The Chaos and Complexity
of Substance Use Disorder
By: Amy Mohr LMSW, LAC
Fourteenth Annual Power Conferences
The Widening Gap: Challenges From the Front
Lines of Social Work
Addiction Defined
• Addiction is defined as a chronic, relapsing brain
disease that is characterized by compulsive drug
behavior and use despite harmful consequences.
Addiction as a disease
• It is characterized by tolerance and well-defined physiological
symptoms upon withdrawal.
• It is considered a brain disease because drugs change the brain – they
change its structure and how it works.
• Drug addiction erodes a person’s self-control and ability to make
sound decisions, while sending intense impulses to take drugs.
How does stimulation of the brain's pleasure
circuit teach us to keep taking drugs?
• Our brain is hard wired to
continue behaviors that will
insure our survival.
• Chemical reactions occur that
will ensure that we do specific
behaviors for survival, ie eating,
and sex.
• Drugs do the same thing to our
brain as sex and food, but it does
it faster, longer lasting, and more
efficiently.
Recipe for Addiction
Risk Factors
Early Aggressive Behavior
Domain
Individual
Protective Factors
Self-Control
Lack of Parental
Supervision
Family
Substance Abuse
Peer
Academic Competence
Drug Availability
School
Anti-drug Use Policies
Community
Strong Neighborhood
Attachment
Poverty
Parental Monitoring
The Chaos Of Addiction
• https://youtu.be/_uaaSXJDwtQ
Impacts of Substance Use
Disorders
• Individual
•
•
•
•
Physical health
Mental Health
Relationships
Career/Job
• Family
• Dysfunctional family roles
• Loss of family members.
• Loss of finical support.
• Society
•
•
•
•
Loss of productivity.
Increase in medical expenses.
Increase need for funding for SUD Tx
Criminal Justice system.
Services Providers for SUD
Wichita
• Detox programs: 3
• Female only detox
• Male only detox
• Intensive Outpatient/Outpatient: over 30 programs
• Bi-lingual services: 3 (Intensive Outpatient/Outpatient only)
• Co-occurring disorder
• Comcare Addiction Treatment Services
• The Caring Center
• Intermediate treatment: 6
• Women Only
• Women and children
• Men only
• Reintegration Treatment Providers: 5
• Men only
• Women only
• Women with children
American Society of Addiction Medicine
(ASAM)
ASAM Level of Care
• American Society of Addiction Medicine.
Levels of Care:
 .5: Early Intervention
 1: Outpatient
 2.1: Intensive Outpatient
 2.5: Partial Hospitalization
 3: Residential Treatment
 3.1: Reintegration
 3.3: Adolescent Residential Treatment
 3.5: High-Intensity Residential Services
 3.7: Medically Monitored Intensive
Inpatient
 4: Medically Managed
United Healthcare
Kansas Utilization Guidelines
Service
Level IV
Hospital Based Detoxification Service
& Residential Inpatient Services
Level III.2-D
Social Detox
Level III.3/III.5
Residential Intermediate Services
Level III.1
Reintegration Services
Authorization Method
Telephonic Review
And
KCPC
Assessment
Initial Authorization timeframe
Review of
KCPC
Assessment submitted while member is in Social Detox
5 – 7 days (This is an on demand service with the request
submitted to VO with a minimum the first 3 dimensions
of the KCPC completed)
Review of KCPC followed by Telephonic Review
Review of KCPC followed by Telephonic Review
Level II.1
Intensive Outpatient Services
Review of KCPC
Level I
Outpatient Services
Includes Individual and Group Sessions
Review of KCPC
Other Services
Medicaid Case Management*
Person Centered Case Management*
Overnight Boarding rate for each child when child is
present with Mother who is in level III services
Support Services *
KCPC
Assessment
KCPC
Assessment
KCPC
Assessment
KCPC
Assessment
3 – 7 days
7-14 days with CSR based on Medical Necessity up to 14
days
14 days with CSR based on Medical Necessity up to 30
days
Adults & Adolescents- 30 days authorized for a 10 week
period to accommodate delayed start. CSR timeframes
based on medical necessity.
Between 40 to 60 hours of treatment, depending on
severity, over 16 weeks to accommodate delayed start.
Individual = 8-12 hours
Group = 32-48 hours
CSR timeframes based on medical necessity.
