Drug and Alcohol Services Guide

Drug and alcohol treatment services are available to anyone who wants services for a problem with drug or alcohol use. Addiction is a serious disease and there are many types of services that can help. There are also specialized programs that serve pregnant women, woman with children, and intravenous substance abusers. Available drug and alcohol services include:

• Detoxification to get off drugs or alcohol in a hospital or other live-in setting. Short-term detoxification consists of seven days or less.
• Residential Rehabilitation/Treatment in a hospital or other live-in setting such as a half-way house. Residential services may be short-term (usually up to 28 days) or long-term (beyond 28 days and dependent on treatment need)
• All-day treatment program (may include Partial Hospitalization)
• Out-patient treatment (may be either regular out-patient or intensive out-patient)
• Medication management or Methadone maintenance for heroin addiction
• Other recovery support services
• Intensive Case Management (ICM)

If a person has private insurance s/he can call the behavioral services phone number on the back of his/her insurance card which should provide contact information to assist with finding a service provider.

If a person is uninsured s/he can call Community Care Behavioral Health at 1-800-553-7499 and ask for a licensed provider.

Adults involved with the criminal justice system in Allegheny County must first be assessed so that the appropriate level of treatment can be determined. Once the appropriate level of treatment is determined, a referral can be made to a facility with those services.

Most facilities will first determine insurance coverage. If a person is not on medical assistance, the provider may request the individual enroll with Medicaid as soon as possible. There are limited County funds to assist persons who are ineligible for Medical Assistance. County funds support only persons who are uninsured or underinsured.

A referral can be made to any licensed treatment facility(PDF, 61KB) and an assessment can be requested. The required assessment instrument in Pennsylvania is Pennsylvania's Client Placement Criteria for Adults (PCPC). The PCPC is a methodology for determining level of treatment and a placement tool for insurers. The PCPC must be conducted by a certified PCPC assessor. A person does not have to receive treatment from the facility where the assessment is done.

Once completed, the PCPC will indicate the level of treatment that an individual needs. As previously indicated, those services may include any one of the following or a sequence of the following treatment options, such as out-patient services following discharge from residential services.

Detoxification

Detoxification is the process of assisting a person with the physical, medical, and emotional consequences of substance withdrawal to minimize health and mental health risks.

Residential Rehabilitation/Treatment

Residential Rehabilitation/Treatment is primarily "in-patient" but can mean either a hospital or other medical setting, or a non-hospital residential treatment setting (e.g., halfway house).

In-patient non-hospital consists of at least one of the following: residential treatment and rehabilitation, transitional type living facilities, and short-term detoxification (seven days or less in a residential facility).

In-patient hospital can be detoxification, treatment, and/or rehabilitation in a 24-hour hospital facility licensed by the Pa. Department of Health (DOH) as an acute care or general hospital, or approved by the DOH as a psychiatric hospital.

A half-way house is a community-based residential treatment and rehabilitation facility. The half-way house modality is considered a level of treatment under the PCPC. It is a live-in/work-out environment with a typical length-of-stay being three to six months.

Note: A three-quarter-way house facility (also known as a recovery home or supportive housing) is not a licensed level of treatment under the PCPC, and is therefore not covered by insurance. A three-quarter-way house is usually an apartment (or multi-resident) living situation that provides support to an individual in recovery from substance abuse. This service modality usually includes levels of "freedom" based on ability to stay clean of drugs. A way to understand the difference between a half-way house and a three-quarter-way house is that, in terms of a person's goal of returning home and his or her life, a half-way house is "halfway home," and a three-quarter-way house is "three-quarters of the way" home.

Partial Hospital

Partial Hospital is designed for individuals who can benefit from multiple treatment modalities and do not require 24-hour residential care. Partial hospital involves a minimum of 10 hours of treatment a week over the course of at least three days. People receiving services from partial hospital may have access to or be referred for other support services (e.g., job readiness and placement, GED preparation).

Out-patient Treatment

Out-patient treatment offers a variety of community-based services such as assessment, specialized professional medical consultation, physical examination, psychiatric evaluation, lab test such as HIV and TB testing, treatment, planning, therapy (individual, group and family), and after-care planning and follow-up. Regular out-patient treatment is provided for a maximum of five hours per week.

Some programs are specifically designed for certain populations, such as women or adolescents. People who temporarily need a higher intensity of out-patient services may benefit from intensive out-patient services which are provided on a scheduled basis at least three days per week, for a minimum of five hours per week to a maximum of nine and one-half hours per week.

Medication Management or Methadone Maintenance

Generally, medication management is assisting people with a regular pharmacological treatment regime. Most common is methadone maintenance. Methadone is a synthetic agent that works by blocking the euphoric and sedating effects of opiates; relieving the craving for opiates that is a major factor in relapse; relieving the symptoms associated with withdrawal from opiates; not causing euphoria or intoxication itself (with stable dosing), thus allowing a person to work and participate normally in society. Methadone is excreted slowly; suppressing narcotic withdrawal for between 24 and 36 hours, so is taken orally only once a day. Because methadone is effective in eliminating withdrawal symptoms, it is used in detoxifying opiate addicts. It is, however, only effective in cases of addiction to heroin, morphine, and other opioid drugs.

