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Prevention, Intervention, Treatment, Aftercare (P-I-T-A)
Continuum of Care
Substance abuse use disorder services are viewed as a continuum of prevention, intervention, treatment, and aftercare. As with all continuums, the boundaries are not always clearly drawn. A comprehensive substance use continuum combines many programs, policies and practices, in order to reduce substance abuse in communities. A local continuum of care may include local services ranging from prenatal parenting classes, student assistance programs, outpatient and residential treatment and community-based relapse prevention and ongoing recovery support services.
Although the P-I-T-A continuum may appear to be a sequential process, in fact, an individual may enter or leave at any point. The ultimate goal is to reduce the need for treatment related services through successful community prevention strategies and programs.
Prevention
The goal of prevention is to foster a climate in which:
- Alcohol use is acceptable only for those of legal age and only when the risk of adverse consequences is minimal, and tobacco and illegal drugs are not used at all.
- Prescription and over-the-counter drugs are used only for the purposes for which they are intended.
- Substances such as gasoline or aerosols are used only for their intended purposes.
- Pregnant and women who may become pregnant do not use alcohol, tobacco, or other drugs.
What does prevention look like?
Prevention programs fall into three categories: Universal, Selective, and Indicated.
- Universal prevention programs/strategies reach the general population, such as all students in a school or all parents of middle school students.
- Selective prevention programs target groups at risk or subsets of the population, such as children of drug users or poor school achievers.
- Indicated prevention programs identify individuals who are showing early signs of problem behavior(s) and targets them with special programs to prevent further onset of difficulties.
Intervention
The goal of intervention is to reduce the risk of harm and decrease problem behaviors that result from continued use of substances. The intent of the intervention is to take action that decreases risk factors related to substance use disorder; enhance protective factors; and provide ongoing services, as appropriate.
The specific goal of each individual client is determined by his or her consumption pattern, the consequences of his or her use, and the setting in which the intervention is delivered.
Intervention techniques vary based on the specific population being served and may be delivered to participants throughout the P-I-T-A continuum. For example, early intervention programs may include a student assistance program that provides assessments of individual students beginning to use drugs and to experience problem behaviors. Intervention may also include case management for chronic public inebriates focused on harm reduction.
Intervention services include but are not limited to:
- School intervention - pre-assessment, screening, information/education and referral
- Mentoring
- Service assessments
- Brief intervention and referral to treatment
- Detoxification
- Outreach
- Linkages to facilitate referral to treatment.
Intervention Services
The Recovery Help Line telephone staff are supervised by state-certified mental health and chemical dependency professionals who ensure callers receive the most effective response.
WHERE TO CALL:
Toll-Free Statewide: 1-866-789-1511
WHEN TO CALL:
Anytime
24-hours, 7 days a week
www.waRecoveryHelpLine.org
TEENS: 866-TEENLINK (1-866-833-6546)
Crisis Clinic has the knowledge, experience, and capacity to provide the best possible support and referrals to our citizens, at the lowest cost. We look forward to this new partnership to provide information and support to those seeking to intervene with friends and family members, and to those who need treatment and recovery services.
Crisis Clinic, located in Seattle, has more than 160 trained volunteers and has provided compassionate and confidential help to thousands of people seeking referrals for recovery and for basic needs. They can communicate with callers in 155 languages through the Tele-interpreter service and with those who have hearing impairments. Each year they help over 190,000 callers.
Crisis Clinic operates Teen Link, a teen-answered help line, each evening between 6 and 10 p.m. Teen Link can be reached at 866-TEENLINK (1-866-833-6546) and www.866TEENLINK.org. Teens who call about substance use, problem gambling or mental health issues when Teen Link is closed will be assisted by Recovery Help Line staff.
Crisis Clinic (www.CrisisClinic.org ) was established in 1964 as a non-profit organization, and is one of the oldest crisis lines in the nation. It is certified by the Washington State Division of Behavioral Health and Recovery (DBHR) for crisis intervention services, and accredited by CONTACT USA, the national organization that sets best quality practices for crisis lines. The phone number is 866-427-4747 24 hours a day, 7 days a week.
