Don't Count on the Media

A report in the American Journal of Public Health evaluated the National Youth Anti-Drug Media Campaign, which spent $1 billion between 1998 and 2004. Results suggest not only was the program not effective in preventing drug use, but the program may have increased marijuana initiation.

Full citation:

Robert Hornik, Lela Jacobsohn, Robert Orwin, Andrea Piesse, and Graham Kalton. Effects of the National Youth Anti-Drug Media Campaign on Youths.2008. Am J Public Health, 98:2229-2236, 10.2105/AJPH.2007.125849.

More Things Brown Can Do for You

Another online offering from Brown University/ATTC-NE, this one in CBT:

Cognitive Behavioral Therapy

Brown University Distance Learning Program is offering a credited, on-line course on cognitive behavioral therapy.

Cognitive-behavioral therapy (CBT) is a treatment approach that has gained widespread application in the treatment of a variety of mental health issues, including substance abuse. Several important features of CBT make it particularly promising as a treatment for substance abuse and dependence:

• CBT is a short-term, comparatively brief approach well suited to the resource capabilities of most clinical programs.
  
• CBT has been extensively evaluated in rigorous clinical trials and has solid empirical support as treatment for substance abuse.
  
• CBT is structured, goal-oriented, and focused on the immediate problems faced by substance abusers entering treatment who are struggling to control their substance use.
  
• CBT is a flexible, individualized approach that can be adapted to a wide range of patients as well as a variety of settings (inpatient, outpatient) and formats (group, individual).
  
• CBT is compatible with a range of other treatments the patient may receive, such as pharmacotherapy and self-help groups such as Alcoholics Anonymous.

CBT's broad approach encompasses several important common tasks of successful substance abuse treatment.

This four week course will explore the central elements of CBT in the treatment of Substance Use Disorders and examine CBT treatment manuals that address alcohol and cocaine addiction.

The course instructor Justin Enggasser, Ph.D. is a Clinical Fellow at Harvard Medical School, Teaching Fellow at Boston University School of Medicine and currently works in the residential and outpatient substance abuse treatment programs at VA Boston Healthcare System. Dr. Enggasser has published several studies in the areas of cognitive vulnerability and substance use. He is currently involved in projects developing and testing new treatment models (a gender-specific cognitive-behavioral treatment protocol for women with substance use disorders) and treatment delivery methods (web-based interventions for problem drinking).

This course will begin on February 2, 2009, and will run for 4 weeks. The required time commitment is two hours per week (8 contact hours). There are no real time events associated with this course. All course material will be posted on the Internet.

The total cost of this course is $60.00 (US) the course payment is due by February 2, 2009. Refund requests will be honored until the posting of the second lesson (February 9, 2009), after which there will be no refunds. For additional information regarding this course offering, as well as a link to the Brown Distance Learning course '383 Cognitive Behavioral Therapy' registration page, please go to the following WWW site and read the Official Course Announcement.

http://www.browndlp.org/cbtann.php

To register for this course please log in/ or create your account then log into your account and click the Enroll in a New Course link at the bottom of your account page. Then select the course you wish to enroll into and click the enroll button. Having enrolled into the course you will be prompted for payment. You may make your payment online. To view payment information please see the payment policies page.

Sincerely,

Monte D. Bryant, BA
Technology Programming and Evaluation Administrator
Addiction Technology Transfer Center of New England
Center for Alcohol & Addiction Studies
Box G-S121 5th
Brown University
Providence, RI 02912
401-863-6606
http://www.attc-ne.org

Recommendations for the President-elect

A blog entry by Mark Kleiman at UCLA summarizes his take on current issues in drug treatment, drug availability, and systems responses, including for adolescents. A couple of highlights:

• 9. Prevalence of diverted opioids and diverted stimulants among adolescents high and rising, with initiation at record levels. Little knowledge about how much damage this does; the pattern of peer-to-peer and internet distribution seems not to be generating problem drug markets or violence.
  
• ...
  
• 22. Data gathering and analysis is a mess.
  • Almost all the money is spent on two big and very expensive annual surveys: NS-DUH (household) and Monitoring the Future (school-based), which give information about prevalence but not about problems.
    
  • ADAM, which was a cheap way to monitor drug use in the criminal-justice population, was shut down early in the decade. A proposal to do the same thing even more cheaply by relying on the drug tests done routinely on probationers and parolees never happened.
    
  • The DAWN system to measure drug-related emergency room visits and deaths has broken down.
    
  • The Community Epidemiology Work Group no longer collects original data.
    
  • The DEA Stride data set on drug prices and purities is no longer available for statistical analysis.

Training Opportunity: Becoming a Supervisor

This notice came over the electronic transom, announcing a training opportunity for moving line workers to supervisory positions:

Moving From Line Worker to Supervisor

Brown University Distance Learning Program is offering a credited, on-line course on moving from line worker to supervisor.

