Information

Definition of Recovery (ASAM)-

A process of sustained action that addresses the biological, psychological, social and spiritual disturbances inherent in addiction. Recovery aims to improve the quality of life by seeking balance and healing in all aspects of health and wellness, while addressing an individual’s consistent pursuit of abstinence, impairment in behavioral control, dealing with cravings, recognizing problems in one’s behaviors and interpersonal relationships, and dealing more effectively with emotional responses. An individual’s recovery actions lead to reversal of negative, self-defeating internal processes and behaviors, allowing healing of relationships with self and others. The concepts of acceptance and surrender are also useful in this process. Since some prescribed and non-prescribed medications can interfere with recovery, it would be prudent to consult with an Addiction Specialist Physician in selected cases.

Definition of Treatment (ASAM)–

Is the use of any planned, intentional intervention in the health,behavior, personal and/or family life of an individual suffering from alcoholism or from another drug addiction, and which is designed to enable the affected individual to achieve and maintain sobriety, physical, spiritual and mental health, and a maximum functional ability.

Addiction Treatment services are professional healthcare services, offered to a person diagnosed with addiction, or to that person’s family, by an addiction professional. Addiction professionals providing addiction treatment services are licensed or certified to practice in their local jurisdiction and may be nationally certified by a professional certification body for their professional discipline.

Definition of Addiction (ASAM)-

Short Definition of Addiction:

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

For the Full Definition of Addiction see:

http://www.asam.org/quality-practice/definition-of-addiction

For a more through Definiton of Terminology Related to Addiction, Treatment and Recovery see:

http://www.asam.org/docs/default-source/public-policy-statements/1-terminology-atr-7-135f81099472bc604ca5b7ff000030b21a.pdf?sfvrsn=0

SBIRT Basics

Screening Brief Interventional and Referral to Treatment (SBIRT) is an evidenced based practice used to identify reduce and prevent risky substance use, The SBIRT model was incited by an Institute of Medicine recommendation that called for community based screening for health risk behaviors, including substance use.

Three Major Components:

Screening-

Assessment by healthcare professional for risky substance use behaviors using standardized tools. Screenings can occur in any healthcare setting.

Brief Intervention-

Engagement by a healthcare professional using an evidenced based algorithm with patients to discuss risky substance use behaviors in a conversation, providing advice and feedback.

Referral to Treatment-

Referral by healthcare professional to indicated level of services in cooperation with the patient.

SBIRT in Schools

Schools are uniquely positioned to provide SBIRT to students. School social workers, nurses, counselors and teachers have an opportunity to shape young minds but can also provide students with a place to educate them about the dangers of substance use, have a discussion about healthy life choices, and connect at risk students with community resources when necessary.

Special Considerations for:

Women

Biological differences between men and women result in different limits for risky use among adults. According to NIAAA guidelines, a woman who drinks 4 or more drinks per one sitting or has more than 8 drinks in the course of one week, is at increased risk for multiple health related issues ranging from osteoporosis, cancer, heart disease, liver disease, kidney disease, depression and substance use disorder. Women’s bodies often have a stronger reaction to alcohol and other drugs, and many women get addicted to substances faster than men and can die sooner than men from drug or alcohol use.

NIAAA guidelines suggest the there is NO safe amount of alcohol that can be ingested during pregnancy. If a woman becomes pregnant, alcohol and drugs could harm her baby too. Multiple studies have shown the impact of alcohol and drugs on babies whose mothers used substances while pregnant with effects ranging from developmental delays or disabilities to increased risk of premature birth.

Men

According to SAMSHA (2014), men are more likely than women to use almost all types of illicit drugs and illicit drug use is more likely to result in emergency department visits or overdose deaths for men than for women. The social culture of masculinity often promotes the use of alcohol as a “right of passage”, while prohibits men from seeking help for substance use treatment for fear of appearing “weak”. These issues create unique challenges for engaging men in treatment.

NIAAA drinking guidelines suggest that a man who drinks 5 or more drinks per one sitting or has more than 15 drinks in the course of one week, is at increased risk for multiple health related issues ranging from osteoporosis, cancer, heart disease, liver disease, kidney disease, depression and substance use disorder.

