ADAW Sept 13 2010

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ADAW Sept 13 2010

  1. 1. EAPs incorporate SBI for alcohol AVolume 22 Number 35 for all callers in new pilot initiativeSeptember 13, 2010 Adding a screening and brief inter- treatment, Goplerud told ADAW. ForPrint ISSN 1042-1394 vention (SBI) component for every example, when JPMorgan Chase, a caller — or visitor — to an employ- participant in the initiative, added al-Online ISSN 1556-7591 ee assistance program (EAP) gives cohol screening questions as a rou- companies the opportunity to help tine practice for every caller to theIn This Issue… their employees cut down on drink- company’s EAP, the rate of identifi- ing, and gives workers who need cation of problem use went from more intensive help to access treat- less than 1 percent to between 18-22Study shows link between moderate ment, according to early findings of percent. This is a significant number,drinking and longevity . . . See page 3 the BIG (Brief Intervention Group) considering that there are 160,000TEDS: Admissions age 50 and over initiative. employees at JPMorgan Chase.growing, in financial straits “The goal of the BIG initiative is “We are getting 500-600 percent. . . See page 4 for every EAP in the United States increases in identification rates, with and Canada to be screening for and the potential of increasing by 50Employment closes the marijuana treating alcohol problems,” said Eric percent the number identified andgateway, researchers find Goplerud, Ph.D., director of Ensur- treated for alcohol problems and for. . . See page 6 ing Solutions to Alcohol Problems, drug problems nationally,” said Go-Study identifies risk factors for which is leading the initiative with plerud, who predicts that when underwriting from grants. EAPs do screen routinely, this willaddiction to painkillers . . . See page 6 This screening has the potential result in 900,000 to 1.2 million pa-California treatment program to dramatically increase the number tients a year who need some kind ofwill focus on veterans . . . See page 7 of employees referred by EAPs to See EAPs on page 2Co-occurring SA, bipolar disorder Organizers in Philadelphia expect Tlinked to violent crime . . . See page 7Suboxone costs, abuse worry 10,000 walkers September 25Kentucky officials . . . See page 8 This month, people in recovery and sponsors — ranging from pharma- their friends and families will partic- ceutical organizations like Reckitt- ipate in more than 1,000 recovery Benckiser to local newspapers and ADAW is on Facebook events all around the country. even coffee shops. PRO-ACT will Philadelphia is the national hub of use all proceeds “to support com- If you are a member of Facebook, the 2010 Faces & Voices of Recovery munity activities, educate the public become a fan today. Rally for Recovery, and organizers and media, raise awareness, end there hope for 10,000 people to join discriminatory policies, reduce stig- the walk on September 25. ma, provide individual recovery Last year 4,500 people partici- support, and advocate at the state, pated in the Philadelphia recovery federal and local levels.” walk — on a rainy day. The number The walk has become an essen- has been steadily increasing since tial stop for politicians as well. “We 2002, the first walk, when there used to beg high-profile legislators HEALTH AND were 150 participants. “We’re really to come,” Haberle told ADAW. “Now MEDICAL WRITING hoping for 10,000 this year,” said we just say, ‘See you at the walk!’” Beverly Haberle, executive director Elected and appointed officials© 2010 Wiley Periodicals, Inc. of Pennsylvania Recovery Organiza- now see the recovery movement asView this newsletter online at wileyonlinelibrary.comDOI: 10.1002/adaw.20249 tion — Achieving Community To- “a constituency of consequence.” gether (PRO-ACT). There are also See Recovery on page 5 A Wiley Periodicals, Inc. publication. wileyonlinelibrary.com
  2. 2. 2 Alcoholism & Drug Abuse Weekly September 13, 2010 EAPs from page 1 Abuse Treatment (CSAT) in 2009 for coholism represents only about 3 treatment. a third pilot to explore industry col- percent of the overall drinking pop- But first, employers have to be laboration, said Goplerud. The first ulation,” he told ADAW. The EAPs in willing to add SBI — and pay for it — two pilots were with Aetna Behav- the BIG initiative want to identify to their EAPs. Ensuring Solutions and ioral Health (JPMorgan Chase) and and intervene with the much larger partners on the BIG initiative — in- ValueOptions (UPS), and the third group — 20 percent — who drink cluding JPMorgan Chase and its EAP was with Optum/United (Medica). above the limits recommended by provider, Aetna Behavioral Health Ensuring Solutions also received a the National Institute on Alcohol — are working towards this goal. small grant from Alkermes to devel- Abuse and Alcoholism (NIAAA). “Aetna is making screening and op SBI training for EAP counselors, “This drinking has social, health