs
Percentages of
Persons
32.33-38.29
30.29-32.32
27.90-30.28
25.51-27.89
21.46-25.50
Binge Alcohol use in Past Month among Persons Aged 12 to 20, by State:
Percentages, Annual Averages Based on 2005 and 2006 NSDUHs
Percentages of
Persons
23.43-28.46
20.33-23.42
18.62-20.32
16.97-18.61
15.23-16.96
Direct Consequences of Underage
Drinking
• 5,000 deaths among youth under 21 per year
from alcohol related injuries including homicides
(1,600) and suicides (300)
• Physical and sexual assaults;
unwanted/unintended sexual activity
• Altered academic/vocational trajectories
• Possible adverse effects on developing brain
Underage Drinking and Driving: 2007
Percent Driving Under the
Influence in the Past Year
30%
25%
25.8%
20%
20.1%
18.3%
15%
10%
5%
7.8%
0%
16-17
18-20
21-25
Age in Years
Source: NSDUH, 2007
26-29
Parent Awareness of Youth Substance
Use
• According to the 2006 National Survey on Drug
Use and Health (NSDUH), the percentage of 12-18
year olds using the following substances during the
past year totaled:
– 17% for cigarettes
– 32.9% for alcohol
– 13.2% for marijuana
• Parent awareness is high for adolescent cigarette
use, but remains low for alcohol use. Findings
regarding parent awareness of adolescent
marijuana use are mixed.
Source: SAMHSA, NSDUH, 2006
Parent Awareness
• There appears to be a link between the level of
parent’s awareness of the child’s substance use
and the reported use during the past year.
– This is particularly true for one-parent
households.
• Reported past-year usage of alcohol, cigarettes,
and marijuana by children 12-17 in one-parent
households was consistently higher for fatherchild pairs than for mother-child pairs.
– Reported parent awareness of the child’s
usage was consistently higher in mother-child
pairs.
Source: SAMHSA, NSDUH, combined data 2002-2006
One Parent Homes vs. Two-Parent
Homes
Percentage of Youths aged 12-17 in Parent-Child Pairs Who Reported Past
Year Substance Use: 2002-2006
40%
36.6%
35%
30%
34.5%
31.9%
31.2%
25%
20%
15%
23.3%
20.2%
18.9%
16.4% 16.8%
14.9%
12.6%
10%
11.9%
Cigarettes
5%
Alcohol
0%
One-Parent
Household
Two-Parent
Household
Mother-Child Pairs
Source: SAMHSA, NSDUH, combined data 2002-2006
One-Parent
Household
Two-Parent
Household
Father-Child Pairs
Marijuana
Mother-Child vs. Father-Child Pairs
Percentages of Parents in Parent-Child Pairs Who Were Aware of Their
Child’s Substance Use (where the child had used in the past year): 20022006
60%
50%
40%
53.8%
53.7%
47.4%
47.0%
41.1%
30%
MotherChild Pairs
32.5%
FatherChild Pairs
20%
10%
0%
Cigarettes
Alcohol
Source: SAMHSA, NSDUH, combined data 2002-2006
Marijuana
Special Population:
Returning Veterans
Substance Abuse and Veterans
• The military enforces a strict schedule of drug
testing – with severe consequences for those who
are found abusing drugs.
• Alcohol remains the primary substance of abuse
among veterans 1
• Between 2005 and 2006, the Army saw an almost
three-fold increase in “alcohol-related incidents,”
according to the DOD Task Force on Mental
Health.
• 75% of combat veterans with lifetime PTSD also
met criteria for alcohol abuse or dependence. 2
1
2
National Survey on Drug Use and Health, 2005
Saxon, et al., . (1998). Archives of General Psychiatry, 55:913-917
57
PTSD, Alcohol Consumption and
Deployment
• In one study of a non-treatment seeking sample
of 800 US Army Iraq war veterans, an increase
in PTSD symptoms between pre-deployment
and post-deployment was associated with
increased drinking from pre- to post
deployment.1
1 Vasterling,
JJ et al, Journal of Rehabilitation Research & Development, vol.45(3), 2008
58
Mental Health Needs of Returning Vets
An estimated 30.7% of troops returning from Iraq and
Afghanistan have a mental health condition or reported
experiencing a traumatic brain injury (TBI).
