Sheriff campaign debate over D.A.R.E. calls Volume 18 Number 45 attention to school-based approaches November 20, 2006 The Drug Abuse Resistance Education Cameron celebrated a resound­ Print ISSN 1042-1394 (D.A.R.E.) program seems destined to ing victory in the election earlier this capture the most attention among month, capturing 56 percent of the Online ISSN 1556-7591 school systems, despite the program’s vote in the county race. weak evidence base and the presence Zylak’s decision to eliminate Highlights… Tof numerous alternatives tailored to a D.A.R.E. had come at a time when variety of age groups. Many commu­ his department was facing other Despite the lack of evidence nities across the country still essential­ constraints, having seen a drop in its showing it works, the D.A.R.E. ly equate school-based prevention overall number of narcotics detec­ program is still beloved of schools, with D.A.R.E. tives. Zylak had said that the depart­ parents, communities, and even The latest battleground over ment didn’t have the staffing to was responsible for the outcome of D.A.R.E. came to light this fall during maintain a prevention program with a sheriff’s race in Maryland that the campaign for sheriff in St. Mary’s questionable effectiveness. made national headlines last week. County, Md., a fast-growing commu­ “We’ve got this situation where The program has strong points, but nity with a rising crime problem. the studies say it’s not effective, but schools shouldn’t think it’s the only program of its kind. See story, top of D.A.R.E. became a central campaign everyone still loves it,” Zylak told this page. issue in the county when challenger The Washington Post in the days be­ Tim Cameron criticized incumbent fore the election. In the wake of the mid-term Sheriff David D. Zylak’s decision to Indeed, many academicians and elections, President Bush quietly eliminate the program and pledged leaders in the addiction community nominated Terry L. Cline, Ph.D. to be to restore D.A.R.E. to the county’s el­ consider D.A.R.E. to be one of the the next administrator of SAMHSA. See D.A.R.E. on page 2 Whether confirmation hearings will ementary schools if elected. be held this fall or delayed until the new — and Democrat — Congress SAMHSA administrator nominated: comes in in January is unclear. But the field cautiously approves of Cline from Oklahoma Cline, noting that his background is Strong mental health the field who know him, but there’s heavy on mental health and light on background some anxiety that substance abuse substance abuse. See story, bottom of Terry L. Cline, Ph.D., the Oklahoma might be given short shrift within this page. Secretary of Health as well as Com­ SAMHSA compared to mental missioner of the Oklahoma Depart­ health. In Oklahoma in particular, Inside this issue… ment of Mental Health and Sub­ there is some concern that mental stance Abuse Services (ODMHSAS), health counselors may end up being Insurance company to conduct ‘commercial evaluation’ of Prometa; Tmay be the next administrator of the only ones who can meet the Payment contingent upon outcome. the Substance Abuse and Mental state’s new licensure requirements. See page 4. Health Services Administration “Personally, I think highly of (SAMHSA). President Bush nomi­ him,” said Brent Katigan, program CSAT corrects methadone dosage nated Cline on November 9, the director of Valley Hope Association error for babies in TIP. See page 4. day before the Veteran’s Day holi­ outpatient programs in Oklahoma St. Christopher’s Inn counselor day and just after the Democrats City, Tulsa, and Wichita (Kan.) among the first to be certified as a won the majority in Congress. “But he was born and raised men­ NIATx Change Leader. See page 5. Not well known to the addiction tal health. I have a little concern treatment field outside of his home about that.”

© 2006 Wiley Periodicals, Inc. state of Oklahoma, Cline’s back­ Valley Hope, a private not-for­ Published online in Wiley InterScience ground is in mental health. Overall, profit multi-state provider, has insu- (www.wileyinterscience.com) DOI: 10.1002/adaw.20067 he receives high marks from those in See Cline on page 6

A Wiley Periodicals, Inc. publication www.interscience.wiley.com 2 Alcoholism & Drug Abuse Weekly November 20, 2006

