Sue Spina, CSW

2. 32%
19.60%
24.10%
11.90%
10.50%
Total Patients 2,569
Alcohol Primary
Heroin Primary
Marijuana
Primary
Cocaine Primary
Other Rx and
OTC Primary

3. 15.60%
4.20%
19.40%
14.70%
0.90%
Total patients 2,569
Alcohol
Secondary
Heroin
Secondary
Marijuana
Secondary
Cocaine
Secondary
(includes crack)
Other Rx/OTC

4. 69.40%
30.60%
Male
Female

5. 58.10%18.90%
23.00%
Column1
Unemployed
Employed
Not in Labor
Force (disabled)

6. 57.30%
42.70%
Prior MH Treatment
Yes
No

7. 73.10%
16.00%
9.30%
3.50%
ED Visits
0 Visits
1 Visit
2 to 4 Visits
5 to 9 Visits

8.  Defined as repeated behavior in spite of
negative consequences.
 Your patients drug of choice is his lifeline
 Your patient uses because it is the only way
that he/she feels normal
 It is the only way that he/she feels ok
 Preprogrammed to addiction?

9.  Heroin: Opioid drug synthesized from
Morphine
 Marijuana
 Bath Salts: 1 or more synthetic chemicals
related to Cathihone, amphetamine like
stimulant found in the KHAT plant (similar
properties to Ecstasy or MDMA.)
 OCD: Narcotics, Adderal, Concerta, sleep
meds.
 Cocaine
 Alcohol

10.  Various tools available
 SBIRT
 CAGE

11.  SBIRT is a comprehensive, integrated, public health
approach that provides opportunities for early
intervention before more severe consequences occur.
 Evidence-based tools that are demonstrated to be valid
and reliable in identifying individuals with problem use
or at risk for a Substance Use Disorder (SUD) must be
used.
 Based on implementation of this model nationally, of
459,599 patients screened, 22.7 percent screened
positive for a spectrum of use (risky/problematic,
abuse/addiction). Of those who screened positive 15.9
percent were recommended for a brief intervention
with a smaller percentage recommended for brief
treatment (3.2 percent) or referral to specialty
treatment (3.7 percent).
 NYS Office of Alcoholism and Substance Abuse Services

12.  Prevent disease, accidents and injuries related
to substance use, resulting in better patient
outcomes.
 SBIRT reduces costly healthcare utilization.
 SBIRT is reimbursable, billing codes are available
in New York State.
 Many payers reimburse for SBIRT services.
 Complete resource tool for screening, training
certification.
NYS Office of Alcoholism and Substance
Abuse Services

13.  CAGE : adapted for both alcohol and/or drug
use.
1.Have you ever felt that you should cut down on
your drinking or drug use?
2. Have people annoyed you by criticizing your
drinking or drug use?
3. Have you felt bad about your drinking or drug
use?
4. Have you ever had a drink or used drugs first
thing in the morning to steady your nerves or get
rid of a hangover?

14.  Moderate: 1 drink per day for women/2
drinks for men
 Binge: BAC. 0.08 4 drinks women/ 5 drinks
men in 2 hours at least 1 day in 30 days
 Heavy: 5+ drinks in a day for 5+ days in 30
 Low Risk: No more than 3 drinks 1 day and no
more than 7 drinks in 1 week for women
 No more than 4 drinks in single day and no
more than 14 drinks in one week.
 NIUAA Research shows 2/100 have Alcohol
Use Disorder

15.  Important to evaluate family history, mental health history/current
Mental Health Provider and psychosocial issues that contribute to
addiction.
 PHQ 9 patient health questionnaire/Geriatric Depression scale
 Higher risk of substance abuse and self injury when positive on
scales.
 Bipolar Disorder:
- 56% had experienced drug or alcohol addiction in their lifetime.
- 46% had abused alcohol or were addicted to alcohol
- 41% had abused drugs and were addicted to drugs
- Alcohol is more commonly used in Bipolar individuals
(Dual diagnosis.org)

16.  Cognitive Behavioral Treatment
evidenced based
 addresses dysfunctional emotions,
maladaptive behaviors
 Problem focused/goal oriented

