substance abuse and crisis intervention

Presented by:

Substance Abuse and Crisis Intervention

Overview of Western Region Grant

• Certifying counties (DHS 34)

• Training

• Stabilization services

Goals of the grant

Reduce inappropriate/unnecessary restriction of rights by using more restrictive placement than needed

Improve access to community based least restrictive options

Meet our Presenter

Lorie Goeser is an Independent Clinical Supervisor, Clinical Substance Abuse Counselor, BA with focus on sociology and criminal justice specialty. Ms. Goeser has worked in private settings and has a combined 12 years of experience with the DHS and County systems, treating addiction or working on addiction policies and statues.Ms. Goeser has 26 years of experience in the addiction field including working with clients in acute crisis, dual diagnosis, consultation for detoxification services, county provider for outpatient and on call, as well as working within the hospital and institution settings providing program development and services for dual diagnosis adolescents and adults. Ms. Goeser has provided training to MDs and medical staff on how to intervene with addicted clients, how to address addiction issues in the ER setting, training on assessment and referral to a variety of providers including social workers, child protection workers, law enforcement and addiction therapists.

What do you think addiction is?

What thoughts do you have about it? What prior experience do you have with

addiction? What knowledge do you have and where did

you obtain it from? Do believe addiction is a brain disease? Do think addiction is a problem in WI?

Debunking Myths about Dependence

MYTH: All someone has to do to overcome alcoholism is go to Alcoholics Anonymous (A.A.).

FACT: A.A. doesn’t work for everyone (even for many people who truly want to stop drinking). For most people, A.A. is a gut-wrenching, lifelong working of the 12 steps. Scientists theorize that people who “get better” in A.A. are somehow learning how to overcome (or compensate for) their brain disease.

MYTH: Nicotine and marijuana are not addicting. FACT: Nicotine is one of the most dependence-producing

chemicals in existence and marijuana has also been proven to create a dependence in a percentage of people who smoke it regularly.

Source: Dr. Carl Erickson- University of Texas @ Austin

Debunking Myths about Dependence

MYTH: Anyone who drinks or uses drugs too often will become “addicted.”

FACT: We know this doesn’t occur in everyone, any more than diabetes occurs in everyone who eats too much sugar or food. It now appears that a person must “have what it takes” to become dependent on drugs. In many cases, genetics is the main risk factor for determining who develops the disease.

MYTH: All addicts are criminals. FACT: Evolving research is demonstrating that “addicts” (people

who are dependent on drugs or alcohol) are not bad people who need to get good, crazy people who need to get sane or stupid people who need education. “Addicts” have a brain disease that goes beyond their use of drugs.

Source: Dr. Carl Erickson- University of Texas @ Austin

Top 10 Addiction Myths — and Myth Busters

Think you know about addiction? Then these common myths may sound familiar:

Myth 1: Drug addiction is voluntary behavior. You start out occasionally using alcohol or other drugs, and that is a voluntary decision. But as times passes, something happens, and you become a compulsive drug user. Why? Because over time, continued use of addictive drugs changes your brain - in dramatic, toxic ways at times, more subtly at others, but virtually always in ways that result in compulsive and even uncontrollable drug use.

Myth 2: Drug addiction is a character flaw. Drug addiction is a brain disease. Every type of drug - from alcohol to heroin - has its own mechanism for changing how the brain functions. But regardless of the addiction, the effects on the brain are similar, ranging from changes in the molecules and cells that make up the brain to mood and memory processes - even on motor skills such as walking and talking. The drug becomes the single most powerful motivator in your life.


Myth 3: You can't force someone into treatment. Treatment does not have to be voluntary. Those coerced into treatment by the legal system can be just as successful as those who enter treatment voluntarily. Sometimes they do better, as they are more likely to remain in treatment longer and to complete the program. In 1999, over half of adolescents admitted into treatment were directed to do so by the criminal justice system.

Myth 4: Treatment for drug addiction should be a one-shot deal. Like many other illnesses, drug addiction typically is a chronic disorder. Some people can quit drug use “cold turkey,” or they can stop after receiving treatment just one time at a rehabilitation facility. But most people who abuse drugs require longer-term treatment and, in many instances, repeated treatments.


