Resilient health march 2018 by Resilient Health

A NATIONAL BEHAVIORAL HEALTHCARE SYSTEM PATIENTS TREATED:

TREATMENT SERVICES FOR:

• Adolescents (12-17 years) • Adults

• Primary Mental Health • Substance Use • Dual Diagnosis • Pain • Cognitive Deficits • Trauma and Emotional Dysregulation • Adolescent and Adult Eating Disorders (Females Only) • Adolescent Transgender and Gender Identity

LEVELS OF CARE: • Detox • Residential Treatment • Partial Hospitalization Program • Intensive Outpatient Program • Outpatient Program • Continuing Care

LOCATIONS:

San Clemente, California

Los Angeles, California

Palm Desert, California

Rancho San Diego El Cajon, California

Fort Myers, Florida

White River Academy Delta, Utah

www.sovhealth.com

(888) 701-7488

24/7 Helpline | Most Private Insurances Accepted

CORPORATE OFFICE: 1211 Puerta Del Sol San Clemente, CA 92673

Issue

In this

March 2018

RESILIENT Health

MESSAGE FROM THE EDITOR Welcome to the March Issue.................................................. 4

FEATURE ARTICLES The War on Behavioral Health Care: Stigma Kills.............. 5

RESILIENT HEALTH is published monthly and copyrighted by Sovereign Health, Inc., all rights reserved. Permission must be granted by the publisher for any use or reproduction of the magazine or any part thereof. Opinions expressed are those of the authors alone and do not necessarily represent the opinions, policies or positions of RESILIENT HEALTH or Sovereign Health, Inc. ©2018, Sovereign Health, Inc. Printed in the U.S.A.

Finding the Best Addiction/Behavioral Health Treatment Rehabilitation Facility............................................................. 9 Fast Facts: 10 Drug Addiction Facts .................................... 11 Measurement-Based Care: Does Behavioral Health Care Measure Up?..................................................13 THE QUIZ CORNER: Nothing’s Wrong… So Why Do I Feel So Depressed?....................................15

Editor-in-Chief TONMOY SHARMA, MBBS, MSc

New Joint Commission Behavioral Health Care Standards .................................................................... 17

Communications Manager LISE MILLAY STEVENS, M.A.

Professional Perspectives: Five Ways Health Care Providers Can Help Patients Recover............................ 20

Managing Editor EDWARD ZINTEL e.zintel@sovhealth.com

Baby Boomers Are Prime Targets for Opioid Addiction..................................................................23 AT A GLANCE: Behavioral Health Care in 2018....................26

Senior Staff Writer DANA CONNOLLY, Ph.D. Graphic Designer SEBASTIAN TIRKEY Content Specialist AMIT MALAVIYA

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RESILIENT HEALTH A Behavioral Health Resource from Sovereign Health Publications, Inc. 1211 Puerta Del Sol, Suite 200 San Clemente, CA 92673 Editorial Tel: (949) 276-5553, ext. 391 Email: editor@reshealth.net Website: www.reshealth.net

MESSAGE from the Editor

reetings and welcome to the March issue of RESILIENT HEALTH. We’d like to thank all the readers who responded so enthusiastically to the inaugural February issue. We’re heartened to know that this resource is relevant and useful for so many readers. This month’s offering is packed with informative and, we hope, enlightening content that will expand your knowledge and help guide your treatment decisions. This month’s At a Glance provides breaking news in behavioral health care, including an article on what the elimination of the Obamacare individual mandate means for addiction treatment (not good). The Fast Facts this month focus on 10 drug-use factoids—do you know what percent of crimes are associated with drug use, and what this scourge costs the country annually (hint: it’s in the billions)? Read on to find out. To round out our shorter pieces, the Quiz Corner features 10 quick questions to ask patients when you suspect depression is in the mix. Our full-length articles this month are both thought-provoking and informative. The article on finding the best behavioral health rehab center provides a thorough “how to” in selecting the best care for patients who may need outpatient or inpatient residential care. It includes what services should be offered and where to find unbiased directories of high-quality licensed facilities, among other tips. We’ve also provided an overview explaining the new 2018 Joint Commission (JC) guidelines and the outcomes measurement standards required for all behavioral health treatment centers that seek to obtain or maintain their JC accreditation. We applaud the JC; our assessment is that implementing these new guidelines will help standardize and improve treatment across the industry and – most importantly – greatly improve the care of the patients we strive to heal. We’ve also provided an accompanying article on the value of measurement-based care that nicely complements the JC update. Our Professional Perspectives offering this time around provides five dynamic tips for providers that help patients to recover. You might find some surprises, such as the importance of humor in clinical practice – yes, really! And our piece about the war on behavioral health care is a heartfelt account of the role stigma played in the demise and tragic death of one of HBO’s brightest True Blood stars, the talented Nelsan Ellis. Let us close this month with the Joint Commission’s mission statement: “To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.”

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We hope this issue of RESILIENT HEALTH brings the behavioral health care community and the people it serves closer to this goal.

The War on Behavioral Health Care:

Stigma Kills By Dana Connolly, Ph.D.

nother beloved actor dies too soon, another casualty of alcohol addiction and the stigma surrounding seeking treatment. Nelsan Ellis, star of HBO’s True Blood, was only 39 years old last July when he attempted to quit drinking on his own. Abruptly quitting alcohol and certain drugs, such as tranquilizers Valium and Xanax, can cause fatal reactions in chemically-dependent persons. Such reactions include seizures, fever, delirium, cardiac arrhythmias and heart failure. Medical care, including therapy with certain medications, can reduce withdrawal symptoms and prevent tragedy. Despite their pain, Ellis’ family decided to share the circumstances of Ellis’ death with

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The Hollywood Reporter via his manager, Emily Gerson Saines. In her statement, Saines said, “According to his father, during his withdrawal from alcohol he had a blood infection, his kidneys shut down, his liver was swollen, his blood pressure plummeted, and his dear sweet heart raced out of control. Nelsan was ashamed of his addiction and thus was reluctant to talk about it during his life. His family, however, believes that in death he would want his life to serve as a cautionary tale in an attempt to help others.” Brave celebrities such as Brad Pitt and the late Carrie Fisher have spoken out about their struggles with addiction in an effort to help others. Countless public awareness campaigns, such as Mental Health Awareness Week

Nelsan Ellis

and D.A.R.E, have launched in cities all over America. Health care institution the National Institute on Drug Abuse, long ago confirmed that addiction is a chronic, relapsing brain disease

RESILIENT HEALTH | March 2018 5

that often goes hand-in-hand with a mental illness. A disease that, similar to diabetes or asthma, needs to be diagnosed, treated and monitored throughout a person’s lifetime. Despite these efforts, people with mental illnesses and addiction in our country are still stigmatized by society and avoid treatment at all costs, compromising their own lives and those of others around them. At a time when Americans are dying in record numbers from suicide, drug overdose and alcohol-related illnesses and accidents, stigma not only marginalizes valuable, competent people from society— it prevents them from seeking lifesaving treatment. Stigma drives behavioral health issues into the closet. Stigma multiplies the body counts. People with behavioral health issues are justifiably concerned that they will face discrimination, social rejection or be the subject of gossip if they seek help. In certain sectors, such as law enforcement, aviation and health care, there is a risk of reputation damage or being deemed unfit to serve in their jobs when mental illnesses or addiction are on their records. Still other individuals avoid seeking treatment out of fear of losing their constitutional right to bear arms.

