How well does GCASA treat co-occurring disorders?

On Tuesday, April 27,2010, GCASA staff were interviewed by staff from the New York Health Center For Excellence In Integrated Care at the request of Ellery Reaves, the Director of Community Services For Genesee County to determine the degree to which GCASA does a good job in providing services to people who suffer from both substance abuse and psychiatric disorders. Combined disorders are called COD, Co-Occurring Disorders, or sometimes MICA, Mentally Ill Chemical Abuser.

Overall, GCASA does very well addressing co-occurring disorders as compared to other substance abuse agencies. The report states the GCASA performs above the state average.

Here is a snippet from the report: (click on image to enlarge for easier reading)



If anyone would like to see the whole report send me an email request at dmarkham@gcasa.org.

GCASA Cares readers want marijuana legalized in New York State

The GCASA Cares poll of the week for the week of 04/18/10 asked Should Marijuana be legalized in New York State? 60% said yes and 40% said no. However the poll numbers were very small so this is not a valid poll.

Nonetheless, GCASA Cares blog readers who took the time to vote think marijuana should be legalized.

Thanks to those who voted.

My Tommy would never use alcohol

Marijuana use drops significantly in Genesee county from 2000 - 2008

I am looking at the Prevention Needs Assessment Data and it is very interesting. I will be presenting it in a series of articles over the next couple of weeks.

GCASA administers what is called a Prevention Needs Assessment in all public schools in Genesee County between grades 6 and 12 every two years. The PNA is also administerd to Notre Dame High School. This data is collected every two years.

In 2000 25.7% of 11th graders in Genesee County reported that they had used marijuana in the previous 30 days.

In 2002, the rate dropped to 24%,
in 2004, to 21.6%,
in 2006, 16.6%,
and in 2008, 15.9%.

In 8 years that is a drop from 25.7% of kids to 15.9%.

How do you account for the change?

This is article #2 in a series on Prevention Statistics.

Use of alcohol by kids in Genesee County significantly changed in 8 years

I am looking at the Prevention Needs Assessment Data and it is very interesting. I will be presenting it in a series of articles over the next couple of weeks.

GCASA administers what is called a Prevention Needs Assessment in all public schools in Genesee County between grades 6 and 12 every two years. The PNA is also administerd to Notre Dame High School. This data is collected every two years.

In 2000 51.9% of 11th graders in Genesee County reported that they had drank alcohol in the previous 30 days.

In 2002, the rate dropped to 49.2%,
in 2004, to 46%,
in 2006, 40.9%,
and in 2008, 38.2%.

In 8 years that is a drop from 51.9% of kids to 38.2%.

How do you account for the change?

This is article #1 in a series on Prevention Statistics.

Proposed criteria for DSM-V edition of Disordered Gambling

The work group has proposed that this diagnosis be reclassified from Impulse-Control Disorders Not Elsewhere Classified to Substance-Related Disorders which will be renamed Addiction and Related Disorders

Disordered Gambling

A. Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following:

1. is preoccupied with gambling (e.g., preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble

2. needs to gamble with increasing amounts of money in order to achieve the desired excitement

3. has repeated unsuccessful efforts to control, cut back, or stop gambling

4. is restless or irritable when attempting to cut down or stop gambling

5. gambles as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)

6. after losing money gambling, often returns another day to get even (“chasing” one’s losses)

7. lies to family members, therapist, or others to conceal the extent of involvement with gambling

8. has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling

9. relies on other to provide money to relieve a desperate financial situation caused by gambling

