SAMHSA administrator Pam Hyde outlined plans to dramatically change the agency and the Substance Abuse Prevention and Treatment Block Grant in preparation for health care reform taking full effect in 2014. Key points include: 1) Medicaid will cover many people currently relying on the block grant for treatment, reducing its role. However, an estimated 15 million people will still be uninsured. 2) The block grant will focus more on non-treatment services not covered by Medicaid/insurance, like services for the criminal justice population. 3) SAMHSA is working with CMS and states to determine what each system (block grant, Medicaid, private insurance) should cover for the estimated 6-10 million people newly eligible

1. https://www.aa.org/pages/en_US/twelve-steps-and-twelve-
traditions
R
W
Regulatory and legislative changes
are in store for the Substance Abuse
and Mental Health Services Admin-
istration (SAMHSA), according to
SAMHSA administrator Pam Hyde.
The block grant will change “dra-
matically” before 2014, said Hyde,
speaking at an “Open House” on
SAMHSA’s eight strategic initiatives
on Oct. 8.
Hyde outlined what some of the
current thinking is at the agency
about how to transition to health re-
form. Medicaid, administered by the
Centers for Medicaid and Medicare
Services (CMS), will be covering
many of the people who otherwise
would receive treatment funded by
the block grant, according to that
current thinking.
“While the block grant is in our
house to administer, CMS pays for

2. over half of the nation’s behavioral
health population,” said Hyde. “By
2014, if we get all of the people in,
CMS will be paying for more than
75 percent. They see that coming at
them and they are asking for our
help.”
The field is concerned that in
the move to health reform, the block
grant as it now exists will be dis-
mantled, a concern that increased
when a grant solicitation, since
pulled, surfaced that indicated this
might occur (see ADAW, Sept. 27).
Then the strategic initiatives to take
SAMHSA from 2011 to 2014 were re-
leased, along with a request for
comments (see ADAW, Oct. 11). This
set the stage for the conversation to
move into the public arena, and dur-
ing the three-hour “Open House,”
While legislation on the credential-
ing of addiction counselors has gen-
erated divisiveness among profes-
sionals in some states, Kansas is
moving toward the effective date of
a licensure law that was adopted
with minimal fanfare and appears
not to be disruptive to most treat-
ment operations in the short term.
Addiction field leaders in the
state attribute the relative harmony
of their process in recent months to

3. several factors, from an agreement
to grandfather the state’s current in-
frastructure of credentialed coun-
selors to the realization that any
cost impacts on treatment organiza-
tions probably won’t be realized for
some time.
Moreover, although they don’t
take credit for predicting the future
of healthcare service delivery,
Kansas leaders believe that moving
to licensure will position addiction
counselors much better for the
changes to come with health reform.
“In hindsight, we were just right
with the timing,” said Sarah Hansen,
executive director of the Kansas As-
sociation of Addiction Professionals,
which represents both counselors
and treatment centers in the state. “I
can’t say we were savvy, though,”
she told ADAW.
In fact, the association had pur-
sued licensure legislation for the
state’s addiction counselors a full
decade ago, but found at the time
that there was not sufficient support
See Kansas on page 6
SAMHSA plans dramatic changes
as health reform proceeds

4. © 2010 Wiley Periodicals, Inc.
View this newsletter online at wileyonlinelibrary.com
DOI: 10.1002/adaw.20254
Volume 22 Number 40
October 18, 2010
Print ISSN 1042-1394
Online ISSN 1556-7591
In This Issue…
NIDA heralds new delivery systems
to treat opioid addiction
. . . See page 3
Alcoholism & Drug Abuse Weekly
wins two Azbee awards
. . . See page 4
SAMHSA grant will help Odyssey
House develop peer workforce
. . . See page 5
Post-disaster alcohol abuse
is pre-existing: Study . . . See page 7
D.A.R.E. Minnesota moves beyond
drugs . . . See page 7
AAAS offers guide for parents
on alcohol . . . See page 8
See SAMHSA on page 2
A Wiley Periodicals, Inc. publication. wileyonlinelibrary.com

5. Kansas professionals see license law
as pivotal to elevating counseling
HEALTH AND
MEDICAL WRITING
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2 Alcoholism & Drug Abuse Weekly October 18, 2010
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:
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broadcast on the web, Hyde and
other SAMHSA officials briefly de-
tailed plans and responded to many
questions from the audience, both
live and on the internet.
There are five goals for the
health care reform initiative:
1) Assure behavioral health is in-
cluded in all aspects of health
care reform implementation.
2) Support federal, state and ter-
ritorial efforts to develop and