Is Stigma Still an Issue? There is no doubt–stigmatization of people with mental illnesses, and especially addiction, is a real problem. According to national survey results published in the October 2014 issue of Psychiatric Services (http://bit.ly/2DkNGng), people surveyed about addiction reported being:

Unwilling to have someone with addiction marry into the family Unwilling to employ a person with a history of addiction Willing to accept discriminatory practices against those affected by addiction Skeptical of addiction treatment effectiveness In opposition to policies that are helpful to individuals recovering from addiction Furthermore, the survey revealed that only 69 percent of the respondents felt that health insurance should cover behavioral health care on par with medical and surgical treatments. Lead author Colleen L. Barry, an associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, commented, “While drug addiction and mental illness are both chronic, treatable health conditions, the American public is more likely to think of addiction as a moral failing than a medical condition.”

6 RESILIENT HEALTH | March 2018

Do Media Outlets Perpetuate Stigma? Media professionals bear the enormous responsibility of educating the public and shaping society’s attitudes and perceptions. While people may realize that only six corporations own 90 percent of the media, many consumers may not fully understand how profoundly their own opinions and viewpoints are shaped by what they read and watch each day. Stigma surrounding mental illness, addiction and behavioral health care is a perfect example. Recent headlines do cover the mental health and opioid crisis, and warn people of the dangers of driving under the influence of prescription painkillers and designer drugs. But despite the shift in treating behavioral health problems as illnesses rather than moral failings, mainstream news and other media outlets often seem to place the blame on the person with the illness and rarely turn the spotlight to alcohol manufacturers, pharmaceutical companies and drug trafficking networks. Desperate parents searching the internet for help for their children are met with horror stories rather than factual information about psychiatric care and the heroes who work in addiction medicine. Headlines scream of sober living homes and fraudulent “treatment centers” involved in criminal activity, such as billing insurance for care patients did

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what to look for when seeking care. Congress must pass a health bill that provides ample funding for anyone who needs treatment. And the public must have respect and compassion for people with behavioral health issues before this war becomes a genocide.

not receive, sex trafficking and money laundering. While there are irresponsible treatment centers that must be held accountable for illegal activities, the importance of supporting high-quality treatment centers should also be emphasized. Media coverage ought to be balanced to prevent the spread of unnecessary fear and loathing of the treatment industry. Blackening the reputation of behavioral treatment as a whole perpetuates stigma and results in lost lives. Including positive stories of the lives saved at reputable institutions and things to look for when choosing a treatment center (http://bit.ly/2DkBJhk) can help balance perceptions that tend to be based purely on the negative actions of a few bad actors.

Can Deaths Be Prevented? Despite problems with regulation and insurance coverage, quality care is available for people with mental illnesses and addiction. Reputable centers offer safe and compassionate care, and advances in clinical therapy and measurement-based care are improving patient outcomes. These advances are in sharp www.reshealth.net

contrast to resources available in other countries, where access to treatment is limited or nonexistent. In Mexico, for example, powerful drug cartels run rehabilitation clinics where “patients” are beaten, killed or forced to sell drugs. Many countries treat the addicted like criminals. In Afghanistan, “patients” are kept in shackles so they don’t run away to get relief from withdrawal symptoms. In China, “patients” spend years working in factories and as forced labor. While such punitive measures do not exist in the U.S. prison system, many people simply go untreated. Those fortunate enough to receive quality care can get better and thereby avoid prison, homelessness and even death. If America is truly concerned about the ever-worsening opioid epidemic, there are many actions the media, legislators and the general population can and must take. The press must present a balanced and truthful picture that stops painting people with behavioral health issues as volatile, violent villains. It must also educate the public about the many excellent treatment centers that are out there, and

Stigma, bias and ignorance are not the only problems facing behavioral health care providers and their patients. The costs of providing treatment often exceed the reimbursement received from health insurance companies, creating an unsustainable environment for treatment providers. These and other financial considerations will be explored in the next article in this series, “The War on Behavioral Health Care.” About the Author Dana Connolly, Ph.D. has decades of experience in health care as a clinician, medical researcher and educator. Dr. Connolly is currently a senior staff writer for Sovereign Health, where she translates current research into practical information. Sovereign Health is a health information resource and Dr. Connolly helps to ensure excellence in their model. For more information and other inquiries about this article, contact the author at d.connolly@sovhealth.com.

RESILIENT HEALTH | March 2018 7

PRIME Program

P RO G R A MS O F S OV E R E I G N H EA LTH

Sovereign Health

PRIME Program for Men Sovereign Health offers specialized residential addiction treatment for men 40 to 65 years of age through our Personal Recovery Integrating Men’s Experiences (PRIME) Program. PRIME is a 45 - to 60-day program that includes all levels of care, from detoxification to outpatient treatment. This holistic program focuses on the psychosocial, physical and financial health issues facing mature men in the “prime” of their lives. PRIME helps men establish sober and supportive relationships, manage medical conditions and create new employment opportunities. We attribute much of our success to our recognition that developmental issues vary across the life span. Our treatment program is based on an appreciation that men in their 40s and older face unique challenges. Employing research in the areas of neurobiology and developmental psychology, PRIME is designed to facilitate recovery and healing from arrival to discharge. Patients Served • Men in their 40s, 50s and 60s • Men whose careers, families and relationships have been affected by alcohol or drug use • Men requiring maximum anonymity

Levels of Care • Detoxification • Residential Treatment • Partial Hospitalization • Intensive Outpatient • Recovery Management

For more information, please visit

www.sovhealth.com

Treatment Programs Offered: • Detoxification • Primary Mental Health • Substance Use • Dual Diagnosis • Telehealth

24/7 ADMISSIONS HELPLINE

888.701.7488

Finding the Best Addiction/Behavioral Health Treatment

REHABILITATION FACILITY By Dan Marzullo

aking the choice to get help for drug or alcohol addiction, an eating disorder or any number of behavioral health issues such as depression or anxiety, is a lifechanging event. But where to find that help? A Google search of “addiction treatment” will return a virtual flood of ads about facilities, methods and services that seem like viable choices. But deciding between such a wide range of treatment styles and facilities across the country can be mindboggling. How does one choose treatment that’s effective and safe? Who should you trust?

Separate the Good from the Bad When it comes to addiction treatment, there are scary stories in the media about shady facility operators, crooked billing schemes, unqualified treatment gurus. There are unethical people who aren’t qualified to treat patients, and who are raking in money on the backs of very sick people. But such unethical establishments are the exception and not the rule. Don’t despair – there is a path to finding good treatment. Behavioral health treatment isn’t new, and it’s getting better all the time. New scientific discoveries have provided insight into how www.reshealth.net

the addicted brain works, as well as the mechanisms involved in many mental disorders. As a result, there are many effective treatments – new medications, innovative therapeutic approaches – that can help you or your loved one succeed on the path to recovery.

