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10/20/2014 12:00 AM

The National Association of State Alcohol and Drug Abuse Directors (NASADAD) is issuing practice guidance to adolescent substance use disorder (SUD) treatment services. Based on an advance copy received by ADAW, guidance provides comprehensive information on the essential elements of treatment and recovery systems for adolescents.

The National Association of State Alcohol and Drug Abuse Directors (NASADAD) is issuing practice guidance to adolescent substance use disorder (SUD) treatment services. Based on an advance copy received by ADAW, guidance provides comprehensive information on the essential elements of treatment and recovery systems for adolescents.

Over the course of the next several months, NASADAD will hold webinars for state youth coordinators that will provide more information to the SSAs (single state authorities) — the state directors with authority over the Substance Abuse Prevention and Treatment (SAPT) block grant. The guidance, however, is not restricted to the use of block grant funds and has no mandates. It could be used for Medicaid or other payers as well, according to NASADAD. The purpose is to better inform SUD services for adolescents across the states.

Language in the document can be incorporated into contracts with treatment providers to ensure that evidence-based, high-quality treatment is delivered to adolescents ages 12 to 18, according to NASADAD.

The project, which was funded under a subcontract to JBS International, under a Substance Abuse and Mental Health Services Administration (SAMHSA) contract, originated in the states themselves, said Henrick Harwood, NASADAD’s director of research and program applications, in an interview with ADAW last week. “Many of the states had been putting together their own documents,” he said. “Other states had been struggling with [adolescent SUD services], and when they heard about this, they wanted to know more.” SAMHSA’s Center for Substance Abuse Treatment funded the development of the project, because they wanted to collect the best state methods being used to manage adolescent treatment systems, added Harwood, who is also NASADAD’s deputy executive director.

“Each state was inventing their own guidelines, their own practices, on how to manage and purchase youth services,” he said. “SAMHSA said, ‘We can help to resource this,’ and gave us a grant to work with the states.”

At least 24 states (Arizona, California, Colorado, Delaware, Georgia, Illinois, Indiana, Kansas, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Montana, New York, North Carolina, Oklahoma, Oregon, South Carolina, Texas, Utah, Washington, Wisconsin and Wyoming) have existing documentation on adolescent treatment standards and/or guidelines for the treatment of adolescents with SUDs.

The 56-page document, called the State Adolescent Substance Use Disorder Treatment and Recovery Practice Guide, encompasses best practices derived from the State Youth Substance Abuse Coordinators Committee, a component of NASADAD’s National Treatment Network’s Adolescent Treatment Committee. SAMHSA gave “input and suggestions,” but the document is a result of a “consensus-building process that involved the expertise of the state youth coordinators,” said Harwood.

Three broad sections

The document is divided into three broad sections: principles of care, service elements and administrative considerations. While the language could be used in regulations and contracts, the document is not meant to dictate specific services or practices, but to give states options to consider.

The principles of care section includes guidance on integrated care, trauma-informed care, family-centered care, and evidence-based practices, including medication-assisted treatment.

Buprenorphine

The guidance is for patients ages 12 to 18; while the majority of adolescent patients in treatment are 16 to 18, some, especially those in the “experimenting” phase, are younger. But the problem is that the SUD treatment system, in particular for opioids, has been geared toward older males, said NASADAD Executive Director Rob Morrison. “Now we’re seeing incremental steps to change on the adolescent side,” he said.

While medication-assisted treatment is considered the first-line therapy for adults with serious opioid addiction, with either methadone or buprenorphine, there has been less consensus on the appropriateness of medication-assisted treatment for adolescents. This guidance notes that buprenorphine is appropriate for adolescents age 16 and older. “The effectiveness of buprenorphine products for adolescents under the age of 16 has not been established,” notes the guidance, citing SAMHSA’s Center for Substance Abuse Treatment. “However, medication-assisted treatment with buprenorphine should be considered part of the menu of treatment options for adolescents over 16.”

Providers who are treating adolescents who have been using opioids “need to be aware of the options,” said Harwood. “They need to consider whether or not using medications might be useful, and buprenorphine has been tested with teens.”