B. The gambling behavior is not better accounted for by a Manic Episode.

Include Pathological (Disordered) Gambling within Addiction and Related Disorders
Pathological (disordered) gambling has commonalities in clinical expression, etiology, comorbidity, physiology and treatment with Substance Use Disorders. These commonalities are addressed in the following selected papers from a relatively large literature:
Blanco C, Hasin DS, Petry N, Stinson FS, Grant BF. 2006. Sex differences in subclinical and DSM-IV pathological gambling: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med. 2006 Jul;36(7):943-53.
Cavedini P, Riboldi G, Keller R, D’Annucci A, Bellodi L. . 2002 Frontal lobe dysfunction in pathological gambling patients. Biol Psychiatry 51:334-341.
de Ruiter MB, Veltman DJ, Goudriaan AE, Oosterlaan J, Sjoerds Z, van den Brink W. Response perseveration and ventral prefrontal sensitivity to reward and punishment in male problem gamblers and smokers. Neuropsychopharmacology. 2009 Mar;34(4):1027-38. Epub 2008 Oct 1. PubMed PMID: 18830241.
Gerstein DR, Volberg RA, Toce MT, et al. Gambling Impact and Behavior Study: Report to National Gambling Impact Study Commission. Chicago, IL: National Opinion Research Center; 1999.
Goudriaan AE, Oosterlaan J, de Beurs E, van den Brink W. Neurocognitive functions in pathological gambling: a comparison with alcohol dependence, Tourette syndrome and normal controls. Addiction. 2006 Apr;101(4):534-47. PubMed PMID: 16548933.
Hodgins DC, Currie SR, el-Guebaly N. 2001 Motivational enhancement and self-help treatments for problem gambling. J Consult Clin Psychol. 69:50-57.
Hodgins DC, el-Guebaly N. 2000, Natural and treatment-assisted recovery from gambling problems: A comparison of resolved and active gamblers. Addiction. 95:777-789.
Hodgins, D.C., Currie, S.R., & el-Guebaly, N. 2001. Motivational enhancement and self-help treatments for problem gambling. Journal of Consulting and Clinical Psychology, 69, 50-57.
Kessler RC, Hwang I, LaBrie R, Petukhova M, Sampson NA, Winters KC, Shaffer HJ. 2008. DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychol Med. ;38:1351-60
National Research Council. Pathological Gambling: A Critical Review. Washington, DC: National Academy Press; 1999.
Petry NM. 2001 Pathological gamblers, with and without substance use disorders, discount delayed rewards at high rates. J Abnorm Psychol; 110:482-487.
Petry NM. 2005. Pathological Gambling: Etiology, Comorbidity and Treatments. Washington, D.C.: American Psychological Association Press.
Petry NM. 2006. Should the scope of addictive behaviors be broadened to include pathological gambling? Addiction, 101,152-160.
Petry NM, Ammerman Y, Bohl J, Doersch A, Gay H, Kadden R, Molina C, Steinberg K 2006 Cognitive-Behavioral therapy for pathological gamblers. J Consult Clin Psychol 74:555-567.
Petry NM, Stinson FS, Grant BF. 2005. Comorbidity of DSM-IV pathological gambling and psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 66:564-574
Potenza MN, Leung HC, Blumberg HP, et al. 2003. An fMRI Stroop task study of ventromedial prefrontal cortical function in pathological gamblers. Am J Psychiatry. 160:1990-1994.
Regard M, Knoch D, Gütling E, Landis T. 2003. Brain damage and addictive behavior: A neuropsychological and electroencephalogram investigation with pathologic gamblers. Cog Behav Neurol. 6:47-53.
Rugle L, Melamed L. 1993. Neuropsychological assessment of attention problems in pathological gamblers. J Nerv Ment Dis. 181:107-112.
Shaffer HJ, Hall MN, Vander Bilt J. 1999. Estimating the prevalence of disordered gambling behavior in the United States and Canada: A research synthesis. Am J Public Health. 89:1369-1376.
Slutske WS, Eisen S, True WR, et al. 2000. Common genetic vulnerability for pathological gambling and alcohol dependence in men. Arch Gen Psychiatry57:666-673.
Welte J, Barnes G, Wieczorek W, Tidwell MC, Parker J. 2001. Alcohol and gambling pathology among U.S. adults. Prevalence, demographic patterns and comorbidity. J Stud Alcohol 62:706-712.
Lower Threshold for Pathological (Disordered) Gambling Diagnosis
Several empirical studies have supported lowering the threshold for a diagnosis of pathological (disordered) gambling. Statistical analyses bearing on this issue are also in progress.
Jiménez-Murcia S, Stinchfield R, Alvarez-Moya E, Jaurrieta N, Bueno B, Granero R, Aymamí MN, Gómez-Peña M, Martínez-Giménez R, Fernández-Aranda F, Vallejo J. 2009. Reliability, validity, and classification accuracy of a Spanish translation of a measure of DSM-IV diagnostic criteria for pathological gambling. J Gambl Stud; 25(1):93-104.
Stinchfield R. 2003. Reliability, validity, and classification accuracy of a measure of DSM-IV diagnostic criteria for pathological gambling. Am J Psychiatry, 160(1):180-2
Stinchfield R, Govoni R, Frisch GR. 2005. DSM-IV diagnostic criteria for pathological gambling: reliability, validity, and classification accuracy. Am J Addict., 14(1):73-82
Eliminate Illegal Act Criterion for Pathological (Disordered) Gambling
The illegal act criterion of pathological (disordered) gambling has been shown to have a low prevalence with its elimination having little or no effect on prevalence and little effect on the information associated with the diagnosis in the aggregate.
Strong DR, Kahler CW. 2007. Evaluation of the continuum of gambling problems using the DSM-IV. Addiction 102:713-721.

