What kind of care do prositutes need in substance abuse treatment?

What kinds of services do women need who have been involved in prositution when they enter substance abuse treatment?

A study reported in the December, 2008 issue of the journal, Psychiatric Services, found that they are more likely to need residential services and more psychosocial services when they are in outpatient care.

Here is the conclusion from the study:

The findings suggest that women involved
in prostitution before entering
substance abuse treatment are more
likely to receive residential care than
women not involved in prostitution.
When they are treated in outpatient
settings, they are likely to receive
more psychosocial services. Such findings
are consistent with ASAM treatment
guidelines (9), which recommend
that providers assess for and respond
to various social and legal risk
factors upon treatment entry.

You can read the study by clicking here.

GCASA offers specialized services for women both in GCASA's outpatient program and in GCASA's residential services program.

"Red flags" that drinking might be a problem

Reas Kroicowl identifies "red flags" in her article on her blog, Trench Warfare that drinking might be a problem.

OK, look. Here's the skinny:

If you have a problem with alcohol, there's going to be some tiny little red flags that wave every now and again. You might be a wee bit close to the situation, as people who drink too much sometimes are, so allow me to summarize the past few years of your life. Hypothetically, of course. I'll let you know when we've reached something that is concerning for people in my profession.

Perhaps you're drinking several times a week. And have been since you were in high school.

You can read the whole brief article by clicking here.

Alcoholics may never fully regain balance

Reuters HealthDay reported on 12/18/09 on a study done at Stanford that found that alcoholics may never fully regain their balance.

The sailor's gait is due to brain damage and peripheral neuropathy.

You can read the Reuter's article by clicking here.

Cannibis as a substitute for alcohol and other drugs.

There was an interesting article in the Harm Reduction journal on 12/03/09 entitled "Cannibis As A Substitute For Alcohol And Other Drugs." It is a descriptive study of 350 patients in a medical group in Berkeley California who substituted cannibis for alcohol and other drugs.

40% of patients said that they substituted cannibis for alcohol.

65.8% of patients said that they substituted cannibis for prescription drugs.

26% of patients said that they subsituted cannibis for other illicit drugs.

65% of patients said they substituted cannibis for other substances because it had fewer adverse side effects.

57.4% of patients said that they substituted cannibis for other drugs because it provided better symptom relief.

I found this study interesting because I have observed the use of cannibis in my private practice clients who often report beneficial effects. It seems to me that cannibis is less toxic and has fewer behavioral and social negative consequences than alcohol. I have also noted that cannibis seems to have fewer adverse side effects and better symtpom relief than prescription drugs.

As a society we would be much better off to raise the drinking age to 35 and legalize cannibis and tax it like we do alcohol.

You can access the article by clicking here.

Violence risk assessment in substance abuse counseling

There is an interesting and helpful article in the Psychiatric Times on 12/14/09 entitled "Violence Risk Assessment In Everyday Psychiatric Practice: Twelve Principles Help Guide Clincians."

In substance abuse counseling, counselors often encounter patients who are suicidal and homicidal. Working with such problems takes knowledge and skill. To read this excellent article, free on line once you register, click here.

Guess how old I am today?

Dear Friends:

I was born on Christmas in 1945. Guess how old I am today?

What states has the highest drunk driving fatality rate?

Wyoming with 12.6/100,000

followed by Montana with 9.4/100,000

followed by Mississippi with 9.1/100,000

followed by South Carolina with 9.00/100,000

followed by Louisiana with 7.7/100,000.

New York State and Utah have the lowest DWI fatality rates in the United States with 1.7/100,000

I hope that you and your family and loved ones are not killed this holiday.

Patch plus lozenge plus 6 counseling sessions help people quit smoking best

Patch plus lozenge plus six counseling sessions work best of all for smoking cessation. Read more click here.

When it comes to GCASA wages - "Let them eat cake."

On 12/12/09 there was an article on this blog entitled, "How Much Money Do People Make At GCASA?"

In the last 5 years GCASA has lost 7 employees who went to work for State Government mostly in the prisons for the Department Of Corrections as substance abuse counselors. They all have said on exit interviews that they love working at GCASA but just can't afford to keep working here. Why is that? Here's why.

GCASA starts an Addictions Counselor I at $21,559. There are 10 steps in the grade and after 10 years an Addictions Counselor I maxes out at $30,685.

In New York State, an Addictions Counselor I is a grade 16, and as of April, 2010, the starting salary is $45,518 which is about $24,000.00 more per year for the same job than GCASA can pay.

At GCASA an Addictions Counselor II starts at $24,134 and can go up to $34,350. In New York State an Addictions Counselor II starts at $51,258.00 which is about$26,000.00 per year more for the same job. In fact, GCASA can hire 2 counselors for the price of the State's one.

At GCASA an Addictions Counselor III starts at $31,938 and can go up to a $45,458. In New York State, an Addictions Counselor III starts at $66,375.00 which is $35,000.00 more than at GCASA for essentially the same job and is more than any staff member at GCASA earns with the exception of the Executive Director.

In the State system most Addictions counselors get much better benefits: more vacation, better health insurance, more personal leave days, better retirement, etc.

Why is there such discrepancy you might ask?

Well, for one, State employees are unionized and most community based non-profits are not. Most counties have decided to outsource their substance abuse services rather than run them themselves because community based non-profits can do it cheaper and much more flexibly. In fact community based non-profits appear to be able to provide substance abuse services at half the cost of the state based on personnel cost comparisons.

The New York State Office of Alcoholism and Substance Abuse has committees which they used to call "workforce development" and now "talent management" to work on human resource strategies to attract and retain a skilled workforce but it has little traction when professional wages are so low for so many professionals in community based nonprofit substance abuse agencies in New York State.

With the budget deficit reduction strategies now being pursued, one high placed OASAS official told GCASA executives that OASAS would not look favorably on GCASA giving raises in 2010. However the average salary for the 82 out of 93 GCASA employees who make less than $40,000.00 per year is only $26,500.00. If GCASA gives 2% raises in 2010, which OASAS looks upon unfavorably, the average increase would be $530.00 which would take the average employee to $27,100.00.

The attitude of OASAS reminds me of Marie Antoinette who, when told the peasants had no bread, said, "Well, let them eat cake."

If the average Addiction Counselor at GCASA was making State wages of $45,940 to $66,375.00 I would not be so concerned. But when the average GCASA addictions counselor is making between $21,559 and mid 30s I think it is a whole other matter.

Further the average increase in a GCASA employee's contribution to his/her health insurance in 2010 will increase $660.00 per year for a single plan and $2076.00 for a family plan. The annual out of pocket contribution of a GCASA employee for a family plan who is making $26,500.00 is 26% of that employee's salary. The increase in employee contibution to his/her health insurance dwarfs any 2% raise they would get.

So, that's the cake. I'm just saying..............

Who says substance abuse prevention doesn't work?