In addition to medication-assisted treatment, the service elements section includes screening, assessment, planning, physical health, case management/care coordination, medication-assisted withdrawal, treatment levels of care, individual and group counseling, co-occurring mental health disorders, and recovery services (transportation, continuing care, education, youth vocational and employment services, housing assistance, pregnant and parenting youth, mutual aid groups, peer-to-peer coaching, and recovery coaching and mentoring).

The administration section includes a focus on designated authority — who (the SSA, state or county) has the authority to procure and oversee adolescent SUD services. There is also information on documentation of treatment records, including compliance with regulations such as 42 CFR Part 2 (confidentiality), monitoring and quality improvement, workforce, and patient rights.

Best practice

The guidance “is meant to be a best practices document,” said Harwood. “We recognize that states are in different positions, but this is a set of guidelines, things to work towards, ideals.”

Asked whether this document is something that an SSA could take to a governor to advocate for treatment services, Morrison responded, “To the extent that governors are going to get into this detailed level, it could be used to show what state experts regarded as the categories that should be considered.” However, he added that “this is mainly for the state agency, to look at what options other states are taking."

However, most of the recommendations in the guidance document would not require legislative or executive changes, said Harwood. “This is more for the purchasing authorities,” he said. “Most of these options are doable within statutory authority.”

By providing language that can be put into contracts with service providers, the document can help the SSAs make sure that treatment for adolescents is evidence-based, said Morrison. “So often we talk about issues and platitudes, but not about the nuts and bolts of how to get there,” he said. “This is about the actual issues that states have to consider.”

The guidance document is not directed at drug courts or juvenile courts, but at treatment, said Harwood. “We are fully aware that many of the kids who go into treatment are involved with drug courts or juvenile courts,” he said, adding that about 40 percent of the people including adults who receive treatment through public dollars are involved with some kind of court. He conceded that the adequacy of treatment services for people in the court system is a “running concern” that goes back decades.

Webinars

Starting next month, NASADAD will have one webinar a month for youth coordinators, devoted to each of the three main sections, said Shalini Wickramatilake-Templeman, research analyst with NASADAD. “The goal will be to train the youth coordinators,” she said.

There are 48 youth coordinators — almost one in every state — said Wickramatilake-Templeman. “They have the general oversight of SUD programs for youth in their respective states,” she said.

The states will in turn reach out to providers. NASADAD on its own doesn’t have the ability to train the hundreds of providers in the system, said Harwood.

States are “interested in getting the training.” Like any new policy or innovation, it will take several years to move ahead, he said, noting that purchasing cycles take time to change. “This is a process,” he said. “But states are moving ahead with this.”

For the guidance, go to http://nasadad.org/wp-content/uploads/2014/10/State-Adolescent-Substance-Use-Disorder-Treatment-and-Recovery-Practice-Guide.pdf.

Bottom Line…

NASADAD has issued a guidance document that purchasers of adolescent substance use disorder treatment can incorporate into contracts to improve the quality of services.

10/6/2014 12:00 AM

The short story is the sudden retirement, effective October 3, of H. Westley Clark, M.D., who for the past 16 years has been the director of the Center for Substance Abuse Treatment (CSAT) at the Substance Abuse and Mental Health Services Administration (SAMHSA). The longer story is how his departure will affect two policy decisions pending at SAMHSA: lifting the cap on the number of patients who can be treated with buprenorphine and preserving the confidentiality regulations for alcohol and drug abuse treatment, 42 CFR Part 2.

The short story is the sudden retirement, effective October 3, of H. Westley Clark, M.D., who for the past 16 years has been the director of the Center for Substance Abuse Treatment (CSAT) at the Substance Abuse and Mental Health Services Administration (SAMHSA). The longer story is how his departure will affect two policy decisions pending at SAMHSA: lifting the cap on the number of patients who can be treated with buprenorphine and preserving the confidentiality regulations for alcohol and drug abuse treatment, 42 CFR Part 2.

