DOCSLIB.ORG

Together at Last: Addiction Medicine and the Behaviorally Enhanced Healthcare Home

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Together at Last: Addiction Medicine and the Behaviorally Enhanced Healthcare Home 12/6/2017 Together at Last: Addiction Medicine and the Behaviorally Enhanced Healthcare Home Mark McGrail, MD, Director of Addiction Medicine Brittany Tenbarge, PhD, Behavioral Health Consultant www.cherokeehealth.com © Cherokee Health Systems 2017 Learning Objectives • Describe the epidemiology of substance use disorders and co-morbid psychiatric and medical illnesses that supports the integration of addiction medicine with behavioral health and primary care. • Identify the main components of the Cherokee Program with regard to addiction medicine levels of care, staff, and implementation. • Describe behavioral health approaches for identification, screening, and treatment of patients with substance use disorders www.cherokeehealth.com © Cherokee Health Systems 2017 Our Mission… To improve the quality of life for our patients through the blending of primary care and behavioral health. Together…Enhancing Life www.cherokeehealth.com © Cherokee Health Systems 2017 1 12/6/2017 Cherokee Health Systems: Merging the Missions of CMHCs and FQHCs www.cherokeehealth.com © Cherokee Health Systems 2017 Kentucky Primary Service Area Virginia CLAIBORNE CAMPBELL GRAINGER Missouri UNION HAMBLEN ANDERSON JEFFERSON KNOX COCKE Tennessee SEVIER North LOUDON BLOUNT Carolina Arkansas MONROE MCMINN HAMILTON Mississippi Alabama Georgia www.cherokeehealth.com © Cherokee Health Systems 2017 Cherokee Health Systems Corporate Profile Last Year: 73,953 patients 353,552 Services 23,720 New Patients Number of Employees: 758 Provider Staff: Psychologists - 50 Cardiologist - 1 Psychiatrists - 7 Primary Care Physicians - 37 Nephrologist - 1 NP (Psych) - 10 NP/PA (Primary Care) - 50 Pharmacists - 12 LCSWs - 62 Community Workers - 41 Dentist - 2 www.cherokeehealth.com © Cherokee Health Systems 2017 2 12/6/2017 Strategic Emphases • Blended behavioral and primary care • Go where the grass is brownest • Outreach and care coordination • Telehealth • Training healthcare providers • Value-based contracting • Healthcare analytics www.cherokeehealth.com © Cherokee Health Systems 2017 Addiction is a Disease Not a Sign of Weakness Definition of Addiction (ASAM, 2014): Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death. www.cherokeehealth.com © Cherokee Health Systems 2017 SUD – By The Numbers • 27.1m individuals 12 years and older used an illicit drug(s) in the past 30 days • 3.8m individuals experienced the misuse of a prescription pain reliever • 138.3m individuals use alcohol, 66.7m binge drink, and 17.3m are heavy drinkers • 52.0m use cigarettes with 12.4m using one or more packs per day • 20.8m individuals have a substance use disorder; only 10.8% needing care received specialty addiction treatment • 41% of SUD patients 18 years and older suffer from a co-morbid mental illness; only 7% received care for both *www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.htm www.cherokeehealth.com © Cherokee Health Systems 2017 3 12/6/2017 Identification of Substance Misuse • Screening • Reporting • Provider/staff referral • Patient self-referral www.cherokeehealth.com © Cherokee Health Systems 2017 Selecting Pre-screening Tools • Screening begins with a brief pre-screen • A positive pre-screen indicates distress that should be further evaluated • There are several evidence-based pre-screening tools; thus, it is possible to tailor the screening process to best meet the needs of the clinic and patient population • Alcohol Use Disorder Identification Test (AUDIT-C) • National Institute on Drug Abuse (NIDA) Quick Screen www.cherokeehealth.com © Cherokee Health Systems 2017 Pre-screening • National Institute on Drug Abuse (NIDA) Quick Screen The NIDA Quick Screen assesses frequency of alcohol, tobacco, prescription and illegal drug use in the past year. If the patient answers “never” for all drugs, the screening is considered negative. Any answer other than “never” indicates a positive screen and the need for additional assessment. www.cherokeehealth.com © Cherokee Health Systems 2017 4 12/6/2017 Screening • The CAGE-AID The CAGE-AID is