Recommendations for severity criteria for this disorder are forthcoming. We encourage you to check our Web site regularly for updates.
A. Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following:
1. is preoccupied with gambling (e.g., preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble)
2. needs to gamble with increasing amounts of money in order to achieve the desired excitement
3. has repeated unsuccessful efforts to control, cut back, or stop gambling
4. is restless or irritable when attempting to cut down or stop gambling
5. gambles as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)
6. after losing money gambling, often returns another day to get even (“chasing” one’s losses)
7. lies to family members, therapist, or others to conceal the extent of involvement with gambling
8. has committed illegal acts such as forgery, fraud theft, or embezzlement to finance gambling
9. has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
10. relies on other to provide money to relieve a desperate financial situation caused by gambling
B. The gambling behavior is not better accounted for by a Manic Episode.


For more information click here.

On August 15, 2010, Leandra's law will require alcohol sensor interlock devices installed on cars of DWI offenders and their family

There is a very interesting article in the April 20, 2010 issue of The Daily News about how Leandra's law will affect Genesee County. As of August 15, 2010 people convicted of DWI will not only have to have interlock alcohol sensors installed in their vehicle but on any other vehicle in their household which they could have access to.

An interlock device has an alcohol sensor on it. Anyone who attempts to start a interlock-equipped vehicle has to blow into the device to test for alcohol on his breath; the car won’t start if alcohol is detected.

The major issue is that the law specifies that all drivers convicted of DWI, not limited to Leandra’s Law violators, have to have interlock equipment installed on their own vehicles for a minimum of six months. It also applies to any other automobiles to which they have access, such as a car owned by a spouse or grown child.

Ciaccia is coordinator of the county’s STOP DWI program. The county averages about 300 DWI arrests per year.

To read the article click here.

Underage drinking video

Underage Drinking video. Click here.

3 thirty second Public Service Announcements about Underage Drinking

Underage drinking Public Service Announcements (PSAs) produced by SAMHSA (Substance Abuse and Mental Health Administration)

3 30 second spots - click here.

The story of Lois Wilson, wife of Bill Wilson the founder of AA, will air this Sunday, April 25, 8:00 PM on CBS

The Lois Wilson Story: When Love Is Not Enough will air on CBS this coming Sunday night at 8:00 PM on the Hallmark Hall Of Fame.

Your story matters

Click on image to enlarge for easier reading.

State contributes to the very problems it tries to prevent

In the New York State OASAS Prevention Strategic plan it reads on page 5 in part:

"In New York alone, it is estimated that annual state spending share due to the burden of substance abuse and addiction was over $13 billion (NCASA, 2009). Almost all of this state spending addressed the related health, criminal justice and educational consequences, while only 3 percent was spent on addiction prevention and treatment."

When you think about what the state takes in on taxes on alcoholic beverages, cigarettes, and from the lottery, 13 billion is a piddling amount. It seems very paradoxical that the state makes money on feeding peoples addictions and abuse and then turns around an spends billions of dollars on the negative consequences.

From a public health perspective the prevalence of alcoholism in a give neighborhood is directly correlated with the number of retail alcohol retail outlets per square mile.