According to a September 30 email from SAMHSA Administrator Pam Hyde, a copy of which was obtained by ADAW, Clark and Hyde met late during the week of September 23. That was the same week of the buprenorphine summit, which was geared toward lifting the cap (see ADAW, September 29). During the discussion, “he let me know then that he was thinking about this decision,” said Hyde. “I was very sorry to hear this, but recognize that each individual’s decision and life trajectory takes its own course and timing comes when it’s right for them.”

“This was Wes’ decision,” said Hyde in the email, which was sent under the subject line “SAMHSA personnel announcement.”

We don’t know what was said between Clark and Hyde. But we do know that he has been on the wrong side, politically speaking, of the debate on 42 CFR Part 2 and on lifting the buprenorphine cap.

42 CFR Part 2

In an August 4, 2010, public meeting on 42 CFR Part 2, Hyde and Clark said 42 CFR Part 2 would not be revised (see ADAW, August 9, 2010). The regulation requires patients to give individualized consent to having their records released. However, last year, Hyde said at a workforce meeting that 42 CFR Part 2 is “getting in our way” (see ADAW, September 23, 2013). Then, there was a “listening session” on 42 CFR Part 2 on June 11 at which Clark was not even present, much less participating, where the door was clearly opened to changing the rule (see ADAW, June 16). SAMHSA told us that his schedule didn’t allow him to be present.

In addition, ADAW has learned that the Department of Health and Human Services (HHS), in a telephone call with federal and state officials and with stakeholders earlier this year, pressed to have methadone patients’ information put into prescription drug monitoring programs (PDMPs). Apparently, the HHS officials weren’t aware of the “Dear Colleague Letter” sent three years ago by Clark to opioid treatment programs (OTPs), advising them not to send patient data to PDMPs (see ADAW, October 24, 2011). The letter advised them to access PDMPs to find out about their patients’ other prescriptions, but said that giving OTP patient information to PDMPs would violate 42 CFR Part 2.

Any effort to require OTP patient data to go to electronic health records and PDMPs would be met with a fight from patient advocates.

CSAT promulgates 42 CFR Part 2 and regulates OTPs.

Buprenorphine cap

At a June 18 forum hosted by Sen. Carl Levin (D-Michigan) on raising the buprenorphine cap — which Levin supports — Clark pointed out, “We are dealing with the issue of addiction, not simply a medication,” and discussed concerns about diversion if the cap is lifted (see ADAW, June 23). This was not a welcome question at the forum, which ultimately led to the introduction of legislation by Sen. Ed Markey (D-Massachusetts) that would allow physicians to treat an unlimited number of patients with buprenorphine (see ADAW, August 11). Finally, there was the buprenorphine summit last month, at which Clark was not present and no discussion about the pros and cons of lifting the cap was allowed — rather, the discussion was about the logistics of how to lift the cap, and Levin himself made a presentation (see ADAW, September 29).

Current law allows physicians to treat only 30 patients with buprenorphine for the first year, and up to 100 patients with additional training. OTP physicians are allowed to have a caseload of 300 patients.

Funding for recovery

Clark has also been a champion for recovery — and patients in opioid treatment programs appreciate him for understanding that they are in recovery. “He always managed to squeeze funding for recovery in, before recovery was even fashionable,” said Walter Ginter, project director of Medication-Assisted Recovery Services in New York. The early days of the Recovery Community Services Program made it possible for the groundswell of support for recovery that now exists. “People forget that this couldn’t have happened without the funding, and there was nobody but Westley Clark getting the money,” Ginter told ADAW. Clark also stood up for patients, “including those in the methadone world,” said Ginter. “He’s going to be a phenomenal loss.”

“Dr. Clark has been an unparalleled voice for patients in medication-assisted recovery throughout his tenure with CSAT,” said Zachary C. Talbott, director of the Tennessee Statewide and Northwestern Georgia chapter of the National Alliance for Medication Assisted Recovery. “We can only hope and pray that his successor will be equally experienced with a background in opioid treatment programs and equally unbiased when looking at the science and evidence base determining what’s effective and what should be priority.”

Recovery researcher Alexandre Laudet, Ph.D., said Clark has “contributed significantly to advancing the recovery-oriented systems of care model both conceptually as well as at the implementation level.” Clark is “a brilliant, dedicated and compassionate individual and I’m sorry to see him leave,” said Laudet.

