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5 Year Plan For Addiction Recovery

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5 Year Plan For Addiction Recovery

  1. 1. The 5 year Plan 1
  2. 2. The 5 year Plan DID YOU HEAR THAT?! Someone dies of an accidental overdose every 19 Minutes, in this country! 80% of THE WORLDS RX’s are taken by Americans & we are only 5% of the global population We prescribe in a year, enough pain meds for every Man, Woman & Child 1 pill every 4 hours for 3 weeks. 2
  3. 3. The 5 year Plan 3
  4. 4. The 5 year Plan 4
  5. 5. The 5 year Plan The 5 year plan is applicable to any addiction 5
  6. 6. The 5 year Plan Statistically Speaking • 40-60% of people relapse after drug and alcohol treatment. NIDA • Anything less than 90 days of treatment increases the chance of relapse – NIDA • An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs - NIDA 6
  7. 7. The 5 year Plan What do we know about the success rate of 30 days in treatment?! How do treatment centers come up with their numbers? What’s really their criteria? 7
  8. 8. The 5 year Plan Are there any hardcore, evidence based statistics out there? There better be… Do you think they’ll let convicted felons out with out being sure they’re clean? ..or a pilot get his license back without knowing for sure?! ..or a Dr. work with a patient? 8
  9. 9. The 5 year Plan Drug Courts are proven to retain offenders in treatment considerably longer than most other correctional programs. 3 phases starting with a treatment plan 90 days inpatient treatment Continued random monitoring Intensive case management Over 2 year span http://www.nycourts.gov/courts/2jd/brooklyntreatment/handbook.pdf 9
  10. 10. The 5 year Plan The Airline Pilots HIMS (Human Intervention Motivation Study) is specific to commercial pilots and coordinates the identification, treatment and return to the cockpit of impaired aviators. It is an industry-wide effort in which companies, pilot unions, and FAA work together to preserve careers and further air safety. http://www.himsprogram.com/Content/Aftercare 10
  11. 11. The 5 year Plan HIMS is the program that United and over 48 other airlines use. (except for American, they have own EAP program.) 4500 total since 1970's 400 are with United 80 are currently active If they fail a test, DOT Offence protocol is to wait year to start process to re-apply for license FAA looking to take license if they are using BUT offer this program 92% long term recovery rate 2 years- less then 10% relapse 8% decided to retire They need to have medical certificate that they are able to fly as long as they are accountable FAA requires quarterly reports from airline from AME (Areal medical evaluator) who decides what should be required The weakest component is the link to aftercare 11
  12. 12. The 5 year Plan Physician Health Programs (PHPs) have a record of success • Blueprint Study* – 904 physicians from 16 state PHPs who’d been under PHP care for 5+ years – 79% no relapse – Most relapses not followed by another – No patient harm • Domino Study – 735 physicians in WA state – under monitoring from 5-11 years – 80% no relapse – no patient harm *Dr. Skipper 12
  13. 13. The 5 year Plan PHPs oversee evaluation and treatment Monitoring evaluation and treatment programs • 28 of 37 programs (76%) maintain list of authorized providers • 48% maintain criteria for authorizing them • All but one program (95%) require treatment programs to send regular progress reports during treatment of a physician 13
  14. 14. The 5 year Plan Treatment alone often fails to attract and retain people suffering from substance use disorders (SUDs). Even when patients complete substance abuse treatment, relapse is so common it is frequently cited as a hallmark of the disorder. Dr. Greg Skipper, MD TREATMENT IS ONLY THE BEGINNING OF RECOVERY! 14
  15. 15. The 5 year Plan Key Components of The 5 year plan are Case Management & Care Planning and they include…  Intervention  Minimum 90 day treatment, Reevaluate  Sober Living - Reevaluate  IOP, Reevaluate  12 – step, continuing  Monitoring, Reevaluate  Motivator /Leverage, Reevaluate 15
  16. 16. The 5 year Plan The 5 year timeline 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 INTERVENTION An Intervention is a meeting of the entire family and or support system to address collectively the problems and or concerns of the family and or support system.” Right there…at the very beginning of treating the addict…we are recognizing that this is a MUCH BIGGER deal than just getting the IP off drugs or drink. This is the meeting that takes place before the IP ever even gets into the room! 16
  17. 17. The 5 year Plan The 5 year timeline 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 I P TREATMENT At this point the IP may or may not even think they have a problem at all. We all see it…The people around the IP all see it, but the IP most likely thinks that their disease is still manageable. So then the solution becomes…”let’s get ‘em to rehab. Yeah…That’s a great next step. Most insurance will pay for at least 28 days, but most professionals agree that 90 days is the minimum amount for any meaningful and effective recovery to begin. The best adjunct for 28 days of residential treatment is 90 days in sober living combined with an IOP (Intensive Outpatient program). 17
