6.7 Substance Abuse
The Substance Abuse section includes:
- 6.7.1 What is substance abuse?
- 6.7.2 What is Chemical Dependency?
- 6.7.3 Who does the substance abuse assessment?
- 6.7.4 Who is financially eligible?
- 6.7.5 Who are Priority Populations?
- 6.7.6 What are the requirements for Modality of Care?
- 6.7.7 What are the different Treatment Modalities?
- 6.7.8 What are there specialized programs and services administered by the Division of Alcohol and Substance Abuse
- 6.7.9 Confidentiality
- 6.7.10 eJAS Codes
- 6.7.11 Substance Abuse - Step-by-Step.
6.7.1 What is substance abuse?
Substance abuse is the misuse or overuse of a legal or illegal chemical or substance, including alcohol, in a way that is different from the way it is generally used medically or socially.
Abuse either creates disruption or problems for the user or complicates an existing problem in the individual's life. It does not matter whether the person is abusing the substance by choice, or abusing as part of an addictive pattern. Eventually, substance abuse will impact the person physically, behaviorally, socially, occupationally, or in other ways and often leads to chemical dependency.
6.7.2 What is Chemical Dependency?
Chemical dependency occurs when the person's abuse of alcohol, chemicals, or other substances progresses to physical and/or psychological dependence. Chemical dependency means the person is addicted to the substance. Addiction is the loss of control and compulsive use of a mood or mind altering chemical along with the inability to stop the use in spite of the fact that such use is causing problems in their life.
6.7.3 Who does the substance abuse assessment?
Substance Abuse Assessments must be completed by a Licensed Chemical Dependency Professional (CDP) to determine:
- Substance abuse
- Chemical addiction
- Level of treatment (if any) that is required to address the individual's needs.
6.7.4 Who is financially eligible for substance abuse treatment?
Persons who are eligible for WorkFirst and Supplemental Security Income (SSI) likely qualify for Washington Apple Health
WorkFirst clients do not need to be referred by an ADATSA assessment agency to receive treatment. They can receive assessment and treatment services from any DASA treatment agency contracted to provide services to WorkFirst clients.
WorkFirst parents without Washington Apple Health due to citizenship verification requirements who need chemical dependency treatment may be able to access ADATSA (W02) services. Please refer to section 6.3.5 How do we treat parents with medial issues who do not have Washington Apple Health?
Require persons to apply for Washington Apple Health in his or her IRP if they don’t currently have coverage or have let their coverage lapse so they can access any needed chemical dependency assessment or treatment. Failure to apply for Washington Apple Health without good cause will result in sanction (See WAH Application IRP for suggested IRP language).
- Persons who do not meet the above criteria and whose income is below a specified means test are also eligible to receive outpatient treatment services under a sliding fee schedule for payment.
- Children who do not meet the above criteria and whose family income is below a specified means test may also be eligible to receive residential treatment.
6.7.5 Who are priority populations?
Priority populations are pregnant women, injecting drug users, WorkFirst families (parents with dependent children), and youth.
|Consider a referral for a substance abuse assessment when there is.|
|Some conditions are so severe that a person should be concentrating solely on getting medical treatment.|
|A history of unfinished substance abuse treatment.|
|Behavior consistent with being under the influence of excessive drug/alcohol use, such as:
|Individuals self-reporting that drug or alcohol use caused:
6.7.6 What are the requirements for Modality of Care?
Admission to modality of care is determined based on the American Society for Addiction Medicine patient placement criteria.
What are the different Treatment Modalities?
1. Detoxification Services
- Assists individuals in withdrawing from alcohol and other chemicals
- Acute detoxification provides medical care and physician supervision
- Sub-acute detoxification provides non-medical detoxification or patient self-administration of withdrawal medications ordered by a physician and provided in a home like environment.
2. Intensive Inpatient/Residential Treatment
Provides up to 30 days of a concentrated short-term program of:
- Individual and group counseling by a CDP
- Activities for detoxified alcoholics/addicts and their families
3. Recovery House/Residential Treatment
Provides up to 60 days of care and treatment with social, vocational, and recreational activities to aid in patient adjustment to abstinence and to aid in job training, employment, or other types of community activities. Treatment includes individual and group counseling by a CDP.
4. Long-term Inpatient/Residential Treatment
Provides up to 180 days of care and treatment to chronically impaired alcoholics/addicts who have personal-care capabilities. Treatment includes:
- Individual and group counseling by a CDP
- Development of social and coping skills
- Assistance with re-entry living skills.
5. Outpatient Treatment
Programs of care include individual and group treatment services of varying duration and intensity according to a prescribe Treatment Plan and education directed at relapse prevention, HIV/AIDS, hepatitis B & C, and sexually transmitted diseases.
6.7.8 Are there other specialized programs and services administered by the Division of Alcohol and Substance Abuse?
The Division of Alcohol and Substance Abuse (DASA) also administer Pregnant and Parenting Women's (PPW) programs, such as Safe Babies Safe Moms (SBSM) and Parent Child Assistance Program (PCAP), and treatment for Opiate dependence.
