adaw23_14e

8/7/2019 ADAW23_14e

1/8

A Wiley Periodicals, Inc. publication. wileyonlinelibrary.com

Volume 23 Number 14

April 4, 2011

Print ISSN 1042-1394

Online ISSN 1556-7591

In This Issue

ASAM paper outlines reasons

for banning medical marijuana. . . See page 3

State Budget Watch:

Treatment and criminal justice

alternatives face cuts in Texas

. . . See page 4

NIAAA, mindful of merger, speaks

out on alcohols harmful effects

. . . See page 5

Pain patients on

opioids not being

adequately monitoredby physicians

. . . See page 7

HITECH funding

would go to SA

providers under new

bill . . . See page 7

Md. Senate approves

alcohol tax increase

to benefit the schools

. . . See page 8

Fla. legislators

propose eliminating

all funding for adult

treatment

. . . See page 8

2011Wiley Periodicals,Inc.

View this newsletter online at wileyonlinelibrary.com

DOI: 10.1002/adaw.20276

HEALTH AND

MEDICAL WRITING

L

O

Recovery support included in SAMHSAsfinal strategic initiativesLast week the Substance Abuse andMental Health Services Administration(SAMHSA) published the final versionof its strategic initiatives document,laying out how the agency will focusresources in the near future.

The 8 strategic initiatives are:1. Prevention of Substance Abuse

and Mental Illness2. Military Families3. Trauma and Justice4. Recovery Support5. Health Reform6. Health Information Technol-

ogy7. Data, Outcomes, and Quality8. Public Awareness and SupportOriginally envisioned as 10 (see

ADAW, June 14, 2010), the strategicinitiatives where whittled down to 8

in the first draft (see ADAW, October11, 2010). This winter an executivesummary came out (see ADAW,February 15) showing one notablechange: recovery support was add-ed as an initiative, replacing Hous-ing and Homelessness.

Jobs/economy was the otherinitiative that was dropped betweenthe June and October drafts; thiswas done because other agenciesare more active in trying to fix eco-nomic problems and unemploymentnationwide.

Throughout the report, calledLeading Change: A Plan forSAMHSAs Roles and Actions 2011-2014, the strategic initiatives breakdown SAMHSAs conventional bar-

See Strategic page 2

See Smoking page 6

by Gary Enos, Contributing Editor

On the day when an exasperatedstaff at The Ark of Little Cotton-wood in Utah imposed a 30-dayrevocation of smoking privilegesfor clients, facility operatorsthought they were merely impos-ing a temporary punishment forbad behaviors that had been ondisplay. What happened insteadbecame a permanent change inpolicy that has created a smoke-free culture at the addiction treat-ment organization, and that in turnhas raised the hopes of stateofficials as they seek to makeall publicly funded behavioralhealth facilities in Utah tobacco-

free by 2012.While The Ark, a Sandy-based

private nonprofit center offering res-idential and outpatient services,would not have been subject to therequirements of Utahs current Re-covery Plus initiative, its surprisingexperience with ridding its campus-es of tobacco several years agocould ease some public facilitiesanxiety as Utah prepares to joinNew York in making its treatmentcenter infrastructure smoke-free.

We were terrified at first aboutgoing tobacco-free, Jeremy Boberg,The Arks director of admissions,told ADAW. Now people come herebecause were smoke-free.

Treatment Program Profile

Centers ability to go smoke-freebodes well for others in Utah

8/7/2019 ADAW23_14e

2/8

Alcoholism & Drug Abuse Weekly April 4, 20112

It is illegal under federal copyright law to reproduce this publication or any portion of it without the publishers permission. Alcoholism & Drug Abuse WeeklyDOI: 10.1002/adaw

riers between substance abuse andmental health.

Response to feedbackThe inclusion of recovery sup-

port is a key change from previousversions, and was made based onpublic feedback, explained KanaEnomoto, director of SAMHSAs Of-fice of Policy, Planning, and Innova-tion. This is where we get recoverysupport into the treatment system,she said. One of the major com-ments that we received from stake-holders was about employment, andhow important that is to people inrecovery from addiction, she toldADAW. It can be preventive, so we

have the emphasis on supportedemployment.

