Addiction Diagnoses May Rise Under Guideline Changes
In what could prove to be one of their most far-reaching decisions, psychiatrists and other specialists who are rewriting the manual that serves as the nation’s arbiter of mental illness have agreed to revise the definition of addiction, which could result in millions more people being diagnosed as addicts and pose huge consequences for health insurers and taxpayers.
The revision to the manual, known as the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., would expand the list of recognized symptoms for drug and alcohol addiction, while also reducing the number of symptoms required for a diagnosis, according to proposed changes posted on the Web site of the American Psychiatric Association, which produces the book. In addition, the manual for the first time would include gambling as an addiction, and it might introduce a catchall category — “behavioral addiction — not otherwise specified” — that some public health experts warn would be too readily used by doctors, despite a dearth of research, to diagnose addictions to shopping, sex, using the Internet or playing video games.
Part medical guidebook, part legal reference, the manual has long been embraced by government and industry. It dictates whether insurers, including Medicare and Medicaid, will pay for treatment, and whether schools will expand financing for certain special-education services. Courts use it to assess whether a criminal defendant is mentally impaired, and pharmaceutical companies rely on it to guide their research. The broader language involving addiction, which was debated this week at the association’s annual conference, is intended to promote more accurate diagnoses, earlier intervention and better outcomes, the association said. “The biggest problem in all of psychiatry is untreated illness, and that has huge social costs,” said Dr. James H. Scully Jr., chief executive of the group.
But the addiction revisions in the manual, scheduled for release in May 2013, have already provoked controversy similar to concerns previously raised about proposals on autism, depression and other conditions. Critics worry that changes to the definitions of these conditions would also sharply alter the number of people with diagnoses.
While the association says that the addiction definition changes would lead to health care savings in the long run, some economists say that 20 million substance abusers could be newly categorized as addicts, costing hundreds of millions of dollars in additional expenses.
“The chances of getting a diagnosis are going to be much greater, and this will artificially inflate the statistics considerably,” said Thomas F. Babor, a psychiatric epidemiologist at the University of Connecticut who is an editor of the international journal Addiction. Many of those who get addiction diagnoses under the new guidelines would have only a mild problem, he said, and scarce resources for drug treatment in schools, prisons and health care settings would be misdirected. “These sorts of diagnoses could be a real embarrassment,” Dr. Babor added.
The scientific review panel of the psychiatric association has demanded more evidence to support the revisions on addiction, but several researchers involved with the manual have said that the panel is not likely to change its proposal significantly. The controversies about the revisions have highlighted the outsize influence of the manual, which brings in more than $5 million annually to the association and is written by a group of 162 specialists in relative secrecy. Besieged from all sides, the association has received about 25,000 comments on the proposed changes from treatment centers, hospital representatives, government agencies, advocates for patient groups and researchers. The organization has declined to make these comments public.
While other medical specialties rely on similar diagnostic manuals, none have such influence. “The D.S.M. is distinct from all other diagnostic manuals because it has an enormous, perhaps too large, impact on society and millions of people’s lives,” said Dr. Allen J. Frances, a professor of psychiatry and behavioral sciences at Duke, who oversaw the writing of the current version of the manual and worked on previous editions. “Unlike many other fields, psychiatric illnesses have no clear biological gold standard for diagnosing them. They present in different ways, and illnesses often overlap with each other.”
Dr. Frances has been one of the most outspoken critics of the new draft version, saying that overly broad and vaguely worded definitions will create more “false epidemics” and “medicalization of everyday behavior.” Like some others, he has also questioned whether a private association, whose members stand to gain from treating more patients, should be writing the manual, rather than an independent group or a federal agency. Under the new criteria, people who often drink more than intended and crave alcohol may be considered mild addicts. Under the old criteria, more serious symptoms, like repeatedly missing work or school, being arrested or driving under the influence, were required before a person could receive a diagnosis as an alcohol abuser.
Dr. George E. Woody, a professor of psychiatry at the University of Pennsylvania School of Medicine, said that by describing addiction as a spectrum, the manual would reflect more accurately the distinction between occasional drug users and full-blown addicts. Currently, only about 2 million of the nation’s more than 22 million addicts get treatment, partly because many of them lack health insurance. Dr. Keith Humphreys, a psychology professor at Stanford who specializes in health care policy and who served as a drug control policy adviser to the White House from 2009 to 2010, predicted that as many as 20 million people who were previously not recognized as having a substance abuse problem would probably be included under the new definition, with the biggest increase among people who are unhealthy users, rather than severe abusers, of drugs. “This represents the single biggest expansion in the quality and quantity of addiction treatment this country has seen in 40 years,” Dr. Humphreys said, adding that the new federal health care law may allow an additional 30 million people who abuse drugs or alcohol to gain insurance coverage and access to treatment. Some economists have said that the number could be much lower, though, because many insurers will avoid or limit coverage of addiction treatment.
The savings from early intervention usually show up within a year, Dr. Humphreys said, and most patients with a new diagnosis would get consultations with nurses, doctors or therapists, rather than expensive prescriptions for medicines typically reserved for more severe abusers.
Many scholars believe that the new manual will increase addiction rates. A study by Australian researchers found, for example, that about 60 percent more people would be considered addicted to alcohol under the new manual’s standards. Association officials expressed doubt, however, that the expanded addiction definitions would sharply increase the number of new patients, and they said that identifying abusers sooner could prevent serious complications and expensive hospitalizations. “We can treat them earlier,” said Dr. Charles P. O’Brien, a professor of psychiatry at the University of Pennsylvania and the head of the group of researchers devising the manual’s new addiction standards. “And we can stop them from getting to the point where they’re going to need really expensive stuff like liver transplants.” Some critics of the new manual have said that it has been tainted by researchers’ ties to pharmaceutical companies.
“The ties between the D.S.M. panel members and the pharmaceutical industry are so extensive that there is the real risk of corrupting the public health mission of the manual,” said Dr. Lisa Cosgrove, a fellow at the Edmond J. Safra Center for Ethics at Harvard, who published a study in March that said two-thirds of the manual’s advisory task force members reported ties to the pharmaceutical industry or other financial conflicts of interest. Dr. Scully, the association’s chief, said the group had required researchers involved with writing the manual to disclose more about financial conflicts of interest than was previously required.
Dr. O’Brien, who led the addiction working group, has been a consultant for several pharmaceutical companies, including Pfizer, GlaxoSmithKline and Sanofi-Aventis, all of which make drugs marketed to combat addiction. He has also worked extensively as a paid consultant for Alkermes, a pharmaceutical company, studying a drug, Vivitrol, that combats alcohol and heroin addiction by preventing craving. He was the driving force behind adding “craving” to the new manual’s list of recognized symptoms of addiction.
“I’m quite proud to have played a role, because I know that craving plays such an important role in addiction,” Dr. O’Brien said, adding that he had never made any money from the sale of drugs that treat craving. Dr. Howard B. Moss, associate director for clinical and translational research at the National Institute on Alcohol Abuse and Alcoholism, in Bethesda, Md., described opposition from many researchers to adding “craving” as a symptom of addiction. He added that he quit the group working on the addiction chapter partly out of frustration with what he described as a lack of scientific basis in the decision making. “The more people diagnosed with cravings,” Dr. Moss said, “the more sales of anticraving drugs like Vivitrol or naltrexone.”
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New report shows more than one in five pregnant White women smoke cigarettes
Study shows significant differences in substance use rates among Blacks, Hispanics, and Whites
A new report shows that 21.8 percent of pregnant White women aged 15 to 44 currently (within the past 30 days) smoked cigarettes. The study conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) also showed that cigarette smoking levels among pregnant White women were significantly higher than the levels among pregnant Black women (14.2 percent) and pregnant Hispanic women (6.5 percent) in the same 15 to 44 age range.
In terms of current illicit drug use, however, the report found that the rate among pregnant Black women (7.7 percent) was significantly higher than among pregnant White women (4.4 percent) and pregnant Hispanic women (3.1 percent).
