Addictions News Now—May 2011
 

The recent National Council Mental Health and Addictions Conference is San Diego afforded participants multiple opportunities to participate in conference sessions as well as engage researchers and practitioners presenting posters on a number of issues related to the treatment of addiction and co-occurring disorders.  All of the handouts are available on-line (http://www.thenationalcouncil.org/cs/workshops_by_track) to facilitate ongoing learning for those of you not able to attend.

Participants in the conference also had the opportunity to hear from former President, William Jefferson Clinton.  Mr. Clinton spoke on the day after the world learned that U.S. forces had identified and killed Osama Bin Laden.  In commenting on the occasion, Mr. Clinton commented on bin Laden's ideology and his notion of an "absolute truth," noting that “anyone who claims to have an absolute truth is in trouble.”

He noted that throughout history systems have failed because they became rigid. “Eventually, people became more interested in advancing their positions than advancing the policies that upheld the institution.” 

The entire healthcare system is facing a period of unprecedented change, and we all know that change is often fraught with anxiety and resistance.  Many of us are familiar with these reactions in the clients that we serve and we have expert advice for them on how to confront and push through resistance as part of the healing and recovery process. 

As our systems confront a period of change in terms of organization and financing, we must resist the urge to resist for the sake of resisting, to acknowledge that change may result in more people in need of addiction services having access, that collaboration and co-location will be necessary as we become part of the fabric of healthcare.  That freedom from addiction will be essential to effectively treating chronic health conditions. 

While it is impossible to know exactly how the future will turn out, let’s resist the temptation to hold onto structures for the sake of structures and always keep in mind why we entered this work in the first place.

Sincerely,

Chuck Ingoglia
Vice President Public Policy
 

Resources and Reminders

Nominations Sought for Presidential Citizens Medal
The White House announced today that they are asking individuals to participate in the nomination process for the Presidential Citizens Medal, the nation’s second-highest civilian honor. For the 2011 Presidential Citizens Medal, they are asking individuals to nominate “everyday heroes” who have performed deeds of service, including those who have demonstrated commitment to service in their own communities or far from home, have helped others through extraordinary acts, or whose service has had a sustained impact on others’ lives and provided inspiration for others to serve. Last year, 6,000 leaders were nominated and 13 were honored with the Medal. For more information on the Citizens Medal as well as for details on how to nominate an outstanding citizen, please visit WhiteHouse.gov/citizensmedal. Nominations must be received by Monday, May 30, 2011 at 11:59 PM Eastern.

National Council Webinar: Implementing SBIRT in Clinical Settings
On April 25th, the SAMHSA-HRSA Center for Integrated Health Solutions conducted a webinar entitled “Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Clinical Settings”.  The SAMHSA-HRSA Center for Integrated Health Solutions, run by the National Council for Community Behavioral Healthcare under a cooperative agreement from the U.S. Department of Health and Human Services, is funded jointly by the Substance Abuse and Mental Health Services Administration and the Health Resources Services Administration. The Center promotes the development of integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions, whether seen in specialty behavioral health or primary care provider settings. During the webinar, Dr. Eric Goplerud and Dr. Bill McFeature demonstrated SBIRT, an evidence-based approach which can be integrated into health center practice. SBIRT identifies and helps manage harmful substance use and dependence among patients and their families.  Please refer to the National Council website for a recording of this webinar.

Visit the National Council’s website for more information and to register for upcoming webinars.

Additionally, please refer to the National Council website for recordings on previous Webinars that provide useful information on healthcare reform, client outcomes and Medicaid as well as other issues.

National Council Announces April Advocacy Challenge Winners
The National Council is pleased to announce the winners of our April Advocacy Challenge:
•    Candace Darcy of Behavioral Health Network in Springfield, Massachusetts
•    Katharine Van Evera of Human Development Center in Duluth, Minnesota
•    Susan Jefford of Southern Hills Counseling Center in Tell City, Indiana

Congratulations to our winners for their dedication and commitment to advocacy on behalf of addictions and mental health treatment! The National Council encourages all of our members to help build support in Congress for a strong behavioral health safety net by participating in the monthly advocacy challenge. Click for more information.