Were pleased to see SAMHSAsrenewed focus and sense of urgencyand opportunity around recovery,Pat Taylor, executive director of Fac-es and Voices of Recovery, said lastweek. The new recovery supportinitiative and the recovery and well-ness orientation woven into the mili-tary families, health reform and oth-er initiatives offers hope for strategiesand programs that will help people

manage their recovery from addic-tion and mental illness the way theymanage other health conditions.

The four goals of the new re-covery support initiative are:

Strategic from page 1 1. Promote health and recovery-oriented service systems forindividuals with or in recov-ery from mental and sub-stance use disorders.

2. Ensure that permanent hous-

ing and supportive servicesare available for individualswith or in recovery frommental and substance usedisorders.

3. Increase gainful employmentand educational opportuni-ties for individuals with or inrecovery from mental andsubstance use disorders.

4. Promote peer support and thesocial inclusion of individualswith or in recovery from men-

tal and substance use disor-ders in the community.

Employment is also a concernfor the treatment workforce, butworkforce one of the original 10initiatives was taken out last fall.We added a section on workforceto every one of the initiatives toshow that our commitment spansthem all, said Enomoto.

PreventionThere are two prevention initia-

tives for substance abuse one isfocused on reducing problem drink-ing and underage drinking, and theother is on reducing prescriptiondrug abuse. Asked how prescription

drug abuse can be the main targetuntil 2014 when trends shift andheroin may be the main problemthen, for example Enomoto saidthe choice was made because of thenumber of partners that need to

help in the effort. Its not becauseof a focus on a drug du jour, saidEnomoto. But alcohol and prescrip-tion drugs both involve multiplesystems in prevention, and thatswhy they are targeted.

With alcohol there are differ-ent players that have to be in-volved, such as retailers, she said.And preventing abuse of medica-tions involves different partnersthan preventing abuse of illegaldrugs, she said. If youre looking

at it from the perspective of an in-dividual with an addiction problem,it doesnt matter about partners, butfrom a policy viewpoint, we needto focus on partners that we didnthave before. In particular, shementioned the National Institute onDrug Abuse and the Food and DrugAdministration.

Partners outside SAMHSAEach initiative comes with two

measures to be used for account-

ability: one an aspirational or pop-ulation-based measure that goes be-yond SAMHSAs resources, and onea SAMHSA-specific measure. For ex-ample, for Data, Outcomes, and

Executive Managing Editor Karienne Stovell

Editor Alison KnopfContributing Editor Gary EnosProduction Editor Douglas DevauxExecutive Editor Isabelle Cohen-DeAngelisPublisher Sue Lewis

U.S./Can./Mex.), $843 (individual, rest of world), $4835 (institutional, U.S.), $4979(institutional, Can./Mex.), $5027 (institutional, rest of world); Print & electronic:$769 (individual, U.S./Can./Mex.), $913 (individual, rest of the world), $5563 (institu-tional, U.S.), $5707 (institutional, Can./Mex.), $5755 (institutional, rest of the world);Electronic only: $699 (individual, worldwide), $4835 (institutional, worldwide).Alcoholism & Drug Abuse Weekly accepts no advertising and is supported solely byits readers. For address changes or new subscriptions, contact Subscription Distri-bution US, c/o John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030-5774;

(201) 748-6645; e-mail: [email protected]. 2011 Wiley Periodicals, Inc., a WileyCompany. All rights reserved. Reproduction in any form without the consent of thepublisher is strictly forbidden. For reprint permission, call (201) 748-6011.

Alcoholism & Drug Abuse Weekly is indexed in: Academic Search (EBSCO), Aca-demic Search Elite (EBSCO), Academic Search Premier (EBSCO), Current Abstracts(EBSCO), EBSCO Masterfile Elite (EBSCO), EBSCO MasterFILE Select (EBSCO),Expanded Academic ASAP (Thomson Gale), Health Source Nursing/Academic,InfoTrac, Proquest 5000 (ProQuest), Proquest Discovery (ProQuest), ProQuestHealth & Medical, Complete (ProQuest), Proquest Platinum (ProQuest), ProquestResearch Library (ProQuest), Student Resource Center College, Student ResourceCenter Gold and Student Resource Center Silver.

Business/Editorial Offices: John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ07030-5774; Alison Knopf, e-mail: [email protected] ; (845) 418-3961.