The rate of current alcohol use among pregnant Black and White women is roughly the same (12.8 percent and 12.2 percent respectively), but their levels were substantially higher than pregnant Hispanic women (7.4 percent)
Overall, pregnant Hispanic women in this age range were less likely to use alcohol and cigarettes than pregnant Black and White women.
“When pregnant women use alcohol, tobacco, or illicit substances they are risking health problems for themselves and poor birth outcomes for their babies,” said SAMHSA Administrator Pamela S. Hyde. “Pregnant women of different races and ethnicities may have diverse patterns of substance abuse. It is essential that we use the findings from this report to develop better ways of getting this key message out to every segment of our community so that no woman or child is endangered by substance use and abuse.”
SAMHSA’s Fetal Alcohol Spectrum Disorders (FASD) Center for Excellence sponsors a number of state-of-the-art programs for addressing the problem of substance abuse among pregnant women. These programs include:
The report entitled, Data Spotlight: Substance Use During Pregnancy Varies by Race and Ethnicity, is based on data analyzed from SAMHSA’s 2002-2010 National Survey on Drug Use and Health (NSDUH). NSDUH is a scientifically conducted annual survey of approximately 67,500 people throughout the country, aged 12 and older. Because of its statistical power, it is the nation’s premier source of statistical information on the scope and nature of many substance abuse and behavioral health issues affecting the nation. The report is available at: http://www.samhsa.gov/data/spotlight/Spot062PregnantRaceEthnicity2012.pdf.
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22 Percent of White Women Have Smoked Cigarettes During Pregnancy
A new government study finds 22 percent of white women have smoked cigarettes during their pregnancy, ABC News reports. In contrast, 14 percent of black women, and 6.5 percent of Hispanic women, have done so. The study was conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA).
“When pregnant women use alcohol, tobacco, or illicit substances they are risking health problems for themselves and poor birth outcomes for their babies,” SAMHSA Administrator Pamela S. Hyde said in a statement. “Pregnant women of different races and ethnicities may have diverse patterns of substance abuse. It is essential that we use the findings from this report to develop better ways of getting this key message out to every segment of our community so that no woman or child is endangered by substance use and abuse.”
The study found the rate of alcohol use during pregnancy was between 12 and 13 percent among both white and black women. Among Hispanic women, the rate was 7.4 percent. Illegal drug use was more common among black pregnant women (7.7 percent) than white women (4.4 percent) or Hispanic women (3.1 percent). According to the Centers for Disease Control and Prevention, the dangers of smoking during pregnancy include premature birth, certain birth defects, and infant death.
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Parents Greatly Underestimate Children’s Secondhand Smoke Exposure
A new study finds parents greatly underestimate their children’s exposure to secondhand smoke. While 13 percent of parents said their children were exposed to cigarette smoke, blood tests showed the rate was 55 percent. In children, secondhand smoke can cause ear infections, more frequent and severe asthma attacks, respiratory symptoms and infections, and a greater risk of Sudden Infant Death Syndrome, according to the Centers for Disease Control and Prevention. The researchers at the University of California, San Francisco, tested 496 blood samples from young children. The study tested blood levels of cotinine, a chemical produced by the body after it is exposed to nicotine, Reuters reports.
In the Archives of Pediatrics and Adolescent Medicine, the researchers noted children do not necessarily need to be around someone who is smoking in order to be exposed to secondhand smoke. They can be exposed if they spend time in a room where someone has recently been smoking. Cotinine testing is not readily available to the general public, according to study co-author Dr. Neal Benowitz.
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SAMHSA report shows trauma-informed care helps improve outcomes among youth exposed to traumatic events
Children and youth involved in child welfare and juvenile justice face significant challenges, but improve when in SAMHSA community-based programs
According to data released today (5/15/2012) by the Substance Abuse and Mental Health Services Administration (SAMHSA), children and youth participating in SAMHSA community-based programs who are involved in the juvenile justice and child welfare systems demonstrate improved outcomes after receiving trauma-informed services. This includes reduced behavioral and emotional problems, reduced trauma symptoms, reduced substance use problems, improved functioning in school and in the community, and improved ability to build relationships.
The report, Promoting Recovery and Resilience for Children and Youth Involved in Juvenile Justice and Child Welfare Systems, shows that upon entering SAMHSA’s Comprehensive Community Mental Health Services Program for Children and Their Families (CMHI), 34 percent of children and youth involved in the child welfare system and 28 percent involved in the juvenile justice system had experienced four or more types of traumatic events. Among children and youth entering SAMHSA’s Donald J. Cohen National Child Traumatic Stress Initiative services, 67 percent involved in child welfare and 57 percent involved in the juvenile justice system had experienced four or more types of traumatic events. Traumatic events can include witnessing or experiencing: physical or sexual abuse; violence in families and communities; natural disasters; wartime events and terrorism; accidental or violent death of a loved one; and a life-threatening injury or illness. Trauma-informed services take into account knowledge about how the experience of trauma can impact the health and well-being of a person and a community.
In 2009, the Centers for Disease Control and Prevention (CDC) reported that 6.3 percent of students in grades 9 through 12 attempted suicide, which is consistent with SAMHSA data. Within 6 months of receiving services through CMHI, suicide attempts for children and youth in the child welfare system decreased from 6 percent to 3 percent and decreased further after12 months to 1 percent.
“Children and youth involved in the juvenile justice or child welfare system are more likely to be exposed to potentially traumatic events and face significant challenges,” said SAMHSA Administrator Pamela S. Hyde. “The good news is that SAMHSA initiatives help these children and youth build resilience and begin to recover by connecting them with supportive adults and providing trauma-informed, evidence-based treatment.”
The report was released today, National Children’s Mental Health Awareness Day (Awareness Day), SAMHSA’s annual celebration highlighting the importance of caring for every child’s mental health. Awareness Day is part of SAMHSA’s strategic initiative on public awareness and support. More than 130 National organizations and Federal agencies and programs are collaborating to provide greater access to community-based mental health services and supports for all children and youth with serious mental health conditions and their families as part of Awareness Day 2012. Across the country, more than 1,100 communities are celebrating this annual observance with local events; social media campaigns; and dance, music, and visual activities with children to raise awareness about the importance of children’s mental health.
To download Promoting Recovery and Resilience for Children and Youth Involved in Juvenile Justice and Child Welfare Systems and view the full list of field references, visit www.samhsa.gov/children.
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Some Question Fairness of New Jersey Drug Treatment Plan
New Jersey Governor Chris Christie’s plan for mandatory treatment for all low-level drug offenders could reduce treatment slots for people who seek treatment voluntarily, but don’t have the money to pay for it, critics say. The governor’s plan, which would make New Jersey the first state to require treatment for nonviolent offenders who are addicted to drugs, has been praised by addiction experts, The Philadelphia Inquirer reports. Some providers point out that the plan would give priority to criminals, some of whom do not want treatment. Providers say that their centers often have waiting lists, and state money to pay for those who cannot afford treatment sometimes runs out before the end of the year, or is frozen.
Michael Drewniak, a spokesman for Governor Christie, disputed the claim that the governor’s plan takes away services from others. “What we’re attempting to do is to address a very serious societal problem,” he said. “In doing that, we are not diminishing the addiction services outside the criminal justice system.” The system that would require drug treatment for low-level offenders, called drug court, could cost up to $35 million, the article notes. The mandatory program would double the court’s current 4,000 participants. Governor Christie has proposed spending $2.5 million for fiscal 2013 to create the mandatory program.
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Report shows decrease in smoking levels among adolescents and young adults in a six year period
Still many adolescents and young adults continue smoking
A new report shows that while a significant segment of minors and young adults are still current smokers there was a decrease in the rate of cigarette use among these populations between 2004 and 2010 (the year with the latest available data). The report, based on the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health (NSDUH), shows that the rate of current cigarette use (having smoked at least once in the past month) among adolescents decreased from 11.9 percent in 2004 to 8.3 percent in 2010. Similarly, the level of current cigarette users among young adults decreased from 39.5 percent in 2004 to 34.2 percent in 2010.