D.A.R.E. from page 1 ing an environment conducive to day get in the way of making com­ weakest options for school systems learning and positive accomplish­ pletely objective decisions about to embrace on a purely evidence-fo­ ment among students. prevention strategies, Watts Davis cused basis. “The shame with “What D.A.R.E. brought to these said. “The federal government has D.A.R.E. is there has never been a communities was some sense of to recognize this; it’s what I call the published scientific article that has order in the classroom that allowed ‘reality factor,’” she said. demonstrated its effectiveness,” young people to learn,” Watts Davis In response to the limitations David J. Hanson, professor emeritus said. Asked if that was a legitimate school systems and communities at the State University of New York at enough reason to use the controver­ face, CSAP’s parent agency, the Sub­ Potsdam and frequent critic of a va­ sial program, she replied, “It’s legit­ stance Abuse and Mental Health riety of conventional approaches in imate enough for that community.” Services Administration (SAMHSA), addiction services, told ADAW. “It’s has begun acquiring planning tools really not even a debatable matter.” Schools’ analysis and making them available in the Yet while many might criticize Watts Davis, who before joining public domain. Last month SAMHSA policy-makers’ decision to continue SAMHSA directed a community anti­ announced the availability of Com­ to embrace D.A.R.E. (the Post re­ drug coalition in San Antonio, munities That Care, a prevention ported that only three Maryland Texas, believes communities and planning system that previously had counties do not use the police-run school districts often ask the wrong been owned by a private provider program in their elementary questions about prevention strate­ (see ADAW, Oct. 30). schools), others counter that gies and don’t do an effective job Watts Davis said she would like D.A.R.E.’s opponents use incom­ matching approaches to their dis­ to see the federal government take plete analyses and subject the pro­ tinct problems. ownership of more of these tools gram to expectations that no pre­ “The most important thing a for communities so that they can be vention effort could meet. school district should do is take a more widely used free of charge. Even at the highest level of the look at what the [local] data tells it,” Watts Davis believes it is cer­ national prevention infrastructure, Watts Davis said. Too often a dis­ tainly important for communities to there are voices that insist that a com­ trict, for example, will see that consider evidence-based approach­ prehensive approach to prevention drunk-driving episodes involving es to prevention, but warns that the in local communities can and should new teen drivers have become a evidence is found in more places include efforts such as D.A.R.E. prevalent problem, but then will than just with researchers on whom “Not a single program can do turn its attention to implementing a million-dollar grants are bestowed. what needs to be done by itself; not mentoring program for elementary She consistently says to local lead­ one,” Beverly Watts Davis, director school students instead of tackling ers, “Do not devalue your ability to of the federal Center for Substance the documented problem head on, come up with evidence-based prac­ Abuse Prevention (CSAP), told she said. tices,” adding, “Local people solve ADAW. Watts Davis added that in Often this occurs because fac­ local problems best.” some high-crime communities, tors such as program costs and And she says that when commu­ D.A.R.E. has been essential to creat­ scheduling constraints in the school nities are looking at what the evi-

Alcoholism & Drug Abuse Weekly (Print ISSN 1042-1394; Online ISSN 1556­ 7591) is an independent newsletter meeting the information needs of all alcoholism and drug abuse professionals, providing timely reports on na­ tional trends and developments in funding, policy, prevention, treatment and research in alcohol and drug abuse, and also covering issues on certi­ fication, reimbursement and other news of importance to public, private Executive Editor: Karienne Stovell nonprofit and for-profit treatment agencies. Published every week except for the first Monday in July, the first Monday in September, the last Mon­ Editor: Alison Knopf day in November and the last Monday in December. The yearly subscrip­ Contributing Editor: Gary Enos tion rate for Alcoholism & Drug Abuse Weekly is $699. Alcoholism & Drug Associate Editor: Sarah Merrill Abuse Weekly accepts no advertising and is supported solely by its read­ Production: Kevin DeYoung ers. For address changes or new subscriptions, contact Subscription Distri­ Editorial Director: Jo-Ann Wasserman bution US, c/o John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030­ 5774; (201) 748-6645; e-mail: [email protected]. © 2006 Wiley Periodi­ Publisher: Sue Lewis cals, Inc., a Wiley Company. All rights reserved. Reproduction in any form without the consent of the publisher is strictly forbidden. For reprint per­ mission, call (201) 748-6011.