The Supervisors of tomorrow are the line workers of today. In the field of chemical dependency counseling, many of the original supervisors of programs are retiring. New qualified supervisors are needed in administrative and clinical supervisory roles. Even if you started your career as a Counselor with no intention of becoming a Supervisor, you have either been offered an opportunity to be a Supervisor or you are interested in finding about how to use your skills to move into a supervisory position, this is the course for you. Through the use of practical examples and readings, participants will learn the basics of supervision and how to incorporate clinical counseling tools into a supervisory setting and how to address the issues of moving from Peer to Supervisor. This course is designed for the new supervisor or the counselor who would aspires to become a supervisor.

The course instructor Susanne Smoller L-RCSW, CASAC, CPP, ACSW , is an independent organizational consultant specializing in substance abuse and HIV/AIDS. Susanne has worked in a variety of substance abuse settings with positions ranging from line worker to program director. Susanne also has experience as a Case Manager and Crime Victim Advocate. Susanne has also been a consultant on research grants regarding Gay, Lesbian, Bisexual teens; bridging substance abuse treatment research to practice; and New York State Expanded Syringe Access Demonstration Program (ESAP). Susanne started her own consulting practice in 2001 and became a Qualified Myers Briggs Type Indicator Practitioner. As an independent consultant, Susanne has been a strong advocate for syringe disposal and needle exchange in Long Island, NY. She has also expanded her work with HIV+ consumers, providing workshops on treatment information and risk reduction. Susanne also provides technical assistance consulting for federal grantees across the country on a variety of issues, including program sustainability and staff training needs. Susanne is currently an instructor at Molloy College's Chemical Dependency Certificate Program. Susanne was named Social Worker of the year in 1998 by the local division of the National Association of Social Workers and in 2006, Nassau County PTA Volunteer of the Year.

This course will begin on January 26, 2009, and will run for 4 weeks. The required time commitment is two hours per week (8 contact hours). There are no real time events associated with this course. All course material will be posted on the Internet.

The total cost of this course is $60.00 (US) the course payment is due by January 26, 2009. Refund requests will be honored until the posting of the second lesson (February 2, 2009), after which there will be no refunds. For additional information regarding this course offering, as well as a link to the Brown Distance Learning course 'Lineworker to Supervisor' registration page, please go to the following WWW site and read the Official Course Announcement.

http://www.browndlp.org/linetosupann.php

To register for this course please log in/ or create your account then log into your account and click the Enroll in a New Course link at the bottom of your account page. Then select the course you wish to enroll into and click the enroll button. Having enrolled into the course you will be prompted for payment. You may make your payment online. To view payment information please see the payment policies page.

Sincerely,

Monte D. Bryant, BA
Technology Programming and Evaluation Administrator
Addiction Technology Transfer Center of New England
Center for Alcohol & Addiction Studies
Box G-S121 5th
Brown University
Providence, RI 02912
401-863-6606
http://www.attc-ne.org

Prescription Pain Killers and Overdoses in WV

A study of unintentional pharmaceutical overdoses in WV found that prescription opioids were present in 93% of cases, according to a CDC study reported in JAMA. From the abstract:

Pharmaceutical diversion [of prescriptions to those not prescribed] was associated with 186 (63.1%) deaths, while 63 (21.4%) were accompanied by evidence of doctor shopping. Prevalence of diversion was greatest among decedents aged 18 through 24 years and decreased across each successive age group...Substance abuse indicators were identified in 279 decedents (94.6%).

An accompanying editorial by Tom McLellan and Barbara Turner of Treatment Research Institute (TRI) calls for better monitoring of prescriptions. Below is a press release from TRI.

December 11, 2008

CDC Study of West Virginia Overdoses Suggests Need for Better Compliance Monitoring

More Vigilance, Better Electronic Records are Needed, Not Less Use of Opioids to Control Pain, Contend A. Thomas McLellan, Ph.D. and Barbara J. Turner, M.D., MSED in Special JAMA Editorial

Physicians who prescribe opioids should be more vigilant and step up monitoring, but not avoid prescribing these drugs when needed for pain management, according to A. Thomas McLellan, Ph.D. and Barbara J. Turner, M.D., MSED in an editorial appearing in the December 10, 2008 Journal of the American Medical Association (JAMA).

Their editorial accompanied a study in the same JAMA issue by Aron Hall, M.D. and other CDC researchers finding that prescription opioids were involved in 275 of the 295 overdose deaths in West Virginia in 2006, and that less than half of those who died had actually been prescribed the drugs. The findings, which McLellan and Turner called "disturbing," suggest that diversion of expensive and potent pain medications (sold or stolen) can lead to lethal outcomes.

"These findings provide further evidence of how significant abuse and misuse of prescription medications has become to America's drug problem," McLellan said. "We know that legitimate, doctor prescribed and managed opioid use is on the rise because of the high prevalence of chronic pain-causing diseases like arthritis. Very disturbing, however, is the rapid increase in accidental drug overdoses, most from opioid use," he said.

"The real message - from this and other studies - is that physicians should increase monitoring, particularly for patients who admit to a history of substance use/abuse when formally queried," he said, "and they should be queried."