“Although some progress has been made in curbing youth smoking, the fact remains that one in 12 adolescents currently smoke and one in three young adults smoke – which means that far too many young people are still endangering their lives,” said SAMHSA Administrator Pamela S. Hyde. “As the recently released Surgeon General’s Report on Preventing Tobacco Use Among Youth and Young Adults notes, smoking is the nation’s leading cause of preventable death and we must take every opportunity to prevent kids and young adults of today from becoming the hooked, ailing adult smokers of tomorrow.”
The NSDUH report revealed that the percentage of daily smokers among adolescents declined from 3.3 percent in 2004 to 1.9 percent in 2010. The percentage of young adults who smoked daily also declined from 20.4 percent in 2004 to 15.8 percent in 2010.
Among these daily young adult smokers, the percentage who smoked 26 or more cigarettes per day (about one and a half packs or more) decreased from 6 percent to 3.4 percent over this time period. Additionally the percentage of young adult daily smokers using 5 or less cigarettes per day rose from 24.4 percent in 2004 to 28.6 percent in 2010.
SAMHSA works to prevent illegal tobacco sales to underage youth and use through the Synar Amendment program -- a federal and state partnership. The most recent Synar Amendment report shows that the average national retailer violation rate of tobacco sales is down to 9.3percent -- the lowest level in the 14 year history of the program.
SAMHSA plans to build upon the success of this program and its other youth tobacco use prevention efforts to promote continued progress against cigarette smoking and other forms of tobacco use by young people.
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New Survey Results Show Majority of Adult Males Arrested in 10 U.S. Cities Test Positive for Illegal Drugs At Time of Arrest
White House Drug Policy Advisor Calls for Addressing Drug Challenge as Public Health Issue, Not Just a Criminal Justice Issue; Outlines Administration Actions to Reform Criminal Justice Systems to Address Underlying Causes of Crime
Gil Kerlikowske, Director of National Drug Control Policy (ONDCP) released the 2011 Arrestee Drug Abuse Monitoring Annual Report (ADAM II). The 2011 report reveals that in the 10 participating cities/counties, more than half of adult males arrested for crimes ranging from misdemeanors to felonies tested positive for at least one drug. Positive test results ranged from 64 percent in Atlanta, GA to 81 percent in Sacramento, CA, illustrating the link between drug use and crime and highlighting the importance of Obama Administration drug policies designed to break the cycle of drug use, arrest, incarceration, release, and re-arrest.
Some other key findings from the report:
“These data confirm that we must address our drug problem as a public health issue, not just a criminal justice issue,” said Director Kerlikowske. “Decades of research and experience show us crime and drug use are linked, and too often underlying substance use disorders are the driving force of criminal activity taking place in our communities. While the criminal justice system will always serve a vital role in protecting public safety, we cannot simply arrest our way out of the drug problem,” he continued, “instead, we must also support evidenced-based programs and policies that work to break the vicious cycle of drug use and crime, reduce recidivism, and make our communities healthier and safer.”
ADAM II is a unique Federal data collection program that shows drug use patterns among arrestees. In each of the ten U.S. counties included in the program, data are collected from adult male arrestees, through voluntary interviews and drug tests, within 48 hours of arrest. The sample is drawn from all adult males arrested, not just those arrested on drug charges. Tests are conducted to detect the presence of the following drugs: marijuana, cocaine, opiates, amphetamines/methamphetamine, Darvon, PCP, benzodiazepines, methadone, and barbiturates. ADAM II does not test for alcohol. The ten sites measured in the report are: Atlanta, GA; Charlotte, NC; Chicago, IL; Denver, CO; Indianapolis, IN; Minneapolis, MN; New York, NY; Portland, OR; Sacramento, CA; and Washington, D.C.
In April, the Obama Administration released the 2012 National Drug Control Strategy, the Obama Administration’s primary blueprint for drug policy in the United States. The new Strategy provides a review of the progress we have made during the past 3 years and also looks ahead to continuing Federal efforts to reform, rebalance, and renew national drug control policy to address the public health and public safety challenges of the 21st century. Specifically, the new Strategy is guided by three facts: addiction is a disease that can be prevented and treated; people with substance use disorders can recover; and innovative new criminal justice reforms can stop the revolving door of drug use, crime, incarceration, release, and re-arrest.
Some key actions taken by the Administration:
Thanks largely to comprehensive efforts to address drug use at the local, state, Federal, and international levels, the rate of overall drug use in the United States has declined by roughly 30 percent since 1979. More recently, there has been a 40 percent reduction in the rate of current cocaine use and meth use has dropped by half. To build on this progress and support the public health approach to drug control outlined in the Strategy, the Obama Administration has committed over $10 billion for drug education programs and support for expanding access to drug treatment for people suffering from substance use disorders in FY 2012. To view the entire report, click here.
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Treating Drug Use as Public Health Issue Could Lower Crime Rate: Report
A new government report suggests that treating drug use as a public health issue could lead to reduced crime rates. The annual report by the White House Office of National Drug Control Policy finds illegal drugs play a central role in criminal acts. The report showed a decline in cocaine use since 2003, which indicates that law enforcement efforts and public education campaigns may be having an effect, according to Reuters. Illegal drug use overall has decreased about 30 percent since 1979, the article notes.
An average of 71 percent of men arrested in 10 U.S. metropolitan areas in 2011 tested positive for an illegal substance when they were taken into custody, the study found. The rates ranged from 64 percent in Atlanta, to 81 percent in Sacramento, California. These rates were higher for almost half of the collection sites since 2007.
Gil Kerlikowske, Director of National Drug Control Policy, said the findings support the White House strategy designed to break the cycle of drugs and crime by focusing on treatment for substance abuse, instead of jail, for nonviolent offenders. “Tackling the drug issue could go a long way in reducing our crime issues,” he told Reuters. “These data confirm that we must address our drug problem as a public health issue, not just a criminal justice issue.” About 23 percent of violent crimes and property crimes were committed by people who tested positive for at least one of 10 illegal drugs. Marijuana was the most common drug found among those arrested, followed by cocaine. Use of cocaine dropped by half in major cities such as Chicago and New York from 2000 to 2011.
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Krokodil
A new designer drug called krokodil -- a derivative of morphine that can turn an addict's skin greenish, scaly and cause it to rot away -- is being eyed by officials at the Drug Enforcement Administration, FoxNews.com has learned. Thus far, users of krokodil -- or desomorphine -- have only been found in large numbers in Russia, where 65 million doses of the opiate have been seized during the first three months of this year alone, Russia's Federal Drug Control Service told Time.
To produce the potentially deadly drug, which has a comparable effect to heroin but is much cheaper to make, users mix codeine with gasoline, paint thinner, iodine, hydrochloric acid and red phosphorous. Codeine, a controlled substance in the United States used to treat mild to moderate pain, is widely available over the counter in Russia.
In 2010, up to a million people, according to various estimates, were injecting the resulting substance into their veins in Russia, thus far the only country worldwide to see it grow into an epidemic, Time reports. The drug's sinister nickname -- also known as crocodile -- refers to the greenish and scaly appearance of a user's skin at the site of injection as blood vessels rupture and cause surrounding tissues to die. According to reports, the drug first appeared in Siberia and parts of Russia around 2002, but has spread throughout the country in recent years.
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The National Association of State Alcohol and Drug Abuse Directors (NASADAD)
Special Update: Initial Results from Prescription Drug Misuse and Abuse Inquiry
The Association’s initial analysis, developed by NASADAD’s Research and Program Applications Department, can be accessed by visiting http://nasadad.org/wp-content/uploads/2012/04/NASADAD-Prescription-Drug-Abuse-Inquiry-FINAL-04-2012-3.pdf. The authors of the work were Cliff Bersamira, Research Analyst and Rick Harwood, Director of Research and Program Applications. In all, 46 States and the District of Columbia responded to the inquiry.
Some highlights of the inquiry are included below:
• Importance of prescription drug abuse issue: Ninety-six percent of States (45) participating in the inquiry noted that prescription drug misuse and abuse is a critical issue.