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It is illegal under federal copyright law to reproduce this publication or any portion of it without the publisher’s permission Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw November 20, 2006 Alcoholism & Drug Abuse Weekly 3 dence says, more factors than simply and doesn’t tend to venture beyond “It’s not that this group can’t say the reduction of drug use among the outreach of a law enforcement no [to drugs]; it’s that they have no young people need to be taken into officer to a group of young people. reason to,” said Hoffmann. Building consideration. “Some communities “The programs that work best self-esteem and decision-making may want to encourage school and tend to be the ones that are most skills is as essential as working on family bonding as well,” she said in comprehensive, involving schools, drug refusal skills when addressing citing an example of what could parents, and the community,” Nor­ youths who are already having constitute a broader agenda. man G. Hoffmann, Ph.D., president problems, he said. of Evince Clinical Assessments and a Hanson said that because Plethora of options longtime evaluator of treatment ef­ D.A.R.E. tends to be so popular with It is abundantly clear that no fectiveness, told ADAW. “They don’t school officials, parents and police, matter what a community thinks of just give it to the cops and let the the prevalent belief in the program D.A.R.E.’s effectiveness, no jurisdic­ cops do it.” despite the lack of research evi­ tion should be using it only because Hoffmann said research has dence sustains its widespread use it thinks there are no other options shown that it is important to follow across the country. He did say that with a track record. up lessons taught in the early school one documentable effect of D.A.R.E. Several government sources in years at later stages, with age-specif­ is that youths who participate in the recent years have issued documents ic approaches throughout the program “tend to like police better.” listing a variety of school- and com­ school cycle. He added that most Hanson believes that whatever munity-based prevention programs youths who begin exhibiting sub­ prevention strategy a community tailored to specific age groups or tar­ stance use problems early have a adopts, leaders should always take geted to specific risk factors for sub­ variety of other problems as well, an honest approach with young stance use. For example, the Nation­ and that school-based programs people. “They shouldn’t be using al Institute on Drug Abuse’s (NIDA’s) should not lose sight of the need for scare approaches, or ever be put in research-based guide entitled Pre­ broader intervention strategies for a position of not giving accurate in­ venting Drug Use Among Children this troubled group. formation,” he said. • and Adolescents includes an entire chapter of examples of research- based prevention programs at each school level and for audience cate­ gories encompassing “universal,” Decline in smoking rates by high schoolers has leveled off “selective,” “indicated,” and “tiered.” Youth smoking went down from 1997 to 2003, but the decline seems to have stalled, according to a Also, a 2006 joint publication recent CDC analysis of data from the national Youth Risk Behavior Survey.While the prevalence of cur­ of the National Institute on Alcohol rent cigarette use declined significantly from 36.4 percent in 1997 to 21.9 percent in 2003, there was Abuse and Alcoholism (NIAAA) no statistically significant difference in use from 2003 to 2005, which is consistent with trends ob­ and Community Anti-Drug Coali­ served in other national school-based surveys. tions of America (CADCA), Using Science to Combat Underage 100% Drinking, states, “The most com­ prehensive interventions to date 80% have involved the coordination of efforts among schools, families, and the community at large.” The 60% report, part of CADCA’s Practical Theorist series, uses the Project 40% 34.8% 36.4% 34.8% Northland effort in 22 northern 27.5% 30.5% 28.5% 21.9% 23.0% Minnesota school districts as an ex­ 20% ample of comprehensiveness, cit­ ing its work with school curricula, parental involvement and commu­ 0% 1991 1993 1995 1997 1999 2001 2003 2005 nitywide efforts to change norms about alcohol use. Several experts say this precise­ Source: Adapted by CESAR from Centers for Disease Control and Prevention (CDC), “Cigarette Use Among ly is what is missing from D.A.R.E., High School Students—United States, 1991-2005,” Morbidity and Mortality Monthly Report 55(26)724­ which generally focuses on only 726, 2006. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5526a2.htm. one elementary-school age group

Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication www.interscience.wiley.com 4 Alcoholism & Drug Abuse Weekly November 20, 2006

Insurance company to conduct ‘commercial evaluation’ of Prometa; Payment contingent upon outcome Hythiam and Horizon Blue Prometa based upon the specific improve the quality of care that Cross Blue Shield of New Jersey needs of our patients and cus- we provide to our membership. (BCBSNJ) are joining together to tomers,” said Dr. Christopher Va- Additionally, Prometa will be conduct a “commercial evaluation” lerian, Executive Medical Direc- evaluated for increases in treat- of Prometa, the $12,000-$15,000 tor, Quality and Clinical Innova- ment retention, reduction of a outpatient program to treat alco- tions, Horizon BCBSNJ. “Sub- patient’s time spent away from hol, methamphetamine, or cocaine stance dependent patients tend the workplace, and reduction of addiction. The outcomes will be to be high utilizers of a spectrum patient utilization of emergency measured at 90 days, “after which of health care services, and the medical care.” initial reimbursement may com- chronic relapsing nature of this For the evaluation, 50 BCB­ mence,” according to BCBSNJ. disease tends to result in signifi- SNJ patients will be treated with “Hythiam has been very cant time off from work. A suc- Prometa protocols. Followup will open to having us evaluate cessful result in this pilot will extend through 6 months.

