Addictions News Now - November 2011

Dear Readers,

An article in a recent issue of the journal Addictive Behaviors reviews the current use of medication-assisted treatment in substance use treatment programs around the country and found low rates of adoption. In the discussion section, Roman and his colleagues outline the barriers to increased adoption: lack of consumer knowledge about medication options, minimal guidance to prescribers, and challenges to bringing new medications to market.

While we're guessing most of this isn't shocking to you, reading this article led us to think about the adoption of innovative practices for individuals with chronic diseases. Whether through the Affordable Care Act or simple creativity of community providers around the country, the notion of "integrated health systems" is taking shape through the creation of person-centered health homes and other models to meet the overall health care needs of the population. Individuals with chronic illnesses are a natural target, given common co-morbidities and high health care system costs, and an opportunity exists for community addiction providers to make the business case for why you should be included in this model. Your ability to provide timely access to treatment, implement innovative practices, and contribute to improved health outcomes will highlight your value as a needed specialty provider in any integrated health system.

Provisions in the Affordable Care Act as well as state policies around the country have the potential to facilitate an environment more conducive to these integrated strategies, but what can you as a provider do to be ready? Pay attention to your peers around the country who are implementing innovative strategies, take note of policy changes that are being discussed at the state and national levels, and look within your organization's practices to identify what you'd like to change in order to make a stronger business case for your value in integrated health systems of the future.

We encourage you to utilize the National Council’s Mental Health & Substance Use Provider Readiness Assessment, prepared by Dale Jarvis designed to provide you with important competencies and strategies that will be necessary to succeed in the new “healthcare ecosystem.”

We also encourage both Mental Health and Addiction programs to assess their readiness to provide integrated treatment for co-occurring disorders with The Dual Diagnosis Capability in Addiction Treatment (DDCAT) and Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) Indices. Both indices provide a snapshot of a program’s current capabilities and suggest tips for evolving closer to full integration. 

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

• Healthcare Reform’s New Managed Care Options and Requirements
  Wed, Nov 9, 2–3:30 pm eastern | Learn more & Register Free
• Serving Our Veterans’ Behavioral Health Needs in the Community
  Thu, Nov 10, 2–3:30 pm eastern | Learn more & Register Free 
• Performance-based Contracting for Behavioral Health
  Mon, Nov 14, 2–3:30 pm eastern | Learn more & Register Free
• Peer-delivered Services: Contracting with Managed Care 
  Wed, Nov 16, 11 am–12:30 pm eastern | Learn more & Register Free
• Improve Access to Care: Eliminate No Shows and Wait Times
  Mon, Nov 28, 3–4:30 pm eastern | Learn more & Register Free
  
  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.

Hazelden Introduces New Level of Recovery Support and Monitoring for Long-Term Recovery
Hazelden has developed an intensive new level of support and monitoring for people in the crucial first months of recovery from addiction aimed at improving their prospects for long-term recovery.

The 18-month “Hazelden Connection” program combines one-to-one coaching with accountability reporting, random drug testing and online support, while involving family members, employers and other concerned persons in the recovery process.

As Janelle Wesloh, Executive Director of Recovery Management for Hazelden, explains, addiction is a chronic disease with relapse rates similar to those for diabetes, hypertension and asthma. The Hazelden Connection program targets the early transition period, which is a key timeframe for reducing the risk factors for relapse and laying a solid foundation for lifelong recovery.

"For people who've been accustomed to planning their days around drinking or other drug use, adapting to life without these chemicals can feel incredibly daunting if not downright terrifying," says Wesloh. "Yet research tells us those who actively engage in continuing care are more likely to remain abstinent for the long haul."

In addition to receiving regular personal guidance from a Hazelden Connection coach, participants designate family members or other concerned persons to be actively involved in their recovery process. The coach monitors the newly recovering individual and compiles monthly reports for key stakeholders, including the participant and their designated family members or loved ones, as well as other contacts such as the legal system or employer, as appropriate.