• States with a prescription drug abuse task force: Sixty-two percent of States responding (29) noted that they currently have a Task Force designed to specifically address the problem of prescription drug abuse. Another fifteen percent (7 States) States previously had a Task Force but the body has completed its work. California provided an example of its Task Force that was created in 2008. The Task Force, led by the State substance abuse agency, included approximately 40 people from both the public and private sectors. The Task Force issued a report, titled “Summary Report and Recommendations on Prescription Drugs: Misuse, Abuse and Dependency” (2009), which can be found by visiting the following address: http://www.adp.cahwnet.gov/Director/pdf/Prescription_Drug_Task_Force.pdf.
• State legislation: At the time of the inquiry, 68 percent of respondents (32 States) reported that State legislation pertaining to prescription drug abuse had been passed within the past five years. An additional 11 percent (5 States) indicated they had legislation pending. It was also found that over half (53 percent) of those responding described legislation in their State as focused on reducing demand (e.g. prevention, treatment, recovery activities) and 38 percent of State respondents described their legislation as focused on the supply-side of prescription drug issue (some States had both elements in the laws that were passed).
• General education of the public and special population targets: The inquiry found that 83 percent (39 States) of States were moving forward with activities to educate the general public regarding prescription drug abuse. In terms of special target populations, over half of State substance abuse agencies responding (53 percent) were engaging in activities focused on adolescents/young adults.
• Family and prescriber/physician education: The inquiry found that approximately half (51 percent) of State substance abuse agency respondents were engaging in activities to educate prescribers and physicians and 53 percent were engaging in activities to educate families about the problems associated with abuse and misuse.
• Importance of, and linkage to, Prescription Drug Monitoring Programs (PDMPs): NASADAD found that a large majority of States, or 77 percent, found the data generated by their State’s Prescription Drug Monitoring Program (PDMP) to be useful. Yet, of the 28 States asked to describe the extent to which their State substance abuse agency is involved with the PDMP, 12 States (43 percent responding to this question) cited no involvement with their States PDMP.
• State specific examples: The inquiry yielded a number of innovative actions being taken by State substance abuse agencies across the country.
o In Ohio, for example, the issue has been identified by Governor Kasich as a top priority and a Task Force has moved a number of initiatives forward. One such initiative, Recovery to Work, is a collaborative approach between the State substance abuse agency, State Rehabilitative Services Agency, and County Authorities that integrates addiction treatment with vocational rehabilitative services to focus on job readiness and placement.
o In Vermont, the State substance abuse agency is leading its “Hub and Spoke Initiative” to focus on opiate dependence. Five locations across the State focus on specialty assessment, treatment and care coordination (Hub) and ongoing care being provided with local/community-based prescribing physicians, substance use disorder professionals, and recovery services (Spokes).
o In Oregon, the State substance abuse agency developed the Prescription Opioid Poisoning Prevention Action Plan (POP) to reduce analgesic overdose in the State.
• Remaining Challenges: State substance abuse agencies identified a number of remaining challenges. The following themes were in the answers provided by respondents: lack of funding, easy access to prescription drugs, need for workforce development, and difficulties with data collection and analysis.
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New Steps Pediatricians Can Take to Reduce Teen Substance Use
Teens who complete a five-minute computer screening program that includes six questions about alcohol and drug use, and who talk with their pediatrician briefly about the results, reduce their risk of drinking up to one year later, according to a new study.
Researchers at Boston Children’s Hospital studied more than 2,000 teens from New England and the Czech Republic. The teens completed the screening program, which asks six questions about alcohol and drug use, and then presents a score and risk level. The teens read through 10 pages with facts and stories that illustrate the serious health effects of substance use. The teens’ doctors receive a report with the results, and a list of talking points for a two- to three- minute conversation about the risks involved in alcohol and drug use. They tell the teens it would be best for their health not to use alcohol or drugs at all. The study found that after using the program, teens’ risk of drinking dropped almost in half for three months, and by about one-quarter one year after the doctor’s visit, the researchers report in the journal Pediatrics.
Screening and brief intervention has been shown to be effective in emergency departments and college campuses, but this is the first study published in an English language journal to demonstrate it is effective in adolescent primary care settings, according to senior author Dr. John R. Knight, Director of the Center for Adolescent Substance Abuse Research at Boston Children’s Hospital. “It’s important to get pediatricians involved, because we know 70 percent of high school seniors have started to drink, and almost 60 percent have started to use drugs, but there are few specialists available to deal with early intervention with teens,” he said.
Dr. Knight noted that teens generally see their primary care physician for a yearly physical. “Kids know they can tell the truth to their doctor, and it won’t get back to their parents. They really listen to their doctors’ advice,” he said. “Since substance abuse kills more teenagers than infectious disease, parents should view this screening as another important vaccination.”
Two key factors may prevent a teen’s doctor from asking about drug and alcohol use, and this program addresses both, Dr. Knight says. One is time constraints. “Doctors are pressed for time, and they have a lot of things they need to screen patients for,” he says. By having patients complete the screening before the visit, doctors have more time to interpret the results and discuss them. The second factor is that doctors who do screen teens for substance use don’t always know what to say to those who admit to using drugs or alcohol.
The screening program is based on the CRAFFT test, a behavioral health screening tool for use with children under the age of 21 that is recommended by the American Academy of Pediatrics (AAP) Committee on Substance Abuse for use with adolescents.
Last fall, the AAP and the National Institute on Alcohol Abuse and Alcoholism unveiled a new tool designed to help pediatricians talk to teenagers about alcohol use. The “Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide” provides doctors with basic questions about whether and how much a patient drinks, and how much their friends drink.
“Our program takes a similar approach, but by using a computer, we are saving the doctor time,” observes Dr. Knight.
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Treating Drug Use as Public Health Issue Could Lower Crime Rate: Report
A new government report suggests that treating drug use as a public health issue could lead to reduced crime rates. The annual report by the White House Office of National Drug Control Policy finds illegal drugs play a central role in criminal acts. The report showed a decline in cocaine use since 2003, which indicates that law enforcement efforts and public education campaigns may be having an effect, according to Reuters. Illegal drug use overall has decreased about 30 percent since 1979, the article notes.
An average of 71 percent of men arrested in 10 U.S. metropolitan areas in 2011 tested positive for an illegal substance when they were taken into custody, the study found. The rates ranged from 64 percent in Atlanta, to 81 percent in Sacramento, California. These rates were higher for almost half of the collection sites since 2007.
Gil Kerlikowske, Director of National Drug Control Policy, said the findings support the White House strategy designed to break the cycle of drugs and crime by focusing on treatment for substance abuse, instead of jail, for nonviolent offenders. “Tackling the drug issue could go a long way in reducing our crime issues,” he told Reuters. “These data confirm that we must address our drug problem as a public health issue, not just a criminal justice issue.”
About 23 percent of violent crimes and property crimes were committed by people who tested positive for at least one of 10 illegal drugs. Marijuana was the most common drug found among those arrested, followed by cocaine. Use of cocaine dropped by half in major cities such as Chicago and New York from 2000 to 2011.
In what could prove to be one of their most far-reaching decisions, psychiatrists and other specialists who are rewriting the manual that serves as the nation’s arbiter of mental illness have agreed to revise the definition of addiction, which could result in millions more people being diagnosed as addicts and pose huge consequences for health insurers and taxpayers.
The revision to the manual, known as the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., would expand the list of recognized symptoms for drug and alcohol addiction, while also reducing the number of symptoms required for a diagnosis, according to proposed changes posted on the Web site of the American Psychiatric Association, which produces the book. In addition, the manual for the first time would include gambling as an addiction, and it might introduce a catchall category — “behavioral addiction — not otherwise specified” — that some public health experts warn would be too readily used by doctors, despite a dearth of research, to diagnose addictions to shopping, sex, using the Internet or playing video games.
Part medical guidebook, part legal reference, the manual has long been embraced by government and industry. It dictates whether insurers, including Medicare and Medicaid, will pay for treatment, and whether schools will expand financing for certain special-education services. Courts use it to assess whether a criminal defendant is mentally impaired, and pharmaceutical companies rely on it to guide their research. The broader language involving addiction, which was debated this week at the association’s annual conference, is intended to promote more accurate diagnoses, earlier intervention and better outcomes, the association said. “The biggest problem in all of psychiatry is untreated illness, and that has huge social costs,” said Dr. James H. Scully Jr., chief executive of the group.
