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HomeMy WebLinkAbout2018-05-24 Board of Health Supplemental Materials (2) Facing Addiction : Surgeon General's Report on Reducing Misuse and Addiction A.Thomas McLellan Senior Editor ° All Sen"ous In Treatment ................... Use 'o Additfidii ' " 1 � � 1 � <e\ � � � /\\` \�: . k �: : »Z �� �� . ,� . ¥� . � � ��. ,�. \ : �°. �«: �:� » ,, ��° � � � ;: � � � � � ° ■ // �� � . � � © \ � . , ?\: :: � � � � \ � , �� # � ©». �g � ■ _« � � ,: . . \\\ , < d� ; : . «. . , \?» � « � »° . : ! \ \ 2 � � . > . . . y � . < / a: . © # : ° ^ . < # � � ,«. . � � � � . ■ .�. � � � 4 . « . � 4 . \ \ � � . � � . � ... \ }� � . \ \ ,� » � \ \ . . � ■ � . � . . y § � � \}} � � �: ; � . IrA d.r 4- 0 NNk a I M 01 U a 21 VAW-1 .......... "N" ...................... g", m MA ,ok �A ng" EINS N, MA"', AbQ6 A1nit These Problems Intractable? � �� _m ...._, �. _e m i � �` � � . � � ,.� AV 1 ■ We have irnisundef--Sitod addiction and institutionalized inappropriate solutions 2. But now we know enough to get it right, we have the right tools and 3. Ae Ve done it before. pig S - _. nts 0 Ad ,. 35 30 07 64 0 25 20 Reduction 137 I g5INT MIG 2211 X 6am 1 1374 v 2015 . . . . .. . . . . . . .. . . . . . . . . a_ . . . . . . . . . . . . - _ mainstream Healthcare Screening, Brief I Disease M\ \� & Monitoring (e.g--. di /. e es) liiiiiilu 4 „'i1 I��, i'' � 'i � � ', �I I� �, �� i sure 40,000,000 N j O rh The critical "at risk" period for addiction 'IRS Adolescence -%QAOL i -Oflate � etween 12 25 mi I -_ -_ _. __ �w,� � ��� � W id �'�� ��a �.,� ,� � +� � � � � . � \ _ _ ° _ _ » ` - • ; y availability vyilabii . . . alcohol o � . � . Reduce underage d . ag. . d ^ DWI . * Reduce • 2availability A amw g, rr AL All AL 40 Al, Alk AL Fwitftid-ing : Po-wlicies to reduce alcohol outlets reduce drinking problems AML Aft 0 1W Iff IF 19 Z U !/to NOTE Privatizing INCREASES sales 40% Evidence: 1 longitudinal studies; over 100 case examples � . �� � ,� r . � � �, �,, I i ,¢ AL AM ^0 Isu w 40ju U1000 1 . Addiction character disorder a) cts" need tough love, must leam to follow rules i "get with the r 2. Addiction = physical dependence a) Only "hard drugs" produce addic tion 3. Addiction o bad choices, deviant lifestyle 1 . A ddiction has not beenart of healthcare Less t % of med or nursingschools teach it b) Virtually, no 7care . volvt 2. Addiction care has not been reimbursed through health insurance a l$ to Cts -ire f'- 3. Addiction is stigmatized - families shamed M ii . . . . . . . . . . . . . . . . . . . . . . _�. . . . . . .. �. . . . . . » « � & < 4 ` � » © � � ; � � ? ■ \# , � «v. « t � l , � < ; � ` ` � 4 ` � � � � � ° # � K ■ a w« : < � #a� : ■ ¥� « «� d: > � c ■ � ^ ■ # � \ � °«\ c \ \ \ � : < \ \¥: � \? \ # a � ` © X © � � ~ . _� � «- ■ ` «« � — � >.. � s . � � � . ; . . � : 2\2 � ■ : _ ��� � 2 , � e \ # ^ � < Incremental, Substance-M* duced changes M * : Gene Expression S I tress response systems Brain circuits controlling motivation, inhibition & reward sensinvity The changes dare long after drug cessation In other diseases technology allows you t progression and severity of an illness — Magnetic Resonance Imaging (MRI) — Positron Emission Tomography (PET) Now We Can Seg � � diction Source.Volkow NO,et W.Long-termftonfal brain tobot c changes in cocaine obtf5vs.Sew 'l - ,1 23 Vaal et at,DecrimSed dqPamnle 02 reCtPtOrt is assodated with reduces tat metabolism hl c di .SYMM 14-169-177,1993. T*v Studs Eye Color 1 .00 ASTHMA (adult only) 35 - .-170 DIABETES (insulin dep) .70 - 95 (males) HYPERTENSION .25 - .54 (males) ALCOHOL addiction .5.5 - .65 (males) OPIOID addiction _45 - .58 (males) COCAINE addiction .40 - .60 (males) CANNABIS addiction 35 - .55 (M & F). --- --------------- 4w 4w, 40 0 4w 4w WN ME M mg 3. Treatment goals are the same as for other chronic 'Illnesses E Reduce symptoms to non-problem s Improve health and function a 3 . Teach!Train self management 4. Treatment Methods are the same IPersonaliZed - NOT program a social2. Evidenced based medications, beha-v?-ioral 3 . Clinical monitofing -to guide care �G ori U► I � N C1 m fD rr Wma � S o Cl) rot* =y a STI 4 01 a a1 O U/ y j •V \\ \\ � \ \\\\\ o,.\\\\\\�\\\\ �,,� \\\ \\ \ \\\��.\, \.\ \ ate•_ \\ \ .\\\ \ \ � Evaluation Evaluate/di*agnose/ Explain PHP Result is contract Monitoring reports to card - 4 yrs ■ , , . � . ! ( - � \ . � - � { - . ■ . � \� ® � 2 ; � � � ! - � » a « | $ ■ : . M, +w 11M ,p AIM 11� two ui 1 i \ V A� \s 1 aSubstance Misuse is ublic health a..�� problqm: It is hurting & killing our young a) Prevention Policies risk and enhance protective - IF delivered throghot s.. ages 12 -. 25 3. Addiction is an acquired brain disease 4) z - s -- ages braits loss of control b) Those with famil-y s most vulnerable c) Adolescence 'is a critical "at risk" period Aft M41- n;zkt, =4# woHeimsdth%.a,,� Screening, brief Interv, Disease :\ ��« rte\ ���( ��\ � ��� , < �� ( �� � ��\ �a i�< ,» ��� ��1 «�� ! ' d;d � �,\ ���\ ° \ ��: ƒ �'\ . ��< ƒ;d ��} ;�\ � \� �� �� , ���d y . \ \ ,