17. Dialectical Behavior Therapy ( DBT)
 Change patterns of behavior that are not
effective
 Develop coping behaviors in sequence of
events: thoughts, feelings, behaviors that
lead to negative behaviors
 Individual and Group therapy

18.  CBT VS DBT
 CBT is commonly practiced today
 DBT is a specific form of CBT
builds upon the CBT foundation
psychosocial/ relationship component
“how one interacts with others in different
environments and relationships.”
Regulates emotions and behaviors in a social
contex

19.  According to NIDA, addiction varies 3-40%
 Based on duration of treatment, develop of
drug tolerance, increased pain sensitivity and
proponent to addiction.
 Check: personal or family hx of addiction
 Increased need for pain refills
 Development of drug tolerance
National Institute
of Drug Abuse. org

20. Research shows that drug abuse is a brain
disease that can be treated effectively.
3 componets:
 Detoxification
 Counseling
 Use of addiction medications
 Behavioral vs. Pharmological
National Institute of Drug Abuse. org

21.  Opiate Addiction
 Treat withdrawal and Cravings
 Treat overdose
 Behavioral Therapy

22. Heroin/Opioids:
NARCAN : acute overdose: complete or partial
reversal of opioid overdose.
Naltrexone ( Vivitrol) injectable: Long acting
antagonist, used for alcohol addiction as
well.
Methadone: synthetic Opioid
Suboxone: antagonist + agonist opioid receptor

23. CNS Depressants/Prescription Stimulants
No Medication Therapy
Medically supervised Detox center
Cognitive Behavioral Treatment
Support Groups
Often seen in combination with alcohol and
Cocaine addictions
National Institute of Drug Abuse.org

24. Marijuana
Must have 3 symptoms in 1 year period.
Tolerance (decreased effects of marijuana over time or a need to increase
the amount used to achieve the desired effect)
Withdrawal (characteristic symptoms that occur when the individual
abstains from using marijuana for several days)
Often taking marijuana in larger amounts or over a longer period of time
than planned
Persistent desire to use marijuana or trouble decreasing or controlling its
use Spending significant time either obtaining marijuana (for example,
buying or growing it), using it or recovering from its effects
Significant social, educational, occupational or leisure activities are either
abandoned or significantly decreased as a result of marijuana use
Marijuana use continues despite being aware of or experiencing persistent
or repeated physical or psychological problems as a result of its use
Coalition against drug
abuse. org

25. Colorado or California?
Outpatient/inpatient
Cognitive behavioral
therapy

26.  Addiction Crisis Center: ACC
 Insight House
 Beacon Center
 McPike
 Milestone

27.  16 bed, Medically monitored withdrawal
service, regulated by Oasas
 Screened for severity and presence of
chemical dependency, medical and mental
health services
 Duration of stay varies: Max 14 days
 LT Treatment = 21 days
 Free Service if can’t afford to pay

28.  Needs collaboration with PCP
 “ativan for ACC only”
 1 RN LPN with a stethoscope and blood pressure
cuff
 Cannot accept .350 BAC, Med and psych stable
 Alcohol and opiates major withdrawal tx at
facility
 Benzo addictions : wean and replace with vistiril
 Alcohol: gapapentin, wellbutrin and depakote
use
 Strong relationship with Conifer Park

29.  Inpatient and Outpatient treatment Center
 No Detox
 Adults and adolescents ( any age)
 Intensive Residential Services
 Outpatient Clinic Services
 Day Rehabilitation Services
 Prevention Services and School Program
 Additional Specialized Services
 Suboxtone: Dr Kozminski
 Psychiatric: Dr Jhori

30.  Intensive Outpatient Program
 Out Patient Counseling
 COMPASS Program
 Women’s Program
 Mens Program
 Adolescents/Youth Programs
 Suboxone Therapy

31.  NYS OASAS Licensed Outpatient Treatment
Program
 Shelter Plus Care
 Supportive Living
 Dual Recovery Supportive Living
 Oasas Medicaid Redesign Team Permanent
Supportive Housing
 Suboxone Therapy

32.  Tobacco Free Inpatient Treatment Center
 Integrated Dual Recovery Program
 Woman’s Program
 18 years and older
 Not based on ability to pay.

33. QUESTIONS?????