an expanded version of the CAGE screener that assesses both alcohol and drug misuse. CAGE is an acronym for key words in the four questions (Cut Down, Annoyed, Guilty, Eye-Opener) and AID indicates it is Adapted to Include Drugs. Each “yes” response earns one point. One point indicates a possible problem, whereas two points indicates probable substance misuse. www.cherokeehealth.com © Cherokee Health Systems 2017 Reporting • High Utilizers of Hospital and ER • Poor Treatment Engagement • Poorly Managed Condition • Unidentified/treated behavioral health concern www.cherokeehealth.com © Cherokee Health Systems 2017 Assessment of Substance Use Ask with the assumption of use. • What drugs do you use? • When’s the last time you took a medication not prescribed to you? • How much alcohol do you drink a day? • How much marijuana do you smoke daily? www.cherokeehealth.com © Cherokee Health Systems 2017 5 12/6/2017 Severity and motivation are separate constructs that vary independent of one another. Severity Motivation www.cherokeehealth.com © Cherokee Health Systems 2017 Stage-matched Interventions • Access to treatment at the point of care • Enhance motivation and facilitate care coordination • Referral • Reabsorption • Long-term maintenance and monitoring www.cherokeehealth.com © Cherokee Health Systems 2017 The Cherokee Experience • Substance Use Diagnosis, of 157 patient intakes: • Alcohol “only” – 18 • Opioids – 138 • Stimulant only – 1 • Medical Co-Morbidities: • HIV – 1/92 • Hep C – 64/107 • Pregnancy – 16 • HTN – 33 • Chronic pain disorder – 43 • Behavioral Health Co-Morbidities • Mood Disorder – 127 • PTSD - 28 www.cherokeehealth.com © Cherokee Health Systems 2017 6 12/6/2017 Medication Therapies Opioid Use Disorder • Methadone – not a federally licensed clinic but local resources available • Naltrexone – available orally (daily dosing) and intramuscular (monthly dosing), payment challenges with IM form, limited use due to the acuity of clinic patients with OUD • Buprenorphine – available orally as film or tablet and with/without naloxone, daily dosing, State grant for uninsured and covered by insurance with prior authorization, used in pregnancy as mono-product, anti-diversion strategies critical Alcohol Use Disorder • Acamprosate – no use in this clinic to date • Disulfiram – available orally, daily dosing, expensive for uninsured compared to naltrexone • Naltrexone – as above, frequent use with primary diagnosis of AUD with/without concomitant OUD www.cherokeehealth.com © Cherokee Health Systems 2017 MT - Opioids Buprenorphine • Approved by FDA in OCT 2002 for use in OBOT by physicians with additional training and authorized by the DEA (“X” number) • High affinity partial mu opioid receptor agonist • Most common side effects: nausea, dizziness, constipation, sedation, insomnia • Metabolized by the liver; active metabolite and high affinity give some flexibility with dosing; no concerns with prolonged QTc • Used as a component of opioid-abstinence treatment program • Requires induction with patient in mild-moderate withdrawal (avoid precipitated withdrawal); follow-up visits variable based upon treatment progress • Starting dose of 2-4mg, increase by 2mg every 2-4 hours until symptoms resolved • Typical first day dose of 8mg, typical maintenance dose 16-24mg per day • Discontinuation usually done by slow taper over several months • Available orally as tablet or film, with/without naloxone; newly approved implant now available, injectable coming www.cherokeehealth.com © Cherokee Health Systems 2017 MT - Opioids Naltrexone • Opioid receptor antagonist • Side effects include headache, weakness, dizziness, injection side redness/infection; usually transient, rare hepatotoxicity • Increased risk of overdose death when resuming opioid use after discontinuation of antagonist treatment • Used as part of abstinence-based opioid treatment program • Formulation based upon patient/provider preference and compliance expectations • Follow-up frequency depends upon treatment progress • Available orally and as IM injection • Starting oral dose is 25mg on Day 1 and then 50mg/day; may also give three times per week at doses of 100mg, 100mg, and 150mg (issues of compliance) • Injectable dose is 380mg IM once per month after oral trial • Does not require induction but consider naloxone challenge • Patient must be opioid-free for 5-10 days prior to initiation www.cherokeehealth.com © Cherokee Health Systems 2017 7 12/6/2017 MT - Opioids Pregnancy • Opioid dependent pregnant women should be offered MAT rather than withdrawal management or abstinence, as early as possible in the pregnancy • Consider in-patient initiation of treatment for methadone or buprenorphine, especially in 3rd trimester
