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ADAW Nov 8 2010 Optum Pilot


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ADAW Nov 8 2010 Optum Pilot

  1. 1. Field struggles to hold on to BG-funded AVolume 22 Number 43 residential treatment in face of ACANovember 8, 2010 As federal officials work behind the won’t be reimbursed” by Medicaid orPrint ISSN 1042-1394 scenes — with stakeholder participa- the health insurance exchanges, said tion — to design the minimum ben- Michael Botticelli, director of theOnline ISSN 1556-7591 efits for what can be offered by Med- Massachusetts Bureau of Substance icaid and the insurance exchanges Abuse Services (BSAS). Botticelli,In This Issue… under health care reform, stakehold- who has first-hand experience as the ers in the field are getting increas- single state authority in one of theGOP control of House may mean ingly worried that publicly funded first states to embrace its own health-changes, or at least delays, for ACA residential treatment will be drasti- care reform, said residential treat-. . . See page 3 cally curtailed. At the same time, the ment is one of the services that will Substance Abuse and Mental Health have to be reimbursed by the Sub-State Budget Watch: Services Administration (SAMHSA) is stance Abuse Prevention and Treat-Mass. voters opt to repeal alcohol clearly considering changes to the ment block, killing dedicated fund block grant, creating uncertainty “We see residential treatment as. . . See page 4 about whether residential treatment an incredibly valuable part of ourFrom the Field: in particular will be covered. treatment continuum, and we wouldAlcohol and the workplace: Last week, ADAW talked to offi- be very concerned if we were to seeThe elephant in the room cials and experts about the pros- some restriction on that,” said Botti- . . . See page 5 pects for residential treatment under celli. It’s important for states to look health care reform. at what gets reimbursed by other Caron offers free “Residential treatment probably See Residential page 2 substance abuse training for pediatric Murder at New York treatment center L residents . . . See page 7 HEALTH ANDMEDICAL WRITING NIH grant funds new shines spotlight on facility safety alcohol-HIV center Last month’s killing of a security charges in 2008, last month was ar- at Brown . . . See page 7 guard at a residential treatment cen- raigned for second-degree murder Marijuana ter in Ellenville, N.Y., served as a in the stabbing death of 60-year-old legalization loses, stark reminder of a reality always security guard Leland Wood. Ac- but proponents say present beneath the surface in treat- cording to local media reports, Giga fight not over ment facilities, particularly those is accused of killing the security . . . See page 8 that specialize in serving criminal guard at the facility and then car- justice-involved clients. The Renais- jacking the vehicle of a staff nurse, Arkansas awards sance Project, a treatment center forcing the woman to drive off site EHR contract with a three-year state certification and then stabbing her several times. to Core Solutions and no regulatory issues as of a visit The nurse survived her injuries. . . . See page 8 from state officials in August, was Giga was be apprehended after the site of a violent crime that shook a 15-hour manhunt, a period during both program staff and a surround- which he apparently broke into sev- ing neighborhood, raising the spec- eral homes in the neighborhood sur- tre of yet more NIMBY (not in my rounding the treatment facility. back yard) siting battles. The incident led many nearby© 2010 Wiley Periodicals,Inc. Richard Giga, a patient at the residents to question the proceduresView this newsletter online at wileyonlinelibrary.comDOI: 10.1002/adaw.20257 Renaissance Project facility who had for placing clients in the treatment pleaded guilty to grand larceny See Safety page 4 A Wiley Periodicals, Inc. publication.