and brief intervention for alcohol the and some funding from Aetna to productivity costs,” said Derr. “I routine practice for everyone in their think it’s important that we raise the EAP portfolio,” said Goplerud. Every level of awareness around the mis- caller will be asked three questions ‘Aetna is making use and inappropriate use of alco- from the Alcohol Use Disorders hol and its impact on the workplace Identification Test (AUDIT) 10-item screening and brief and healthcare costs.” screen, and if those are positive, the next seven questions, he said. “If intervention for But in the SBI process, the EAP will identify alcoholism as well, said you don’t ask, you can’t identify” alcohol the routine Derr. And if someone is identified in people with alcohol problems. En- the Aetna EAP who also is covered suring Solutions is helping to train practice for everyone by Aetna’s MBHO, that person can counselors on using the AUDIT, and on engaging employees, by the use in their EAP portfolio.’ be “warm-transferred to treatment in a very smooth manner,” he said. of motivational interviewing and Eric Goplerud, Ph.D. Although the same managed cognitive behavioral therapy tech- behavioral health organizations niques, to follow through on refer- (MBHOs) that run the big EAPs are rals and behavior change. train their telephone EAP sponsors. opposing parity’s interim final rule, Ensuring Solutions, based at In addition, SAMHSA is transferring they are supporting SBI by EAPs, George Washington University, re- $50,000 to NHTSA to continue to said Goplerud. There is a clear dis- ceived a two-year grant in 2008 from fund BIG for six months. tinction between an MBHO and an the National Highway Traffic Safety EAP — even if they both operate Administration (NHTSA) to pilot the From EAP to MBHO under the same umbrella, as is the adaptation of SBI in two workplace The goal of SBI is to identify case in these pilots — but “there settings, and a supplemental grant “inappropriate use of alcohol and shouldn’t be a conflict,” said Go- from the Substance Abuse and Men- alcohol misuse,” not alcoholism, plerud. “The orientation of the EAP tal Health Services Administration’s said Dennis Derr, director of the is toward helping people work. The (SAMHSA’s) Center for Substance EAP at Aetna Behavioral Health. “Al- focus of a behavioral health carve- (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 by its readers. For address changes or new subscriptions, contact Subscription Distrib- ution US, c/o John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030-5774; (201) Executive Managing Editor Karienne Stovell 748-6645; e-mail: subinfo@wiley.com. © 2010 Wiley Periodicals, Inc., a Wiley Com- Editor Alison Knopf pany. All rights reserved. Reproduction in any form without the consent of the pub- lisher is strictly forbidden. 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Contributing Editor Gary Enos Production Editor Douglas Devaux Alcoholism & Drug Abuse Weekly is indexed in: Academic Search (EBSCO), Acade- mic Search Elite (EBSCO), Academic Search Premier (EBSCO), Current Abstracts Executive Editor Isabelle Cohen-DeAngelis (EBSCO), EBSCO Masterfile Elite (EBSCO), EBSCO MasterFILE Select (EBSCO), Publisher Sue Lewis Expanded Academic ASAP (Thomson Gale), Health Source Nursing/Academic, InfoTrac, Proquest 5000 (ProQuest), Proquest Discovery (ProQuest), ProQuest Alcoholism & Drug Abuse Weekly (Print ISSN 1042-1394; Online ISSN 1556-7591) is Health & Medical, Complete (ProQuest), Proquest Platinum (ProQuest), Proquest an independent newsletter meeting the information needs of all alcoholism and Research Library (ProQuest), Student Resource Center College, Student Resource drug abuse professionals, providing timely reports on national trends and develop- Center Gold and Student Resource Center Silver. ments in funding, policy, prevention, treatment and research in alcohol and drug abuse, and also covering issues on certification, reimbursement and other news of Business/Editorial Offices: John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ importance to public, private nonprofit and for-profit treatment agencies. Pub- 07030-5774; Alison Knopf, e-mail: aknopf@bestweb.net; (845) 418-3961. lished every week except for the first Monday in April, the first Monday in July, the last Monday in November and the last Monday in December. The yearly subscrip- To renew your subscription, contact Subscription Distribution US, c/o John Wiley tion rates for Alcoholism & Drug Abuse Weekly are: Print only: $699 (individual, & Sons, Inc., 111 River Street, Hoboken, NJ 07030-5774; (201) 748-6645; e-mail: U.S./Can./Mex.), $843 (individual, rest of world), $4835 (institutional, U.S.), $4979 subinfo@wiley.com. It is illegal under federal copyright law to reproduce this publication or any portion of it without the publisher’s permission Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw
  3. 3. September 13, 2010 Alcoholism & Drug Abuse Weekly 3out is on dealing with the present- situation: the need to reintroduce al- lems — underground, said Go-ing problem.” Typically, EAPs are cohol issues to the EAP of today, plerud. When companies have poli-focused on problem-solving and so- said Goplerud. cies of disciplining or firing employ-lutions. “You aren’t going to be “As EAPs became professional- ees who test positive for drugs or al-dealing with serious addiction in an ized by the carveouts, they were cohol, those employees won’t evenEAP, but there could be some brief staffed by people with good mental talk to the EAP.counseling.” health training, but probably not a “One of our transportation com- About 11 percent of the people lot of substance abuse training,” he panies that’s piloting used to have ain the Aetna pilot who screened said. In addition, by the 1990s EAPs very punitive attitude towards alco-positive as potentially at risk for al- were responding to the marketplace hol or drug use,” said Goplerud. “Ifcohol problems were identified as by offering “broad brush” programs the EAP or the health plan or drug“very high risk, possibly alcohol de- designed to help people with every- testing caught you, they fired you,”pendent,” said Goplerud. “This is thing from weight loss and smoking he said. That policy hasn’t been inwhere SBI becomes very relevant cessation to finding a nursing home existence for a decade, but there isfor the treatment world, because it for a worker’s elderly parents. “Fi- still a problem with trust, becausewill identify everyone with prob- nally, EAPs have increasingly be- 41 percent of the callers to the EAPlems, a good proportion of whom come a commodity, something say they don’t drink at all. “That’s anare going to need specialty sub- workplaces think they have to have, unbelievable rate,” said Goplerud.stance abuse treatment.” but they want to do it as cheaply as “If you don’t truly trust your EAP possibly. To do a good job on alco- not to rat on you, you’re not goingBarriers to SBI hol and drug problems, it costs to talk to someone you don’t know In the early days — about 50 money.” The EAP premium for one from Adam about something thatyears ago — EAPs were mainly fo- employee for a year is about 80 could lead to retaliation.”cused on alcoholism, and run by cents, said Goplerud. For EAPs to be successful, em-people who were in recovery them- Another barrier for EAPs trying ployees must trust them, or theyselves, said Goplerud. They were to do SBI is lack of trust on the part won’t share information aboutconcentrated in unions, with mem- of employees. But the drug-free drinking, agreed Derr. “You want tobers helping one another. The mar- workplace program which started in create a culture where the EAP isketplace and the carveouts them- the 1980s drove some people — es- the first resource people go to,” heselves are to blame for the current pecially those with alcohol prob- said. •Study shows link between moderate drinking and longevity For some time researchers have Longer than Non-Drinkers,” for ex- – notably, social isolation. But evenreported that people who don’t ample, did not take into considera- when adjusting for these factors, ab-drink die at a younger age than peo- tion the cautions expressed by the stainers still died earlier than mod-ple who drink moderately. A new authors Charles J. Holahan, Ph.D. erate drinkers.study by researchers who have been and colleagues. “Overall, our findings are con-looking at this phenomenon sheds “Even among moderate drinkers, sistent with an interpretation that anlight on the role of confounding fac- higher levels of alcohol consump- important part of the survival effecttors — people who used to be tion and heavy episodic drinking for moderate drinking compared toheavy drinkers, for example — but may adversely affect safety and abstention among older adults is ex-still concludes that, in fact, moder- quality of life,” they wrote, noting plained by the effect of confoundingate drinking does seem to increase that consuming more than two factors associated with alcohol ab-longevity, compared to heavy drink- drinks a day has been associated stention,” the authors wrote. “How-ing, light drinking, and abstaining. with an increased risk of falls, a ever, even after taking account of all The study, “Late Life Alcohol higher risk of alcohol use problems, of these traditional and nontradition-Consumption and 20-Year Mortali- and potential adverse interactions al covariates, moderate alcohol con-ty,” created a stir in the lay press with medications. sumption continued to show a sig-when it was published online Au- Current abstainers in the study nificant, though attenuated, associa-gust 24 in Alcoholism: Clinical and included former problem drinkers, tion with lower mortality risk.”Experimental Research. But the people with health problems such The study looked at alcoholheadlines that blared “Live Longer as obesity and smoking, and so- consumption and mortality amongwith Three Glasses of Alcohol” and ciodemographic and behavioral fac- 1,824 older adults over a 20-year pe-“Consume Lots of Alcohol, Live tors linked to increased risk of death Continues on next pageAlcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication. wileyonlinelibrary.com