CSAT corrects methadone dosage error for babies in TIP The Substance Abuse and Mental • Column 1, line 6 from the bot­ mg/mL morphine-equivalent; Health Services Administration’s Cen­ tom, reads “0.4 mg/kg/dose.” starting dosage, 0.4 mg/kg/day ter for Substance Abuse Treatment It should read “0.04 mg/kg/ orally in six to eight divided (CSAT) recently corrected two typo- dose.” doses [timed with the feeding graphical errors in the Treatment Im- In subsequent printings of TIP schedule]). Dosage is increased provement Protocol (TIP) 43: Medica­ 43, page 219, the paragraphs re- by 0.04 mg/kg/dose until control tion-Assisted Treatment for Opioid garding this topic have been is achieved or a maximum of 2.0 Addiction in Opioid Treatment Pro- changed to read: mg/kg/day is reached. If Neona­ grams. These are serious typos which tal Abstinence Scores stay high need to be corrected, according to “If pharmacological management but daily dosage nears maximum, CSAT. The corrections are noted is indicated, several methods symptoms are reassessed and below as it appears in Chapter 13. have been found useful. The concurrent phenobarbital therapy In Treatment Improvement American Academy of Pediatrics considered. When control is Protocol (TIP) 43: Medication-As- Committee on Drugs policy state- achieved, the dosage is continued sisted Treatment for Opioid Addic­ ment on Neonatal Drug With- for 72 hours before pharmacolog­ tion in Opioid Treatment Programs drawal (1998) describes several ical weaning, in which dosages (2005 printing), Chapter 13, page agents for the treatment of NAS are decreased 10 percent daily or 219, incorrect information about including methadone, tincture of as tolerated. When 0.2 mg/kg/day medication treatment for neonatal opium, paregoric, and morphine. is reached, medication may be abstinence syndrome (NAS) was One method (J. Greenspan, stopped. Decisions about dosage published. Thomas Jefferson University Hos­ decrease during pharmacological • Column 1, line 9 from the bot­ pital, Philadelphia, personal com­ weaning are based on Neonatal tom, reads “0.4 mg/kg/dose.” It munication, October 2006) uses Abstinence Scores, weight, and should read “0.4 mg/kg/day.” neonatal opium solution (0.4 physical exams.” •

Volum e 18 Number 38 October 2, 2006 Print ISSN 1042-139 RWJF to stop funding addiction treatment Online ISSN 1556-75914 and prevention: current grants to finish The Tired of routing your subscription? Robert Woo tion (RWJF), d Johnson Foun w diction p hich support da­ Long a vital reven ed ad­ The with m tion and treatment lett the Ro support ore than “determ er said that RWJF had bert Wo er of the is cutting that p$18rogram out of its in Fo od Johnson field, million ing relateded that our undatio portfolio and sh last yea new addiction n will d r to addicti grantmak­ iscontinue and treatment on prevention portfo treatment a its funding into its “vuiftinlngera all addiction lio, folding nd preventio rated into the fouwillndnoation’s vulnera­ populatio tions” category, w be incorpo­ it into “vulnerable n ble po ble p addiction ns.” Th e ex Over the last 20A DyeaAWrs, RW pula­ opulations portfolio,” spo tent t has learned. woman A eligible program o which given for s will still be more than half a billion dol­ “We w ndrea kes­ the grants depends lars to the addiction JF has ill honor andDait coz mpconlefirmte ou applications grant commitments over the program fit into the on how prevention field. ed. ,w treatmen progre hich is st new t an several years but r ss.” See ill a “work in There d n story, to was n sion m we do ext A new re p of th nouncement of the o official an­ aking new not envi­ po is page. diction outside ofin vestmentsthe vulnerable of co-occurrinrt gspotlights th was decide chan e proble d at a July gestra, wtehg populations in ad­ abus ADHD and ms plann ich e in ad s ing m we are may end olescents. You ubstance 21, a letter weeting. O ic The Pri serving.” up ng n Septem foun nceton depa in the e people diction ent out ber dation , N rtment bec mergency grantees to all the supporte has been a prom.J.-base the aus Mourey, RWJF ad­ d se medic e of misuse from Ris r of addi sno ations; some of a Lav and treatm ction preve inent rt them to get high you advising president and CEO,izzo- ent treatm ths them of field is ver for d ntion ent provid .Some thi ecades, and n s chang this y concern the For pricing on bulk subscriptions call Sandy Quade: ew patients to b ers do e. w not allow ill mean. ed about wha stimulant m e on the Daitz stressed that:t wait a edicatio se nd see ns, prefe withou how th rring to tthem e child does ADHD medication misuse raises questions say that untreate.Psychiatri sts, h ow increase d AD ever, for treatment providers the likeliho HD can abu od se. See of su Against the backdrop of increasing story, bo bstance ttom of this abuse page. of prescrip report linking medicationtio s for atten­ n drugs comes a for tion deficit/hyperactivity ADHD, such as ato Grant pro (Stratter ject w (ADHD) to emer a), are moxetine addict ill seek diso not ad not stim ion,DD services. to link mostly due to nonmgency room visirdets,r dictive. ulants, and Maryland See these According to the current page 5. drugs. This tapsed inicato l au losen gof­ makes slow pro Abuse Warnin stressing treatment ove time co page gress in ntroversy Report, g Network Drug 6. r jail. tients w about w Emer (DAW See ith addictions shouldheth beer pona­ its Involving gency Department V N) New these m A grants fo edica ications DHD Stimulan is­ prog r commu trolled tions, w , almost rams treating nity-b substance hich are con­ gency depa 8,000 visi t Med­ fami a ased pecially s an ts to emer­ lies. See dolescents when the pillsd adaredictive crushed, es­ from the usertments in 2004 resulted page 7. and and sn ©2006 orted. Nonme of these medications. Wiley P Publis eriodicals, Inc. The dical use accou hed onlin medications in question percent of the visits, and (www. e in Wiley InterScience m wileyinterscienc ethylp nted for e.com)D henidate (co use accounted 48 OI: 1 names are are 0.1002/ada mmon medical use, accforording to themedical w.20 060 R 34 percent. 203-643-8066 and italin and Concerta), trade amphetamine port, Non­ mine (Adderal). -de includ xtroamph son too es: case re­ Other eta­ k a dose thas wt henwas hig medications than pre the per­ scribed, cases when the her A public ation ww w. i ntersci ence.w iley. c om