Load more

Recommended publications
  • Addiction Stigma Language- the Words We Use Matter
    naabt.org The National Alliance of Advocates for Buprenorphine Treatment The Words We Use Matter. Reducing Stigma through Language. Why does language matter? Stigma remains the biggest barrier to addiction treatment faced by patients. Changing the stigma will benefit everyone. It will allow patients to The terminology used to describe addiction has contributed to the stigma. more easily regain their self esteem, allow lawmakers to appropriate Many derogatory, stigmatizing terms were championed throughout the “War funding, allow doctors to treat without disapproval of their peers, allow on Drugs” in an effort to dissuade people from misusing substances. Education insurers to cover treatment, and help the public understand this is a took a backseat, mainly because little was known about the science of medical condition as real as any other. addiction. That has changed, and the language of addiction medicine should be changed to reflect today’s greater understanding. By choosing language Choosing the words we use more carefully is one way we can all make that is not stigmatizing, we can begin to dismantle the negative stereotype a difference and help decrease the stigma. associated with addiction. “…In discussing substance use disorders, words can be powerful when used to inform, clarify, encourage, support, enlighten, and unify. On the other hand, stigmatizing words often discourage, isolate, misinform, shame, and embarrass…” Excerpt from “Substance Use Disorders: A Guide to the Use of Language” published by CSAT and SAMHSA Words to avoid and alternatives. Following are stigmatizing words and phrases which could be replaced Habit or Drug Habit with the suggested “preferred terminology” as a start in reducing the Problem with the terms: Calling addictive disorders a habit denies stigma associated with addiction.
    [Show full text]
  • Addiction and Substance Abuse in Anesthesiology Ethan O
    Ⅵ REVIEW ARTICLES David S. Warner, M.D., and Mark A. Warner, M.D., Editors Anesthesiology 2008; 109:905–17 Copyright © 2008, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Addiction and Substance Abuse in Anesthesiology Ethan O. Bryson, M.D.,* Jeffrey H. Silverstein, M.D.† Despite substantial advances in our understanding of addic- idents, and 19% reported at least one pretreatment tion and the technology and therapeutic approaches used to fatality.2 Substantial advances have occurred in our fight this disease, addiction still remains a major issue in the understanding of addiction as well as both the tech- anesthesia workplace, and outcomes have not appreciably changed. Although alcoholism and other forms of impair- nology and therapeutic approaches used to fight this ment, such as addiction to other substances and mental ill- disease, although outcomes have not appreciably ness, impact anesthesiologists at rates similar to those in changed. Starting with a brief review of the basic other professions, as recently as 2005, the drug of choice for concepts of addiction, this article highlights the cur- anesthesiologists entering treatment was still an opioid. rent thoughts regarding the pathophysiologic basis of There exists a considerable association between chemical dependence and other psychopathology, and successful addiction, as well as clinical manifestations, legal is- treatment for addiction is less likely when comorbid psycho- sues, and treatment strategies. pathology is not treated. Individuals under evaluation or Anesthesiologists (as well as any physician) may suffer treatment for substance abuse should have an evaluation from addiction to any number of substances, though with subsequent management of comorbid psychiatric con- addiction to opioids remains the most common.