To renew your subscription, contact Subscription Distribution US, c/o John Wiley& Sons, Inc., 111 River Street, Hoboken, NJ 07030-5774; (201) 748-6645; e-mail:[email protected].

ISBN 978-1-118-02077-7

Alcoholism & Drug Abuse Weekly (Print ISSN 1042-1394; Online ISSN 1556-7591) isan independent newsletter meeting the information needs of all alcoholism anddrug abuse professionals, providing timely reports on national trends and develop-ments in funding, policy, prevention, treatment and research in alcohol and drugabuse, and also covering issues on certification, reimbursement and other news ofimportance to public, private nonprofit and for-profit treatment agencies. Pub-lished every week except for the last Monday in April, the first Monday in July, thelast Monday in November and the last Monday in December. The yearly subscrip-tion rates for Alcoholism & Drug Abuse Weekly are: Print only: $699 (individual,

8/7/2019 ADAW23_14e

3/8

April 4, 2011 Alcoholism & Drug Abuse Weekly 3

Alcoholism & Drug Abuse WeeklyDOI: 10.1002/adaw A Wiley Periodicals, Inc. publication. View this newsletter online atwileyonlinelibrary.com

Continues on next page

Quality, the population-based mea-sure is to increase the number ofstates adopting the BehavioralHealth Barometer for planning andreporting purposes. The SAMHSA-specific measure is to reduce con-

tract evaluation expenditures by 10percent by 2012 through implemen-tation of a SAMHSA-wide evaluationstrategy.

SAMHSA is still developing theBehavioral Health Barometer, whichwill provide a snapshot of the statusof various behavioral health indica-tors both nationally and withinstates, showing trends and progressin mental health promotion and sub-stance abuse and mental illness pre-vention and treatment.

It is important for SAMHSA tobe accountable for achieving out-comes within its programs, saidEnomoto. But we could have the

Were trying to set a tone for the nation,for states, to see what their responsibility is.

Kana Enomoto

most effective programs in the world if were not moving the needleoutside our programs as well, it isnt

working. The population-basedmeasures are things in which SAM-HSA has a role to play, she said.We have the incentive and the con-vening power to bring together part-ners who otherwise might not seetheir roles this way.

The message is that there are

other players to help SAMHSA. If wesay only SAMHSA is responsible forbehavioral health than other people

would abdicate that responsibility,said Enomoto. Were trying to set atone for the nation, for states, to seewhat their responsibility is.

The initiatives will guide budgetdecisions, according to SAMHSA,with health care reform and parity

driving changes.

ASAM paper outlines reasons for banning medical marijuanaThe American Society of Addic-

tion Medicine (ASAM) has issued awhite paper urging a halt to medi-cal marijuana, even in the 16 stateswhere it has been declared legal,

and telling physicians that if theyprescribe it, they may be violatingtheir oath to do no harm.

Throughout the white paper,medical marijuana is in quotationmarks, conveying ASAMs belief thatas an unapproved substance, it isnot medical.

In the report, first approved bythe ASAM board two years ago, andthen put out for field review, the or-ganization discourages states fromgetting involved in the Food andDrug Administration (FDA) approvalprocess of medications. ASAM is-sued its policy statement againstmedical marijuana that is not ap-proved by the FDA a year ago, whenit also said ASAM rejects smokingas a means of drug delivery since itis not safe. The white paper ex-plains how botanical products canbe approved as medications, whysmoking isnt the best way to get the

right dose, and goes into detailabout the addictive and damagingproperties of smoked marijuana.

We do not recognize this as amedication as it has not gone

through an official FDA-approvalprocess, said Louis E. Baxter, Sr.,

MD, FASAM, president of ASAM andboard chair, in a March 23 state-ment. As experts in addiction medi-cine, we reject having its use as suchfoisted upon us to effectively regu-late a non-FDA-approved substanceto administer as medicine. We alsoadvise physicians against recom-

We urge physicians to reject this role,and remind those who recommend cannabisthat they could fail to meet their professional

obligations to patients and possiblyhave their license revoked.

Andrea G. Barthwell, M.D.

mending it, as it is, and possibly for-saking the Hippocratic Oath of firstdo no harm.