In addition to asking patients about past drug, alcohol, and possibly tobacco use, McLellan and Turner recommended executing agreements where patients assent to: receiving opioid drugs from one physician and one pharmacy; limits on timing of refills; taking the medications as prescribed; and adhering to doctor visits for urine screens and other safety checks. Another necessary monitoring tool, they said, is through statewide or even multi-state prescription monitoring databases that physicians can easily access from their offices. "For 20% of the West Virginia deaths, patients appeared to be 'doctor shopping' (obtaining prescriptions from multiple physicians, sometimes based on fraudulent claims of pain or other symptoms). This makes a compelling case for prescription monitoring programs that span multiple states - but such databases are not widely available," they said.

Copies of the editorial and the CDC study can be obtained from the JAMA website.

The Treatment Research Institute is a non-profit research and development organization specializing in science-driven reform of policy and practice in substance use and abuse. For more information contact Bonnie Catone, TRI Director of Communications, at bcatone@tresearch.org.

ED Visits for Underage Drinkers

SAMHSA's Drug Abuse Warning Network (DAWN) reports this month on ED use by underage drinkers.

SAMHSA Releases New Data on Drug-related Hospital Emergency Department Visits (12/5/08)

The latest Drug Abuse Warning Network (DAWN) report - drawn from a sample of hospital emergency departments across the Nation - indicates that more than 1.7 million visits for treatment were associated with some form of substance misuse or abuse. The 2006 DAWN report, developed by the Substance Abuse and Mental Health Services Administration (SAMHSA), provides the latest estimates on how substance use affects this critical part of the Nation's healthcare system.

Click on the link for more information about the DAWN report

Key findings:

According to the Drug Abuse Warning
Network (DAWN):

• During 2004, an estimated 142,701 alcohol-related emergency department (ED) visits were made by patients aged 12 to 20.
  
• Nearly half (42%) of drug-related ED visits among patients aged 12 to 20 involved alcohol.
  
• Patients aged 18 to 20 were approximately 3 times as likely as patients aged 12 to 17 to have an alcohol-related ED visit.
  
• Visits involving alcohol with other drugs were almost 2 times as likely as visits involving only alcohol to result in admission to the hospital for inpatient care (19% vs. 10%).

Reno 411

The College on Problems of Drug Dependence meets 20-25 June 2009 in Reno, NV. SAMHSA's Randy Muck sent this email regarding travel scholarships for practitioners that wish to attend (award deadline: 10 Jan 2009):

Dear Grantee,

The College on Problems of Drug Dependence (CPDD) is holding is 71st Annual Scientific Meeting, June 20-25, 2009 in Reno/Sparks, Nevada and CSAT will once again be sponsoring up to 30 Travel Awards for clinical supervisors or directors who are in positions to implement evidenced-based practices in substance abuse treatment and recovery settings. The CPDD conference is the premier scientific conference in the field and this is an exceptional opportunity for those clinical supervisors and program directors to learn first-hand about the most recent findings in treatment and recovery that they can use in their programs. In addition, it is a wonderful opportunity for providers and clinical supervisors to dialogue with researchers in an environment conducive to promoting the adoption of evidenced-based practices.

Below is specific information about the application process, including the deadline for the applications and the person to whom the applications should be sent.

CSAT Travel Awards
The Center for Substance Abuse Treatment (CSAT) will sponsor up to 30 Travel Awards for substance abuse treatment practitioners to attend the 2009 CPDD meeting. To be eligible, candidates must hold full-time employment as a director or clinical supervisor in a substance abuse treatment program and not be an employee of the federal government. Only one award will be given to any specific program. Previous CSAT travel award recipients are not eligible to apply. All expenses will be covered: i.e., conference registration, airfare, travel to and from the airport, and hotel accommodation. Applicants will be sent emails by the end of March indicating award status.

To apply, send five collated copies of the following:

1. An up-to-date resume or vitae including contact information, previous travel fellowships, if applicable, work experience and academic experience. Please include your current e-mail address.

2. A one page letter on institutional letterhead indicating interest in receiving an award and including a statement as to how this conference will benefit your work in your current position. Please include a valid telephone number and e-mail address.

3. A letter of support on institutional letterhead from your direct supervisor stating should you be selected that you will be allowed to attend.

Complete, collated applications must be received on or before January 10, 2009. Late or incomplete applications will not be considered. Applicants are required to arrive prior to 4:30 PM on June 19, attend a networking session sponsored by CSAT in the evening on June 19, the CSAT-sponsored satellite session June 20, a breakfast sponsored by CPDD for the awardees on June 21, and remain for the entire CPDD meeting. Materials should be mailed to:

Dr. Alison Oliveto, Chair, CPDD Travel Awards Committee, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Mail Slot 843, Little Rock, AR 72205. For inquiries call: 501.686.8969.”

Randolph D. Muck, M.Ed.
Chief, Targeted Populations Branch
Division of Services Improvement
Center for Substance Abuse Treatment
1 Choke Cherry Road
Room 5-1097
Rockville, MD 20857

Phone: 240-276-1576

Gender Drinking Gap

An article in the popular press discusses increases in female alcohol consumption.