Crisis Clinic also operates Teen Link, a teen-answered help line, each evening between 6 and 10 p.m. Teen Link can be reached at 866-TEENLINK (1-866-833-6546) and www.866TEENLINK.org. Teens who call about substance use, problem gambling or mental health issues when Teen Link is closed will be assisted by Recovery Help Line staff.
Crisis Clinic (www.crisisclinic.org) was established in 1964 as a non-profit organization, and is one of the oldest crisis lines in the nation. It is certified by the Washington State Division of Behavioral Health and Recovery (DBHR) for crisis intervention services, and accredited by CONTACT USA, the national organization that sets best quality practices for crisis lines.
WHERE TO CALL:
Toll-Free Statewide: 866-TEENLINK (1-866-833-6546)
WHEN TO CALL:
Each evening between 6 p.m. and 10 p.m., 7 days a week
www.866TEENLINK.org
Purpose
The Dutch Shisler Sobering Support Center serves people who are alcoholic and addicted, and who need a safe place to sleep off the effects of alcohol or drugs.
The Sobering Support Center, located in downtown Seattle, is open all day, every day of the year. It is the "front door" through which people can get services. People can move toward a stable living arrangement, can get help with income support, and can begin to develop greater self-care and self-determination.
Population Served
People who are chronically alcoholic and addicted are the Sobering Center's primary focus. These clients are often homeless and have very little control of their lives. They are challenged by the rules in our society. It is hard for them to keep appointments, provide needed documentation, or to stay in touch with case workers. King County has made an active effort to reach out to this vulnerable population for more than twenty years. The Sobering Center is one of the chief means of outreach to this group, jointly funded by King County and the City of Seattle.
More than 1,000 people who are chronically addicted to alcohol/drugs have been identified in King County. About 900 of them are homeless and live on the streets of Seattle. They have a problem finding safe shelter because most homeless shelters will not take people who are intoxicated, due primarily to liability issues and not being equipped to handle their special needs. The Dutch Shisler Sobering Support Center is set up to meet these special needs and point a way out of the street lifestyle.
Services
Services provided by the Sobering Center include:
- Emergency Services Patrol van transportation to and from the facility
- Screening for medical problems
- Shelter for sleeping off the effects of alcohol or other drugs
- Case management to assist with needed social services.
The Dutch Shisler Sobering Support Center offers a safe a place where people who are alcoholic/addicted can sleep off the effects of alcohol/drugs. The center is clean, dry and warm. People usually stay in the facility for 8 to 14 hours per visit. They can get food and clean clothing if they need them.
The center can have up to 60 people at any one time and serves about 2,000 people a year.
Dutch Shisler Sobering Support Center staff members are trained to know and recognize the common medical problems of homeless people with chronic alcohol or drug addiction. They give emergency first aid and send people in need of emergency medical care to Harborview Medical Center.
Case Management
People using the center are asked to get involved with case management. Case managers can assist clients with income support, employment, housing, health care, substance abuse treatment, and the development of self-sufficiency skills.
About the Name
The Sobering Support Center is named in honor of the late Dutch Shisler, the first supervisor of the King County Emergency Services Patrol, a long-time King County employee, and an enthusiastic advocate for people who are chronically alcoholic and addicted.
For More Information
Dutch Shisler Sobering Support Center
1930 Boren Avenue
Seattle, WA 98121
To speak to someone about a referral, call (206) 477-6363.
The Emergency Service Patrol (ESP) helps people who are under the influence of alcohol and other drugs. Drivers get calls from the 9-1-1 emergency system and patrol in the downtown Seattle area to identify and assist persons in need of help. The drivers do a basic screening of a person's needs and take them to a safe location. Drivers are on duty 24 hours a day, 7 days a week.
Van drivers bring people to helping agencies such as the Dutch Shisler Sobering Support Center, or to hospitals or other health centers if there are medical problems. The drivers take clients who have finished sobering services back into the community.