Stuart Gitlow, M.D., president of the American Society of Addiction Medicine (ASAM), sent us this comment: “I first met Wes Clark in 1995 when he began serving on the ASAM board of directors. In the two decades since, he has always been an inspiration to me personally as well as an outspoken and respected voice within the broad field of addiction medicine. We at ASAM wish him well in his retirement and look forward to many more years of collaboration.”

“Dr. Clark’s departure from SAMHSA represents a giant loss for the federal government and the addiction field,” said Robert I.L. Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors. “As Director of CSAT, he provided incredible leadership on a range of issues. Further, he performed his duties with unrivaled integrity and commitment. It was great to see Dr. Clark recognized at our most recent Annual Meeting when Mark Stringer, President of our Board of Directors, chose to honor him with the 2014 President’s Award. I hope we can convince him to stay involved in these issues because of his expertise and knowledge.”

The American Association for the Treatment of Opioid Dependence (AATOD), which represents OTPs, gave Clark a “friend of the field” award at its conference last November, noted President Mark Parrino. “That was the first time AATOD recognized a SAMHSA official through such a public honor,” he said. “We gave Dr. Clark the award because of what he did to provide guidance to the field of addiction. We also recognize many of his behind-the-scenes struggles to protect patients and the integrity of the treatment system.”

Carol McDaid, principal with Capitol Decisions, offered the following: “Dr. Clark is a true pioneer in our field in so many ways. He has that rare gift of being a true expert steeped in the science of addiction and its treatments while really getting on a deep level the plight of those in or seeking recovery from addiction. He championed recovery before it was popular to do so, stuck his neck out on new medical innovations to treat addiction and always walked a bright line on being a true public servant. He will be missed at SAMHSA but we won’t let him get too far out of the fray. There’s more work to be done.”

And Paul Samuels, president of the Legal Action Center, said: “We are very sorry to see Westley leave, as he has been a terrific champion of addiction treatment in many aspects, including his understanding of the importance of confidentiality protections for people in substance use disorder treatment.”

Finally, Pam Hyde sent a comment as well: “Dr. H. Westley Clark has announced that he will be retiring from SAMHSA after 16 years of distinguished service with the agency and 33 years of federal service. His career has been marked by a series of extraordinary contributions to science and learning, to service and practice, and to teaching and leading. His passion for the field and his dedication to staying abreast of the latest evidence and emerging issues — domestic and international — are without equal. His commitment to the people who experience addiction and/or mental illness sets a standard to which we all can aspire. SAMHSA will deeply miss his ideas, his vast knowledge, his perspective, and many other attributes. We are profoundly grateful for his service and wish him well in all future endeavors.”

By October 2, SAMHSA had still not announced that Clark would be retiring the next day. There was no indication of who would be replacing him. Observers speculated that it would most likely be someone who would approve changing 42 CFR Part 2 and lifting the buprenorphine cap. And based on the hastiness of his departure, these changes may be taking place fairly soon.

Bottom Line…

H. Westley Clark is hastily retiring from CSAT, leaving the fate of 42 CFR Part 2 and lifting the buprenorphine cap to his still-unnamed successor.

9/22/2014 12:00 AM

Yet another blogger has criticized and mischaracterized substance use disorder treatment providers based on faulty information. On September 15, a harm-reduction advocate named Kenneth Anderson published a blog post under the headline “The Training Manual for US Addiction Counselors is Full of Myths.” We read it and found it had plenty of “myths” — for want of another word — of its own.

It accused the International Certification and Reciprocity Consortium (IC&RC) of requiring training counselors “to memorize long-debunked myths originating in the 12-step-dominated treatment industry.” It quoted a National Epidemiologic Survey on Alcohol and Related Conditions study and said that 90 percent of people recovered from dependence without treatment (what it did not say was that 87 percent of people in the sample were dependent on nicotine).

Yet another blogger has criticized and mischaracterized substance use disorder treatment providers based on faulty information. On September 15, a harm-reduction advocate named Kenneth Anderson published a blog post under the headline “The Training Manual for US Addiction Counselors is Full of Myths.” We read it and found it had plenty of “myths” — for want of another word — of its own.