It is illegal under federal copyright law to reproduce this publication or any portion of it without the publisher’s permission Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw November 20, 2006 Alcoholism & Drug Abuse Weekly 5 From the Field… Field… From the St. Christopher’s Inn counselor among the first to be certified as a NIATx Change Leader

By Maureen Fitzgerald

Thomas King has worn many hats at St. Christopher’s mented reminder calls 24 hours before the assess­ Inn, a community-based substance abuse treatment ment and follow-up calls 24 hours after the ap­ provider in Garrison, N.Y. serving the metropolita pointment. And the no-show rate dropped to zero.” New York City area. A credentialed alcohol and sub­ Success with the first Change Project gave Kin stance abuse counselor and also affiliated with the the confidence to tackle a more challenging issue for a TAmerican Association of Marriage and Family Thera­ second Change Project: how to improve the continua­ pists, King began working in the field in 1989. With a tion rate among men admitted for St. Christopher’s passion for helping people who suffer from sub­ residential treatment program.“St. Christopher’s Inn is stance abuse and/or mental illness, King has also ha run by the Franciscan Friars of Atonement, whose mis­ the the opportunity to develop new programs at St. sion is to provide food, shelter, and clothing for the Christopher’s, including a structured family program needy. Homeless men admitted here can start a 90­ and an intensive outpatient program. day residential treatment program, or they can choos In 2003, as a Robert Wood Johnson Foundation just to stay for shelter for 21 days. We noticed that Paths to Recovery grantee, St. Christopher’s Inn be­ many of our new admissions for treatment—about 35 came a member of the Network for the Improvement percent—were leaving after the first 72 hours. So our of Addiction Treatment (NIATx). In the NIATx model of second Change Project attempted to correct that.” process improvement, staff members work togethe Strategies that King’s Change Team tested to in­ to improve business processes. An Executive Sponso crease continuation included a peer mentoring o (typically the director or CEO) designates a staff mem­ “buddy” system.“When we saw that the buddy system ber as a Change Leader to improve a process that in­ was helping, we also tested another change, which fluence one of the four key NIATx aims: reduce no- was to give our new admits a “treatment menu”—ba­ shows, reduce waiting times to treatment, increase sically, detailed information on what to expect durin admissions, and increase continuation. Then the the course of their stay.”With those two changes, Change Team works together to test a strategy using King’s team was able to reduce the number of new ad­ rapid-cycle change—or a Plan-Do-Study-Act Cycle. mits leaving treatment early to 25 percent. “After we became a NIATx member, I was very While King and his team conducted the Chang excited to be part of the first Change Teams at St. Projects, King kept in touch with his classmates from Christopher’s Inn” says King. “I had worked at other the Change Leader Academy through monthly telecon­ organizations in the field that were resistant to ferences. In these calls, he was able to share his suc­ change. With NIATx, we were able to look at our pro­ cesses and challenges with other Change Leaders-in­ grams with an objective eye to identify things that training.“The regular calls really supported my efforts needed improvement.” as a Change Leader,” says King.“It helped tremendous­ An initial process improvement exercise at St. ly to hear what others were experiencing.” Christopher’s Inn focused on increasing admissions The first NIATx Change Leader Academy concluded After examining the organization’s phone system,“We with a second Madison workshop in September 2006 realized that a lot of calls were coming in at lunch time “Overall, the NIATx Change Leader Academy was a when no one was available to answer the phones,” great opportunity for professional and personal devel­ comments King. By staggering lunch times, the agency opment. I learned new ways to look at my organization was able to increase the number of phone calls that with an eye for process improvement,” King concludes. were answered live. With fewer missed calls, St. Christopher’s saw an increase in admissions as well. Maureen Fitzgerald is editor at the Network for the “When I was asked to pick a Change Initiative, I Improvement of Addiction Treatment (NIATx), a picked something that would be easy to change partnership between The Robert Wood Johnson the “no-show” rate for the evening outpatient clin­ Foundation’s Paths to Recovery program, the Center ic,” said King, who participated in a national for Substance Abuse Treatment’s Strengthenin “Change Project” called the “Change Leader Acade­ Treatment Access and Retention (STAR) program, my.” The no-show rate baseline measure showed and a number of independent addiction treatment that there was a 40 percent no-show rate for as­ organizations. Reach her at NIATx, (608) 890-0937; sessments. “To improve that, my team and I imple­ [email protected].

Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication www.interscience.wiley.com 6 Alcoholism & Drug Abuse Weekly November 20, 2006

Cline from page 1 lated itself from these forces in Ok­ Cline’s background lahoma. “The good news — which is always bittersweet — is that in Cline has a doctorate in clinical psychology from Oklahoma State Univer­ Oklahoma our facility is overflow­ sity, was clinical director of a community mental health center in Cam­ ing with patients,” Ken Gregoire, bridge, Mass., then staff psychologist at McLean Hospital in Belmont, Ph.D., president and CEO of Valley Mass. He was a health care policy fellow at SAMHSA’s Center for Mental Hope Association, told ADAW. “We Health Services where he focused on organization and financing of men­ accept no state funding, everything tal health services, and in 2001 returned to Oklahoma, where he headed is self-pay or insurance,” he said. ODMHSAS. In 2004 Gov. Brad Henry appointed him Secretary of Health. “We don’t want to take money from the state and then have them tell us how to do treatment.” And Bill Crowell, MD, a retired abuse counselors. This program just “Terry assisted in the transition to medical examiner who is also a began this year (see ADAW, April 3). make it very smooth,” Miller — who LADC (licensed alcohol and drug Sallie McLaughlin, past presi- had just taken the oral test for his counselor), says Cline “will be fair dent of the Oklahoma Substance certification — told ADAW. “They and a consensus builder, but his in­ Abuse Services Alliance, the state’s increased the qualifications, which I clination will be toward mental SAAS chapter, had nothing but think was a good move. Now the health issues.” The best case sce­ praise for Cline. “Under Terry counselor is required to have a nario for the field under a merged Cline’s leadership, we have re- bachelor’s degree, and by 2009 it mental health-substance abuse sys­ ceived more funds than we have will be Master’s.” tem will be “to train substance ever been able to get in the past,” But there is no Master’s pro- abuse counselors to do mental she told ADAW. “He led the charge gram in addiction offered in Okla­ health assessments,” says Crowell. for us to be able to get $18 million homa, said Katigan. Since the licen­ “But Cline’s plan in Oklahoma has in drug court funding, in two year sure requirement will be for a Mas- been to train mental health coun­ increments.” ter’s in any kind of behavioral sci- selors to do substance abuse as­ She also credits Cline with the ence, the counselors with masters in sessments,” he told ADAW. “When higher fee-for-service rates for sub- psychology and social work will be they do that, the very next step is stance abuse counselors. “Typically first in line for the addiction coun­ mental health counselors doing we have always been paid less seling jobs, he worries. “When the substance abuse treatment. Our money than the mental health sys- licensure in our state began, there drive is to do the mental health as­ tems, but within three years we’ll be was a strong push by the LPCs sessments.” paid the same. Last year we got our (mental health counselors) to get But the view from the public first increase, this year, the second, grandfathered in so they could do treatment side is more optimistic. and next year we’ll get the third.” all the substance abuse counseling,” “Our Oklahoma association and Cline handled the transition for he said. SAAS have worked with Terry Cline, the licensing of counselors well, ac- And this feeds the real fear that and in my experience — which is cording to Michael Miller, program mental health counselors will treat somewhat limited — I have found director for Valley Hope’s 72-bed substance abuse, instead of the “no him to be balanced, open, and very residential program in Cushing. wrong door” concept, in which committed to moving forward,” said Howard B. Shapiro, Ph.D., execu­ tive director of the State Associa­ tions of Addiction Services (SAAS), Deputy commissioner on administrative leave based in Washington, D.C. “I’m con­ fident that he will have a balanced The only possible hitch insiders can see to Cline’s confirmation as SAMHSA approach to substance abuse and administrator is the investigation into Ben Brown, deputy commissioner in mental health,” he told ADAW. the Oklahoma Department of Mental Health and Substance Abuse Services, who was placed on administrative leave in September. If there is any find­ Counselor pay ing that an impropriety was committed by Brown involving the Oklahoma One particular plus is the move, Citizens Advocates for Recovery and Treatment Association, and Cline is spearheaded under Cline, to equal­ linked to it, that could be damaging, sources say. The alleged impropriety ize pay for substance abuse and involved the hiring of a “plant” member under pressure from Brown, be­ mental health counselors in the state cause the group gets funding from the State Department of Mental Health. — with an increase for substance

