Iden%fying & Managing The Red Flags of Opioid Misuse

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1 Turning Low Outcome Patients Into High Outcome Success Stories Stephen F. Grinstead, Dr. AD, LMFT, ACRPS Dr. Stephen F. Grinstead Ø Co-Founder & Chief Clinical Officer A Healing Place The Estates Ø Developer of the Addiction-Free Pain Management System 1

2 Ø Estimated 1.9 Million people in US suffered from substance use disorders related to Rx opioids. Ø Treatment admission from these medications quadrupled between 2002 And Ø From 2001 To 2013 overdose deaths due to these medications more than tripled. Ø There is a big need for medication-assisted treatment (MAT) but currently only a third of people who need MAT will get it. Source: Advances In Addiction Recovery Winter 2015, Vol. 3, No. 4 Chronic Pain Disorder Zone 2

3 Coexisting Disorder Zone Chronic Chronic Coexisting Disorder Pain & Coexisting Pain Disorder Disorder Zone Zone Syndrome Zone Medication Abuse And Addictive Disorders Unresolved Trauma Disorders (PTSD) Depressive Disorders Anxiety Disorders Sleep Disorders Personality Disorders Cognitive Impairment (pain) Eating Disorders 3

4 Ø Failure to recognize and/or treat coexisting disorders Ø Family system problems Ø Judgmental healthcare providers Ø Patients self-defeating reactions Ø Is your stress, depression, isolation increasing? Ø Do you experience cravings or preoccupation with your pain medication? Ø Are all medications being taken as prescribed? Ø Is there a reduction in your non-pharmacological pain management interventions? Ø Are you experiencing any negative consequences associated with your medication use? 4

5 Ø Are you honest with your support group about all medications, (including alcohol)? Ø Do you use more than one prescriber for pain meds? Ø Are you considering any elective medical or dental surgeries in the near future? Ø Are you resistant to non-narcotic medications or referrals to non-medication pain management? Ø Are you using non-prescribed substances including alcohol and/or other drugs i.e., marijuana, over-thecounter analgesics, methamphetamine, etc.? negatively impacted by your use of pain medication? Ø Is your quality of life and/or relationships being Ø Do you experience withdrawal symptoms if you go too long between doses or stop your medication abruptly? Ø Do you have a history or family history of alcoholism or other drug addiction? 5

6 Ø Do your family members or friends report concerns about your use of pain medication? Ø Are you unable to fulfill major obligations with family, friends, and/or work due to your use of medication? Ø Are you resistant to sign consent to release forms allowing your provider to discuss your treatment with other healthcare providers you have been seeing? Ø Are you more concerned about your medication than your pain condition? addiction indicators (red flags) that you have seen? Ø What are some other prescription misuse/abuse and/or Ø Each Table Group should come up with at least three or four more. It s A New Climate... The Old System Doesn t Work For Everyone It s Time for a Paradigm Shift With New Solutions 6

7 Ø Ø The Addiction-Free Pain Management System 7

8 Ø Core Principles - Bio Psycho Social Spiritual Ø Biomedical Interventions Ø Psychological Clinical Processes Ø Non-Pharmacological Approaches Ø Spirituality Focuses Ø Groups, individual and family processes Ø For Chronic Pain And Mental Health Disorders Ø Evidence-Based Ø Recovery Friendly Ø Minimum Effective/Low Dose Ø Individualized and Strategic Ø Compliance Monitoring Ø Cost Effective Ø Community Advisory Board Oversight 8

9 Two Clinical Examples The Plan Relapse Prevention Core Clinical Analyzing Processes & Managing HRS Medication Agreement & Intervention Plan Understanding The Effects Of Medication Assess Motivate Relapse Prevention Recovery Mapping HRS Identifying High Risk Situations Decision Making About Medication Understanding The Effects Of Chronic Pain Ø Meditation And Relaxation Ø Emotional Management Ø Massage Therapy Ø Physical Therapy Ø Chiropractic Treatment Ø Acupuncture Ø Biofeedback Ø Hypnosis 9

10 Ø Become maliciously compliant in half-heartedly following recommendations with their provider Ø Expect to become pain free with minimal personal effort Ø Are NOT motivated to experiment with both traditional & non-traditional pain management methods Ø Lack of Positive Family and/or Social Support Ø Become actively involved in understanding their pain disorder and the available treatment interventions Ø Let go of Magical Thinking and are willing to work Ø Become self-motivated to actively & systematically experiment with both traditional & non-traditional concurrent pain management modalities Ø Have Positive Family and/or Social Support Ø Patients need to become knowledgeable active participants Not passive recipients Ø The patient is always the captain of the team Ø Our job is to be guides or coaches Ø Use a collaborative non-confrontational approach Ø Create concurrent and collaborative treatment plans Ø Develop recovery & relapse prevention plans for pain flare ups and coexisting disorders including addiction 10

11 Ø Healthcare Utilization Including Medications Ø Ascending/Descending Pain Assessment Ø PCL-5 PTSD Checklist Ø Depression, Anxiety and Stress Scale Ø Family Assessment Device - General Functioning Ø Bio-Psycho-Social-Spiritual Functioning Assessment Ø Spirituality Index of Well Being Ø Quality of Life and Patients Goals Ø Zung Depression and Anxiety Indexes Ø Functional Physical Capacity Assessment Turning Low Outcome Patients Into High Outcome Success Stories Stephen F. Grinstead, Dr. AD, LMFT, ACRPS 11