Another pharmacological treatment that is widely-used is buprenorphine. Two formulations of buprenorphine exist: Subutex® which contains buprenorphine alone, while the other Suboxone® is a combination of buprenorphine with naloxone, an opioid antagonist.

All of these medications must be prescribed by a physician. A licensed D&A treatment facility may dispense methadone.

Drug and Alcohol Service Intensive Case Management (ICM)

Criteria for drug and alcohol ICM services

• Resident of Allegheny County
• Willingness on the part of the person to participate in services, which are voluntary.
• Acknowledgement by the person that the dependency exists.
• Willingness of the person to recognize the adverse effects of dependency on activities of daily living and quality of life.

Anyone, with any type of insurance, can be referred for county drug and alcohol ICM services. These services are voluntary. While any court personnel may make the referral for services, the person does not have to receive them. Drug and alcohol ICM services are not treatment. ICM is considered a support service to help individuals obtain access to needed services including treatment, housing, training, etc.

A referral form(PDF, 231KB) must be submitted to the ICM Unit. An intensive case manager is assigned who then will contact the person either by phone or mail. If it is determined that the service is not desired, the case manager will not pursue the person further. If a person does want assistance through intensive case management the ICM will schedule an appointment. Intensive case management consists of four contacts, with a minimum of two contacts being face-to-face, during the first and second months of participation. During the third month through discharge, two contacts per month are required with one meeting being face-to-face. If a person needs more assistance, however, the ICM will be available to assist the person. A person may receive case management for up to one year. Upon completion of the established goals and "graduation" from intensive case management, follow-up services are available for six months. The ICM will contact the person at intervals of 30, 90 and 180 days. The purpose for follow-up is to monitor a person's progress and need for additional case management intervention or support services.

Once the level of treatment is determined, the client with those assisting the client must determine which facility is best for him or her. Direct contact with a facility to determine appropriateness and availability is best. The link above takes you to a directory of contracted providers in Allegheny County.

There is no guarantee that a person's first choice of treatment facility will be able to accept him or her immediately and a second choice may have to be considered.

In the event detoxification is required, the person should be taken to Transitions-Wilkinsburg, operated by Pyramid Healthcare.

A legal representative, family member or friend may make the initial contact with a facility, but the facility staff will also want to consult with the person and a receive a copy of the assessment, confirming the PCPC level of treatment or may conduct their own PCPC assessment.

There are currently no locked licensed inpatient drug and alcohol treatment facilities. Typically, defendant/clients are initially escorted on outings/appointments while in treatment. Many facilities, however, have policies which allow a defendant/client to earn privileges for unescorted community outings/appointments/employment. In these situations, a curfew is usually imposed and the defendant/client is held accountable for his or her whereabouts.

Regardless of legal relationship, no drug and alcohol treatment records may be disclosed to anyone (even defense counsel) without a signed written release form. Once a person becomes a "patient," the treatment records are protected by 42 CFR Part II, Confidentiality of Alcohol and Drug Abuse Patient Records. While there are exceptions for extraordinary circumstances, generally, if a judge or counsel wishes to have access to the treatment records, the person must have signed a release of information form.

Generally, the release of information consent allows court personnel to receive:

• Whether the person is or is not in treatment
• The type of facility
• Client progress
• Whether or not the person has relapsed
• Prognosis

These regulations do not cover verbal release of information.

That is mostly up to the person. It is often recommended that a person continue with out-patient services or at least a self-help support group, like AA or NA. Most in-patient facilities will discharge a person with a follow-up plan. But, it is the person who must follow-up with services.

A judge can certainly order that a person get treatment, but because of the PCPC requirement in Pennsylvania, it is not within a judge's purview to order the type of or a particular facility for a defendant. It is not in the best interest of the individual, and indeed may actually do harm, if a person was ordered to a type of treatment facility unsuited to his or her needs.

Once a judge is made aware of the treatment need, he or she may indicate a preferred treatment facility that provides treatment to the required need. Court personnel must be aware, however, that a facility may not have an opening at the time of a release order. A facility should be contacted for status of beds before a person is even referred to that facility.

A judge may remand (send) a person to the Allegheny County Jail pending availability of a bed at the desired facility, but this can be for an indeterminate period of time. It is advised that defense counsel provide more than one treatment site option to avoid unnecessary and indeterminate incarceration.

Yes. A judge may impose treatment as a stipulation of community supervision/ probation, however, the above process for determining the appropriate level of care still applies. If a judge requires a treatment as a condition of community supervision, the assigned probation officer is responsible for ensuring that the defendant/client has a PCPC evaluation and attends the recommended level of care. The person must sign a consent to release information for his or her probation officer, otherwise, patient records, including the recommended level of care, are closed to probation officers.