  2. 2. 2 Alcoholism & Drug Abuse Weekly November 8, 2010 Residential from page 1 treatment,” he said. “I’m very con- their actual treatment, and treatment payers, and to see how they can use cerned that we might be making would be designed around a day- the block grant to supply the ser- changes to the block grant before treatment model, he told ADAW. vices that won’t be reimbursed, such we know what the minimum benefit “I can’t imagine how we’re go- as residential treatment, he said. will be.” If SAMHSA makes changes ing to take a 20-year heroin addict Massachusetts is a perfect exam- in the block grant too soon, people who’s been in and out of prison and ple of why the Affordable Care Act who do not end up being covered treat them outpatient,” said Carlson. (ACA) won’t replace the block grant under the ACA may not have access The big question for TCs is whether in terms of funding treatment services. to residential treatment. they will be defined in the regula- “The block grant continues to play a tions implementing the ACA — the very large role in terms of providing Threat to TCs minimum benefit — as a form of treatment services for those clients For example, therapeutic com- treatment. “If not, you’ll have to who remain uninsured, and for sup- munities (TCs) — long-term resi- come up with a hodgepodge of porting a whole host of the unreim- dential facilities where patients have funding,” he said. bursed services,” said Botticelli. About traditionally stayed for months — Carlson, CEO of Odyssey 70 percent of the block grant to are at risk of being viewed at least House, a 126-bed TC in New Or- Massachusetts goes to services that partially as housing, not treatment. leans, is already facing that situa- are not currently reimbursed by insur- “We’re not going to know anything tion, because the state has moved ers in the state, he said. for sure until the regulations come away from paying for long-term residential treatment. “I’ve had to go out and find additional money,” he ‘In the next three to four years, most said, noting that he goes to founda- tions for help, and also has cottage of the systems we’re used to dealing with industries, such as a catering com- pany, to make money to fund treat- will probably not be around.’ ment. “All of our treatment beds that are funded by the state are 28 days Ed Carlson only.” So all patients go through the 28-day program, and only the sick- est say long-term. “We’re down to That’s why it’s vital that there be out, but based on what I’ve heard, 20 long-term beds,” he said. a minimum benefit before any broad we’re going to get two separate “Block grant dollars are proba- brush changes are made to the block rates, one for housing and one for bly going to wind up in Medicaid,” grant, said Botticelli. “The last thing treatment,” said Ed Carlson, vice said Carlson. Medicaid doesn’t pay that we want to do is to make pre- president of Therapeutic Communi- for residential treatment, and the mature changes to the block grant ties of America. Under this model ACA doesn’t change that. Carlson that have the potential to destabilize TC clients would go off site to do agrees with most observers that it 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 by its readers. For address changes or new subscriptions, contact Subscription Distri- Executive Managing Editor Karienne Stovell bution US, c/o John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030-5774; Editor Alison Knopf (201) 748-6645; e-mail: © 2010 Wiley Periodicals, Inc., a Wiley Company. All rights reserved. Reproduction in any form without the consent of the Contributing Editor Gary Enos publisher is strictly forbidden. For reprint permission, call (201) 748-6011. 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Pub- lished every week except for the first Monday in April, the first Monday in July, the To renew your subscription, contact Subscription Distribution US, c/o John Wiley last Monday in November and the last Monday in December. The yearly subscrip- & Sons, Inc., 111 River Street, Hoboken, NJ 07030-5774; (201) 748-6645; e-mail: tion rates for Alcoholism & Drug Abuse Weekly are: Print only: $699 (individual, 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. November 8, 2010 Alcoholism & Drug Abuse Weekly 3won’t. “A lot of residential programswill probably go out of business,” GOP control of House may mean changes,he said. “In the next three to fouryears, most of the systems we’re or at least delays, for ACA Republicans who now control the House of Representatives may notused to dealing with will probably be able to outright repeal the Affordable Care Act — they don’t have thenot be around.” votes to overcome a filibuster by Democrats, much less override a It’s also important to diversify. Presidential veto — but they can tweak it, delay it, and otherwise hinderAt Odyssey House there’s a lot more its smooth process. Some