The ESP patrol area in Seattle is Denny Way on the north, Spokane Street on the south, Broadway to Roy Street on the east, and Elliot Bay on the west. Drivers can go outside of the area in special situations.
King County Behavioral Health and Recovery Division contracts with two facilities in King County for withdrawal management (detox) services for people in need of detox from alcohol and other drugs. Detox is a medically supervised service with the goal of safely ensuring that people are stable coming off of alcohol or drug and then transitioning them on to the appropriate ongoing care. Detox length of stay is based on medical necessity, but usually lasts three to five days.
The two detox facilities in King County are:
Seadrunar
10344 14th Ave S
Seattle, WA 98168
Phone 206-245-1086
Recovery Place Seattle at Beacon Hill
Detox & Inpatient SUD Treatment Services
1701 18th Ave. South
Seattle, WA 98144
Phone: 253-833-7444
Intervention service for youth include detoxification and stabilization.
With detoxification services, medical staff provides a safe and temporary environment for youth who have been excessively using alcohol and other drugs. Other services are available to help the youth stay free of drugs and alcohol.
Stabilization services may be provided if a young person does not need medical detoxification but may need to stay up to 14 days while waiting for an inpatient bed. A Juvenile Probation Counselor could also use this option in place of sending a youth to juvenile detention.
Detoxification and Stabilization Services are available to youth who are ages 13 to 17 if they are:
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using alcohol and other drugs
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experiencing shaking hands, throwing up, having trouble sitting still or sleeping due to the use of alcohol or other drugs
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in present danger to harm self or others due to alcohol and other drugs.
Youth either under the age 13 or over age 17 may be served, based on clinical need and availability of appropriate services.
Youth Detoxification/Stabilization facilities in King County
Facilities are available in other counties through Washington State. For more information, go to https://www.dshs.wa.gov/bha/substance-use-treatment-services
Involuntary Commitment is used when a person with a severe drug or alcohol problem will not agree to go to treatment on his or her own.
A person may be committed if he or she is alcoholic or addicted, and at least one of the following reasons exists:
- The person is in danger of serious harm. The person is gravely disabled by alcohol or drug addiction.
- The person has threatened to harm another person or has harmed another person.
- The person may harm another person unless they are committed.
Involuntary commitment can be a difficult process. It may take time to get the person into treatment. The court will decide if treatment is ordered or not, and if the person has to go to treatment even if they do not want to do so. The facts and information given to the court must prove that the person is in need of commitment.
The Process
The process for involuntary commitment next begins when someone refers a person who is alcoholic or addicted. Referrals are looked into by Chemical Dependency Specialists. Their evaluation of the facts and information will determine whether a case to commit the person is possible.
If a case is possible, the Chemical Dependency Specialist will take a statement from the person who referred the alcoholic or addicted person. Next is an outreach to this person who is alcoholic or addicted. This allows the Chemical Dependency Specialist to see the individual in his or her own area, and allows the Chemical Dependency Specialist to get more information.
At this time, the Chemical Dependency Specialist can give the person a chance to go to treatment on his or her own, and can help the person to enter treatment.
If the case goes to a court hearing, the court will look at all the information and the statements of witnesses and the person who is alcoholic or addicted. If there is enough proof for commitment, the court may order commitment for up to 60 days in treatment.
Contact Information
The Chemical Dependency Involuntary Treatment Services office is open Monday through Friday, 8:00 a.m. to 5:00 p.m. Call (206) 477-6165 for referrals or questions.
For help after 5:00 p.m. or on weekends, call the Alcohol/Drug 24-Hour Help Line at (206) 722-3700.
Needle exchange is a Public Health program approach for people who use drugs intravenously (inject drugs into a vein with a needle). It is an important tool in reducing the spread of HIV/AIDS and other blood-borne infections among injection drug users, their families and communities.
Locally, the Public Health - Seattle & King County Needle Exchange Program provides outreach to people who use drugs intravenously. This program provides new sterile syringes in a one-for-one exchange for used syringes and then safely disposes of the used syringes. It also provides important infection risk reduction information, helps drug users get needed health care, and can help with entering drug treatment.