"The idea is to leverage and consolidate resources in support of the individual in recovery -- to get them on solid footing -- because we know that while getting sober is the first step,” explains Wesloh.  “Learning how to stay sober is a lifelong journey.”

Hazelden Connection is available for those who need additional support and accountability in their early recovery. Participants are not required to have had a previous addiction treatment experience prior to participating in the Hazelden Connection program. Learn more.

Addiction Recovery Program Reduces Aetna Treatment Readmissions
Addiction treatment admissions dropped by 67% for Aetna members who were enrolled in a social networking addiction recovery support program operated by OneRecovery, Inc. Members who enrolled in this support program enrolled after completing detoxification or addiction treatment. OneRecovery provides treatment support for members through a private, secure, online and mobile platform. This online support program enables treatment provider organizations to use existing programs and professionals to provide post-treatment support. Learn more.

New Teen Alcohol Risk Screening Guide from NIAAA Released
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) released a guide for health care professionals to help identify children and teenagers age 9 to 18 who are at risk for alcohol-related problems, provide brief counseling, and refer them to treatment resources. The guide includes a two-question risk assessment as well as links to resources for motivational interviewing.

IN THE NEWS

Medicare to Cover Screening for Alcohol Abuse and Depression
The Centers for Medicare & Medicaid Services (CMS) has added alcohol misuse screening, short-term behavioral counseling and screening for depression to its list of covered preventive services for Medicare recipients. 

Citing the related health risks associated with alcohol abuse, as well as the significant long-term costs to society at large, CMS added these important new benefits to the current preventive care list that includes services like vaccines for the flu and pneumonia, screenings for breast and colon cancer, cholesterol and blood-sugar measurements and others.

“Preventive services bring relief to Medicare beneficiaries for whom preventive care means early identification of disease and greater opportunity for treatment and recovery,” said CMS Administrator Donald M. Berwick, MD.  The new benefit will include primary care brief screenings, as well as up to four behavioral counseling sessions per year furnished by the primary care provider, if beneficiaries screen positive for alcohol misuse.  Annual depression screenings will now be covered in primary care settings that have sufficient trained staff in place to follow up with appropriate treatment and referrals.

Data Spotlight

• A new SAMHSA report found that for the 669,000 adults admitted for addiction treatment for the first time last year, an average of 15.6 years elapsed since the first time they used the substance for which they were being treated.  The length of time was longer for males than females (16.5 years versus 13.8).  The study is based on data from the Treatment Episode Data Set (TEDS) from treatment facilities across the country.
• According to the National Survey on Drug Use and Health, methamphetamine use has declined sharply. The number of past-month users of meth fell from 731,000 in 2006 to 353,000 in 2010. Click here to read the report.
• Police are still making more drug arrests than any other kind.  This is according to the FBI’s Uniform Crime Reporting Program, which compiles data from over 18,000 agencies nationwide.  Of the estimated 13,120,947 non-traffic arrests U.S. police made last year, 1,638,846 were for drug-related charges -- 81.9 percent for possession and 45.8 percent specifically for marijuana possession.  Other crime statistics, meanwhile, continue to drop. The national murder rate fell 4.2 percent last year, and violent crime such as murder, rape and aggravated assault dropped 6 percent.  Property crime fell 2.7 percent from 2009, motor vehicle thefts dropped by 7.4 percent, and burglaries declined 2 percent.   Based on this data, police made an average of one drug arrest every 19 seconds in 2010.  
• A new Government Accountability Office (GAO) report found that more than 170,000 Medicare beneficiaries got prescriptions for painkillers that are often abused from five or more physicians.
• According to the Centers for Disease Control and Prevention, episodes of drunk driving have decreased by 30 percent over the past 5 years. Click here to read the report.  
  
   

GOVERNMENT AFFAIRS UPDATE

SAMHSA Teams with Bureau of Justice Assistance to Support Drug Courts
As part of its Strategic Initiative focusing on Trauma and Justice, SAMHSA has joined forces with the U.S. Department of Justice’s Bureau of Justice Assistance (BJA) to enhance drug court services.