Myth 5: We should strive to find a "magic bullet" to treat all forms of drug abuse. There is no “one size fits all” form of drug treatment, much less a magic bullet that suddenly will cure addiction. Different people have different drug abuse-related problems. And they respond very differently to similar forms of treatment, even when they're abusing the same drug. As a result, drug addicts need an array of treatments and services tailored to address their unique needs. Finding an approach that is personally effective can mean trying out several different doctors or treatment centers before a “match” is found between patient and program.

Myth 6: People don't need treatment. They can stop using drugs if they really want to. It is extremely hard for people addicted to drugs to achieve and maintain long-term abstinence. Research shows that when long-term drug use actually changes a person's brain function, it causes them to crave the drug even more, making it increasingly difficult to quit without effective treatment. Intervening and stopping substance abuse early is important, as children become addicted to drugs much faster than adults and risk greater physical, mental and psychological harm

Myth 7: Treatment just doesn't work. Studies show drug treatment reduces drug use by 40 to 60 percent and can significantly decrease criminal activity during and after treatment. There is also evidence that drug addiction treatment reduces the risk of infectious disease, Hepatitis C and HIV infection - intravenous-drug users who enter and stay in treatment are up to six times less likely to become infected with HIV - and improves the prospects for getting and keeping a job up to 40 percent.


Myth 8: No one voluntarily seeks treatment until they hit rock bottom. There are many things that can motivate a person to enter and complete treatment before that happens. Pressure from family members and employers, as well as personal recognition that they have a problem, can be powerful motivators. For teens, parents and school administrators are often driving forces in getting them into treatment before situations become dire.

Myth 9: People can successfully finish drug abuse treatment in a couple of weeks if they're truly motivated. For treatment to have an effect, research indicates a minimum of 90 days of treatment for outpatient drug-free programs, and 21 days for short-term inpatient programs. Follow-up supervision and support are essential. In all recovery programs, the best predictor of success is the length of treatment. Patients who are treated for at least a year are more than twice as likely to remain drug free, and a recent study showed adolescents who met or exceeded the minimum treatment time were over one and a half times more likely to stay away from drugs and alcohol.


Myth 10: People who continue to abuse drugs after treatment are hopeless. Completing a treatment program is merely the first step in the struggle for recovery that can last a lifetime. Drug addiction is a chronic disorder; occasional relapses do not mean failure. Psychological stress from work or family problems, social cues - meeting someone from the drug-using past - or the environment - encountering streets, objects or even smells associated with drug use - can easily trigger a relapse. Addicts are most vulnerable to drug use during the few months immediately following their release from treatment. Recovery is a long process and frequently requires multiple treatment attempts before complete and consistent sobriety can be achieved.

(Sources: National Institute on Drug Abuse, National Institute of Health; Dr. Alan I. Leshner, former director of the National Institute on Drug Abuse; “The Principles of Drug Addiction Treatment: A Research-Based Guide” (October 1999); The Partnership for a Drug-Free America)


Addiction- Definition:

Addiction is a health condition in which an individual manifests a pathological pattern of use of alcohol, tobacco or other drugs that interact with brain systems of reward. Genetic, psychological, environmental and cultural factors influence its onset and progression. Persons with addiction have altered motivational hierarchies so that they are preoccupied with procuring supplies of using substances that early in the illness can produce euphoria, and substance use persists despite a range of medical, family, occupational, legal and other consequences. Individuals, families, and communities suffer when addiction is prevalent and not adequately treated.(Adapted from definitions of the American Society of Addiction Medicine.)

Substance Use Definition

Substance Use refers to the risky, chronic, problematic or harmful use of alcohol, tobacco, prescription drugs, and controlled substances. (Healthiest Wisconsin 2010)

Why is it important to Address Addiction and Substance Use?