Help entering treatment may help include with an application for public assistance, help scheduling a chemical dependency assessment, or a direct referral to a treatment program.
A variety of treatment options may be available. Treatment using the medication methadone is often an important option. For more information contact the Needle Exchange Program, King County programs, or the Opioid Treatment Program Directory.
Also see:
This state program works with hospital emergency rooms in six Washington counties - hospitals with some of the busiest emergency rooms in the state. Harborview Medical Center is the King County provider and employs five staff in the program.
Harborview staff watch for patients in the emergency room who might need assistance with drug or alcohol services. They screen for alcohol and other drug use, provide brief counseling and a brief intervention. The patient may get a referral for brief contact with a counselor or a referral to other resources or services.
The program goals are to:
- Increase the number of emergency room patients with substance abuse problems recognized through screening.
- Bring brief interventions to patients who test positive for substance use disorders. At Harborview, this usually takes 5-20 minutes.
- Increase more referrals of people from the emergency room to chemical dependency treatment.
- Drop future emergency room use and medical costs and reduce criminal action.
- Decrease injury and death for patients with alcohol and other drug problems.
- Examine how substance abuse services can include early intervention.
- Improve the contact between the emergency room and substance abuse treatment and make screenings and interventions for substance use problems a regular routine.
The Family Navigator provides support to parents looking for treatment services for their sons and/or daughters. An experienced advocate will help parents and families walk through the treatment system. In addition, the advocate can also provide skills to assist the parents motivate their child to get the care they need.
For more detail use this link: www.samafoundation.org
A Guide to Accessing Services
Local Community Services Offices (CSO), provide many state Department of Social and Health Services (DSHS) referrals. Your local CSO can provide you with details about these services and how to apply. The DSHS Web site can help you to:
- Learn about services available at your Community Services Office (CSO).
- Locate an office nearest to you.
- Apply for services, report a change or submit an eligibility review online
- Obtain Department of Social and Health Services (DSHS) forms.
- Find other DSHS services (a directory of resources for DSHS Clients, Case Managers and Providers.)
- Link to the DSHS EAZ Manual. The DSHS EAZ Manual explains eligibility for DSHS services.
Do I qualify?
Does your family need help with food, cash assistance, child care, medical benefits or long-term care?
You can use the DSHS on-line Do I qualify? calculator to see if you are eligible. Or click here to see if you are eligible for any federal, state, city or other local benefits.
Where do I get treatment services if I do not qualify for public assistance?
If you do not meet the requirements for public assistance, you may still be able to receive treatment. Many of the mental health and substance abuse treatment programs offer sliding fee scales or may allow you to make payments. Contact the treatment program directly.
Some employers have employee assistance plans that include substance abuse treatment. Ask your employee assistance program.
If you have insurance, your insurance may offer partial coverage. Ask your insurance company.
Treatment
The goal of treatment is to improve social functioning through complete abstinence from alcohol and drugs for individuals diagnosed with substance use disorder. Treatment is the use of any planned, intentional intervention in the health, behavior, personal and/or family life of an individual suffering from alcoholism or from another drug dependency designed to help that person achieve and maintain sobriety, physical and mental health and a maximum functional ability.
Diagnosis
Treatment therapies are linked to the Diagnostic and Statistical Manual under the diagnosis of Substance Use Disorder (mild, moderate or severe).
Substance Use Disorder
Use of a substance, whether legal or illegal, does not constitute a substance use disorder even though it may be unwise and strongly disapproved of by family, friends, employers, religious groups, or society at large.
Substance use is not considered a medical disorder. For a medical disorder to be present, substance use must occur more frequently; occur at high doses; and/or result in a number of problems.
The term substance abuse or substance misuse is sometimes used to refer to any substance use by adolescents, because their use of substances is illegal and poses developmental and physical risks associated with substance use at an early age.