Tips for Choosing Track Record First and foremost, consider a center’s credibility. Look for details such as how long the center has been in operation. Check for certain accreditations and state licenses that a facility has obtained. (For example, the Joint Commission objectively evaluates health care organizations on their performance, so JC approval is a good sign. Be sure facilities

have the proper state and local licensing.) Understanding industry licenses and certifications can help you steer clear of treatment centers that are involved in illegal activities or unethical practices. Type of Therapy Patient/ Needs Treatment styles and recovery methods are another key consideration; there is more than one path to health and recovery. Be sure there’s a wide range of options for counseling, detoxification, chemical and natural therapy methods to choose from. Prospective patients might like the idea of combining yoga and art therapy with more traditional approaches, such as group therapy and one-on-one counseling. Consider the length of time that the program entails, and if it includes post-treatment

RESILIENT HEALTH | March 2018 9

cause. Be sure the length of stay can be adjusted as needed.

recovery resources that help a patient assimilate back into everyday life. Other considerations include each individual patient’s needs. According to a Narconon International article, a person who’s struggled with substance issues may need extra support with life skills, like managing emotions and finances in a healthy, responsible way. In that case, success might mean attending weekly therapy meetings or becoming gainfully employed. Often family therapy might be needed if the addiction and other problems have caused divisions and damage to familial relationships. The effects of drugs and alcohol may have caused actual damage to the brain and how it functions; in some cases, there are exercises and strategies for dealing with such deficits. Taking care of these types of issues during treatment can help patients heal on many levels and prepare them for their lives after treatment. Length of Stay There are short- and long-term treatment programs. The most common length for a rehabilitation program is 28 days. But sometimes, this is not long enough to reverse the physical and mental damage that a battle with substance addiction can

Consult Various Sources To help you choose a trustworthy and ethical treatment center, talk to a trusted family physician, therapist, clinician or a knowledgeable community member for recommendations. Check established government health agencies, for example, the Substance Abuse and Mental Health Services Administration (SAMHSA). Every year, SAMHSA publishes the National Directory of Drug and Alcohol Abuse Treatment Facilities (http://bit.ly/2I0rEbl), a national directory of treatment centers that includes treatment facilities that are (1) licensed, certified, or otherwise approved for inclusion in the Directory by their state substance abuse agencies, and (2) provided data about their programs on the annual National Survey of Substance Abuse Treatment Services (N-SSATS). All government and private facilities in this directory are approved by state substance abuse agencies, so it’s a great resource for finding credible and trustworthy programs.

Another good resource is to look for Harvard Medical School Affiliate’s McLean Hospital eBasis participation. This resource is unique because McLean gathers information every three months

10 RESILIENT HEALTH | March 2018

from 50 treatment facilities nationwide and creates an unbiased assessment of patients’ treatment outcomes over the last quarter. What is unique about this method is that the information is based on patients’ feedback about their treatment.

Medication-Assisted Therapy (MAT) Although it may seem counterintuitive to prescribe drugs to a substance user, many drugs actually help patients to recover. Asking a potential rehab service what medications they prescribe and why helps patients to understand why there may be a need for prescription medications. When used correctly, MAT can be instrumental in helping patients to succeed.

Patient Motivation and Comfort The next step in finding the right treatment center is researching a program’s methods and practices. As explained by Alexandre Laudet, Ph.D., director of the Center for the Study of Addictions and Recovery, “The person has to feel that continuing to come to this program is going to be to their benefit.” Factors that influence patient comfort include whether friends or family are allowed to visit, and if the family participates in counseling sessions. Other amenities such as meeting patient dietary requirements (e.g., vegetarian, kosher) may matter, in addition to options such as fitness programs or massage therapy. Remember, there is a facility that is right for you or your loved one, so don’t delay. Get treatment, save a life, plan for a better tomorrow. Addiction can, and must be, treated.

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10 DRUG

ADDICTION FACTS 1. 2.

Drug addiction and abuse costs the American taxpayers an average of $484 billion each year. This number includes lost job wages, health care costs, crime, traffic accidents and associated costs of the criminal justice system. Drug addiction and abuse is linked to at least half of all major crimes committed in the United States. Roughly half of those taken into custody for violent offenses such as assault or homicide were under the influence at the time of arrest.

Nearly two-thirds of individuals who wound up in addiction recovery centers report sexual or physical abuse as children. Studies show child abuse to be a major factor in drug addiction later in life.

Nearly a million Americans abuse prescription stimulants every month. Common stimulants include prescription medications such as Adderall, Ritalin and Dexedrine, plus cocaine and other amphetamines and can be quite addictive.

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Drug addiction takes its toll on all Americans. The emotional and financial impact resonates throughout every town, community and state.

Many drugs are addictive due to the chemical changes they trigger in the brain. Brain chemistry affects how people act, feel and experience life overall. By changing

the equation, these substances can cause permanent harm and even psychosis.

Substance users may crush and then snort, inhale or inject their drugs of choice. Any IV drug use increases the risk of HIV exponentially.

Inhalants encompass an array of office and household products. Users will inhale the fumes emitted by these products to obtain a high. Common inhalants include paints, glues, gas and other chemicals. According to the National Institute on Drug Abuse, the largest at-risk group for inhalant use are adolescents ages 12 to 15 years.

Though many people tend to focus their attention on alcohol and illegal drug use, the most addictive drugs are often found in the medicine cabinet. Many people become addicted to medications prescribed by a licensed physician to treat chronic pain, anxiety or sleeplessness. Others steal medications from friends and family members, or purchase them illegally.

10. reputation as a medicinal cure, the drug Though

marijuana

has

garnered

offers its fair share of side-effects, including memory loss, learning issues, clumsiness, altered reality perceptions and increased heart rate. The THC found in marijuana works to inhibit brain function and can result in long-lasting effects even after a user has quit using.

RESILIENT HEALTH | March 2018 11

P RO G R A MS O F S OV E R E I G N H EA LTH

Eating Disorders Patients in Sovereign Health’s Eating Disorders Program receive treatment and live in a nurturing, compassionate and non-judgmental environment that helps them recognize their strengths while working to eliminate the shame and guilt associated with eating disorder behaviors. The Eating Disorders Program offers an extensive variety in group therapies, dietary education and outside activities that promote healing. We aim to increase positive behaviors while minimizing the emphasis on negative behaviors. The results we seek for our patients are better self-esteem, more self-confidence, an ability to set and meet goals, and an interest and desire to live a full and meaningful life.

Treatment Provided For:

The Eating Disorders Program at Sovereign Health helps instill hope and belief that there is a better way to deal with the stresses of life. Our priority is to help patients discover a way to live without the focus on food and body image. Eating disorders are life-threatening. Untreated, eating disorders can lead to malnutrition, organ damage and death. The psychiatric effects and impact on relationships are also severe, causing some people with eating disorders to turn to drugs or alcohol to numb their feelings of shame, depression, anxiety and fear.