Funding to Enhance State and Tribal Substance Abuse Treatment Service Systems
The Substance Abuse and Mental Health Services Administration announced the availability of FY 2011 funds for cooperative agreements to expand and enhance State and Tribal substance abuse treatment service systems. The grants should expand the State/Tribe’s continuum of care to include screening, brief intervention, and referral to treatment (SBIRT) in general medical and other community settings including military, reserve and guard units. Click here to learn more.

Tobacco Cessation Resource for Clinicians
The Community Anti-Drug Coalitions of America and the Smoking Cessation Leadership Center are working together to assist people to quit smoking. “Rx for Change” is a comprehensive program for training students and licensed clinicians in almost any health professional field; however, a person does not have to be a clinician to learn and administer the program. Any person who is interested in tobacco cessation can take the free training which includes videos, handouts and PowerPoint slides. There are tailored versions of the curricula for individuals and clinicians in various specialties. To register for the curriculum that applies to your profession, visit  http://rxforchange.ucsf.edu/about.php.
   
Fight for Our Future at Hill Day, July 19-20
On July 19-20, 2011, join hundreds of your colleagues in Washington, D.C. for our field’s premiere public policy and networking event! The National Council’s Annual Public Policy Institute and Hill Day brings together addictions and mental health providers, administrators, board members, consumers, and community stakeholders from across the country. Participants come to D.C. for a full day of sessions and workshops on federal behavioral health policy – followed by visits with their elected officials on Capitol Hill to advocate for our field’s priorities.

This year, Congress is under intense pressure to slash the Federal discretionary funding that is so vital to supporting mental health and addictions services. There’s no more important time to fight for our future! Hill Day gives you the opportunity to influence policy and make your voice heard on Capitol Hill. Click here to see how last year’s attendees made a difference.

Free Registration is now open for the 7th Annual Public Policy Institute and Hill Day. Thanks to the feedback we received from last year’s attendees, the National Council is planning several enhancements and improvements to our Hill Day 2011 events – stay tuned to learn the details.

Participating in Hill Day is easy. Visit our website to learn the details and view a tentative schedule of events. Questions? Contact Rebecca Farley at RebeccaF@thenationalcouncil.org or 202-684-7457, ext 235.
 

On the Hill

HHS Releases FY 2011 Operating Plan: Cuts to SAMHSA Included
The Department of Health and Human Services released its FY 2011 Operating Plan, which indicates the programs whose funding will be reduced in order to meet the overall level of cuts specified in the fiscal year 2011 federal budget. According to the FY2011 budget, SAMHSA will be funded at an overall level of $3,379,538,000 which is a $51.5 million reduction from fiscal year 2010. The 2011 budget did not identify specific programs to be slated for cuts, but the newly released Operating Plan specifies that the Center for Mental Health Services received a $16.2 million reduction and the Center for Substance Abuse Treatment received a $28.2 million dollar reduction. The Substance Abuse Prevention and Treatment block grant was reduced by $15.9 million to bring its funding for the whole of FY 2011 to $1.7 billion. It is important to note that because the 2011 budget was not enacted until April (halfway through the fiscal year), these reductions must be entirely implemented between now and the end of the fiscal year: Sept. 30, 2011. This means that SAMHSA has only four and a half months to cut spending on these programs to the indicated levels.

House Releases Appropriations Levels for 2012 Budget Bills
Last week, the House Budget Committee released the overall spending levels for each of the 12 annual appropriations bills that comprise the federal budget. These appropriation levels are set based on the framework enacted in each year’s budget resolution and represent the upper limit of spending for each group of federal agencies. Although no budget resolution has yet been enacted into law this year, the appropriations spending caps released today are based on the budget blueprint proposed by Representative Ryan and approved by the House. This year’s Labor-Health and Human Services-Education spending limit represents a cut of $18.2 billion below Fiscal Year 2011 levels (-11.6%) and is $41 billion below President Obama’s budget request.

