this is the marchman act introduction andgeneral provisions module 1. approximately 24.6 million peoplein the united states alone suffer from some form of substance abuse. because these people lose everything. they lose their health. they lose their beauty. they lose their teeth. they lose their wealth. they lose human relationship and in theend they often lose their lives and yet
nothing shakes them from their addiction.nothing can force them to give up their addiction. the addictions are powerful. substance abuse is a pandemic in the us. from the abuse of seemingly innocent substances such asmarijuana and alcohol to the abuse of street drugs like cocaine and heroin.substance abuse costs individuals
substantially and it costs the nation as awhole according to the us department of health and human services. illicitdrug use costs the us approximately $181 billionannually. excessive alcohol use cost the country approximately $235 billion annually. it's not surprising thatsubstance abuse comes with such a high price tag when you consider allthe health, legal, criminal, and personal issues that often come in its wake. substance abuse refers to a set of related conditions associated with the consumption of mind and behavioraltering substances that have negative
behavioral and health outcomes. many people do not understand why or how other individuals become addicted todrugs. it's often mistakenly assume that drug abusers lack moral principles orwillpower and that they could stop using drugs simply by choosing to change theirbehavior. in reality drug addiction is a complex disease and quitting takes morethan good intentions or a strong will. in fact because drugs change the brainin ways that foster compulsive drug abuse quitting is difficult even forthose who are ready to do so. through scientific advances we know more abouthow drugs work in the brain. florida legislature understood thegrowing problems associated with
substance abuse and its effects onsociety. in this module i will review a brief history of the establishment of thelegislation regarding substance abuse and addiction, discuss the general intentto the marchman act, defined substance abuse, substance abuse impairment andaddiction, identify when to use the marchman act or when a more appropriatealternative regulation should be used, and focus on some of the symptoms andeffects of alcohol. but the numbers are frightening and staggering when it comes to addiction in this country. there are more than 23.5 million addicts in the united states. the costs are staggering. the substance abusecosts $600 billion every single year.
after alcohol marijuana has the highestrate of dependence or abuse among all drugs. the number of persons who usedillicit drugs and one month was approximately 24.6 millionpeople and yet there continues to be a large treatment gap in this country. in2013 an estimated 22.7 million americans or 8.6% needed treatment for a problemrelated to drugs or alcohol, but only about 2.5 million people or 0.9%actually received treatment. as early as the 1970s the floridalegislature became aware of the need to discourage alcohol and substance abuseand to promote a healthy lifestyle. in 1970 the florida legislature enactedchapter 397 governing the treatment and
rehabilitation of drug dependence in 1970.the following year it enacted chapter 396 titled the myers act as the state'scomprehensive alcoholism prevention control and treatment act. it was modeledafter the federal use act. each of these laws each governing different aspects ofaddiction had a different florida administrative code that was promulgatedby the state to fully implement the respective pieces of legislation. sincepersons with substance abuse issues often don't contain their misuse to onesubstance or another having two separate laws dealing withthe prevention and treatment of addiction was cumbersome and did notaddress the problems faced by florida's citizens.
then in 1993 a representativefrom jacksonville introduced legislation to combine chapters 396 and 397 of theflorida statutes into a single law that clearly spelled out legislative intent,licensure of service providers, client rights, voluntary and involuntary admission,offender and inmate programs, service coordination, and children's substanceabuse services. the statute was named the hal s. marchman alcohol and other drug services act of 1993. it's generally referred to as the marchman act. the act was namedafter reverend hal s. marchman who is a tireless lobbyists and advocate forpersons who suffered from alcoholism and drug abuse. he was recognized by thelegislature for his contributions
addressing the delivery of substanceabuse services. in addition to the florida substance abuse impairment act, 397 of the florida statutes, there's another key piece of legislation thatalso focuses on the substance abuse issues 65d-30 of the florida administrative code. florida statues. florida administrative code. do you know the difference between the two? let me briefly give you an explanation. the state cannot explicitly cover all of the potential interest by statute however so,it delegates some of it's authority to state agencies and to local units ofgovernment like counties and cities. state executive agencies carry out statelaws through the development and
enforcement of regulations in specificareas of the law. the state creates state executive agencies like doea, dcf, and agency for health care administrationauthorized by statute regulations that are also called rules or administrative codes have theeffect of law. someone violating a regulation is in effect violating the lawthat created it. regulations are designed to increaseflexibility and efficiency in the operation of the laws. many of the actual working provisionsof statutes are embodied in regulations, rules or administrative codes. most regulations orcodes are developed and enacted through
a rule making process which includespublic input. state agencies hold open meetings and public hearings like thesample notices to the left allowing citizens to participate in thecreation of regulations. participation in the process is extremely important,but often overlooked by citizens. it provides a unique opportunity for citizens to influenceand shape their lives directly. most regulations are in effect for only a limited period of timeand must be updated or reenacted on a regular basis. the rules that are relevant to this training and basically implement chapter 397 in the floridastatutes are identified as chapter 65d-30 of the florida administrative code. theseroles have specific legislative authority.
