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Research and Evidence-Based Best Practices

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Behavioral Health System Baltimore’s substance abuse treatment uses the guiding principles and elements of recovery-oriented systems of care, known as ROSC.

SAMHSA’s guiding principles of recovery-oriented systems of care:

  • Recovery emerges from hope:  The belief that recovery is real provides the essential and motivating message of a better future – that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them.
  • Recovery is person-driven:  Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s).
  • Recovery occurs via many pathways:  Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds, including trauma experiences that affect and determine their pathway to recovery.
  • Recovery is holistic:  Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. The array of services and supports available should be integrated and coordinated.
  • Recovery is supported by peers and allies: Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery.
  • Recovery is supported through relationship and social networks:  An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change.
  • Recovery is culturally-based and influenced: Culture and cultural background in all of its diverse representations, including values, traditions, and beliefs, are keys in determining a person’s journey and unique pathway to recovery.
  • Recovery is supported by addressing trauma: Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.
  • Recovery involves individual, family, and community strengths and responsibility:  Individuals, families, and communities have strengths and resources that serve as a foundation for recovery.
  • Recovery is based on respect:  Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems – including protecting their rights and eliminating discrimination – are crucial in achieving recovery.

SAMHSA believes that the “four major dimensions that support a life in recovery” are:

  • Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way;
  • Home: a stable and safe place to live;
  • Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creating endeavors, and the independence, income and resources to participate in society; and
  • Community: relationships and social networks that provide support, friendship, love, and hope.

What is SBIRT or Screening, Brief Intervention, and Referral to Treatment?

SBIRT is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders. Primary care centers, hospital emergency rooms, trauma centers, and other community settings provide opportunities for early intervention with at-risk substance users before more severe consequences occur.  BHS Baltimore uses the four part SBIRT approach in several of its programs. Click here to see an info sheet from SAMSHA.

  • Universal screening assesses substance use and identifies people with substance use problems.
  • Brief intervention is provided when a screening indicates moderate risk. Brief intervention utilizes motivational interviewing techniques focused on raising patients’ awareness of substance use and its consequences and motivating them toward positive behavioral change.
  • Brief therapy continues motivational discussion for persons needing more than a brief intervention. Brief therapy is more comprehensive and includes further assessment, education, problem solving, coping mechanisms, and building a supportive social environment.
  • Referral to treatment provides a referral to specialty care for persons deemed to be at high risk.

What is considered treatment?

Treatment varies depending on the type of drug and the characteristics of the patient. The best programs provide a combination of therapies and other services.

The National Institute on Drug Addiction (NIDA) points to a number of guidelines to keep in mind when dealing with treatment. Here is a list of the top 10:

  • No single treatment is appropriate for everyone.
  • Treatment needs to be readily available.
  • Treatment must attend to the multiple needs of the individual, not just his or her drug abuse.
  • Remaining in treatment for an adequate period of time is critical.
  • Counseling—individual and/or group—and other behavioral therapies are the most commonly used forms of drug abuse treatment.
  • Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
  • An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs.
  • Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.
  • Treatment does not need to be voluntary to be effective.
  • Drug use during treatment must be monitored continuously, as lapses during treatment do occur.

NIDA’s full guide to the Principles of Drug Abuse Treatment can be found here.

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