But the addiction revisions in the manual, scheduled for release in May 2013, have already provoked controversy similar to concerns previously raised about proposals on autism, depression and other conditions. Critics worry that changes to the definitions of these conditions would also sharply alter the number of people with diagnoses.
While the association says that the addiction definition changes would lead to health care savings in the long run, some economists say that 20 million substance abusers could be newly categorized as addicts, costing hundreds of millions of dollars in additional expenses.
“The chances of getting a diagnosis are going to be much greater, and this will artificially inflate the statistics considerably,” said Thomas F. Babor, a psychiatric epidemiologist at the University of Connecticut who is an editor of the international journal Addiction. Many of those who get addiction diagnoses under the new guidelines would have only a mild problem, he said, and scarce resources for drug treatment in schools, prisons and health care settings would be misdirected. “These sorts of diagnoses could be a real embarrassment,” Dr. Babor added.
The scientific review panel of the psychiatric association has demanded more evidence to support the revisions on addiction, but several researchers involved with the manual have said that the panel is not likely to change its proposal significantly. The controversies about the revisions have highlighted the outsize influence of the manual, which brings in more than $5 million annually to the association and is written by a group of 162 specialists in relative secrecy. Besieged from all sides, the association has received about 25,000 comments on the proposed changes from treatment centers, hospital representatives, government agencies, advocates for patient groups and researchers. The organization has declined to make these comments public.
While other medical specialties rely on similar diagnostic manuals, none have such influence. “The D.S.M. is distinct from all other diagnostic manuals because it has an enormous, perhaps too large, impact on society and millions of people’s lives,” said Dr. Allen J. Frances, a professor of psychiatry and behavioral sciences at Duke, who oversaw the writing of the current version of the manual and worked on previous editions. “Unlike many other fields, psychiatric illnesses have no clear biological gold standard for diagnosing them. They present in different ways, and illnesses often overlap with each other.”
Dr. Frances has been one of the most outspoken critics of the new draft version, saying that overly broad and vaguely worded definitions will create more “false epidemics” and “medicalization of everyday behavior.” Like some others, he has also questioned whether a private association, whose members stand to gain from treating more patients, should be writing the manual, rather than an independent group or a federal agency. Under the new criteria, people who often drink more than intended and crave alcohol may be considered mild addicts. Under the old criteria, more serious symptoms, like repeatedly missing work or school, being arrested or driving under the influence, were required before a person could receive a diagnosis as an alcohol abuser.
Dr. George E. Woody, a professor of psychiatry at the University of Pennsylvania School of Medicine, said that by describing addiction as a spectrum, the manual would reflect more accurately the distinction between occasional drug users and full-blown addicts. Currently, only about 2 million of the nation’s more than 22 million addicts get treatment, partly because many of them lack health insurance. Dr. Keith Humphreys, a psychology professor at Stanford who specializes in health care policy and who served as a drug control policy adviser to the White House from 2009 to 2010, predicted that as many as 20 million people who were previously not recognized as having a substance abuse problem would probably be included under the new definition, with the biggest increase among people who are unhealthy users, rather than severe abusers, of drugs. “This represents the single biggest expansion in the quality and quantity of addiction treatment this country has seen in 40 years,” Dr. Humphreys said, adding that the new federal health care law may allow an additional 30 million people who abuse drugs or alcohol to gain insurance coverage and access to treatment. Some economists have said that the number could be much lower, though, because many insurers will avoid or limit coverage of addiction treatment.
The savings from early intervention usually show up within a year, Dr. Humphreys said, and most patients with a new diagnosis would get consultations with nurses, doctors or therapists, rather than expensive prescriptions for medicines typically reserved for more severe abusers.
Many scholars believe that the new manual will increase addiction rates. A study by Australian researchers found, for example, that about 60 percent more people would be considered addicted to alcohol under the new manual’s standards. Association officials expressed doubt, however, that the expanded addiction definitions would sharply increase the number of new patients, and they said that identifying abusers sooner could prevent serious complications and expensive hospitalizations. “We can treat them earlier,” said Dr. Charles P. O’Brien, a professor of psychiatry at the University of Pennsylvania and the head of the group of researchers devising the manual’s new addiction standards. “And we can stop them from getting to the point where they’re going to need really expensive stuff like liver transplants.” Some critics of the new manual have said that it has been tainted by researchers’ ties to pharmaceutical companies.
“The ties between the D.S.M. panel members and the pharmaceutical industry are so extensive that there is the real risk of corrupting the public health mission of the manual,” said Dr. Lisa Cosgrove, a fellow at the Edmond J. Safra Center for Ethics at Harvard, who published a study in March that said two-thirds of the manual’s advisory task force members reported ties to the pharmaceutical industry or other financial conflicts of interest. Dr. Scully, the association’s chief, said the group had required researchers involved with writing the manual to disclose more about financial conflicts of interest than was previously required.
Dr. O’Brien, who led the addiction working group, has been a consultant for several pharmaceutical companies, including Pfizer, GlaxoSmithKline and Sanofi-Aventis, all of which make drugs marketed to combat addiction. He has also worked extensively as a paid consultant for Alkermes, a pharmaceutical company, studying a drug, Vivitrol, that combats alcohol and heroin addiction by preventing craving. He was the driving force behind adding “craving” to the new manual’s list of recognized symptoms of addiction.
“I’m quite proud to have played a role, because I know that craving plays such an important role in addiction,” Dr. O’Brien said, adding that he had never made any money from the sale of drugs that treat craving. Dr. Howard B. Moss, associate director for clinical and translational research at the National Institute on Alcohol Abuse and Alcoholism, in Bethesda, Md., described opposition from many researchers to adding “craving” as a symptom of addiction. He added that he quit the group working on the addiction chapter partly out of frustration with what he described as a lack of scientific basis in the decision making. “The more people diagnosed with cravings,” Dr. Moss said, “the more sales of anticraving drugs like Vivitrol or naltrexone.”
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New report shows more than one in five pregnant White women smoke cigarettes
Study shows significant differences in substance use rates among Blacks, Hispanics, and Whites
A new report shows that 21.8 percent of pregnant White women aged 15 to 44 currently (within the past 30 days) smoked cigarettes. The study conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) also showed that cigarette smoking levels among pregnant White women were significantly higher than the levels among pregnant Black women (14.2 percent) and pregnant Hispanic women (6.5 percent) in the same 15 to 44 age range.
In terms of current illicit drug use, however, the report found that the rate among pregnant Black women (7.7 percent) was significantly higher than among pregnant White women (4.4 percent) and pregnant Hispanic women (3.1 percent).
The rate of current alcohol use among pregnant Black and White women is roughly the same (12.8 percent and 12.2 percent respectively), but their levels were substantially higher than pregnant Hispanic women (7.4 percent)
Overall, pregnant Hispanic women in this age range were less likely to use alcohol and cigarettes than pregnant Black and White women.
“When pregnant women use alcohol, tobacco, or illicit substances they are risking health problems for themselves and poor birth outcomes for their babies,” said SAMHSA Administrator Pamela S. Hyde. “Pregnant women of different races and ethnicities may have diverse patterns of substance abuse. It is essential that we use the findings from this report to develop better ways of getting this key message out to every segment of our community so that no woman or child is endangered by substance use and abuse.”
SAMHSA’s Fetal Alcohol Spectrum Disorders (FASD) Center for Excellence sponsors a number of state-of-the-art programs for addressing the problem of substance abuse among pregnant women. These programs include:
- Project CHOICES—Reaches out to women at risk of having an alcohol-exposed pregnancy before they become pregnant to provide information and help.
- Screening and Brief Intervention (SBI) – Helps identify and provide assistance to people in need of treatment. The program uses a simple written assessment of alcohol use and a 10-15 minute intervention with pregnant women who report drinking.
- Parent-Child Assistance Program (P-CAP) – The program uses an intensive paraprofessional home visitation model to reduce risk behaviors in women with substance abuse problems over a three-year period.