  4. 4. 4 Alcoholism & Drug Abuse Weekly September 13, 2010 Continued from previous page abstainers and heavy drinkers both ular moderate drinking.” riod. Prior to adjusting for con- showed increased mortality risks Participants were enrolled be- founding factors, abstainers had compared to moderate drinkers, of tween the ages of 55 and 65; life- more than twice the mortality risk 49 and 42 percent. After adjusting, time abstainers were excluded. The compared to moderate drinkers. there was no longer any difference researchers defined four categories Heavy drinkers had a 70-percent in- in mortality risk between moderate of average daily alcohol consump- creased risk compared to moderate and light drinkers. tion at baseline: abstainer, light (up drinkers, and light drinkers had a Citing previously published re- to one drink a day), moderate (be- 23-percent increased risk. search, the authors suggested that tween one to less than three drinks The researchers found that at health-protective effects of moder- a day), and heavy (3 or more drinks baseline, abstaining older adults ate alcohol consumption may be re- per day). This resulted in a total of were significantly more likely than lated to reductions in cardiovascular 345 (19 percent of the sample) ab- moderate drinkers to have prior disease. The adverse health effects stainers, 595 (32 percent) light drinking problems, current obesity of heavy drinking compared to drinkers, 560 (31 percent) moderate and smoking, to have depressive moderate drinking are due mainly drinkers, and 324 (18 percent) symptoms, not to be physically ac- to non-cardiovascular diseases: heavy drinkers. tive, not to have close or quality head and neck cancer, cirrhosis, The researchers concluded by friends, and not to be married. After pancreatitis, and hypertension, as saying that more research is needed controlling for all of these factors, well as injuries. The authors stress to further explore the reasons for the mortality risk for abstainers that “any health-protective effects of the link between moderate drinking compared to moderate drinkers alcohol appear to be limited to reg- and longevity. • dropped by one third, approaching the same risk as that of heavy For the study, which is available online, go to drinkers. Still, even after adjusting, http://onlinelibrary.wiley.com/doi/10.1111/j.1530-0277.2010.01286.x/full. TEDS: Admissions age 50 and over growing, in financial straits Older adults admitted to treat- group has dropped, from 32 percent clear depiction, in graphs, of the ment are in increasingly difficult fi- in 1992 to 24 percent in 2008. drastic economic situation of pa- nancial situations, with more than The percentage of older adults tients age 50 and older, showing half of them either on unemploy- admitted to treatment with no in- also that homelessness grew among ment assistance or having no in- come at all has been steadily in- this group. The report urges treat- come at all, according to a report re- creasing, from 11 percent in 1992 to ment providers to pay special atten- leased last week by the Substance 20 percent in 2000 to 29 percent in tion to the financial needs of these Abuse and Mental Health Services 2008. The percentage on a retire- patients. “These findings suggest that this population may need fi- nancial assistance with the costs as- ‘These findings suggest that this population sociated with substance abuse treat- ment,” the report states. “Additional may need financial assistance with the costs case management programs and associated with substance abuse treatment.’ services may be needed to help in- dividuals in this age group who are SAMHSA currently in treatment or transition- ing out of treatment find housing and employment.” Administration (SAMHSA). Between ment or pension declined as well, These patients also have fewer 2000 and 2008, the percentage of from 10 percent in 1992 to 7 percent social supports, with a greater pro- adults age 50 or over who are on in 2000 to 4 percent in 2008. And portion having never married. Pa- unemployment rose from 18 per- fewer are on public assistance; in tients who had never married more cent to 31 percent. In 1992, 19 per- 1992 16 percent of this age group than doubled between 1992 (13.2 cent of this population was on un- was on public assistance, compared percent) and 2008 (30.3 percent). employment, reflecting the better to 11 percent in 2000 and 8 percent And even among those had married, economic times of the 1990s. At the in 2008. more were divorced or widowed. same time, wages or salary as a The Treatment Episode Data Set “This finding draws attention to a principal source of income for this (TEDS) report from SAMHSA gives a possible need for additional social It is illegal under federal copyright law to reproduce this publication or any portion of it without the publisher’s permission Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw
  5. 5. September 13, 2010 Alcoholism & Drug Abuse Weekly 5support for these admissions as they ic, indicating “the need for gender Distributing print or PDF copies ofprogress through and transition out and culturally appropriate services.” Alcoholism & Drug Abuse Weeklyof treatment.” The number of older adults is a copyright violation. The report also showed an in- admitted to treatment has doubled, If you need additional copies,crease in the number of admissions from 102,700 in 1992 to 231,200 in please contact Sandy Quade atwho were female, Black, or Hispan- 2008. • 860-339-5023 or squadepe@wiley.comGo to http://oas.samhsa.gov/2k10/240/240OlderAdm2k10Web.pdf for the for special discounted rates.complete report.Recovery from page 1Gil Kerlikowske, director of the Of-fice of National Drug Control Policy, The recovery movement and methadoneand H. Westley Clark, M.D., J.D., di- in Pennsylvaniarector of the Center for Substance Opioid treatment programs (OTPs) are getting some support fromAbuse Treatment, will be at the the recovery movement in Pennsylvania, where a group of legislators arePhiladelphia walk as well. trying to severely limit methadone maintenance treatment (see ADAW, June 28). “We’ve met with some of the prime sponsors to give our inputTeams and express our concern about this,” said Beverly Haberle, executive Many recovery month activities director of PRO-ACT.are sponsored by organizations that The Pennsylvania Drug and Alcohol Coalition tried to come up withare engaged in recovery activity, a response in support of medication-assisted treatment and OTPs at itssaid Pat Taylor, executive director last meeting, said Haberle, who serves on the coalition. But reaching aof Faces & Voices of Recovery, consensus was difficult because “some factions within the field arewhich is coordinating the events anti-medication,” she told ADAW. “The goal was to present somethingon a national basis. “The impact atthe community level is a much from the entire coalition that everyone could agree on.”broader network supporting recov- Pat Taylor, executive director of Faces & Voices of Recovery, whichery month activity,” she told ADAW. strongly supports the concept that people in medication-assistedTeams of people walk, sometimes treatment, including with methadone, are in recovery, noted that Reckittfor a family, or honoring a recov- Benckiser (maker of Suboxone) and Alkermes (maker of Vivitrol) areery. There are also teams like sponsors of the September 25 recovery walk to be held in Philadelphia.“Teachers for Recovery” and There will be representatives from OTPs marching as well, and, she“Lawyers for Recovery.” hopes, patients. “Usually there is a recovery speaker at every rally who The Philadelphia walk is also represents medication-assisted treatment as well,” she told ADAW. “Butgoing to have an “honor guard” — there is still a lot of work to do to help people understand that beingpeople with at least 10 years of re- in medication-assisted treatment is being in recovery.”covery. The honor guard will leadthe walk, and then will part and letthe rest of the walkers through, people trying to break away from stages of recovery, who themselvessymbolizing hope for people newly their old drinking and drug-using are just learning how to define it,”in recovery, said Haberle. “Our goal “friends, places and things.” she said. “We have to talk about re-is to have 500 people in the honor currence, not relapse.” It’s importantguard, representing 5,000 years of Stages of recovery to make the movement “safe” forrecovery.” The recovery movement in- people newly in recovery, as well as Some providers bring everyone cludes people who are no longer for people in long-term recoveryin treatment with them to the walk, using alcohol or other drugs, people who still are rooted in the AA beliefsaid Haberle. “It’s very reinforcing who are on medication-assisted treat- in anonymity.for them, to see that long-term re- ment such as methadone or Vivitrol, The involvement of manycovery is possible.” And because of and even people who have cut back young people who have four or fivethe many family-oriented events on their use of alcohol and drugs. years of recovery in Faces & Voicesthat take place around the walk, “From PRO-ACT’s perspective, peo- of Recovery, and the recoverythey can also see that the recovery ple are in recovery when they say month activities, has contributed tomovement gives them social oppor- they’re in recovery,” said Haberle. a year-round focus on support andtunities — particularly important for “We have people in the early Continues on next pageAlcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication. wileyonlinelibrary.com