• Anorexia Nervosa

Patients Served

Levels of Care

• Women • 18 Years and Older

• Partial Hospitalization • Intensive Outpatient

For more information, please visit

www.sovhealth.com

• Women Only

• Bulimia Nervosa • Binge Eating Disorder

24/7 ADMISSIONS HELPLINE

888.701.7488

Measurement-Based Care:

DOES BEHAVIORAL HEALTH CARE MEASURE UP? By Dana Connolly, Ph.D.

hat if a doctor prescribed medication for a patient with high blood pressure and, when the patient came back in for checkups, the physician neglected to measure the blood pressure again? Most people would question the quality of care that patient was receiving, because the doctor had no way of knowing whether the prescribed treatment was working or whether it needed to be adjusted.

behavioral health care cannot be physically measured. Patients in treatment for drug or alcohol use disorders routinely have their urine tested, with a negative test suggesting treatment success. But urine testing does not predict who is at risk for relapse. Therapeutic drug monitoring is often used to determine whether blood levels of antipsychotic medications are in the therapeutic range but does not provide information about whether the drug is effective or whether it caused side-effects.

recently released Issue Brief, titled, “Fixing Mental Health Care in America: A National Call for Measurement Based Care in Behavioral Health and Primary Care” (http://bit.ly/2oKaExq), experts at The Kennedy Forum stated, “Measurement-based care will help providers determine whether the treatment is working and facilitate treatment adjustments, consultations or referrals for higher intensity services when patients are not improving as expected.”

Using quantifiable measures such as blood pressure to drive clinical decision-making is part of standard medical practice. However, except for drug testing,

Measurement-based care (MBC) uses validated symptom scales completed by patients and reviewed by clinicians during therapeutic encounters. In a

MBC is not considered standard for all treatment centers. Clinical judgment is the current method most often used to detect changes in symptom severity and

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RESILIENT HEALTH | March 2018 13

treatment response, although this method has been shown to be accurate only about 20 percent of the time. MBC has been shown to significantly improve outcomes in behavioral health care patients.

Psychometrics A more accurate way to measure symptoms of mental illness is to ask for feedback from patients. Symptom rating scales can be used to measure abstract concepts, such as thoughts, feelings, pain and psychiatric symptoms. Most such scales consist of multiple questions that measure one or more aspects of a specific concept. An entire field of social science specializes in the development, testing and analysis of such scales, called psychometrics. Psychometrics help to ensure that a scale:

Accurately measures what it is intended to measure Is consistently reliable Applies to the population for which it is being used Is practical to administer Has predictive value, so that risk of adverse outcomes can be highlighted and prevented

Typically, scale development takes many years. First, the social scientist must decide what is to be measured and clearly define it. Second, he or she develops relevant questions and tests the scale in a pilot study. Third, the scientist analyzes pilot data using various statistical analyses that will help him or her to determine validity, reliability and which questions to keep. Fourth, the scientist revises and retests the scale. Even scales with good psychometrics are only effective on the population on which they are tested. Translating a standard scale to another language or format, for example, would require further pilot testing before it could be used.

Methodology Fortunately, there are many established measures of symptom severity for mental disorders, such as depression, anxiety, posttraumatic stress disorder and most other conditions described in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Other important factors also must be measured to evaluate treatment outcomes, such as role functioning, quality of life, readiness for change and the quality of the therapeutic relationship between patients and their providers. Behavioral health patients will likely have several different questionnaires to complete at each visit in the future. The Kennedy Forum and its partners vetted many rating scales to help measure patient outcomes. The Forum’s experts recently published the most psychometrically sound scales that they felt were suitable for widespread adoption. They included symptom ratings, functional status, substance use

14 RESILIENT HEALTH | March 2018

and screening tools for children, adolescents and adults. Several other national organizations are working on how MBC can be implemented as a standard for all behavioral health care providers, including:

The National Quality Forum, which works toward quality improvements in health care The American Psychiatric Association’s Council on Quality Care, which helps set standards of care in psychiatry The Joint Commission, which accredits and certifies health care institutions and programs based on standardized criteria Measuring behavioral health care outcomes makes sense for providers, patients and payers for several reasons. Providers will receive valuable feedback on their treatment plans, affording them continuous opportunity for improvement. Results may also alert providers to changes in their patients’ conditions that may otherwise go undetected. Patients will theoretically receive better care and not have to continue treatment that is not helping them. Payers will be able to hold providers accountable for the effectiveness of treatments that they are mandated to cover. Once MBC is implemented, providers, patients and payers will be able to ensure that treatment outcomes measure up to stated goals. Data can be tracked and compared to benchmark treatment standards. Best practices can then be leveraged and shared to improve behavioral health care nationwide. With the current epidemics of mental illness, addiction and suicide in the United States today, such improvements can’t happen soon enough.

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When patients report feeling depressed but nothing is wrong in their lives, they may be clinically depressed. A chemical imbalance may be causing their depressive symptoms although nothing is actually wrong. So, what should clinicians do when their patients are feeling depressed, but nothing is wrong? First, here are some questions to ask clients to determine if they are clinically depressed:

Q Are you living with feelings of sadness, tearfulness, emptiness or hopelessness? Q Are you more irritable than usual? Q Have you lost interest in things that used to make you happy? Q Are you not sleeping as well as you used to? Q Have your sleep patterns changed? Are you spending more time in bed? Q Have your eating patterns changed? Have you lost or gained weight? Q Are you more anxious than you used to be? Q Do you struggle with feelings of worthlessness? Q Do you have a hard time focusing? Q Do you think about committing suicide? Q Do you have new physical problems, like headaches or backaches?

An answer “yes” to any, or all, of these questions, your client might be struggling with clinical depression. Clinical depression is a disease caused by a chemical imbalance — the same as heart disease, the same as thyroid disease. Clinical depression is perceived by many in society as a personal weakness. Patients may face questions such as, How can you be depressed if nothing is wrong? Fortunately, more and more people are speaking up about living with mental illness. Clinicians can make a difference by assuring patients that depression can occur without an obvious cause and prescribing medications when needed to restore chemical deficits that may be present.

This quiz was found at www.psychcentral.com.

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RESILIENT HEALTH | March 2018 15

SPECIAL SECTION

Treating Substance Use Disorders:

A Resolution to Embrace Measurement-Based Care Why Measuring Treatment Outcomes is a 21st Century Mandate for Treating Addiction

e are well into the second decade of the 21st century. On almost a weekly basis, new discoveries gleaned from advanced neuroimaging techniques, rigorous clinical trial outcomes data, and the development of novel neuropsychiatric medications are opening new pathways in addiction treatment. Individuals with substance use, and those with the comorbidities of addiction and an underlying psychiatric condition, should be reaping the beneﬁts of evidence-based addiction treatment. But sadly, data show that health care professionals are not implementing evidence-based science (Scott & Lewis, 2015) in treating the 21.5 million Americans who have a substance use disorder (SAMSHA, 2016).

Dr. Tonmoy Sharma, MBBS, MSc CEO, Sovereign Health

of symptoms, and empowers patients to participate in their own care while improving their outcomes (Lambert et al.; 2005).

n 2015, the Kennedy Forum released an Issue Brief titled “Fixing Mental Health Care in America: A National Call for Measurement-Based Care in the Delivery of Behavioral Health Services,” which illustrated the domino eﬀect caused by a

espite the deleterious effects of not implementing an MBC model, clinicians have been slow to change. It is worth noting that, in general, it takes 17 years for 14 percent of research to reach consumers (Balas & Boren; 2000). In addition, clinicians have negative perceptions about MBC, including that the burden of training themselves and their staffs is too onerous, negative feelings about prescribed manuals and protocols, and a belief that specific evidence-based practices may not be appropriate for their clients and their practice settings (Scott & Lewis, 2015).