Substance Use Disorders features:
- Taking the substance in larger amounts or over a longer period of time that was originally intended
- Persistent desire to cut down or regulate substance use and may include multiple unsuccessful efforts to decrease or discontinue use
- Spending a great deal of time obtaining the substance, using the substance, or recovering from its effects
- Craving is manifested by an intense desire or urge for the drug that you can’t think of anything else
- Substance use may result in failure to fulfill major role obligations at work, school, or home
- Continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance
- Important social, occupational, or recreations activities may be given up or reduced because of substance use
- Recurrent substance use in situations in which it is physically hazardous
- Continued substance use despite knowledge of having a persistent of recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
- Tolerance is signaled by required a markedly increased dose of the substance to achieve the desired effect or a markedly reduced effect when the usual dose is consumed
- Withdrawal symptoms.
Related treatment services for individuals diagnosed with substance use disorder include but are not limited to:
- Detoxification service
- Outpatient treatment/intensive outpatient treatment
- Intensive inpatient treatment
- Recovery House services
- Opiate substitution treatment.
Assisting the individual to establish the recovery process is the goal of treatment.
Drug Courts offers a choice and options to individuals whose criminal charges stem from alcohol and other drug abuse, alcoholism and addiction. The court may dismiss the original charge, reduce the sentence, set aside a sentence, or offer some lesser penalty, once an individual completes treatment.
Adult Drug Court
The judge is the central figure in this team effort. The Drug Court team focuses on sobriety from alcohol, abstinence from drugs, and being accountable for treatment participation and recovery progress. The judge takes on the role of trying to keep participants active in treatment by reinforcing success. Treatment providers focus on engaging and maintaining the individual in treatment and the recovery process, as well as keeping the Court informed of each person's progress. The judge positively reinforces the person for staying involved with treatment and recovery, but the judge can also penalize the person if they do not follow through with the treatment and recovery plan.
Drug Courts have clear rules. These rules are easy to understand, and success is up to the individual. For example, the participant appears in court or does not, attends treatment sessions or does not. Frequent drug tests reveal drug use or abstinence. The results are directly communicated to the judge, who rewards progress or penalizes noncompliance. Drug courts present clear choices, and encourage each individual to take control of their own recovery.
Please use this link for more information about the King County Drug Diversion Court Program
Juvenile Drug Court
Similar to the Adult Drug Court described above, a team of court and treatment professionals track a youth's progress regularly. Each hearing is led by a juvenile court judge. Criminal charges may be dismissed, depending on the participants' crime and/or their progress in the program.
About five percent of the U.S. population misuses opiates, including prescribed opiate pain medications. Mixing opiates with alcohol can be life threatening, as can combining opiates or mixing opiates with other drugs.
Opiates include heroin, morphine, codeine, OxyContin, Dilaudid, Vicodin, methadone, and other pain medications or painkillers. Opiates can cause a physical dependence and addiction.
With physical dependence, the body gets used to the drug or adapts to the drug. If the drug is taken away, the individual has withdrawal symptoms. Symptoms may be mild or very severe. Severe withdrawal from opiates may be life threatening, especially when there are other medical problems present or, or the opiates are mixed with other drugs or alcohol.
Withdrawal symptoms include shaking, sweating, headaches, drug craving, nausea, vomiting, abdominal cramping, diarrhea, insomnia, agitation and depression.
Opiate Addiction Treatment
Opiate addiction treatment options include Methadone , Buprenorphine, and Behavioral Therapies.
Methadone has proven very successful for people addicted to opiates. Methadone is a synthetic opiate that blocks the effects of opiates and stops withdrawal symptoms.
Other medical treatments, such as buprenorphine, are also used to treat opiate addiction. Buprenorphine is a new medication and different from methadone. It has less risk of addiction and can be prescribed by specially licensed physicians.
There are many good behavioral treatments. In treatment, patients build skills to change their lives so that it is no longer centered around drug use. They learn to replace drug-using activities with drug-free activities, improve problem-solving skills, and learn relapse prevention skills. Behavioral treatment may be even more effective when used with medication treatments.
Get more information on heroin and other opiates abuse and addiction, and medication assisted treatment.
Get more information on the principles of drug addiction treatment.
