October 2010

Dear Readers:

As we begin the process of designing the course offerings for the National Council’s 41st  Mental Health and Addictions Conference that will be held in San Diego, May 2-4, 2011 we need to hear from you about your training needs and desires.  We know that the next few years have the potential to bring changes to the way that behavioral healthcare services are organized and financed, and that these changes will pose challenges for our organizations on multiple levels.  Our field will likely experience challenges in the areas of technology, billing, compliance, workforce, revenue cycle management, contracting,  to name but a few. 

Please send us your ideas for topics and/or speakers for the upcoming conference.  Also feel free to share with us the issues that keep you up at night – we will do our best to identify speakers that can offer practical solutions to your problems.  Please send ideas to Jeannie Campbell – jeanniec@thenationalcouncil.org, and then plan to be with us in San Diego to get answers to your most pressing problems!

Sincerely,
Chuck Ingoglia
Vice President, Public Policy

Resources and Reminders

SAMHSA Seeks Public Comment
The Substance Abuse and Mental Health Services Administration is seeking public feedback on eight strategic initiatives to focus the Agency’s work. SAMHSA released a draft paper outlining its planned initiative for the next several years. These initiatives will help focus SAMHSA’s efforts and maximize the impact on areas of urgency and opportunity. The initiatives include: 

• Prevention of Substance Abuse and Mental Illness;
• Trauma and Justice;
• Military Service Members, National Guard, Reserve, Veterans, and their Families
• Health Insurance Reform Implementation;
• Housing and Homelessness;
• Health Information Technology, Electronic Health Records and Behavioral Health;
• Data, Outcomes, and Quality: Demonstrating Results; and
• Public Awareness and Support.

Comments are due to SAMHSA by October 22, 2010. You can provide comments to SAMHSA through the SAMHSA website or by going through their newly launched blog, SAMHSA Dialogue.

SAMHSA Releases New Substance Abuse Treatment Publication
The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Knowledge Application Program (KAP) provides substance abuse treatment professionals with publications, online education and other resources on treatment practices. They have released three new publications:

The Next Step Toward a Better Life: This brochure is for people who are undergoing detoxification or are about to leave detoxification services. It provides information on what to expect following detoxification in two parts: the first focuses on the first 30 days after detoxification and assists the reader in developing strategies for avoiding the use of drugs and alcohol; the second focuses on longer term recovery.

Quick Guide for Mental Health Professionals Based on TIP 42: Substance Abuse Treatment for Persons with Co-Occurring Disorders: This resource presents information about co-occurring substance use and mental disorders. It summarizes the information from the Treatment Improvement Protocol (TIP) 42 in an easy to use format. Guiding principles on assessment, treatment strategies and models, and substance abuse screenings are included. This guide is free to order or download here.

Quick Guides and KAP Keys Based on TIP 49: Incorporating Alcohol Pharmacotherapies into Medical Practice: These quick reference tools provide guidance for the use of acamprosate, disulfram, oral naltrexone and injectable natrexone in the treatment of alcohol use disorders. Three versions are available: for Counselors, for Physicians and for Clinicians.

National Council Webinars; Access Recordings Online
On September 21, CoOccurring Disorders Innovation and Integration, a SAMHSA-supported initiative, offered a webinar entitled Healthcare Reform-Implications for Behavioral Health Providers. This webinar provided information as to how healthcare reform will affect the role of States, behavioral health providers, and consumers in regard to clinical and fiscal changes, including Medicaid. Presenters included: Chuck Ingoglia, Vice President of Public Policy at the National Council, Dale Jarvis, Managing Consultant at MCPP Consulting, and John O’Brien, Senior Advisor to the Administrator on Health Finance, SAMHSA. Please refer to the National Council website for recordings.

Visit the National Council’s website 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.

Online Addiction Treatment Support for Sailors
The Navy and Hazelden have signed a five-year contract through which Hazelden will provide online recover support services for sailors. The program, developed in partnership with Hazelden, is tailored for younger soldiers and those on active duty, retired Navy personnel and family members. The program is called Navy MORE (My Ongoing Recovery Experience) and was developed for sailors who have completed addiction treatment but who need help staying clean and sober. Sailors, retirees, and their families will be able to use MORE to access 12-step recovery materials, a suicide hotline, and treatment for post-traumatic stress as well as connect online to support groups, recovery coaches and counselors. The program is free for participants and additional information is available at www.navymore.org and through the Hazelden site.