References

e know that quality health care, including substance use and addiction care, should be ﬁrmly rooted in established biomedical research. Measurement-based care (MBC) — the practice of basing clinical care on client data collected throughout treatment (Scott & Lewis, 2015) — is a core component of evidence-based practices (Klerman, Weissman, Rounsaville & Chevron, 1984; Beck & Beck, 2011). Over the past decade, MBC has emerged as an incontrovertible, evidence-based method that can be used for virtually any health issue (Lambert et al., 2003; Trivedi et al., 2007), and research has shown that applying MBC (such as monitoring symptom change using idiographic assessments) is beneﬁcial for improving client outcomes (Weisz et al., 2011). Overall, MBC elucidates treatment progress, allows for adjusting treatment plans as necessary, reduces exacerbation

services. Providers and, indeed, entire health care systems miss opportunities for ongoing improvement. A lack of symptom rating scales precludes individual practices and health care networks from proving the eﬃcacy of their treatment protocols to third-party payers. This lack of empirical data on treatment success leads to chronic federal and state underfunding of behavioral health treatment, and decisions about reimbursement for services rendered are not aligned with treatments that are proven to be the most beneﬁcial (Kennedy Forum, 2015).

non-MBC approach in behavioral treatment. The conclusions are mind-boggling; per the Brief, a mere 18 percent of psychiatrists and 11 percent of psychologists monitor the eﬃcacy of speciﬁc treatment approaches by routinely administering symptom rating scales and therapist assessments to their patients. This lack of assessment cements clinical inertia, and creates barriers to improving clinical

iven the stakes, we cannot accept that these perceived barriers to MBC are insurmountable, unresolvable or even valid. A lack of evidence-based treatment spells failure for clinicians, institutions, health care networks and, most importantly, our patients. Let us resolve to embrace our brave new world of clinical innovations and scientific advances that enable us to provide the best measurement-based care for substance use and addiction treatment.

Balas, E. A., & Boren, S. A. (2000). Managing clinical knowledge for health care improvement. Yearbook of Medical Informatics, 65–70; Beck J.S., Beck A.T. (2011). Cognitive behavior therapy: Basics and beyond. New York: Guilford Press; Kennedy Forum (2015). Fixing Behavioral Health Care in America: A National Call for Measurement-Based Care in the Delivery of Behavioral Health Services; http:// thekennedyforum-dot-org.s3.amazonaws.com/documents/KennedyForum-MeasurementBasedCare_2.pdf; Klerman G.L., Weissman M.M., Rounsaville B.J., Chevron E.S. (1984). Interpersonal psychotherapy of depression. New York: Basic Books; Lambert, M. J., Whipple, J. L., Hawkins, E. J., Vermeersch, D. A., Nielsen, S. L., & Smart, D. W. (2003). Is It time for clinicians to routinely track patient outcome? A meta-analysis. Clinical Psychology: Science and Practice, 10, 288–301; Lambert, M. J., Harmon, C., Slade, K., Whipple, J. L., & Hawkins, E. J. (2005). Providing feedback to psychotherapists on their patients’ progress: Clinical results and practice suggestions. Journal of Clinical Psychology, 61, 165–174; Scott K., Lewis C.C. (2015). Using Measurement-Based Care to Enhance Any Treatment. Cognitive and Behavioral Practice, 22:49-59; Simons, A. D., Rozek, D. C., & Serrano, J. L. (2013). Wanted: Reliable and valid measures for the science of cognitive behavioral therapy dissemination and implementation. Clinical Psychology: Science and Practice, 20, 181–194; Substance Use and Mental Health Services Administration (2016). Mental and Substance Use Disorders. SAMSHA; Rockville, MD. https://www.samhsa. gov/disorders; Trivedi, M. H., Rush, A. J., Gaynes, B. N., Stewart, J. W., Wisniewski, S. R., Warden, D., … Howland, R. (2007). Maximizing the adequacy of medication treatment in controlled trials and clinical practice: STAR*D measurement-based care. Neuropsychopharmacology, 32, 2479–2489; Weisz, J. R., Chorpita, B. F., Frye, A., Ng, M. Y., Lau, N., Bearman, S. K., … Hoagwood, K. E. (2011). Youth Top Problems: Using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy. Journal of Consulting and Clinical Psychology, 79, 369.

The New Joint Commission

GUIDELINES MADE SIMPLE By Resilient Health Staff

ccredited behavioral health care organizations take note: Outcomes measures standards have changed, meaning that to maintain Joint Commission accreditation, all providers must comply with the revised standards to maintain accreditation. This implementation of measurementbased care has the potential to improve mental health care and addiction treatment dramatically.

What Is MeasurementBased Care? Measurement-based care employs psychometric science, in which questionnaires are used to determine the status of some aspect of a patient’s condition that might not easily be quantified. For example, weight and blood pressure are easily quantified, but depression symptoms and suicidal risk are not. Psychometrics science helps questionnaires to be developed, tested, validated and standardized for use in patients with behavioral health issues.. Understanding how patients are feeling and responding to treatment is an important piece of the clinical puzzle. Having this information is a proverbial game-changer for all involved in behavioral health care. Here’s how:

Patients can provide input and play an active role in their care www.reshealth.net

Clinicians have feedback from patients and access to information they might have otherwise missed Treatment teams can revise care plans based on patients’ responses, improving outcomes Insurance companies can determine if treatment is being used to maximize treatment outcomes Use of measurement-based care helps distinguish quality treatment centers from others The latest measurement-based care instruments involve selfadministered, computer-based assessments, which patients can privately complete without any pressure from their care providers. This encourages open, honest answers. Computer-based administration also helps dangerous symptoms to be noted and automatically reported to clinicians, such as suicidal ideation. In addition, outcomes for organizations can be compared to help determine which centers provide the best results. RESILIENT HEALTH | March 2018 17

There are many resources available to those interested in learning about psychometrics and measurement-based care. For a summary, visit http://bit.ly/2mr4KzN. The Kennedy Forum’s Issue Brief, “Fixing Behavioral Health Care in the Delivery of Behavioral Health Services,” is another helpful resource and can be found at http://bit.ly/2mmAupU.

What is the Joint Commission?

Joint Commission to gain accreditation. Certification is like licensure, except it is voluntary and can be applied to treatment centers, specialty programs or individual practices. One example might be a hospital seeking certification from the Joint Commission for its intensive outpatient program or eating disorder program. Again, accreditation and certification are not legally

The Joint Commission is a nonprofit organization that inspects health care organizations to ensure that the standards the Commission sets are being met. The stated mission of the organization is “To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value (http://bit.ly/2qVaHuk).” According to their website, “Accreditation can be earned by many types of health care organizations, including hospitals, doctor’s offices, nursing homes, office-based surgery centers, behavioral health treatment facilities, and providers of home care services.” The Joint Commission also accredits clinical laboratories. Certification is also offered for special programs or services within an organization. The following outlines the difference between accreditation and certification:

Accreditation is granted to an organization by a nongovernmental agency after verifying that pre-determined standards have been met. For example, hospitals volunteer to be inspected by the

Measurementbased care employs psychometric science, in which questionnaires are used to determine the status of some aspect of a patient’s condition that might not easily be quantified.

mandatory, so organizations volunteer for inspection. Once accredited or certified, organizations are inspected at least every three years to ensure ongoing compliance. Some benefits of accreditation include improved safety standards and decreased liability, a competitive edge from demonstrating high quality standards and deeming authority for Medicare

18 RESILIENT HEALTH | March 2018

and Medicaid certification (without undergoing a separate inspection).

