| Survey of Provider Agencies on EBP Implementation and Monitoring |
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In September 2011, the North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services administered a web-based survey to provider agencies to determine the extent to which evidence-based practices (EBPs) for children and adults with mental health, substance abuse, and intellectual and developmental disabilities were being implemented and monitored across the State. Emails were sent to 215 provider agencies. Of this number, 88 responded for a 40.9% response rate (111 provider agencies did not respond, and delivery failed for 16). The 88 provider agencies indicated that they served the following populations:
Of the 66 provider agencies that offered adult mental health EBPs, 15 offered integrated dual diagnosis treatment (IDDT), 13 assertive community treatment, 9 family psychoeducation, 9 peer support, 8 self-management, 7 clubhouses, 3 medication algorithm for bipolar disorders, 3 medical algorithm for schizophrenia, and 3 supported employment. Of the 74 provider agencies that offered child mental health EBPs, 34 offered Cognitive Behavioral Therapy (CBT) for depression, 29 CBT trauma, 28 CBT anxiety, 13 Dialectical Behavior Therapy, 11 Seeking Safety, 11 Child-Parent Psychotherapy, 8 Parent-Child Interaction, 5 Multi-Systemic Therapy, 4 Teaching Family Model, 3 Functional Family Therapy, and 2 Incredible Years. Of the 49 provider agencies that offered adult substance abuse EBPs, 24 offered Motivational Interviewing, 10 Relapse Prevention, 8 Dialectical Behavior Therapy, 7 Matrix Model, 7 IDDT, 5 Contingency Management, 5 SBIRT (Screening, Brief Intervention, and Referral To Treatment), 5 Motivational Enhancement Therapy, 4 Medication-Assisted Treatment, 4 Buprenorphine, 3 Acceptance and Commitment Therapy, and 1 Seeking Safety. Of the 40 provider agencies that offered child substance abuse EBPs, 21 offered Motivational Interviewing, 15 Trauma-Focused CBT, 11 Seven Challenges, 8 Cannabis Youth Treatment, 5 Strengthening Families, 3 Adolescent Community Reinforcement Approach, 3 Family-Centered Therapy, 3 LifeSkills Training, 3 Brief Strategic Family Therapy, 2 Functional Family Therapy, 1 Multi-Systemic Therapy, and 1 Towards No Drug Abuse. A review of the data related to regular fidelity monitoring indicated that in general, less than 50% of the provider agencies conducted fidelity assessment on any EBP across the disabilities. Rates for provider agencies providing clinical supervision and conducting quality assurance were higher but dependent on the individual EBP. |
| Teen Surveys on Substance Abuse Attitudes and Behaviors |
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In the past month, two agencies have announced the release of reports on teen attitudes and behaviors related to tobacco, alcohol, and other drugs. On August 22, 2012, the National Center on Addiction and Substance Abuse at Columbia University released its 17th annual report on teen attitudes toward substance abuse . The survey was conducted by telephone of a nationally representative sample of 1,003 teens, between the ages of 12-17 (493 boys and 510 girls). Respondents were asked questions about the prevalence of alcohol and other drug use in their high schools. When asked about the most important problems they face, 26% say alcohol and other drugs, 18% say social pressures, and 11% say academic pressures. Eighty-six percent say that 17% of their classmates (2.8 million teens) are smoking, drinking, and drugging during the school day. Over a third (36%) say it is easy for students to smoke, drink, or use drugs during the school day without getting caught. Sixty percent say that drugs are used, kept, or sold on school grounds. When asked which drugs are sold on school grounds, 91% say marijuana, 24% say prescription drugs, 9% say cocaine, and 7% say ecstasy. Data also indicate that 54% of private schools are drug-infected. They were also asked about the impact of social networking and parental attitudes. For the first time, survey results showed that digital peer pressure, where 75% say that seeing pictures of teens partying with alcohol or marijuana encourages other teens to party similarly. Forty-seven percent of teens who have seen these pictures say that it seems like the teens are having a good time. Twenty-nine percent of respondents say that they have been home alone overnight. When compared with teens who have never been home alone overnight, those left alone are nearly three times likelier to have used tobacco, almost twice as likely to have used alcohol, and twice as likely to use marijuana. When teens perceive that their parents would not be upset about substance use, they are nine times likelier to say it is okay for teens their age to smoke cigarettes, ten times likelier to get drunk, and eight and a half times likelier to use marijuana. On September 24, SAMHSA issued a news release stating that results from the 2011 National Survey on Drug Use and Health had showed declines since 2002 in the rate of past month drinking (28.8% to 25.1%), binge drinking (19.3% to 15.8%), and heavy drinking (6.2% to 4.4%) among 12-20 year olds. Tobacco use had also declined for 12-17 year olds from 2002, from 15.2% to 10.0%. Rates of marijuana use (7.4% among 12-17 year olds) and non-medical prescription drug use (20% among 12-20 year olds) did not change. A look at available statistics for NC teens shows 20.3% of high school students and 5.8% of middle school students smoked cigarettes in 2005 according to the Health and Wellness Trust Fund. The AA-Carolina reported that an estimated 39,000 teens (5.5%) between the ages of 12-17 had an alcohol addiction or alcohol abuse problem in the State over a one-year period. An estimated 69,000 teens (9.7%) between the ages of 12-17 engaged in binge drinking over a one-month period . According to Drug Free NC in May 2012, nearly 20% of high schoolers admitted to marijuana use at least once in the past month and almost 40% admitted to lifetime use of marijuana . While the 2011 NSDUH results did not report the treatment gap for ages 12-17 or for North Carolina, SAMHSA did, however, state that only 10.8% of those needing treatment for alcohol or illicit drug use received treatment at a specialty facility. Clearly, NC teens and their parents would benefit from not only from evidence-based treatment but also from prevention and education programs. |
| SA8 – Buprenorphine Treatment for Opioid Addiction |
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Buprenorphine, a partial opioid agonist, suppresses opioid withdrawal symptoms and blocks the effects of other opioids. There are 2 preparations: buprenorphine alone and a combination of buprenorphine and naloxone (an opioid antagonist). As with other medication assisted treatment, buprenorphine treatment should be combined with psychosocial treatment.
| MH7 – Evidence Based Identification and Treatment of TBI |
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The presence, degree of severity, and functional implications of brain injuries are one of the most daunting tasks a clinician serving military service members will face. While there are many established relationships between areas of the brain and neuro-function, each person’s cerebral response and recovery to a traumatic brain injury event is unique. Best practices associated with the identification and treatment of TBI is clear: Timely access and provision of services. This bulletin highlights data on TBI and offers readers a guide to key resources.| SA7 – Substance Use Disorders in Military Service Members |
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Data on the prevalence of problematic drug use among military service members is alarming. To combat this trend in an effective and timely manner, the best practice recommendations for this growing problem is the promotion of a more sensitive screening and assessment process capable of identifying “at risk” use behavior before dependence takes root. This Bulletin introduces readers to the use trends of service members and recommended best practices with this population.