they were developed to establish thestandards that service providers must uphold in order to be licensed to serve personswith addictions. these rules also provided detailed policies governing theentire licensing process as well as other provisions. since the rules cannotrestate language from this statute it is critical that individuals are aware ofthe provisions from the law and the rules in order to carry out the law, protect their agencies from liability,and protect their clients from harm. substance abuse means the misuse or abuse ordependence on alcohol, illicit drugs, or prescription medications. as anindividual progresses along this
continuum of misuse, abuse, and dependencethere is an increased need for substance abuse intervention andtreatment to help abate the problem. as used in this act the term substanceabuse means the use of any substance if such use is unlawful or if such use isdetrimental to the user or to others, but is not unlawful. substance abuseprograms and services or drug control applies generally to the broad continuumof prevention, intervention, clinical treatment, recovery, support initiatives,efforts to limit substance abuse, and initiatives and efforts by lawenforcement agencies to limit substance abuse. a person who wishes to entertreatment for substance abuse may apply
to a service provider for voluntaryadmission. within the financial and space capabilities of the service provider aperson must be admitted to treatment when sufficient evidence exists that theperson is impaired by substance abuse and the medical and behavioralconditions of that person are not beyond the safe management capabilities of theservice provider. the service provider must emphasize admission to the servicecomponent that represents the least restrictive setting that is appropriateto that individual's treatment needs. a person meets the criteria forinvoluntary admission to a receiving or treatment facility if there's goodreason to believe that the person is
substance abuse impaired and because ofthat impairment has lost the power of self control with respect to substance use and either a.) has inflicted or threatened or attempted to inflict or unless admitted is likelyto inflict physical harm themselves or another or b.) is in need of substanceabuse services and by reason of substance abuse impairment theirjudgment has been so impaired that the person is incapable of appreciatingtheir need for such services and of making a rational decision in regard tosuch services however, just mere refusal to receive such services does notconstitute evidence of lack of judgment with respect to their need for the services.
addiction is not just the individual. think about the individual as a pebble that falls into a pond, ok. as that pebble falls into the pond it cascadesoutward and that impact has direct effects on that person's family and ontheir friends in on their school and as that cascades outward it begins toimpact the county and the city and as it begins to cascade outward it begins toaffect the state and the nation and the and the world. the bottom line is that addiction is abi-directional reciprocal relationship with the environment. the act does notabuse drugs or alcohol in a vacuum it goes back and forth. the floridalegislative findings were that substance abuse is a major health problem thataffects multiple service systems and
leads to such profoundly disturbingconsequences as serious impairment, chronic addiction, criminal behavior, vehicular casualties, spiraling health care costs, aids, and business losses andsignificantly affect the culture, socialization, and the learning abilities ofchildren within our schools and educational systems. substance abuse impairment is a diseasewhich affects the whole family and the whole society and it requires a systemof care that includes prevention, intervention, clinical treatment, andrecovery support services that support and strengthen the family unit. addiction is defined as a chronic relapsing brain disease that is characterized bycompulsive drug seeking and use. despite
harmful consequences it is considered abrain disease, because drugs change the brain. they change its structure and howit works. these brain changes can be long-lasting.they can lead to many harmful often self-destructive behaviors. abuse of and addiction to alcohol, nicotine, and illicit and prescription drugs cost americans more than $700 billion dollars a year in increased health care costs, crime, and lostproductivity. every year illicit and prescription drugs andalcohol contribute to the death of more than90,000 americans.
