On the Home Front
Empowerment Evaluation Work Receives Recognition
The work of Melanie Ogleton, Practice Area Lead for Altarum’s Center for Behavioral Health, and BHTAC with Dr. David Fetterman and the Recovery Café in Seattle, was highlighted at conferences for both the American Evaluation Association (AEA) and the American Public Health Association (APHA). The content of the presentations, entitled “Empowerment Evaluation & Recovery Café: Assessing a Peer Support Center for People Traumatized by Homelessness and Addiction,” results from a technical assistance project conducted in Washington State as a part of BHTAC’s Access to Recovery contract with the Substance Abuse and Mental Health Services Administration. In this work, Altarum and Dr. Fetterman assisted the Recovery Café, a support center for people who have been traumatized by homelessness, addiction, and various mental health challenges, in adopting an empowerment evaluation approach to assess program performance and effectiveness.
Thus far, empowerment evaluation has proven valuable in helping the Recovery Café clarify roles and responsibilities, more clearly define organizational structures and lines of communication, and create more effective pre- and post-assessments in order to collect beneficial data from its members. The work was highlighted as a panel presentation at AEA on October 29, 2016, in Atlanta and as a poster session at APHA in Denver on October 31. Ms. Ogleton, Dr. Fetterman, and the Recovery Café are currently working to complete the final stage of the empowerment evaluation.
Much has been written and is available online about empowerment evaluation. Those who are unfamiliar with the concept can learn more about it here.
Stories of Recovery
The following stories of recovery are part of the #WeAreRecovery campaign. Submit your story here to be shared on social media for the #WeAreRecovery project, or here for the #WeAreRecoveryAllies campaign. All stories are unique, and you can inspire others with yours. Your story may be featured in an upcoming issue of BHchat Corner: News You Can Use. If you have questions, email the BHTAC team.
Melanie from Clinton, Maryland writes: I’m a #RecoveryAlly: When I look at this picture. I see joy, I see happiness, and the beauty of life. When I experience a dark moment in my life, this picture reminds me to shine regardless. I have a close family member living with bipolar disorder and another in recovery from a substance use challenge. What I have learned as an ally is that sometimes I can't help. Sometimes I don't have the answers, but that's ok. What I have is the ability to be that bright spot. I have the awesome role of celebrating the joys, acknowledging their fears, and being that voice that reminds them to embrace their shine. I am that reminder that "you've got this, you matter always, I am here, and I love you!"
Kelsi from Rockville, Maryland, writes: I'm a #RecoveryAlly: My recovery from Bipolar 2 Disorder is a reminder of the beauty that results when I honor my true self. Every good day is a reason to celebrate. Every challenging day is a reminder to slow down and find balance. Mental illness steals your ability to experience life's joys. Recovery gifts you with the ability to more clearly see and experience the things that matter most. Being a recovery ally lets me share that gift with others.
No Puff Piece: New Year’s Resolutions
Every year, more than 160 million Americans make New Year’s resolutions. While 75 percent of people make it through the first week, only 46 percent remain true to their pledge 6 months later. In the long run, only 8 percent of people are successful in achieving their New Year’s resolutions. Even if making resolutions does not guarantee long-term success, there appears to be some power in these vows: people who explicitly make resolutions are 10 times more likely to attain their goals than those who do not.
Every year, quitting smoking is among the top 10 New Year’s resolutions, right up there with losing weight and saving money. But quitting smoking is difficult. For those who made such a covenant this month, we offer some considerations that may help better your odds at staying smoke-free for life.
- Be persistent. Recall the famous quote attributed to Mark Twain: “Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of times.” It takes most smokers 6 to 11 quit attempts before they attain their smoke-free goal.
- Be ready for the challenge. It is hard to quit smoking. Cravings can be frequent, but most only last 3 to 5 minutes. Let them run their course, knowing they are signals that your body is healing itself.
- Don't sabotage yourself. Feeling sorry that you cannot smoke undermines efforts to quit. You are choosing not to smoke because you want to be free of this killer addiction. That makes it a gift, not a sacrifice. It is all in your perspective.