It accused the International Certification and Reciprocity Consortium (IC&RC) of requiring training counselors “to memorize long-debunked myths originating in the 12-step-dominated treatment industry.” It quoted a National Epidemiologic Survey on Alcohol and Related Conditions study and said that 90 percent of people recovered from dependence without treatment (what it did not say was that 87 percent of people in the sample were dependent on nicotine).

It relies on one study guide, Getting Ready To Test from the Distance Learning Center, to lambaste IC&RC, which does not produce study guides for its exams (that would be a conflict of interest). There are many training materials that are available. And the criticisms Anderson levies at IC&RC and the study guide are all based on his point of view — that AA is harmful, and that IC&RC is to blame for even allowing it to be mentioned in training manuals. He inaccurately portrays IC&RC and addiction counselors as being opposed to harm reduction. His post ends with this: “Who is to say how many of the people served by all these professionals have suffered additional harm—even death—from their addictions as a direct result of the inaccurate information contained in Getting Ready to Test? It’s high time to reform the credentialing process, teach accurate information and replace mythology with science.”

You can read his entire post at http://www.substance.com/the-training-manual-for-us-addiction-counselors-is-full-of-myths/12204/

Counselor Job Analysis

Had Anderson contacted IC&RC, he would have learned that they also are advocates of harm reduction. “Mr. Anderson did not contact IC&RC for verification of statements made in his article relative to our credentials and practices,” said IC&RC’s Mary Jo Mather in an email to ADAW. “Had he done so, much of the information could have been corrected.” For example, she said, IC&RC’s Alcohol and Drug Counselor 2013 Job Analysis (JA) does include harm reduction. The JA task statement for IC&RC alcohol and drug counselors calls for utilizing “multiple pathways of recovery in treatment planning and referral” and requires knowledge of:

  • Benefits and limitations of the 12 Steps and 12 Traditions.
  • Benefits and limitations of other recovery support approaches.
  • Benefits and limitations of harm-reduction-based models of recovery.
  • Ways in which medical consultation and treatment may enhance the recovery process.

As for the specific manual (which was very selectively quoted for the Anderson blog post), “There are many varied training tools available on the market, including flash cards, practice exams, online trainings, study guides, etc., all developed by independent organizations who market to addiction professionals,” said Mather. “No one has access to IC&RC examinations; not ReadyToTest.com which is referenced in Mr. Anderson’s article or any other organization.”

IC&RC does provide for free its JAs, which are developed by subject matter experts and the testing company, said Mather. “JAs identify domains, tasks, knowledge, skills and abilities for each IC&RC credential,” she said. “JAs are then used as a basis for developing curricula, trainings and study materials by organizations and colleges/universities.”

IC&RC does not have a formal process of reviewing and approving training and education materials, said Mather. “As such, content of training and education and content of study guides is not reviewed or vetted through IC&RC,” she said.

DLC responds

The other organization mentioned in the blog post but not contacted was the Distance Learning Center, which makes the guide. “Our Getting Ready To Test study guide is not a training manual,” said Kevin Scheel, CEO and director of education services for DLC, in an email to ADAW. “It is what we present it to be — a study guide designed to assist students who are seeking drug/alcohol credentialing.”

When students come to ReadyToTest.com, they already have their training hours and work experience in hand, said Scheel. “We work to provide them with materials to refresh many of the core elements they have already studied — after all, many of these students have worked for 2 years or more to gather the training hours they must have.” Scheel added that he is “quite proud of the fact that we have been doing this since 1992 and have tens of thousands of students that have been able to obtain their credential as a drug/alcohol professional with our help.”

Scheel said that Anderson did not contact him or anyone at the Distance Learning Center. “I am happy at any time to discuss this with anyone, sharing my thoughts and ideas while listening to yours,” he said. “I would have gladly entertained such a discussion with Mr. Anderson, but this did not happen. I do see from one of the comments posted with his blog that he claims to have reached out to me for feedback and comment. Yet a search of our email and phone logs do not indicate that we ever received an email, a fax, or a phone call. All of our contact information can be found at the bottom of our ReadyToTest.com website, including phone, fax, and email contact information. I’m really not that hard to find. To suggest that I ‘blew him off with no reply’ is both dishonest and far from the truth.”

