What to expect from state-of-the-art addiction treatment for - PowerPoint PPT Presentation

What to expect from state-of-the-art addiction treatment for criminal justice populations in applying the new ASAM Criteria BJA Drug Court Technical Assistance Project at American University February 10, 2016 David Mee-Lee, M.D. Chief Editor, The ASAM Criteria Senior Fellow, Justice Programs Office (JPO) American University Washington, DC Senior Vice President, The Change Companies Carson City, NV Davis, CA www.changecompanies.net www.ASAMCriteria.org www.tipsntopics.com davidmeelee@gmail.com w w w. c h a n g e c o m p a n i e s . n e t

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Methamphetamine 1500 Dopamine Levels 1000 500 Frontal cortex 0 0 1 2 3 hr • Time after methamphetamine COCAINE 500 Nucleus 400 accumbens VTA/SN 300 200 1 1 0 0 0 1 2 3 4 5 hr Time After Cocaine w w w. c h a n g e c o m p a n i e s . n e t

Addiction is a Brain Disease Prolonged Use Changes the Brain in Fundamental and Lasting Ways “Cocaine “Healthy” Brain Addict” Brain w w w. c h a n g e c o m p a n i e s . n e t

• “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry August 15, 2011 • Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. ASAM’s Revamped Definition of Addiction w w w. c h a n g e c o m p a n i e s . n e t

• Pathologically pursuing reward and/or relief by substance use and other behaviors.” • “Addiction is about brains. Not just about behaviors” ASAM’s Revamped Definition of Addiction w w w. c h a n g e c o m p a n i e s . n e t

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INDIVIDUALIZED, CLINICALLY & OUTCOMES-DRIVEN TREATMENT ASAM Principles of Addiction Medicine 5 th Edition, 2014 w w w. c h a n g e c o m p a n i e s . n e t

The ASAM Criteria Multidimensional Assessment 1. Acute Intoxication and/or Withdrawal Potential 2. Biomedical conditions and complications 3. Emotional/Behavioral/Cognitive conditions and complications 4. Readiness to change 5. Relapse/Continued Use/Continued Problem potential 6. Recovery Environment The ASAM Criteria pp. 43-53 w w w. c h a n g e c o m p a n i e s . n e t

Criminogenic Factors/ASAM Criteria Dimensions Criminogenic Factors ASAM Criteria Dimensions • Dimensions 3, 4 and 6 • Antisocial values, attitudes, behavior, personality • Dimension 6 • Criminal/deviant peer association • Dimensions 1, 4, 5, 6 • Substance abuse • Dysfunctional family • Dimension 6 relations w w w. c h a n g e c o m p a n i e s . n e t

Biospychosocial Treatment Treatment Matching - Modalities • Motivate - Dimension 4 • Manage – All Six Dimensions • Medication – Dimensions 1, 2, 3, 5 - MAT • Meetings – Dimensions 2, 3, 4, 5, 6 • Monitor- All Six Dimensions w w w. c h a n g e c o m p a n i e s . n e t

The ASAM Criteria Treatment Levels of Service 1 Outpatient Treatment 2 Intensive Outpatient and Partial Hospitalization 3 Residential/Inpatient Treatment 4 Medically-Managed Intensive Inpatient Treatment w w w. c h a n g e c o m p a n i e s . n e t

Level 0.5 and OTS Level 0.5: Early Intervention Services - Individuals with problems or risk factors related to substance use, but for whom an immediate Substance -Related Disorder cannot be confirmed Opioid Treatment Services (OTS) - Criteria for Opioid Treatment Program (OTP) (methadone); antagonist meds (naltrexone) and Office-Based Opioid Treatment (OBOT) - buprenorphine w w w. c h a n g e c o m p a n i e s . n e t

Detoxification  Withdrawal Management Services for Dimension 1 Level 1-WM - Ambulatory Withdrawal Management without Extended On-site Monitoring Level 2-WM -Ambulatory Withdrawal Management with Extended On-Site Monitoring w w w. c h a n g e c o m p a n i e s . n e t

Withdrawal Management Services for Dimension 1 (continued) Level 3.2- WM- Clinically-Managed Residential Withdrawal Management Level 3.7- WM - Medically-Monitored Inpatient Withdrawal Management Level 4-WM - Medically-Managed Inpatient Withdrawal Management w w w. c h a n g e c o m p a n i e s . n e t

Level 1 and 2 Services Level 1 Outpatient Treatment Level 2.1 Intensive Outpatient Treatment Level 2.5 Partial Hospitalization w w w. c h a n g e c o m p a n i e s . n e t

Level 3 Residential/Inpatient Level 3.1- Clinically-Managed, Low Intensity Residential Treatment Level 3.3 - Clinically Managed Population- Specific High Intensity Residential Treatment (Adult Level only) w w w. c h a n g e c o m p a n i e s . n e t

Level 3 Residential/Inpatient (cont.) Level 3.5- Clinically-Managed, Medium/High Intensity Residential Treatment Level 3.7- Medically-Monitored Intensive Inpatient Treatment w w w. c h a n g e c o m p a n i e s . n e t

Level 4 Services Level 4 Medically-Managed Intensive Inpatient w w w. c h a n g e c o m p a n i e s . n e t

Focus Assessment and Treatment What Does the Client Want? Does client have immediate needs due to imminent risk in any of six dimensions? Conduct multidimensional assessment w w w. c h a n g e c o m p a n i e s . n e t

Focus Assessment and Treatment (cont.) DSM-5 diagnoses? Multidimensional Severity/LOF Profile Which assessment dimensions are most important to determine Tx priorities w w w. c h a n g e c o m p a n i e s . n e t

Focus Assessment and Treatment (cont.) Specific focus/target for each priority dimension What specific services needed for each dimension What “ dose ” or intensity of these services needed w w w. c h a n g e c o m p a n i e s . n e t

Focus Assessment and Treatment (cont.) Where can these services be provided in least intensive, but “ safe ” level of care? What is progress of Tx plan and placement decision; outcomes measurement? w w w. c h a n g e c o m p a n i e s . n e t

DSM-5 diagnoses? Multidimensional Severity/LOF Profile Which assessment dimensions are most important to determine Tx priorities Specific focus/target for each priority dimension What specific services needed for each dimension What “ dose ” or intensity of these services needed Where can these services be provided in least intensive, but “ safe ” level of care? What is progress of Tx plan and placement The ASAM Criteria p 124 decision; outcomes measurement? w w w. c h a n g e c o m p a n i e s . n e t

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David Mee-Lee, M.D. Senior Vice President The Change Companies Carson City, NV www.changecompanies.net www.ASAMCriteria.org www.tipsntopics.com These materials have been prepared under the auspices of the Bureau of Justice Assistance (BJA) Drug Courts Technical Assistance Project at davidmeelee@gmail.com American University, Washington, D.C. This project was supported by Grant No. 2012- DC-BX-K005 awarded to American University by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime. Points of view or opinions in this document are those of the authors and do not represent the official position or policies of the U.S. Department of Justice. w w w. c h a n g e c o m p a n i e s . n e t