hope to then repeal it in 2012 if there is aprovided besides residential. “We Republican president. Rep. Fred Upton (R-Michigan), who may well behave medically-supported detox, the new chairman of the House Energy and Commerce Committee, whichshort-term treatment, and long-term has jurisdiction over the Department of Health and Human Services, toldtreatment,” said Carlson, noting that Politico last week that he would use subpoena power to have HHSthe facility treats more than 800 peo- Secretary Kathleen Sebelius testify on how health reform was putple a month. together. “I don’t know that a lot of people know her,” Representative But not every provider can pro- Upton said. “She’s only been up once before the committee. They’revide all services. “You need to have writing a lot of regulations to help the states write regulations toall levels of care, so you can move promulgate. ... She might get her own parking place in Rayburn.”people up or down the levels,” said Republicans could also refuse to pass appropriations that would fundCarlson. “It can’t be cookie cutter. the law, although that would make them look like obstructionists. TheSome people might need 28 days, result could be a stalemate, with President Obama refusing to sign ansome people might need a year.” appropriations bill that doesn’t fund the ACA, the outcome of which is a Asked what the process is for government shutdown. The Republicans would be blamed for that, asdeveloping a minimum benefit, they were in 1994 when the same thing happened.SAMHSA spokesman Mark Webersaid “the process is in internal dis-cussions, and timing is being dis- a member of the SAMHSA work- nois. Even after the ACA minimumcussed as well.” He said SAMHSA is group on adult residential treatment, benefit is finalized, states will still“working with Congress” on block believes early indications from SAM- develop their own laws, he said. “Igrant issues, but Hill staffers who HSA indicate that residential treat- don’t think there is common agree-work on SAMHSA told ADAW that ment will be part of the essential ment other than the patient place-they have not heard anything about benefit package. In addition, a soon- ment criteria from the American So-this. In September SAMHSA broad- to-be-released study by Brandeis ciety of Addiction Medicine on whatcast its intentions to drastically University finds “substantial evi- residential means,” he said. In Illi-change the block grant in a contract dence of the efficacy of residential nois, the license is for a “subacutesolicitation (see ADAW, Sept. 27). treatment,” she told ADAW. The inpatient” facility. Proposed changes for the block ACA relies on clinical guidelines like Dennis Gilhousen, interim presi-grant could come as early as the the ASAM criteria to drive care deliv- dent/CEO of the National AssociationPresident’s FY 2012 budget proposal ery, she added. “ASAM clearly in- of Addiction Treatment Providers, isin February. However, a proposal cludes residential treatment as part working on a definition of “residen-that reorganizes SAMHSA would still of a continuum of care.” tial” for SAMHSA. “It’s a catchwordhave to deal with Charitable Choice Finally, McDaid cites recent ef- that has a large basket, including ev-and objections from Americans Unit- forts to integrate addiction into pri- erything from intensive inpatient toed for Separation of Church and mary care and to require that addic- therapeutic community to halfwayState, which is holding up reauthori- tion be provided on par with other houses to social clubs,” he toldzation under threat of a challenge medical issues, which will demon- ADAW last week. “We’re trying toon constitutional grounds (see strate the comparability of residen- narrow the scope of what it means.”ADAW, Sept. 6). tial addiction and medical/surgical But Gilhousen is concerned that treatment. “Who would ever con- health reform, by restricting pay-Different perspective sider eliminating stroke or cardiac ment for residential treatment, could Meanwhile, the private sector is rehabilitation from the medical ben- undermine the gains made by thetrying to carve out its niche, particu- efit?” she asked rhetorically. parity law. “The intent of parity waslarly because it had counted on par- The key to finding out what will to treat substance abuse issues on aity to guarantee reimbursement after be funded under the ACA is the state par with medical issues,” he said.decades of discrimination by payers. insurance commissioner, said Philip Before parity, insurance focused Carol McDaid, principal with Eaton, president/CEO of Rosecrance mainly on outpatient, and withlobbying firm Capitol Decisions and Health Network in Rockford, Illi- Continues on next pageAlcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication. 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  4. 4. 