Medical marijuana laws putphysicians in an untenable position

as gatekeepers to a controlled sub-stance still deemed illicit by the fed-

eral government, said Andrea G.Barthwell, M.D., former president ofASAM and CEO of her own consult-ing firm EMGlobal. We urge physi-cians to reject this role, and remindthose who recommend cannabisthat they could fail to meet their

The report is available athttp://store.samhsa.gov/shin/content/SMA11-4629/01-FullDocument.pdf.

8/7/2019 ADAW23_14e

4/8



Continued from previous page

professional obligations to patientsand possibly have their license re-voked. Barthwell was formerly withthe Office of National Drug ControlPolicy in the Bush Administration,

where she championed screeningand brief intervention.Robert L. DuPont, M.D., who

worked with Barthwell on develop-ing the policy on medical marijuanaand who was the first director of theNational Institute on Drug Abuse inthe 1970s under President Nixon,noted that marijuana is not theharmless herb many believe it is.He added that more than half of thepeople who had an illicit substanceuse disorder in 2009 were depen-

dent on or abused marijuana.Smoking marijuana leaves tar in

the lungs four times as much ascigarettes do, because marijuanasmokers take deep breaths and holdthem, said DuPont.

But that does not mean ASAM isagainst the development of cannabi-

noids to treat various conditions, in-cluding those that medical marijuanais prescribed for (nausea caused bychemotherapy, for example). Weare accumulating knowledge aboutthe bodys cannabinoid receptor sys-tem, said DuPont. ASAM recom-mends developing ways to manipu-late the system with standardizedpreparations or single molecules tousher in a new era of medical treat-ments, he said. But medical mari-

juana currently has no quality con-trol, marijuana bought in dispensariescan be contaminated with pesticidesand germs, and patients do not get areliable and reproducible dose.

Without a foundation of rigor-

ous data developed in proper clinicaltrials and published in peer reviewedjournals, no cannabis product cangain entrance into the physicians ar-mamentarium and thereby becomeavailable to patients as a legitimateoption among various treatmentchoices, said Barthwell. And ironi-cally, continued legalized usage un-dermines any reason to put cannabis-based products through the FDAapproval process.

Texas reforms instituted fouryears ago led to investing funds incommunity-based treatment instead

of building more pris-ons. Those reforms,which led to a de-

crease in the crime rateand fewer inmates, are now threat-ened by budget cuts. So is non-crim-inal justice related treatment.

The biennial budget is any-where from $15 billion to $27 bil-lion short, and the legislature wasspending last week making cuts,mainly to education, treatment, andrehabilitation.

Against this backdrop, TreatTexas is calling on legislators to savefunding for substance abuse treat-ment programs. A coalition ofgroups, Treat Texas notes that if thelegislature slashes several milliondollars or more from the budgetcurrently allocated for those pro-grams, the state would forfeit theblock grant match.

We know that the state has abudget shortfall and that, as a result,cuts in all areas will be on the table,said Cynthia Humphrey, executive

director of Treat Texas, which isbased in Austin. But reducing fundsfor drug and alcohol treatment pro-grams is short-sighted and will ulti-mately cost taxpayers more in thelong run.

Rather, Treat Texas is askinglegislators to increase funding fortreatment, to help reduce the budgetshortfall in future years. Humphreysaid drug and alcohol treatmentrepresents a miniscule portion ofthe states overall healthcare spend-

But reducing funds

for drug and alcohol

treatment programsis short-sighted and

will ultimately cost

taxpayers more in

the long run.

Cynthia Humphrey

ing. Out of every dollar Texasspends on solving substance abuseproblems, 2 cents is spent on pre-vention and treatment, she said. In2008, Texas treated only 5.8 percentof addicted people who qualified

for state-funded services.Although Texas has doubled in

population over the past 16 years,funding for treatment has not keptpace, according to Humphrey. Withnearly 1.8 million Texans sufferingfrom alcohol or drug dependency,its very likely this problem touchespeople in everyones life, saidHumphrey. Treat Texas has launcheda grassroots program urging peopleto contact their legislators.

