Introduction to Harm Reduction Treatment for Alcohol Use Disorders - - PowerPoint PPT Presentation

▶
introduction to harm reduction treatment for alcohol use
SMART_READER_LITE
LIVE PREVIEW

Introduction to Harm Reduction Treatment for Alcohol Use Disorders - - PowerPoint PPT Presentation

Mar 13, 2023 298 likes •833 views

Introduction to Harm Reduction Treatment for Alcohol Use Disorders in American Indian and Alaska Native Populations Susan E. Collins University of Washington-Harborview Medical Center Harm Reduction Research and Treatment Center Lonnie A.

slide-1
SLIDE 1

Introduction to Harm Reduction Treatment for Alcohol Use Disorders in American Indian and Alaska Native Populations

Susan E. Collins University of Washington-Harborview Medical Center Harm Reduction Research and Treatment Center Lonnie A. Nelson Washington State University Partnerships for Native Health

slide-2
SLIDE 2

Session Outline

slide-3
SLIDE 3

Hello!

Family

HaRRT Center Outdoor Wiccan goth Seema, my partner in science Susan E. Collins, PhD Community-based participatory research (1811 Eastlake Advisory Board)

slide-4
SLIDE 4

Osiyo!

  • Lonnie A. Nelson, PhD

– Where I came from – Schooling – Partnerships for Native Health – My current work

slide-5
SLIDE 5

Full Disclosure 

slide-6
SLIDE 6

Alcohol Use Disorders in AI/ANs

slide-7
SLIDE 7

Alcohol Use Disorders in AI/ANs

  • 2015 JAMA report: AI/ANs have highest prevalence
  • f Alcohol Use Disorders (AUDs)

– Current: 19% – Lifetime: 43%

  • Severe AUDs 2.5 times the prevalence of Non-

Hispanic Whites (8% vs. 3%)

  • Alcohol related mortality rate 2 times that of the

general US population

slide-8
SLIDE 8

Alcohol Use Disorders in Urban AI/ANs

  • AUDs in Urban AI/ANs:

– Earlier age of drinking onset (12 years) than urban dwellers of other races (15 years) – Higher prevalence of heavy episodic drinking

  • 4 or more drinks for women and 5 or more drinks for men on a

single occasion

– National Household Survey on Drug Use and Health (NHSDUH): 15% of urban AI/ANs needed treatment for AUDs – twice the percentage of non-Hispanic Whites (7%) – Urban AI/ANs are 5 times more likely to die of liver disease than urban Whites

slide-9
SLIDE 9

Urban AI/ANs

  • Urban AI/ANs:

– 72% of the 5.2 million AI/ANs in the US – More often live in poverty than members of the general US population (28% vs. 10%) – More often lack a high school diploma (22% vs. 6%)

slide-10
SLIDE 10

AUD Treatment Engagement among AI/ANs

  • According to

SAMHSA, in from 2003 - 2011

– ~186,000 (88%) needed but did not receive treatment – ~33,000 received treatment

slide-11
SLIDE 11

AUD Treatment Engagement among AI/ANs

  • Nearly all available treatments for AUDs focus on

achieving and maintaining abstinence

  • NHSDUH:

– 88% of AI/ANs needing treatment did not receive it – 81% of these did not feel they needed (abstinence based) treatment

  • 2012 qualitative study showed:

– AI/ANs perceive existing abstinence-based treatments as mismatched to their cultural values and are often disinterested in abstinence-based goals

slide-12
SLIDE 12

What Cultural Values?

slide-13
SLIDE 13

What is Being Ignored in Usual Treatment?

Collins et al (2012a,b), Clifasefi et al (2016)

slide-14
SLIDE 14

What is Harm Reduction?

slide-15
SLIDE 15

Harm Reduction Is…

Harm reduction is a grass-roots and “user-driven” set of compassionate and pragmatic approaches to reducing the substance-related harm and improving quality of life without requiring abstinence or use reduction.