Alcohol use is associated with 41% of road traffic deaths, 29% of suicides, Suicides and road traffic accidents are leading caused of death among 15-34 year olds. (WHO Burden of Disease Statistics 2001)

Alcohol misuse is now the leading risk factor for serious injury in the United States, and the third leading cause of preventable death. It accounts for more than 75,000 deaths annually. Little has been done to address the misuse of alcohol and drugs a major cause of severe and repeat injuries among hospitalized trauma patients. (CDC-2003 Conference proceedings on Alcohol and Other Drug Problems)

Excessive alcohol consumption is the third leading preventable cause of death in the United States it is associated with multiple adverse health consequences, including liver cirrhosis, various cancers, unintentional injuries, and violence. Alcohol-attributable deaths (ADD) is approx. 75,766, and 2.3 million years of potential life lost (YPLL’s). (Source-CDC-AADs &YPLLs-US, 2001)

Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2008

Key Findings Consequences of Alcohol and Other Drug Consumption

Many types of mortality, morbidity, and dangerous criminal behavior have been linked to the use of alcohol and other drugs. Given Wisconsin’s high rate of alcohol consumption, it is not surprising that the rates at which Wisconsin experiences the consequences associated with alcohol use also tend to be higher than the national average.

Rates of alcohol dependence, alcohol abuse, and alcohol-related motor vehicle fatalities are higher in Wisconsin than in the United States as a whole. Wisconsin has one-and-a-half times the national rate of arrests for operating a motor vehicle while intoxicated and more than three times the national rate of arrests for other liquor law violations. Wisconsin also has the highest rate in the nation of self-reported drinking and driving.

Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2008 Wisconsin’s rate of alcohol-related motor vehicle deaths has been

decreasing in recent years, although more slowly than the overall rate of motor vehicle deaths. One surprising finding is that Wisconsin has had a lower rate of alcohol-related liver cirrhosis than the national average, although this difference may be disappearing. Wisconsin’s rate of other alcohol- related deaths (other than liver cirrhosis and motor vehicle) has increased since 1999.

The number of clients receiving publicly funded services for alcohol and other drug abuse increased 11% between 1997 and 2006, while inflation-adjusted public expenditures for those services increased just 4%.

From 1999 to 2006, Wisconsin’s age-adjusted rate of drug-related deaths increased; the statewide rate of drug-related hospitalizations has also increased in recent years. Wisconsin’s rate of arrests for drug law violations remains lower than the national average but has increased since 1997.


Alcohol Consumption

Wisconsin's rates of alcohol use and misuse are among the highest – if not the highest – in the nation. As of 2006, Wisconsin adults continue to have the highest rates of alcohol consumption, binge drinking and heavy drinking among all U.S. states and territories, and Wisconsin rates of underage drinking (ages 12-20) exceed national levels. As of 2007, Wisconsin high school students have a binge drinking rate that is the third highest of reported states, and the highest rate of current alcohol use.

In good news, high school students in both Wisconsin and the nation are decreasingly likely to report they began alcohol use before age 13. Also, binge drinking among young adults (ages 18-24) has declined in Wisconsin since 2000.


Alcohol Consumption

Data for the most recent decade consistently show that Wisconsin women of childbearing age are more likely to drink – and to binge drink – than their national counterparts. This has important implications for unplanned pregnancy and infant health.


Other Drug Consumption

The use of drugs other than alcohol also remains a problem in Wisconsin. As a whole, consumption patterns of illicit drugs in Wisconsin mirror national trends with few exceptions.

One notable trend was in the use of marijuana. In 1997, the prevalence of both lifetime and current use of marijuana was lower than the national average. Over the next four years, however, these measures rose until they were nearly identical to the national averages.

Since 2001, both lifetime and current use of marijuana in the United States and Wisconsin have decreased at similar rates. Both nationally and in Wisconsin, the misuse of prescription drugs for non-medical purposes has emerged as a problem, especially among young adults.


Conclusion Areas of need are clearly identified in this report. Wisconsin data for

2006 reflect a higher prevalence of alcohol use and binge drinking in adults, especially young adults, compared to the country as a whole. Underage drinking and underage binge drinking also occur at higher rates in Wisconsin, as does drinking among women of childbearing age. Concerning illicit drug use, Wisconsin rates of death and hospitalization from drug use have been increasing. From 1996 to 2006, Wisconsin's arrest rate for liquor law violations was more than three times the national rate; arrests for operating while intoxicated also occur at a higher rate in Wisconsin.

