Addictions News Now - January 2012

Dear Readers,

Our entire healthcare system is currently re-orienting itself to improve the health outcomes of persons living with multiple chronic conditions. This movement desires to increase health outcomes for these individuals, while also reducing overall healthcare spending. It may seem that this is a problem for other parts of the healthcare system, but up to 75% of people struggling with addictions also have a mental illness, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Similarly, up to 50% of those with mental illness have a substance use problem. With such a high prevalence of co-occurring mental health and substance use disorders, implementing a systematic approach to treat individuals who are struggling with multiple needs in a competent manner seems like the right thing to do.

We are happy to tell you about a new initiative designed to help organizations provide effective integrated and comprehensive care to individuals with co-occurring mental health and substance use disorders. Tthe National Council for Community Behavioral Healthcare, in partnership with Hazelden and MTM Services, has begun working with ten community behavioral health organizations in a Co-Occurring Disorder Learning Community.

The 10 community behavioral health organizations participating in this learning community are:

• ADAPT, Inc. – Roseburg, OR
• Area Mental Health Center – Garden City, KS
• Centerstone, Columbus, IN
• Jerome Golden Center for Behavioral Health – West Palm Beach, FL
• Pathways Community Behavioral Healthcare, Inc. – Clinton, MO
• Pine Belt Mental Healthcare Resources – Hattiesburg, MS
• Sacred Heart Rehabilitation Center, Inc. – Memphis, MI
• Tropical Texas Behavioral Health – Edinburg, TX
• Upper Bay Counseling and Support Services – Elkton, MD
• United Community Services, Inc. – Des Moines, IA
  

Through February 2013, the 10 organizations will receive technical assistance, aiding them in developing clinical processes designed to better serve individuals with both mental illness and addictions. Key elements of the Co-Occurring Disorder Learning Community include:

• Access to curriculum and leading experts who are involved in providing effective integrated treatment of co-occurring disorders and organizational change management
• Baseline and follow-up administration of a co-occurring treatment capacity assessment: the Dual Diagnosis Capability in Addiction Treatment (DDCAT) and the Dual Diagnosis Capability for Mental Health Treatment (DDCMHT)  
• Implementation of a Rapid Cycle Change quality improvement process which will provide goals and action steps to address co-occurring disorder service delivery capacity needs.
  We encourage you to keep an eye out for additional resources on co-occurring disorders and for helpful strategies that you can use to enhance your organizations ability to deliver holistic, effective healthcare services.

For more information on the Co-Occurring Disorder Learning Community, check out our website.

Sincerely,

Mohini Venkatesh
Senior Director, Public Policy

Dean Peterson
Director of the Center for Public Advocacy at Hazelden

RESOURCES & REMINDERS 

Register Now for Upcoming National Council Live Webinars

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If you forgot to register or missed out on one of our other free webinars, be sure to check out previously recorded National Council Webinars. 

HHS Announces Guidance to States on Essential Health Benefits; National Council Analysis Available on Our Blog
On December 16, the Department of Health and Human Services released its initial guidance on how states and insurance plans should implement the essential health benefits provisions of health reform. The HHS information bulletin is the latest step in an ongoing process of determining what type of coverage will be available to consumers in Medicaid benchmark plans and the state health insurance exchanges when health reform is fully rolled out in 2014. The National Council has published on our blog an analysis of how this guidance impacts behavioral health. A summary is below, and the full analysis can be read on MentalHealthcareReform.org.

Rather than designing one standard benefit package for all health plans in the nation to follow, HHS has opted to leave states with broad discretion in defining essential benefits in their state. The recent information bulletin proposes to allow states four options for selecting a “benchmark” plan whose covered benefits would be the basis of the EHB package in that state. This approach is an indication that the Obama Administration plans to allow states a fair amount of flexibility in carrying out the new insurance requirements of the Affordable Care Act (ACA). How behavioral health will fare during this process may vary on a state-by-state basis and will depend in large part on how each state decides to approach the issue.

HHS is accepting public comments on this information bulletin through January 31, 2012. Click here for our detailed analysis of the bulletin and instructions on how to comment.