4 Alcoholism & Drug Abuse Weekly November 8, 2010 Continued from previous page need to keep working to make our gave the anti-health reform Republi- health reform, there is a fear it could position clear, and to advocate on cans a majority in the House of Rep- happen again. “There’s the potential behalf of our patients.” resentatives, could mean that “the for that. SAMHSA understands that In the meantime, there are po- whole landscape will change,” said some people need residential treat- litical realities to deal with. Last Gilhousen. “But that doesn’t mean ment,” said Gilhousen. “But we week’s midterm elections, which we have to stay quiet.” • State Budget Watch Mass. voters opt to repeal alcohol tax, killing dedicated fund An alcohol sales tax expected (BSAS). “I think it’s too soon to tell,” is federal). “We didn’t have the re- to bring $110 million a year to he told ADAW in an interview the day sources to combat their advertising,” a dedicated fund for substance after the vote, adding that he does not he said. abuse treatment was have budget-making authority. The health insurance industry repealed last week in The funding was supplanting endorsed the tax, but did not give Massachusetts. The tax, funding that had been provided by any money to help campaign against which was implement- the state, and expanded it. With the the repeal, although DiGravio asked ed in 2009 (see ADAW, April 13, dedicated fund, as long as alcohol them to. “It was disappointing that 2009) and only this July went to- sales held steady, there would be a they didn’t contribute,” he said. “Up wards the dedicated fund (see steady source of funding, so treat- until 2 weeks ago, all the polls ADAW, June 14), had support from ment providers wouldn’t be subject- showed we were winning,” he said. voters according to polls until late ed to fluctuations in general tax rev- “The real story is that we were out- last month when the alcohol bever- enue, said DiGravio. “Alcohol sales spent in advertising by the alcohol age industry launched a full-blown were up, despite what the alcohol industry.” advertising campaign against it. industry claims,” he said. The funding from BSAS for pro- “It’s a setback, and we’re con- viders is $82 million. The tax — ex- cerned,” said Vicker V. DiGravio III, pected to collect $110 million a year president and CEO of the Associa- tion for Behavioral Healthcare, an ‘The real story is that — was collected for the dedicated fund starting July 1, and will expire at organization representing providers we were outspent in the end of December. DiGravio ex- in the state. “We don’t know exactly pects there to be $55 million for that what it means in terms of actual dol- advertising by the six-month period for the dedicated lars yet,” he told ADAW. “But it’s a fund. But after that, it’s unclear where very unfortunate situation. We had alcohol industry.’ the difference between the $110 mil- worked hard to find a sustainable lion and the $82 million (from BSAS) funding source to protect the pre- Vicker V. DiGravio, III will come from. “I don’t think we’re vention and treatment system.” going to lose $30 or $40 million in While there may be some legis- funding, but we’ll lose some fund- lative or regulatory solution, it’s too The alcohol beverage industry ing,” he said. “And we’re going to soon to say what that could be, said spent $3 million to defeat the ballot lose some programs, unless the legis- DiGravio. “It’s going to take the ad- initiative, convincing voters that the lature can find a way to fix it.” ministration some time to sort this alcohol beverage tax was a “double The tax was 6.25 percent. Li- out,” he said. tax” because it added a sales tax to quor stores had argued that resi- “We don’t know what the im- the excise tax. “They overspent us dents could go to neighboring New plications will be,” said Michael 15 to 1,” said DiGravio, noting that Hampshire, which had no alcohol Botticelli, director of the state’s Bu- 45 states impose a sales tax on alco- tax, to buy liquor and that put them reau of Substance Abuse Services hol (as well as the excise tax, which at a competitive disadvantage. • Safety from page 1 from state regulators have pointed “This is a 100-bed intensive resi- center, while two people told Ellen- to any systemic problems at Renais- dential facility opened in March ville police officers that they had sance, which is certified by the New 2009 and was rated in substantial seen Giga walking off the grounds York Office of Alcoholism and Sub- compliance with regulatory require- of the facility unaccompanied in the stance Abuse Services (OASAS) for ments in April 2009, providing them past. But no official communications intensive residential treatment. Continues on page 6 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. November 8, 2010 Alcoholism & Drug Abuse Weekly 5Alcohol and the workplace: The elephant in the room From the Field…Aby Andy Sekel, Ph.D.According to a 2007 