What Are the New Standard Revisions? The Joint Commission revisions to Care, Treatment and Services Standard for accredited behavioral health care organizations went into effect January 1, 2018 (http://bit.ly/2AXgFLi). The thrust of the revisions requires the use of outcomes measures, such as standardized symptom rating scales, that patients can use to describe how they feel during a certain point in treatment. Repeating assessments during treatment with scores on admission, for example, can help clinicians know whether patients are improving so that adjustments can be made to improve results. Specifically, the revisions include revised elements of performance that require organizations to:

Use a standardized tool to monitor an individual’s progress Analyze the data generated and use the results to inform the individual’s goals and objectives as needed Use the data to evaluate outcomes of care, treatment, and services provided to their patient population To read the detailed revisions, visit http://bit.ly/2AXgFLi. To learn how to get started implementing measurement-based care, visit http://bit.ly/2qZwgtZ. For information on troubleshooting, visit http://bit.ly/2FwlxKJ.

www.reshealth.net

FAC I L I T I E S O F S OV E R E I G N H EA LTH

Sovereign Health of Rancho San Diego San Diego, California Sovereign Health of Rancho San Diego is designed specifically to treat adolescent and teen patients struggling with substance use, mental health disorders and behavioral problems. Our residential facility is staffed by a compassionate and multidisciplinary treatment team who are trained to work with adolescents through every step of their treatment. Upon admission, our clinicians diagnose any underlying condition which may be present such as anxiety or depression. After a thorough assessment, patients are given a customized treatment plan to achieve the most successful outcomes. The San Diego facility sits on 25 acres of mountainous landscape with green belts and trees surrounding the property. It is the perfect place for adolescent patients to recover in a safe, tranquil and rural location. Accredited by the Joint Commission, our program utilizes evidence-based treatment modalities combined with a holistic focus for a well-balanced recovery. In addition, the San Diego facility holds a Community Care License from the Department of Social Services. Our licensed clinicians and multi-disciplinary medical professionals use several approaches to combat each presenting condition. Patients Served • Males and Females • 12 – 17 Years Old

Levels of Care • Residential Treatment • Partial Hospitalization • Intensive Outpatient • Recovery Management

For more information, please visit

www.sovteens.com www.reshealth.net

Treatment Programs Offered: • Adolescents Only • Primary Mental Health • Substance Use • Dual Diagnosis • Telehealth • Eating Disorders • Gender Diversity & Transgender Identity Service

JOINT COMMISSION ACCREDITED

24/7 ADMISSIONS HELPLINE

888.701.7488

RESILIENT HEALTH | March 2018 19

Professional Perspectives:

FIVE WAYS HEALTH CARE PROVIDERS CAN HELP PATIENTS RECOVER By Dana Connolly, Ph.D.

ina was only 25 years old when she went to rehab for the first time. By then, she had been drinking and taking drugs for 13 years. At first, her alcohol and drug use helped her make friends and feel more confident in social situations. She maintained her grades and stayed out of trouble. By the time she entered rehab, she had failed out of college and was unable to keep a job. Gina had reached the end of her proverbial rope before her life even had a chance to begin. She

had no friends and her mother was the only person in her family who would still speak to her. Throughout her addictions, Gina thought she could stop whenever she wanted but she could not. The last few years before she sought professional treatment were the worst; she wished there was a way to simply die painlessly. She tried Alcoholics Anonymous and Narcotics Anonymous meetings, but could not get through the withdrawal process without relapsing. She realized she was mentally, physically and spiritually dying, so she checked herself into a treatment center that offered medical detox.

The first few days in detox were difficult for Gina, but surprisingly easier than her previous attempts at quitting cold turkey. The staff gave her medications to slowly wean her off the alcohol and drugs, so she didn’t feel like she was dying. They also treated her nausea, diarrhea, body aches, anxiety and insomnia. She started to feel like herself again. Another surprising thing Gina experienced was the nonjudgmental attitude of the staff and treatment team at the center. They were extremely kind, compassionate and funny. She soon found herself laughing aloud, something she hadn’t done in years. Through this core group of professionals, Gina realized that she did belong in the world and she had her whole life ahead of her. She gradually learned how to stay sober, live sober and thrive in the worldwide recovery community. Gina’s story is typical of a young person struggling with addiction, yet it brings up several critical points about the role of health

care professionals in addiction treatment and recovery: 1. Medical treatment makes the withdrawal process safer and more comfortable. For those chemically dependent on alcohol or benzodiazepines, abrupt cessation of use can be life-threatening. Medication and medical supervision offer a safer alternative. Withdrawal symptoms can be so severe that they overpower a person’s true desire to stop drinking or taking drugs. Minimizing withdrawal symptoms can help people withdraw more comfortably, which can make the difference between relapse and successful detoxification. 2. Addiction is a mental, physical and spiritual illness. Each person’s spiritual journey is unique, but to be able to address their spiritual needs, patients must be in good health. Addiction treatment providers are tasked with restoring patients’ mental and physical health, and helping people connect with others who can help them improve their spiritual condition. Emotional lability and setbacks are common in early recovery, so clinicians must be able to anticipate their patients’ needs and guide them through the not-so-smooth pathway to recovery. 3. The mind-body connection is real. Mental and spiritual health requires a brain in good working order. Mindaltering substances do just that – they alter the brain. Thoughts, feelings, sensory processing, decision-making, memory and more all occur in the brain. Therefore, restoring brain health and cognitive function is one of the most important aspects of early recovery. Fortunately, the brain can recover and

www.reshealth.net

form new brain cells and neuropathways when given the essential elements it needs to do so– nutrition, hydration, oxygen, stimulation and sleep. Health care providers can help facilitate brain recovery by ensuring patients have adequate nutrition, hydration, physical exercise, cognitive rehabilitation, sleep and recreation. To be beneficial for the brain, recreation should include exposure to fresh air and sunlight, positive peer interaction, creative expression, relaxation and pleasure. 4. A non-judgmental and compassionate approach is most effective in addiction treatment. At least 70 percent of people who seek

Through this core group of professionals, Gina realized that she did belong in the world and she had her whole life ahead of her. treatment for substance use disorders recall experiencing trauma. Substance use and its consequences may be the reason for admission to a treatment center, but health care professionals should keep in mind that most patients are likely self-medicating because of severe emotional pain from events in their past. Punitive

approaches may modify short-term behavior, but will not help heal underlying emotional wounds. Learning to incorporate trauma-informed care into addiction treatment practices is essential. 5. Use of humor in clinical practice. Patients recovering from addiction have been shown to benefit from humor and a light-hearted viewpoint on life. Not every clinician has the innate ability to make others laugh, but laughter truly can be the best medicine. Providing patients with experiential therapy involving humor, funny games and other opportunities to laugh are a few ways to help them to put their lives into perspective. Laughter causes a release of dopamine, which boosts mood. Laughter also fosters a sense of belonging, something essential for long-term sobriety. For Gina, the professionals at the addiction treatment center made the difference in her not going back to her former life of addiction and instead embarking on a lifetime of recovery. Many patients feel that because they made some mistakes in the past, the rest of their lives will be all doom and gloom – but quite the contrary is true. Health care providers can show their patients that there are gifts of hope, healing, renewal, acceptance and joy in life. Giving them a taste of these gifts in early recovery might just get them hooked for life. Gina is a fictional character used to illustrate a typical addiction experience.