The economic and health costs of substance abuse in Wisconsin are great, as are the related costs to the community of arrests and criminal offenses. Focus on these key areas will be useful in guiding the state’s funding decisions regarding which problems to address and which interventions to use.


Consequences of Alcohol Consumption

In Wisconsin in 2006, at least 1,678 people died, 5,654 were injured, and 88,000 were arrested as a direct result of alcohol use and misuse. Given Wisconsin’s high rate of alcohol consumption, it is not surprising that the consequences associated with alcohol use also tend to be higher than the national average. Rates of alcohol dependence, alcohol abuse, and alcohol-related motor vehicle fatalities are higher in Wisconsin than in the United States.

Wisconsin has one-and-a-half times the national rate of arrests for operating a motor vehicle while intoxicated and more than three times the national rate of arrests for other liquor law violations. Wisconsin has generally experienced a lower rate of alcohol-related liver cirrhosis than the national average, although this may be changing.

WI EPI Study 2008

Motor Vehicle Injuries and Fatalities Many motor vehicle injuries and fatalities are a direct consequence

of alcohol use and abuse. In 2006, 364 people in Wisconsin died in alcohol-related motor

vehicle crashes according to the national Fatality Analysis Reporting System. Approximately 51% of all Wisconsin motor vehicle fatalities in 2006 were alcohol-related (Figure 3).

Wisconsin’s mortality rate from alcohol-related motor vehicle crashes has been higher than the United States rate since 2000 (Figure 4, page 15). In 2006, the alcohol-related motor vehicle mortality rate was 6.6 per 100,000 population in Wisconsin and 5.9 per 100,000 in the United States.

Between 1997 and 2006, the total number of nonfatal alcohol-related motor vehicle injuries in Wisconsin dropped 17%, from 6,797 to 5,654. The rate of nonfatal injuries in alcohol-related crashes has also fallen during this period, to a low in 2006 of 102 injuries per 100,000 population (Figure 5, page 15).

WI EPI Profile 2008

Non-Medical Use of Prescription Drugs

Findings from a recent survey report indicated that lifetime non-medical use of prescription stimulants among college students in the United States was approximately 7%, and past-year use was an estimated 4%. The study also found that non-medical prescription drug use was associated with use of alcohol, cigarettes, marijuana and other illicit drugs.

During 2005-2006, 5% of Wisconsin residents ages 12 and older reported using pain relievers for non-medicinal purposes (Figure 45). This percentage has not changed since 2003-2004, and is the same prevalence reported nationally. The prevalence of use was highest among young adults ages 18 to 25 (12%, Figure 38).

WI EPI Profile 2008

Non-Medical Use of Prescription Drugs

Other than marijuana, pain relievers and psychotropics were the most commonly reported drugs consumed for non-medical reasons. During 2002-2004, 18% of Wisconsin residents age 12 and older reported non-medical use of psychotropics and 12% reported non-medical use of pain relievers at some point in their lifetime (Table 27, page 64). During the same time period, 6% reported using psychotropics and 4% reported using pain relievers for non- medical reasons in the past year(Table 27).

In 2007, the Youth Risk Behavior Survey found that 23% of Wisconsin high school students had used prescription pain relievers for non-medical purposes at some point in their lives, and 16% had used other prescription drugs non-medically at some point (data not shown). No comparable data for earlier years or the United States were available.

WI EPI Study 2008

Alcohol Use by Women of Childbearing Age Alcohol use can impair decision-making and result in risk-taking

behaviors, including sexual behaviors; an unplanned pregnancy may be one result. Studies also have shown that alcohol use during pregnancy can harm the developing fetus. The Centers for Disease Control and Prevention (CDC) has reported that Wisconsin is among the states that report the highest rates of drinking among pregnant women and high-risk drinking among women of childbearing age.

Wisconsin women of childbearing age are more likely to drink than women nationally (Figure 35). In 2006, 66% of Wisconsin women ages 18-44 said they had at least one alcoholic drink in the past 30 days; this compares with 54% of women in the United States.

Binge drinking is also more prevalent among Wisconsin women of childbearing age, compared with their national counterparts. In 2006, among women ages 18-44, 24% in Wisconsin and 16% nationally said they had consumed four or more drinks on one occasion in the past 30 days (Figure 36).