6. implement new provisions
under Medicaid/Medicare.
3) Finalize and implement the
parity provisions in the Men-
tal Health Parity and Addic-
tion Equity Act and the Af-
fordable Care Act.
4) Develop changes in SAMHSA
block grants to support re-
covery and resilience.
5) Foster the integration of pri-
mary and behavioral health
care.
Not everyone will be covered
by Medicaid, Medicare, or private
insurance by 2014, so the block
grant will still be needed, said Hyde.
But how much of it will be used for
non-treatment services, and whether
CMS would want to take some of it
to use to treat its new enrollees, has
not been revealed. John O’Brien,
who is in charge of SAMHSA’s
health reform efforts, was not at the
Open House at all — he was at CMS
“working on health reform,” Hyde
explained.
Safety net needed
The National Association of

7. State Alcohol and Drug Abuse Di-
rectors (NASADAD) is the single
biggest stakeholder when it comes
to the block grant. It represents each
single state authority who controls
the block grant in that state. And
NASADAD has conducted studies in
three states — including Massachu-
setts, which implemented its own
health care reform two years ago —
and found that the block grant was
essential because not everyone was
covered. “What you thought it
would be and what it is, are two dif-
ferent things,” said NASADAD exec-
utive director Rob Morrison, speak-
ing at the Open House.
Morrison stressed the impor-
tance of the safety net, so that peo-
ple who walk into treatment but
have no access to Medicaid or pri-
vate insurance can still obtain care.
He also noted that 40 percent of the
referrals to the block grant come
from the criminal justice system.
“And health reform does not touch
those folks beyond the walls,” he
said, referring the people who are
still incarcerated but need treatment.
“We know there will be gaps in
coverage after health reform,” re-
SAMHSA from page 1 sponded Hyde. Currently, about 61
percent of patients in publicly fund-

8. ed treatment for substance abuse
are uninsured, and 39 percent of pa-
tients in publicly funded mental
health treatment are uninsured, she
said. “We expect a lot of those peo-
ple to have access to Medicaid and
health insurance exchanges,” said
Hyde. But there will still be about
15 million uninsured people, and
one-fifth to one-third of them will
have “major substance abuse is-
sues,” she said. The block grant will
have to provide services for them.
The block grant will also be
used to provide services that will
not be covered by Medicaid or pri-
vate insurance – non-treatment serv-
ices – said Hyde. Exactly what these
will be is still to be determined, al-
though the basics are outlined in
O’Brien’s “good and modern” treat-
ment systems paper, released this
summer (see ADAW, June 14) and
on the web.
New demands in 2014
One issue the federal govern-
ment is working on is how to pro-
vide services for the people who
will be newly covered by Medicaid
or insurance in 2014. “Those num-
bers are staggering,” said Hyde. Out
of the 32 million people who will be
newly covered, six to 10 million are

9. expected to have “major behavioral
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$699 (individual,
health issues,” she said. “Medicaid is
working with us on how to manage
that,” she said. “What should be
covered by Medicaid, what is likely
to be covered by insurance, and
what should we be trying to cover
with the block grant?”
Hyde noted that there are “lim-
ited dollars,” and that by 2014 there
will have to be “coordination of
benefits” between SAMHSA, the
states, and Medicaid. This is where
the block grant, worth about $1.8
billion, comes in. In fact, O’Brien,
who is in charge of health reform at
SAMHSA, is the one working on de-
veloping a regulation for the block
grant, said Hyde.
SAMHSA is also working with
stakeholders, including some states,
to look at what the block grant
should be used for, said Hyde. “We
understand that the block grant is
going to have to change pretty dra-
matically. We don’t want to just let

12. that happen. We want to guide it.”
SBI
There is also a concern is that the
role of primary care in screening and
brief intervention (SBI), which is a
lynchpin of the administration’s sub-
stance abuse strategy, will usurp the
role of the specialty treatment
provider. To paraphrase one ques-
tioner: What can be done to ensure
that referral to qualified substance
abuse treatment is part of the SBI
equation? “We recognize that linkages
need to be established where they
don’t exist, and maintained when
they do,” responded H. Westley
Clark, M.D., director of SAMHSA’s
Center for Substance Abuse Treat-
ment. “SBIRT is not a panacea,” he
said, going on to explain that SBI is
for the people who do have a sub-
stance abuse problem but don’t rec-
ognize it.
“Ninety-five percent of the peo-
ple who meet criteria for abuse and
dependence perceive no need for
treatment,” said Clark. “The intent is
to intervene early, assist the individ-
ual to understand that there may be
a problem, and make a determina-
tion.” In the federal SBIRT grant
program, there was only a 3 percent

