HXR 2016: Designing for Addiction and Recovery -Mary Beth Schoening, Behavioral Health Innovators, Inc.
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This panel is comprised of parents who’ve lost their children to addiction, a parent whose son is in recovery, and individuals themselves in long-term recovery. We will hear directly from them about their struggles, the impact on individuals and families dealing with addiction, as well as their opinions on where the system could benefit from solutions. The addiction issue is complex and would benefit from solutions in many areas. We invite you to join us to hear first hand.
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HXR 2016: Designing for Addiction and Recovery -Mary Beth Schoening, Behavioral Health Innovators, Inc.
- 1. Designing for Addiction Prevention and Recovery Presentation by Mary Beth Schoening, Co-founder, Behavioral Health Innovators Lauren Stahl, Founder, SPARKITE • Stephanie Briody • John Cabral • Louise Griffin • Cory Gys • Lauren Stahl “Lived Experience” Panel
- 2. Behavioral Health Innovators “Combining the power of human compassion with technology, advanced research and best practices from industry to create innovative solutions to some of the biggest problems in behavioral health – starting with Substance Use Disorder/Addiction”
- 3. Addiction & Co-Occuring Disorders: Cause or Effect? 75% Co-occuring 7%= TX for both Addiction Mental Health ?
- 4. MIDDLE/ HIGH SCHOOL INTERVENTION EARLY WARNING CRIMINAL JUSTICE/ POLICE • Alcohol violation • Course drops – there is no tracking here, no interventional assessment • Grades going down – look at trends • Attendance rates • Dorm RA, friends recognize issues • Health services screening • All opptys for intervention • FERPA allows parental involvement in discipline cases COLLEGE ER/HOSPITALS SCHOOL NURSES • Flooded w/ anxiety, SUD, eating disorders, LGBT • No standards screening, intervention, referral • Desperate for help • Social worker needs to be involved w/ this • Many friends know when someone “has an issue” • Don’t feel empowered to do anything about it • If they do, they try to reason with addict directly • After an intervention some can show lots of support and will admit to knowing about the problem • Some friends are part of the addicts enablement environment = companions in abuse • Many times girls intervene on behalf of their boyfriends • People in recovery maybe able to direct message friends they are concerned about – need helpntact me at any time – I’m doing very well now. I FRIENDS << INTERVENTION • Disciplinary cases • Attendance record • Teachers, coaches observations • Nurse, social worker, psychologist • Administrators • Intervention opptys • Need curriculum • Need tools for parents PARENTS/FAMILY • Drug Overdose • Injury/Accident • Alcohol poisoning • Sexual assault • Need programs here • Need chronic disease care model • Assessment, transfer to treatment • Oppty for Intervention – Angels, Treatment interventionists • Crime • Addiction is an illness; criminal reform/treatment is needed • Injury/Accident • Overdose • Blackout • Protective custody process broken, 24 hour warrants issued in a.m. but beds don’t open till p.m. • Judges order to treatment but insurance doesn’t cover • Addicts can sweet talk judges in sober moments • Diversion, Amnesty Programs, Drug Courts • Recognize first sometimes • Suffer in silence for months/years • They might be more willing to acknowledge issue than the addicted • Don’t know where to turn or how to get addict help • Reluctant to “pull the trigger” • Will act during narrow window of crises • Need 24x7 support • Need intervention guidance • Navigation of system & insurance PRIMARY CARE/PEDS/B EHAVIORAL HEALTH SPECIALISTS • Anxiety, Depression,SUD not picked up • Lack of integration w/ PCP and BH • PCP not screening or trained in treatment • Industry push to integrate but lots of help needed • SUD and MH is component of many other diseases • Intervention oppty Mapping the Addiction Chain From Early Warning Through Sustained Recovery to Discover Gaps DETOX FACILITY • Short term solution 3-5 days • Revolving door • Must transition to long term care w/ transport • Relapse & OD high risk here HOMELESS SHELTERS IN PATIENT TREATMENT CENTERS • 15 day discharge common due to