Meanwhile, the state budget de-liberations are continuing. TheHouse Appropriations Committeelast month approved the $164.5 bil-lion two-year budget by a vote of18-7, with all Republicans voting forit and all Democrats voting against it.There are many freshmen in theHouse with Tea Party connectionswho want to cut funding. The cut of12.3 percent nearly $23 billon is bigger than even the 10.4 percent

State Budget Watch

Treatment and criminal justice alternatives face cuts in Texas

For the white paper, go towww.asam.org/pdf/Advocacy/MedMarijuanaWhitePaper20110314.pdf.

8/7/2019 ADAW23_14e

5/8



cut contained in the initial budget byHouse budget leader Rep. Jim Pitts.

The House was scheduled todebate the budget April 1, but thereis a Republican supermajority and

the cuts are likely to pass. The Sen-ate, however, would rather takemore of the rainy day fund theHouse budget takes one third of it to ease cuts.

NIAAA, mindful of merger, speaks out on alcohols harmful effectsAlthough National Institutes of

Health director Francis S. Collins,M.D., Ph.D., made the decision lastyear (see ADAW, December 6, 2010)to merge the National Institute onDrug Abuse (NIDA) and the Nation-al Institute on Alcohol Abuse andAlcoholism (NIAAA), the battle be-tween the two research communi-ties isnt over.

Last week Bridget F. Grant,Ph.D., Ph.D., Deborah A. Dawson,Ph.D., and Howard B. Moss, M.D,three top scientists at NIAAA, pub-lished a commentary in the earlyview edition ofAlcoholism: Clinicaland Experimental Research (ACER)

showing that five times as manypeople are dependent on alcohol asare dependent on all illicit substanc-es combined. The commentary,called Disaggregating the Burdenof Substance Dependence in the

United States, also noted the para-dox that while heavy drinkingcauses the greatest amount of harmat the individual level, low to mod-erate drinking, because it is so prev-alent, causes the greatest amount ofharm at the aggregate level.

NIAAAs point, according toMoss, who is associate director forclinical and translational research atNIAAA, is funding. We had usedthis paper internally to deal withsome of the issues related to themerger, Moss told ADAWlast week.Our colleagues at NIDA had over$1 billion for research in 2010, hesaid. NIAAA had $455 million. Thereal public health needs and the po-tential for public health benefits liein addressing alcohol and tobacco,said Moss, who, along with his col-leagues, is clearly upset about thefunding disparity.

Both NIDA and NIAAA have

active medication developmentprograms, and both are doing largescale clinical trials. Yet the develop-ment of a medication that workshas been elusive. Methadone,acamprosate, and naltrexone wereapproved decades ago, and bu-prenorphine was developed morethan 10 years ago.

The ACER commentary is thefirst time NIAAA publicized thisdata, said Moss, who said its impor-tant to recognize that the garden-variety drinkers cause public healthharm because there are so many ofthem, even if individually they donthave alcohol dependence.

The new institute, still unnamed,would combine relevant portfoliosfrom NIDA, NIAAA, and other NIHinstitutes and centers, with some ofthe current organ research (suchas liver) expected to go to other in-stitutes.

Also in the April issue ofACERwas a commentary by BankoleJohnson, M.D., Professor and Chair-man of the Department of Psychia-try and Neurobehavioral Sciences atthe University of Virginia, who saidthat collaboration is important. Healso said that alcohol generally haslow addiction potential but becauseof its wide use, contributed to great-er harm than drugs.

ACER is the publication of theResearch Society on Alcoholism,which strongly opposed a merger.

Prevalence and population estimatesof past-year substance use among users: U.S.Adults 18 years of age and older

Substance Prevalence (%) Numberof past year use of past year users

Alcohol 65.44 136,035,000

Tobacco use 27.66 57,503,000

Cannabis 4.07 8,468,000

Opiates 1.81 3,756,000

Sedatives 1.24 2,583,000

Tranquilizers 0.93 1,940,000

Hallucinogens 0.57 1,192,000

Cocaine 0.56 1,169,000

Amphetamines 0.49 1,019,000

Solvents/inhalants 0.11 231,000

Heroin 0.03 64,000

Source: Alcoholism: Clinical and Experimental Research

Distributing print or PDF copies

ofAlcoholism & Drug Abuse Weekly

is a copyright violation.

If you need additional copies,

please contact Sandy Quade

at 860-339-5023 or

[email protected].