The report entitled, Data Spotlight: Substance Use During Pregnancy Varies by Race and Ethnicity, is based on data analyzed from SAMHSA’s 2002-2010 National Survey on Drug Use and Health (NSDUH). NSDUH is a scientifically conducted annual survey of approximately 67,500 people throughout the country, aged 12 and older. Because of its statistical power, it is the nation’s premier source of statistical information on the scope and nature of many substance abuse and behavioral health issues affecting the nation. The report is available at: http://www.samhsa.gov/data/spotlight/Spot062PregnantRaceEthnicity2012.pdf.
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22 Percent of White Women Have Smoked Cigarettes During Pregnancy
A new government study finds 22 percent of white women have smoked cigarettes during their pregnancy, ABC News reports. In contrast, 14 percent of black women, and 6.5 percent of Hispanic women, have done so. The study was conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA).
“When pregnant women use alcohol, tobacco, or illicit substances they are risking health problems for themselves and poor birth outcomes for their babies,” SAMHSA Administrator Pamela S. Hyde said in a statement. “Pregnant women of different races and ethnicities may have diverse patterns of substance abuse. It is essential that we use the findings from this report to develop better ways of getting this key message out to every segment of our community so that no woman or child is endangered by substance use and abuse.”
The study found the rate of alcohol use during pregnancy was between 12 and 13 percent among both white and black women. Among Hispanic women, the rate was 7.4 percent. Illegal drug use was more common among black pregnant women (7.7 percent) than white women (4.4 percent) or Hispanic women (3.1 percent). According to the Centers for Disease Control and Prevention, the dangers of smoking during pregnancy include premature birth, certain birth defects, and infant death.
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Parents Greatly Underestimate Children’s Secondhand Smoke Exposure
A new study finds parents greatly underestimate their children’s exposure to secondhand smoke. While 13 percent of parents said their children were exposed to cigarette smoke, blood tests showed the rate was 55 percent. In children, secondhand smoke can cause ear infections, more frequent and severe asthma attacks, respiratory symptoms and infections, and a greater risk of Sudden Infant Death Syndrome, according to the Centers for Disease Control and Prevention. The researchers at the University of California, San Francisco, tested 496 blood samples from young children. The study tested blood levels of cotinine, a chemical produced by the body after it is exposed to nicotine, Reuters reports.
In the Archives of Pediatrics and Adolescent Medicine, the researchers noted children do not necessarily need to be around someone who is smoking in order to be exposed to secondhand smoke. They can be exposed if they spend time in a room where someone has recently been smoking. Cotinine testing is not readily available to the general public, according to study co-author Dr. Neal Benowitz.
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SAMHSA report shows trauma-informed care helps improve outcomes among youth exposed to traumatic events
Children and youth involved in child welfare and juvenile justice face significant challenges, but improve when in SAMHSA community-based programs
According to data released today (5/15/2012) by the Substance Abuse and Mental Health Services Administration (SAMHSA), children and youth participating in SAMHSA community-based programs who are involved in the juvenile justice and child welfare systems demonstrate improved outcomes after receiving trauma-informed services. This includes reduced behavioral and emotional problems, reduced trauma symptoms, reduced substance use problems, improved functioning in school and in the community, and improved ability to build relationships.
The report, Promoting Recovery and Resilience for Children and Youth Involved in Juvenile Justice and Child Welfare Systems, shows that upon entering SAMHSA’s Comprehensive Community Mental Health Services Program for Children and Their Families (CMHI), 34 percent of children and youth involved in the child welfare system and 28 percent involved in the juvenile justice system had experienced four or more types of traumatic events. Among children and youth entering SAMHSA’s Donald J. Cohen National Child Traumatic Stress Initiative services, 67 percent involved in child welfare and 57 percent involved in the juvenile justice system had experienced four or more types of traumatic events. Traumatic events can include witnessing or experiencing: physical or sexual abuse; violence in families and communities; natural disasters; wartime events and terrorism; accidental or violent death of a loved one; and a life-threatening injury or illness. Trauma-informed services take into account knowledge about how the experience of trauma can impact the health and well-being of a person and a community.
In 2009, the Centers for Disease Control and Prevention (CDC) reported that 6.3 percent of students in grades 9 through 12 attempted suicide, which is consistent with SAMHSA data. Within 6 months of receiving services through CMHI, suicide attempts for children and youth in the child welfare system decreased from 6 percent to 3 percent and decreased further after12 months to 1 percent.
“Children and youth involved in the juvenile justice or child welfare system are more likely to be exposed to potentially traumatic events and face significant challenges,” said SAMHSA Administrator Pamela S. Hyde. “The good news is that SAMHSA initiatives help these children and youth build resilience and begin to recover by connecting them with supportive adults and providing trauma-informed, evidence-based treatment.”
The report was released today, National Children’s Mental Health Awareness Day (Awareness Day), SAMHSA’s annual celebration highlighting the importance of caring for every child’s mental health. Awareness Day is part of SAMHSA’s strategic initiative on public awareness and support. More than 130 National organizations and Federal agencies and programs are collaborating to provide greater access to community-based mental health services and supports for all children and youth with serious mental health conditions and their families as part of Awareness Day 2012. Across the country, more than 1,100 communities are celebrating this annual observance with local events; social media campaigns; and dance, music, and visual activities with children to raise awareness about the importance of children’s mental health.
To download Promoting Recovery and Resilience for Children and Youth Involved in Juvenile Justice and Child Welfare Systems and view the full list of field references, visit www.samhsa.gov/children.
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Some Question Fairness of New Jersey Drug Treatment Plan
New Jersey Governor Chris Christie’s plan for mandatory treatment for all low-level drug offenders could reduce treatment slots for people who seek treatment voluntarily, but don’t have the money to pay for it, critics say. The governor’s plan, which would make New Jersey the first state to require treatment for nonviolent offenders who are addicted to drugs, has been praised by addiction experts, The Philadelphia Inquirer reports. Some providers point out that the plan would give priority to criminals, some of whom do not want treatment. Providers say that their centers often have waiting lists, and state money to pay for those who cannot afford treatment sometimes runs out before the end of the year, or is frozen.
Michael Drewniak, a spokesman for Governor Christie, disputed the claim that the governor’s plan takes away services from others. “What we’re attempting to do is to address a very serious societal problem,” he said. “In doing that, we are not diminishing the addiction services outside the criminal justice system.” The system that would require drug treatment for low-level offenders, called drug court, could cost up to $35 million, the article notes. The mandatory program would double the court’s current 4,000 participants. Governor Christie has proposed spending $2.5 million for fiscal 2013 to create the mandatory program.
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Report shows decrease in smoking levels among adolescents and young adults in a six year period
Still many adolescents and young adults continue smoking
A new report shows that while a significant segment of minors and young adults are still current smokers there was a decrease in the rate of cigarette use among these populations between 2004 and 2010 (the year with the latest available data). The report, based on the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health (NSDUH), shows that the rate of current cigarette use (having smoked at least once in the past month) among adolescents decreased from 11.9 percent in 2004 to 8.3 percent in 2010. Similarly, the level of current cigarette users among young adults decreased from 39.5 percent in 2004 to 34.2 percent in 2010.
“Although some progress has been made in curbing youth smoking, the fact remains that one in 12 adolescents currently smoke and one in three young adults smoke – which means that far too many young people are still endangering their lives,” said SAMHSA Administrator Pamela S. Hyde. “As the recently released Surgeon General’s Report on Preventing Tobacco Use Among Youth and Young Adults notes, smoking is the nation’s leading cause of preventable death and we must take every opportunity to prevent kids and young adults of today from becoming the hooked, ailing adult smokers of tomorrow.”
The NSDUH report revealed that the percentage of daily smokers among adolescents declined from 3.3 percent in 2004 to 1.9 percent in 2010. The percentage of young adults who smoked daily also declined from 20.4 percent in 2004 to 15.8 percent in 2010.
