Foundations of Addictions Counseling 3E David Capuzzi Mark

Foundations of Addictions Counseling, 3/E David Capuzzi & Mark D. Stauffer Chapter 20 Inpatient and Outpatient Addiction Treatment Updated by Melinda Haley, Walden University Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Levels of Care n Continuum of Care n ASAM Patient Placement Criteria (PPC) n n n Treatment matching Qualitative assessment Multidimensional Risk Profile Bundling and unbundling of care Assessment dimensions Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Levels of Care n The six ASAM dimensions are: Dimension 1 2 3 4 5 6 Criterion Acute Intoxication and/or Withdrawal Potential Biomedical Conditions and Complications Emotional, Behavioral, or Cognitive Conditions & Complications Readiness to Change Relapse, Continued Use or Continued Problem Potential Recovery Environment Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Levels of Care n The ASAM Levels of CARE: # Level ASAM Levels of Care 1 Level 0. 5 Early Intervention 2 Level I Outpatient Treatment 3 Level II Intensive Outpatient or Partial Hospitalization 4 Level III Residential or Inpatient 5 Level IV Medically Managed Inpatient Care. Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Levels of Care n The ASAM Sub-Levels of CARE: Sublevel Level III. 1 Level III. 3 Level III. 5 Level III. 7 Treatment Modality Clinically Managed Low-Intensity Residential Treatment Clinically Managed Medium-Intensity Residential Treatment Clinically Managed High-Intensity Residential Treatment Medically Monitored Inpatient Treatment Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Types of Inpatient Services n Classifications of detoxification n n Ambulatory Detoxification with Extended On Site Monitoring Inpatient Treatment Setting Clinically Managed Residential Detoxification Medically Monitored Inpatient Detoxification Medically Managed Inpatient Detoxification Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Clinician Determination n Screening, Brief Intervention, and Referral to Treatment (SBIRT) n n n Substance Abuse Subtle Screening Inventory (SASSI) Michigan Alcohol Screening Test (MAST) Drug Abuse Screening Test (DAST) Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Clinician Determination Screening, Brief Intervention, and Referral to Treatment (SBIRT) Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Readiness for Change Motivational Interviewing Stages Stage Description 1 Pre-Contemplation No intended change behavior 2 Contemplation Awareness of problem with no commitment to change 3 Preparation 4 Action 5 Maintenance Intent to change Steps taken to modify behavior Continuing commitment to and action toward change Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Motivational Interviewing n Motivational Interviewing (MI) n Is a directive, person centered approach that has been shown to be effective in enhancing intrinsic motivation to change. n Helps assess ambivalence. n Used in conjunction with the Stages of Change model. Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Challenges Facing Rehabilitation Centers n n Most operate predominately in the specialty sector. Funding problems Public perception Staffing Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Client Inpatient Experiences n n n Most inpatient programs are 28 days in length. May have a waiting list as long as six months. Programs are generic in nature. Most are not fully staffed 24 -hours per day or seven days per week. Program is very structured. Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Outpatient Treatment n Drug and Alcohol Legislation Affecting Treatment n n n Temperance Movement War on Drugs Anti-Drug Abuse Act of 1986 Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Incarceration Rates Race/Gender African American males Ratio 4, 618 per 100, 000 Hispanic males Caucasian males African American females 1, 747 per 100, 000 773 per 100, 000 348 per 100, 000 Hispanic females Caucasian females Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer 146 per 100, 000 95 per 100, 000 Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Rehabilitation versus Incarceration n The United States has one of the highest, if not the highest incarceration rate in the world. Incarcerations for substance abuse issues has increased within the last ten years. Of those incarcerated for substance related issues, only about 11% have received any type of treatment. Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Residential Drug Abuse Program n n The Federal Bureau of Prisons Drug Court n n n Nonresidential drug abuse treatment Residential Drug Abuse Program (RDAP) Residential Reentry Centers and in Home Confinement n Community Treatment Services Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Residential Drug Abuse Program n Drug Court n n Deferred prosecution Post prosecution n 6 -12 months in length Repeated drug testing Cost ranges from $9, 500 -$12, 000, plus the cost of therapy. Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Residential Drug Abuse Program n Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). n This law now requires health insurance providers to cover both mental and physical health equally. Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

SAMHSA Relapse Rates Drug of Choice Alcohol Heroin Crack Cocaine PCP, inhalants, hallucinogens Relapse Rate 86% within 5 years 87% after 1 year 55% after 1 year 43% after 5 years Methamphetamine Depressants 54% after 5 years 51% after 5 years Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Useful Web Sites n American Society for Addiction Medicine (ASAM) Criteria n n http: //www. asam. org/publications/the-asam-criteria Drug and Alcohol Dependence Journal n http: //www. drugandalcoholdependence. com/home Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved