BRIEF: Substance Use Disorder (SUD)Substance Use Disorder (SUD)
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STATISTICSAlcohol Abuse: 10% of Americans over the age of 12 have Alcohol Use Disorder. (previously referred to as alcoholism) 10.7% of individuals age 65 or older engaged in past-month binge alcohol use. Nat’l Center for Drug Abuse Stats
Children & Youth: By 11th grade, nearly a quarter of California teens actively use alcohol and drugs. Children Now 2023. Cultural Disparities: Overdose deaths disproportionately occur in Black and American Indian/Alaska Native individuals, due to inequities in access to mental health and substance use care. Centers for Disease Control and Prevention (DCD) Drug Overdoses: 11,145* Californians died from drug overdoses from July 2023 - June 2024. (*Under-reported due to incomplete data.) CDC Opioid Overdoses: 5,502 Californians died due to opioid overdose in 2020. 3.946 died due to fentanyl overdose. 968 young people under the age of 25 died from opioid-related overdose deaths in California in 2021. CDC Stimulant Overdoses: Deaths related to cocaine, methamphetamine and other stimulants have soared since 2011; in 2021, 65% of drug-related overdose deaths involved stimulants, compared to 22% in 2011. Nearly 70% of stimulant overdose deaths in 2022 also involved fentanyl. National Institutes of Health Treatment: Only around one out of ten people with a substance use disorder receive treatment. Substance & Mental Health Services Adm (SAMHSA) |
KEY COMPONENTSWithin a local continuum of care,
key components include: Access and linkage to care across-sectors (SUD, Mental Health, Primary Care, Schools, Crisis Care, Hospitalization, Residential Care, Criminal Justice)
Behavioral Health Continuum--Summary Paper Culturally-responsive offerings that meet the needs of diverse communities (including: race, ethnicity, culture, LGBTQ+, and age.) calbhbc.org/cultural-issues Quality Monitoring
Workforce, Education & Training—See Issue Brief |
COMMUNITY DEFINED EVIDENCE PRACTICES (CDEPs)
Community Defined Evidence Practices (CDEPs) are cultural, racial, ethnic practices that are known to increase behavioral wellness. The CA Department of Health Care Services is in the process of developing a list of CDEPs in consultation with state and local entities and individuals. More at: calbhbc.org/cultural-issues
EVIDENCE-BASED PRACTICES (EBPs)
Contingency Management provides motivational incentives to treat individuals who are experiencing SUD due to drugs known as “stimulants”. Stimulants include cocaine, amphetamine, methamphetamine, MDMA (also known as ecstasy or molly), and prescription drugs such as Adderall and Ritalin. Common incentives provided through contingency management include gift cards to local businesses, vouchers for retail items, small cash rewards, food vouchers, transportation tokens, prize drawings for larger items like electronics, or even access to additional treatment services - all given contingent on providing a negative drug test or consistently attending therapy sessions, effectively reinforcing positive behaviors like abstinence. DHCS Fact Sheet
Full Service Partnership (FSP): A program that provides individualized, team-based care through a “Whatever it Takes Approach”. FSPs include the following EPBs:
ACT: Assertive Community Treatment service components include: Assessment, Crisis Intervention, Employment and Education Support Services, Medication Support , Peer Services, Psychosocial Rehabilitation, Referral and Linkages, Therapy, Treatment & Planning.
FACT: Forensic Assertive Community Treatment is ACT for individuals involved with the criminal justice system.
HFW: High Fidelity Wraparound is a collaborative, team-based process for developing and implementing individualized care plans for children with behavioral health challenges and their families.
IPS: Individual Placement and Support is a team-based, integrated employment practice that includes: competitive employment, systematic job development, rapid job search, integrated services, benefits planning, zero exclusion, time-unlimited support and worker preferences.