For more information on addiction

and substance abuse, visit

www.wiley.com

8/7/2019 ADAW23_14e

6/8



Eradicating problemsBoberg explained that The Ark

experienced a number of manage-ment challenges in the years when it

allowed smoking. A client wouldagree to keep another clients secretin exchange for cigarettes. On otheroccasions, clients would refuse toshare information in group sessions,only to counsel each other later dur-ing smoke breaks with no clinicianpresent.

Clients also would create dan-gerous situations around smoking,such as lighting up in a barn oncampus and putting out the cigarettein a bale of hay. One time, a group

of ladies went up on the roof of thebuilding to smoke, Boberg recalled.

Even a restriction against clientssmoking together didnt seem tomake the problems go away. Finally,it was announced at the center oneday back in 2004 that if one moreproblem related to smoking oc-curred, the facility would go smoke-free for the subsequent 30 days.

It didnt take long for the threat-ened ban to go into effect a prob-lem triggered it later that day. But

what was designed to be a 30-dayreprimand would eventually be ex-tended to a permanent ban onsmoking for both residents and staff,based largely on positive commentsfrom clients during the initial ban,Boberg explained.

After two weeks, we had cli-ents coming to us and saying, Thankyou, Boberg said. We said,What?

Even at that point, facility ad-ministrators werent sure theywould make the ban permanent,wondering if in some way prohibit-ing smoking would constitute toomuch of a punishment for recover-ing addicts. But as a 12-Step basedorganization that also integratesother interventions that show effec-tiveness in research evidence, TheArk began to be swayed by studiesshowing that not addressing smok-ing among those addicted to other

substances can impede their recov-ery, leaving the tobacco use as apotential trigger to relapse to othersubstance use.

We decided that if we were go-ing to end up closing our doors,

wed close the doors doing the rightthing, Boberg said.Now, rather than being seen as

a deterrent to admission for pro-spective clients and their families,the smoke-free campus has becomea selling point for The Ark, Bobergsaid. Many incoming clients are cur-rent smokers who want to get offtobacco as they seek to stop usingother substances, he said.

In addition, Every family mem-ber wants to have the person in a

facility that is tobacco-free, he said.We hear in particular from momsand sisters on this.

Certainly the ban has broughtsome challenges. Boberg said thatover the past four years, The Arkhas lost three clinicians who werentable to live by the smoke-free edict.Now Boberg says, Id much ratherhire staff members who are in re-covery from tobacco or who havenever smoked.

Also, some clients still will try tocheat the system, though Bobergsays most confiscations of cigarettestake place at admission. Relapse totobacco use while in the programremains more common in The Arksclient population than relapse toother substance abuse is, and Bo-berg says the facilitys response tothese occurrences depends on indi-vidual circumstances.

Id much rather hirestaff members whoare in recovery fromtobacco or who have

never smoked.Jeremy Boberg

Some of the questions the facil-ity asks in evaluating a situation in-clude where the clients tobaccowas obtained, what problem the cli-ent might be self-medicating, andwhat the clients intentions are long-

term, Boberg said.Sometimes we still get resis-tance [to the policy], he said.Sometimes I will have someonesobbing in my office telling me thatI have to give them one more ciga-rette. The answer is always no.

State effortBoberg said that since the time

The Ark was able to go smoke-free,other private facilities in Utah haveinitiated the policy as well. Now at-

tention in the state has turned tosubstance abuse and mental healthfacilities that receive public funding,as all of these centers will be re-quired to go smoke-free by 2012.

Noreen Heid, program managerwith the Utah Division of SubstanceAbuse and Mental Health, toldADAW that while facilities have fo-cused mainly on the smoke-freecampus aspect of the states Recov-ery Plus initiative, the project actu-ally involves much more than sim-

ply banning on-site tobacco use byclients and staff. Treatment centersalso will need to treat nicotine ad-diction along with the other addic-tion issues they address, and the dis-charge planning functions theyconduct will have to include infor-mation about tobacco relapse pre-vention, Heid said.

Its a real culture change, sheexplained.

The state in early 2010 receivedan initial federal grant of $200,000for activities designed to pave theway for changing the system. Stateofficials have emphasized proceed-ing deliberately on an issue that cer-tainly generates anxiety for sometreatment centers that cant envisiontaking away something that has be-come a major part of many of theirpatients lives.