Editor's Note: This article was updated to reflect the fact that the Distance Learning Center, LLC is the parent company. ReadyToTest.com is one division, which does test prep; the other division is DLCAS.com, which provides continuing education hours by distance learning.

From the Field
6/30/2014 12:00 AM

Marijuana is a potent drug. My personal experiences with marijuana — occasional recreational use during graduate school — were relatively benign. A few times I had experiences I found distinctly unpleasant. Usually I found that marijuana made me feel slow, heavy, dull and sedate. And because I am a person who is predisposed to the seduction of altered states, I generally enjoyed those feelings. But I found that mixing alcohol and marijuana tended to make those unpleasant experiences more likely. And because I greatly preferred the effects produced by alcohol to those produced by marijuana — and because I was uncomfortable with the illegality of marijuana — I almost always forsook smoking for drinking.

In sobriety, I have had the opportunity to see a very different side of marijuana from the privileged, private-university world I inhabited when I indulged. In the rooms of Alcoholics Anonymous, it is very common that the stories I hear involve both drugs and alcohol. While I consider myself to be fairly exclusively an alcoholic and not a drug addict, I have no illusions about the nature of my disease: I enjoy treating discomfort with mind-altering substances. Though alcohol is my preference, I have also used marijuana and benzodiazepines. That’s not uncommon at all, nor is using cocaine, heroin, methamphetamine, or any number of prescription drugs.

The effects of chronic marijuana use that I have seen are not particularly dissimilar in their manifestations from the effects of chronic alcohol use. Not in terms of how they affect a person’s body, perhaps, but in terms of how they affect a person’s life — increasing isolation from mainstream society, ruptures in relationships and families, unemployment, legal consequences, despair, suffering and misery — problems that are routinely relieved when the abuser commits to abstinence and a program of recovery.

I also see what we in AA call “The Marijuana Maintenance Program.” Many of us come to realize that we have a problem with alcohol and need to stop imbibing. But we are unwilling or unable to face the things in ourselves that are necessary to face in order to recover. And so we turn to a drug that we believe is less harmful, or more manageable. This is no different from deciding that liquor is too dangerous so we try to switch to beer. There is occasionally a brief period of respite, but our addiction will not remit until we abandon all of our artificial anesthesias and examine the underlying causes of our affliction.

As a member of Alcoholics Anonymous — I do not, of course, speak for that organization — I take no position on the legalization of marijuana for recreational use. As a scientist, I do believe that the medical value of the cannabis plant should be studied as we study any other plant and given appropriate opportunities to relieve human morbidity and suffering as is possible. Simply because some people abuse it, we should not discard it as a source of medicines. And there is significant evidence that medicines derived from marijuana, or marijuana itself, may be beneficial for a variety of conditions. A recent article in the British Medical Journal (Farrell M et al., Should doctors prescribe cannabinoids? BMJ 2014;348:g2737) neatly capsulizes the evidence and counter-evidence for marijuana as a medical intervention for a variety of conditions.

Medical marijuana is, of course, also obviously a capillary-action attempt to open the door to recreational marijuana, and it has been successful in Washington and Colorado. The joke I’ve heard over and over again from such advocates is “I need medical marijuana because I get depressed when I run out of pot.” From the pragmatic perspective of someone who is primarily interested in addicts and alcoholics having a path to recovery, and the opportunity to reclaim lost lives, I am not certain that whether marijuana, or even alcohol, is legal or not matters much to me. Humans will use and abuse mind-altering substances. Some will become dependent. Of those, a few will seek recovery.

There are enormous societal investments and consequences associated with the control and enforcement of marijuana as a banned substance, and it may be worth investigating whether legalization would have a net positive or net negative impact on things like crime, poverty and social disparities. I don’t pretend to know the answer. What I know is that marijuana abuse and dependence are real and troublesome problems, but recovery from them is entirely feasible. I have seen it countless times.