The number of DWI fatalities in 1982 = 21,113

The number of DWI fatalities in 2008 = 11,773

Who says prevention doesn't work?

44% positive change in 26 years. Tens of thousands of lives saved.

A Kind Christmas Gift to GCASA counselors

Click on image to enlarge for easier reading.

DUI fatalities haunt families for years

There was an article in the Denver Post on 12/20/09 entitled "DUI fatalities haunt families for years".

We know this at GCASA.

GCASA holds a victim impact panel for DWI offenders every month at the Batavia City Centre. It serves primarily people from Orleans, Genesee, and Wyoming Counties. The panel as about 35 people that attend each month.

Laura Ricci coordinates the panel. She can be reached at 585-343-1124 or lricci@gcasa.org.

There were 340 DWI deaths in New York State in 2008. I hope that you and your family or anyone you love are not killed this holiday season.

Two of my children Brigid and Ryan were killed by a 3 time drunk driver in 1993 when they were 5 and 9. This Christmas they would be 22 and 25. I miss them.

The "truth" about teen smoking

Teen smoking rates are down in Genesee and Orleans counties significantly over the last 5 years because of all the good prevention work that has been done by multiple agencies and organizations.

Almost 1 in 4 kids in Orleans County is on food stamps

Food stamp usage is up signifcantly across the country.

In Genesee County 8% of adults and 16% of children are on food stamps which is up 16%since 2007.

In Orleans County 12% of adults and 23% of children are on food stamps which is up 25% since 2007.

To check out food stamp usage in the U.S. check out the interactive map on the New York Times Web Site by clicking here.

10 step program to end email addiction

Video lasts 3:52.

GCASA's units of service increase regularly for years and then level off.

GCASA's clinical treatment services have seen decreases in deficit funding over the last ten years. Orleans and Genesee Counties have cut their contributions and New York State Office of Alcoholism and Substance Abuse Services (OASAS) has done likewise.

Also, there has been no increase in insurance payment for a unit of service in over 10 years. How is it then that GCASA has increased its units of service?

Increased staff productivity and better management.

Having achieved this improvement though, it appears that the system has been maximized and that further increases in productivity are not possible with current treatment modalities.

As New York State moves from a criminal justice approach of incarceration for substance abusers to treatment which in general is far more effective and cost efficient, the resources have not also moved from the criminal justice system to the treatment system.

If costs $35,000 per year to keep a person in State prison. The same person can be treated by GCASA in outpatient treatment and 3 or 4 months at GCASA's Community Residence for about $4,500.00

Here is a chart showing the increase in units of service in Genesee and Orleans County clinics over the last 5 years.

Click on image for easer reading.

Thanks to multiple efforts DWI deaths are down in most states including New York

Drunk driving deaths are down but still way too many.

Last year, 11,773 people died nationally in crashes involving a driver whose blood alcohol level was 0.08 or higher. That represented a 9.7 percent decrease compared with 2007.

DUI deaths also declined in Pennsylvania, from 504 in 2007 to 496 last year. Those deaths made up 34 percent of crash fatalities in the state.

New York State had 340 DWI fatalities in 2008. GCASA working with law enforcement, the courts, the District Attorney, the Drug Free Communities Coalitions and the public at large will all take credit for saving significant lives.

In the 80s, 40,000 people a year were being killed across the country in drunk driving crashes. To learn that the number is now down to 12,000 is cause for great celebration and joy. Now lets close the gap and eliminate the other 12,000!

Click on image to enlarge for easier reading.



To read the article click here.

Dr. Charles B. King, GCASA's Medical Director, on prescription pain medication abuse

We made this video back in September, 2008.

Today, 12/15/09, a person posted this comment on the YouTube web site:

5 out of 5 stars. This is the best, detailed narrative/explanation that I have seen!

The video has had 952 views in the last year.

I watched it again and it is good. I recommend it to you.

Video lasts 9:03

Drugs kill - Opiod deaths in Ontario, Canada double since 1991

Right next door to us in Ontario Canada deaths from opiod abuse have doubled since 1991.

Deaths from opioid use in Ontario, Canada, have doubled since 1991 and the addition of long-acting oxycodone to the drug formulary was associated with a 5-fold increase in oxycodone-related deaths, found a new study in CMAJ (Canadian Medical Association Journal).

GCASA has a specialty program for people addicted to Opiods. We have seen a big increase here of patients wanting service. There are over 85 patients on Suboxone treatment. The primary source of addiction is prescription pain pills.

When you look at the public health data, it is clear that programs like the Opiod treatment program at GCASA save lives.

You can read more by clicking here.

OASAS official says that OASAS would look unfavorably on GCASA giving its employees a 2% raise in 2010

OASAS official on 12/04/09 - "OASAS would look unfavorably on GCASA giving raises next year."

Average salary of the of 82 out 93 GCASA employees who make under $40,000.00 per year in 2009 is $26,500.00

Amount of a 2% raise for an employee making $26,500.00 = $530.00

Increase in employee share of single premium health insurance in 2010 = $660.00 per year.

Increase in employee share of family health insurance premium in 2010 = $2,076.00 per year.

Cost of health insurance for a GCASA employee with the family health plan making $26,500 = 26% of employee's salary.

What to do?

GCASA board voted to give 2% raises in 2010 at the Executive Director's recommendation in spite of what OASAS officials say.

David Markham, Executive Director of GCASA, said that most GCASA employees are already working for poverty wages and have one of the poorest benefit packages of any not-for-profit according to a not-for-profit survey of 72 agencies in Western New York done by Dopkins & Company, a Certified Public Accounting firm. The State has also cut out the Cost Of Living increase for 2010 so not-for-profit substance abuse employees will fall even further behind. "OASAS seems not to know or not to care that employees in its not-for-profit licensed programs are suffering due to financial stress. A recent poll by CNN Business found that substance abuse counselor is the 13th worst job out of 50 listed in the United States. Social Worker is number one. GCASA employs both. You would think there would be more assistance and understanding from OASAS."

Most of GCASA's employees have Bachelor's and Master's Degrees. Many have a hard time paying back their school loans because of their low salaries.

Natural High

In Albany, NY, the message is "a drunk driver is as dangerous as a misguided missile."

From Albany Times Union published on 12/12/09

Ed Frank's message is simple: "A drunk driver is as dangerous as a misguided missile."
That's why he created a large missile with an anti-DWI slogan painted on its side.

As the founder of Choices 301, Frank, a retired deputy chief from the Colonie Police Department, knows the dangers of drinking and driving. His mission has often involved adopting new methods to promote his message, but the missile is a new tactic.

"When you think about the devastation that comes with that drunk behind the wheel and the lives that are lost needlessly, the missile represents exactly what we want it to do," Frank said. "You get behind the wheel ... you have no control whatsoever of that motorized machine."