Hazelden Intensifies Its Focus on Youth
As part of its strong commitment to helping young people find freedom from the disease of addiction, Hazelden has expanded its youth and adolescent continuum of care offerings. Research shows that young people suffering from addiction miss out on many of the joys of adolescence, like developing healthy friendships, achieving success at school and reaching personal goals, and the longer those patterns persist, the more it impacts their adult lives. It is also common for young people who struggle with addiction to experience co-occurring mental health problems or family difficulties, requiring an integrated approach to effectively address such complex needs. Specific new Hazelden youth initiatives include: 

• Residential care. Concerned by shifting patterns of teen drug and alcohol abuse and a shortage of treatment options for young addicts, Hazelden recently broke ground on a $30 million expansion of its Center for Youth and Families in Plymouth, Minnesota. The site, which since 1981 has treated teens and adults from 14-25, will now include a 32-bed unit for female patients, improved facilities for parents participating in their children's treatment and a variety of “step-down” programs to help patients ages 14 to 25 stay sober as they make the transition home. 
• Outpatient care. As part of the Plymouth expansion, Hazelden is also developing recovery resource centers where young people and their families can go for outpatient addiction treatment, mental health services and related resources. 
• Collegiate structured sober living. In partnership with Columbia University’s Department of Psychiatry, Hazelden recently opened Tribeca Twelve, a first-of-its-kind collegiate recovery residence in New York City’s Tribeca neighborhood for young adults ages 18 to 29 who are committed to their sobriety and are attending college or planning to return. Programming addresses the unique needs of young adults with co-occurring substance use and mental health disorders, and combines a seamless continuum of integrated care with state-of-the-art treatment.
• Recovery management. Hazelden is piloting new technology into an enhanced post-treatment program of personalized recovery coaching, guidance and support to help patients transition successfully to home life, school and work.
• Research. Hazelden’s Butler Center for Research conducts research that informs youth outcomes, such as a study currently underway examining the impact of text messaging on recovery for young people.
• Publishing. Hazelden Publishing, the leading publisher of evidence-based treatment curricula for youth and adolescents and prevention programs that target bullying, dating violence and youth suicide, is currently focused on developing new electronic products and applications that aim to help young people build lifelong recovery from addiction.

SAMHSA Releases New FAQs on Substance Abuse Confidentiality
SAMHSA recently released new FAQs on 42 CFR Part 2, addressing the confidentiality of alcohol and substance use patient records. With the contemporary emphasis on electronic health records (EHRs) and health information, SAMHSA’s updated “frequently asked questions,” or FAQs, will better help providers navigate confidentiality issues in integrated settings and systems. 

IN THE NEWS

SAMHSA Announces a Working Definition of “Recovery”
The Substance Abuse and Mental Health Services Administration (SAMHSA) recently announced a new working definition of recovery from mental disorders and substance use disorders. The definition is the product of a year-long effort by SAMHSA and a wide range of partners in the behavioral health care community and other fields to develop a working definition of recovery that captures the essential, common experiences of those recovering from mental disorders and substance use disorders. Major guiding principles support the recovery definition. SAMHSA led this effort as part of its Recovery Support Strategic Initiative.

The new working definition of recovery from mental disorders and substance use disorders is: a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

Through the Recovery Support Strategic Initiative, SAMHSA also has delineated four major dimensions that support a life in recovery:

• Health: Overcoming or managing one's disease(s) as well as living in a physically and emotionally healthy way.
• Home: A stable and safe place to live.
• Purpose: Meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society.
• Community: Relationships and social networks that provide support, friendship, love, and hope.

Click here to read the full SAMHSA press release.

2011 Monitoring the Future Survey Shows Evolving Substance Use Patterns Among Teens
The results of the National Institute on Drug Abuse’s (NIDA) 2011 Monitoring the Future survey are in, and they demonstrate changes in teen substance use. The survey, which has been measuring drug, alcohol and cigarette use in 12th graders since 1975, and in 8th and 10th graders since 1991, surveyed 46,773 students from 400 public and private schools in 2011. On the positive side, teen use of alcohol and cigarettes is at an all-time low. But that positive news is tempered by a slowing rate of decline in teen smoking and continuing high rates of abuse of other tobacco products such as hookahs, small cigars and smokeless tobacco. The survey also found more teens continue to abuse marijuana than cigarettes; and that despite declines, alcohol is still the drug of choice among all three age groups queried.

The report notes regular teen marijuana usage has grown in recent years. Nearly 6.6% of 12th graders report daily use, up from 5% in 2006. That upward trend corresponds to downward trends in perception of risk: just 43.4% of eighth-graders reported they saw great risk in smoking marijuana occasionally, compared to 48.9% five years ago. Further, concerns about the use of synthetic marijuana, known as K2 or spice, prompted its inclusion in the survey for the first time in 2011. Surprisingly, 11.4% of 12th graders reported past year use.