Treatment Advisory on Protracted Withdrawal Released by SAMHSA
The Substance Abuse and Mental Health Services Administration has released Protracted Withdrawal the latest in their Substance Abuse Treatment Advisory series. This advisory offers suggestions to clinicians and counselors on how they can differentiate between acute and protracted withdrawal and how they can help clients to manage protracted withdrawal in recovery. It also provides an overview of protracted withdrawal signs and symptoms as well as guidance on differentiating between protracted withdrawal and a co-occurring disorder. This advisory, as well as additional information about SAMHSA’s Knowledge Application Program can be downloaded at www.kap.samhsa.gov. 

SAMHSA Launches Blog to Encourage Dialogue
The Substance Abuse and Mental Health Services Administration launched their blog, SAMHSA Dialogue, earlier this month. The SAMHSA Dialogue blog is a place where the diverse community of SAMHSA can engage with each other and give feedback to other users and SAMHSA staff. It will also provide up-to-date information such as articles from SAMHSA staff, announcements of new programs, links to reports, grant opportunities and ways to connect to other resources.  At this time, users can read about SAMHSA’s 8 Strategic Initiatives and provide comments directly to SAMHSA. Visit the SAMHSA Dialogue Blog.

AAAS Guide for Parents and Children
A new book has been released by the American Association for the Advancement of Science to help parents discuss the topic of alcohol with their children. Delaying That First Drink: A Parents’ Guide is meant to help children understand how alcohol affects the brain and body. The book contains information regarding current research on high-risk adolescents, the chemical and biological effects of alcohol on the body, as well as advice for talking to children about alcohol use. The author also provides a list of valuable resources for parents and providers. Delaying That First Drink: A Parents’ Guide is being offered as a free, online resource by AAAS.

Hazelden Launches Online Community
Hazelden has launched a social media site that helps people maintain recovery from addiction and compulsive behaviors. Sober24 offers free online membership to everyone in recovery and provides members with access to experts, resources and services. Available on the site are discussion groups, chats, twelve step meetings, book clubs, and blogs. There is a private place for personal journaling and members are also invited to submit stories of personal recovery. SoberFuse is also utilized by the site to help members monitor the status of their sobriety. Sober24 currently has a membership of approximately 11,000 and is growing.

Defining the Addiction Treatment Gap
Defining the Addiction Treatment Gap, a CATG review of the National Survey on Drug Use and Health (NSDUH), indicates that addiction impacts many segments of American society. The review is intended to provide a statistical context for efforts to close the addiction treatment gap. Citations for the data, along with reviews of current data on addiction and treatment, are available at www.treatmentgap.org.

Integration of Services in Substance Use Treatment
The Treatment Research Institute (TRI) of Philadelphia released a white paper which summarized the experiences of national integration projects currently underway.Integrating Appropriate Services for Substance Use Conditions in Health Care Settings: An Issue Brief on Lessons Learned and Challenges Ahead provides a summary of an April 22nd meeting of leaders of integration projects who discussed their models and the recommendations they had.

The paper summarizes four themes: (1) The importance of the integration of substance use screening in general health care; (2) different models of integration between substance abuse treatment and physical health services can be successfully implemented; (3) Creation of new workforce roles can facilitate the integration of substance use conditions within medical care; and (4) it is possible for integration programs to be successfully financed, but barriers also exist. These recommendations may be useful information for demonstration projects in some states. 

Hazelden and NAADAC Partner to Train Clinicians on Co-Occurring Disorders
Hazelden and the National Association of Alcoholism and Drug Abuse Counselors (NAADAC) announced a partnership to improve training for clinicians on co-occurring disorders. The title of this new initiative is “Integrating Treatment for Co-Occurring Disorders: An introduction to what every addiction counselor needs to know”. Training will be restricted to less severe, but still serious, mental health problems such as anxiety, depression and PTSD. There are also plans for the two organizations to host web conferences and highlight relevant trainings and publications on their websites. More information is available on Hazelden’s website and the NAADAC website.

Check Out MentalHealthcareReform.Org
Check out the National Council’s healthcare reform blog for the latest news about reform implementation and behavioral health and substance use issues along with additional resources. The blog serves as a clearing house for all of our resources, news, and technical assistance. Check out MentalHealthcareReform.org to view the latest news and information on Medicaid, Medicare, integration, parity, payment reform, and much more.

On The Hill

Due to the Congressional Recess, the next “On the Hill” segment will be published in the November edition.