New York State Confidentiality Law and HIV

New York State Public Health law 27-7 regulates HIV testing and status and confidentiality. This web site is done in a question and answer style and is very informative. You can access it by clicking here.

GCASA Cares readership

Readers might be interested in the fact that the GCASA Cares blog has been growing in readership and now gets about 100 hits per day. In November, 2009, the GCASA Blog had 2,723 hits. This is small by some standards, but for a small niche blog this number seems to be worth the effort of publishing it.

If people have preferences for the kinds of topics covered, please leave a comment.

Thank you to our readers for reading and be assured that "GCASA Cares!"

Client satisfaction at GCASA very high

Did you read the article on this blog which reported that based on survey taken with 133 clients during a week in May 2009 at 5 different treatment sites that 92% agreed or strongly agreed with the statement "I got a lot out of the services I received at GCASA, and 93% agreed or strongly agreed with the statement, "I would refer a family member or a good friend for services at GCASA."

It would seem if you read the comments on The Daily News blog on the recent articles dealing with GCASA that GCASA is held in contempt and disdain by a very few members of the community. While this may be true of a very small minority, overall, GCASA services are held in very high regard especially by 9 out of 10 people who actually use the service.

If anyone would like to comment on GCASA's services please contact Joanne Beck at the Daily News at 585-343-8000 or at jbeck@batavianews.com.

Parolles with co-occuring psychiatric and substance abuse disorders at higher risk for violating their parole

In the November, 2009, issue of the journal, Psychiatric Services, there as a study which describes the violation of parole in Texas of parolees with co-occuring disorders of serious psychiatric illness and a substance abuse disorder.

The study found that parolees with both a psychiatric and a substance abuse disorder had a substancially greater risk of being violated on their parole while parolees with only a psychiatric disorder, or a substance abuse disorder alone had no difference in parole violations that the general population.

You can read the abstract by clicking here.

How much money do people make at GCASA?

There were accusations made on the Daily News blog in Batavia, NY that GCASA bilks the taxpayers, that it is just a money grubbing agency, and staff are getting rich at the expense of the clients.

Here is a preview of a full report to the public which will be made next week.

Out of the 92 employees at GCASA only 11 make more than $40,000 per year.

Of the 81 employees who make less than $40,000 per year the average annual salary of a GCASA employee is $26,500 dollars. Most staff members at GCASA have Bachelor's degrees from college and a large number have Master's Degrees.

The highest paid person at GCASA is the Executive Director who has a Master's Degree and 41 years of experience in the Behavioral Health field and who has been employed at GCASA as executive director for 9 years. His annual salary in 2009 is $74,459.32. He is eligible for a 2% raise in at the end of 2009 which would be an increase of $1,489.19 which he has declined. So the Executive Director will not receive a raise in 2009 and 2010.

Most of GCASA's employees, if they depend on their GCASA salary alone have incomes below the median salaries in the counties we serve.

According to the U.S. Census bureau 5,451 people or 13.9 percent of the population in Orleans County lives in poverty. The median income is $46,220.00.

In Genesee County 5,992 people live in poverty or 10.6 percent of the population. The median income is $49,133.00

81 of GCASA's 92 employees have salaries under $40,000.00 per year, the average salary being $26,500.00

As professionals GCASA employees get paid much less than professionals in comparable jobs such as police officers, teachers, nurses, and even correction officers, etc.

According to a recent CNN poll, substance abuse counselor is the 13th worst job out of 50 listed in America. Social Work of which I am a member is the #1 worst job in America.

More information next week.

Less than 1 in 9 Americans with Alcohol use diorders recognize their need for treatment

Based on a study reported in the December, 2009, issue of the journal, Psychiatric Services, fewer than 1 in 9 people in the United States with Alcohol Use Disorders recognize their need for treatment.

You can read the abstract by clicking here.

Client satisfaction at GCASA

GCASA's client satisfaction numbers are in and crunched. A full report next week.

For now let it suffice to say that

92% of GCASA's outpatient treatment clients said that they agreed or strongly agreed with the statement, "I got a lot out of the services I received at GCASA."

93% of GCASA's outpatient treatment clients said that they agreed or stronly agreed with the statement, "I would refer a family member or a good friend for services at GCASA."

There were 133 client satisfaction surveys completed during one week last May, 2009. Some clients had just entered treatment that week and others had been in a treatment for a couple of months.

It is even more amazing that GCASA achieved this level of client satisfaction when about 60% of clients are mandated for treatment by the criminal justice system, i.e. drug court, probation, parole, their attorneys after a DWI arrest, etc.

The raw data is available if anyone would like to see it by emailing me at dmarkham@gcasa.org.

Brief Motivational Interview curtails recidivist drunk driving

This study almost seems too good to be true. A brief, 30 minute, motivational interview helped hard core drunk drivers reduce their drunk driving according to this study.

You can read a brief report of the study by clicking here.

The study will appear in Alcoholism: Clinical and Experimental Research, November, 2009.

While a bit different, GCASA offers a victim impact panel once per month for about 25-40 offenders. Based on the evaluations of the sessions, most people who attend report being highly motivated to never drink and drive again.

Older alcoholics binge drink more than younger ones study finds

It seems that that older people over 60 who have problems with alcohol binge drink more often than young people.

You can read more by clicking here.

The slaughter continues

Smoking is associated with increased seizures

Smoking and siezures are associated. This is new to me. I had never heard this before. Check it out by clicking here.

My bad mood is lifting - DWI Fatalities are decreasing

The last month has been lousy for me. We have had to lay off staff, shut down services, and be attacked by community members who think GCASA's services are nothing but a scam to bilk taxpayers.

Also, at this time of year, I miss my dead children. Brigid was killed when she was 5 and Ryan was killed when he was 8 in 1993 by a three time drunk driver. If they were alive today Brigid would be 22 and Ryan would be 25 and we would be looking forward to the Christmas holidays.

So, it was a special gift today when I came across the recent DWI statistics published by the Century Council. Here's what they show in part:

DWI fatalities in the United States were 21,113 in 1982. They were 13,739 in 1993. Two of those were Brigid and Ryan. In 2008, there were 11,773. DWI fatalities have decreased 44% in 26 years.

Further the DWI fatality rate in New York state is 1.7/100,000 which is the lowest in the nation.

There were 340 DWI fatalities in New York State in 2008. That is 340 too many, but much better than the 600 and some back in the 80s and 90s.

So, I wondering who gets the credit for the saving of lives? I give credit to law enforcement, to the courts, to the district attorneys, to the treatment agencies, to the prevention programs, to the probation departments, to the drunk driver education programs, to our citizens who are more knowledgable and cooperative about not driving drunk.

I am proud of the work we have done and do at GCASA. You and your family is alive today because you weren't killed by a drunk driver. I hope that you will thank a police officer, a magistrate, a district attorney, a probation officer, and maybe a substance abuse professional who evaluated and treated a patient for their alcohol use disorder, and who facilitated a Victim Impact Panel for DWI offenders, and who engaged in other educational activities to raise awareness about the danger of drinking and driving.