13. referral rate, he said. “But that
means out of 1 million people, that’s
30,000 who would not have been
seen.” •
October 18, 2010 Alcoholism & Drug Abuse Weekly 3
Continues on next page
A Wiley Periodicals, Inc. publication.
wileyonlinelibrary.comAlcoholism & Drug Abuse Weekly DOI:
10.1002/adaw
Skolnick, Ph.D., director of NIDA's
Division of Pharmacotherapies and
Medical Consequences of Drug
Abuse. “For medications that are
used to treat substance abuse disor-
ders in general, the biggest issue is
compliance,” Skolnick told ADAW
last week. “You can take naltrexone
pills to prevent relapse, but if you
decide you want to get high this
weekend, all you have to do is not
take the pill.” And every day, the
patient must decide to take the pill,
or not. With Vivitrol, that decision
only needs to be made once a
month, noted Skolnick. Naltrexone
completely blocks the effects of opi-
oids. Even if a patient “experiments”
and tries to get high while on nal-
trexone, it won’t work, said Skol-
nick. “You will not be able to over-
and there was a sense at NIDA that

14. this heralded a new day in the treat-
ment of opioid addiction.
Methadone, the traditional treat-
ment for opioid addiction, can only
be provided through specialized
clinics, and, like sublingual bupre-
norphine, requires daily dosing.
Long-term treatments mean that
there are fewer compliance prob-
lems with the medication, according
to NIDA. In addition, Vivitrol is not
an agonist, and it would offer an al-
ternative to patients who would
prefer not to take an opioid med-
ication like methadone or buprenor-
phine, according to NIDA.
Compliance and daily dosing
Buprenorphine and naltrexone
are not new medications, but the
delivery systems are, explained Phil
NIDA heralds new delivery systems to treat opioid addiction
Last week the Food and Drug
Administration (FDA) approved Viv-
itrol (naltrexone), a month-long nal-
trexone depot injection, for the
treatment of opioid dependence.
Also last week, results of a clinical
trial of a 6-month buprenorphine
implant (Probuphine) were pub-
lished showing it had better results
than the sublingual form of the

15. medication. Vivitrol has already
been approved, and is being used,
for the treatment of alcoholism.
Both developments were ap-
plauded by the National Institute on
Drug Abuse (NIDA), which issued a
special advisory about them from
director Nora Volkow, M.D. Both
happened to take place at about the
same time (the FDA approved Vivit-
rol on Oct. 12, and the Probuphine
study was published on Oct. 13),
‘What should be covered by Medicaid,
what is likely to be covered by insurance,
and what should we be trying to cover
with the block grant?’
Pam Hyde
To read the Strategic Initiatives Paper, leave comments, read
the com-
ments others have provided, and vote, go to
http://feedback.samhsa.gov.
Copyright of Alcoholism & Drug Abuse Weekly is the property
of John Wiley & Sons, Inc. and its content may
not be copied or emailed to multiple sites or posted to a listser v
without the copyright holder's express written
permission. However, users may print, download, or email

16. articles for individual use.
D A T A
The Brown University
Digest of Addiction
Theory and Application
August 2007
Vol. 26, No. 8 • ISSN 1040-6328
Online ISSN 1556-7559
Highlights…
Researchers from Stanford University
recently examined whether improved
outcomes and lower health costs
associated with involvement in a self-help
group were sustained at 2-year follow-up.
Our other page one story looks at data
showing an increase in abuse of
prescription drugs in college students.
� � �

17. In This Issue…
Study: Men oscillate between cocaine use
and abstinence more often than women
See page 2
Spiritual growth linked to less heavy
drinking among alcoholics in recovery
See page 3
Parents of adult children with drug use
problems at risk for ill health
See page 4
Study investigates psychophysiologial
responses in pathological gamblers
See page 5
From the Field
Dangerous liaisons: Alcohol’s role in injury
occurrence — by Michael J. Mello, M.D.
See page 8
Treatment Outcomes
Promoting self-help group involvement improves

18. long-term recovery and lowers health costs
Actively promoting self-help group
involvement appears to improve post-
treatment outcomes while reducing the
costs of continuing care, according to
findings published in Alcoholism: Clinical
& Experimental Research.
Researchers Keith Humphreys and
Rudolf H. Moos from the Veterans Affairs
and Stanford University Medical Centers,
Palo Alto, reached this conclusion after
examining whether positive clinical out-
comes and reduced health care costs evi-
dent 1 year after treatment among sub-
stance-dependent patients who were
strongly encouraged to attend 12-Step
self-help groups were sustained at 2-year
follow-up.

