Kern County Mental Health: Substance Abuse System Of Care

Substance Abuse System Of Care

Drug Use Is Preventable
Drug Addiction Is Treatable

Lily Alvarez, System Administrator

Address:

Phone:
Fax:
Crisis Services:

Kern County Mental Health
3300 Truxtun Avenue
P.O. Box 1000
Bakersfield, CA 93302-1000
(661) 868-6600
(661) 868-6786
1-800-991-5272 or 661-868-8000

Introduction
Facts & Information
Frequently Asked Questions
Primary Prevention Strategies
Principles Of Effective Treatment

Message From 1999 NIDA Director
How To Access Substance Abuse Services
Treatment Programs
Friday Night Live (opens new window)
Links

Introduction:

Alcohol & Drug Dependence are America's Number One Health Problem

The cost and consequences of alcoholism and drug dependence place an enormous burden on American society. As the nation's number one health problem, addiction strains the health care system, the economy, harms family life and threatens public safety.

Substance abuse crosses all societal boundaries, effects both genders, every ethnic group, and people in every tax bracket. Scientific documentation defines alcoholism and drug dependence as a disease that has roots in both genetic susceptibility and personal behavior.

Facts & Information

The Scope of the Problem

There are more deaths and disabilities each year in the U.S. from substance abuse than from any other cause.
About 18 million Americans have alcohol problems; about 5 to 6 million Americans have drug problems.
More than half of all adults have a family history of alcoholism or problem drinking.
More than nine million children live with a parent dependent on alcohol and/or illicit drugs.

The Consequences

One-quarter of all emergency room admissions, one-third of all suicides, and more than half of all homicides and incidents of domestic violence are alcohol-related.
Heavy drinking contributes to illness in each of the top three causes of death: heart disease, cancer, and stroke.
Almost half of all traffic fatalities are alcohol-related.
Between 48% and 64% of people who die in fires have blood alcohol levels indicating intoxication.
Fetal alcohol syndrome is the leading known cause of mental retardation.

The Cost

Alcohol and drug abuse costs the American economy an estimated $276 billion per year in lost productivity, health care expenditures, crime, motor vehicle crashes, and other conditions.
Untreated addiction is more expensive than heart disease, diabetes and cancer combined.
Every American adult pays nearly $1,000 per year for the damages of addiction.

Frequently Asked Questions
The following information was obtained through the National Institute on Drug Abuse.

What is drug addiction treatment?
Treatment can occur in a variety of settings, in many different forms, and for different lengths of time. Because drug addiction is typically a chronic disorder characterized by occasional relapses, a short-term, one-time treatment often is not sufficient. For many, treatment is a long-term process that involves multiple interventions and attempts at abstinence. The best programs provide a combination of therapies and other services to meet the needs of the individual patient, which are shaped by such issues as age, race, culture, sexual orientation, gender, pregnancy, parenting, housing, and employment, as well as physical and sexual abuse.

Why can't drug addicts quit on their own?
Nearly all addicted individuals believe in the beginning that they can stop using drugs on their own, and most try to stop without treatment. However, most of these attempts result in failure to achieve long-term abstinence. Research has shown that long-term drug use results in significant changes in brain function that persist long after the individual stops using drugs. These drug-induced changes in brain function may have many behavioral consequences, including the compulsion to use drugs despite adverse consequences - the defining characteristic of addiction.

How effective is drug addiction treatment?
In addition to stopping drug use, the goal of treatment is to return the individual to productive functioning in the family, workplace, and community. Measures of effectiveness typically include levels of criminal behavior, family functioning, employability, and medical condition. Overall, treatment of addiction is as successful as treatment of other chronic diseases, such as diabetes, hypertension, and asthma. Individual treatment outcomes depend on the extent and nature of the patient's presenting problems, the appropriateness of the treatment components and related services used to address those problems, and the degree of active engagement of the patient in the treatment process.