Substance Abuse and Mental Health be implemented in the workplace setting with similarServices Administration survey, 8.4 percent of those results. “Alcohol SBI has been rigorously tested in medicalemployed full-time were current illicit drug users, and settings, and has been effectively delivered by a range8.8 percent reported heavy alcohol use. The Journal of of providers,” says Gregory Greenwood, Ph.D., leadStudies on Alcohol reported an estimated 1.8 percent of researcher at OptumHealth Behavioral Solutions. “Theemployed adults consumed alcohol before coming to overall goal of the study was to examine the effects ofwork, and 7.1 percent drank alcohol during the workday translating an evidence-based alcohol SBI protocol for(2006). The U.S. Department of Labor’s Working Partners delivery in telephonic EAP.”for an Alcohol- and Drug-Free Workplace website reads During the study’s pilot program, employees who“the impact of employee substance use and abuse is a called into the EAP would be encouraged to participateproblem that extends beyond the substance-using in a brief, validated 10-question screening tool to helpemployee. There is evidence that co-worker job the EAP staff member determine the risk level of alcoholperformance and attitudes are negatively affected. use. Then, based on the employee’s level of risk, theWorkers have reported being put in danger, having been employee received information about alcohol education,injured, or having had to work harder, re-do work, or simple advice, a combination of advice and briefcover for a co-worker as a result of a fellow employee’s counseling or a referral for alcohol treatment programs.drinking.” While the researchers had hypothesized that alcohol In fact, U.S. employers are paying $134 billion in screening in a telephonic EAP setting would improvelosses associated with alcohol abuse, including reduced rates of risky alcohol use identification, the actual resultsproductivity, missed work, job turnover and skyrocketing were overwhelmingly positive. In fact, results showedhealth care costs. that routine screening produced a 185 percent increase With this potentially devastating impact on the in the identification of “at risk” alcohol misuse. This isbottom line, businesses are compelled to address the particularly significant to employers because earlyproverbial elephant in the room and establish strategies identification and intervention for alcohol misuse mayfor alcohol screening and intervention. Despite the fact curtail the likelihood of larger workplace problems andthat more than 100 million American workers have associated excess health care costs.access to employee assistance programs (EAP) and that With the pilot program such a success, the77 percent of substance abusers are employed, recent researchers not only put SBI into practice across theresearch indicates “only about 160,000 EAP cases EAP, they joined a learning collaborative named theexplicitly identify alcohol use as a primary problem.” Brief Intervention Group (BIG) — led by Eric Goplerud(Journal of Employee Assistance, 2010). With this glaring and Tracy McPherson at George Washington Universitydisparity in mind, many employers are investigating the — to make screening, brief intervention, and referral toquality of their current EAP provider’s alcohol intervention treatment for alcohol misuse routine practice acrossprograms. Some are even competitively shopping EAP the EAP industry. “As we began to analyze the results,providers with competency in mind. In an effort to we immediately felt a social responsibility to share oureducate employers on recent advancements in the area SBI tools and practices,” says Greenwood. “Alcoholof EAP-provided alcohol screening and brief interventions misuse and its effect on the workplace have grown to(SBI), this article highlights recent alcohol-related epic proportions. OptumHealth hopes to continue toresearch, publications and initiatives. lead the way to keeping our country’s workers healthy Recently published in the Journal of Employee and productive.”Assistance (2010) and the Journal of Workplace Behavioral In addition to OptumHealth, other active partnersHealth (2010), a collaborative research team spearheaded in the BIG Initiative include Aetna, ValueOptions, Chestnutby OptumHealth’s Behavioral Health Science department Global Partners, Federal Occupational Health, Associationand George Washington University theorized that the of Flight Attendants, First Sun EAP, First Advantage,same alcohol misuse screening that has been CIGNA, Magellan Health Services, MHN, LifeSynch-Asuccessfully proven in medical settings for years could Continues on next pageAlcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication. View this newsletter online at