Click on image to enlarge for easier reading.

Medicaid police terrorize providers

The New York Nonprofit Press has an interesting article which it published on November 30, 2009 entitled "The OMIG Who Stole Xmas."

The title is a bit of a misnomer because OMIG (Office Of Medicaid Inspector General) is not stealing Christmas, it is destroying a system of behavioral health care in New York.

It seems that the Governor and the Legislature is intending to balance the budget on the backs of health care providers by auditing their paperwork. The way the game is played is to send in auditors to comb through patient's medical records with a fine tooth comb to find any medical record deficiencies that do not meet regulatory requirements. Where paper work is deficient, the Office Of The Medicaid Inspector will demand reimbursement for the services provided and extrapolate from that deficiency to assume that the deficiency found is a symtom for futher deficiencies and so guestimated deficiencies will be alledged and further reimbursements demanded.

The rallying cry is "Medicaid Fraud!" and health care providers are criminalized. Providers are anxious and scared of third party agendas that intrude into treatment processes in very punitive ways. For counselors and supervisors the coercive power of the state has become an Orwellian nightmare which becomes the primary consideration in delivering supposedly therapeutic services to patients.

This has nothing to do with patient care mind you or the fact that services were provided. These severe and significant financial penalties are simply based on the failure of paperwork to be 100% accurately completed.

What are the consequences of this?

“These audits and onerous financial penalties are going to destabilize individual providers and weaken the entire system at a time when it is already under extreme stress,” says Philip Saperia.

Service delivery processes become focused primarily on paper work compliance and to a lesser degree on patient care. An old proverb from Total Quality Management is "Be careful what you choose to measure because it will skew organizational behavior in that direction."

You can read the article by clicking here.

December is Drugged and Drunk Driving Elimination Month

Alcoholism inflicts James Hetfield of Metallica

James Hetfield of Metallica talks about his alcoholism.

Video lasts 3:43.

Alcohol kills

Alcohol kills in Columbia County. Click here.

Cirrhosis or the liver - a slow pickeling

DWI motorcade spreads message about drunk driving

YNN can a brief clip yesterday about the DWI motorcade to remind people not to drink and drive. It is brief. You can watch it by clicking here.

Is alcohol causing you problems?

To GCASA's critics

There was a second article in the Daily News on Thursday, 12/02/09, outlining some of the answers to some of the questions which were raised by the first article.

The appearance of these articles has generated a flurry of comments about GCASA being a money making scam, bilking the taxpayers out of their money, and existing to aggrandize its staff whose main purpose is to exploit people. There also have been a few people who stated that they found GCASA's services helpful.

Further, there have been people in high places who have found the articles objectionable because GCASA has brought the fact that diminishing resources are having the consequence of a reduction in service. The sentiment seems to be that this should not have been made a public issue and the public would be better off having been left in the dark.

As I reflect on my experience the last couple of weeks, there is part of me that agrees that the changes that have had to be made might have better been handled by doing it quietly and left unsaid. And yet that has not been our management style and not the organizational culture which we have tried to create at GCASA. We strive to be honest, above board, and democratic if possible. We believe in the inherent worth and dignity of every person, and in justice, equity, and compassion in our human relations. As the Executive Director I have often made mistakes. When this occurs I try to always be available to listen, promptly admit my faults, and, if possible, make amends.

I am very proud of the work that we have done, and do, and intend to continue to serve the individuals, families, and communities that struggle with substance abuse issues. There is a deep commitment on the part of staff many of whom, like myself, have personally and tragically been affected by this disease. (Two of my children were killed by a three time DWI driver.)

When substance abuse problems strike families, they need a place to turn. Getting treatment can mean the difference between life and death, the difference between a civilian life or incarceration, the difference between continuing poverty and dysfunction or a higher quality of life.

I appreciate the criticisms and feedback, negative and positive, and if I have sounded arrogant, as one commenter said, or have been out of line saying things I shouldn't have, I am deeply sorry and I apologize to those who have been offended and harmed.

It is with great humility that I, and GCASA's staff, will continue on as best we can to serve those who request and have need of our services.

The above are my personal views and do not necessarily represent the official position of GCASA.

Drug testing

The art of seduction

Landlords in New York State banning smoking in their apartment buildings in increasing numbers

There was an article in the New York Times on 11/16/09 which describes the efforts in New York City of some landlords to ban smoking in their apartments.

You can access the article by clicking here.

When GCASA had the Smoke Free NOW program, before the grant was cut, the Smoke Free NOW coalition had a campaign to ask landlords in Orleans, Genesee, and Wyoming counties to ban smoking in their apartment buildings. Quite a few agreed and signed on.

The damage done to apartment walls, ceilings, fixtures, drapes, rugs, etc from nicotine and tar staining is signficant over time. The second hand smoke seeping from one apartment unit to another has been shown to be a hazard to other tenants not just the occupants of the apartment with the smoker.

Are Eating Disorders an addiciton?

What is the Evidence That Eating Disorders are Addictions?

The Calgary Addiction Program presents Dr. Kristin von Ranson.

The podcast of her lecture at the Calgary Addiction Program conference day in August 2009. The lecture is a very good overview of the thinking in the field. There is a large cormodibity of substance abuse/dependence and eating disorders. How is this explained? She doesn't make the case one way or another but leaves the listener interested in the topic with helpful ways to think about the question.

I recommend it to you. You can access it by clicking here.

Binge drinking and sex more likely in co-ed dorms

Research reported in a recent issue of the journal, American Journal of College Health, found that students living in co-ed dorms are 2.5 times more likely to engage in binge drinking, and twice as likely to have had three or more sex partners in the last year that students living in single sex dorm

In substance abuse treatment, we tell patients that they may have to change their people, places, and things if they are to avoid triggers for relapse. This idea that external circumstances can trigger destructive and dysfunctional behavior is equally helpful if one is to prevent problems.

If I were a student, or a parent paying room and board at college for my child, I would not recommend co-ed dormitory living based on the findings of this study.

You can read a brief report of the study by clicking here.

Changing community norms and attitudes regarding college drinking

While the short video is done at UC Davis, it could have been SUNY Brockport or at SUNY Geneseo where a student drank himself to death last year.

GCASA's prevention program works towards changing community norms and attitudes. To do this effectively, it takes all of us.

Clozaril seems to help people with Schizophrenia and alcoholism more with their alcoholism than other antipsychotics

GCASA treats many patients with co-occuring psychiatric and substance abuse disorders.

New research indicates that second generation antipsychotic medications seem to be more effective than first generation anti-psychotic medications in treating people with Schizophrenia and alcoholism.

Second generation anti-psychotics, Zyprexa (Olanzapine) and Clozaril (clozpine) were far more effective in helping patients suffering from Schizophrenia and alcohol abuse their alcoholism. Clozaril, in one small study seemed much more effective.