- Buprenorphine Physician and Treatment Program Locator
- Opioid Treatment Program Directory and Locator
The purpose of treatment is to help people with substance abuse problems learn about and understand their addiction, learn ways to live without using alcohol or drugs, and learn skills to stay away from substance abuse. Outpatient treatment takes about three to four months, but clients may stay in treatment longer, if needed.
Outpatient treatment provides counseling, including individual meetings with a counselor and group meetings that provide education and information about substance abuse, alcoholism and drug addiction. Counseling also includes learning about recovery, what recovery is and how to maintain recovery. A counselor helps each client to develop their own recovery plan.
If the person wanting or needing treatment has insurance, can pay for treatment, or has medical coupons, they can go right to a treatment agency.
If the person does not have insurance, cannot afford to pay, or does not have medical coupons, they should go to the treatment program and ask for alcohol/drug treatment. The treatment program will either refer them to the local welfare/public assistance office to apply for medical coupons, or if available, discuss fee scale payment options.
To apply for medical coupons, contact the nearest Community Service Office of Washington State DSHS at 877-501-2233 or go to do I qualify? for additional information.
King County contracts with agencies throughout the county to provide youth outpatient treatment services. For information, see the providers list at right.
Youth residential treatment is also available.
A Guide to Accessing Services
Local Community Services Offices (CSO) provide many DSHS services. Your local CSO can provide you with details about these services and how to apply for them. The DSHS web-site can also help you to:
- Learn about services available at your Community Services Office (CSO).
- Locate an office near you.
- Apply for services, report a change, or submit an eligibility review on-line.
- Learn more about Community Services Division.
- Obtain Department of Social and Health Services (DSHS) forms.
- Find other DSHS services. A directory of resources for DSHS Clients, Case Managers and Providers.
- Link to the DSHS EA-Z Manual. The DSHS EA-Z Manual guides how we determine if you are eligible for DSHS services.
DSHS Client Eligibility A-Z
Do I qualify?
Does your family need help with food, cash assistance, child care, medical benefits or long-term care?
You can use the DSHS on-line Do I qualify? calculator to see if you would be eligible
Where do I get treatment services if I do not qualify for public assistance?
If you do not meet the requirements for public assistance, you may still be able to receive treatment.
Many of the substance abuse treatment programs offer sliding fee scales or may allow you to make payments. Contact the treatment program.
Some employers have employee assistance plans to also include substance abuse treatment. Ask your employee assistance program.
If you have insurance, your insurance may offer partial coverage. Ask your insurance company.
Youth Residential Treatment provides 24-hour supportive living arrangements for youth while they are receiving substance abuse treatment. The program includes individual and group counseling. Education and activities are also available for youth and their families.
Level I Basic Residential Treatment
Level I treatment is for youth ages 13 through 17 who have a diagnosis of chemical dependency. Length of stay is based on clinical needs and program design. Maximum stay is 60 days, although longer stays may occur if clinically indicated.
Participant's ages 12 and younger, or youth ages 18, 19, or 20 may be served with clinical assessment and, if appropriate, may receive treatment.
Level II Youth Intensive Residential Treatment
Level II treatment is for youth ages 13 through 17 who are both chemically dependent and have symptoms of a mental health diagnosis (or potential diagnosis).
The length of stay is based on clinical need, but usually will be longer than Level I treatment. Maximum stay may extend to 120 days, but an expected range is 45 to 90 days. Level II programs are required to provide staff trained in other areas in addition to chemical dependency. Other training may include developmental issues, abuse, anger, and behavior management. The facility is also required to provide mental health specialist staff. Some Level II programs are locked or are secure facilities.
Participant's age 12 and younger, or youth ages 18, 19, or 20 may be served with clinical assessment and, if appropriate, may receive.
Aftercare or Continuing Care
The goal of aftercare and continuing care is to support the person's abstinence through relapse prevention after primary care and throughout their recovery. Aftercare is the stage following more intensive services.
Related aftercare and relapse prevention services for individuals who are part of a treatment continuum include but are not limited to:
- Periodic outpatient aftercare
- Relapse/recovery groups
- Recovery support group
- Oxford House
- Access to Recovery wraparound.