Drug courts provide an alternative to incarceration for people involved with the criminal justice system and who are in need of substance abuse treatment services.

BJA and SAMHSA will provide nearly $13 million in grants.  BJA will fund the drug court component, with 10 grants totaling $3 million over three years, and SAMHSA will fund the substance abuse treatment component with up to $9.6 million over the three year span. 

"All too often the first place people get help for behavioral health problems is the criminal justice system.  While we work to improve early identification in the health system, courts are one of the places people abusing alcohol and using drugs illegally show up," said SAMHSA Administrator Pamela S. Hyde in a press release announcing the grants. "Through these new grants we meet people where they are and the court system is one venue available to help people on the path towards recovery and a productive life."

Since originating in Miami-Dade County in 1989, drug courts have proliferated rapidly: over 100,000 people are now treated annually in more than 2,400 Drug Courts throughout all 50 states. Click here to learn more and for a full list of grantees.  
 

CDC Estimates Societal Costs of Heavy Drinking at Almost $2 per Drink
A new Centers for Disease Control and Prevention (CDC) study found that the cost to society from excessive alcohol consumption in the U.S. came to $223.5 billion in 2006, or more than $1.90 per drink.  That equates to approximately $746 for every man, woman or child in the U.S.

Researchers said the costs were for losses in workplace productivity (72% of the cost); health care expenses due to heavy drinking (11%); law enforcement and criminal justice expenses (9%); and motor vehicle crash costs from impaired driving (6%).

Excessive alcohol consumption, or heavy drinking, is defined as an average of more than one alcoholic beverage per day for women, and an average of more than two alcoholic beverages per day for men, and any drinking by pregnant women or underage youth.  Nearly 75% of the costs were due to binge drinking, defined as four or more alcoholic beverages per occasion for women or five or more drinks per occasion for men. 

HHS Launches Smoking Cessation mHealth Initiatives
The Department of Health and Human Services launched a new mobile health (mHealth) initiative to increase the use of mHealth services to aid in smoking cessation. In November 2010, HHS established the department-wide Text4Health Task Force to help identify ongoing initiatives and proposals for new mHealth projects. The new smoking cessation initiatives include a SmokeFreeTXT program, launched by The National Cancer Institute (NCI) at the National Institute of Health, which is a mobile smoking cessation service designed for teens and young adults. NCI is also launching a library of smoking cessation messages which provide the foundation for an interactive text-based intervention for adult smokers called QuitNowTXT. The QuitNowTXT text messages offer tips, motivation, encouragement and facts based on information tailored to the user’s response. Click here to learn more. The Text4Health recommendations to HHS were released September 19, 2011. 
 

2012 Appropriations Process Inches Forward; Quick Action on HHS Bill Unlikely
With the Supercommittee still mired in negotiations, the House and Senate Appropriations Committees this week continued working on the 2012 budget. Reports indicate that rather than passing each of the 12 annual spending bills separately, Congress will combine them into several “minibuses” to expedite the appropriations process. Nonetheless, it appears increasingly unlikely that Congress will be able to wrap up the entire process before November 18, when the continuing resolution that is currently funding the government is set to expire.

The Labor-Health and Human Services-Education bill, typically one of the most contentious annual spending bills, is among those that will not likely see action in the coming weeks. The House and Senate remain sharply divided both on funding levels for federal health programs and on the “policy riders” included in the House version of the legislation. Policy riders are provisions that do not relate directly to specific funding levels but rather articulate policy positions about whether and how funding should be spent on federal programs.

Funding for SAMHSA is among the major differences between the House and Senate bills, with Chairman Denny Rehberg (R-MT) of the House Appropriations Subcommittee on Labor-HHS-Education proposing over $160 million in cuts to SAMHSA relative to the Senate version.