How long does drug addiction treatment usually last?
Individuals progress through drug addiction treatment at various speeds, so there is no predetermined length of treatment. However, research has shown unequivocally that good outcomes are contingent on adequate lengths of treatment. Generally, for residential or outpatient treatment, participation for less than 90 days is of limited or no effectiveness, and treatments lasting significantly longer often are indicated. For methadone maintenance, 12 months of treatment is the minimum, and some opiate-addicted individuals will continue to benefit from methadone maintenance treatment over a period of years.

Where do 12-step or self-help programs fit into drug addiction treatment?
Self-help groups can complement and extend the effects of professional treatment. The most prominent self-help groups are those affiliated with Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Cocaine Anonymous (CA), all of which are based on the 12-step model, and Smart Recovery. Most drug addiction treatment programs encourage patients to participate in a self-help group during and after formal treatment.

How can families and friends make a difference in the life of someone needing treatment?
Family and friends can play critical roles in motivating individuals with drug problems to enter and stay in treatment. Family therapy is important, especially for adolescents. Involvement of a family member in an individual's treatment program can strengthen and extend the benefits of the program.

Is drug addiction treatment worth its cost?
Drug addiction treatment is cost-effective in reducing drug use and its associated health and social costs. Treatment is less expensive than alternatives, such as not treating addicts or simply incarcerating addicts. For example, the average cost for one full year of methadone maintenance is approximately $4,700 per patient, whereas one full year of imprisonment costs approximately $18,400 per person. According to several conservative estimates, every $1 invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft alone. When savings related to health care are included, total savings can exceed costs by a ratio of 12 to 1. Major savings to the individual and society also come from significant drops in interpersonal conflicts, improvements in workplace productivity, and reductions in drug-related accidents.

What is outpatient drug-free treatment?
Such treatment varies in the types and intensity of services offered, costs less than residential or inpatient treatment, and often is more suitable for individuals who are employed or who have extensive social supports. Low-intensity programs may offer little more than drug education and admonition. Other outpatient models, such as intensive day treatment, can be comparable to residential programs in services and effectiveness, depending on the individual patient's characteristics and needs. In many outpatient programs, group counseling is emphasized.

What is residential treatment?
Residential treatment provides care 24 hours per day, generally in non-hospital settings. Programs with planned lengths of stay of 45 days focus on the "resocialization" of the individual and use the program's entire "community," including other residents, staff, and the social context, as active components of treatment. Addiction is viewed in the context of an individual's social and psychological deficits, and treatment focuses on developing personal accountability and responsibility and socially productive lives. Treatment is highly structured and can at times be confrontational, with activities designed to help residents examine damaging beliefs, self-concepts, and patterns of behavior and to adopt new, more harmonious and constructive ways to interact with others.

What is detoxification?
Detoxification is a process whereby individuals are systematically withdrawn from addicting drugs in an inpatient or outpatient setting, typically under the care of a physician. Detoxification is sometimes called a distinct treatment modality but is more appropriately considered a precursor of treatment, because it is designed to treat the acute physiological effects of stopping drug use. Medications are available for detoxification from opiates, nicotine, benzodiazepines, alcohol, barbiturates, and other sedatives. In some cases, particularly for the last three types of drugs, detoxification may be a medical necessity, and untreated withdrawal may be medically dangerous or even fatal.

Primary Prevention Strategies

Information Dissemination
This strategy provides awareness and knowledge of the nature and extent of substance abuse and addiction and their effects on individuals, families, and communities. It also increases knowledge and awareness of available prevention programs and services. This strategy is characterized by one-way communication from the source to the audience, with limited contact between the two.

Substance Abuse Education
This strategy involves two-way communication and is distinguished from the information dissemination strategy by the interaction between the educator/facilitator and the participants. Services under this strategy aim to affect critical life and social skills such as decision-making skills, refusal skills, critical analysis, and systematic judgment abilities.