In The News

National Survey Reveals Increases in Substance Use from 2008 to 2009
The National Survey on Drug Use and Health (NSDUH) reports that between 2008 and 2009, the use of illicit drugs by Americans rose from 8.0% to 8.7%. Although the overall use of substances by youth ages 12-17 was lower than 2002 levels, 2009 levels were higher than 2008 (10% in 2009, 9.3% in 2008, 11.6% in 2002).  The survey indicates that this rise was in part due to an increase in marijuana usage and prescription drugs.  Among youths ages 12-17, past month marijuana use went up from 6.7% in 2008 to 7.3% in 2009. This is the first increase since before 2002.  From 2002 to 2009, there was an increase from 5.5% to 6.3% in the rate of nonmedical use of prescription-type drugs. The 2009 NSDUH indicated that tobacco and cocaine use among those aged 12 or older has declined. Complete survey findings are available on the SAMHSA website at: http://oas.samhsa.gov/nsduhLatest.htm

Number of Older Adults Treated for Substance Abuse Rises
Data from the Substance Abuse and Mental Health Services Administration’s most recent Treatment Episode Data Set indicate that the number of older adults admitted to a facility for substance abuse treatment has nearly doubled since 1992. The findings show that the number of patients aged 50 or older admitted to substance abuse treatment facilities increased from approximately 102,700 in 1992 to 231,170 in 2008. The study breaks down findings by types of drug used and reports increases in heroin, cocaine, and multiple substance usage. However, the study also found a decrease in alcohol abuse for this population.

SAMHSA has issued a press release summarizing the results of the analysis from the Treatment Episode Data Set. The full data set is also available online, along with a report on the trends in substance abuse among older Americans.

New Center to Help Parents Address Substance Use by Their Children
The Treatment Research Institute (TRI) of Philadelphia will be launching a new center intended to help parents address alcohol and drug use by their children. The Parents Translational Research Center will conduct research to aid parents and caregivers and disseminate it to the public through collaboration with the Partnership at Drugfree.org. The Center, which is funded by a five-year grant from the National Institute on Drug Abuse (NIDA), will focus on three main areas: prevention of drug use by children, finding appropriate treatment, and working with children who refuse treatment

New Addictions Institute to Potentially Replace NIAAA and NIDA
A National Institute of Health (NIH) panel has recommended dissolving the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA) and creating a new institute on addictions. The recommendations suggest that “all relevant addiction research portfolios” from NIAAA and NIDA as well as other NIH institutes would be integrated into one general institute.  Having all addiction related programs centered in one institute would enable better integration and communication across research fields. If the recommendations of the panel are accepted, the director of the NIH would submit a proposal for the new institute to the Secretary of the Department of Health and Human Services. Secretary Sebelius would then notify Congress and reorganization would take place within 180 days after said notification provided that Congress does not object.

Millions with Alcohol and Drug Addiction Could Benefit from Health Care Reform
An analysis by the Closing the Addiction Treatment Gap (CATG) initiative, indicates that if implemented properly, the federal health care reform legislation could remove financial barriers to treatment for millions of Americans. Defining the Addiction Treatment Gap provides a summary of data related to drug and alcohol addiction with the intent to provide a context for efforts to close the treatment gap. CATG is focused on four key elements necessary to maximize the opportunities presented by health care reform: 1. Developing a meaningful addiction treatment benefit, 2. Improving coordination and integration of available services, 3. Monitoring implementation to prevent new barriers to treatment and ensure full coverage, and 4. Preserving federal and state safety nets to ensure treatment is available to those not covered by health care reform or unable to afford insurance coverage.

Alcohol Consumption Rates Rise
An analysis of national alcohol consumption patterns conducted by University of Texas Southwestern Medical Center and the University of North Texas Health Science Center determined that more people are consuming alcohol now than in the early 1990s. Data from the 1991-92 National Longitudinal Alcohol Epidemiologic Survey and the 2001-02 National Epidemiologic Study on Alcohol and Related Conditions showed that more White, Black and Hispanic-Americans are reported drinking in 2002 than the decade before. Heavier drinkers, regardless of race or gender, had increased the numbers of days they consumed five or more drinks. Caucasian women were more likely than Black or Hispanic women to drink more than five drinks per day. The study appears in the October 2010 issue of Alcoholism: Clinical & Experimental Research.

Self-Medicating Behaviors may Lead to Addiction
A study reported October 1st in Medscape Today, based on data from the National Epidemiologic Survey on Alcohol and Related Conditions, found that self-medication predicted substance abuse three years later. The use of alcohol or drugs to self-medicate anxiety symptoms increases the risk of substance abuse. In the short term, self-medication may alleviate the symptoms of anxiety; however, in the long term this behavior can exacerbate panic symptoms.

FDA Approves Vivitrol for Opioid Treatment
On October 12, 2010, the US Food and Drug Administration (FDA) approved Vivitrol for the treatment and prevention of relapse in patients with opioid dependence. Vivitrol is an extended-release form of natrexone and is administered intramuscularly once a month. The FDA found that patients were more likely to stay in treatment and refrain from using illicit drugs when treated with Vivitrol. In a study, 36% of patients treated with Vivitrol were able to stay in treatment for six months compared to 23% of the placebo group. For more information, please refer to the FDA news release.