This significant reduction in the Labor-HHS-Education allocation means that all programs under the umbrella of these agencies will be at risk for substantial cuts. Particular targets will include any programs that saw their funding reduced in the House Republican version of the 2011 budget and then restored in the House-Senate compromise that allowed the 2011 budget to become law. Thus, SAMHSA is at high risk for additional cuts. The Labor-HHS-Education bill is currently scheduled for consideration by the House Appropriations Committee on August 3, with a subcommittee hearing to take place the week before.

House Votes to Block Grant Medicaid; Report Details Impact of Spending Cap Proposal on Medicaid
Late last month, the House voted 235-193 to approve H.Con.Res.34, which provides a framework for consideration of the fiscal year 2012 budget. This legislation was crafted by Representative Paul Ryan (R-WI), Chairman of the Budget Committee; included in the bill is a dramatic restructuring of Medicaid and Medicare. Under Congressman Ryan’s proposal, Medicaid would be converted to a block grant beginning in 2013, and Medicare would be converted to a privatized voucher system starting in 2022. The result would be a shift in costs to states, consumers, and providers over the coming decades – and an undermining of key beneficiary protections in both programs. Currently, individuals who experience a disability due to a substance use disorder cannot access Medicaid with an addiction-only diagnosis, unless they qualify through a different eligibility pathway (such as having an income below their state’s eligibility threshold). It is anticipated that the Medicaid expansion set to take effect in 2014 will help individuals with substance use disorders gain access to insurance; however, converting Medicaid to a block grant will place that under major threat.
 
The Senate is unlikely to take a vote on H.Con.Res.34. Instead, the Senate will draft its own version of a budget resolution, which is the legislation that outlines overall spending levels and other requirements for consideration of each year’s budget. In the event that the House and Senate are unable to agree on a budget resolution, the previous year’s resolution will remain in force, allowing the appropriations process to move forward despite a stalemate over the budget resolution.
 
However, the danger to Medicaid is far from over. Senators Bob Corker (R-TN) and Claire McCaskill (D-MO) have introduced legislation (S. 245) that would cap federal spending at no more than 20.6% of Gross Domestic Product. Not only would this legislation force automatic, across-the-board cuts to discretionary programs when the cap is breached, it would cut spending on Medicaid by $547 billion over the next 9 years – a level of cuts that could only be achieved by converting Medicaid to a block grant. A new report from the Center on Budget and Policy Priorities explains that the Corker-McCaskill bill would reduce Medicaid spending by 19%. As a result, "states almost certainly would also institute substantial cuts in reimbursement rates for hospitals, physicians, nursing homes, pharmacies, managed care plans, and other providers that furnish care to Medicaid beneficiaries." These cuts would grow steadily deeper over time as health care costs continue to rise at a rate faster than inflation. While the future of the Corker-McCaskill bill is unclear at this time, it is likely that fiscal conservatives will try to attach a similar spending cap requirement to upcoming legislation increasing the federal government’s debt limit. Medicaid will continue to be at risk throughout the debt limit debate and the 2012 budget process.
 
The behavioral health field must be vigilant in guarding against these dangerous cuts to Medicaid. The National Council would like to thank those of you who responded to our latest Action Alert and contacted your Representatives urging them to oppose converting Medicaid to a block grant. Stay tuned to our Action Alerts for more opportunities to fight against these cuts to this important program!

Congresswoman Issues Letter in Support of Strengthening Initiatives Against Prescription Drug Abuse
Representative Mary Bono Mack (R-CA) has sent a letter to the Food and Drug Administration urging the FDA to do more to combat prescription drug abuse. Representative Bono Mack writes, “I strongly urge you to take additional, critically necessary safeguards immediately. Most importantly, the FDA should limit the use of OxyContin and other oxycodone prescription drugs for severe pain only. This is one of the best ways to limit the “street supply” of these powerfully addictive narcotic drugs.”