There was mixed news in the non-medical use of prescription drugs. There were slight declines for both 10th and 12th graders in the use of the opioid Vicodin, although OxyContin use remains flat, as does non-medical use of the ADHD medicines Adderall and Ritalin, which remain about the same.

U.S. Painkiller Overdose Death Rate Triples In Ten Years
More Americans die annually from prescription painkiller overdoses than from the combined total of heroin and cocaine, according to a new CDC Vital Signs report released this month. Deaths from narcotic overdoses such as Opana (oxymorphone), OxyContin (oxycodone), methadone and Vicodin (hydrocodone) average over 40 people per day. The 2010 National Survey on Drug Use and Health (NSDUH) found over 70% of people who abused prescription pain relievers got them from friends or relatives, while roughly 5% got them from a drug dealer or on the Internet.

To tackle this crisis, the Administration launched an action plan in April called “Epidemic: Responding to America's Prescription Drug Abuse Crisis.” The plan will expand state-based monitoring programs, encourage disposal of unused medications, improve education for healthcare providers and their patients and provide stronger support for law enforcement agencies.

Research Indicates Fatty, Processed Foods May Be As Addictive as Drugs
There is a growing body of research pointing to the addictive qualities of fatty, processed foods and sugary drinks. In a recent Bloomberg.com article, Nora Volkow, director of the National Institute on Drug Abuse, asserted “the data is so overwhelming the field has to accept it. We are finding tremendous overlap between drugs in the brain and food in the brain.”

According to Bloomberg’s review of the National Library of Medicine database, 28 scientific studies and papers on food addiction have been published in the past year alone. Lab studies have found sugary drinks and fatty foods can produce addictive behavior in animals. Brain scans of obese people and compulsive eaters, meanwhile, reveal disturbances in brain reward circuits similar to those experienced by drug abusers.

While unhealthy nutrients have always been part of the human diet, what’s new is processing, which creates food with concentrated levels of sugars, unhealthy fats and refined flour but without redeeming levels of fiber or nutrients. Consumption of large quantities of those processed foods may be changing the way the brain is wired. In one 2010 study, scientists at Scripps Research Institute fed rats an array of fatty and sugary products. The rats that had access to these foods for one hour a day started binge eating, even when more nutritious food was available all day long. Other groups of rats that had access to the sweets and fatty foods for 18 to 23 hours per day became obese. The results produced the same brain pattern that occurs with escalating intake of cocaine, wrote Paul Kenny, the Scripps scientist heading the study, in the journal Nature Neuroscience.

Study Finds Relationship Between Economic Pain and Drinking, Smoking for Older Americans
According to a study of more than 2,300 older Americans, many of them were more likely to drink or smoke when their finances took a hit. While the findings do not necessarily prove a direct causal relationship, it has been shown that people frequently use alcohol and cigarettes as a way of coping with stress, and that financial troubles often drive stress levels.

The older adults (65+) in the study were surveyed periodically between 1992 and 2006. Older men under increasing financial strain were 30% more likely to take up heavy drinking than men who had remained financially stable. When it came to smoking, participants were found more likely to increase their smoking during financial hardship, with relatively younger study participants (those who were age 65 at the study's start) most likely to smoke more.

Study Explains Why Denial of Access to Medication Assisted Treatment in the Criminal Justice System Violates Federal Statutory and Constitutional Law
The Legal Action Center recently released a report, Legality of Denying Access to Medication Assisted Treatment in the Criminal Justice System, which describes why criminal justice agencies violate Federal anti-discrimination laws and the United States Constitution when they deny access to medications, such as methadone and buprenorphine, to treat opiate addiction. The report was written at the request of the American Association for the Treatment of Opioid Dependence and explains the prevalence of opioid addiction in the criminal justice system, its devastating consequences, and the widespread denial of access to medication assisted treatment.