- Use your tools. Some people quit by going “cold turkey;” however, research suggests that those who use comprehensive treatment have succeeded at rates 10 times higher than those going it alone. The U.S. Food and Drug Administration has approved seven medications that help manage withdrawal from tobacco, and a free-of-charge trained quit counselor is just a phone call away at 1-800-QUIT-NOW.
- Surround yourself with support. Request help from people who will remind you of your resolution and help you get back on track if you stumble. Success comes with loving encouragement and support, and people surrounded by community have a better chance at success than “lone rangers.”
You may end up not keeping your resolution. It happens. Take heart—you have not failed! You simply have a chance to try again.
Spotlights and Highlights
There’s an App for That! SAMHSA Releases App to Help Treat Opioid Use
The Substance Abuse and Mental Health Services Administration (SAMHSA) recently released MATx, an app to support practitioners who provide or plan to provide medication-assisted treatment (MAT) for opioid use. The free app aggregates vital information for healthcare practitioners, including step-by-step guidance on becoming certified to prescribe buprenorphine, the latest training opportunities, and the most current MAT resources to provide effective, evidence-based treatment.
MATx features include:
- Information on treatment approaches and medications approved by the U.S. Food and Drug Administration for opioid use.
- A buprenorphine prescribing guide, which includes information on the Drug Addiction Treatment Act of 2000 (DATA 2000) waiver process and individual limits.
- Clinical support tools, such as treatment guidelines, ICD-10 coding, and recommendations for working with special populations.
- Access to critical helplines and SAMHSA’s treatment locators.
Behavioral healthcare professionals can download the MATx app here.
Surgeon General Issues Landmark Report on Alcohol, Drugs, and Health
A new Surgeon General’s report finds addiction to be one of America’s most pressing public health concerns. The report, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, marks the first time a U.S. Surgeon General has dedicated a report to substance misuse and related disorders. The dense 428-page report addresses alcohol, illicit drugs, and prescription drug misuse, with chapters dedicated to neurobiology, prevention, treatment, recovery, health systems integration, and recommendations for the future. It provides an in-depth look at the science of substance use challenges and addiction, calls for a cultural shift in the way Americans talk about the issue, and recommends actions we can take to prevent and treat these conditions and promote recovery.
As the nation anticipates a new health policy direction under the Trump administration, behavioral health providers have expressed concern that new policies will have less emphasis on addiction treatment. Meanwhile, the U.S. Surgeon General, Dr. Vivek Murthy, is calling for an ambitious public health approach that is based on evidence, and which includes financing strategies for service delivery.
If you are not inclined to read the full 428-page report, Judy Miller, Editor and Chief of Behavioral Healthcare Executive, suggests that the following is the least you need to know from the surgeon general’s report:
- Addiction is very costly. Substance misuse and substance use challenges are estimated to cost $442 billion each year in healthcare costs, lost productivity, and criminal justice costs. Report authors say it is an economic imperative to address addiction comprehensively.
- The report will help set the tone in America that addiction is a disease and not a moral failing. Everyone in the behavioral health industry has been conveying that message for years and can only hope that it finally sinks in.
- Summarizing data from six large studies, the report indicates 25 million people in the United States are in recovery. Authors also caution that widely held pessimistic views of recovery will continue to affect public opinion, partly because sustained recovery can take several years and several episodes of treatment.
- Marijuana legalization is mentioned. Although it is not a focus, the report recommends easing barriers in research to allow for more study of the potential therapeutic uses of marijuana.
- Authors note that relapse rates for substance use challenges are comparable to other chronic diseases. Substance use relapse rates are 40 percent to 60 percent, while diabetes, hypertension, and asthma rates range from 20 percent to 70 percent, according to the report, which cites an article from 2000 in the Journal of the American Medical Association.
- Medication-assisted treatment (MAT) is highlighted as an evidence-based component of care. Federal efforts in the past year or so have called for greater use of MAT. The report also notes that more research is needed on if, when, and how individuals might be transitioned off MAT.