40 units for every 12 weeks of treatment.
40 units for every 12 weeks of treatment.
One day for each day in level 3 treatment services when
the child is present with mother.
40 units for every 12 weeks of treatment.
Funding Sources
• Block Grant
• Problem Gambling and Addictions Grant Fund
• City of Wichita Liquor Tax
• Private Insurance
• MCO:
• United Health Care
• Amerigroup
• Sunflower
Block Grant (AAPS funding)
• Fund priority treatment and support services for individuals without
insurance or for whom coverage is terminated for short periods of time.
• Fund those priority treatment and support services not covered by
Medicaid, Medicare or private insurance for low income individuals and
that demonstrate success in improving outcomes and/or supporting
recovery.
• Fund primary prevention - universal, selective and indicated prevention
activities and services for persons not identified as needing treatment.
• Collect performance and outcome data to determine the ongoing
effectiveness of behavioral health promotion, treatment and recovery
support services and plan the implementation of new services on a
nationwide basis.
Block Grant
Pros
Cons
• Provides funding for those with out
insurance.
• Provides services for low income
families with insurance but little or
no coverage for SUD.
• Providers are monitored on a
consistent and regular basis.
• Requirements for documentation
regarding proof of income/proof of
residency have been more lenient.
• Must be a Kansas Resident with
proof of residency.
• Must be an American Citizen.
• Must be able to show proof of
income, or proof of no income.
• Audit complete every two years for
all providers.
• An allotted amount is provider for
each agency, once this amount has
been met, services must continue
to be provided.
Problem Gambling and
Addictions Funds
• 2% of net revenues created by State-owned casino gaming.
• Is a supplement for Block Grant funds.
• Purpose:
• Provide problem gambling services to more people in need
• Identify gaps in addiction services and explore means to leverage PGOAF to
meet current and emerging service demands
• Improve the effectiveness and efficiency of addiction services
• Support and acknowledge KDADS behavioral health services providers as
partners in reducing harm caused by problem gambling and other addictions.
Problem Gambling and Addiction
Funds Allocation 2015
• Veterans’ Programs $ 1,587,428
• Economic Development Initiatives Fund $ 42,432,000
• Juvenile Detention Fund $ 2,496,000
• Correctional Institutions Building Fund $ 4,992,000
• Problem Gambling Grant Fund $ 80,000
• State General $ 25,020,240
Total $ 75,020,240
Liquor Tax
• 1.1 Million dollars allocated in 2016
• A drop of 400,000 for prior year
• Allocation:
• 805,000 directly to SUD providers
• 195,000 preventions services
• 100,000 Social Detox (decrease from prior years)
• 18 providers submitted request for the funds, only 10 providers were
accepted.
Medicaid
• Privatization of Medicaid
• Kancare: MCO
• United Healthcare
• Amerigroup
• Sunflower
• Federal Government attempted sanctioning Kancare for being out of
compliance.
Gaps in Services for Specific
Populations
• No residential programs for men with children
• No medical detox for the uninsured
• No Spanish residential programs
• Lack of long term treatment providers or coverage
Limited Services for Specific
Populations
• Only one residential adolescent treatment center
• Limited services for the homeless population
• Limited co-occurring treatment providers
• Limited Spanish speaking programs
• 12 step recovery limited for adolescents
What Kansas is doing well
• Sobering Unit
• SACK
• Located at COMCARE Crisis 625 N. Main
• 18th Judicial Drug Court Program.
• Drug Court is a collaboration among:
•
•
•
•
Sedgwick County COMCARE,
Department of Corrections,
18th Judicial District Court
Office of the District Attorney.
• City of Wichita Drug Court Program.
SACK Sobering Unit Located at
Crisis
Eligibility
• Referrals to the sobering unit are typically screened by telephone prior to
admission to ensure proper placement, but drop-in consumers may be admitted
if appropriate.
• Must be intoxicated at the time of admission.
• A Blood Alcohol Content (BAC) will be taken during intake. The consumer must
have a BAC no higher than .30 and no lower than 0.04. If above or below these
levels, the consumer will be referred to another facility.
• Must be medically stable and ambulatory.
• Must be free from suicidal, homicidal, or psychotic behavior.