Collins et al (2011); Marlatt (1998)

slide-16
SLIDE 16

Harm Reduction Values

Collins et al (2011)

slide-17
SLIDE 17

Shared Values

slide-18
SLIDE 18

Shared Values

slide-19
SLIDE 19

The Philosophy is COMPASSIONATE

slide-20
SLIDE 20

The Approach is PRAGMATIC

slide-21
SLIDE 21

Harm reduction is practiced at various levels

Policy Level Population Level Community Level Person Level

slide-22
SLIDE 22

At the individual level the focus is on…

…how we talk to people.

slide-23
SLIDE 23

HaRT is NOT…

slide-24
SLIDE 24

HaRT is NOT…

slide-25
SLIDE 25

Harm Reduction ≠ Use Reduction

Use reduction can be “one mean to the end.”

HOWEVER

Harm reduction is the true “end.”

slide-26
SLIDE 26

HaRT Components

Improved health- related quality of life Decreased substance- related harm Medication/pharmacological adjunct

slide-27
SLIDE 27

Use of HaRT-specific components is associated with…

65% reduction in alcohol-related harm 66% reduction in peak alcohol consumption 16% reduction in positive urine tests

… over a 3 month treatment and follow-up period.

slide-28
SLIDE 28

Harm Reduction in Practice:

Mindset, Heart-set and Concrete Tools

slide-29
SLIDE 29

Mindset

  • Use reduction
  • Ultimate goal is abstinence
  • Use and problems are in 1:1

agreement

  • Prescriptive: provider

“prescribes” treatment

  • Doctor-knows-best!
  • Harm reduction
  • Goal is harm reduction
  • Risk of problems is variable

and individually based

  • Predictive: helping client

assess their risk for harm

  • Client knows better!
slide-30
SLIDE 30

Example of a relative risk hierarchy

Primary source of alcohol-related harm: Black outs

slide-31
SLIDE 31

Heart-Set

slide-32
SLIDE 32

HaRT Tools

slide-33
SLIDE 33

HaRT Tools

Multidimensional assessment

  • Substance use and related harm
  • Decisional balance
  • Quality of life
  • Biomarkers
slide-34
SLIDE 34

HaRT Tools

slide-35
SLIDE 35

HaRT Tools

slide-36
SLIDE 36

HaRT Tools

slide-37
SLIDE 37

HaRT Tools

Multidimensional assessment

  • Substance use and related harm
  • Decisional balance
  • Quality of life
  • Biomarkers

Client-led tracking

  • Clients choose most relevant outcomes to focus on
  • Clients track with provider how they are doing over time
  • Sense of transparent QI
slide-38
SLIDE 38

Client-led Assessment Tracking

slide-39
SLIDE 39

HaRT Tools

Multidimensional assessment

  • Substance use and related harm
  • Decisional balance
  • Quality of life
  • Biomarkers

Client-led tracking

  • Clients choose most relevant outcomes to focus on
  • Clients track with provider how they are doing over time
  • Sense of transparent QI

Harm-reduction goal setting

  • What goals do you have during your hospital stay/treatment/this session/in general

(whatever is relevant)?

  • What do you want to see happen for yourself?
slide-40
SLIDE 40

Harm Reduction Goal Setting

slide-41
SLIDE 41

Recording goals on SHaRE

slide-42
SLIDE 42

Recording goals for client

slide-43
SLIDE 43

HaRT Tools

Multidimensional assessment

  • Substance use and related harm
  • Decisional balance
  • Quality of life
  • Biomarkers

Client-led tracking

  • Clients choose most relevant outcomes to focus on
  • Clients track with provider how they are doing over time
  • Sense of transparent QI

Harm-reduction goal setting

  • What goals do you have during your hospital stay/treatment/this session/in general

(whatever is relevant)?

  • What do you want to see happen for yourself?