One of the report’s recommendations is for a diverse group of stakeholders to work to establish recovery outcomes and measures. Creating agreed-upon measures is a huge task, and behavioral health leaders should not shy away from it. Never before has the behavioral health field had such potential to effect change, and we must not let the opportunity slip away.
Latest in Research
New Device Offers Hope, Less-Painful Opioid Detox
A new device designed to help with withdrawal from opiates could become another important tool in helping deal with heroin/opiate addiction. The device, called the Neuro-Stims Systems (NSS) BRIDGE, was pioneered by a company in Indiana called Innovative Health Solutions and offers an alternative to the pain of opioid withdrawal in individuals overcoming the disease of addiction. The BRIDGE is a tool that could help with one of the most challenging aspects of overcoming an opioid addiction—the initial detox, company officials said.
Addiction withdrawal, especially opioid and heroin detox, is painful and typically takes 10 to 14 days for a person to overcome. Many people quit during this challenging detox period, even before long-term treatment (with medications like Naltrexone or Vivitrol) can begin. The BRIDGE can reduce pain by up to 75 percent within 30 minutes, and reduces the detox period from 10 to 14 days to only 2 to 4 days. Studies are showing that the BRIDGE helps 8 out of 10 people successfully progress to long-term treatment in fewer than 4 days.
The BRIDGE is flat, made of plastic, and is about the size of a quarter. It sticks to a person’s head with adhesive. Thin electrodes from the BRIDGE are shallowly implanted in the skin around the ear. Tiny electric pulses travel through the wires down the nerves to parts of the brain that control pain and change the sensation, reducing a person’s perception of discomfort.
After five days, the bridge is taken off and thrown away—the batteries won’t recharge. Then, the person is ready to enter counseling and, if necessary, receive other medication. The BRIDGE is intended to be one part of a system of treatment that includes detox, therapy, and long-term treatment.
Even though the bridge is cleared by the U.S. Food and Drug Administration, research is still being conducted. There is no word on when it might become more widely available.
Vaccine for Opioid Use and Overdose
According to a recently published study, scientists at The Scripps Research Institute have developed a vaccine that blocks the pain-numbing effects of opioid drugs while also appearing to decrease the risk of fatal opioid overdose. This new vaccine approach, as tested on mice, uses the immune system’s ability to recognize invaders, seek them out, and neutralize them. As noted by Kim D. Janda, Professor of Chemistry and a member of the research team, “We saw both a blunting of the drug’s effects and, remarkably, prevention of drug lethality.”
This vaccine approach could have an advantage over current opioid addiction therapies, as it would not alter brain chemistry like many current anti-addiction therapies do. "The vaccine approach stops the drug before it even gets to the brain," says study co-author Cody J. Wenthur, a research associate in the Janda laboratory. "It's like a preemptive strike."
Teens, Smoking, and Drug Addiction
As many as three out of four people with substance use challenges also smoke cigarettes. Accounting for and understanding the linkages between the two addictions can be a critical element in treatment success.
According to a 2-year study conducted by researchers at Case Western Reserve University School of Medicine, teens who stop smoking during residential treatment services benefit from lower cravings for alcohol and drugs than young people who were still smoking at discharge. Higher cravings for alcohol and drugs has been shown to increase the risk of relapse. Smoking prohibition at treatment and service facilities is a key factor in reducing teen smoking during treatment.
As noted by lead author Maria E. Pagano, Ph.D., the study suggests that treatment for drug and alcohol addiction may need to also include smoking cessation activities, which are not typically included in these treatment programs. Dr. Pagano notes, “The concern is that drug and alcohol addiction is a challenging enough battle by itself, let alone trying to quit smoking at the same time. Our results suggest that this outlook may need to be modified."
In addition, the study found that individuals receiving care who have attention deficit hyperactivity disorder did not experience similar smoking cessation success rates. "We found that these teens were less likely to quit smoking," says Pagano. "This could help explain their poorer drug and alcohol treatment outcomes."
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