  6. 6. 6 Alcoholism & Drug Abuse Weekly November 8, 2010 Continued from previous page lives in the United States. If your EAP is not participating, it Humana Company, APS Healthcare, Perspectives, Peer might be a good time to ask why not.” Assistance Services Inc., Partners Healthcare, Select Inc. and Andy Sekel, Ph.D., is the CEO of OptumHealth Behavioral other EAP providers. “Corporations and their EAPs can no Solutions. longer afford to look the other way when it comes to alcohol screening and subsequent inventions,” says Eric Goplerud, Editor’s Note: For more on the BIG Initiative, see ADAW, Ph.D. “Fortunately, through the partners in the BIG Initiative, September 13. we have the potential to reach more than 100 million covered Continued from page 4 mainly on staffing level require- Joint Commission with a three-year certification,” ac- ments. It states in part, “There shall Security concerns are prominent cording to a statement furnished by be sufficient staff available to all throughout the behavioral health OASAS to members of the media af- residents at all times. During late community, not just for intensive res- ter the stabbing incident occurred. evening and night shifts, there shall idential programs in substance abuse. “The most recent OASAS visit to the be at least one responsible staff per- In the wake of an October strangling site was this past August, when no son awake and on duty.” death allegedly at the hands of pa- regulatory concerns were found.” In addition, the regulation seeks tient at the Napa State Hospital psy- to ensure the provision of respon- chiatric facility in California, the Los Security measures sive counseling and rehabilitation Angeles Times conducted a review William Magwood, Renaissance’s services by requiring these residen- indicating that attacks on staff at the CEO, did not respond to two phone tial programs to maintain a ratio no state hospital had more than quadru- messages and e-mail inquiry from lower than 1 clinical staff member pled from 2009 levels in the second ADAW last week. But last month he for every 15 residents. quarter of this year. told the Times Herald-Record news- The statement issued by OASAS Ironically, some staff members paper, which covers the Hudson Val- following the Renaissance incident at the state hospital blame court- ley area, that he had not heard any added, “We work with providers to mandated changes designed to im- previous reports of Renaissance pa- support their security needs and at prove conditions at the facility, say- tients wandering through the sur- this facility there was, in fact, a secu- ing these have created an atmosphere rounding neighborhood. rity station and a guard.” in which patients can roam more freely and in some cases pose a dan- ger to fellow patients or staff. ‘The requirements cover things like screening Security issues also have be- come quite prominent in the world for all individuals served, in terms of their risk of behavioral health accreditation. Peggy Lavin, senior associate direc- to self or others, and then actions must be tor for the behavioral health care ac- creditation program at The Joint taken in the treatment plan.’ Commission, told ADAW that ensur- ing the safety of the environment of Peggy Levin care goes hand in hand with im- proving care quality as the top prior- ity in its facility evaluation process. “They’re not allowed to walk While most of the patients at Re- Safety-related issues do not in- out on the road,” said Magwood, naissance are referred to the inten- volve each accredited facility meet- who indicated that the facility is in sive treatment program by the justice ing the same set of specific require- the process of installing cameras to system, they are considered volun- ments, but instead relate to each monitor activity outside the center. tary clients, although they can face facility assessing what its specific Asked whether treatment cen- sanctions related to their charges if risks are and having plans in place to ters that contract with New York they choose to leave the grounds. address them in treatment planning state are regulated in terms of mea- “If an individual chooses to and in incident response, Lavin said. sures to protect staff and neighbor- leave the program, the referred “The requirements cover things ing residents, an OASAS spokesper- criminal justice entity is notified im- like screening for all individuals son cited a regulation for intensive mediately,” according to the state- served, in terms of their risk to self residential rehabilitation that focuses ment from OASAS. or others, and then actions must be 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. November 8, 2010 Alcoholism & Drug Abuse Weekly 7taken in the treatment plan,” said must conduct a proactive analysis of ronment of care, Lavin said. For ex-Lavin. “Another element requires a one of their high-risk processes. ample, a staffing pattern that mightlegal screening, which should pick “They must also look at their near- make sense when working