substance abuse impairment is defined in the statutes as a condition involving the use of alcohol or any psychoactive or mood alteringsubstance in such a manner as to induce mental emotional or physical problemsand to cause socially dysfunctional behavior. the marchman act is designed toprovide for substance abuse services. it is the goal of the florida legislatureto discourage substance abuse by promoting healthy lifestyles, healthyfamilies, and drug free schools, workplaces, and communities. the purposeof and intent of the marchman act is to provide a comprehensive continuum ofaccessible and quality substance abuse prevention, intervention, clinical treatment,
and recovery support services in theleast restrictive environment that promotes long-term recovery whileprotecting and respecting the rights of individuals. further the legislature'sintent is to insure that within available resources a full system ofcare for substance abuse services, to establish services for individuals withco occurring substance abuse and mental health disorders, to provide analternative to criminal imprisonment for substance abuse impaired adults andjuvenile offenders. also to provide within the limits of appropriation andsafe management of the juvenile justice and corrective system substance abuseservices to substance abuse impaired
offenders. the intent of the legislatureis to provide for assisting substance abuse impaired persons primarily throughhealth and other rehabilitative services. persons covered by the marchman actinclude a wide range of situations and status. any person including minors mayapply for voluntary admission. a person must be admitted when sufficientevidence exists that they are substance abuse impaired, the setting is the leastrestrictive and appropriate within licensed ___ , medical and behavioralconditions can be safely managed, and it would be within the financial means ofthe person. involuntary admission can be either non court involved, protectivecustody, emergency, or alternative
involuntary assessment for minors orcourt involved which would be involuntary assessment, stabilization or involuntary treatment. the individual may be competent or incapacitated. the facility could be publicly or privately funded be it addiction receiving facilities, hospitals,detoxification facilities, or jail. public receiving facilities provide examinationand short-term treatment and access cannot be denied based on race, gender,ethnicity, age, sexual preference, hiv status, disability, use of prescribedmedications, prior service departures against medical advice, or the number ofrelapse episodes. publicly-funded providers cannot deny access to servicesbased solely on an inability to pay if
space and state resources are available. a law enforcement officer finds wesleysitting near a busy intersection unable to stand on his own. behind wesley are beercans and an open case of beer. wesley informs the officer that he is lost and hejust wants to go home, but he doesn't know how to get back to his house nordoes he know the address. the officer smells alcohol on wesley's breath as he talks andnotices his speech is slurred. the officer decides to take wesley to the nearest receiving facility. does the officer have enough reason to placewesley under protective custody status? yes. the officer can file forprotective custody status as he has
enough information to believe thatwesley is unable to determine for himself the need for services andwithout services it is likely wesley will inflict harm or be a danger tohimself as he has lost power of self control with respect to substance use. ie:he's no longer able to stand on his own and doesn't remember where he lives and isin need of substance abuse services by reason of substance abuse impairment. hisjudgment has been so impaired he is unable to appreciate his need forservices ie: wesley just wants to go home. it is important to note that the marchman act only be used in cases where the person is substance impaired. the marchman act is known
as the florida substance abuseimpairment act does not authorize provision of psychiatric or medicaltreatment. for many persons the use of other statutes may be more appropriate. some alternative statutes may includethose identified on the following slides. physicians and hospitals also provide examinationto persons that are brought in with emergency medical conditions that make them unableto provide consent to treatment. chapter 395.1041 of the florida statutes governs access to emergency services and care. under these conditions staff presume that the person would have consented to the exam if they had been able to do so.
chapter 744 of the florida statutes regardingguardianship states that some people due to their incapacity require either a limited ora plenary guardian to make many life decisions. an incapacitated personis one who has been adjudicated to lack the capacity to manage at least some oftheir property or to meet at least some of the essential health and safety requirementsof such a person. both plenary and limited guardianship is initiated by apetition to the court and any court order from a circuit judge must state thenature of that guardianship and what rights or limitations are included. aguardian advocate can be appointed only to represent a person during the marchman act court hearing if that person cannot attend,
otherwise no substitute decision-makeris provided under florida statute 397 other than the parent of a minor. treatment asauthorized by the patient, the court order, or the parent of a minor is acceptable. if a person has previously executed an advance directive designating a health caresurrogate and a physician has found that person to be incompetent orincapacitated to consent to their own treatment then the surrogate may insteadbe asked to provide such consent. if there has not been a surrogate appointed then a proxy, a health care proxy may be appointed by the court. an incapacitated or incompetent individualmeans someone who is physically or
mentally able to communicate a willfuland knowing health care decision. a health care facility is to notify thesurrogate or proxy in writing when they've been authorized to begin. thesurrogate or the proxy has the authority to make written consent to health caredecisions that the individual or principal would have made if they were capableof making such decisions. they also have the authority to access clinical records, authorize release of records forcontinuity of care, authorize the transfer of that individual to or from ahealth care facility, and apply for public benefits for that individual.