PPW programs address specialized needs associated with substance abuse/chemical dependency for pregnant and parenting women, including:
- Therapeutic child care for women in residential treatment
- Counseling to address other issues including:
- Sexual Assault
- Eating Disorders
- Family Planning
- Fetal Alcohol Syndrome
- Domestic Violence
- Mental Health Issues
- Life Skills training
- Vocational/Employment Services
- Transitional Housing
Safe Babies/Safe Moms Program:
- Professional Model available only in Whatcom, Snohomish, Benton, and Franklin Counties.
- Targeted Intensive Case Management for up to 3 years.
- Specialized counseling or referral to address issues as described under the Pregnant and parenting Women's Programs
Parent Child Assistance Program:
- Paraprofessional model of case management and up to the target child's third birthday.
- Available only in King, Pierce, Yakima , Spokane , Grant, Cowlitz, and Skagit counties
- Specialized counseling or referral to address issues as described under the Pregnant and Parenting Women's Programs.
- Opiate substitution treatment (Methadone)
- Outpatient treatment including individual and group counseling
Federal law prohibits the disclosure of personal information relating to alcohol and/or drug use, with criminal and civil penalties applied for unauthorized disclosure. This means:
- Treatment agencies cannot give you any information without a signed copy of the DSHS 17-063 Authorization to Release Information.
- You cannot share any substance abuse information with other agencies without getting this same form signed by the individual (releasing information from you to the other agency).
Be particularly thorough in the completion of the form if you are requesting an exchange of information regarding a client either:
- With an assessment/treatment agency, or
- To share information with another program/agency
The form must be very specific as to the purpose of the release and to whom the information is to be shared. If the forms are not completed thoroughly and correctly, the treatment agency cannot give any information and you may not share information.
Information stored in eJAS Special Records Chemical Dependency notes is highly restricted and protected. Enter all substance abuse assessment and treatment information on the Chemical Dependency Special Records screen in eJAS notes. Do not document information about substance abuse assessment or treatment in less protected areas of eJAS.
When adding the requirement to follow through with a substance abuse assessment and any treatment requirements on the individual's IRP, the WFPS or WFSSS needs to add the requirements to the Special Records IRP available in eJAS.
6.7.10 eJAS Codes
For tracking purposes, it is very important to always enter the following appropriate eJAS code when an individual is referred for a substance abuse assessment and when an individual enters treatment.
Use the following appropriate eJAS code when an individual is referred for a substance abuse assessment or when an individual enters treatment: SR - Referred for substance abuse ASSESSMENT
- SR - Referred for substance abuse ASSESSMENT
- XE - Enters substance abuse TREATMENT
6.7.11 Substance Abuse - Step-by-step guide
- The WorkFirst Program Specialist (WFPS) or WorkFirst Social Service Specialist (WFSSS) suspects there is a substance abuse problem and:
- Refers the individual to a -Division of Behavioral Health and Recovery (DBHR)contracted treatment agency using the DSHS 14-299, DASA Adult Assessment Referral Form (flag the referral as a WorkFirst/TANF referral).
- Uses local procedures to schedule the appointment.
- Enters SR (substance abuse referral code) in eJAS.
- Documents in eJAS Chemical Dependency note type and creates an IRP using the Special Records IRP available in eJAS.
- Gives the parent or sends the provider a copy of the eJAS WorkFirst Participation Verification form
- Sends the Community Service Office (CSO) a DSHS 14-311A, Assessment Center Summary for TANF , indicating:
- Whether the person needs treatment and if so, where the individual will go for treatment.
- Providers will use the DSHS 04-432, Treatment Plan and Change Report form for reporting:
- The treatment plan established for the individual.
- Failure to participate.
- Referral to another provider.
- Changes in the treatment provided.
- Discharge from treatment.
- Child care needs (when in-house child care is not provided by the facility)
- Opens XE in eJAS once the individual enters treatment. Enter substance abuse information in the Special Records under the category Chemical Dependency in eJAS notes.
- Provide support services, as needed.
- Add other activities to the IRP when the individual is ready, in consultation with the treatment provider.
- Does nothing, if treatment does not interfere with other required WorkFirst activities.
- Sends a DSHS 17-063 Authorization to Release Information form, a letter of referral and a copy of the individual's IRP to the treatment provider to coordinate treatment with WorkFirst requirements.
Relapse During Recovery:
It is not uncommon for individuals to relapse during treatment, especially during the early stages of recovery. Relapses, within themselves, should not be considered as non-compliance. Therefore, individuals should not be sanctioned or have treatment services denied just because there was a relapse.
Without good cause, failure to have a substance abuse assessment or attend treatment when the need has been identified may be considered non-compliance. Work closely with the CDP to ensure the treatment plan is being following. Case staffings involving the individual and the CDP are strongly recommended. Individuals are much more likely to be successful in their recovery if they have support of others including the WFPS and WFSSS.
Related WorkFirst Handbook Sections
- 6.1 Resolving Issues - Overview
- 3.2 Comprehensive Evaluation (CE)
- 3.3 IRP
- 3.4 Intensive Services
- WAH Application IRP