RESILIENT HEALTH | March 2018 21

S E RV I C E S O F S OV E R E I G N H EA LTH

Addiction / Dual Diagnosis Sovereign Health is a leader in the treatment of addiction, mental health disorders and dual diagnosis. Dual diagnosis refers to a mental health condition and substance abuse occurring simultaneously. Sovereign believes that addiction is a chronic brain disease that may include periods of relapse. It is important to note that repeated relapses after periods of sobriety may indicate the presence of an underlying disorder requiring professional treatment.

Treatment Programs Offered:

At Sovereign Health, we specialize in the complex assessment and multidisciplinary care required to successfully treat patients who are struggling with dual diagnosis. Our behavioral health team of masterand doctoral-level therapists are uniquely qualified to treat the mental health conditions that often accompany substance abuse.

• Detoxification

We attribute much of our success to the holistic approach we employ with each individual patient. Multidisciplinary aspects of care are all interrelated and each person has different needs. From arrival to discharge, our treatment team includes each dual diagnosis patient in all decision-making related to his or her own plan of care.

• Telehealth

Patients Served • Adolescents • Adults • Males, Females and Transgender

Levels of Care • Detoxification • Residential Treatment • Partial Hospitalization • Intensive Outpatient • Outpatient • Recovery Management

For more information, please visit

www.sovhealth.com

22 RESILIENT HEALTH | March 2018

• Primary Mental Health • Substance Use • Dual Diagnosis • Eating Disorders • Pain Recovery • CROSS: Christian Recovery Offering Significant Success • POWER: Primary Opportunities for Women Experiencing Recovery • PRIME: Personal Recovery Integrating Men’s Experiences

24/7 ADMISSIONS HELPLINE

www.reshealth.net 888.701.7488

Baby Boomers Are

PRIME TARGETS FOR OPIOID ADDICTION By Dana Connolly, Ph.D.

he Baby Boomer generation, named for the surge in birthrate that followed World War II, arrived on this planet between 1946 and 1964. Boomers have experienced the technological revolution, the end of the gold standard, numerous wars and several drug epidemics. Surviving members are now between 53 and 72 years old and all of them are now at high risk for opioid addiction, including heroin. According to a recent study, baby boomers joined millennials (those born between 1979 and 1992) as a demographic group most afflicted by the opioid crisis. Researchers from the Department of Epidemiology at the Mailman School of Public Health, and the Center for Injury Epidemiology and Prevention at Columbia University in New York examined prescription opioid and heroin overdose mortality in the United States from 1999 to 2014. When reporting their findings in the January 2018 issue of the American Journal of Public Health, the authors called for intervention programs to reduce the excess mortality from opioids in these populations. The unwitting route to heroin addiction is simple, regardless of age: Doctors prescribe prescription painkillers, patients become addicted, heroin is cheaper and easier to get than prescription painkillers, patients turn to heroin www.reshealth.net

rather than go through the agony of opioid withdrawal. Addiction can happen to anyone. All it takes is an accident, injury, illness or surgery requiring prescription painkillers to be “off to the races,” so to speak.

Age Group

Avoiding the Pitfalls of Opioid Use Researchers can call for intervention programs and presidents can declare public health emergencies, but in the meantime, the drug business is booming, and people are dying. So how can clinicians help baby boomers protect themselves? Here are the simple ways patients can avoid addiction when taking opioids for acute (short-term) pain:

Avoid opioids entirely unless pain is absolutely excruciating Try to limit the number of days taking opioids to three or less, and definitely no more than five to avoid the development of tolerance and addiction Painkiller dose and frequency should decrease as pain subsides, not increase

Managing Chronic Pain Another problem chronic pain patients encounter is the mixed messages they receive from the medical community. Some prescribers use opioids as firstline treatment for chronic pain, while others use it as a last resort.

Relative Share of Abusers (%)

Abuse Rate (%)

0-19

0.3%

0.1%

20-24

1.9%

1.0%

25.29

3.3%

1.8%

30-34

6.2%

2.9%

35-39

7.8%

3.8%

40-44

10.2%

4.7%

45-49

13.0%

5.8%

50-54

17.7%

7.1%

55-59

17.6%

7.4%

60-64

13.6%

7.3%

65+

8.4%

8.9%

Note: The abuse rate is defined as the share of prescription holders that abuse. Difference between each age group and youngest has a p-value <.001 except for 50-64 age group, which is statistically the same.

Some prescribers decide to stop refilling prescriptions when patients show signs of tolerance or addiction, even though tolerance and addiction are to be expected when opioids are used to manage chronic pain. Patients whose prescribers discontinue their medication describe feeling villainized and terrified they will be left without any options for their pain or withdrawal symptoms. The Centers for Disease Control and Prevention published guidelines for the use of opioids for chronic pain last year in the wake of the 42,000 overdose

RESILIENT HEALTH | March 2018 23

2.0% Millennials

7.4% Baby Boomers

deaths seen in 2016. Sally Balsalmo, Executive Director of the Alliance for the Treatment of Intractable Pain, believes the guidelines prevent patients from having access to medication they need and is pushing to have the guidelines revised. She said that the guidelines recommend cancer patients have access to opioids, but not non-cancer, chronic pain patients. She added, “When it comes to people with intractable pain who take opioids, they are dependent on those drugs – just as someone who is diabetic depends on insulin.” The trouble is, treating chronic pain with opioids is not like treating diabetes with insulin, due to the nature of opioids themselves. The biggest problem with treating chronic pain with opioids is that these drugs only work for a finite period. Tolerance develops, requiring the user to take progressively higher doses to achieve the same effect. Eventually, the body becomes chemically dependent on the drugs and higher and higher doses are required merely to prevent withdrawal symptoms,

also called dope sickness. At this stage of addiction, pain management is difficult, and overdose is common. In addition to decreased effectiveness, withdrawal symptoms and overdose, long-term opioid use can adversely affect multiple organ systems. Constipation, intestinal obstruction, respiratory, hormonal changes, anxiety, depression, fractures and sleep disorders are a few of the most common. While quality of life may improve initially, it tends to decrease as tolerance progresses. Chemical dependency often leads to depression, anxiety, social isolation, unemployment and suicide. In addition, many prescription painkillers contain acetaminophen, which is hepatotoxic (toxic to the liver). Anyone who is taking opioids for chronic pain, especially those who have progressed to heroin addiction, should carry the opioid overdose antidote naloxone as well as wear a medical bracelet indicating where the antidote is. Family and loved ones should also have the antidote available

24 RESILIENT HEALTH | March 2018

and understand how to use it in an emergency. Because naloxone is short-acting, the antidote can wear off and the opioid user can slip back into overdose. Anyone given naloxone outside of a hospital should be transferred to an emergency room for observation and referral to treatment.