WI EPI Profile 2008

Other Alcohol-Related Mortality

Alcohol use contributes to many different causes of death in varying degrees. For example, it contributes to 100% of alcohol-related liver cirrhosis deaths, but a smaller percentage of deaths from stroke. Alcohol-Related Disease Impact (ARDI) software from the Centers for Disease Control and Prevention identifies fractional alcohol-related mortality for a total of 63 chronic and acute conditions.

For each of these 63 conditions, ARDI specifies a distinct fraction of cases attributable to alcohol. The number of alcohol-attributable deaths can be estimated by multiplying the number of deaths for each condition by the specified alcohol-attributable fraction and summing over conditions. This method was used to estimate the total number of alcohol- related deaths in Wisconsin, as well as the subset of “other” alcohol-related deaths (other than those from alcoholic liver cirrhosis and motor vehicle crashes).

WI EPI Profile 2008

Other Alcohol-Related Mortality

Alcohol-related causes other than alcoholic liver cirrhosis and motor vehicle crashes accounted for an estimated 1,075 deaths in Wisconsin in 2006 (see Figure 1, page 11). The most frequent causes of “other” alcohol-related deaths are mental and behavioral disorders due to alcohol, alcohol dependence syndrome, unspecified liver cirrhosis, homicide, non-alcohol poisoning, and suicide.

The Wisconsin mortality rate from other alcohol-related causes increased from 16.0 deaths per 100,000 in 1999 to 19.3 deaths per 100,000 in 2006.

Based on combined data for 1999-2006 at the county level (Table 4, next page), the mortality rate from other alcohol-related causes ranged between 8.7 per 100,000 in Calumet County to 29.2 per 100,000 in Marquette and Milwaukee counties.

Addiction is only one of the Substance-Related Disorders

Addiction (Substance Dependence) Problem Use (Substance Abuse) Intoxication States Withdrawal States Substance-Induced Medical Problems Substance-Induced Psychiatric Problems Health Problems linked to Secondary Use Codependency and ACOA Syndromes

Levels and Patterns of Drinking

Heavy drinking – For women, more than 1 drink per day on average. – For men, more than 2 drinks per day on average.

Binge drinking – For women, more than 3 drinks during a single

occasion or 7 drinks in one week– For men, more than 4 drinks during a single occasion

or 14 drinks in one week Excessive drinking includes both binge drinking and

heavy drinking.(Source- NIAAA)

Mortality

Illicit Drugs - 25,000/year USA Alcohol - 100,000/year USA Tobacco - 450,000/year USA

Actual Causes of Death,1 United States - 2000

Actual CauseActual Cause No (%) in 2000No (%) in 2000

TobaccoTobacco 435,000 (18.1)435,000 (18.1)

Poor diet and physical inactivityPoor diet and physical inactivity 365,000 (15.2)365,000 (15.2)

Alcohol ConsumptionAlcohol Consumption 85,000 (3.5)85,000 (3.5)

Microbial agentsMicrobial agents 75,000 (3.1)75,000 (3.1)

Toxic agentsToxic agents 55,000 (2.3)55,000 (2.3)

Motor vehicleMotor vehicle 43,000 (1.)43,000 (1.)

FirearmsFirearms 29,000 (1.2)29,000 (1.2)

Sexual behaviorSexual behavior 20,000 (0.8)20,000 (0.8)

Illicit drug useIllicit drug use 17,000 (0.7)17,000 (0.7)

1Actual causes of death are the major external (nongenetic) modifiable factors that 1Actual causes of death are the major external (nongenetic) modifiable factors that contribute to death in the United Statescontribute to death in the United States

Mokdad AH, Marks JS, Stroup DF, Gerberding JL. JAMA (2004). 29:1238-45; Mokdad AH, Marks JS, Stroup DF, Gerberding JL. (2005). JAMA 19;293:293-4.

Assessing Quantity ‘Backwards’

6 pack -- 12 pack -- 18 pack -- 24 pack 1/2 pt -- pint ---1/5 gal (27 oz or 18 drinks) 4/5 quart of wine -- 1/2 gal of wine

1.75 liters = 57 oz ( 12 ‘drinks’ of wine, 38 ‘drinks’ of 80-proof, 48 ‘drinks’ of 100-proof)

‘HOW MANY DO YOU BUY PER WEEK?’