    [Show full text]
  • Addiction Medicine
    Supplemental Guide for Addiction Medicine Supplemental Guide: Addiction Medicine January 2019 Supplemental Guide for Addiction Medicine Milestones Supplemental Guide This document provides additional guidance and examples for the Addiction Medicine Milestones. This is not designed to indicate any specific requirements for each level, but to provide insight into the thinking of the Milestone Work Group. Included in this document is the intent of each Milestone and examples of what a Clinical Competency Committee (CCC) might expect to be observed/assessed at each level. Also included are suggested assessment models and tools for each subcompetency, references, and other useful information. Review this guide with the CCC and faculty members. As the program develops a shared mental model of the Milestones, consider creating an individualized guide (Supplemental Guide Template available) with institution/program-specific examples, assessment tools used by the program, and curricular components. 2 Supplemental Guide for Addiction Medicine Patient Care 1: Screening, Evaluation, Differential Diagnosis, and Case Formulation of the Patient with or at Risk for Substance Use, Addictive Disorders, and Comorbidities Overall Intent: To correctly identify patient on continuum from low risk to substance use disorder (meeting DSM-5 criteria) while recognizing other medical and psychiatric conditions and contributing social factors Milestones Examples Level 1 Uses validated screening and • Correctly administers a National Institute on Alcohol Abuse and Alcoholism
    [Show full text]
  • Overview of Substance Use Disorder (SUD) Care Clinical Guidelines
    Overview of Substance Use Disorder (SUD) Care Clinical Guidelines: A Resource for States Developing SUD Delivery System Reforms April 2017 For the past two years, the Medicaid Innovation Accelerator Program (IAP) has been providing a broad group of state Medicaid and behavioral health agencies with a variety of technical support resources to support the development of robust approaches for addressing substance use disorders (SUD). In addition, IAP has also been working directly with a small group of leader states on issues related to reducing substance use disorders, as well as with a number of states to assist with their planning and development of section 1115 demonstration proposals focusing on SUD.1 Through our close work with states under various IAP SUD activities, we have developed tools and resources such as this one designed to support state efforts to introduce policy, program and payment reforms appropriate for a robust SUD delivery system. The purpose of this resource is to support states in their ongoing efforts to introduce SUD service coverage and delivery system reforms by providing information about the preventive, treatment and recovery services and the levels of care comprising the continuum of SUD care. This document also provides an overview of nationally developed guidelines for SUD treatment criteria, including provider and service standards for each level of care. In addition, it provides useful tools and examples of state-based initiatives that can assist states in their efforts to ensure that care is delivered consistent with industry standard SUD treatment guidelines and that Medicaid beneficiaries receive the most appropriate services given their treatment and recovery needs.
    [Show full text]
  • Drug Testing: a White Paper of the American Society of Addiction Medicine (ASAM)
    Drug Testing: A White Paper of the American Society of Addiction Medicine (ASAM) October 26, 2013 DRUG TESTING: A WHITE PAPER OF THE AMERICAN SOCIETY OF ADDICTION MEDICINE Adopted by the Board of Directors 10/26/2013 © Copyright 2013. American Society of Addiction Medicine, Inc. All rights reserved. Permission to make digital or hard copies of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for commercial, advertising or promotional purposes, and that copies bear this notice and the full citation on the first page. Republication, systematic reproduction, posting in electronic form on servers, redistribution to lists, or other uses of this material, require prior specific written permission or license from the Society. ASAM Public Policy Statements normally may be referenced in their entirety only, without editing or paraphrasing, and with proper attribution to the Society. Excerpting any statement for any purpose requires specific written permission from the Society. Public Policy statements of ASAM are revised on a regular basis; therefore, those wishing to utilize this document must ensure that it is the most current position of ASAM on the topic addressed. American Society of Addiction Medicine 4601 North Park Avenue, Upper Arcade Suite 101, Chevy Chase, MD 20815-4520 TREAT ADDICTION • SAVE LIVES PHONE: (301) 656-3920 • FACSIMILE: (301) 656-3815 E-MAIL: [email protected] • WEBSITE: HTTP://WWW.ASAM.ORG Writing Committee Members Robert L. DuPont, M.D., Committee Chair President, Institute for Behavior and Health, Inc. Corinne L. Shea, MA, Editor Director of Communications, Institute for Behavior and Health, Inc.