To read the brief report, click here.

Cat Power talks about her alcoholism

Video lasts 4:40

BAC of .477

Reas Kroicowl is a Psychiatric Social Worker who works in an unnamed city and writes a blog entitled "Trench Warfare".

She tells the story of a patient brought into the ED (Emergency Department) with a BAC of .477.

I worked as a Psychiatric Social Worker in three large urban hospitals for over 18 years and I remember seeing a few patients with BAC's in this range as well. Most people couldn't survive with a BAC this high which indicates a very high tolerance.

To read her quick report, click here.

The CAGE music video

The CAGE music video comes from the Calgary Addiction Program.

It's cute, short, and worth watching. To watch it click here.

The CAGE is an easily administered four question screen for problems with alcohol.

1. Have you ever thought you should CUT down on your drinking?

2. Have people ANNOYED you by criticizing your drinking?

3. Have you ever felt bad or GUILTY about your drinking?

4. Have you ever had a drink first think in the morning to steady your nerves or get rid of a hangover? ( An EYE-OPENER)

Make-up or beer?

Recovery doesn't have to be done alone

Most people make changes on their own. About 80%. But the other 20% have a much tougher time. Their biochemistry has been altered and recovery is no longer just a choice, but a biological craving like being extremely thirty for water when one is parched.

To deal with these cravings people need understanding, support, and tools to manage these cravings and triggers. That's where treatment helps. There are people who know what it takes, how it might be accomplished, and can teach and assist in taking life changing action.

If you have promised yourself that you can stop your use or behavior, that you will quit tomorrow, but tomorrow never comes or doesn't last, you are not alone. Treatment is available which is life transforming for you and your relationships.

Is addiction a choice?

Research Psychologist Gene Heyman says that addiction is a choice and he has written a book about it. Tom Ashbrook interviews Heyman and others about this idea on his show "On Point" on August 11, 2009.

I think the argument is kind of silly because addiction is BOTH a choice and a disease not one or the other.

It is worth listening to. Show lasts about 50 minutes and you can access it by clicking here.

Break your shopping addiction - Buy nothing day is 11/27/09

Click on image to enlarge it for easier reading.

Social Work is the most stressful and badly paid job in the CNN poll.

Ladies and Gentleman I am a Social Worker, proud to be a Social Worker, and have been for 41 years.

I feel very validated to see a CNN poll on jobs that pay badly and are very stressful and find that Social Work is #1 not #5 or #10 but #1.

In light of what has been going on recently at GCASA with its financial difficulties and it high demands for service with clients who have multiple and at times overwhelming problems, and being snipped at by people who seem to believe that we are overpaid and a drain on the taxpayers, it was very vaidating to find out that there is some objective evidence that my thoughts and feelings are correct.

Substance abuse counselor is #13 on the list out of 50. You can check it out by clicking here.

I recommend this brief article to you.

What can health care providers do about prescription drug abuse?

SAMHSA pamphlet for health care providers on talking to patients about prescription drug abuse. Click here.

Millions of Americans Go Without Substance Abuse Treatment

Millions of Americans go without substance abuse treatment reads a headline in the October 16, 2009 issue of the Psychiatric News. To read the article click here.

Click on image to enlarge for easier reading.

Poverty and addiction - cutting services to those least able to pay for them

According to the U.S. Census bureau 5,451 people or 13.9 percent of the population in Orleans County lives in poverty. The median income is $46,220.00.

In Genesee County 5,992 people live in poverty or 10.6 percent of the population. The median income is $49,133.00

In Monroe County 92,057 people live in poverty or 13.1 percent of the population and the median income is $51,799.00

In Erie County 118,825 people live in poverty or 13.5 percent of the population. The median income is $48,427.00.

In Niagara County 25,504 people live in poverty or 12.1 percent. The median income is $45,545.00

In Wyoming County 4,252 people live in poverty or 11.4 percent of the population. The median income is $48,472.00.

From the data, it is clear that GCASA serves the poorest county in the region where people have the least ability to pay for services. It seems unfortunate that GCASA has had to curtail services to people in this county because of a lack of deficit financing from County and State government where people need the help the most because of their inability to pay for the services that they often desperately need.

It is interesting to note that Orleans County has higher poverty rates that the larger counties like Erie and Monroe even with their large populations of urban poor in their large cities.

GCASA for the last several years has been able to subsidize its service delivery in deficit plagued Orleans Counties with the surpluses it generated from its operations in Genesee County, but with the advent of another provider in Genesee County skimming off clients who can pay and leaving people needing a sliding fee scale with GCASA, the surpluses in Genesee have been eliminated and now both county treatment service programs are running deficits requiring the agency to cut services.

And so it goes...................

Idea of the day

Thoughts as I struggle to go to work.

There was an article in the Batavia Daily News last Friday, 11/13/09 which describes the deficits which GCASA is facing in 2010 and the curtailment in staffing and services which will occur to balance the budget.

GCASA is a private nonprofit agency which has contracts with State and County governments and since State and County governments are going through their own financial difficulties there is no ability to provide additional resources to provide services to help people struggling with substance abuse problems.

We live in a society where alcohol, tobacco, gambling, street drugs, and prescription drugs are glamorized and sold as the means to experience the good life. These advertisements and marketing strategies are, of course, lies because while these substances and activities can provide temporary enjoyment, their consistent use and abuse leads to disease and death.

While the breweries and distilleries and casinos and state lottery commission spend billions of dollars per year to convince Americans to use their products, there is very little spent to warn people of the dangers and to help them when their use turns to abuse and addiction.

Substance abuse kills hundreds of thousands Americans a year. Two of my own children were killed by a three time drunk driver and so I personally know the pain and tragedy that substances cause our society. The man who killed my children was known as the "town drunk" and he had never had any treatment for his alcoholism.

The comments to the Daily News article are very disturbing for me and the GCASA staff. They indicate a contempt and disdain for the services that GCASA provides and for the patients that we serve. As a Psychiatric Social Worker I am well aware of the shame and humiliation which mental illness and addiction bring to patients and their families. Throughout history people suffering from these disorders have been ridiculed, vilified, stigmatized and humiliated. These reactions are what in psychology we label "projections" because we tend to attack others when we see what is most shameful in ourselves.

Any one who is willing to sit quietly for 10 minutes and just watch one's own thoughts and feelings will quickly observe how we each are full of lust, greed, hate, envy, fear, arrogance, and shame. We all have our weaknesses and what Carl Jung called our "shadow side". We hide it not only from others but most of all from ourselves but it is there and not repressed very deeply either if we are only willing to watch.

We live in an addictive society. We are addicted to our substances, consumerism, militarism, sex, eating, anything which will alter our mood and help us feel less scared, less depressed, less frustrated with the chaos and darkness we see around us. It is always a delight to find people who are willing to look into the darkness, call a spade a spade, take the ugly bull by the horns and with the help of others move toward the light.