Safer-use strategies

  • Offer clients a list of safer use tips based on their primary substance
  • Have them choose one they feel like they could try
slide-44
SLIDE 44

Safer Drinking Tips

slide-45
SLIDE 45

HaRT Tools

Multidimensional assessment

  • Substance use and related harm
  • Decisional balance
  • Quality of life
  • Biomarkers

Client-led tracking

  • Clients choose most relevant outcomes to focus on
  • Clients track with provider how they are doing over time
  • Sense of transparent QI

Harm-reduction goal setting

  • What goals do you have during your hospital stay/treatment/this session/in general

(whatever is relevant)?

  • What do you want to see happen for yourself?

Safer-use strategies

  • Offer clients a list of safer use tips based on their primary substance
  • Have them choose one they feel like they could try

Checking in

  • If possible, check in with clients regarding their progress towards their goals/risk

reduction/safer use

  • Even a brief check in or phone call can be helpful!
slide-46
SLIDE 46

Integration of HaRT with cultural practices

slide-47
SLIDE 47

Harm Reduction Talking Circles (HaRTC)

slide-48
SLIDE 48

HaRT for American Indians and Alaska Natives

slide-49
SLIDE 49

How it might work…

slide-50
SLIDE 50

This is your brain on harm reduction… Any questions?

We would like to acknowledge our staff and trainees at the Harm Reduction Research and Treatment (HaRRT) Center; our research partners, including DESC, REACH, Neighborcare, Dutch Shisler Sobering Center; MHCADSD; and the many community members and participants who have shaped our work. We dedicate this training to Dr. Alan Marlatt who was a legendary alcohol researcher, compassionate clinician, mentor to many, and inspiration to all.

slide-51
SLIDE 51

Resources on Harm Reduction

  • Websites

– https://depts.washington.edu/harrtlab/ – www.harmreduction.org – www.andrewtatarsky.com/links_harmreduction.html – www.ihra.net/ – www.harmreductiontherapy.org/ – www.drugpolicy.org – www.anypositivechange.org – http://hamsnetwork.org/

  • Self-help for clients

– Anderson, K.A. (2010). How to change your drinking: A harm reduction guide to alcohol (2nd edition). New York: The HAMS Network. – Denning, P. & Little, J. (2017). Over the influence: The harm reduction guide for managing drugs and alcohol. New York: The Guilford Press. – Sorge, R., & Kershnar, S. (1998). Getting off right: A safety manual for injection drug users. New York: Harm Reduction Coalition. – Harm Reduction Coalition. (2017). http://harmreduction.org/drugs-and-drug-users/drug-tools/getting-off-right/

  • Literature on harm reduction approaches and psychotherapy

– Denning, P. & Little, J. (2012). Practicing harm reduction psychotherapy: An alternative approach to addictions (2nd edition). New York: Guilford Press. – Marlatt, G. A., Witkiewitz, K., Larimer, M.E. (2011). Harm reduction: Pragmatic strategies for managing high-risk behaviors (2nd edition). New York: Guilford Press. – Marlatt, G. A. (1996). Harm reduction: Come as you are. Addictive Behaviors, 21, 779-788. – Stout, D. D. (2009). Coming to harm reduction kicking and screaming: Looking for harm reduction in a 12-step world. Bloomington, IN: AuthorHouse. – Tartarsky, A. (2002). Harm reduction psychotherapy: A new treatment for drug and alcohol problems. Plymouth, UK: Rowman & Littlefield Publishers, Inc.

slide-52
SLIDE 52

For more information regarding these slides, please contact us at:

Susan E. Collins, PhD University of Washington – Harborview Medical Center 325 Ninth Avenue, Box 359911 Seattle, WA 98104 Tel: 206-744-9181 collinss@uw.edu https://depts.washington.edu/harrtlab/ Lonnie A. Nelson, PhD Partnerships for Native Health Washington State University 1100 Olive Way, Suite 1200 Seattle, WA 98101 (573) 424-0888 lonnie.nelson@wsu.edu http://www.p4nh.org