    [Show full text]
  • Pain and Addiction Case Vignette: James J
    Pain and Addiction James J. Manlandro, DO, FAOAAM, FACOFP, DABM American Osteopathic Academy of Addiction Medicine 1 James Manlandro, DO, FAOAAM FACOAFP, DABM Disclosures • James Manlandro, DO, FAOAAM, FACOAFP, DABM is a paid speaker for Reckitt Benckiser The contents of this activity may include discussion of off label or investigative drug uses. The faculty is aware that is their responsibility to disclose this information. 2 Planning Committee, Disclosures AAAP aims to provide educational information that is balanced, independent, objective and free of bias and based on evidence. In order to resolve any identified Conflicts of Interest, disclosure information from all planners, faculty and anyone in the position to control content is provided during the planning process to ensure resolution of any identified conflicts. This disclosure information is listed below: The following developers and planning committee members have reported that they have no commercial relationships relevant to the content of this module to disclose: PCSSMAT lead contributors Maria Sullivan, MD, PhD, Adam Bisaga, MD and Frances Levin, MD; AAAP CME/CPD Committee Members Dean Krahn, MD, Kevin Sevarino, MD, PhD, Tim Fong, MD, Robert Milin, MD, Tom Kosten, MD, Joji Suzuki, MD; AOAAM Staff Stephen Wyatt, DO, Nina Albano Vidmer and Lara Renucci; and AAAP Staff Kathryn Cates-Wessel, Miriam Giles and Blair-Victoria Dutra. All faculty have been advised that any recommendations involving clinical medicine must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in the presentation must conform to the generally accepted standards of experimental design, data collection, and analysis.
    [Show full text]
  • Pain Management in Patients with Substance-Use Disorders
    Pain Management in Patients with Substance-Use Disorders By Valerie Prince, Pharm.D., FAPhA, BCPS Reviewed by Beth A. Sproule, Pharm.D.; Jeffrey T. Sherer, Pharm.D., MPH, BCPS; and Patricia H. Powell, Pharm.D., BCPS Learning Objectives regarding drug interactions with illicit substances or prescribed pain medications. Finally, there are issues 1. Construct a therapeutic plan to overcome barri- ers to effective pain management in a patient with related to the comorbidities of the patient with addic- addiction. tion (e.g., psychiatric disorders or physical concerns 2. Distinguish high-risk patients from low-risk patients related to the addiction) that should influence product regarding use of opioids to manage pain. selection. 3. Design a treatment plan for the management of acute pain in a patient with addiction. Epidemiology 4. Design a pharmacotherapy plan for a patient with Pain is the second most common cause of work- coexisting addiction and chronic noncancer pain. place absenteeism. The prevalence of chronic pain may 5. Design a pain management plan that encompasses be much higher among patients with substance use dis- recommended nonpharmacologic components for orders than among the general population. In the 2006 a patient with a history of substance abuse. National Survey on Drug Use and Health, past-year alco- hol addiction or abuse occurred in 10.3% of men and 5.1% of women. In the same survey, 12.3% of men and Introduction 6.3% of women were reported as having a substance-use Pain, which is one of the most common reasons disorder (abuse or addiction) during the past year.