What we do at GCASA at the superficial level is provide medical services to help people with their addictions and to help our society become aware of and deal with the shadow side of the culture, but at the deeper level we attend to people's spirit and help them become all that they were created to become so that they can realize their potential, create healthy more satisfying lives for themselves, and to help others.

It seems strange to be criticized and hated for this but even the existence of agencies like GCASA reminds us as Americans of our weaker natures, of our vulnerabilities, of more shameful problems, and it is understandable how those who would step forward to call attention to this and try to help would be feared and subject to the expressions of contempt and disdain.

The work we do at GCASA is honorable and noble work in spite of the lack of support and outright contempt it engenders. We will continue on as best we can trying to help and serve those who are in need. If the man who killed my children had had the help he needed with his alcoholism, my children today would be 22 and 25 instead of killed at 5 and 8.

What we do at GCASA among other things is turn pain and sorrow into understanding and hope, anger and shame into compassion and self respect, confusion and loathing into clarity and admiration.

I will go to work today because I believe in the work, to honor the memories of my dead children, because I know that there are people suffering who need a place to turn, and because there are many colleagues and volunteers who understand. They are silent in the comment section of the Daily News article for various reasons, but I know they are there and so it keeps me going.

Having worked in the field of mental health and substance abuse for over 41 years, I am in the last stretch of my career and life. I have seen many ups and downs and the support for mental health services and substance abuse services wax and wane on the political tides of our society. Overall, though, the treatment for people with mental health and substance abuse disorders is much better now than it was when I started at Kings Park State Hospital on Long Island back on 10/31/68. I think and I hope that I have helped.

Peace.

Significant progress in tobacco free initiative says OASAS commissioner

The following letter was sent by OASAS Commissioner, Karen Carpenter-Palumbo, yesterday, 11/17/09 concerning New York's leadership in treating tobacco addiction.

At GCASA our staff as not been able to be nicotine dependent since 1999 and our grounds became smoke free in 2003.

Here is the letter:

Colleagues:

I want to congratulate you on the significant progress occurring throughout New York with the tobacco-free initiative. We are continuing to capture the program compliance rate during recertification and are encouraged to report that we now have over 80 percent compliance – showing a steady increase since July, 2008.

As New York leads the nation with addressing tobacco in the same context as treating all other substance abuse disorders, we are demonstrating to the country the ability to change the cultural acceptance of tobacco use and treat the deadliest addiction of all. Substance abuse counselors have the knowledge and skills to help individuals working toward recovery deal with their use of addictive substances. These skills are the backbone of the OASAS system of care and directly apply to the treatment of tobacco. The most commonly used models for tobacco treatment combine cognitive behavioral therapy such as motivational enhancement with nicotine replacement therapy (NRT).

Tobacco kills over 430,000 Americans every year. While New York smoking rates have dropped below 17 percent, the addicted population is more than four times that rate, ranging from 80-92 percent. We should remind ourselves that it was not that long ago that another legal substance was allowed during breaks and reward ceremonies. That substance was alcohol. Today, we understand the connection between alcohol and substance use and the studies are becoming more pervasive regarding the strong correlation of tobacco use and the development of other substance use disorders and with more severity such as:

• Early onset of smoking and heavy smoking are highly correlated with the subsequent development of other substances use. (Degenhardt, Hall and Lynskey, 2001)
• Heavy smokers have more severe substance use disorders than do non-smokers and more moderate smokers. (Marks et al., 1997; Krejci, Steinberg and Ziedonis, 2003)
• Tobacco use impedes recovery of brain function among clients whose brains have been damaged by chronic alcohol use. (Durazzo et al., 2007; Durazzo et al., 2006)

Programs are adopting a variety of policies that lead to improved health and long-term recovery. Keeping people engaged in treatment to address their addiction, including tobacco, is the best place for progress. Your policies, commitment and leadership will prevail as we continue to treat tobacco in the same context as treating all other substance abuse disorders. Together we are helping New Yorkers reach their goal of recovery and enhanced health.

Thank you for the work you do each and everyday to prevent, treat and help individuals recover from addiction - saving lives one day at a time.

Sincerely,
Karen M. Carpenter-Palumbo
Commissioner

Observations and thoughts from the front lines

Having lost 3 of 6 counselors in GCASA'a Albion office I have been helping out doing evaluations. I have done 10 in the last 2 weeks and it is an enlightening experience. I want to capture and share some of my experience.

1. The paperwork is overwhelming. A great deal of it is unnecessary and amounts to checking boxes and collecting data and filling in boxes that have nothing to do with the client's primary concerns nor does it help in establishing therapeutic rapport or obtaining good outcomes. The paperwork has been promulgated in response to regulatory requirements and reimbursement mechanisms not good clinical practice. Regulatory have no good means of measuring good treatment and good outcomes and so they rely on compliance with paperwork completion as a proxy for good treatment. This is a false assumption, and a dangerous way of evaluating good care. Staff are constantly harassed to treat the medical record not the client and the acknowledgement and recognition of good programs depends on compliance with paperwork requirements not the interaction and service provision to clients.

2. As stated in #1, good treatment is determined by correct completion and compliance of paperwork not client satisfaction or good treatment outcomes. Unfortunately, this has perverted the system of care and the primary customer of service has become the regulator and the payer not the client.

3. It has been impressed on me once again that self destructive behavior should not be equated with criminal behavior. Most of the clients I evaluated were sent by the criminal justice system or other governmental bodies such as the Department of Social Services, the Department of Motor Vehicles, Probation, the courts, etc. The health care system for substance abuse disorders has been captured by government to coerce behaviors which government has determined is in its own best interest and not necessarily in the individual's. What Michel Foucault calls "governmentality" increasingly deprives individuals from their freedom. There is a fine line between whether agencies like GCASA are health care agencies whose mission is to help individuals improve their health or coercive agents of social control. It looks to me like 75% of GCASA's services are designed to exert social control and the client's right to self determination is marginalized if respected at all.

I have further observations and thoughts which I will share in future posts.

Trick or treat? You tell me.

Governor proposes 16 million in cuts to OASAS as part of Deficit Reduction Plan

The article below comes from the New York State Conference Of Local Mental Hygience Directors newsletter dated October 16, 2009.

Click on image to enlarge for easier reading.

17th Annual Batavia Halloween Parade

On Sunday, 10/25/09, at 12:45PM, there will be the annual Batavia Halloween Parade sponsored by multiple agencies and organizations including GCASA.

Click on image to enlarge for easier reading.

Red Ribbon Week, 10/23-10/31/09

Click on image to enlarge for easier reading.

What part of "smoking is harmful" don't you understand?

Back in the trenches

We've lost 3 of our 6 counselors in our Albion office for a variety of reasons. The requests for service have escalated and last week we had 25 requests for intakes.