19. Participants were low-income male
veterans treated in either 12-Step-based
(N=887) or cognitive-behavioral (N=887)
treatment programs who were matched
on their history of mental health utiliza-
tion. The treatment programs comprised
5 12-Step-oriented programs and 5 CB
inpatient programs participating in the
Dept. of Veterans Affairs nationwide mul-
tisite substance abuse treatment out-
come study. These programs treated sub-
stance-dependent patients on an inpa-
tient basis for 21 to 28 days and offered
outpatient continuing care after dis-
charge. The 12-Step-based programs
placed substantially more emphasis on
12-Step ideas, had more staff members in
recovery, had a more spiritually focused

20. treatment environment, and promoted
self-help group involvement much more
Prescription Drugs
Survey reveals increase in non-medical use
of prescription drugs in U.S. colleges
Non-medical use of prescription drugs
(NMPD) among U.S. college students
increased steadily between 1993 and
2001, according to findings published in
the journal Addiction.
Researcher Sean Esteban McCabe of
the University of Michigan, Ann Arbor,
and colleagues reached this conclusion
after examining the prevalence and
trends of NMPD among US college stu-
dents between 1993 and 2001. McCabe
and his team also sought to explore
whether college-level characteristics
explained the variation in college-level

21. prevalence trajectories over time.
Data for the study were collected via
the College Alcohol Study (CAS) from 119
4-year colleges and universities between
1993 and 2001. The representative sam-
ples included all respondents from the
same 119 institutions in 1993 (N=15,282),
1997 (N=14,428), 1999 (N=13,953) and
2001 (N=10,904). The demographic char-
acteristics of students were generally sim-
ilar in all 4 survey years. The mean age of
the sample was around 21 years for each
survey year. The proportion of women
responding increased over time (57% in
1993, 59% in 1997, 61% in 1999 and 64%
in 2001), while the proportion of white
students responding decreased over time
(82% in 1993, 78% in 1997, 77% in 1999

22. and 76% in 2001).
See Prescription Drugs, page 7…
See Self-help Group Involvement, page 6…
Published online in Wiley InterScience
(www.interscience.wiley.com) • DOI: 10.1002/data.20049
The Brown University Digest of Addiction Theory and
Application August 2007
6
extensively than did the CB programs.
Patients completed a self-adminis-
tered survey at baseline, 1-year, and 2-
year follow-up. The 2-year follow-up
assessed patients’ substance use, psychi-
atric functioning, self-help group affilia-
tion (AA, CA, and NA), and mental health
care utilization costs. The national VA
database was used to calculate the num-
ber of mental health outpatient visits and

23. inpatient days for each patient from 1 to 2
years posttreatment. Mental health care
was defined as that provided for patients’
substance use disorder and any psychi-
atric comorbidities. Costs were calculated
using VA budgets at $85 per outpatient
visit and $750 per day for inpatient care.
Results
Of the 1,774 veterans followed up at 1
year, 86% (N=1,528) were followed up
again at 2 years. Their clinical outcomes
and mutual help group affiliations consti-
tute this report. Findings revealed a
slightly higher follow-up rate for patients
treated in CB than in 12-Step programs
(88% vs. 84%, respectively). As VA health
care data are available on all patients, fol-
low-up rate for the cost and utilization

24. outcomes was 100%.
Results indicated that the pattern of
findings at the 1-year follow-up largely
persisted at 2 years, except for the absti-
nence rate, which was substantially high-
er among 12-Step patients than among
CB patients (49.5% vs. 37%, respectively).
Group differences in help-seeking pat-
terns were also similar to those found at the
1-year follow-up, with patients treated in
12-Step programs demonstrating signifi-
cantly higher rates of self-help group
involvement at 2 years. Specifically, among
12-Step patients, the rate of attending 10
self-help treatment meetings in the past 3
months was about 50% greater (36% vs.
24% in CB) and the rate of talking to a spon-
sor once or twice a month or more was