withup any criminal or court issues.” misses,” Lavin said, referring to inci- older adolescents transitioning to Also as part of the behavioral dents that fall short of the most seri- more independent living would behealth accreditation program, facili- ous crises. considered woefully inadequateties must develop a working defini- There is no one-size-fits-all for- when applied to a facility treating ation of “sentinel event” that is at mula for determining when a par- sexually aggressive youth popula-least as comprehensive as the Joint ticular behavioral health facility has tion that requires close supervision,Commission’s own definition, and maximized the security of its envi- she said. •Caron offers free substance abuse training for pediatric residents Caron Treatment Centers last into curricula, with the cooperation to be able to trust you,” he said. Oneweek held its first graduation of six of the schools. “Pediatricians are of the first stages of development ispediatricians from its addiction train- constantly learning in academic med- the conflict between trust and dis-ing program, offered free to pediat- icine, but we have always pushed trust, he said. “If you don’t resolveric residents and fellows. addiction aside,” said Stratyner. that conflict, then a youngster doesn’t Led by Harris Stratyner, Ph.D., “Carefrontation” is the method develop hope.” If a child tells a pe-regional vice president of Caron’s Stratyner uses to “make a personal diatrician that parents smoke mari-New York center, the training pro- connection with a kid.” Instead of juana, for example, and the child getsgram is designed to help pediatri- “shaming and blaming,” it’s impor- a visit at school the next day from acians be better at helping their pa- tant to treat them with respect and child protection services caseworker,tients with substance abuse problems. dignity. “At the same time, you hold the pediatrician has lost that child’s The program, which is offered them responsible for dealing with trust. “You have to try to get to theat Caron’s New York City offices, is their illness,” he said. parents through the child, but youdesigned to help pediatricians: Stratyner does, on occasion, use have to do it at the child’s urging,” • Understand the causes of drug testing, but what he really said Stratyner. “You have to decide addiction and the substances wants is for a patient to tell him the what’s best for the child.” often abused by adolescents. truth. “If I can get a kid to tell me the The pediatrician training pro- • Recognize the impact of al- truth, I can get him to get sober,” he gram is ongoing, with six pediatri- coholism and addiction on said. “I don’t punish a kid — I try to cians trained a month. • society. have a therapeutic alliance.” • Learn to approach addiction in a non-judgmental way. Many physicians, as soon as they find out that there is a sub- Briefly Noted • Recognize that addiction is stance abuse problem, say immedi- a family disease requiring ately “You have to go to treatment,” NIH grant funds new alcohol-HIV assessment, intervention and said Stratyner. This sounds more center at Brown treatment for all family like punishment than help, he said. A five-year, $7.5 million grant members. “You want to get the kid to think, to from the National Institutes of Health • Integrate addiction screening feel good about talking to you,” he will establish the Brown Alcohol Re- into routine medical assess- said. Motivational interviewing is search Center on HIV. Peter Monti, ments. not a skill that is taught in medical Ph.D., Donald G. Millar Distinguished • Understand their role in pre- school, he said. But it’s needed to Professor of Alcohol and Addiction vention and treatment. be able to help patients, many of Studies at Brown University and di- Nicholas Pace, M.D., Clinical As- whom in fact do not need specialty rector of the new center, told thesociate Professor of Medicine at NYU treatment – they just need the care Providence Journal that alcohol andLangone Medical Center is helping of their pediatrician. HIV both adversely affect the liver,with the program. “Nick has trained Another special problem faced and that alcohol can compromisephysicians and psychologists on this by pediatricians is parental substance HIV treatment and safe sex practices.throughout his career,” Stratyner told abuse. Stratyner, a psychologist, op- “We want healthier individuals livingADAW last week. Along with addic- poses reporting parental substance with HIV, especially now that theytions experts from top medical abuse to child welfare authorities un- are living longer,” he said in the arti-schools in New York City, Pace and less the child’s life is in danger or cle, published Oct. 24. “We’ll hope-Stratyner are building this training there is sexual abuse. “The child has Continues on next pageAlcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication. View this newsletter online at