There is no more money. No increase in our county and state funding. No increase in our reimbursements, not in 10 years.

Yes, you've read that right. Not in a decade.

Now the governor is cutting the state budget and how it will affect substance abuse services isn't clear, but it isn't pretty.

So, I'm the kind of executive director who rolls up his shirt sleeves and helps out. Last week I did 8 intakes.

I'm almost 64 years old. I've been in the field 41 years, and I'm back where I started, providing direct services where they are needed most, on the front lines.

I wonder if the commissioner of OASAS can provide the kind of leadership I provide?

No, she is not a substance abuse professional. She wouldn't have a clue.

I wonder if the regional office staff could do what I'm doing?

No, they re making sure the Ts are crossed and the Is are dotted. They are counting beans as if the patient with DTs cares.

At the end of the day, somebody has to do the work - actually see patients. The people who actually do the work, are the lowest paid, the most harassed by the bureaucrats, the ones criminalized by the Medicaid fraud units because the treatment plans didn't get signed in the designated time frames.

As I leave my administrative desk and actually see patients again, I am reminded that something is terribly wrong with our service delivery systems. We have inverted the system so that the most highly paid, the most highly recognized, the most highly rewarded are the ones furthest away from the actual work.

I am enjoying seeing patients, but the budgets and regulatory paperwork is getting behind so I will leave the patients to suffer waiting for care while Albany makes its paperwork demands, and silly meetings have to be attended, and we pretend that the policy makers and the regulators have the really important work to do.

This week I will do both, see patients and work on my paperwork, but I do so with a renewed awareness about what the work really means and the value it really has, something that too many leaders have never known, or forgotten, or maneuvered to get promoted away from to where the real money is and there is alot less stress and pressure, and in some ways, responsibility.

I am taking care of patients again not worrying about corporate compliance. I have been doing God's work, not the work for soulless bureaucrats.

Indigenous Peoples Day

Today is Indigenous Peoples Day or Columbus Day if you prefer.

Indigenous people have suffered from substance abuse more than most whether is is the result of genetic predispositions, from genocide, from cultural disposssosion or a little of both.

Please stand in solidarity with indigenous peoples this day and be a resource, if possible in their recovery.

A Guide for Substance Abuse Services for Primary Care Physicians

A Guide For Substance Abuse Services for Primary Care Physicians. To access click here.

Cocaine laced with veterinary anti-parasite drug

SAMHSA (Substance Abuse and Mental Health Services Administration)released an alert on 09/21/09 that cocaine in some regions has been found to be laced with a veterinary anti-parasite drug which is very toxic to humans. You can read the alert by clicking here.

Death from Opioid Overdose is a big concern

Those of us who work in the Substance Abuse field all know of patients who have died from Opioid overdoses. Every time this happens we are reminded once again that substance abuse can be a terminal illness.

OASAS (New York State Office of Alcoholism and Substance Abuse) and DOH (New York State Department of Health) have issued a Health Advisory entitled "Interventions To Prevent Opioid Overdose". You can access it by clicking here.

Helping female vets in New York State

From the NYS Conference of Mental Hygiene Directors Newsletter for September 25, 2009.

NYS Office of Alcoholism and Substance Abuse Services (OASAS) Commissioner Karen M. Carpenter-Palumbo announced that Samaritan Village will break ground on a 25-bed facility designed specifically to meet the rehabilitative needs of women veterans, the first of its kind in New York. Samaritan Village has 11 facilities throughout the state, providing substance abuse treatment, homeless services, senior services, and veterans' services.

"Nearly 17 percent of the armed forces are women," said Commissioner Carpenter-Palumbo. "There are 66,000 women veterans in New York State alone, many of whom have experienced the physical and emotional traumas of combat in addition to sexual harassment or assault, which we know when left untreated, often lead to substance use disorders. Women veterans return home expected to resume their role as wife, mother, professional, or family caregiver, but if they are suffering, quietly or not, from post traumatic stress disorder, substance use disorders, mental health issues, or the self-imposed guilt or shame of sexual assault, then we all lose: the individual, the family and the community.” She added, "Samaritan Village is committed to the veterans it serves, and I congratulate them on leading the charge with a unique women's program that is truly first in the nation."

This specialized women's veterans program is made possible through $5 million in funding from the OASAS, and is the result of an RFP released by the state to build 100 residential treatment beds for veterans throughout New York.

In 2007, seven percent of the near 14,000 veterans admitted to the state's treatment system were women — that's almost 1,000 female veterans in need of gender-specific, individualized care. The multifaceted experiences of women in the military generate a need for varied types of treatment upon their return. Vital to their overall health, well-being, long-term recovery, and reintegration into society is treatment provided in a safe and reassuring environment. The U.S. Department of Veterans Affairs now has staff within every region who serves as a Women Veteran Program Manager to help women veterans connect to expanded health care benefits offered through VA Healthcare. VA Hospitals now provide maternity care, gynecological care, osteoporosis screening and treatment, mental health, as well other health care services. To find a local Women Veteran Program Manager in your region, call 1-800-877-222- VETS (8387).

Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis

To access the Guidelines for Referral and Diagnosis of Fetal Alcohol Syndrome click here.

Batavia Drug Court graduation this Friday, 10/02/09 at 10 AM

Click on image to enlarge for easier reading.

Smoking has gone to the dogs

SAMHSA has released its findings from its National Survey on Drug Use and Health from 2008

SAMHSA has released its 2008 findings on drug use and health compliled from its national survey.

You can access it by clicking here.

Financial resources for substance abuse services stagnant

It has been over a decade since GCASA has had any increase in deficit financing from the counties it primarily serves, Genesee and Orleans, or from State Government. In fact, GCASA has had significant decreases in County deficit funding over this decade, 50% in Orleans County from about $77,000 in 2001 down to $36,000 in 2003 and ever since. Similarily there have decreases in deficit funding from Genesee County from about $40,000 in 2001 down to $32,000 currently.

There has been no increase in reimbursement rates for a unit of service in our clinics in over a decade while costs have continued to increase significantly over the same time.

How has GCASA continued to increase its service activities? Simply by more efficient management and an increase in productivity. In 1999, GCASA had about 500 admissions that year. In 2008 GCASA had 1100 admissions.

It has now come to the point where there is no more fat in the system. Without further resources, GCASA will have to cut into muscle and decrease services. The agency itself is in good financial health because of good management, but its ability to meet the needs of the community is increasingly compromised because of inadequate public financial support.

Alcoholism: Self- Help support groups

Video lasts 2:27

Have an alcohol free pregnancy

Fred Sarkis to speak on gambling addiction in Warsaw, NY on 09/25/09

Click on image to enlarge for easier reading.

Orleans County United Against Substance Abuse to meet on September 23, 2009

Registration is at 8:45 AM and meeting starts at 9:00 AM

Click on imgage to enlarge for easier reading

Recovery Rally, NYC, 09/12/09

Recovery Rally in NYC on 09/12/09

To view video click here.