  6. 6. 6 Alcoholism & Drug Abuse Weekly September 13, 2010 Continued from previous page work — which is often unromantic events being held across the coun- advocacy, said Taylor. The increas- and hard — involved in organizing, try this month. “Rally for Recovery is ing participation in the walks is also such as the billboards that must be meant to focus attention on one a reflection of the more sophisticat- ed organizing ability of groups that are involved, she said, adding that ‘It’s more than people coming together to put every month there is a telephone call for people involved in the a face and voice on recovery — it’s advocacy.’ movement to share information. Pat Taylor “It’s more than people coming together to put a face and voice on recovery – it’s advocacy,” said Tay- put up along the highway to publi- day, so we’re really pleased to be lor. Work on getting the parity bill cize the walk (PRO-ACT did that able to partner with PRO-ACT in passed helped strengthen the advo- this year). terms of this being a national hub cacy component, which this year is There are over 1,000 recovery event,” said Taylor. • focused on making sure that recov- ery support services are included in For people who want to participate via the web, Faces & Voices of Recovery health reform. launched a new online rally last week. And that energy pays off in the Go to www.facesandvoicesofrecovery.org/rally. Employment closes the marijuana gateway, researchers find The gateway from marijuana use ployed, were not any more likely illicit drug use in adolescence, our to harder drugs is stress related to to use other illicit substances as results indicate that the effect may unemployment, not the marijuana it- young adults. be short-lived, subsiding by age 21,” self, according to research published “Employment in young adult- the researchers said. “Interestingly, in the September issue of the Jour- hood can protect people by closing age emerges as a protective status nal of Health and Social Behavior. the marijuana gateway,” said Karen above and beyond the other life sta- According to the study, marijuana Van Gundy, associate professor of tuses and conditions considered here. does not have a “gateway effect” in sociology at the University of New We find that respondents ‘age out’ and of itself, and the strongest pre- Hampshire and lead author of the of marijuana’s gateway effect regard- dictor of whether someone will use study. “Over-criminalizing youth less of early teen stress exposure or harder drugs — whether or not they marijuana use might create more se- education, work, or family statuses.” used marijuana — is race/ethnicity. rious problems if it interferes with The article has implications for For the study, researchers from later employment opportunities.” drug policy, the authors conclude, the University of New Hampshire Furthermore, once young adults urging policymakers “to consider used survey data from 1,286 young reach age 21, the gateway effect dis- stress and life-course approaches in adults who attended Miami-Dade appears completely. “While marijuana their pursuit of solutions to the public schools in the 1990s. Within use may serve as a gateway to other ‘drug problem.’” • the final sample, 26 percent of the respondents are black, 44 percent are Hispanic, and 30 percent are non-Hispanic white. Not graduating Briefly Noted links to an increased risk for addic- tion to painkillers. The study, con- from high school or attending col- ducted by Joseph Boscarino, Ph.D., lege was associated with higher Study identifies risk factors an epidemiologist and senior inves- rates of both marijuana and harder for addiction to painkillers tigator at Geisinger’s Center for drug use. Those who used marijua- A study published in the Sep- Health Research, suggests that these na as teenagers were more likely to tember issue of Addiction has iden- risk factors may also indicate an in- use other illicit drugs as young tified four risk factors for painkiller creased risk for drug addiction even adults if they were unemployed fol- addiction in patients with chronic in patients without a history of lowing high school. pain: age (65 years or younger), a chronic pain. “These findings sug- However, employment elimi- history of drug abuse and depres- gest that patients with pre-existing nated those differences — people sion, and the use of psychiatric risk factors are more likely to be- who used marijuana as teenagers, medications. Researchers also stud- come addicted to painkillers, pro- but went on to college or were em- ied — and found — possible genetic viding the foundation for further It is illegal under federal copyright law to reproduce this publication or any portion of it without the publisher’s permission Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw
  7. 7. September 13, 2010 Alcoholism & Drug Abuse Weekly 7clinical evaluation,” said Boscarino. Noting that 61 percent of the city’s gram. The Army is hiring seven“By assessing patients in chronic voters approved Proposition T, more counselors to work at Fortpain for these risk factors before which would provide “treatment on Carson. Last year, Fort Carson wasprescribing painkillers, doctors will demand,” Avalos criticized the “tug the subject of an investigation fol-be better able to treat their patients’ of war” between Mayor Gavin lowing a spate of homicides, andpain without the potential for future Newsom and the Board of Supervi- one finding – that soldiers whodrug addiction.” For the study, re- sors. “The mayor’s cuts and the needed substance abuse help wouldsearchers accessed electronic health board’s restorations to substance have to leave the service in order torecords of Geisinger patients with abuse treatment are like a never- get it – led to calls to remove barri-back pain and related conditions ending cycle, repeated year after ers to such assistance (see ADAW,who were prescribed opioid pain- year in a downward spiral exacer- July 27, 2009).killers for more than 90 days. A bated by the ongoing budgetsample (705) of these patients were deficit,” he said. Before proposing Study of compound shows linkinterviewed, and their DNA was col- the fee, the city commissioned a between alcohol and eatinglected and studied. The researchers study which found that alcohol A compound that suppresses al-looked at a gene located on chro- costs the city $17.7 million in am- cohol craving in humans also de-mosome 15 that has been implicat- bulance, treatment, prevention, and creases sugar consumption by ro-ed in alcohol, cocaine and nicotine, hospital services. It does not in- dents, according to a study by re-but did not find a clear link to opi- clude law enforcement costs. searchers at the Ernest Gallo Clinicoid addiction, they said. and Research Center of the Univer- California treatment program sity of California, San Francisco. TheAlcohol lobby vs. San Francisco as will focus on veterans compound, ezlopitant, blocks thefee fight continues Victory Village, owned by the action of a neurotransmitter that A proposal to pay for substance Oroville Economic and Community plays a role in the reward system,abuse treatment in San Francisco by Development Corporation, is according to researchers. The ratsadding a fee, to be paid by whole- launching a program to treat veter- were less motivated to drink sugarsalers and distributors, equivalent ans with substance abuse problems water when on ezlopitant. “Thisto 3 to 5 cents a drink, has public in Northern California. The residen- finding suggests a possible link be-support but is opposed by the alco- tial program will provide substance tween the neurochemical pathwayshol lobby. The Alcohol Cost Recov- abuse treatment as well as mental for addiction and compulsive eat-ery Fee proposed by John Avalos, health counseling, medical care, job ing,” said principal investigator Sele-chair of the San Francisco Board of training, and other services. Mike na Bartlett, director of the Pre-Clini-Supervisors budget committee, Anderson, a drug and alcohol coun- cal Development Group at the Gallowould be on wholesalers and dis- selor, will run the program, which Center. The study was publishedtributors, not local bars and restau- will serve 48 veterans and include September 1 in PLoS One.rants. Yet “big alcohol” has stepped 30 housing units and 16,000 squarein to oppose it, said Avalos. Two feet of retail space. The nonprofit Co-occurring SA, bipolar disorderSan Francisco lobby firms have corporation is buying the property linked to violent crimebeen brought into the fray to “whip and rehabilitating it for $6 million, Although guidelines don’t rec-up local opposition to the fee and according to news reports. About ommend routine risk assessment forfoment fear among bar and restau- 3,000 homeless veterans live in violence for violence in patientsrant owners and local merchants Northern California. with bipolar disorder, if there is co-organizations,” he said. “They claim occurring substance abuse therethe fee will be passed through as a Alcohol abuse counseling to be may be need for such an assess-50 cents-to-$1 increase on a serv- offered anonymously at Fort Carson ment, according to research pub-ing, and have dressed up the fee as In an effort to encourage sol- lished in the current issue of thea major job and business killer. Yet diers to seek help for alcohol prob- Archives of General Psychiatry. Theaccording to the controller’s chief lems, a new Army program will goal of the study was to see if thereeconomist, the fee will decrease allow them to be treated anony- is a link between violent crimeconsumer spending on alcohol by mously, the Associated Press report- (convictions for homicide, assault,less than 1 percent and have very ed earlier this month. Some other robbery, arson, any sexual offense,minimal impact on the economy.” posts already offer anonymous illegal threats, or intimidation) and counseling. Under the new pro- bipolar disorder, and it found no Renew your subscription today. gram, soldiers will no longer have such link exists. But when there was 888-378-2537 to notify supervisors before they go substance abuse as well, the risk in- to the Armys Substance Abuse Pro- Continues on next pageAlcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication. wileyonlinelibrary.com
