New Treatment Resources for Substance

Use Disorder

James MatneyWV Bureau for Behavioral Health & Health Facilities

July 9-10, 2018 July 16-17, 2018

WV CIP Cross Training Conference

Learning Objectives

1

1. Addiction as a disease, not a choice

2. Extent of the opioid epidemic in WV

3. Array of community based treatment and recovery services – what’s new

Disease Addiction is a primary, chronic disease of brain

reward, motivation, memory and related circuitry. It is characterized by one or more of the following (ABCDE):

Inability to consistently abstain

Impairment in behavioral control

Craving

Diminished recognition of problems

Dysfunctional emotional response

Cycle of relapse and remission

This disease is often progressive and fatal

Contain vs. Cure

Two main goals:

Keep alive

Increase quality of life ASAM Public

Policy Statement

What Science Says About Addiction

Brain Pathways

BiologicalDysregulation

Cultural

Environmental

Genetic

Social

Psychological

SUBSTANCE

USE

DISORDER

Addiction is a Multifactorial Disease

What Complicates Recovery?

•Poverty

•Single parent

•Minority

•Gender

•Religion

•Treatment method

• Co-Occurring

• Co-dependency

• Unemployment

• Domestic violence

• Living situation

• Family or lack of

7

Geographic Analysis

8

Accidental Rx Drug Overdose Death Rates Reach New Highs(WV resident deaths occurring in WV)

2001 2015Preliminary

2.0 and under

Accidental Rx Drug Overdose Deaths per 100,000 residents (Crude)

2.1 – 14.4

14.5 – 24.4

24.5 – 34.4

34.5 – 44.4

44.5 and higher

The statewide death rate from accidental overdoses involving prescription drugs rose from 5.7 in 2001 to 22.2 in 2015.

McDowell County had the state’s highest death rate in 2001 at 38.0. Wyoming County had the highest in 2015 at 94.8. Raleigh, Boone and Webster counties’ rates also fall in the 44.5 and higher range.

Source: West Virginia Health Statistics Center, Vital Statistics System

Clinical/Treatment Context

• Move to community-based care system

• SAMHSA – “many paths to recovery”

• Advancements in brain science and mental/SUD health treatments

• Move to integrated health care

• Move to person-centered care and stigma reduction

• ACEs (Adverse Childhood Experiences) strongly related to prevalence of SUDs; move to trauma-informed care and avoiding re-traumatization.

9

Clinical/Treatment Context, cont’d.

• Medication Assisted Treatment (MAT) – combining psychosocial therapy and medication

• Related issues: medication assisted withdrawal therapy, medication assisted treatment, medication assisted recovery

• Relapse prevention and harm reduction – esp. for PWID

• Stop/reduce withdrawal symptoms, including drug cravings (no euphoria)

• Improve health and social function;

• Additional medications, e.g., naloxone (brand name: Narcan)

10

Continuum of Care (Surgeon General’s Report)

Enhancing Health Primary

Prevention Early Intervention Treatment Recovery Support

Promoting optimum physical and mental health and well-being, free from substance misuse, through health communications and access to health care services, income and economic security, and workplace certainty.

Addressing individual and environmental risk factors for substance use through evidence-based programs, policies, and strategies.

Screening and detecting substance use problems at an early stage and providing brief intervention, as needed.

Intervening through medication, counseling, and other supportive services to eliminate symptoms and achieve and maintain sobriety, physical, spiritual, and mental health and maximum functional ability.Levels of care include: Outpatient services; Intensive Outpatient/ Partial Hospitalization Services; Residential/Inpatient Services; and Medically Managed Intensive Inpatient Services.

Removing barriers and providing supports to aid the long-term recovery process. Includes a range of social, educational, legal, and other services that facilitate recovery, wellness, and improved quality of life.

11

SUD Resource Development

BBHHF provides support to the full continuum of behavioral health care, from prevention and early intervention, to treatment and recovery support.

12

HANCOCK

BROOKE

OHIO

MARSHALL

WETZEL

MONONGALIA

TYLER

MARION PRESTON

TAYLOR

HARRISONDODDRIDGE

MINERAL

HAMPSHIRE

JEFFERSON

MORGAN

BERKELEY

HARDYGRANT

TUCKER

LEWIS

BARBOUR

RANDOLPH

PENDLETONBRAXTON UPSHUR

POCAHONTAS

WEBSTER

NICHOLAS

GREENBRIER

FAYETTE

WYOMING

McDOWELL

MERCER

RALEIGH

SUMMERS

MONROE

BOONE

MINGO

LOGAN

LINCOLN

KANAWHA

WAYNE

CABELL

PUTNAM

CLAY

PLEASANTS

WOOD

MASONJACKSON

ROANE

WIRT

RITCHIE

CALHOUNGILMER

Catchment Areas

EastRidge

Healthways

Potomac Highlands

Southern Highlands

FMRS

Seneca

Valley

Northwood

Logan

Mingo

Prestera

WESTBROOK

APPALACHIAN

United

Summit

West Virginia Community Behavioral Health Centers

FY 2016

Provider Resources beyond CBHCs

• WV has 97 Licensed Behavioral Health Centers (LBHC’s) providing outpatient services

• The Growing Role of Federally Qualified Health Centers in WV (FQHCs) • approximately half of WV’s FQHCs across 108 sites employ a

behavioral health provider• the option to employ a behavioral health provider is open to all

FQHCs

• Additional Licensed Behavioral Health individual providers offer assessments, as well as individual, group, family and crisis services to West Virginia Medicaid members across the state:• 9 licensed social work (LICSW) practices• 164 psychiatric practices• 219 psychological practices

14

Statewide Prevention Structure: Opportunities for Partnership

BBHHF funds 6 Prevention Lead Organizations: Represent all 6 regions of WV

Partner and provide leadership for county-level coalitionsCounty Coalitions serving all 55 counties

Provide evidence-based prevention programming, presentations, & materialsProvide prescription take-back initiatives

Stigma reduction and media campaigns

15

Prevention, cont’d.

