Evidence Based Treatment Approaches December 26 2021 Why

Evidence Based Treatment Approaches

December 26, 2021 Why Evidence Based Practices? • If the goal is to achieve success, use practices that have demonstrated it • Need to have practices that are effective with different populations, problems, etc. • Cost effective • Non-effective approaches lead to relapse 2

December 26, 2021 https: //www. samhsa. gov/nrepp 3

December 26, 2021 4 Need for Options • • • Drug Age Gender Culture Issues (e. g. Trauma) Family Involvement

December 26, 2021 5 NREPP List • • 424 Interventions are submitted for review Criteria/process for inclusion Describes – Population(s) – Settings – Outcomes demonstrated

December 26, 2021 6 Caveats with NREPP • Not all EBP’s are listed • Listed programs go through a specific process • Others don’t go through process, but have research demonstrating effectiveness • New (Promising) Practices still being developed.

December 26, 2021 7 The Basics • • • Motivational Interviewing/MET Cognitive Behavioral Therapy Contingency Management Trauma Programs – (e. g. Seeking Safety) Criminogenic Thinking- (MRT) Medication Assisted Therapy

December 26, 2021 Motivational Approaches q Motivational approaches focus on engaging substance users in considering, initiating and continuing substance abuse treatment while stopping their use of alcohol and other drugs. q “Being where the client is” – what they are motivated by. q Motivational approaches involve combining “motivational interviewing” with a stages-of-change model. q Stages of change include; pre-contemplation regarding change, contemplation, preparation, action, and maintenance 8

December 26, 2021 9 New Windows

December 26, 2021 10 Cognitive Behavioral Therapy (CBT) Approaches • A research review of meta-analyses found that cognitive behavioral approaches consistently appear to be among the most effective treatment therapy for substance abusers (Taxman, 1999). • CBT approaches suggest that unless offenders’ faulty thinking is addressed, there is a reduced likelihood of long-term change. • The three main cognitive models now utilized by criminal justice agencies are Reasoning and Rehabilitation (R&R), Thinking for a Change and Moral Reconation Therapy (MRT®).

December 26, 2021 11 Thinking Errors Hanson! I want to see you in my office first thing tomorrow! YOU’RE FIRED!!

December 26, 2021 Contingency Management ü Uses the community to reward non-using behavior so that the client makes healthy lifestyle changes ü High levels of satisfaction in drug and alcohol free lifestyles are needed to compete with the reinforcement derived from substance use and the substance-using lifestyle ü The CRA approach is analogous to helping a child conclude— through experience, not talking—that it’s more satisfying to be good than to be naughty. 12

December 26, 2021 Rewarding the Behavior 13

December 26, 2021 Should We Use MAT? 14

December 26, 2021 15 Federal Position • Drug courts that receive federal dollars will no longer be allowed to ban the kinds of medication-assisted treatments that doctors and scientists view as the most effective care for opioid addicts, Botticelli announced in a conference call with reporters. (Michael Botticelli ONDCP Director) • "We've made that clear: If they want our federal dollars, they cannot do that. We are trying to make it clear that medicationassisted treatment is an appropriate approach to opioids. ” (Pamela Hyde, SAMHSA’s Administrator) 12/26/2021 15

December 26, 2021 16 BJA Grants Applicants must demonstrate that the drug court for which funds are being sought will not: 1. deny appropriate and eligible client for the drug court access to the program because of their medically necessary use of FDA-approved medication assisted treatment (MAT) medications (methadone, injectable naltrexone, non-injectable naltrexone, disulfiram, acamprosate calcium, buprenorphine) that is in accordance with an appropriately authorized physician's prescription; and 2. mandate that a drug court client no longer use medically necessary MAT as part of the conditions of the drug court if such a mandate is inconsistent with a physician's recommendation or prescription. Under no circumstances may a drug court judge, other judicial official, or correctional supervision officer connected to the identified drug court deny the use of these medications when medically necessary and when available to the clients and under the conditions described above. 12/26/2021 16

December 26, 2021 17

December 26, 2021 18 Treatment • Traditional Recovery Based/NA • Naltrexone - Antagonist/Blocker - Vivitrol • Opiate Maintenance Tx – withdrawal management – Methadone- daily – Buprenorphine/Suboxone/Zubsolv

December 26, 2021 19 Pharmacological Approaches Goals – Provide: – relief from withdrawal symptoms, – prevent drugs from working, – reduce craving, – aversive reactions These actions are helpful in reducing relapse and increasing retention in programs

December 26, 2021 20 Does Treatment Work? • • Medications + psychosocial therapy both benefit brain function and recovery. Each affects different parts of brain and in opposite ways. PET scans adapted and retouched from Goldapple et al. 2004

December 26, 2021 21 Pharmacological Approaches Methadone – Opiate addiction – reduces craving, mediates withdrawal symptoms, helps restore normal functioning Buprenorphine (Suboxone) – similar to methadone, may be prescribed by an MD with special training)

December 26, 2021 22 Pharmacological Approaches Naltrexone (Vivitrol) – stops opiates from working, changes alcohol action for some – reduction in relapse – 30 day dose. Baclofen – FDA Approved for cocaine cravings

December 26, 2021 23 Patient Needs • • Diabetes Some can control with diet Some can control with medication Some are insulin dependent Without adequate treatment - many will die • • Opioid Addicts Some can quit on own Some can remain abstinent with “regular” treatment Some need ORT Without adequate treatment - many will die

December 26, 2021 24 Methadone Effectiveness Gunne & Gronbladh, 1984 Baseline Methadone Regular Outpatient Rx. H H H H H H H H H

December 26, 2021 25 Methadone Effectiveness After 2 Years Methadone No Methadone P P H 1 2 H 3 H H H H P H H H H D D 1 - Sepsis & endocarditis 2 - Leg amputation 3 - Sepsis

December 26, 2021 26 Methadone Effectiveness After 5 Years Methadone No Methadone P P D D D P H H P D H D

December 26, 2021 28 Buprenorphine A tragic appendix: Mortality Heilig, Lancet 2003 Placebo BPN Dead 4/20 (20%) 0/20 (0%)

December 26, 2021 29 Vivitrol • • • Long Acting Injectable Action: Blocks opioid receptor sites Opioids and Alcohol impacted Helps with compliance Reports in craving reduction Non-Addicting

December 26, 2021 30 Vivitrol • Must be opioid free for 7 -10 days prior to injection – past acute withdrawal symptoms

December 26, 2021 31 Is Vivitrol “THE ANSWER”? • Shows a lot of promise – more research is pending • New release population – lower risk of overdose death • People may try to overcome the blocking effect

December 26, 2021 32 Thank you and Discussion