5 year plan for addiction recovery

The 5 year PlanThe 5 year Plan

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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


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The 5 year plan is applicable to any addiction

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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

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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?

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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?

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Drug Courts are proven to retain offenders in treatment considerably longer than most other correctional programs.

http://www.nycourts.gov/courts/2jd/brooklyntreatment/handbook.pdfhttp://www.nycourts.gov/courts/2jd/brooklyntreatment/handbook.pdf

3 phases starting with a treatment plan90 days inpatient treatmentContinued random monitoringIntensive case management Over 2 year span

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http://www.himsprogram.com/Content/Aftercare

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.

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The Airline Pilots

http://www.himsprogram.com/Content/Aftercare

The 5 year PlanThe 5 year PlanHIMS 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 activeIf they fail a test, DOT Offence protocol is to wait year to start process to re-apply for licenseFAA looking to take license if they are using BUT offer this program92% long term recovery rate 2 years- less then 10% relapse 8% decided to retireThey need to have medical certificate that they are able to fly as long as they are accountableFAA requires quarterly reports from airline from AME (Areal medical evaluator) who decides what should be required The weakest component is the link to aftercare

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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

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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

PHPs oversee evaluation and treatment

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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!TREATMENT IS ONLY THE BEGINNING OF RECOVERY!

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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

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INTERVENTIONINTERVENTIONAn 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!

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The 5 year timeline


I P TREATMENTI 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).

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The 5 year timeline


SOBER LIVINGSOBER 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….

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The 5 year timeline



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…

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The 5 year timeline


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INTENSIVE OUT PATIENTINTENSIVE 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.

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The 5 year timeline


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MONITORINGMONITORING

The quantitative component of the plan.

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The 5 year timeline


12 STEPPING & Peer Support12 STEPPING & Peer Support1 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

NOBODY Does this alone

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The 5 year timeline


INTERVENTIONINTERVENTION

I P TREATMENTI P TREATMENT


MONITORINGMONITORING

12 STEPPING12 STEPPING

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INTENSIVE OUT PATIENTINTENSIVE OUT PATIENT

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The 5 year timeline


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.

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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

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Also part of the recovery plan…

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Motivators

Leverage

Consequences

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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.

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If we were dealing with Cancer…When would be the best time to start treatment?

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Why is an outsider better than doing it yourself?

Same reason that a company shouldn’t monitor an employee

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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.

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Contracts, Contracts, Contracts!!!


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“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


Why a skilled interventionistWill minimize the natural progression of negative consequencesWill know how to dissect the family system to create the bottom line (license) to motivate the loved oneWill 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

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Motivators

Leverage

Consequences

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Questions?

5 year plan for addiction recovery

Health & Medicine