florida statute 415, adult abuse neglect and exploitation, may be appropriate whena vulnerale adult who was a person 18 years of age or older whose ability toperform the normal activities of daily living or toprovide for their own care or protection is impaired due to a mental, emotional,physical or developmental disability or dysfunctioning or brain damage or theinfirmities of aging. emtala and cobra are federal statute that prohibited the delay or denial of emergency medical services including psychiatric and substanceabuse emergencies. this law applies to all hospitals having emergency servicecapability including freestanding psychiatric hospitals. each personsuspected of having an emergency medical
condition who is presented to ahospital's emergency room must have a medical screening conducted within thefull capacity and capability of the hospital and must be stabilized before atransfer or discharge takes place. emtala / cobra governs access toemergency care, transfers between hospitals or facilities, and penaltiesfor violation by physicians or hospitals. the emergency examination and treatmentof incapacitated persons act provides insulation from liability in cases wherethe person's emergency medical condition is a life-threatening one and treatmentis provided absent consent. persons with severe substance abuse impairmentoften experience severe medical
consequences resulting in the need foremergency medical care. emergency medical services means that the activities orservices to prevent or treat a suddent critical illness or injury and to provideemergency medical care in pre-hospital emergency medical transportation tosick, injured, or otherwise incapacitated persons. a person is incapable of providinginformed consent if they cannot generally understand the procedure, themedically acceptable alternatives, and the substantial risks and hazardsinherent in the proposed treatment of the person or procedures. ems personnelmay treat without informed consent if the person at the time of exam ortreatment is intoxicated, under the
influence of drugs, or otherwiseincapable of providing informed consent without the ems having fear of having torespond to a civil suit. the florida mental health act which is better knownas the baker act was enacted to provide a bill of rights for persons with mentalillnesses and due process rights for those persons for whom voluntary orinvoluntary procedures were initiated to provide needed treatment in times ofacute illness. intoxication and substance abuse impairment are expressly excludedfrom the definition of mental illness and cannot be the basis of aninvoluntary examination or placement under the baker act. unfortunately, lawenforcement officers and mental health
professionals sometimes erroneously usedthe baker act instead of the marchman act to be able to access care quickly ina secure location. while some persons with substance abuse impairment alsohave a co occurring diagnosis of mental illness, the mental illness must beseparately diagnosed as the severe thought or mood disorder. there is a great deal of confusion and overlap between the baker act and the marchman act. the floridahouse and senate are scheduled to address the issues and streamline thedelivery of mental health and substance abuse treatment during the 2016legislative session. one proposal would merge the baker act and marchman act according to judge
leifman, who is known for reformingmental health services in the miami-dade eleventh circuit, the dual system oftenconfuses families and law enforcement officers trying to respond to a personin crisis. "if you're having a psychotic episode you're supposed to goto the crisis stabilization unit" he said, "but if you're having a drug inducedepisode you're not supposed to go to a crisis stabilization unit you'resupposed to go to somewhere else and there isn't a lot of somewhere else inthe state to go. there aren't that many and it's hard for people to access them". again the criteria for marchman act involuntaryadmission is reason to believe that the
person is substance abuse impaired andbecause of such impairment has lost the power of self control with respect tosubstance use and either has inflicted or threatened or attempted to inflictphysical harm on themselves or another or is in need of substance abuse servicesand by reason of substance abuse impairment is incapable of appreciatinghis need for such service and of making a rational decision with regard to it. review this next case scenario keeping thesecomponents in mind. jimmy is 39 years old. he's a successfulrestaurant manager. jimmy abuses substances daily after work. jimmy neveruses during the day only at night before
going to bed. his family is concerned abouthis use, because they called in the evening and he was noticeably under theinfluence. his brother and sister discussed theirconcerns about his substance use and asked jimmy to seek treatment services. jimmy admits to spending $50 per week onsubstances, but it still able to pay his bills and has no problems working orcaring for himself. he refuses to seek treatment. does he meet criteria forinvoluntary placement? no. his substance use is not interfering with activitiesof daily living such as paying bills so he has not lost power of self controlwith respect to substance use and neither
has he inflicted or threatened toinflict or attempted to inflict or unless admitted is likely to inflict physical harm on himself or others nor is he in need of substance abuse services byreason of substance abuse impairment. his judgment has not been so impaired he isunable or incapable of appreciating his need for such services. alcohol-related problems which result from drinking too much, too fast, or too often are among the most significant public health issues in the unitedstates. many people struggle with controlling their drinking at some timein their lives. approximately 17 million adults age 18and older have an alcohol use disorder
and 1 in 10 children live in a homewith a parent who has a drinking problem. we will therefore begin our series ofprofessional tips about the various substance disorders with informationabout alcohol. alcohol is one of the most commonly abused substances as anyone 21 years or older can legally purchase and consume alcohol. alcohol includes beers, wines, or hard liquors. short-term effects may include impaired brainfunction resulting in poor judgment, reduced reaction time, loss of balanceand motor skills, or slurred speech. long-term effects could include liverdisease or various cancers. consuming alcohol rapidly or in large amounts could result in coma or death. alcohol enters the body and ends up in the stomach.