  8. 8. 8 Alcoholism & Drug Abuse Weekly September 13, 2010 Continued from previous page creased (adjusted odds ratio of 6.4), Coming up… according to the research, which was written by Seena Fazel, M.D., The 2010 Annual Conference and Training Institute of the Substance Abuse and colleagues. Program Administrators Association will be held October 17-21 in Las Vegas. Go to www.swiftpage6.com/CampResource/2Y0RJSUNHVITLMSO/1/text.pdf for more information. In the States The American Association for the Treatment of Opioid Dependence, Inc. (AATOD) will hold its 2010 National Conference, “Building Partnerships: ‘Don’t share Rx medication’ bags Advancing Treatment & Recovery,” on October 23-27 in Chicago. For more distributed in West Virginia information, visit www.aatod.org. This month Take Care West Vir- The Association for Medical Education and Research in Substance Abuse will ginia, a statewide prescription drug hold its annual conference November 4-6 in Bethesda, Md. For more abuse prevention campaign, will information, go to www.amersa.org/conf.asp. help pharmacies distribute medica- Therapeutic Communities of America will hold its national conference tion bags that say “Don’t share Rx November 7-10 in Washington, D.C. For more information, go to http:// medication.” The campaign is “aimed registration.sitesolutionsworldwide.com/synergy/v_1_/home/?id=267&info=1 at changing social/culture norms or call Site Solutions Worldwide at (866) 374-6338. about sharing prescription drugs,” said Andy Whisman, senior evalua- The American Academy of Addiction Psychiatry will hold its annual meeting tion specialist at the W.Va. Preven- December 2-5 in Boca Raton, Fla. For more information, go to tion Resource Center, which is run- http://www2.aaap.org/meetings-and-events/annual-meeting. ning the campaign. Almost all of the state’s 55 counties are participating in the Take Care W.Va. message, and so questioned why the state was pay- py — one for counselors, and one are most pharmacies. The campaign ing for Suboxone without counsel- for physicians — both based on is supported with funding from the ing, noting that medication alone is TIP 49. following grants: 2009 Drug Free not enough to treat addiction. But For the Quick Guide for Coun- W.Va. Grant, W.Va.’s federal Strategic Medicaid in Kentucky doesn’t pay selors Based on TIP 49: Incorporat- Prevention Framework State Incen- for substance abuse treatment at all, ing Alcohol Pharmacotherapies Into tive Grant (SPF SIG), and W.Va.’s except for pregnant women. In Medical Practice, go to http:// federal Projects of Regional & Na- most cases, Suboxone is being pre- kap.samhsa.gov/products/tools/cl- tional Significance (PRNS) Grant. scribed by primary care or other guides/pdfs/QGC_49.pdf. physicians, and not by addiction For the Quick Guide for Physi- Suboxone costs, abuse worry treatment programs. cians Based on TIP 49: Incorporat- Kentucky officials ing Alcohol Pharmacotherapies Into Last year Medicaid spent almost $11 million on Suboxone for Ken- Resources Medical Practice, go to http:// kap.samhsa.gov/products/tools/cl- tucky residents, but didn’t pay for guides/pdfs/QGP_49.pdf. any of the recommended counsel- SAMHSA issues guides on alcohol These quick reference tools ing or other treatment, the Louisville pharmacotherapy provide guidance for the use of Courier-Journal reported last week. The Substance Abuse and Men- acamprosate, disulfiram, oral nal- In addition, law enforcement offi- tal Health Services Administration trexone, and extended-release in- cials in the state are concerned (SAMHSA) has issued new Quick jectable naltrexone in the treatment about illegal sales of the medication. Guides on alcohol pharmacothera- of alcohol use disorders. One prescribed tablet costs $7.50 but sells on the street for $20, ac- cording to the report. The $11 mil- lion covers about 1,800 patients a In case you haven’t heard… month. While the state’s Medicaid Three-year old Ardi Rizal from Indonesia, who became famous for being addicted Commissioner thinks Suboxone is a to nicotine, has been treated for one month and is now in recovery, according to good medication, she said there the National Commission for Child Protection. He became addicted after his father need to be tighter controls, partly gave him one cigarette; his parents kept giving them to him to prevent temper because of the increased costs, and tantrums that resulted from craving. Viewers who saw a video of the boy smoking partly because of the drug abuse were shocked. He had been smoking since the age of 11 months and could even problem. Drug treatment officials blow smoke rings. Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication. wileyonlinelibrary.com

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