Ms. Bono Mack’s letter came a day after the Obama Administration unveiled its multi-agency strategy to fight prescription drug abuse. Educating providers about the proper way to prescribe opioids and identifying individuals who might abuse or misuse the drugs is a key component of the new strategy. The plan also calls for every state to develop a prescription drug-monitoring program and encourages them to share the information with other states.
 

In The News 

National Drug Court Commencement Week
From May 16-20, 2011, drug courts across the nation will celebrate National Drug Court Month. This year the focus is on the social and economic benefits of drug courts. Federal, State and Local stakeholders will be given the opportunity to attend any of the drug court graduations happening nationwide. These celebrations offer a glimpse into the best of drug courts, the success of treatment and exit from the criminal justice system. This year National Drug Court Commencement Week coincides with Congressional District Work week so drug courts were encouraged to reach out to their Representatives in Congress to attend a graduation ceremony or a drug court session. For more information about National Drug Court Month, please visit: http://www.nadcp.org/act/2011NDCM

President Obama Writes Letter in Support of Drug Courts
On May 13, President Obama wrote a letter in recognition of National Drug Court Commencement Week indicating the administration’s support of drug courts. The President highlights drug courts as part of the Administration’s strategy to provide alternatives to incarceration. He indicates that drug courts help approximately 120,000 individuals annually recover from addiction and prevent future criminal activity while reducing the costs of incarceration.

NIDA Addiction Science Awards
The Intel International Science and Engineering Fair (ISEF) Addiction Science Awards were presented last week. The ISEF is the largest science competition for high school students in the world. The Addiction Science Awards were presented by the National Institute on Drug Abuse and Friends of NICA. First place went to a high school senior from New York for her project which looked at delayed discounting, a phenomenon where people discount the value of a reward to be received at a later time versus an immediate, but smaller, reward. This phenomenon is particularly high in people who are addicted to substances and may contribute to impulsive risk taking behaviors.  Awards were also given to a freshman from Tennessee and a sophomore from Oregon. Friends of NIDA partnered with NIDA to sponsor these awards as part of their ongoing support of NIDA research. NIDA has a section on its website, which includes resources on addiction science and showcases the winning projects.

NIDA Addiction Performance Project
The National Institute on Drug Abuse (NIDA) has started the Addiction Performance Project with the intent of helping primary care providers break down the stigma of addiction. The Project includes an interpretation of a family struggle with addiction, followed by a dialogue that is designed to foster compassion and understanding. The program aims to help doctors move beyond their comfort zones when discussing drug abuse with their patients. Doctors can receive continuing medical education credits for completion of the program. For more information or to register for a performance visit NIDA’s website.

World Health Organization Report: Smoking and Drinking Cause Millions of Deaths Worldwide
The World Health Organization (WHO) released a report on non-communicable diseases- including diabetes, cancer and respiratory and heart diseases- which says that a large percentage of those conditions could be prevented by reducing alcohol and tobacco use. The report indicates that almost 6 million people die from tobacco use and 2.5 million from harmful use of alcohol yearly.  It explains that tobacco is expected to kill 7.5 million people worldwide by 2020. The report includes strategies for reducing tobacco use such as distributing information about the harmful effects, restrictions on smoking in public areas, and bans on advertising for alcohol and tobacco. To view the report, please visit the WHO website.

Nationally Accredited Addiction Medicine Residency Programs
10 newly accredited addiction medicine residencies will start training the first groups of medical residents on July 1. The programs are accredited by the American Board of Addiction Medicine and will produce physicians with full training in addiction medicine to help with the care of patients with addictive disorders. The program will begin with approximately 25 students. The one- to two-year programs will include a 12 month educational component, rotations through inpatient and outpatient settings as well as additional electives. The first graduates should finish the program in July 2012.

Recovery in Mental Health and Substance Use Disorder: Is There a Common Vision?
Recovery is a personal and individualized process of growth for which there are multiple pathways. People in recovery from either mental health problems or substance use disorders have described recovery both as a transformational and an incremental process, with recovery narratives filled with elements of both types of change. It is important that people are active agents of change in their own lives—not passive recipients of care. Click here to read the summary, view resources and suggested readings.