Youth Alternative Activities
This strategy provides for the participation of target populations in activities that exclude substance abuse. The assumption is that constructive, supervised, and healthy activities offset the attraction to alcohol and other drugs, or otherwise meet the needs they usually fill. Therefore, the need to use these substances is minimized.

Problem Identification and Referral
This strategy aims at the general classification of those who have engaged in illegal or age-inappropriate use of alcohol and/or indulged in the first use of illicit drugs, in order to ascertain whether or not the behavior can be reversed through education. Note that this strategy does not include any function designed to determine whether an individual is in need of treatment.

Community-Based Process
This strategy aims to enhance the community's ability to provide more effective treatment and prevention services for substance abuse. Services include organizing, planning, and enhancing the efficiency and effectiveness of service implementation, interagency collaboration, coalition building and networking.

Environmental
This strategy establishes or changes written and unwritten community standards, codes and attitudes, thereby influencing the incidence and prevalence of alcohol and drug abuse in the general population. This strategy is divided into two subcategories to permit distinction between activities that center on legal and regulatory initiatives related to availability and those that relate to the service and action oriented initiatives.

Principles Of Effective Treatment
The following information is provided courtesy of the "Principles of Drug Addiction Treatment," National Institute on Drug Abuse (NIDA), NIH Publication No. 99-4180.

No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.
Treatment needs to be readily available. Because individuals who are addicted to drugs may be uncertain about entering treatment, taking advantage of opportunities when they are ready for treatment is crucial. Potential treatment applicants can be lost if treatment is not immediately available or is not readily accessible.
Effective treatment attends to multiple needs of the individual, not just his or her drug use. To be effective, treatment must address the individual's drug use and any associated medical, psychological, social, vocational, and legal problems.
An individual's treatment and services plan must be assessed continualy and modified as necessary to ensure that the plan meets the person's changing needs. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient at times may require medication, or other medical services, family therapy, parenting instruction, vocational rehabilitation, and social and legal services. It is critical that the treatment approach be appropriate to the individual's age, gender, ethnicity, and culture.
Remaining in treatment for an adequate period of time is critical for treatment effectiveness. The appropriate duration for an individual depends on his or her problems and needs. Research indicates that for most patients, the threshold of significant improvement is reached at about 3 months in treatment. After this threshold is reached, additional treatment can produce further progress toward recovery. Because people often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.
Counseling (individual and/or group) and other behavioral therapies are critical components of effective treatment for addiction. In therapy, patients address issues of motivation, build skills to resist drug use, replace drug-using activities, and improve problem-solving abilities. Behavioral therapy also facilitates interpersonal relationships and the individual's ability to function in the family and community.
Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. Methadone and levo-alphaacetylmethadol (LAAM) are very effective in helping individuals addicted to heroin or other opiates stabilize their lives and reduce their illicit drug use. Naltrexone is also an effective medication for some opiate addicts and some patients with co-occurring alcohol dependence. For persons addicted to nicotine, a nicotine replacement product (such as patches or gum) or an oral medication (such as bupropion) can be an effective component of treatment. For patients with mental disorders, both behavioral treatments and medications can be critically important.
Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way. Because addictive disorders and mental disorders often occur in the same individual, patients presenting for either condition should be assessed and treated for the co-occurrence of the other type of disorder.
Medical detoxification is only the first stage of addiction treatment and by itself does littel to change long-term drug use. Medical detoxification safely manages the acute physical symptoms of withdrawal associated with stopping drug use. While detoxification alone is rarely sufficient to help addicts achieve long-term abstinence, for some individuals it is a strongly indicated precursor to effective drug addiction treatment.
Treatment does not need to be voluntary to be effective. Strong motivation can facilitate the treatment process. Sanctions or enticements in the family, employment setting, or criminal justice system can increase significantly both treatment entry and retention rates and the success of drug treatment interventions.
Possible drug use during treatment must be monitored continuously. Lapses to drug use can occur during treatment. The objective monitoring of a patient's drug and alcohol use during treatment, such as through urinalysis or other tests, can help the patient withstand urges to use drugs. Such monitoring also can provide early evidence of drug use so that the individual's treatment plan can be adjusted. Feedback to patients who test positive for illicit drug use is an important element of monitoring.
Treatment programs should provide assessment for HIV/AIDS/, Hepatitis B and C, Tuberculosis and other infections diseases, and counseling to help patients modify or change behaviors that place themselves or others at risk of infection. Counseling can help patients who are already infected manage their illness.
Recovery from drug addition can be a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug use can occur during or after successful treatment episodes. Addicted individuals may require prolonged treatment and multiple episodes of treatment to achieve long-term abstinence and fully restored functioning. Participation in self-help support programs during and following treatment often is helpful in maintaining abstinence.