Alcohol IntoxicationBlood Alcohol Level Clinical Picture

20-100mg percent Mood and behavior changes

Reduced Coordination

Impaired ability to drive a car

101-200mg percent Reduced coordination

Speech Impairment

Trouble walking

General impairment in thinking and judgment

201-300mg percent Marked impairment of thinking, memory, and coordination

Marked reduction in level of alertness

Memory blackouts

Nausea, vomiting, blackouts

5TIP45 Training Curriculum Module 1-5

Alcohol Withdrawal

Restlessness, irritability, anxiety and agitation Anorexia, nausea, and vomiting Tremors, elevated heart rate, and increased blood pressure Insomnia, intense dreaming, and nightmares Poor concentration, impaired memory, and judgment Increased sensitivity to sound, light, and tactile sensations Hallucinations—auditory, visual, or tactile Delusions Grand mal seizures Hyperthermia Delirium

TIP45 Training Curriculum 7 Module 1–7

Intoxication and Withdrawal from Heroin and Other Opioids

Fast Facts: Opioids are highly addicting. Chronic use of opioids leads to withdrawal

symptoms that, although not medically

dangerous, can be highly unpleasant and

produce intense discomfort.

Opioid Intoxication

Opioid Intoxication Signs Slow pulse Low blood pressure Low body temp Sedation Pinpoint pupils Slowed movement Slurred speech Head nodding

Opioid Intoxication SymptomsEuphoriaImperviousness to painCalmness

TIP45 Training Curriculum 8 Module 1–8


Opioid Withdrawal Signs & Symptoms:Fast Pulse, Abdominal cramps, High body

temperature, Vomiting, Enlarged pupils, Nausea, Sweating, Diarrhea, Increased respiratory rate, Anxiety, Yawning, Bone and muscle pain, High blood pressure, Insomnia, Abnormally heightened reflexes, Gooseflesh, Tearing (as in crying), Runny nose


Management of Withdrawal from Heroin and Other Opioids It is not recommended that clinicians attempt to manage significant

opioid withdrawal symptoms without effective detoxification agents. The management of opioid withdrawal with medication is most

commonly achieved through the use of methadone. The initial dose requirements for methadone are determined by

estimating the amount of opioid use and gauging the patient’s response to administered methadone.

Methadone can be given once daily and generally tapered over 3 to 5 days in 5 to 10mg daily reductions.

Clonidine can also be used to treat opioid withdrawal, but it is usually ineffective for common symptoms such as insomnia, muscle aches, and drug craving.

Intoxication and Withdrawal from Cannabis (Marijuana)

Fast Facts: Marijuana and hashish are the two substances containing THC

(delta-9-tetrahydrocannabinol) commonly used today. The THC abstinence syndrome usually starts within 24 hours of

cessation. The amount of THC that one needs to ingest in order to experience withdrawal is unknown. It can be assumed, however, that heavier consumption is more likely to be associated with withdrawal symptoms.

Symptoms of Cannabis Intoxication Impaired short term memory Impaired attention, judgment, and other cognitive functions Impaired coordination and balance Increased heart rate

Intoxication and Withdrawal from Cannabis (Marijuana)

Cannabis Withdrawal Symptoms Anxiety Restlessness Irritability Sleep disturbance Change in appetite Tremor Sweating Elevated heart rate Nausea, vomiting, diarrheaManagement of Withdrawal From Cannabis There are no medical complications of withdrawal from THC, and medication

is generally not required to manage withdrawal. Screening the patient for suicidal ideation or other mental health problems is

warranted. The patient should be encouraged to maintain abstinence from THC as well

as other addictive substances.

Intoxication and Withdrawal From Other Drugs: An Overview

Nicotine Two issues regarding tobacco smoking merit

consideration by staff of substance abuse detoxification programs. The first is the program management’s desire to establish a smoke-free treatment environment to comply with workplace ordinances and to safeguard the health and comfort of patients from exposure to second hand smoke. The second issue is the patient’s dependence on nicotine as a drug of abuse.