BBHHF supports WV SADD (Students Against Destructive Decisions): Youth-led initiatives at the local level feed into statewide network geared to engage youth early to promote positive mental health and decision making and to evolve youth leadership – 350 Chapters statewide with nearly 1000 members www.wvsadd.org

BBHHF supports Screening and Early Intervention around the statePromotion of SBIRT and training with more than 3500 trained statewidePartnered with Bureau for Public Health and the Benedum Foundation to support

Drug-Free Moms and Babies (DFMB) initiative to promote early screening, intervention, behavioral health support, treatment and recovery supports, support sites, and expand.

BBHHF meeting quarterly with WV Board of Education and WV Bureau for Public Health on Prevention Efforts

16

Historical Array of SUD Services

• Residential Detoxification Services (“CSUs” and hospital based)

• Outpatient Treatment/Intensive Outpatient Treatment

• Residential Treatment (30-90 days)

• Recovery Residences and Supports

17

Crisis Stabilization/Detox and Residential Treatment programs

18

TREATMENT BEDSTOTAL Crisis Stablization Services: 171 16

TOTAL SA Short-term Treatment BEDS: 67 0

TOTAL SA Long-term Treatment BEDS: 26 10

TOTAL SA LT Treatment BEDS: PPW 32 0

TOTAL SA LT Treatment BEDS: TY 16 0

Total Crisis Stabilization; Short Term TX; Long Term TX

312 26

19

Recovery Beds

20

RECOVERY BEDS Op

en

Un

der

D

evel

op

men

t

TOTAL TX PROVIDER RECOVERY BEDS: 211 0

TOTAL PEER RECOVERY HOME BEDS: 235 16TOTAL PEER RECOVERY FACILITY BEDS: 340 100

TOTAL: WV Subtance Use Recovery Capacity - Recovery Beds 786 116

BARBOUR

BERKELEY

BRAXTON

BROOKE

CABELL

CLAY

FAYETTE

GILMER

GRANT

GREENBRIER

HAMPSHIRE

HANCOCK

HARDY

HARRISON

JACKSON

KANAWHA

LEWIS

LINCOLN

MCDOWELL

MARION

MASON

MERCER

MINERAL

MONONGALIA

MONROE

MORGAN

NICHOLAS

OHIO

PENDLETON

POCAHONTAS

PRESTON

PUTNAM

RALEIGH

RANDOLPH

RITCHIE

ROANE

SUMMERS

TUCKER

TYLER

UPSHUR

WAYNE

WEBSTER

WETZEL

WIRT

WOOD

WYOMING

ANTSPLEAS-

RIDGEDODD-

HOUN

CAL-

MARSHALL

JEFFERSON

TAYLOR

MINGO

LOGAN

BOONE

07-06-18

Provider Recovery Operated

17

46

78

53

Substance AbuseRecovery Residences

Peer Operated Recovery Facility(60 – 100 beds)

9

Peer Operated Recovery Home(8 – 20 beds)

8

100

60

60

80

24

11

8

8

15

12

8

20

20

18

26

7

42

NEW – Under DevelopmentPeer Operated Recovery Facility(60 – 100 beds)

100

New Resources

Medication Assisted Treatment

22

New Resources

23

Peer Recovery Coaches

• Supported by BBHHF state and federal grant funds

• Extensive training required

• What’s NEW:

Additional coaches in specialized areas of Pregnant and postpartum women (Drug Free Moms

and Babies programs)Offenders re-entering community Overdose survivors who have contact with emergency

responders or Emergency Departments

New Resources

Law Enforcement Assisted Diversion Programs

24

New Resources

Quick Response Teams

25

New Resources

Collegiate Recovery

26

New Resources

Expansion of services for pregnant women and their families

• Additional locations for Drug

Free Moms and Babies

• Additional residential treatment

and recovery services

27

New Resources

Ryan Brown Fund – Residential Treatment Services

• House Bill 2428 (2017) mandates that the Secretary of the West Virginia Department of Health and Human Resources (DHHR):

• ensure beds, for purposes of providing substance use disorder (SUD) treatment services in existing or newly constructed facilities, are made available in locations throughout the state

• Administers the newly created Ryan Brown Addiction Prevention and Recovery Fund for the purpose of implementing the provisions of the bill.

28

29

30

Improving Access: Opportunities for Partnership

31

The HELP4WV Call Line launched on September 9, 2016 to provide assistance

to callers seeking assistance with substance abuse or behavioral

health issues.

Since its launch, the hotline has

received

16,690*calls.

Presenter

James Matney, M.S. Clinical Psychology/WV Drug and Alcohol Counselor

Single State Authority/State Opioid Treatment AuthorityJames.A.Matney@wv.gov

Bureau for Behavioral Health and Health Facilities (BBHHF)WV DHHR

350 Capitol Street, Room 350Charleston, WV 25301

32