insurance limits- not enough • 14-21 days after detox is when individual has acceptance vs. denial • Sleep, brain function start but need more time to work on recovery • Re-evaluate every 15 days • Have addict sign promisory notes while “impaired” • Need tight continuum and insurance coverage EMPLOYERS • Employer assistance programs • Company insurer aware of issues, case mgmt oppty • Privacy ensured – employer doesn’t know • Companies can provide EAP support & education IOP/STEP DOWN • Intensive outpatient program • Sometimes combined with sober living • Lack of insurance an issue • 6 weeks ideal, but rarely get enough time SOBER HOUSING • Ideally 5 months + • Medication management • Life skills support • Peer support • Matchmaking is needed • Reportedly depressing places SUSTAINED RECOVERY, WELLNESS PROGRAMS • Ongoing 12 Step or SMART programs, Yoga • Need more sustained recovery modalities • Mix of in-person and virtual TREATMENT>> © Copyright 2016, Please Use w/ Attribution Mary Beth Schoening Stephanie Briody THERAPISTS • Many people in recovery don’t go into residential treatment programs and use traditional therapy • Mental health and substance use treatment are separated in many cases • Integrated treametne needed • Insurance reimbursement lacking INSURANCE COMPANIES • Provide intervention services based on health algorithms • Confidential, employer not informed • Working on prevention strategies and programs for future=ACO model PHARMACY • Need to address overprescribing • 70% opioid start w/ prescription • 90% OD get another script • MD doesn’t know about OD • Clinical, parental, & onsumer education needed • Prescription take back • Dentists included TREATMENT APPROACHES • Medicated assissted treatmentvs. abstinence • MAT outcomes better • Many feel suboxone, bupenorphene subs one drug for another • AA vs. SMART • Faith based recovery strong for some • Anonymity of AA questioned • Need more to speak up to remove stigma Behavioral Health Innovators, Inc. www.bhinnov.com marybeth@bhinnov.com @mbschoening Thank you to the individuals in recovery and their families for contributing to this document 1/3
- 5. 2/3
- 6. 46.6%
- 7. “THE WAR WITHIN” DEATHS PER YR. Vietnam = 47k WWI = 53k Vs. Drugs = 46k Alcohol = 47k WE’RE LOSING THE WAR…AND EACH OTHER
- 8. -Problem Drinkers, Users -Early Intervention Addiction Stage 4 = Revolving Door • Younger in age • Better prognosis • Easier to recover • Have lost jobs, families, homes • Further into addiction • Criminal activity • Harder to treat • Lower recovery rates End stage 2.5M Early Intervention w/ problem drinkers 60 M
- 15. MIDDLE/ HIGH SCHOOL INTERVENTION EARLY WARNING CRIMINAL JUSTICE/ POLICE • Alcohol violation • Course drops – there is no tracking here, no interventional assessment • Grades going down – look at trends • Attendance rates • Dorm RA, friends recognize issues • Health services screening • All opptys for intervention • FERPA allows parental involvement in discipline cases COLLEGE ER/HOSPITALS SCHOOL NURSES • Flooded w/ anxiety, SUD, eating disorders, LGBT • No standards screening, intervention, referral • Desperate for help • Social worker needs to be involved w/ this • Many friends know when someone “has an issue” • Don’t feel empowered to do anything about it • If they do, they try to reason with addict directly • After an intervention some can show lots of support and will admit to knowing about the problem • Some friends are part of the addicts enablement environment = companions in abuse • Many times girls intervene on behalf of their boyfriends • People in recovery maybe able to direct message friends they are concerned about – need helpntact me at any time – I’m doing very well now. I FRIENDS << INTERVENTION • Disciplinary cases • Attendance record • Teachers, coaches observations • Nurse, social worker, psychologist • Administrators • Intervention opptys • Need curriculum • Need tools for parents PARENTS/FAMILY • Drug Overdose • Injury/Accident • Alcohol poisoning • Sexual assault • Need programs here • Need chronic disease care model • Assessment, transfer to treatment • Oppty for Intervention – Angels, Treatment interventionists • Crime • Addiction is an illness; criminal reform/ treatment is needed • Injury/Accident • Overdose • Blackout • Protective custody process broken, 24 