    [Show full text]
  • Addiction Medicine, Substance Abuse, and Chemical Dependency Course Syllabus
    Phar 6249: Addiction Medicine, Substance Abuse, and Chemical Dependency Course Syllabus Table of Contents Meeting Time, Place, Credits Course Instructional Teamh.30j0zll Overview of the courseh.1fob9te Computer/Technology Requirements Course Goals & Objectives Attendance Policy Course Materialsh.1t3h5sf Assessments and Grading Exam Policy Grading Information Detailed Course Outline & Schedule* Meeting Time, Place, Credits The class meets Wednesdays from 3:35-5:30 On the TC campus - Weaver-Densford Hall W7-193 On the Duluth campus (via ITV) - Life Sciences Bldg 165 2 credits Course Web Site: https://ay15.moodle.umn.edu/course/view.php?id=1225https://moodle2.umn.edu/ Term: Fall 2016 Dates: September 7th, 2016 - December 16, 2016 Location: Twin Cities/Duluth Target audience: P2 and P3 students Course Instructional Team Course Directors Dan Berkner, Pharm.D. 320-249-1850 [email protected] [email protected] *Any problems concerning the presentation of this curriculum or any problems related to this course should be directed to the course director. Dr. Berkner will have office hours by appointment. Please call to make arrangements; he will be more than happy to get together with you. Course Instructors 1 Leo Sioris, Pharm.D. Professor, College of Pharmacy, University of Minnesota, & Senior Toxicologist and CEO, SafetyCall International, PLLC Dan Berkner, Pharm.D Adjunct Professor, College of Pharmacy, University of Minnesota Tracy Erfourth, MS Case Manager, Health Professionals Service Program (HPSP) Kelly Sioris, Pharm.D. Adjunct Assistant Professor, College of Pharmacy, University of Minnesota and Senior Clinical Toxicologist - SafetyCall International, PLLC Joe Cappello, DEA Officer Diversion Investigator Minneapolis/St. Paul Resident Office Jim Alexander, RPh Director of PRN Minnesota Ashley Brown, Pharm.D.
    [Show full text]
  • Common Language Glossary
    - OHO AM - Common Language Glossary This resource was developed as an integral part of Ohio’s work related to the Regional Judicial Opioid Initiative, a cross-disciplinary approach to address the opioid epidemic from a regional perspective. The Ohio team strived to research and select terminology from sources that emphasized that addiction is a brain disease, carefully considered the use of person-first language, and demonstrated a philosophy of acceptance. The words we use matter. By using clinical and non-shaming terminology, we promote greater education and understanding for the public. Language choice also can help to reduce the stigma associated with substance use disorders and eradicate misconceptions about individuals who suffer from the disease of addiction. Furthermore, standardizing recovery language helps promote standards of care across disciplines and amongst the professionals dedicated to combating the opiate crisis. TERMS 12-Step Program Addiction A group providing mutual support and fellowship for A primary, chronic disease of brain reward, motivation, people recovering from addictive behaviors. The first memory and related circuitry. Dysfunction in these 12-step program was Alcoholics Anonymous, founded circuits leads to characteristic biological, psychological, in 1935; an array of 12-step groups following a similar social and spiritual manifestations. This is reflected in model have since emerged and are the most widely an individual pathologically pursuing reward and/or used mutual aid groups and steps for maintaining relief by substance use and other behaviors. recovery from alcohol and drug use disorders. It is not Source: American Society of Addiction Medicine (ASAM) a form of treatment, and it is not to be confused with the treatment modality called Twelve-Step Facilitation.
    [Show full text]
  • Substance Abuse
    \1\A-10/PSA/93.10 ORIGINAL: ENGUSH DISTR.: GENERAL PROGRAMME ON SUBSTANCE ABUSE Approaches to Treatment of Substance Abuse WORLD HEALTH ORGANIZATION ABSTRACf The aim of this report is to provide an updated description of different methods used around the world to treat health problems associated with substance use. The scope of treatment approaches currently practised around the world is wide, ranging from traditional healing practices via mutual self-help groups, psychological/behavioural treatment to pharmacological treatment. Also included is a chapter on the generalist responses to alcohol and other drug problems and a chapter on the concept of harm minimization. Another aspect is a chapter on specific descriptors, which distinguishes different treatments from one another and provides economic means of describing them. Social and structural extra-treatment factors influencing the treatment process are also a subject described in this report. ©World Health Organization, 1993 This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced and translated in part or in whole, but not for sale nor for use in conjunction with commercial purposes. The views expressed in documents by named authors are solely the responsibility of those authors. ii CONTENTS page Acknowledgements . v Introduction . 1 I. Descriptors of Treatments . 3 11. Factors Influencing Treatment . 31 Ill. Generalist Responses to Alcohol and other Drug Problems . 53 IV. Pharmacological Treatment of Dependence on Alcohol and other Drugs: An Overview . 75 V. Psychological, Behavioural and Psychodynamic Treatments for Substance Abuse . 103 VI.