Harm Reduction emphasizes approaches, initiatives, programs and services that promote compassion and preservation of life. It seeks to reduce the harmful impacts of stigma, mistreatment, discrimination, and harsh punishment of people who use drugs, especially those who are Black, Indigenous, and other People of Color. SAMHSA Harm Reduction Framework
Medication Assisted Treatment (MAT) utilizes medications, in combination with counseling and behavioral therapies. Medications commonly used include methadone, buprenorphine, and naltrexone, which reduce or prevent cravings and withdrawal symptoms, and reduce the risk of overdose. MAT is primarily used for the treatment of addiction to opioids (heroin and prescription pain relievers that contain opiates). Additionally, acamprosate may be used to reduce cravings for individuals with alcohol use disorder, and disulfiram deters drinking because combining it with alcohol causes physical illness. Naltrexone is also used for alcohol use disorder since it blocks the euphoric effects and feelings of intoxication. SAMHSA
Screening, Brief Intervention & Referral to Treatment (SBIRT) is an integrated, comprehensive, evidence-based approach to identify, reduce and prevent risky or unhealthy substance use and can be utilized in a variety of different settings, such as: in primary care and community health settings (e.g., health centers, hospital systems, health maintenance organizations (HMOs), preferred-provider organizations (PPOs) health plans, Federally Qualified Health Centers (FQHC), behavioral health centers, pediatric health care providers, children’s hospitals, etc.) and schools with a focus on screening for underage drinking, opioid use, and other substance use. SAMHSA
Therapies (Evidence-Based) include:
· Cognitive Behavioral Therapy (CBT)
· Dialectical Behavior Therapy (DBT)
· Brief Strategic Family Therapy (BSFT)
· Multidimensional Family Therapy (MDFT)
· Multisystemic Therapy (MST)
Additional information at:
www.calbhbc.org/evidence-based-practices
Full Service Partnership (FSP): A program that provides individualized, team-based care through a “Whatever it Takes Approach”. FSPs include the following EPBs:
ACT: Assertive Community Treatment service components include: Assessment, Crisis Intervention, Employment and Education Support Services, Medication Support , Peer Services, Psychosocial Rehabilitation, Referral and Linkages, Therapy, Treatment & Planning.
FACT: Forensic Assertive Community Treatment is ACT for individuals involved with the criminal justice system.
HFW: High Fidelity Wraparound is a collaborative, team-based process for developing and implementing individualized care plans for children with behavioral health challenges and their families.
IPS: Individual Placement and Support is a team-based, integrated employment practice that includes: competitive employment, systematic job development, rapid job search, integrated services, benefits planning, zero exclusion, time-unlimited support and worker preferences.
Harm Reduction emphasizes approaches, initiatives, programs and services that promote compassion and preservation of life. It seeks to reduce the harmful impacts of stigma, mistreatment, discrimination, and harsh punishment of people who use drugs, especially those who are Black, Indigenous, and other People of Color. SAMHSA Harm Reduction Framework
Medication Assisted Treatment (MAT) utilizes medications, in combination with counseling and behavioral therapies. Medications commonly used include methadone, buprenorphine, and naltrexone, which reduce or prevent cravings and withdrawal symptoms, and reduce the risk of overdose. MAT is primarily used for the treatment of addiction to opioids (heroin and prescription pain relievers that contain opiates). Additionally, acamprosate may be used to reduce cravings for individuals with alcohol use disorder, and disulfiram deters drinking because combining it with alcohol causes physical illness. Naltrexone is also used for alcohol use disorder since it blocks the euphoric effects and feelings of intoxication. SAMHSA
Screening, Brief Intervention & Referral to Treatment (SBIRT) is an integrated, comprehensive, evidence-based approach to identify, reduce and prevent risky or unhealthy substance use and can be utilized in a variety of different settings, such as: in primary care and community health settings (e.g., health centers, hospital systems, health maintenance organizations (HMOs), preferred-provider organizations (PPOs) health plans, Federally Qualified Health Centers (FQHC), behavioral health centers, pediatric health care providers, children’s hospitals, etc.) and schools with a focus on screening for underage drinking, opioid use, and other substance use. SAMHSA
Therapies (Evidence-Based) include:
· Cognitive Behavioral Therapy (CBT)
· Dialectical Behavior Therapy (DBT)
· Brief Strategic Family Therapy (BSFT)
· Multidimensional Family Therapy (MDFT)
· Multisystemic Therapy (MST)
Additional information at:
www.calbhbc.org/evidence-based-practices
PROGRAM EXAMPLES
Access Lines
· Kern County Substance Use Access Line
· 988lifeline.org
Crisis Care
· Crisis Stabilization: Lotus Center in Placer County
· Crisis Residential: Momentum in Santa Clara
· Sobering Program: Bakersfield Recovery Station
· Paramedicine and Triage to Alternate Destination Projects
Children & Youth
· Riverside County Full Service Partnership for Children & Youth, (Page 70+ of MHSA Plan)
· Friday Night Live
· Youth Substance Use Prevention in Orange County
· Youth Multi-Agency Integrated Service Team (MIST) in Kern County
Collaborative Courts—The goals of these courts are to provide needed services and support and divert participants from imprisonment.
· Yolo County Addiction Intervention Court (AIC)
· Merced County Behavioral Health Court & CARE Court (MHSA 2022-23 Update, Page 52)
Outpatient Services & Programs
· Kern County Outpatient Treatment Team
· Riverside County Recovery Services include:
° Outpatient Counseling: individual or group counseling
° Recovery Monitoring: recovery coaching and monitoring via telephone/telehealth.
° Substance Abuse Assistance: Peer-to-peer services and relapse prevention.