25. almost 100% greater (25% vs. 14% in CB).
Analyses of treatment utilization and
cost revealed that from 1-year to 2-year
follow-up, 12-Step patients had fewer
inpatient days (7 vs. 10 in CB) and outpa-
tient visits (7 vs. 10 in CB). These findings,
according to the study, translate to about
30% lower average per patient costs in the
12-Step condition ($5,638) than in the CB
condition ($8,078).
Study limits
This study was not a randomized trial.
Patients in each condition did not differ
at baseline on any measured variable.
Additionally, these findings must be con-
sidered in light of the impressive size of
12-Step mutual help organizations in the
U.S. An addicted individual can find an
AA or NA meeting in most U.S. cities and

26. towns, and at most hours of the day.
Finally, the authors note that these results
do not suggest that professional treat-
ment services be cut back in lieu of pro-
moting self-help group therapy. They
note that each patient in this study
received an intensive professional inter-
vention, and many received outpatient
continuing care afterwards.
Authors’ conclusions
These results indicate that actively pro-
moting self-help group involvement is a
useful method for maximizing the benefits
of treatment while lowering its ongoing
Continued from page 5…
Self-help Group Involvement
From page 1
Study sample
N = 1,774 veterans

27. 25% were employed
20% were married
20% had comorbid
Axis I psychiatric disorder
Average mental health costs
in year prior to intake = $3,313
adequate decision making in real life.
Whether somatic markers and psy-
chophysiological responses to positive
and negative consequences can be
“trained”, for example through biofeed-
back, or whether these phenomena are
nonremediable remains an open ques-
tion, according to the authors. They note
that an applicable intervention might
involve psycho-education aimed at absti-
nence for pathological gamblers with low-
ered psychophysiological risk sensitivity.
� � �

28. Goudriaan AE, Oosterlaan J, de Beurs E, et al.:
Psychophysiological determinants and concomi-
tants of deficient decision making in pathological
gamblers. Drug Alcoh Dep 2006; 84:231-239. E-mail:
[email protected]; [email protected]
Suggested reading:
Blaszczynski A, Nower L: A pathways model of
problem and pathological gambling. Addiction 2002;
97:487-499.
positive and negative consequences in
the pathological gambling group.
Study limits
The pathological gambling group in
this study excluded persons with co-mor-
bid alcohol or substance abuse or
dependence, thereby limiting generaliza-
tion of the results to a general pathologi-
cal gambling population.
Authors’ conclusions

29. The disadvantageous decision making
by pathological gamblers on the IGT, com-
bined with a pattern of both abnormal
anticipatory SCR and HR reactivity, sug-
gests that deficiencies in developing psy-
chophysiological reactions to behavior
with negative consequences could play a
role in the development and/or continua-
tion of pathological gambling. The authors
posit that the diminished risk sensitivity in
pathological gamblers may interfere with
the number of cards picked from advan-
tageous decks. Control participants
showed a larger decrease in HR before
selecting from the disadvantageous decks
compared to when they selected from
advantageous decks, while this effect was
in the opposite direction for pathological

30. gamblers.
Controls also showed stronger antici-
patory SCRs before selecting from a dis-
advantageous deck, whereas no such dif-
ferences were present for the PG group.
Further, HR increased in controls after
rewards, while HR decreased after wins in
the PG group.
No significant differences were
observed between pathological gamblers
and controls when dividing the groups in
high and low BIS/BAS scores. However
pathological gamblers did score higher
on both BIS and BAS measures, suggest-
ing a higher sensitivity for immediate
The Brown University Digest of Addiction Theory and
Application August 2007
7

31. Measures
The measures in the CAS survey
assessed demographic characteristics,
alcohol use, illicit drug use and NMPD
for all 4 study years. NMPD was meas-
ured by asking students how often, if
ever, they had used any of the following
drugs in the absence of a doctor’s order:
(a) opiate-type drugs (controlled sub-
stances such as codeine, Demerol, Perco-
dan); (b) tranquilizers (drugs such as Val-
ium, Librium); (c) barbiturates (sleeping
pills such as Quaaludes, downs, Yellow
Jackets); and (d) amphetamines (stimu-
lants such as speed, uppers, ups). To
reflect the changing prominence of spe-
cific drugs, the lists of examples for the 3
classes of prescription medications were

32. updated in 2001 as follows: (a) opiate-
type drugs (codeine, morphine,
Demerol, Percodan, Percocet, Vicodin,
Darvon, Darvocet); (b) tranquilizers
(drugs such as Valium, Librium, Xanax,
Ativan, Klonopin); and (c) barbiturates
(sleeping pills such as Seconal, Nembu-
tal, downs or Yellow Jackets). Students
rated their responses as (1) never used,
(2) used, but not in the past 12 months,
(3) used, but not in the past 30 days and
(4) used in the past 30 days.
Using the same response scale, the
study measured illicit drug use by asking
students how often, if ever, they had used
marijuana, crack cocaine, other forms of
cocaine, heroin, LSD, or other psyche-
delics. College-level variables included

