Substance Abuse Disorders (SUDs) are a prevalent public health concern in both the national and local arena resulting in millions of dollars in pubic health costs and loss of life. Navigating the treatment options available in Chittenden County can be time consuming, difficult, and delay treatment. In order to help guide adult patients and their families in Chittenden County along their journey towards recovery from SUDs, a treatment decision aid was developed for choosing the right level of care.https://scholarworks.uvm.edu/fmclerk/1500/thumbnail.jp

McLeod, Elizabeth V

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UVM ScholarWorks

University of VermontScholarWorks @ UVMFamily Medicine Clerkship Student Projects Larner College of Medicine2019Substance Use Disorder Treatment Decision Aidfor Adults in Chittenden County VermontElizabeth V. McLeodFollow this and additional works at: https://scholarworks.uvm.edu/fmclerkPart of the Medical Education Commons, Primary Care Commons, and the Substance Abuseand Addiction CommonsThis Book is brought to you for free and open access by the Larner College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion inFamily Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contactdonna.omalley@uvm.edu.Recommended CitationMcLeod, Elizabeth V., "Substance Use Disorder Treatment Decision Aid for Adults in Chittenden County Vermont" (2019). FamilyMedicine Clerkship Student Projects. 426.https://scholarworks.uvm.edu/fmclerk/426PATIENT & FAMILY EDUCATION:DETERMINING APPROPRIATE LEVEL OF CARE FOR SUBSTANCE ABUSE/MISUSEElizabeth V. McLeod, M.S.Family Medicine Clerkship, Dec 2018 – Jan 2019Thomas Chittenden Clinic, Williston, VTProject Mentor: Dr. Dan Donnelly & Dr. Adrianne TroutPROBLEM IDENTIFICATION• Substance Abuse Disorders (SUDs) are a prevalent public health concern in both the national and local arena.• In the United States, approximately 21.5 million people aged 12 or older in 2014 had SUDs in the past year, including 17.0 million people with an alcohol use disorder and 7.1 million people with an illicit drug use disorder.1• More Vermonters (ages 12 and up) are drinking alcohol compared to the country overall. The number of Vermonters binge drinking is also higher in our state than in the country overall.2• Vermonters in the 18-25 year-old age group have among the highest use rates of opioids in the country.2• Less than half of Vermont youth and adults with a recent diagnosis of SUDs are seeking out treatment.• In 2017 only 44% of youth and adults Medicaid recipients with a new episode of alcohol or other drug dependence initiated treatment through an inpatient alcohol or drug admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis.3• The secretive and isolative nature of SUDs make identification, diagnosis, and treatment difficult.4• What types of treatment (inpatient, outpatient, intensive outpatient, partial hospitalization, recovery housing,  peer support groups) areavailable to residents of Chittenden County?• Sorting through the mass of information on the internet can be time consuming, difficult, and delay treatment.PUBLIC HEALTH COST• Nationally:• Substance use is estimated to cost Americans more than $600 billion each year.5• In 2009, substance abuse prescription medicine cost $866 million nationwide.6• Despite high costs of opioid Medication Assisted Treatment, overall healthcare costs have been found to be 29% lower for those being treated versus those who aren’t, demonstrating the ultimate cost-effectiveness of treating addiction.7• Vermont:• Vermont Medicaid spends $12,985 annually for each buprenorphine client, and $13,523 for each methadone client, constituting a grand total of $34,675,475.8• Loss of Life:• SUDs lead to considerable loss of life and is a growing public health concern as a treatable disease.• InVermont, there was a 30% increase in opioid-related deaths from 2015 to 2016 (from 74 to 96 deaths among Vermont residents) and there was a 5% increase in deaths from 2016 to 2017 (from 96 to 101 deaths among Vermont residents).9• In Vermont during 2016 there were 342 deaths attributable to both chronic and acute alcohol consumption.10MOTHER OF TEEN WITH RECENT OVERDOSE“I didn’t know where to start. I had no idea my son was struggling with drug addiction, particularly not bad enough that he would end up in the ICU after an overdose. What would be best for him and our family? Our insurance did nor cover typical inpatient options, and I had no clue there were non-medical inpatient options such as the Plymouth House available in our region. The amount of information available on the internet was overwhelming.”