The Opening Salvo: Democrats, Republicans Issue Competing Supercommittee Plans
The federal government would achieve $3 trillion in savings, half of it from spending cuts, under a plan proposed this week by Democrats on the Supercommittee. This is the first time that details of the Supercommittee negotiations have become public during its two months of talks.

The plan, unveiled by Senator Max Baucus (D-MT) and supported by a majority of the panel’s Democrats, goes well beyond the $1.2 trillion in savings required by the Budget Control Act. Although the plan was announced behind closed doors and full details have not yet been released, it is reported to include about $500 billion in cuts to Medicare.

Cuts to Medicaid could decimate mental health and addictions treatment in the U.S. and leave countless Americans without access to critical healthcare services. That was the message sent by 579 behavioral health organizations and 1162 consumers, family members and concerned citizens this week in a letter to the Supercommittee. The letter notes that people with mental illness and addictions rely on Medicaid for access to psychiatry, counseling, medications, residential treatment, case management, rehabilitation, and much more. Budget cuts and the ongoing recession have already put an unprecedented strain on community behavioral health organizations. Additional federal cuts to Medicaid would further harm our communities, as people in need find themselves unable to access treatment. The sign-on letter urges the Supercommittee to reject any proposals that would fundamentally restructure Medicaid or slash its funding.

Republican aides lambasted the Democratic proposal for its inclusion of new tax revenues, which make up about $1.3 trillion of the total savings package. One day after the release of the Democratic plan, Republicans on the committee responded with a proposal of their own. The Republican plan relies primarily on spending cuts, which make up roughly 75% of the $2.2 billion total in savings. Most of the rest would come from non-tax revenue increases, such as anticipated economic growth and the sale of government assets. Reports indicate that the plan might also include an overhaul of the tax code, though Supercommittee members and aides have declined to comment further on the details.

Neither of these initial plans will be adopted in whole. However, these first bids shed light on important areas of conflict – and potential agreement – that could shape the Supercommittee’s final bargain. It is noteworthy that both plans well overshot the $1.2 trillion mark, perhaps indicating bipartisan support for a large deal. The proposals also suggest that Democrats may be willing to look at cuts to entitlement programs, while Republicans have not completely rejected tax reforms.

Another plan aimed at reaching the $1.2 trillion savings goal, proposed by House Appropriations Committee member Dennis Rehberg (R-MT), although very unlikely to make it past the Joint Select Committee, is to eliminate the health reform law’s Medicaid expansion and its subsidies to help low-income consumers purchase health insurance. Representative Rehberg does not sit on the Joint Select Committee, but as Chair of the influential subcommittee that handles funding for healthcare programs, he will play a central role in guiding any eventual agreement through the Appropriations Committee.

The substantial differences between proposals are a measure of how far apart the parties remain. The Supercommittee will have to come to an agreement on the details of its plan by early November if the Congressional Budget Office is to have sufficient time to produce a cost-savings estimate in time to meet the committee’s Nov. 23 deadline for submitting the plan to Congress.  

Obama Administration Opts Not to Implement CLASS Act
After 19 months of work examining how to structure the voluntary long-term care insurance program enacted under health reform, the Obama Administration has decided to halt its implementation. Secretary Kathleen Sibelius of the Department of Health and Human Services said in a statement that HHS could not find a way to make the Community Living Assistance Services and Supports Act (CLASS Act) financially viable over the 75 years required by the law, while still meeting the benefits requirements laid out in statute. The central problem with the CLASS Act arose from its nature as a completely voluntary and self-financing program, which would be supported only through participating employees’ optional payroll deductions. HHS reported that these fiscal pressures made it impossible to fully fund the benefits required under the law.

Although HHS stated that it did not wish to repeal the CLASS Act, it did not offer solutions for reforming the program or providing alternative options for reforming the U.S. long-term care system. Secretary Sibelius said that she hoped the information gathered during the agencies’ efforts on CLASS could be used to develop other affordable and sustainable long-term care options.

The decision has provided fodder for critics of the health reform law, as the first instance in which the Administration has backed away from one of the components of its signature legislation.

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