From the field
12/20/2012 12:00 AM
Advocates call for mental health treatment, gun control in wake of tragedy in Newtown.

(Editor’s note: On December 14, 20 elementary school students and six school teachers and administrators were shot and killed by a troubled young man, Adam Lanza, who also killed his mother and himself.)

Now is the time for the substance use and mental health community to act together to help end the violence and self-mutilation we as a nation encourage. The victims, their families and all of our children and communities must be comforted. Substance use and mental health clinicians are often at the forefront helping in the aftermath of these too frequent massacres.

We can resolve to change this social environment of destruction. Below is a letter from the behavioral health community to President Obama, congressional leadership, members of Congress and state government officials. Will you sign on? Will you send this or your own letter to your member of Congress, governor or state legislator? Will you help recruit others — people in recovery, families caring for a loved one struggling with substance use or mental illness, counselors and leaders of behavioral health programs — to send letters and call their congressional delegations, governors and state legislators?

As people touched by the tragedies in Connecticut, Arizona, Colorado and too many other communities, as people who are touched by the destruction of untreated alcohol, drug and mental health problems, we must act together to end these killings.

We must all be part of the solution — by showing the faces, voices and resolve of people affected by mental illness and addiction to end this violence and repair our communities. Mental health and substance use are not the causes of the violence, but we can help with solutions.

Dear Mr. President, Mr. Speaker and Members of Congress:

As people who have direct, lived experience with mental illness and addiction, as family members caring for our loved ones with these illnesses, as counselors and healthcare workers and as leaders of behavioral health programs, we all call on you, the leaders of our nation, to begin with us a road to recovery from these tragedies. We grieve for the innocents murdered in Newtown. These are our children, our neighbors, our families, our friends. There can be no greater tragedy in a society than losing its young, its own future, so needlessly and so senselessly. Such actions strike at the very heart of who we are and who we hope to become.

So we must grieve. We grieve for the families who lost their children, for the families of their teachers who were killed, for the entire Newtown community and for America itself. Yet, we owe them all much, much more than just our tears. They also deserve our action to identify and implement solutions.

To begin our recovery, we recommend that you provide federal assistance to:

  • Immediately double the capacity of public mental health and substance abuse programs. Funding for community mental health and substance use treatment services has been cut dramatically. As a result, only a third of those with moderate mental illness and two-thirds of those with severe illness ever receive any care. Families simply cannot get badly needed care. The Affordable Care Act must be implemented fully, and mental health and substance use care must be fully integrated into good medical care.
  • Immediately implement school- and community-based programs to promote mental health, to prevent mental illness and substance abuse and to provide early interventions for those exhibiting these conditions. Prevention and early intervention strategies can strengthen children’s mental health and resiliency, prevent or lessen the burden of illness and help them and their families to recover from trauma. Further, teachers must be taught how to identify troubled children and to guide them into effective supports before these children get into trouble.
  • Immediately begin teaching students at all levels to recognize the signs of mental illness and addiction, and to seek help when needed. Few young people get even a single hour of education about mental illness or addiction, its signs or its treatment. We can’t expect people to step forward or to seek help for a family member when we don’t even provide them the rudimentary tools to do so. We must begin to do so.
  • Immediately ban assault rifles and large-capacity clips. Possession of these weapons is a fundamental public health problem. They are designed for the battlefield, not our closets. They are used to kill people senselessly and needlessly. In Newtown, an assault weapon was used to kill 20 young children just starting their lives and six of their heroic teachers. Enough!

Yes, we must grieve for the innocents, just as we grieved recently for those lost in Tucson, Aurora and Portland. But this time, our grieving must have a direction and purpose to galvanize action. As people who know firsthand the tragedies of mental illness and addiction, and the triumphs that are possible, we all call on you to take immediate action.

Our nation expects nothing less of all of us.