“Often times clients come to detox in crisis. They know that they have a substance abuse problem, they know they need physical detoxification services, but then they don’t know what to do next. Individuals in this type of crisis need it to be kept simple.”DETOXIFICATION CENTERCLINICIANCOMMUNITY PERSPECTIVEINTERVENTION & METHODOLOGY• In order to help guide adult patients and their families in Chittenden County along their journey towards recovery from SUDs, a treatment decision aid was developed for choosing the right level of care.• The double sided handout also includes a variety of inpatient, outpatient, recovery housing, and peer support groups in Chittenden County and beyond.• Information provided includes:• Facility/organization name• Location• Contact information• Level of care• Additional information• This hand out is ready for use on demand within the clinic or hospital setting.INTERVENTION:TREATMENT DECISION AIDRESULTS• Family medicine, inpatient psychiatry, and outpatient providers responded favorably to the simple treatment decision aid and have high hopes it will come in handy for helping guide patients with a new diagnosis of SUDs, or those who have failed lower levels of care, to make decisions about their next steps.• There was appreciation for the simplicity of the design, as well as the amount of information it contained within a single, double-sided handout.• Having all the information for recovery services available in Chittenden County and beyond on one simple handout that can be given to patients and/or their families will help ease the fear and anxiety associated with searching out this type of care.EVALUATION OF EFFECTIVENESS & LIMITATIONS• Assessing Effectiveness:• An assessment could be undertaken comparing the utility the treatment decision aid in helping patients and their families find an appropriate level of care.• Does the treatment decision aid simplify the search for treatment?• Is the treatment decision aid being utilized?• An increase in the number of patients referred to and utilizing these services would be on indication of this projects efficacy.• Limitations:• The treatment decision aid only provides information on the services available. It would be up to the patient and/or their family to contact these services and follow through with completing care.• The handout will require regular updating as new services become available. or old services change.RECOMMENDATIONS FOR THE FUTURE• Optimize the exposure of the Treatment Decision Aid to those who may needhelp.• Display in the waiting room at primary care offices in Chittenden County rather than only hand out to patient identified by clinicians.• Disperse to additional recovery-associated organizations such as the Turning Point Center of Chittenden County.• Support community efforts to reduce the sigma associated with SUDs.• Provide continued education on the disease model of substance use disorders for providers, clinicians, and the local community of Chittenden County.REFERENCES1. Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved from http://www.samhsa.gov/data/2. 2016-2017 NSDUH National Maps of Prevalence Estimates by State. Annual Report, State Report. Retrieved from https://www.samhsa.gov/data/report/2016-2017-nsduh-national-maps-prevalence-estimates-state3. Alcohol and Other Drugs Scorecard. Vermont Department of Health. Retrieved from http://healthvermont.gov/scorecard-alchohol-drugs4. Sixth Edition Basic Text, Narcotics Anonymous. (2008). Chatswroth, California: Narcotics Anonymous World Services, Inc. 5. Substance Abuse and Mental Health Services Administration. (2014). Prevention of substance abuse and mental illness. Retrieved from http://www.samhsa.gov/prevention6. Excessive Drinking is Draining the U.S. Economy. (2016, January 12). Retrieved from https://www.cdc.gov/features/costsofdrinking/index.html 7. Baser, O., Chalk, M., Fiellin, D., & Gastfriend, D. (2011). Cost and utilization outcomes of opioid-dependence treatments. The American Journal of Managed Care, 17(8), S235-48.8. Medication Assisted Treatment Program for Opioid Addiction. ASTHO. Retrieved from http://www.astho.org/Health-Systems-Transformation/Medicaid-and-Public-Health-Partnerships/Case-Studies/Vermont-MATProgram-for-Opioid-Addiction/9. Opioid-related Fatalities Brief, 2017 Annual Data Pubkication (2018). Vermont Department of Health, Vermont Vital Statistics System. Retrieved from http://www.healthvermont.gov/sites/default/files/documents/pdf/ADAP_Data_Brief_Opioid_Related_Fatalities.pdf10. Alcohol-attributable Deaths in Vermont Brief (2016). Vermont Department of Health. Retrieved from http://www.healthvermont.gov/sites/default/files/documents/pdf/ADAP_Data_Brief_AlcoholDeath.pdf

Substance Use Disorder Treatment Decision Aid for Adults in Chittenden County Vermont

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Substance Use Disorder Treatment Decision Aid for Adults in Chittenden County Vermont

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