Smoking and pregnancy

Video lasts 1:21 Click here to watch.

Which is a more dangerous drug; alcohol or marijuana?

"The plain and simple truth is that alcohol fuels violent behavior and marijuana does not. Alcohol contributes to literally millions of acts of violence in the United States each year. It is a major contributing factor to crimes like domestic violence, sexual assault, and homicide. Marijuana use, on the other hand, is absent in that regard from both crime reports and the scientific literature. There is simply no causal link to be found."

Norm Stampler, former Chief of Police, Seattle, WA.

As a public health and criminal justice observation, we would be far better off as a society legalizing marijuana and criminalizing alcohol not that I am recommending the criminalization of alcohol again (we did that during prohibition), nor am I recommending the legalization of pot. I am simply pointing out the irrationality of our drug policies in the United States. Marijuana is a much safer drug and has far fewer negative social consequences than alcohol.

These irrational policies have huge consequences for our criminal justice system and our health care system which we, as tax payers, pay for in implementing ineffective policies, and programs and services.

The old saying in the substance abuse field is "A Drug is a drug is a drug" but this is ignorant and not at all true and drugs operate in different ways on the human body and have different meanings in our society. Much more effective social policies and treatment services could be developed and provided if these social policies and treatment services were based on our current state of scientific knowledge and not based on ideologies and politics which have outlived their usefulness.

Here at GCASA we strive to provide up to date scientific information and to provide services based on our current state of knowledge.

SUPA (Students United For Positive Action) meeting on Tuesday, 9/15 at 5:00 PM

Click on image to enlarge for easier reading.

What is the Monitoring the Future Drug Abuse Survey?

Video lasts 6:38



GCASA does it own survey in Genesee and Orleans Counties. For more information contact Maryann Bowman at GCASA at mbowman@gcasa.org or 585-343-1123.

September is Recovery Month

September is recovery month. For more information click here.

Drug Policies in America

America's drug policies are not rational. They never have been and are not currently. America's drug policies have been driven by ulterior motives for religious, moral, and political reasons not based on scientific facts and rational public health policies.

There will be a series of articles on GCASA Cares which will explore these societal and political attitudes towards drugs and provide tools to use in a critical and rational analysis.

Please leave your comments.

There are a number of observations which will underlie this analysis:

1. Human beings have altered their consciousness with chemicals throughout their history. There is nothing unusual or new about this phenomenon. What the motivations are for altering one's consciousness may vary somewhat, but the fact that human beings have always done this, do this now, and will do this into the future is indisputable.

2. At various times and in different societies the altering of one's consciousness with chemicals has been either encouraged such as for religious reasons and celebratory reasons or demonized and made criminal as in prohibition. The reasons for a societal attitude and mores seems somewhat arbitrary based on ideological and political beliefs not on any rational analysis.

3. The use of chemicals for mood altering experiences is best analysed on a use - abuse - dependence continuum. In other words, there can be a recreational or other positive use of some mood altering chemicals such as for pain reduction and anesthesia for example, but these same chemicals can be abused contributing to personal and social dysfunction or physical negative consequences, and these same chemicals can become addictive and habituating leading to further and more serious physical, psychological, and social problems.

4. Some drugs are stigmatized for poor reasons such as marijuana or readily accepted such as caffeine and alcohol. This phenomenon of stigmatization and social acceptance often makes no rational sense when one considers the effects of the drug on the body or the negative social consequences of its use.

It is apparent that most people have not carefully and thoughtfully thought through the drug policies that influence their attitudes, and behavior. Many substance abuse professionals also have not examined drug policies with a critical eye. It is hoped that this series of articles will help inform professionals and lay people so that they will more critically examine the drug policies in America and that improving these policies will improve our public health.

The posts on this theme will be tagged "Drug Policies"

GCASA Cares will resume publication in September 2009

In September, 2009, GCASA Cares will be resuming publication twice per week on Mondays and Thursdays. It will include topics that are of concern to people interested in the Substance Abuse field.

Information specific to New York State and especially Western New York State will be emphazized. Your comments are especially welcomed.

GCASA Cares is being discontinued.

GCASA Cares is being discontinued.

Thank you for visiting while it existed.

Growing up in substance abusing home

Children who grow up in homes where substance abuse is an issue are often confused, perplexed, ashamed, guilty, and often feel responsible for the dysfunctional things that occur.

It is easy to see why these children become substance abusers themselves just as a way to cope with the dysphoric emotions that they have grown up with and become accustomed to.

These children need to hear from responsible adults the "3 Cs" - You didn't cause it, you can't control it, you can't cure it.

These children need to hear this from what Alice Miller, the Swiss Psychoanalyst who has spent her career helping aduts who were abused as children, an elightened witness.

The enlightened witness is the person who understands the situation, has credibility with child and says, "It isn't you. You're not crazy. You're Okay. It's them. They are the ones with the problems."

This is validating for the child and clears up the mystification which has occured wherein the dysfunction has been made to seem like the child's fault and responsibility. The child asks herself, "Is it me or them? Am I crazy?"
The enlightened witness says, "No, it's not you." and the child takes a big sigh of relief and feels Okay even though she must still deal with the dysfunctional sitations that occur.

This is article #15 in a series on Substance Abuse, the Family Disease.

Dysfunctional rules of substance abusing families

The featured topic in July, 2009 was Substance Abuse: The Family Disease and it did not get fully addressed for a variety of reasons so in August, GCASA Cares will continue to feature this topic as well as the topic of Recovery since September is Recovery month.

In this article we will briefly review the rules in families affected by substance abuse and other kinds of dysfunction. They are simply called the "Don't trust", "Don't feel", "Don't talk", and "Don't think" rules.

The rules are pretty self explanatory and operate to maintain equilibrium on the dysfunctional family system. The unconscious learning of these rules have tremendous bearing on the family member's life both in the family of origin where they are learned and later in subsequent relationships.

In healthy relationships the opposite is true. It is Okay to talk, to feel, to think and to trust but it may take years and therapy to learn this.

This is article #14 in a series on Substance Abuse The Family Disease.

Making Smart Choices

Click on image to enlarge for easier reading.

Dr. Nora Volkow talks with teens about drugs

Dr. Volkow, the Director of the National Institute On Drug Abuse, talks to kids about drugs.

Video lasts 9:43

Images of addiction #7

This is article #7 in a series on Images Of Addiction.

Images of addiction #6

This is article #6 in a series on Images Of Addiction.

Relationship of drugs and crime?

What is the relationship between drugs and crime? Huge!

One half to 2/3rds of arrestees are found positive for drugs. The primary drug differs from city to city. In New York City it is primarily marijuana and Cocaine.

Take a look at this new report from CESAR.

Click on image to enlarge for easier reading.