No PTSD,
Depression or TBI
7.3%
69.3%
12.2%
30.7%
11.2%
PTSD or
Depression, NO TBI
PTSD or
Depression & TBI
TBI only
Source: Rand Center for Military Health Policy Research, Invisible Wounds: Mental Health & Cognitive Care
Needs of America’s Returning Veterans, retrieved 4/18/08 from www.rand.org
Prevalence of Serious Psychological Distress
(SPD), SUD, and Co-Occurring SPD and SUD
in the Past Year among Veterans, by Gender:
2004 to 2006
16%
14.5%
14%
12%
10%
8%
6.5%
7.2%
Males
Females
5.8%
6%
4%
1.5% 2.0%
2%
0%
SPD
SUD
Source: The NSDUH Report, November 1, 2007
Co-Occurring
SPD & SUD
The Younger Veteran Population Has
Specific Challenges
• Among depressed veterans, younger individuals
(18-44 years) committed suicide at the highest
rate (95 suicides per 100,000 person-years) 1
• Veterans aged 18 to 25 have the highest rate of
serious psychological distress (SPD) and
substance use disorder (SUD) at 8.4%, with
veterans 55 or older having the lowest rate at
0.7%. 2
1 Hampton,
2
T., PhD, Research, Law Address Veterans’ Suicide, JAMA, 12/19/07
The NSDUH Report, November 1, 2007
61
Mental Health and Co-Occurring Illness
Among Veterans
• Veterans with family incomes of less than $20,000
per year were more likely to have had co-occurring
SPD & SUD in the past year than veterans with
higher family incomes.1
• According to the Department of Veterans Affairs,
18% of the veterans recently back from tours of duty
are unemployed. Of those employed since leaving
the military, 25 percent earn less than $21,840 a
year.
1
The NSDUH Report, November 1, 2007
An Holistic Approach to
Recovery:
Integrating Resources to
Create a Client-centered
Recovery Process
The Recovery Process
Recovery from alcohol and drug problems
is a process of change through which an
individual achieves abstinence and
improved health, wellness, and quality of
life.
Source: CSAT National Summit on Recovery, 2005
64
Challenges for a Traditional Approach
• Traditional treatment approaches provide
challenges that translate into less cost-effective use
of funds:
• 52.3% of those admitted to U.S. public substance
abuse treatment programs in 2006 were re-entering
treatment:
– 21.3% for the second time, 17.4% for the third or fourth
time, and 13.6% for the fifth or more time. 1
• One recent study found the that median time from
first treatment to 1 alcohol- and drug-free year was
9 years – with 3 to 4 episodes of treatment.2
¹SAMHSA, Office of Applied Studies. Treatment Episode Data Set (TEDS). Highlights - 2006. National Admissions to Substance
Abuse Treatment Services
65 28
2 Dennis, M.L. et al, 2005. The duration and correlates of addiction and treatment careers, Journal of Substance Abuse Treatment
(Suppl. 1): S51-S62
Description of Recovery-Oriented
Systems of Care
A recovery-oriented systems of care approach
supports person-centered and self-directed
approaches to care that build on the strengths
and resilience of individuals, families, and
communities to take responsibility for their
sustained health, wellness, and recovery from
alcohol and drug problems.
Source: CSAT National Summit on Recovery, 2005
66
Recovery-Oriented Systems of Care: A
Paradigm Shift
Recovery-Oriented Systems of Care shift
the question from
“How do we get the client into treatment?”
to
“How do we support the process of
recovery within the person’s
environment?”
A Traditional Course of Treatment for a
Substance Use Disorder
Symptoms
Severe
100
Person’s
Entry into
treatment
Discharge
Remission0
Time
Resource: Tom Kirk, Ph.D
68
A Traditional Service Response
Symptoms
Severe
100
Remission0
Resource: Tom Kirk, Ph.D
Acute symptoms
Discontinuous treatment
Crisis management
69
A Recovery-Oriented Response
Symptoms
Severe
100
Continuous
treatment
response
Remission0
Promote Self Care, Rehabilitation
70
Resource: Tom Kirk, Ph.D
Helping People Move Into A Recovery
Zone
Severe
Symptoms
Recovery Zone
Improved client outcomes
Remission
Time
71
Resource: Tom Kirk, Ph.D
Recovery-Oriented Systems of Care
Approach
• In the recovery-oriented systems of care approach,
the treatment agency is viewed as one of many
resources needed for a client’s successful
integration into the community.
• No one source of support is more dominant than
another.
• Various supports need to work in harmony with the
client’s direction, so that all possible supports are
working for and with the person in recovery.
Source: Addiction Messenger, November 2007, Vol. 10 Issue 11, published by the
Northwest Frontier ATTC.
Benefits of Moving into a Recovery Zone
• Chronic care approaches, including selfmanagement, family supports, and integrated
services, improve recovery outcomes 1
• Integrated and collaborative care has been
shown to optimize recovery outcomes and
improve cost-effectiveness 2
1 Lorig
2
et al, 2001; Jason, Davis, Ferrari, & Bishop; 2001; Weisner et al, 2001; Friedmann et al, 2001
Smith, Meyers, & Miller, 2001; Humphreys & Moos, 2001)
73
ROSC offer a comprehensive menu of services and supports
that can be combined and readily adjusted to meet the
individual’s needs and chosen pathways to recovery.