Message From The 1999 NIDA (National Institute on Drug Abuse) Director
Taken from the "Principles of Drug Addiction Treatment, A Research-based Guide," published by the National Institute on Drug Abuse, NIH Publication No. 99-4180

Drug Addiction is a complex illness, characterized by compulsive, at times uncontrollable drug craving, seeking, and use that persist even in the face of extremely negative consequences. For many people, drug addiction becomes chronic, with relapses possible even after long periods of abstinence.

The path to drug addiction begins with the act of taking drugs. Over time, a person's ability to choose not to take drugs can be compromised. Drug seeking becomes compulsive, in large part as a result of the effects of prolonged drug use on brain functioning and, thus, on behavior.

The compulsion to use drugs can take over the individual's life. Addiction often involves not only compulsive drug taking but also a wide range of dysfunctional behaviors that can interfere with normal functioning in the family, the workplace, and the broader community. Addiction also can place people at increased risk for a wide variety of other illnesses. These illnesses can be brought on by behaviors, such as poor living and health habits, that often accompany life as an addict, or because of toxic effects of the drugs themselves.

Because addiction has so many dimensions and disrupts so many aspects of an individual's life, treatment for this illness is never simple. Drug treatment must help the individual stop using drugs and maintain a drug-free lifestyle, while achieving productive functioning in the family, at work, and in society. Effective drug abuse and addiction treatment programs typically incorporate many components, each directed to a particular aspect of the illness and its consequences.

Three decades of scientific research and clinical practice have yielded a variety of effective approaches to drug addiction treatment. Extensive data document that drug addiction treatment is as effective as are treatments for most other similarly chronic medical conditions. In spite of scientific evidence that establishes the effectiveness of drug abuse treatment, many people believe that treatment is ineffective. In part, this is because of unrealistic expectations. Many people equate addiction with simply using drugs and therefore expect that addiction should be cured quickly, and if it is not, treatment is a failure. In reality, because addiction is a chronic disorder, the ultimate goal of long-term abstinence often requires sustained and repeated treatment episodes.

Of course, not all drug abuse treatment is equally effective. Research also has revealed a set of overarching principles that characterize the most effective drug abuse and addiction treatments and their implementation.

Alan I. Leshner, Ph.D., NIDA Director

How To Access Substance Abuse Services

If you think that you need substance abuse services, please phone the Gate Team at (661) 868-6453 to arrange for an assessment to determine the appropriate level of treatment. You will then be referred to a treatment provider in the community to receive services. There is no charge for the assessment and referral completed by the Gate Team. You will make your own financial arrangements with the provider.

Substance abuse assessments and referrals are available throughout Kern County. Please call (661) 868-6453 for directions to the site most convenient for you.

Treatment Programs

Information coming soon

Links

All links below open new windows:

Agency	Link
California Department of Alcohol & Drug Programs	www.adp.state.ca.us
Substance Abuse & Mental Health Services Administration	www.samhsa.gov
National Institute on Drug Abuse	www.nida.nih.gov
National Council on Alcoholism & Drug Dependence	www.ncadd.org
California Attorney General	caag.state.ca.us
National Clearinghouse for Alcohol & Drug Information	ncadi.samhsa.gov
Kern County Network for Children	www.kcnc.org

Last Modified
1/18/2005

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