From the Field
10/1/2012 12:00 AM

We have seen a recent uptick in one-sided reporting by media outlets that are either misinformed about the successes and difficult challenges of the treatment field, have no interest in balanced reporting on these important issues or are using old and outdated information. CRC Health Group, in particular, the nation’s largest provider of behavioral health and addiction treatment services, has been the subject of a disproportionate number of these reports. And while this increased attention on addiction and treatment would be welcome if it were to raise awareness about this devastating disease, the unfortunate reality is that these media inquiries are spurred by our nation’s upcoming presidential election, CRC’s exaggerated connection with one of the candidates and the continued stigmatization of addicts and treatment.

We have seen a recent uptick in one-sided reporting by media outlets that are either misinformed about the successes and difficult challenges of the treatment field, have no interest in balanced reporting on these important issues or are using old and outdated information. CRC Health Group, in particular, the nation’s largest provider of behavioral health and addiction treatment services, has been the subject of a disproportionate number of these reports. And while this increased focus on addiction and treatment would be welcome if it were to raise awareness about this devastating disease, the unfortunate reality is that these media inquiries are spurred by our nation’s upcoming presidential election, an exaggeration of CRC’s connection with one of the candidates and the continued stigmatization of addicts and treatment.

Some recent media articles have attempted to politicize what CRC does and have accused CRC of “putting profits ahead of patients.” This is just not true. The truth is, having for-profit, investor-owned treatment centers is a positive thing for our country. Unlike many nonprofits or single-owned facilities, we have the geographic breadth and financial stability that enable us to continue to provide these necessary services, even in challenging economic times. As a result of our structure and access to capital, our programs are more insulated from state and local budget cuts or economic downturns. Our structure also allows us to invest significant dollars on patient quality, even when the general economic environment is stagnant.

Some journalists have chosen to focus on anecdotal — and dated — reports of incidents in our facilities and falsely extrapolate to a conclusion of declining quality. But the reality is that the addiction treatment field is increasingly dealing with more medically complex and highly compromised patients. While very unfortunate, incidents do happen within this field of healthcare, one that treats a population of people who are at the ends of their ropes, in the depths of their despair: troubled teens, patients with alcohol and drug abuse addiction, co-occurring mental health and drug and alcohol issues, sometimes suicidal, most in denial, and many untruthful to themselves, their families and us about preexisting medical and mental health conditions.

Some media have chosen to focus their criticism on incidents that occur outside of our facilities, when patients, under the supervision of doctors, take their methadone or buprenorphine home for administration of doses, despite the safeguards that we put in place such as lockboxes and patient accountability checks and contracts. Our mission is to help these individuals, but sadly, we cannot report 100 percent success. No treatment provider can.

The media often fails to mention that the overwhelming number of patients do experience significant success. Journalists rarely interview any of the number of referrals provided by CRC who have positive experiences. Instead, the articles rely extensively on “survivor” organizations that criticize youth treatment or drug and alcohol programs across the board, critics with no firsthand knowledge of the events they purport to describe, and the selective republication of erroneous information from earlier media articles.

It is a fact that treatment organizations are prohibited by law from discussing specific cases or patient care, while other sources and family members making allegations have no such restraints. The occasional article that does mention such privacy regulations does so in a way that implies that treatment providers hide behind this language so as not to have to publicly discuss patient incidents. In actuality, these regulations are to protect our clients, every individual who enters our doors to get the treatment they so desperately need, who can take some comfort in this time of great distress knowing that their confidentiality is assured and trusting that it will never be revoked.

Several journalists who have written about CRC and treatment began their reporting with biased perspectives, specifically soliciting only critics of treatment programs to be sources.

CRC treats 30,000 people every day, yet this is just the tip of the iceberg when considering this nation’s treatment gap of people who need but do not receive treatment is over 20 million. We need more, not fewer, treatment options. When the media criticizes one provider because that sells newspapers or increases web hits, ignoring all of the positive aspects of treatment and lambasting our outcomes research, they are perpetuating the stigmatization, condemnation and discrimination of the entire treatment industry, with likely ramifications on millions of lives.

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  • Meet the Editor

    Alison Knopf
    Editor

    Alison Knopf is a professional journalist who began covering the addiction field in 1984 as founding editor of Substance Abuse Report. She has been the editor of Alcoholism & Drug Abuse Weekly since 2005.
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