    [Show full text]
  • Abuse Treatment and Rehabilitation
    Drug Abuse Treatment Toolkit Printed in Austria V.02-59610—July 2003—1,150 DRUG ABUSE GUIDE PRACTICAL PLANNING AND IMPLEMENTATION AND REHABILITATION—A TREATMENT Back to navigation page Drug Abuse Treatment and Rehabilitation A Practical Planning and Implementation Guide United Nations publication Sales No. E.03.XI.II B ISBN 92-1-148160-0 UNITED NATIONS OFFICE ON DRUGS AND CRIME Vienna Drug Abuse Treatment and Rehabilitation: a Practical Planning and Implementation Guide UNITED NATIONS New York, 2003 The Office for Drug Control and Crime Prevention became the United Nations Office on Drugs and Crime on 1 October 2002. UNITED NATIONS PUBLICATION Sales No. E.03.XI.II ISBN 92-1-148160-0 The designations employed and the presentation of the material in this publication do not imply the expres- sion of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or the delimitation of any frontiers or boundaries. ii Acknowledgements The present text of Drug Abuse Treatment and Rehabilitation: a Practical Planning and Implementation Guide was commissioned by the Demand Reduction Section of the United Nations International Drug Control Programme (UNDCP). For their contributions to the preparation of the Guide, UNDCP would like to express its gratitude to the following: • The consultant project team: Dr. John Marsden, National Addiction Centre, Institute of Psychiatry, United Kingdom of Great Britain and Northern Ireland; Dr. Robert Ali, Drug and Alcohol Services Council, Adelaide, South Australia; Dr. Michael Farrell, National Addiction Centre, Institute of Psychiatry, United Kingdom; and Dr.
    [Show full text]
  • Addiction and Substance Abuse in the Pharmacy Professions: from Discovery to Recovery American Pharmacists Association
    CPE Addiction and substance abuse in the pharmacy professions: From discovery to recovery American Pharmacists Association Advisory board: Wallace Cross, BSPharm, MHS, CADC, Pharmacy Program Coordina- Abstract tor, Presence Health (Behavioral Health), Professionals Addiction Treatment Program, Objectives: To increase pharmacists’ knowledge about substance use disorders Chicago. in their profession, to assist them in recognizing those problems, and to suggest Development: This activity is supported by how they can help a colleague who may have a substance use disorder. independent educational grants from Reckitt Benckiser, Endo Pharmaceuticals, and Summary: Pharmacy professionals are not immune to substance use disorders, Mallinckrodt, The Pharmaceuticals business including addiction. Awareness of the signs and symptoms can help pharmacists of Covidien. deal with a colleague who may be abusing drugs or alcohol. It is particularly im- Funding: This activity is supported by portant that pharmacists are aware that many resources are available to help a col- independent educational grants from Reckitt league get help and that many of these options offer confidential assistance. Benckiser and Endo Pharmaceuticals. Conclusion: Substance abuse among pharmacists is an important issue with se- This publication was prepared by Gail Dearing rious consequences ranging from personal and professional problems to harming on behalf of the American Pharmacists As- patients as a result of poor judgment or medication errors. Most professionals who sociation. have become impaired because of substance abuse recover and return to practice. Keywords: Substance abuse, substance use disorder, addiction, pharmacists, im- pairment. Pharmacy Today. 2013(Aug);19(8):62–72. Learning objectives At the conclusion of this knowledge- based activity, the pharmacist will be able to: ■ Summarize the issue of addiction and its prevalence in health profes- sionals, including pharmacists.
    [Show full text]