hour warrants issued in a.m. but beds don’t open till p.m. • Judges order to treatment but insurance doesn’t cover • Addicts can sweet talk judges in sober moments • Diversion, Amnesty Programs, Drug Courts • Recognize first sometimes • Suffer in silence for months/years • They might be more willing to acknowledge issue than the addicted • Don’t know where to turn or how to get addict help • Reluctant to “pull the trigger” • Will act during narrow window of crises • Need 24x7 support • Need intervention guidance • Navigation of system & insurance PRIMARY CARE/PEDS/ BEHAVIORAL HEALTH SPECIALISTS • Anxiety, Depression,SUD not picked up • Lack of integration w/ PCP and BH • PCP not screening or trained in treatment • Industry push to integrate but lots of help needed • SUD and MH is component of many other diseases • Intervention oppty Mapping the Addic on Chain From Early Warning Through Sustained Recovery to Discover Gaps DETOX FACILITY • Short term solution 3-5 days • Revolving door • Must transition to long term care w/ transport • Relapse & OD high risk here HOMELESS SHELTERS IN PATIENT TREATMENT CENTERS • 15 day discharge common due to insurance limits- not enough • 14-21 days after detox is when individual has acceptance vs. denial • Sleep, brain function start but need more time to work on recovery • Re-evaluate every 15 days • Have addict sign promisory notes while “impaired” • Need tight continuum and insurance coverage EMPLOYERS • Employer assistance programs • Company insurer aware of issues, case mgmt oppty • Privacy ensured – employer doesn’t know • Companies can provide EAP support & education IOP/STEP DOWN • Intensive outpatient program • Sometimes combined with sober living • Lack of insurance an issue • 6 weeks ideal, but rarely get enough time SOBER HOUSING • Ideally 5 months + • Medication management • Life skills support • Peer support • Matchmaking is needed • Reportedly depressing places SUSTAINED RECOVERY, WELLNESS PROGRAMS • Ongoing 12 Step or SMART programs, Yoga • Need more sustained recovery modalities • Mix of in-person and virtual TREATMENT>> © Copyright 2016, Please Use w/ Attribution Mary Beth Schoening Stephanie Briody THERAPISTS • Many people in recovery don’t go into residential treatment programs and use traditional therapy • Mental health and substance use treatment are separated in many cases • Integrated treametne needed • Insurance reimbursement lacking INSURANCE COMPANIES • Provide intervention services based on health algorithms • Confidential, employer not informed • Working on prevention strategies and programs for future=ACO model PHARMACY • Need to address overprescribing • 70% opioid start w/ prescription • 90% OD get another script • MD doesn’t know about OD • Clinical, parental, & onsumer education needed • Prescription take back • Dentists included TREATMENT APPROACHES • Medicated assissted treatment vs. abs nence • MAT outcomes be er • Many feel suboxone, bupenorphene subs one drug for another • AA vs. SMART • Faith based recovery strong for some • Anonymity of AA ques oned • Need more to speak up to remove s gma Behavioral Health Innovators, Inc. www.bhinnov.com marybeth@bhinnov.com @mbschoening Thank you to the individuals in recovery and their families for contributing to this document
- 16. RAMP RAMP Risk Addiction Mapping Progression Peer Model – Solution Co-development & Delivery of Messages w/ Their Voice • Typical Everyday Behaviors – Can Relate To • Their Language • Understanding of Progression • Where They Are on Ramp • How to Get Off
- 17. THE RAMP™
- 24. My mind was always going crazy, I could never think straight
- 26. Personas: Different Approaches Work for Different Personas Family Unit Personas • Family is aware and addict is resistant • Family and addict are both in denial • Family and addict are both open to help • Addict is open to help and family is in denial
- 27. Industry Snapshot: How Technology Can Help • Most Go Undetected – as Many as 9/10 • Behavioral Health and Primary Care Chasm and SUD TX • Severe Shortage of Clinicians and Beds • Broken Care Continuum, Patient Centered Planning • Lack of Standard Treatment Protocols • Stigma –We’re Working On It, But Still There • Lack of Understanding of Addiction as a Disease • No Black and White Diagnosis – Life Disruption • Denial is So Strong