The state has spent the past yearasking facilities to assess their cur-

Smoking from page 1

8/7/2019 ADAW23_14e

7/8



Continues on next page

rent situation around smoking. Heidsaid some of what she termed oldattitudes about smoking persist.Some people say that theyre al-ready asking clients to give up somuch, so how can they ask them to

give this up too? she said.But the division cites a growingbody of research to support the wis-dom of helping clients free them-selves from nicotine dependence.Studies have shown that cravings fornicotine can also increase cravingsfor other drugs. A 2006 study head-ed by renowned researcher JamesProchaska stated that individualswho engage in smoking cessationefforts simultaneously with other ad-diction treatment have a 25 percent

greater likelihood of maintaininglong-term abstinence from alcohol

and illegal drugs.State officials would like to see

facilities adopt comprehensive nico-tine addiction treatment efforts, al-though centers will have leeway indetermining how to design these ini-tiatives. You cant just give people a

nicotine patch and say that youregiving them therapy, Heid said.

Heid added that the division istrying to leverage state health dollarsthat could give treatment centers aone-time infusion of cash to supportmaking nicotine addiction treatmentservices available to clients.

Heid believes that several fac-tors, including national health re-form and its expected emphasis onwellness and preventive care, willserve to convince more states andtreatment providers to embracesmoke-free policies. The Ark of Lit-tle Cottonwoods Boberg believesthat smoking simply has proven tobe too big of a problem for treat-ment centers to ignore.

This is the number one drugof choice for humans, he said. Its

the most addictive substance weknow of.

Briefly Noted

Pain patients on opioids not beingadequately monitored by physicians

Patients prescribed opioids forchronic pain were not appropriatelymonitored, in many cases, by theirphysicians, according to a study

published online February 24 inthe Journal of General InternalMedicine. For patients with a druguse disorder, only 29.3 percent hadurine tests at any time, 52.9 percentsaw their physician at least once anysix months, and 66.7 who requestedearly refills were not given them(patients who say they lost theirmedication should be red flags forpossible abuse). To view the study,Low use of opioid risk reductionstrategies in primary care even forhigh risk patients with chronic pain,go to http://1.usa.gov/f8ACAF.

Monkey study shows cocainescognitive deficits can be overcome

Cocaine use impairs visualworking memory and causes othercognitive deficits, but these can beovercome by increasing the re-wards, according to a results of ananimal study published in the

March 20 issue of The Journal ofNeuroscience. Its well known thatthe level of cognitive deficit canpredict how successful treatment islikely to be, said lead authorCharles W. Bradberry, Ph.D., asso-ciate professor of psychiatry at theUniversity of Pittsburgh School ofMedicine. If we understand whatthe problems are and whether thedrug itself was the cause, then wemight be able to design treatmentsthat have a better chance of work-ing. The researchers studied mon-keys, and found that the cocaineusers had a harder time maintainingfocus and attention. When the re-ward value for accomplishing taskswas increased, the cognitive deficitwas overcome. The next step is touse imaging to see how the brainsstructure changes due to cocaineexposure. The study was funded by

the National Insintute on Drugabuse and the Veterans Affairs Med-ical Research Service.

HITECH funding would goto SA providers under new bill

Last month Sen. Sheldon White-house (D-R.I.) introduced the Be-havioral Health Information Tech-nology Act, which would extendthe Health Information Technologyfor Economic and Clinical Health(HITECH) Act portion of the 2009stimulus bill, the Center for PublicIntegrity reported last week. Thebill, which has been referred to theSenate Committee on Finance,would help fund the use of elec-tronic health records for substanceabuse and mental health providers,who are ineligible to receive HI-TECH funds. According to the Cen-

The Ark of Little CottonwoodFounded: 1999

Capacity: 40 residential beds among

three separate facilities

Treatment Stay: Core program of

90 days

Costs: $12,800 per month for

residential treatment

Payer Source: Primarily self-pay, with

some insurance coverage

CorrectionIn the March 28 issue, Karen Carpenter-Palumbo was identified as the

new president and CEO of the National Association of Addiction Treat-ment Providers, which is correct, and also as board chair due to a typo-graphical error. The board chair is currently Cathy Palm, and a new boardchair will be elected by the board at the NAATP meeting in May. We regretany confusion.