° Support for Education and Job Skills: linkages to life skills, employment services, job training, and education services.
° Family Support: linkages to childcare, parent education, child development support services, and family/marriage education.
° Support Groups: linkages to self-help and faith-based support.
° Ancillary Services: linkages to housing assistance, transportation, case management, and individual services coordination.
Overdose Prevention
· Overdose Prevention and Naloxone Distribution Program in San Diego County (The number of unintentional deaths caused by drugs and/or alcohol among persons aged 12 - 17 decreased 87% between 2021 and 2023, and a 35% decrease for those aged 18 - 25.)
· Vending Machine Dispenser, San Diego County, See Page 26, 2023
Prevention
· Kern County Outreach & Education
· Street Medicine: Access Harm Reduction, Overdose Prevention and Education (AHOPE)
· Also see “Children & Youth” (previous column)
Sober Living Environments—These facilities are homelike environments that offer adult behavioral health clients a 24-hours a day, supervision and structured community living environment that supports a clean and sober lifestyle free from the use of illicit drugs and alcohol. Often these facilities serve a transitional purpose between supported living and independent living.
· Sober Living Environment and Recovery Housing Resources in Humboldt County
Recovery Housing is a program that provides short term housing to patients who are homeless or without stable housing.
· START-ODS Recovery Bridge Housing, Los Angeles County
· Sober Living Environment and Recovery Housing Resources in Humboldt County
Residential Treatment typically includes 24-hour supervision and monitoring within a non-hospital setting, often aimed at providing an intensive therapeutic environment for clients with mental health and/or substance use issues. Examples:
· Adult Residential Treatment in Santa Clara County (Voluntary, community-based licensed board and care )
· Parisi House Residential Treatment where moms can stay with their babies & young children, Santa Clara County
· Kern County Substance Use Access Line
· 988lifeline.org
Crisis Care
· Crisis Stabilization: Lotus Center in Placer County
· Crisis Residential: Momentum in Santa Clara
· Sobering Program: Bakersfield Recovery Station
· Paramedicine and Triage to Alternate Destination Projects
Children & Youth
· Riverside County Full Service Partnership for Children & Youth, (Page 70+ of MHSA Plan)
· Friday Night Live
· Youth Substance Use Prevention in Orange County
· Youth Multi-Agency Integrated Service Team (MIST) in Kern County
Collaborative Courts—The goals of these courts are to provide needed services and support and divert participants from imprisonment.
· Yolo County Addiction Intervention Court (AIC)
· Merced County Behavioral Health Court & CARE Court (MHSA 2022-23 Update, Page 52)
Outpatient Services & Programs
· Kern County Outpatient Treatment Team
· Riverside County Recovery Services include:
° Outpatient Counseling: individual or group counseling
° Recovery Monitoring: recovery coaching and monitoring via telephone/telehealth.
° Substance Abuse Assistance: Peer-to-peer services and relapse prevention.
° Support for Education and Job Skills: linkages to life skills, employment services, job training, and education services.
° Family Support: linkages to childcare, parent education, child development support services, and family/marriage education.
° Support Groups: linkages to self-help and faith-based support.
° Ancillary Services: linkages to housing assistance, transportation, case management, and individual services coordination.
Overdose Prevention
· Overdose Prevention and Naloxone Distribution Program in San Diego County (The number of unintentional deaths caused by drugs and/or alcohol among persons aged 12 - 17 decreased 87% between 2021 and 2023, and a 35% decrease for those aged 18 - 25.)
· Vending Machine Dispenser, San Diego County, See Page 26, 2023
Prevention
· Kern County Outreach & Education
· Street Medicine: Access Harm Reduction, Overdose Prevention and Education (AHOPE)
· Also see “Children & Youth” (previous column)
Sober Living Environments—These facilities are homelike environments that offer adult behavioral health clients a 24-hours a day, supervision and structured community living environment that supports a clean and sober lifestyle free from the use of illicit drugs and alcohol. Often these facilities serve a transitional purpose between supported living and independent living.
· Sober Living Environment and Recovery Housing Resources in Humboldt County
Recovery Housing is a program that provides short term housing to patients who are homeless or without stable housing.
· START-ODS Recovery Bridge Housing, Los Angeles County
· Sober Living Environment and Recovery Housing Resources in Humboldt County
Residential Treatment typically includes 24-hour supervision and monitoring within a non-hospital setting, often aimed at providing an intensive therapeutic environment for clients with mental health and/or substance use issues. Examples:
· Adult Residential Treatment in Santa Clara County (Voluntary, community-based licensed board and care )
· Parisi House Residential Treatment where moms can stay with their babies & young children, Santa Clara County
Links to articles, webinars, definitions and treatment information: calbhbc.org/substance-use-disorder-sud