AnnouncementsStudy guide will be released Friday eveningHandouts have been posted to Learn@UW for prior lecturesTwo handouts updated: Public health and health disparities, stigmaTuesday will be all review day and then there will be answers to the handouts.Recovery Follow-UpCan someone be “in recovery” if they are still drinking or using?Many people who use drugs have a drug of choiceIf someone is really addicted to one drug and they stop using it and still use something else, will they be considered to be in recovery?Still could consider someone who is on methadone or other replacement therapies, this is still using something, but it is not the drug. Should this count as recovery?What about someone who was previously on heroin and now smokes marijuana occasionally, does this count as recovery?To be recovered from one addiction must you stop using all other types of psychoactive substances?Current Consensus:Someone who has been addicted to alcohol now prescribed drugs for pain this is considered to be recovery.On the flip slide, if someone was addicted to drugs or alcohol and they stop using and they are abstinent but they still drink in moderation…they are not considered to be in recovery.Recovery is still something that is being defined.Stable living environmentsHalfway houses structured living environments (e.g. testing, duties, restrictions and privileges, employment)Sober living housesInformal arrangements, often with friends who meet in treatment or 12-step programsThese are the halfway houses that have to do with people who have had drug problems, not the prison halfway houses.Halfway houses are restricted environments; these can be compared to sober living houses.Sober living houses are less restrictive; it is for people who want to live in an environment where drugs are not the focus. There aren’t a lot of restrictions imposed on those people. They are more about establishing community for people.People make friends in the treatment programs and they end up talking to each other about getting a place to live together so they are crafty in ways to come up with living arrangements that don’t expose them to substance use.Phases of recoveryEarly sobriety (30 days to 1 year)Relapse risk decreases exponentially throughout this periodSustained sobriety (1 to 5 years)Stable sobriety (>5 years)Stable sobriety doesn’t mean cravings are going to go away.IclickerPeople who subscribe to the disease model of addiction tend to think that harm reduction is unacceptable because ____________, and the only accepted means of overcoming addiction is _____________.A) addiction has no cure, abstinenceHarm reduction: A pragmatic approachPeople engage in risky behaviors, so let’s try to reduce the consequencesHarm reduction philosophy can be applied to policies, public health interventions, and treatmentsHow can be minimize/remove the most destructive harms and costs?Also, if we can’t get people to quit, can we modify their level or type of use?What are the risks that are modifiable? There are certain risks that aren’t modifiable. Like binge drinking for someone’s whole life there are risks that cannot be changed. But there are some risks you can do something about, harm reduction tries to find risks that are the most impactful on society and tries to change them.Most of these programs end up decreasing the costs to society like accidents in the ER, drunk driving, etc. Harm reduction programs end up saving a ton of money.Huge focus on improving public health and decreasing costs associated with addiction.If people are going to use drugs and need a symbolic mediator, can we convince people to use drugs that aren’t as harmful? Or have people drink less? It’s practical because it realizes that abstinence, although it’s a great goal for a lot of people, it isn’t achievable by other people.Replacement therapies as harm reductionMethadone maintenanceeCigs vs. cigarettes?Legalization debate: Cannabis vs. opiates?This is a realization that a person may not be able to get over their addiction, so this replacement therapy means that the person can still use the drug but it will not be as destructive to society.Some replacement therapies have risks and can increase your addiction; this is one thing to think about. Are these replacement therapies more helpful? But maybe they are. It is an open question right now. We would need to randomize people to receive eCigs as a replacement therapy and see what happens to costs and outcome.Legalization debate may think about one society cost associated with cannabis being criminalized is very expensive incarceration costs. What do we use for pain relief? Opiates, Vicodin, Oxycontin…Marijuana works for pain and it is less addictive and less harmful, would it be better to have people switch to marijuana for pain? (This is an open question)From the harm reduction perspective cannabis could be introducing new risks like lung problems, but it doesn’t have to be smoked.What would make us more likely to want to see a treatment professional who was open to us reducing our use of alcohol/drugs than one who was only open to complete abstinence?Progression…it is obvious that if people stop at least some substances that would be a better situation then nothing at all.Countless people say that they are scared to imagine completely stopping usingIf you have a wife or job if you don’t have abstinence it could be bad. It could be a situation where they need to totally stop. Social pressures can be pretty effective at least in some regards.Abstinence versus reduced drinkingTraditionally treatment programs have required abstinence as the ultimate goal of treatmentIn a recent survey of treatment professionals about 50% accepted reduced use as an acceptable goalWould more people enter treatment if reduced use were a broadly acceptable goal?Before people were turned away if they did not have the goal of complete abstinence.It is possible to find treatment professionals that don’t require complete abstinence.Opiate Overdose PreventionNaloxone available at AIDS Resource Center of WisconsinHuge risk of overdose from opiates, of any opiate. And there is now a drug that if someone has oded the person has stopped breathing, they may lose color in their face. These are clear signs that someone has oded, the respiration will slow down. There is now a drug that can be injected that will completely change the od process. It is extremely beneficial to keep this