33. geographic region, admissions selectivity,
private/public status, commuter status,
co-educational status, size of student
enrollment, urbanization, and historical-
ly black school status.
Results
Findings indicated that lifetime and
12-month prevalence of non-medical use
of several prescription drugs increased
between 1993 and 2001. Analyses showed
the estimated 12-month prevalence of
any NMPD (tranquilizer/ anxiolytic, opi-
oid, sedative/sleeping medication)
increased at a steady rate from about 4%
in 1993 to 6% in 1997, to 7% in 1999 and to
10% in 2001. In contrast, results showed
the 12-month prevalence of illicit drug
use other than marijuana experienced a
significant increase between 1993 and

34. 1997, followed by decreases in 1999 and
2001. Despite the increasing rates of any
NMPD relative to illicit drug use other
than marijuana, the study showed the 12-
month prevalence of any NMPD was
lower than illicit drug use other than mar-
ijuana in 3 of the 4 survey years.
Analyses of college-level trends
showed that historically black college and
university (HBCU) status was significant-
ly associated with NMPD in 1993, 1999
and 2001. In the 1993 survey, an estimat-
ed 2% of students at these institutions
reported NMPD in the past year, com-
pared to 4% of students at non-HBCUs;
larger differences between the 2 groups
were detected in 1999 and 2001. Addi-
tionally, findings revealed that commuter

35. status was significantly associated with
NMPD in 1997, 1999 and 2001. In the
1997 survey, an estimated 6% of students
at non-commuter schools reported
NMPD in the past year, compared to 4%
of students at commuter schools. Addi-
tional analyses indicated that both col-
lege-level marijuana use status and illicit
drug use status in 1993 were significantly
associated with NMPD in each of the 4
survey years.
Hierarchical linear models assessing
between-college variation in prevalence
trends over time revealed increasing
trends in any NMPD prevalence across all
4 study years, and significant between-
college variance in terms of the preva-
lence trends. In particular, these results

36. suggest illicit drug use status in 1993 may
have explained higher levels of NMPD
use during this time period.
Study limits
This study represented secondary
analyses. As such, the survey items in the
original questionnaires limited the scope
of what could be examined. Additionally,
student-level inference about trends in
NMPD over time was not possible, as the
study data were cross-sectional and not
collected from the same students over
time. Finally, response rates were low at
some colleges, resulting in small samples
in some cases.
Authors’ conclusions
These findings emphasize a need for
continued monitoring of NMPD and illic-
it drug use among college students.

37. Results suggest that prevention and inter-
vention efforts aimed at reducing mari-
juana and other illicit drug use should
also include multi-faced efforts to reduce
NMPD simultaneously. Results also sug-
gest that prevention and policy efforts to
reduce NMPD be targeted at non-HBCU
and non-commuter schools.
CAS data were collected under grants
from the Robert Wood Johnson Founda-
tion. Manuscript development was sup-
ported by a grant from the National Insti-
tute on Drug Abuse, National Institutes
of Health.
� � �
McCabe S, West B, Wechsler H: Trends and
college-level characteristics associated with the
non-medical use of prescription drugs among US

38. college students from 1993 to 2001. Addiction
2006; 102:455-465. E-mail: [email protected]
Suggested reading:
Mohler-Kuo M, Lee J E, Wechsler H: Trends in
marijuana and other illicit drug use among college
students: results from 4 Harvard School of Public
Health College Alcohol Study surveys: 1993–2001.
J Am Coll Health 2003; 52:17–24.
costs. Although the difference in cost is
smaller in proportion (30% vs. 40% at 1
year) and in size ($2,440 per patient vs.
$5,735 at 1 year) at 2 years, it is still a sub-
stantial savings, particularly in a time of
reduced resources for addiction treatment.
� � �
Humphreys K, Moos RH: Encouraging posttreat-
ment self-help group involvement to reduce
demand for continuing care services: Two-year

39. clinical and utilization outcomes. Alc Clin Exp Res
2007; 31(1):64-68. E-mail: [email protected]
Suggested reading:
Humphreys K, Moos RH: Can encouraging sub-
stance abuse inpatients to participate in self-help
groups reduce demand for health care?: A quasi-
experimental study. Alc Clin Exp Res 2001;
2:711–716.
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