Among these daily young adult smokers, the percentage who smoked 26 or more cigarettes per day (about one and a half packs or more) decreased from 6 percent to 3.4 percent over this time period. Additionally the percentage of young adult daily smokers using 5 or less cigarettes per day rose from 24.4 percent in 2004 to 28.6 percent in 2010.
SAMHSA works to prevent illegal tobacco sales to underage youth and use through the Synar Amendment program -- a federal and state partnership. The most recent Synar Amendment report shows that the average national retailer violation rate of tobacco sales is down to 9.3percent -- the lowest level in the 14 year history of the program.
SAMHSA plans to build upon the success of this program and its other youth tobacco use prevention efforts to promote continued progress against cigarette smoking and other forms of tobacco use by young people.
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New Survey Results Show Majority of Adult Males Arrested in 10 U.S. Cities Test Positive for Illegal Drugs At Time of Arrest
White House Drug Policy Advisor Calls for Addressing Drug Challenge as Public Health Issue, Not Just a Criminal Justice Issue; Outlines Administration Actions to Reform Criminal Justice Systems to Address Underlying Causes of Crime
Gil Kerlikowske, Director of National Drug Control Policy (ONDCP) released the 2011 Arrestee Drug Abuse Monitoring Annual Report (ADAM II). The 2011 report reveals that in the 10 participating cities/counties, more than half of adult males arrested for crimes ranging from misdemeanors to felonies tested positive for at least one drug. Positive test results ranged from 64 percent in Atlanta, GA to 81 percent in Sacramento, CA, illustrating the link between drug use and crime and highlighting the importance of Obama Administration drug policies designed to break the cycle of drug use, arrest, incarceration, release, and re-arrest.
Some other key findings from the report:
- Fewer adult male arrestees are testing positive for cocaine. All ten sites showed a significant decrease in 2011 compared to 2007 (see chart below). In New York and Chicago, cocaine positives dropped from 50 percent or more in 2000 to half that in 2011.
- Use of opiates (including heroin and prescription pain relievers) changed significantly in different directions across sites. In Chicago and New York, use has steadily declined from 20-36 percent in 2000 to nearly half those numbers in 2011. In Denver, Indianapolis, Sacramento, and Minneapolis use has more than doubled from 3-4 percent in 2000 to 8-10 percent in 2011.
- Methamphetamine positives remain high and have increased in recent years in Portland, OR and Sacramento with 23 percent and 43 percent, respectively, testing positive for the drug in 2011.
“These data confirm that we must address our drug problem as a public health issue, not just a criminal justice issue,” said Director Kerlikowske. “Decades of research and experience show us crime and drug use are linked, and too often underlying substance use disorders are the driving force of criminal activity taking place in our communities. While the criminal justice system will always serve a vital role in protecting public safety, we cannot simply arrest our way out of the drug problem,” he continued, “instead, we must also support evidenced-based programs and policies that work to break the vicious cycle of drug use and crime, reduce recidivism, and make our communities healthier and safer.”
ADAM II is a unique Federal data collection program that shows drug use patterns among arrestees. In each of the ten U.S. counties included in the program, data are collected from adult male arrestees, through voluntary interviews and drug tests, within 48 hours of arrest. The sample is drawn from all adult males arrested, not just those arrested on drug charges. Tests are conducted to detect the presence of the following drugs: marijuana, cocaine, opiates, amphetamines/methamphetamine, Darvon, PCP, benzodiazepines, methadone, and barbiturates. ADAM II does not test for alcohol. The ten sites measured in the report are: Atlanta, GA; Charlotte, NC; Chicago, IL; Denver, CO; Indianapolis, IN; Minneapolis, MN; New York, NY; Portland, OR; Sacramento, CA; and Washington, D.C.
In April, the Obama Administration released the 2012 National Drug Control Strategy, the Obama Administration’s primary blueprint for drug policy in the United States. The new Strategy provides a review of the progress we have made during the past 3 years and also looks ahead to continuing Federal efforts to reform, rebalance, and renew national drug control policy to address the public health and public safety challenges of the 21st century. Specifically, the new Strategy is guided by three facts: addiction is a disease that can be prevented and treated; people with substance use disorders can recover; and innovative new criminal justice reforms can stop the revolving door of drug use, crime, incarceration, release, and re-arrest.
Some key actions taken by the Administration:
- Over the past three years, the Federal Government has spent over $30 billion on drug prevention and treatment—more than what the Federal Government spends on U.S. drug law enforcement and incarceration.
- The Administration is ardently supporting the expansion of drug courts, which place non-violent drug offenders into treatment instead of prison. Today, there are more than 2,600 drug courts across the Nation, diverting about 120,000 people a year into treatment instead of incarceration.
- The Administration is implementing the Second Chance Act, providing funding for programs that improve coordination of reentry services and policies at the state, tribal, and local levels, including demonstration grants, reentry courts, family-centered programs, substance abuse treatment, employment, mentoring, and other services needed to reduce recidivism and improve the transition from prison and jail to communities. As part of this effort, the Department of Justice (DOJ) awarded $100 million in FY 2010 to support 178 state and local reentry grants to provide a wide range of services and in FY 2011 DOJ awarded another $83 million to 118 new grantees. An additional $63 million has been appropriated this year for new grants.
- The Obama Administration has convened a cabinet-level Federal Interagency Reentry Council consisting of 20 Federal agencies to eliminate barriers to successful reentry by formerly incarcerated individuals through improved employment, housing, treatment, and education opportunities.
Thanks largely to comprehensive efforts to address drug use at the local, state, Federal, and international levels, the rate of overall drug use in the United States has declined by roughly 30 percent since 1979. More recently, there has been a 40 percent reduction in the rate of current cocaine use and meth use has dropped by half. To build on this progress and support the public health approach to drug control outlined in the Strategy, the Obama Administration has committed over $10 billion for drug education programs and support for expanding access to drug treatment for people suffering from substance use disorders in FY 2012. To view the entire report, click here.
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Treating Drug Use as Public Health Issue Could Lower Crime Rate: Report
A new government report suggests that treating drug use as a public health issue could lead to reduced crime rates. The annual report by the White House Office of National Drug Control Policy finds illegal drugs play a central role in criminal acts. The report showed a decline in cocaine use since 2003, which indicates that law enforcement efforts and public education campaigns may be having an effect, according to Reuters. Illegal drug use overall has decreased about 30 percent since 1979, the article notes.
An average of 71 percent of men arrested in 10 U.S. metropolitan areas in 2011 tested positive for an illegal substance when they were taken into custody, the study found. The rates ranged from 64 percent in Atlanta, to 81 percent in Sacramento, California. These rates were higher for almost half of the collection sites since 2007.
Gil Kerlikowske, Director of National Drug Control Policy, said the findings support the White House strategy designed to break the cycle of drugs and crime by focusing on treatment for substance abuse, instead of jail, for nonviolent offenders. “Tackling the drug issue could go a long way in reducing our crime issues,” he told Reuters. “These data confirm that we must address our drug problem as a public health issue, not just a criminal justice issue.” About 23 percent of violent crimes and property crimes were committed by people who tested positive for at least one of 10 illegal drugs. Marijuana was the most common drug found among those arrested, followed by cocaine. Use of cocaine dropped by half in major cities such as Chicago and New York from 2000 to 2011.
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Krokodil
A new designer drug called krokodil -- a derivative of morphine that can turn an addict's skin greenish, scaly and cause it to rot away -- is being eyed by officials at the Drug Enforcement Administration, FoxNews.com has learned. Thus far, users of krokodil -- or desomorphine -- have only been found in large numbers in Russia, where 65 million doses of the opiate have been seized during the first three months of this year alone, Russia's Federal Drug Control Service told Time.
To produce the potentially deadly drug, which has a comparable effect to heroin but is much cheaper to make, users mix codeine with gasoline, paint thinner, iodine, hydrochloric acid and red phosphorous. Codeine, a controlled substance in the United States used to treat mild to moderate pain, is widely available over the counter in Russia.