Adolescents

Most adolescents report having used alcohol or another drug by the time they have reached 12th grade. Alcohol is the most commonly used drug among adolescents and is responsible for more mortality and morbidity in this age group than all other drugs combined. Furthermore, early use of substances is directly correlated with increased risk for developing a substance use disorders in adulthood. Early screening and intervention is critical to combating adolescent substance use.

The CRAFFT is a SAMSHA approved behavioral health screening tool for use with children under the age of 21, recommended by the American Academy of Pediatrics’ Committee on Substance Abuse for use with adolescents. The CRAFFT works equally well for alcohol and drugs, for boys and girls, for younger and older adolescents, and for youth from diverse race/ethnicity backgrounds.

Marijuana Guidance

Rhode Island

Contrary to popular belief, marijuana is not legal in RI. RI law has “decriminalized” marijuana possession for amounts under 28g. The penalty is results in a civil violation for first offense with a fine of $150. Second or multiple offenses result increased fines, and possession of over 28 g is a misdemeanor punishable by up to 1 year in jail and $500 fine.

Nationwide

According to SAMHSA (2016) marijuana is the most commonly used illicit drug in the United States. Its use is widespread among young people. In 2015, more than 11 million young adults ages 18 to 25 used marijuana in the past year. Research suggests that 30 percent of those who use marijuana may develop some degree of marijuana use disorder (Hasin D.S., Saha T.D., Kerridge, B.T., et al, 2015). For more info click here: https://www.drugabuse.gov/publications/drugfacts/marijuana

Opioid Guidance:

The National Institute on Drug Abuse states, the abuse of and addiction to opioids such as heroin, morphine, and prescription pain relievers is a serious global problem that affects the health, social, and economic welfare of all societies. It is estimated that between 26.4 million and 36 million people abuse opioids worldwide, with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin.

Impact on Rhode Island:

Overdose affects communities across Rhode Island: In 2016, 336 Rhode Islanders lost their lives to overdose. From 2011 to 2016, overdose deaths increased by more than 90 percent. (RI, DOH)
Like many other states, Rhode Island’s overdose crisis began with prescription drugs. Since 2009 deaths caused by prescription drugs have leveled; deaths from illicit drugs are on the rise. Overdose deaths caused by a combination of illicit drugs and prescription medication are up nearly a third since 2011. (RI DOH)
Fentanyl, a highly potent opioid, poses a great threat and exacerbates our overdose crisis. The number of overdose deaths related to fentanyl has increased 15-fold since 2009. A significant portion of the 2016 deaths involved fentanyl. (RI DOH)

What is an opioid?

The National Institute of Health describes opioids as follows, Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, buprenorphine (Suboxone), Methadone, and many others. These drugs are chemically related and interact with opioid receptors on nerve cells in the body and brain. (NIH, 2017)

Opioid vs. Opiate:

Opiates are drugs derived from opium. At one time “opioids” referred to synthetic opiates only (drugs created to emulate opium, however different chemically). Now the term Opioid is used for the entire family of opiates including natural, synthetic and semi-synthetic. Medical professionals use the word opioid to refer to most opioids, and opiate for a specific non-synthetic opioid; however, many only use “opioid”. (SAMASHA, 2017)

Medication Assisted Treatment (MAT) Options for Opioid Use:

Medication-assisted treatment (MAT), including opioid treatment programs (OTPs), combines behavioral therapy and medications to treat substance use disorders. (SAMSHA, 2017)

Naloxone-Antagonist

Naltrexone
Vivitrol
Naltrexone implant
Narcan

Methadone- full-agonist
Buprenorphine- partial-agonist
- Suboxone
- Subutex

MAT Strengths and Limitations

Agonist and partial-agonist Rx
- Long half-life = difficult to get off
  - Heroin- 30 mins
  - Buprenorphine – 24-48 hrs
  - Methadone -10 40 hrs.
- Anhedonia
- Relapse potential? Blum et al. 2011,
- Hormone interactions
- Chronic pain benefits
- Retention
Antagonist
- Dysthymia
- Chronic pain/injury
- Cost
- Prescription Adherence
- Bloodwork
- Hepatic contraindications
- No withdrawal
- Abstinence commitment
- No psychological impairment

Rhode Island Overdose Deaths by Drug Type

Note: Rx medications include prescription opioids such as oxycodone, hydrocodone, and benzodiazepines. Illicit drugs include substances such as heroin, illicit fentanyl, and cocaine.

Source, Rhode Island Department of Health