Recovery
Services & Supports
Family/
Child Care
Education
Vocational
Individual
Family
Community
Housing/
Transportation
Cultural &
Spiritual
PTSD &Mental Health
Physical Health Care
HIV Services
Adolescent Care
Financial
Wellness
Alcohol/Drug Services
Legal
VSO & Peer Support
Case Mgt
Health
ROSC encompass and coordinate the
operations of multiple systems…
Recovery
Systems of Care Addiction
Child Welfare
and Family Services
Services & Supports
Social Services
Family/
Child Care
Education System
Housing System
Faith Community
Services System
Educational
Housing/
Transportation
Alcohol/Drug Treatment
Individual
Family
Community
Vocational
PTSD & Mental Health
Health Care
Primary Care
System
HIV Services
Spiritual
Indian Health Services
Mental Health
System
Adolescent
Svcs.
Legal
Financial
Vocational Services
VSO & Peer Support
Case Mgt
Health Insurance
Wellness
Criminal & Juvenile
Tribal Authorities
Justice Systems
DoD & Veterans Affairs
Health
…providing responsive, outcomes-driven
approaches to care.
Recovery
Abstinence
Evidence-Based
Practice
Systems of Care
Child Welfare
and Family
Services
Cost
Effectiveness
Perception
Of Care
Social Services
Menu of Services
Family/
Child Care
Housing System
Educational
Education System
Housing/
Transportation
Faith Community
Retention
Indian Health
Services
Wellness
Addiction
Services System
Employment
Mental Health
System
Alcohol/Drug Treatment
Vocational
Individual
Family
Community
PTSD &Mental Health
Health Care
Primary Care
System
Crime
Organized Recovery
HIV Services Community
Spiritual
AdolescentFinancial VSO & Peer Support
Svcs.
Legal
Case Mgt
Vocational Services
Homelessness
Health Insurance
Criminal & Juvenile
Justice System
Tribal Authorities
DoD & Veterans Affairs
Access/Capacity
Social Connectedness
Health
Goals of a Recovery-Oriented Systems
Approach
• To support preventive strategies related to
substance use problems & disorders;
• To intervene early with individuals with
substance use problems;
• To support sustained recovery for those with
substance use disorders; and
• To improve individual, family and community
outcomes.
77
Benefits of a Recovery-oriented Systems
Approach
Reasons for integrating an ROSC approach into
current programs:
• The ROSC approach more effectively responds
to individuals, families, and communities
• It supports a framework for structuring policy
development and planning
• It provides an opportunity to apply knowledge
gained from recovery-oriented research
North Dakota SAPT Block Grant
Outcomes
North Dakota received $5.14 Million in SAPT Block
Grant funds in FY 2007/2008.
The latest available outcome data are from FY 2006:
Clients reporting… Admission Discharge
Rate of
Change
No alcohol use
59.6%
84.5%
41.8%
No drug use
71.3%
85.6%
20.1%
No arrests
84.6%
89.5%
5.8%
Being employed
45.4%
54.0%
19.0%
Being housed
98.0%
98.2%
0.2%
Source: SAMHSA, SAPT BG 2006
The Ripple Effect: Tsunami of
Destruction and Despair
• The evidence is substantial that the impact
alcohol misuse and illicit drug use ripples across
the lives of individuals, their families and the
community at large.
• We must remember that a ripple can become a
tsunami: with neglect and denial we get a
tsunami of destruction and despair.
The Ripple Effect: Tsunami of Hope
& Recovery
• With Prevention & Treatment we can cast a
pebble of Hope into the pool of substance
misuse, abuse and dependence.
• There are many pathways to Recovery, the
benefits of Recovery ripple across the lives of
individuals, the community and society.
• With the commitment of the community, the
ripple of that commitment will become a
tsunami of Hope & Recovery for those at risk or
suffering from substance use disorders..
SAMHSA Resources
• SAMHSA Website: www:samhsa.gov
• SAMHSA Substance Abuse Treatment Facility Locator at
http://findtreatment.samhsa.gov
• SAMHSA Health Information Network is our new
clearinghouse – 1-877-SAMHSA-7
– Monday-Friday 9 am – 4:30 p.
• www.AddictionEd.org -- An international reference for
distance education opportunities
• SHIN 1-800-729-6686 for publication ordering or
information on funding opportunities
– 1-800-487-4889 – TDD line
• 1-800-662-HELP – SAMHSA’s National Helpline (average #
of tx calls per mo.- 24,000)