In 2010, up to a million people, according to various estimates, were injecting the resulting substance into their veins in Russia, thus far the only country worldwide to see it grow into an epidemic, Time reports. The drug's sinister nickname -- also known as crocodile -- refers to the greenish and scaly appearance of a user's skin at the site of injection as blood vessels rupture and cause surrounding tissues to die. According to reports, the drug first appeared in Siberia and parts of Russia around 2002, but has spread throughout the country in recent years.
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The National Association of State Alcohol and Drug Abuse Directors (NASADAD)
Special Update: Initial Results from Prescription Drug Misuse and Abuse Inquiry
The Association’s initial analysis, developed by NASADAD’s Research and Program Applications Department, can be accessed by visiting http://nasadad.org/wp-content/uploads/2012/04/NASADAD-Prescription-Drug-Abuse-Inquiry-FINAL-04-2012-3.pdf. The authors of the work were Cliff Bersamira, Research Analyst and Rick Harwood, Director of Research and Program Applications. In all, 46 States and the District of Columbia responded to the inquiry.
Some highlights of the inquiry are included below:
• Importance of prescription drug abuse issue: Ninety-six percent of States (45) participating in the inquiry noted that prescription drug misuse and abuse is a critical issue.
• States with a prescription drug abuse task force: Sixty-two percent of States responding (29) noted that they currently have a Task Force designed to specifically address the problem of prescription drug abuse. Another fifteen percent (7 States) States previously had a Task Force but the body has completed its work. California provided an example of its Task Force that was created in 2008. The Task Force, led by the State substance abuse agency, included approximately 40 people from both the public and private sectors. The Task Force issued a report, titled “Summary Report and Recommendations on Prescription Drugs: Misuse, Abuse and Dependency” (2009), which can be found by visiting the following address: http://www.adp.cahwnet.gov/Director/pdf/Prescription_Drug_Task_Force.pdf.
• State legislation: At the time of the inquiry, 68 percent of respondents (32 States) reported that State legislation pertaining to prescription drug abuse had been passed within the past five years. An additional 11 percent (5 States) indicated they had legislation pending. It was also found that over half (53 percent) of those responding described legislation in their State as focused on reducing demand (e.g. prevention, treatment, recovery activities) and 38 percent of State respondents described their legislation as focused on the supply-side of prescription drug issue (some States had both elements in the laws that were passed).
• General education of the public and special population targets: The inquiry found that 83 percent (39 States) of States were moving forward with activities to educate the general public regarding prescription drug abuse. In terms of special target populations, over half of State substance abuse agencies responding (53 percent) were engaging in activities focused on adolescents/young adults.
• Family and prescriber/physician education: The inquiry found that approximately half (51 percent) of State substance abuse agency respondents were engaging in activities to educate prescribers and physicians and 53 percent were engaging in activities to educate families about the problems associated with abuse and misuse.
• Importance of, and linkage to, Prescription Drug Monitoring Programs (PDMPs): NASADAD found that a large majority of States, or 77 percent, found the data generated by their State’s Prescription Drug Monitoring Program (PDMP) to be useful. Yet, of the 28 States asked to describe the extent to which their State substance abuse agency is involved with the PDMP, 12 States (43 percent responding to this question) cited no involvement with their States PDMP.
• State specific examples: The inquiry yielded a number of innovative actions being taken by State substance abuse agencies across the country.
o In Ohio, for example, the issue has been identified by Governor Kasich as a top priority and a Task Force has moved a number of initiatives forward. One such initiative, Recovery to Work, is a collaborative approach between the State substance abuse agency, State Rehabilitative Services Agency, and County Authorities that integrates addiction treatment with vocational rehabilitative services to focus on job readiness and placement.
o In Vermont, the State substance abuse agency is leading its “Hub and Spoke Initiative” to focus on opiate dependence. Five locations across the State focus on specialty assessment, treatment and care coordination (Hub) and ongoing care being provided with local/community-based prescribing physicians, substance use disorder professionals, and recovery services (Spokes).
o In Oregon, the State substance abuse agency developed the Prescription Opioid Poisoning Prevention Action Plan (POP) to reduce analgesic overdose in the State.
• Remaining Challenges: State substance abuse agencies identified a number of remaining challenges. The following themes were in the answers provided by respondents: lack of funding, easy access to prescription drugs, need for workforce development, and difficulties with data collection and analysis.
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New Steps Pediatricians Can Take to Reduce Teen Substance Use
Teens who complete a five-minute computer screening program that includes six questions about alcohol and drug use, and who talk with their pediatrician briefly about the results, reduce their risk of drinking up to one year later, according to a new study.
Researchers at Boston Children’s Hospital studied more than 2,000 teens from New England and the Czech Republic. The teens completed the screening program, which asks six questions about alcohol and drug use, and then presents a score and risk level. The teens read through 10 pages with facts and stories that illustrate the serious health effects of substance use. The teens’ doctors receive a report with the results, and a list of talking points for a two- to three- minute conversation about the risks involved in alcohol and drug use. They tell the teens it would be best for their health not to use alcohol or drugs at all. The study found that after using the program, teens’ risk of drinking dropped almost in half for three months, and by about one-quarter one year after the doctor’s visit, the researchers report in the journal Pediatrics.
Screening and brief intervention has been shown to be effective in emergency departments and college campuses, but this is the first study published in an English language journal to demonstrate it is effective in adolescent primary care settings, according to senior author Dr. John R. Knight, Director of the Center for Adolescent Substance Abuse Research at Boston Children’s Hospital. “It’s important to get pediatricians involved, because we know 70 percent of high school seniors have started to drink, and almost 60 percent have started to use drugs, but there are few specialists available to deal with early intervention with teens,” he said.
Dr. Knight noted that teens generally see their primary care physician for a yearly physical. “Kids know they can tell the truth to their doctor, and it won’t get back to their parents. They really listen to their doctors’ advice,” he said. “Since substance abuse kills more teenagers than infectious disease, parents should view this screening as another important vaccination.”
Two key factors may prevent a teen’s doctor from asking about drug and alcohol use, and this program addresses both, Dr. Knight says. One is time constraints. “Doctors are pressed for time, and they have a lot of things they need to screen patients for,” he says. By having patients complete the screening before the visit, doctors have more time to interpret the results and discuss them. The second factor is that doctors who do screen teens for substance use don’t always know what to say to those who admit to using drugs or alcohol.
The screening program is based on the CRAFFT test, a behavioral health screening tool for use with children under the age of 21 that is recommended by the American Academy of Pediatrics (AAP) Committee on Substance Abuse for use with adolescents.
Last fall, the AAP and the National Institute on Alcohol Abuse and Alcoholism unveiled a new tool designed to help pediatricians talk to teenagers about alcohol use. The “Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide” provides doctors with basic questions about whether and how much a patient drinks, and how much their friends drink.
“Our program takes a similar approach, but by using a computer, we are saving the doctor time,” observes Dr. Knight.
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Treating Drug Use as Public Health Issue Could Lower Crime Rate: Report
A new government report suggests that treating drug use as a public health issue could lead to reduced crime rates. The annual report by the White House Office of National Drug Control Policy finds illegal drugs play a central role in criminal acts. The report showed a decline in cocaine use since 2003, which indicates that law enforcement efforts and public education campaigns may be having an effect, according to Reuters. Illegal drug use overall has decreased about 30 percent since 1979, the article notes.
An average of 71 percent of men arrested in 10 U.S. metropolitan areas in 2011 tested positive for an illegal substance when they were taken into custody, the study found. The rates ranged from 64 percent in Atlanta, to 81 percent in Sacramento, California. These rates were higher for almost half of the collection sites since 2007.
Gil Kerlikowske, Director of National Drug Control Policy, said the findings support the White House strategy designed to break the cycle of drugs and crime by focusing on treatment for substance abuse, instead of jail, for nonviolent offenders. “Tackling the drug issue could go a long way in reducing our crime issues,” he told Reuters. “These data confirm that we must address our drug problem as a public health issue, not just a criminal justice issue.”
About 23 percent of violent crimes and property crimes were committed by people who tested positive for at least one of 10 illegal drugs. Marijuana was the most common drug found among those arrested, followed by cocaine. Use of cocaine dropped by half in major cities such as Chicago and New York from 2000 to 2011.
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