• The duration of stay is up to 23 hours based on intoxication levels. On average,
consumers are in the sobering unit for 10 hours.
th
18
Judicial Drug Court Program
• Program implemented October 1st, 2008.
• Drug Court is a collaboration among Sedgwick County COMCARE, the
Department of Corrections, the 18th Judicial District Court and the
Office of the District Attorney.
• Treatment providers, Judge, and ISO work together to ensure
treatment continuity.
• Client are high risk felony drug offenders.
• 18 month treatment program.
• Mission is to decrease recidivism for this population.
City of Wichita Drug Court Program
• Started in 1995
• Judge, Prosecutor, Probation officers, and treatment providers work together to
provide rewards and consequences for drug offenders in the Wichita and
surrounding areas.
• All participants must complete a minimum one-year program that includes:
 SUD Treatment
 Court appearances
 Random drug testing
 Payment of all treatment and court fees.
• Upon successful completion of all requirements of the Drug Court program, the
charges are dismissed and thus afford the defendant an opportunity to avoid a
criminal conviction.
Stay Informed
• Be mindful of the upcoming changes to Kancare.
• Changes in the affordable care act.
• Reallocation of State Substance Use Treatment Funds.
• Cuts in preventions services.
• The impact of cuts in education has on SUD.
Discussion and Q & A
Resources:
•
Treatment Providers List. Wichita: City of Wichita Municipal Court, 2016. Print.
•
United States, Sedgwick County. (2011, August). Criminal Justice Comprehensive Master Plan for Sedgwick County. Retrieved January 31, 2017.
•
Department for Aging & Disability Services (2012). Problem Gambling and Other Addictions Fund: Strategic Plan Fiscal Years 2014 - 2017. Topeka, KS: Author.
•
United States, Sedgwick County, 18th Judicial District of Kansas. (2009). Public Safety 2009 Budget.
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United States, Sedgwick County, Sedgwick County Communications & Community Initiatives. (February 2011). Facts & Details about Sedgwick County Government.
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City of Wichita Drug Court Program [Pamphlet]. (2005). Wichita, KS: City of Wichita Municipal Court.
•
McCauley, K. T. (Director). (2009). Pleasure unwoven: Institute for Addiction Study.
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National Institute on Drug Abuse (NIDA). (n.d.). National Institute on Drug Abuse (NIDA). Retrieved May 3, 2014, from http://www.drugabuse.gov/
•
National Institute on Drug Abuse. (2008). Drugs, Brains, and Behaviors the Science of Addiction. : NIDA. (Original work published 2007)
•
Sandor, R. (2010, June 10). The disease concept of addiction revisited. . Retrieved May 1, 2014, from http://www.addictionpro.com/article/disease-concept-addiction-revisited
•
HealthDay. (2011, June 29). Addiction Starts early in American Society, Reports Finds. . Retrieved April 29, 2014, from http://health.usnews.com/health-news/familyhealth/childrens-health/articles/2011/06/29/addiction-starts-early-in-american-society-report-finds
•
Detox and Sobering Unit. (2015). http://www.saack.org/dsu.php
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Drug addiction Risk factors. (n.d.).http://www.mayoclinic.org/diseases-conditions/drug-addiction/basics/risk-factors/con-20020970
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[email protected], D. (2016, October 16). Drug-alcohol programs getting less money. Retrieved February 05, 2017, from http://www.kansas.com/news/politicsgovernment/article107503807.html
•
State of Kansas - Office of Information Technology Services. (n.d.). Kansas Substance Abuse and Mental Health Services Administration Block Grant.
https://www.kdads.ks.gov/commissions/behavioral-health/substance-abuse-and-mental-health-services-administration-block-grant
•
[email protected], H. (2017, January 23). After blistering report faults Kansas' Medicaid program, state officials respond. http://www.kansascity.com/news/politicsgovernment/article128269914.html
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H. (2003, October). What are risk factors and protective factors? https://www.drugabuse.gov/publications/preventing-drug-abuse-among-children-adolescents/chapter-1-riskfactors-protective-factors/what-are-risk-factors
•
The Impact of Drugs on Society - National Drug Threat Assessment 2006. (n.d.). https://www.justice.gov/archive/ndic/pubs11/18862/impact.htm
•
Sedgwick County Grants. (n.d.). http://www.scks.info/grants/Lists/Sedgwick%20County%20Grants/Totals.aspx