It is illegal under federal copyright law to reproduce this publication or any portion of it without the publisher’s permission Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw November 20, 2006 Alcoholism & Drug Abuse Weekly 7 each profession could at least assess for the other. “That’s a big fear in White House says it will keep Cline away Oklahoma right now,” said Katigan. “And I don’t know that Terry Cline from press until after confirmation and his crew have done anything to Immediately after the November 9 nomination, which was made as part relieve that.” of a White House “personnel announcement,” the Bush Administration But McLaughlin from the Okla­ erected a wall around Cline, saying he would not be allowed to talk to homa chapter of SAAS wanted to re­ the press until he was confirmed by the Senate — something that may assure treatment providers that she not happen until next year when the new Congress steps in. “It’s this Ad­ has never seen Cline “favoring men­ ministration’s policy not to make nominees available for interviews be­ tal health over addictions or addic­ fore they are confirmed,” Christie Parell, spokeswoman for the White tions over mental health. What he House media office, told ADAW. has done is helped move our addic­ Even SAMHSA was told they could not comment on Cline or “any­ tion treatment field to be more pro­ thing regarding the new administrator nominee until he is confirmed,” fessional, using evidence-based SAMHSA spokeswoman Shelly Burgess told ADAW. treatment, so we can improve the care for our people.” •

Briefly Noted of which hold that giving up control ing committees,” reported The Asso­ to a higher power or ideal is the key ciated Press on November 10. The to long-term recovery. For example, watchdog group Citizens Against High co-occurrence of alcohol the Sentinel writes that although 12­ Government Waste stated that in the misuse and prescription drug abuse step programs claim not to require past two fiscal years, Pelosi has Only recently have substance belief in a Christian God, the first channeled millions of dollars to sup­ abuse researchers begun to identify three steps involve entering into a port San Francisco projects, includ­ individual characteristics and vulner­ faith contract with a higher power. ing $5.6 million to the University of abilities associated with nonmedical Last spring President Bush spoke in California at San Francisco Depart­ use of prescription drugs (NMUPD), support of the Christian program Cel­ ment of Neurology Gallo Center, in­ according to a report in the October ebrate Recovery, which in the past 12 cluding $3.75 million for alcoholism issue of Drug and Alcohol Depen­ years has seen the participation of research. Pelosi also secured dence. Dr. Sean McCabe from the more than 150,000 people. Carla Ven­ $450,000 for the San Francisco “Safe Substance Abuse Research Center at cil, who has worked in recovery for Streets Project,” and $750,000 to the the University and his colleagues 25 years and currently co-pastors a Bay Area Youth Violence Network. completed a study investigating the music-based spiritual program called little examined co-occurrence of al­ God Rocks, explains, “If you are an Canadian addiction treatment cohol use disorders (AUDs) and addict and you think you are still ‘in ‘empire’ under intense scrutiny NMUPD. They found that although control,’ you are not ready for recov­ Ontario’s Comquest Systems, Inc. individuals with AUDs comprised ery.” In addition to weekly worship is under scrutiny for improper billing less than 9 percent of the 43,093 services, God Rocks includes intimate and medical practices, reported the adults interviewed (NESARC), those home Bible study groups which meet Toronto Star on November 1. The with AUDs accounted for more than several times a month. company, headed by Dr. Jeff Daiter one in three cases of NMUPD. This and Dr. Michael Varenbut, encom­ co-occurrence was particularly high Pelosi’s gains mean funds for passes the “rapid detox” clinic Cana­ among young adults ages 18-24. The San Francisco da Detox, a medical software compa­ researchers conclude that treatment Rep. Nancy Pelosi, as Speaker ny, and the Ontario Addiction Treat­ for AUDs should include a thorough of the House would be able to help ment Center, which treats about one screening for NMUPD, particularly addiction research and treatment in third of Ontario’s 14,000 methadone among young adult patients. the Bay Area, which has already patients. On October 31, Comquest benefited significantly as Pelosi has was convicted of improperly billing Faith-based recovery involves “moved through the ranks of spend­ Continues on next page giving up control On November 11 the Santa Cruz Alcoholism and Drug Abuse Weekly will not be published next week, Sentinel surveyed the popularity of Monday, November 27. Publication will resume Monday, December 4. faith-based recovery programs, many

Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication www.interscience.wiley.com 88 Alcoholism & Drug Abuse Weekly November 20, 2006

Continued from previous page the Ontario Health Insurance Plan (OHIP) for “expensive, excessive” Coming up… tests, and a second inquiry was an­ Children and Family Future and the Children’s Research Triangle will sponsor nounced exploring their medical “Putting the Pieces Together for Children and Families: The National Conference on practices. Meanwhile, an inquest in Substance Abuse, Child Welfare and the Courts,” to be held January 30 through underway regarding the 2005 death February 2, 2007 in Anaheim, Cal. For more information, visit www.cffutures.org. of John Martellacci, who died in the The Harm Reduction Project is sponsoring the Second Annual National Canada Detox clinic after undergoing Conference on Methamphetamine, HIV and Hepatitis: Science & Response “rapid detox.” The controversial pro­ 2007, to take place February 1-3 in Salt Lake City. For more information and to cedure is not covered by OHIP and is register, visit www.methconference.org. not supported by the American Soci­ ety of Addiction Medicine (ASAM). The National Rural Institute on Alcohol and Drug Abuse will hold its Twenty- Furthermore, it’s been found that third Annual Conference on June 3-7 at the University of Wisconsin-Stout. For Martellacci’s urine was not tested on more information, visit www.uwstout.edu/outreach/conf/nri/. the day of the procedure; it’s possible that cocaine in his system contributed to his cardiac arrest. Awards of Excellence for work in the Resources areas of prevention, intervention and Baltimore trains doctors in treatment of alcohol and drug abuse. buprenorphine treatment Next year marks the 23rd Annual NIDA summer internships It is estimated that many thou­ Conference of the National Rural In­ for students sands of Baltimore residents are ad­ stitute on Alcohol and Drug Abuse, The National Institute on Drug dicted to heroine, and the city’s taking place June 3-7 at the Universi­ Abuse (NIDA) announced on No­ Health Department aims to get at ty of Wisconsin-Stout. Awards of Ex­ vember 10 it is seeking student ap­ least 10,000 of them into treatment cellence will be distributed at a June plicants aged 16 years and older for with buprenorphine, reported The 5 luncheon in the following cate­ its Summer 2007 Internship Pro­ Associated Press last month. First ap­ gories: Rural Professional, honoring gram. Interns work at the NIDA fa­ proved by the FDA (in high-dose someone who exemplifies devotion cility in Baltimore, Maryland, par­ preparations Suboxone and Subu­ to their specific program or popula­ ticipating in NIDA’s Intramural Re­ tex) in 2001, buprenorphine is less tion of need; Rural Program, recog­ search Program (IRP). Research prone to abuse than methadone and nizing a model rural program devel­ projects could include: drug-seek­ can be taken at home through a pri­ oped for a rural population; Rural ing behavior in rats, smoking ces­ mary care doctor. In order to reach Community, for a rural community sation and genomic studies for its treatment goal, the city must first that has identified a problem and nicotine dependence. Applicants train enough doctors to administer pulled together resources to address should be enrolled at least half­ the medication. Currently, only that problem; and Responsiveness to time in high school, have complet­ about 90 Baltimore doctors have Rural Issues and Concerns, for a ed high school or be attending an earned the credentials to treat up to non-rural individual/agency that has accredited U.S. college or universi­ 30 buprenorphine patients at a time. demonstrated repeated aid to a rural ty. Stipends will be paid. The dead­ In a city with so many physicians, population. Nominations will be due line to apply is March 1, 2007. Go said Health Commissioner Dr. in January 2007. For more informa­ to www.training.nih.gov/student/ Joshua Sharfstein, buprenorphine tion, contact: Louise Monson, sip/index.asp for information and training “offers a potential for a [email protected]. to apply. major expansion of access to care.” In a contract with Clinical Tools, Inc., which offers the 8-hour train­ In case you haven’t heard… ing in an online program, the city government will subsidize $10,000 A new idea for a controlled-dose pill dispenser is touted as deterring abuse of to train 100 additional doctors. medications such as OxyContin uses, of all things, rocket fuel. If anyone tries to take more than one pill at a time, the contents of the container, known by the Rural awards honor prevention inventers as Pill Safe, all the pills inside get burned up. It’s operated by battery, intervention efforts and anybody who tries to force open the device will ignite the fuel. In order to Since 1991 the National Rural Al­ take a pill legitimately, the user presses a button. That button will not work cohol and Drug Abuse Network, Inc. again until the next dose is supposed to be taken. No fire comes out of the (NRADAN) has been distributing device if it gets set off, according to the inventers, Just a wisp of smoke.

Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication www.interscience.wiley.com