Data Spotlight
The following provides summaries of recently-released data and research findings:

• A new report, Illicit Drug Use among Older Adults, found that more than 5% of adults aged 50 and older used illicit drugs in 2009.
• According to a recent World Health Organization’s Global Burden of Disease report, 13% of the global burden of disease is due to mental illness, nervous system disorders, or substance use. 
• A recent study done by the Substance Abuse and Mental Health Services Administration, the number of older adults who need substance abuse treatment is expected to more than triple from 700,000 in 2000 to about 2,300,000 in 2020.
• Data from the White House report on prescription drug overdoses show:
  • Death rates from prescription painkillers are three times higher among non-Hispanic whites than for African-Americans and Hispanic whites.
  • Death rates among Alaskan Natives and American Indians are about the same as they are for non-Hispanic whites.
  • The highest death rates are among people between ages 35 and 54 years.
  • Some 830,652 years of “potential life” before the age of 65 were lost in one year because of prescription painkiller overdoses.
  • Overdoses from prescription painkillers destroy a similar number of years of potential life lost as road accidents, and significantly more than homicide.
  • According to 2008 data, death rates from prescription medication overdoses range from a low of 5.5. per 100,000 individuals in Nebraska to 27 per 100,000 in New Mexico.
  • An estimated 1 in every 12 people aged at least 12 years use prescription painkillers recreationally in Oklahoma, the highest rate in the U.S. Nebraska has the lowest rate at 1 in every 30 people.
  • Sales of prescription painkillers per head in Florida (highest state) are three times higher than Illinois (lowest state). The higher the sales per person the higher that state's drug overdose death rate tends to be.

GOVERNMENT AFFAIRS UPDATE

Congress Enacts 2012 Budget, Averts Feared Cuts to Behavioral Health
Overcoming a political impasse, Congress recently approved the remaining nine bills that make up the 2012 budget. The “megabus,” as the 9-bill package was dubbed, includes several notable funding increases for behavioral health and addictions programs, a major victory given the massive reductions to behavioral health and addictions that were included in the budget proposal by the House of Representatives. Overall, the Substance Abuse and Mental Health Services Administration saw a $27 million cut, for a total of $3.5 billion in funding for the agency. This total amount is still subject to a 0.189% decrease that was included in the megabus bill.

Within the Center for Substance Abuse Treatment, the agreement includes: $28.2 million for Screening, Brief Intervention, Referral, and Treatment (level vs. FY 2011); $98.5 million for Access to Recovery level vs. FY 2011), and $67.6 million for criminal justice activities (+$2.5 million vs. FY 2011).

Within the SAMHSA budget, several key programs received funding increases:

• Substance Abuse Prevention and Treatment Block Grant: $1.8 billion (+21 million vs. FY 2011)
• Primary Care and Behavioral Health Integration (PBHCI): $30.8 million for SAMHSA portion (+$3 million vs. FY 2011; this figure does not include the additional Prevention and Public Health Fund money that may be allocated to the program)
• Primary Care and Behavioral Health Integration Technical Assistance: $2 million (this is a new line item in the budget; funding previously came from the PBHCI line item)

Click here for more details about specific program funding levels (the section for SAMHSA begins on p. 39). 

Congress Authorizes 2-Month Delay of Medicare Physician Pay Cut
With Medicare physician payment rates scheduled to take a 27% cut in January, Congress acted late last week to postpone the pay cuts for two more months, until February 28. The agreement gives lawmakers breathing space to work out a longer-term compromise to address the issue of physician pay in Medicare.

The agreement was included in a last-minute deal on legislation to extend the payroll tax holiday and unemployment benefits. A few weeks ago, a deal appeared unlikely, with the Senate already in recess for the holidays and the House leadership insisting it would not approve the Senate-passed version of the bill. However, bowing to political pressure, the House agreed to minor changes in the Senate version, staving off a potential political blowout from a failure to extend the popular tax holiday and physician payment fix.

Nonetheless, the recent deal leaves the future of Medicare physician payment uncertain. The American Medical Association and other doctors’ groups have long advocated a permanent solution to Congress’ annual dilemma of averting scheduled pay cuts, and there is widespread support for a permanent solution in both parties. The problem arises over how to pay for a permanent fix. Because of the accounting rules used by the Congressional Budget Office (CBO) to calculate the cost of proposed policies, any permanent solution will “cost” billions of dollars in foregone revenue – despite the fact that the politically unpopular cuts will almost certainly never take effect, and thus the government will never see the actual savings that must be counted as foregone revenue under the CBO rules.

Fiscal hawks in Congress have insisted on offsetting all costs with spending cuts elsewhere in the budget, but other legislators disagree on whether or where to seek savings. With the 2012 elections adding additional political pressure on an already divided Congress, it is unclear whether the two-month delay will be sufficient time for lawmakers to work out the details of a permanent fix – or whether they will enact another short-term patch.

The National Council’s Addiction News Now is published monthly and is produced in partnership with Hazelden.