Drugs That Do Not Produce a Withdrawal Syndrome Chronic use of PCP can cause toxic psychosis that takes

days or weeks to clear; however, PCP does not have a withdrawal system. LSD and ecstasy do not produce physical dependence.

Intoxication and Withdrawal From Other Drugs: An Overview

Polydrug Use People who abuse substances rarely use just one

substance. Typical combinations and preferred modes of treatment are as follows:

Alcohol and stimulant: Treat alcohol abuse. Cocaine and opiate: Treat opiate dependence Cocaine and amphetamine: No detoxification protocol is

known.

Assessment

Quantity / Frequency Questions

‘Standard Drink’ =– 0.6 oz of 100% ethanol = 13 gm.– 12 oz of 5% beer– 5 oz of 12% wine– 1.5 oz of 80-proof liquor

Assessment for detox:

Considerations: History of previous delirium tremens or

withdrawal seizures No Capacity for informed consent Suicidal/homicidal/psychotic condition Able/willing to follow tx recommendations Co-occurring medical conditions Supportive person

TIDBITS

Ask if any other herbals or substances taken Bring any medications to hospital or

assessment appt. List of providers prescribing medications Who is supportive contact Evaluate-Stabilize- Readiness-Referral

Options to access services:

EAP contact Primary MD Call # on medical insurance card Call National Tx Directory for service provider in

your area- 1-800-662-HELP Yellow pages for providers of MH and SA in your

area Substance Abuse Counseling services for your

county

CAGE Questions

C—Cut Down (Have you ever felt you ought to Cut Down on your drinking; or--did you ever try to reduce your drinking but found you were unable to do so?)

A—Annoyed (Have people Annoyed you by criticizing your drinking?)

G—Guilty (Have you ever felt bad or Guilty about your drinking?)

E—Eye-Opener (Have you ever had a drink the first thing in the morning to steady your nerves or get rid of a hangover?)

Other screens available:

DAST- Drug Abuse Screening Test

MAST-Michigan Alcohol Screening Test

AUDIT-Alcohol Use Disorders Identification Test-WHO

GAIN Short Screen-www.chestnut.org

Many are available on-line to self-administer

Tips for addressing a concern:

Be respective and non-reactive Open ended questions Remember cognitive “thinking distortions” are a part of Addiction Keep in mind-most people are aware of the probable problem Addiction is a brain disease like any other chronic progress disease Change is a process Never underestimate the effect you can have by just asking about

possible SA/Addiction Need to “hit bottom” a myth-Not True! Do not glamorize binge, heavy, or excessive drinking Alcohol any type or drugs any type-it does not matter any can be a

problem Be aware of your own biases and patterns of use

Prochaska and DiClemente’s Stages of Change Model

The stages of change are: Precontemplation (Not yet acknowledging that there is a

problem behavior that needs to be changed) Contemplation (Acknowledging that there is a problem

but not yet ready or sure of wanting to make a change) Preparation/Determination (Getting ready to change) Action (Changing behavior) Maintenance (Maintaining the behavior change) and Relapse (Returning to older behaviors and abandoning

the new changes)

Where to learn more:

Numerous resources- internet helpful

Websites by Federal agencies handout– www.nattc.org– www.hbo.com/addiction– www.cdc.gov– www.who.org– www.jointogether.org

Additional resources:

Ordering Information TIP 45 Detoxification and Substance Abuse Treatment Three Ways to Obtain FREE Copies of All TIPs

Products: Call SAMHSA’s National Clearinghouse for Alcohol and Drug

Information (NCADI) at 800-729-6686, TDD (hearing impaired) 800-487-4889.

Visit NCADI’s Web site at: www.ncadi.samhsa.gov. You can also access TIPs online at: www.kap.samhsa.gov.

Contact Information:

Lorie Goser

Email: [email protected]

Email: [email protected]

Phone: 608-635-2146-clinic

Phone: 608-215-9114-work cell

Poynette Counseling & Psychotherapy Associates Inc.

415 N. Main Street Suite #3, Poynette, WI 53948

Locations- Baraboo, Mauston, Monona, & Poynette

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