Winning the War Like all drug wars, the sellers of legal and illegal opioids wind up rich and the consumers end up with nothing but pain, suffering and eventual death, unless they can get help and recover. Fortunately, excellent addiction treatment is still available in the United States New evidence-based treatments, such as medication-assisted therapy, combined with intensive cognitive-behavioral therapy and peer support, is helping many people with opioid addiction recover and live healthy and fulfilling lives.

www.reshealth.net

P RO G R A MS O F S OV E R E I G N H EA LTH

POWER Program for Women Sovereign Health is proud to announce specialized residential treatment services for women 40+ years of age through our POWER Program in Palm Desert, CA. Primary Opportunities for Women Experiencing Recovery (POWER) Program creates hope and recovery for mature women who are struggling with addiction or behavioral health disorders as they recover their physical and mental health. POWER includes all levels of care from detoxification to ongoing care management. The entire program was designed to provide the highest quality care possible to women over 40 and their families, from medical experts to specialized therapeutic modalities. This integrative program utilizes evidenced-based care and medical technology to diagnose and treat all underlying and co-occurring disorders to promote lasting recovery. POWER helps women manage health conditions, repair relationships and establish sober and supportive networks. Many women inadvertently develop unhealthy ways of coping with stress that compound over time until they simply can no longer manage life. In the POWER Program at Sovereign Health, we understand how addiction and mental illness develop and how to treat these inter-related conditions. Our multidisciplinary treatment teams work together to determine each woman’s needs and goals and strive to include her loved ones in the process. From arrival to discharge, patients are the most important members of our treatment teams. Patients Served • Women in their 40’s, 50’s, and 60’s • Women whose health, families, occupation or relationships have been affected by substance use or mental illness • Participants must voluntarily enter the program • Must be medically stable and ambulatory • Not actively suicidal, homicidal or psychotic

Conditions Treated: • Detoxification • Residential treatment • Partial hospitalization • Intensive outpatient • Ongoing care management and telehealth

For more information, please visit

www.sovhealth.com

www.reshealth.net

Treatment Programs Offered: • Detoxification • Primary Mental Health • Substance Use • Dual Diagnosis • Telehealth

24/7 ADMISSIONS HELPLINE

888.701.7488

RESILIENT HEALTH | March 2018 25

AT A GLANCE:

BEHAVIORAL HEALTH NEWS By Lise Millay Stevens, M.A. Eliminating the Individual Mandate and Addiction Care

he U.S. Congress passed the GOP-crafted tax bill in December; the legislation contains a provision to repeal a part of Obamacare concerning the individual mandate. The mandate itself will not disappear, but by 2019 the dollar amount and percentage of income penalties will be eliminated, reducing the federal budget deficit by $338 billion between 2018 and 2027, according to a report from the non-partisan Congressional Budget Office. But the savings comes at a cost; the CBO also reports that 4 million people will lose their insurance in 2019 and another 13 million by 2027. In addition, the COB estimates, many insured individuals will see a 10 percent hike in their premiums as a result of the tax bill provision. The fallout for behavioral health treatment could be catastrophic. According to an extensive analysis in the journal Health Affairs, the effect of losing the individual mandate will vary from state to state, but premiums in the individual market will increase overall. In certain states, these increases may be quite steep and force subscribers to drop their insurance; other states may

see insurers leave their markets altogether, Health Affairs predicts. The effect of millions of people losing their insurance will doubtless have a negative impact on behavioral health treatment. The opioid crisis is growing exponentially every year; the prospect of fewer insured does not bode well for curbing the epidemic.

Cigarette Smoking in Drug Users Rising According to Columbia University’s Mailman School of Public Health, the prevalence of U.S. smoking rates amongst people with a substance use disorder has increased significantly since 2002. The findings contrast with nationwide statistics, which have shown a drop in smoking rates overall. The researchers found that more than half (56 percent) of substance users reported cigarette use in the past month. That is nearly three times higher than the 18 percent of non-substance users who reported cigarette smoking in the past month. Behavioral health care professionals should be aware that smoking cigarettes, in addition to other addictions, is prevalent in substance users. Although the conventional wisdom is that quitting smoking and substance use simultaneously is a bad idea,

26 RESILIENT HEALTH | March 2018

other research shows that giving up cigarettes and drugs or alcohol at the same time increases the chances of sustained sobriety.

Interim Dosing for Wait-Listed Patients A component of the growing drug and alcohol use crisis is the lack of treatment centers to meet the rising need for care. Individuals in need of treatment can wait weeks or even months to be admitted, and in the interim fall at risk for contracting HIV, hepatitis and other diseases, as well as perishing from an overdose. A new intervention from the University of Vermont’s College of Medicine seeks to reduce the risks to people dependent on opioids as they await treatment. A 12-week study showed that interim dosing reduced opioid and injection drug use among wait-listed patients. The program dispensed buprenorphine via a computerized, single-dose dispenser to administer the medication in the patient’s home. The dispenser includes locks and alarms to prevent misuse of the drug. Automated phone monitoring and random call-back visits for urine testing were implemented to ensure compliance.

www.reshealth.net

FAC I L I T I E S O F S OV E R E I G N H EA LTH

Sovereign Health of San Clemente San Clemente, California Sovereign Health of San Clemente offers high-quality and comprehensive detox, addiction, dual diagnosis and mental health services in residential, partial hospitalization, intensive outpatient and outpatient settings. We also provide specialized treatment including: a holistic detox recovery program, an eating disorders program and a pain recovery program. All of our programs focus on addressing underlying mental health conditions by utilizing innovative and cutting-edge cognitive testing, rehabilitation techniques, and meaurement-based treatment modalities. In addition to thorough assessments, cognitive behavioral therapy, dialectical behavior therapy and individual and group psychotherapy, we offer alternative therapeutic activities such as yoga, equine therapy, art therapy, mindfulness meditation and breathing techniques to help an individual overcome issues and regain control of his or her life.

Treatment Programs Offered: • Detoxification • Nutritionally Assisted Detox • Primary Mental Health

Our Orange County location acts as the flagship for Sovereign Health services by offering both a treatment center and our main offices. This center sits only a few miles from the Pacific Ocean, providing the ideal setting for anyone seeking behavioral health treatment. We have a caring and understanding staff that helps patients feel comfortable and ultimately focus on healing and rebuilding their lives.

• Substance Use

Patients Served

Levels of Care

• Pain Recovery

• Men and Women • 18 Years and Older

• Detoxification • Residential Treatment • Partial Hospitalization • Intensive Outpatient • Outpatient • Recovery Management

For more information, please visit

www.sovcal.com www.reshealth.net

• Dual Diagnosis • Telehealth • Eating Disorders

24/7 ADMISSIONS HELPLINE

888.701.7488

RESILIENT HEALTH | March 2018 27

1211 Puerta Del Sol, Suite 200 San Clemente, CA 92673 (888) 701-7488 www.sovhealth.com

28 RESILIENT HEALTH | March 2018