  8. 8. 8 Alcoholism & Drug Abuse Weekly November 8, 2010 Continued from previous page fully determine whether people have to stop drinking or reduce their Coming up… drinking.” One study will involve A conference on Substance Use Disorders: Understanding Prevention and how heavy drinking and light drink- Treatment Interventions with the Hispanic/Latino Family will be held November ing in people with HIV affects the 18-19 in New York City. The conference is jointly sponsored by the NYU Post-Graduate brain, metabolism, and cognitive Medical School, Caribbean Basin and Hispanic ATTC and Northeast ATTC, and is functioning. Another study will in- presented by the Center for Latino Health (NYU Langone Medical Center). volve helping patients in emergency For more information, go to rooms with HIV who are heavy The American Academy of Addiction Psychiatry will hold its annual meeting drinkers get motivated to cut back on December 2-5 in Boca Raton, Fla. For more information, go to their alcohol consumption. “You ask them whether they’d be interested in changing and if the answer is yes, you give them some thumbnail the mix.” Meanwhile, the federal records, including co-occurring dis- sketches about how they might want government, which had campaigned orders, client assessments, treatment to go about that,” he said. against Proposition 19, celebrated. plans and diagnoses, and to report “Today, Californians recognized that on provider-level management and State News legalizing marijuana will not make our citizens healthier, solve Califor- financial data. “We’re very, very pleased to have been selected by nia’s budget crisis, or reduce drug OADAP,” said Ravi Ganesan, presi- Marijuana legalization loses, related violence in Mexico,” said Gil dent of Core Solutions, in announc- but proponents say fight not over Kerlikowske, director of the Office ing the award last week. “Our com- Last week California voters said of National Drug Control Policy. prehensive system will allow the no to Proposition 19, which would staff to provide improved quality of have legalized the recreational use of marijuana in the state. The Drug Business care to the citizens of Arkansas while controlling costs.” Policy Project, which supported the initiative, said that older voters who Arkansas awards EHR contract CRC owner wants to acquire generally come out for mid-terms to Core Solutions U.K.-based Priory Group were responsible for the defeat, and The Office of Alcohol and Drug Bain Capital, the leveraged buy- that in two years when there are Abuse Prevention (OADAP), the sin- out firm that acquired CRC Health more younger voters at the polls the gle state authority for Arkansas, has Group for $720 million in 2005, is group will try again. “It’s still a his- awarded Core Solutions a contract now trying to buy Priory Group, a toric moment in this very long strug- to install and implement an elec- treatment chain based in England, gle to end decades of failed mari- tronic health record (EHR) system Bloomberg reported last week. Bain juana prohibition,” said Stephen for 60 licensed substance abuse has asked banks to finance its bid to Gutwillig, California director for the treatment providers throughout the the current owner, Royal Bank of Drug Policy Project. “Unquestion- state. The Philadelphia-based com- Scotland Group. Bids by other pri- ably, because of Proposition 19, pany was selected after competitive vate equity companies including marijuana legalization initiatives will bidding. The system will allow Blackstone Group failed, offering be on the ballot in a number of OADAP to capture and report on all less than 1 billion pounds (the states in 2012, and California is in client-specific and service-specific equivalent of $1.6 billion). Royal Bank of Scotland, which was seek- ing 1.1 billion pounds, had inherited In case you haven’t heard… Priory when it bought Dutch bank ABN Amro Holding NV in 2007. Pri- An airport screener, bored with the job of evaluating screening equipment at ory has treated celebrities including Philadelphia International Airport, planted vials of what looked like cocaine in model Kate Moss. passengers’ luggage, The Smoking Gun, an investigative web site, reported last week. The Smoking Gun used the Freedom of Information Act to find out about an incident that took place last January. The screener asked a woman if the vial If you need additional copies of Alcoholism & Drug Abuse Weekly, (which actually contained a nutritional supplement) was hers. She was very please contact Sandy Quade upset and reported him to airport officials, and said she didn’t think it was funny. at 860-339-5023 or The federal Transportation Security Administration fired the employee for the pranks, and records show that he was sorry for what he did. Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication. View this newsletter online at