8/7/2019 ADAW23_14e

8/8

Alcoholism & Drug Abuse Weekly April 4, 20118 Alcoholism & Drug Abuse Weekly8


Continued from previous page

terstone Research Institute, only 8percent of behavioral health pro-viders have fully implemented elec-tronic health records. SenatorWhitehouse authored a similar bill

last year, after then-RepresentativePatrick Kennedy offered a Houseversion. Neither bill made it even asfar as a committee vote.

In the States

Maryland Senate approves alcoholtax increase to benefit the schools

The Maryland Senate voted27-19 March 30 to increase a salestax on alcohol from 6 percent to 9

percent, Business Week reported.The increase would raise about $29million in the next fiscal year. Themoney is to be used for the schools,with $9 million going to PrinceGeorges County and $12 million toBaltimore. It also allocates $5 mil-lion for the developmentally dis-abled in fiscal year 2012, $10 mil-lion in fiscal year 2013, and $15million in fiscal year 2014. The al-cohol beverage industry is stillfighting the measure.

Fla. legislators propose eliminatingall funding for adult treatment

Last week the Florida SenateSubcommittee on Health and Hu-man Services Appropriations re-leased a budget proposal thatwould eliminate all state fundingfor adult substance abuse services.More than 37,000 adults would loseaccess to treatment under this pro-posal, advocates say. In addition,each state dollar spent on treatmentgenerates two dollars from localand federal matches.

Indiana facility gets $1.4 millionstate contract

LifeSpring has won a $1.4 mil-lion contract from the Indiana De-partment of Mental Health and Ad-diction to allow its Turning PointCenter to offer subsidies to patientswho cant pay for treatment. The

Coming upThe National Association of Addiction Treatment Providers (NAATP) will hold its

annual meeting May 14-17 in Chandler, Arizona. Go to www.naatp.org for more

information.

The annual meeting of the National Association of State Alcohol and Drug Abuse

Directors will be held June 7-10 in Indianapolis, Idiana. For more information, go to

http://nasadad.org/annual-meeting.

subsidies would be for detoxificationand residential services for 18 beds.The program, based in Jeffersonville,usually only serves nine patients at atime due to lack of funding. Wehope to work closely with localcourts and correctional programs to

maximize the effectiveness of thesenew treatment opportunities, saidTerry L. Stawar, Lifespring presidentand CEO, last week.

Resources

When drug court goes wrongTo find out what can happen to

someone who gets into the wrongdrug court, listen to last weeks ThisAmerican Life episode (you can get

a podcast at thisamericanlife.org).Called Very Tough Love, the pro-gram shows how a teenager whoforged two of her parents checksended up in prison for 10 years,rather than getting probation ordrug treatment, because the drugcourt she was in did not adhere to

the standards recommended by theNational Association of Drug CourtProfessionals. For the transcript, goto http://bit.ly/ftTrN1.

LifeSKills Training top evidence-basedprevention program in schools

According to a study publishedin the Journal of Drug Education,the LifeSkills Training program is thetop evidence-based drug abuse pre-vention program used by elementa-ry schools in the United States. Thestudy is based on a national surveyof school-based prevention curricu-la identified as evidence-based onthree registries: the National Registryof Evidence-based Programs andPractices (NREPP), Blueprints forViolence Prevention, and the U.S.

Department of Educations Office ofSafe and Drug-free Schools. LifeSkillsTraining was the only program onall three registries. The study, fund-ed by the National Institute on DrugAbuse, found that one-third ofschools use a program that is notevidence-based.

In case you havent heardA group of sixth graders, on a class assignment from Boulder Creek High School

in Anthem, Arizona, got a drug-education bill passed in the state legislature

because they felt their community especially their parents werent aware

of the extent of the problem, the Arizona Republic reported. They were so excited

that they made a video calling attention to the bill and posted it on Youtube. But

when local business leaders saw the video Drugs are consuming Anthem, a

voice says, as the camera pans a gated community they complained to school

administrators. Tempers flared, the teacher was almost fired, the principal

threatened to call the police on a parent, and it took spring break for people to

calm down. Now, the teacher, students, and parents say the school administrators

are more concerned about politics than anything else. But they are still going to

pursue getting their bill signed into law.

adaw23_14e

Documents