at which point about 20% is absorbedimmediately and the other 80% is absorbed in the small intestine. the heart then pumps the absorbed alcohol to every part of the body including the central nervoussystem which consists of the brain and spinal cord and it gets to the brain really fast sothat's why even after just one drink you can feel light-headed or relaxed. alcoholacts primarily on the nerve cells within the brain and interferes withcommunication between nerve cells and other cells slowing everything down andthat's why when we drink even a little we experience the effects of alcohol on our emotions, judgment, balance, memory, speech, and anger levels of just a few. 1000 people die from alcohol overdoses each year. many of them are young people who drink fast to try and show off for their friends.
drinking during the teen years heights the chances of alcoholism later in life. those who begin drinking before the age of 21 are more than twice as likelyto develop alcohol-related problems compared to those who began drinking at age 21 orolder. individuals who begin drinking before the age of 15 are four times likelier to becomealcoholic dependent than those who do not drink until age 21 or later. the incident of lifetime alcohol abuse and dependence is greatest for those who begin drinking between theages of 11 and 14. these facts shed light on current advertising and marketing practices that expose children and young people to extensive magazine and television advertising for alcohol and the entry into the market of sweet malt-based alcoholic drinks that haveparticular appeal to kids. "these white papers reveal an urgent need to mount an aggressive public health campaign to curb under age drinking and excessive adult drinking."
i was first introduced to drugs really early in my childhood. my dad was a drug abuser. he drank a lot too so i was introduced to drugs and alcohol. um, i remember as a kid he would constantly be smoking pot in the truck while we're there and i'd constantly see little bags of cocaine. i didn't know at the time what it was until i got older. um, i was first introduce. i first smoked pot when i was 13 and from then on i began to use it on a regular basis. i began to, to drink along with it too and from pot it led to other drugs. the heavier drugs. i began to use the ecstacy, cocaine and i was drinking on a regular basis. my whole, my entire life would just consist of me trying to get high everyday. i spent all my money on drugs on alcohol. i would steal from family members just so i could end up high that day. in florida the data on teenagers shows that approximately 265,000 students or 34.8% have had at least one drink of alcohol within the past month. the marchman act provides for the involuntary or voluntary assessment and stabilization ofa person allegedly abusing substances like drugs or alcohol and provides fortreatment of substance abuse. this concludes the course content from module 1. doyou know the difference between a statute
and an administrative code? do you understand the intent of the marchman act legislation and can you name some other names for this law? how about the background of the marchman act? what was its origins? are you familiar with the definition ofsubstance abuse, substance abuse impairment, and addiction? when is it appropriate to use to marchman act or not? what arethe criteria for voluntary and involuntary admission and do you understand the significance of alcohol abuse in our culture? if you answered yes to these questions then you're ready to proceed to the knowledge reviewotherwise go back over this module and review the content again. you are now ready to complete the knowledge review. go back to the m1 tab and click open the module 1 knowledge review section. after
baker act and marchman act,completing the knowledge review you maydecide that you need additional study of
this information. if so return to thebeginning of the module. if you correctly answer 8 out of the 10questions on the knowledge review you may choose to go on to module 2 the m2 tab.