- 28. Please come talk to us! Lived experience, developers, researchers, film/content, clinicians, donors MaryBeth@bhinnov.com @mbschoening Stephanie@bhinnov.com @sjbriody Next up: Lauren Stahl
- 29. • Stephanie Briody • John Cabral • Louise Griffin • Cory Gys • Lauren Stahl Lived Experience Panel
- 30. John and his son Eric
- 31. Louise and her son Zack
- 32. Cory and his cousin Zack, Louise’s son
Editor's Notes
- We know there is a significant population of people with substance use disorder that have co-occuring mental health issues. Many people develop anxiety and depression and other issues as a result of their addiction and some start out with mental health issues and are at higher risk for developing substance use disorder
- We are focusing on student population because 1/3 of mental health disorders present by age 13. The average age of the onset of both anxiety and impulsivity is age 11
- And 2/3 by age 24
- 46.6 % of the population will experience a mental health issue at one time in their lives
- To give you an order of magnitude
- Focus much energy, money on end stage when it is harder to fix. Its like only funding treating people with cancer at stage 4. only 2 cents for every dollar is spent on prevention. 57k ER visits drug OD in MA last year. We are going to bankrupt our states by keeping the top of the funnel wide open. “There are 60 million people who drink or use substances in a harmful manner. Yet we’ve chosen instead to focus on the 2.5 million who are at the extreme end of the spectrum. I want to show businesses and local governments that they can actually save money by addressing all 60 million people through prevention and early intervention. If we can do that successfully, the forces of the marketplace will take over. All we lack is good ideas and preliminary data to show that it works.” McLellan . Thomas McLellan (former Obama Drug Czar) compares America’s too-little, too-late approach to the treatment of addiction—the “hitting bottom” scenario—to allowing a diabetic to lose a foot before addressing their diet. “You can’t treat chronic pain, sleep disorders, breast cancer, prostate cancer, diabetes, or asthma effectively or efficiently without simultaneous concurrent efforts to control substance use disorders. And it’s not necessarily addiction; it’s just people who drink too much, drink too often.” McLellan
- We were in washington recently at the unite to face addiction rally and it really brings it home to see these parents looking for their kids that they’ve lost to overdoses
- Look at this beautiful girl. Shortage of beds and lack of access due to insurance is huge issue
- But if there is momentum DR Vivek Murthy who is a Boston guy from the Brigham is now the Surgeon General in Washington and here he is announcing that he will release the first ever SG report of substance use disorder and addiction later this year. This is likened to the SG report on aids and smoking which completely transformed those industries. But it needs transformation
- A lot of attention is being paid to opioids because you can go from 0-100 so fast and the risk of OD is high but in terms of prevalence you can see here alcohol is the biggie. This is old but will give you an idea.
- So when we first stared we worked with people in recovery from alcohol and heroin addictions to understand their stories and journeys from early warning through to sustained recovery to see where the gaps were – where people were leaking from our system. http://www.sustainablebedford.org/wp-content/uploads/2014/04/014222972-rusty-pipeline.jpg
- We transformed dozen plus pages of notes to create this addiction chain. Every single entry on this page hs, colleg, parent. Crmimanl justice, er – there is room for innovation
- show everyday risky behaviors that young people can relate to, in their language provide a language for talking about these risky behaviors show an individual where they are on the RAMP educate them about what the addiction feels like and what the negative impact of the addiction can have on their life – in very hard hitting ways. Show them the EXIT RAMP, or ways to reduce and eliminate risky behaviors
- boasting on social media Lying to cover up Treating friends poorly Sleeping off weekends
- John and Eric Cabral
- Louise and her son Zack