  18. 18. The 5 year Plan The 5 year timeline 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 4 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 SOBER LIVING The best plan after treatment is if IP’s are placed into sober living facilities directly from treatment. This will help maintain some of the structure they’ve become used to in treatment…. 18
  19. 19. The 5 year Plan The 5 year timeline 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 SOBER LIVING The problem most sober living facilities is that the IP goes from the intense structure of treatment into a very unstructured sober living facility so they take advantage of the excessive freedom and that’s when they get into trouble, therefore it’s very important to find a Sober Living facility that has a good relationship with their treatment facility and can work with both the IP and treatment team to keep the momentum going… 19
  20. 20. The 5 year Plan The 5 year timeline 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 INTENSIVE OUT PATIENT IOP is extremely valuable in terms of supporting the transition from “In Patient” recovery to the delicate task of reintegration into full life. 20
  21. 21. The 5 year Plan The 5 year timeline 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 MONITORING The quantitative component of the plan. 21
  22. 22. The 5 year Plan The 5 year timeline 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 12 STEPPING & Peer Support NOBODY Does this alone 22
  23. 23. The 5 year Plan The 5 year timeline 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 INTERVENTION I P TREATMENT SOBER LIVING MONITORING INTENSIVE OUT PATIENT 12 STEPPING 23
  24. 24. The 5 year Plan Ongoing Case Management Ongoing Case management can really take you from the pre- intervention phase through all 5 years of monitoring. It includes contingency contracts, intensive monitoring of Urine Testing, validating meeting slips, monthly or quarterly reports, intensely structured phone support for family system, ongoing frequent check-ins with recovery team and, if warranted…check-ins with therapists. 24
  25. 25. The 5 year Plan Ongoing Case Management The benefits of Long term Case Management & Care planning are numerous. Case Management is: •A tool the therapist can use to help the patient with compliance •The ability to create plan to elevate to a higher level of care if they fall out of compliance •The Therapist and/or Family do not having to “police” behavior •Support to treatment plan established by therapist or facility 25
  26. 26. The 5 year Plan Also part of the recovery plan… 26
  27. 27. The 5 year Plan Motivators Leverage Consequences 27
  28. 28. The 5 year Plan For many, the idea of addiction is that it is still a moral issue. For others, they understand that it is a medical problem. What most non-addicts fail to understand is that it’s NOT a curable disease; but it is a treatable one. 28
  29. 29. The 5 year Plan If we were dealing with Cancer…When would be the best time to start treatment? 29
  30. 30. The 5 year Plan Why is an outsider better than doing it yourself? Same reason that a company shouldn’t monitor an employee 30
  31. 31. The 5 year Plan Full Disclosure..Addicts respond better when they know what’s coming ahead of time & they are a part of the process. Very important to plan & implement while still in treatment. 31
  32. 32. The 5 year Plan Contracts, Contracts, Contracts!!! 32
  33. 33. The 5 year Plan “The “carrot” is the ability to practice medicine, and make a living, without a public record. The “stick” is action against the license if the physician does not comply with the requirements in the contract. As you know, consequences are GOOD!!! Our success is based on behavior modification. Good behaviors are rewarded and unwanted behaviors result in prompt negative consequences.” Dr. Scott Hambleton 33
  34. 34. The 5 year Plan Why a skilled interventionist Will minimize the natural progression of negative consequences Will know how to dissect the family system to create the bottom line (license) to motivate the loved one Will educate family on the importance of the 5 year plan Will insure case manager remain objective about their recovery so the family can be emotional in the relationship 34
  35. 35. The 5 year Plan Motivators Leverage Consequences 35
  36. 36. The 5 year Plan Questions? 36

Editor's Notes

  • So how do we stop this?
  • Project Blueprint is a longitudinal study, involving 904 physicians, in 16 states, over 7.2 years. 78% sober at the end of 7.2 years!!! Compare to drug courts(70% sober one year, monitored one year; 50% arrested after monitoring stops, between year 1-2) Recovery involves brain “healing” so that natural rewards (food, music, art) are once again perceived as pleasurable, that is, recalibration of Hedonic Set Point.

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