From a public health perspective the amount of a toxic stimulus in a given population is directly related to the amount of disease. In this case access to addictive substances and activities contributes to higher prevalence. The state has enormous control over the access to these substances and activities and yet voters often don't connect the dots.

As our understanding of public health models and environmental strategies increase, we will be better able to prevent the development of addictive disorders and limit the negative consequences for our communities.

This is article #2 in a series on Prevention strategic plan.

Bobby's coming in next Saturday! - Get your tickets now!

Dave Brubeck and Bobby Militello in Moscow in 1997.

Bobby Militello will be coming to Batavia on April 24th to headline the First Annual GCASA Evening Of Jazz at GCC. Tickets are going fast!

For more information click here.

OASAS just releases first ever prevention strategic plan

The New York State Office Of Alcoholism and Substance Abuse Services has just released its first ever Prevention Strategic Plan: 2010-2014.

You can access a copy of it by clicking here.

Under the leadership of OASAS Commissioner Karen Carpenter-Palumbo, OASAS has moved forward with developing addiction prevention models which are on the forefront of public health models to decrease the incidence and prevalence of addiction problems and to improve protective factors which improve the health of our communities in multiple areas not just substance abuse.

GCASA applauds the good work of OASAS and is proud to work with OASAS in a collaborative way to further prevention services around New York State and the country.

This is article #1 in a series on prevention strategic plan.

First Annual GCASA Evening Of Jazz on Saturday, April 24th

There was a very good article yesterday in The Daily News in Batavia, NY about the upcoming First Annual GCASA Evening Of Jazz at the Stuart Steiner Theater at Genesee Community College on Saturday, April 24th at 7:30 PM.

To read the article, click here.

Matt Lovejoy arrested by DEA

Bobby Militello headlines GCASA's First Annual Evening Of Jazz

Dave Brubeck and Bobby Militello in Russia in 1997.

Bobby Militello is coming to Batavia on April 24th for the First Annual GCASA Evening of Jazz at GCC's Stuart Steiner Auditorium.

For more information click here.

Butt Drugs

How many people of admitted patients at GCASA have gambling problems?

Of the 1050 people admitted to GCASA treatment and residential programs in 2009, 610 were screened for having problems with gambling. Out of the 610, 12 were positive for the screen which is 2% of the group. Unfortunately 440 people admitted were not screened.

GCASA does offer treatment services for people with gambling problems and GCASA offers Gambling prevention programs in both Genesee and Orleans Counties.

The co-occurance of substance abuse and gambling problems is usually predicted to be higher than what we are finding at GCASA. I am not sure why. This area requires more study.

When people with substance abuse problems have childfren what happens to the kids?

Of the 1050 people admitted to GCASA treatment and residential programs in 2009, 561 or 53% had children.

Only 218 or the people admitted or 21% had children living with them.

31 people admitted or 3% had children living in foster care.

Implications for services:

1. It is very clear from these statistics that substance abuse is, indeed, a family disease.

2. Of the people admitted for treatment who have children only a third of them have their children living with them, meaning that their children are being cared for by someone else. Some of these are being cared for by the Counties in Foster Care.

3. Family services such as parenting, family therapy, and reunification services are not funded and rarely provided even though there is a huge need.

4. At GCASA, like most substance abuse agencies, we do provide services to Children of Substance Abusers through our prevention programs knowing that these children are at high risk for substance abuse problems themselves.

GCASA's patients have a huge prevalence of tobacco addiction

About 75% of the patients which GCASA admitted to its outpatient programs in 2009 have used tobacco and about 90% of residential services clients have used tobacco.

Right now the New York prevalence rate for tobacco use is about 18%. Why would substance abuse patients use tobacco at a rate 4 times the general population?

There is some evidence that the same brain chemistry which is at work when someone becomes addicted operates the same way with tobacco.

What are the implications for service delivery?

1. GCASA has a policy that tobacco and tobacco paraphanalia are contraband on GCASA grounds and in GCASA vehicles.

2. The most complaints that we receive from the public are concerning the people who smoke on the public sidewalks in front of GCASA's properties.

3. GCASA aggressively provides treatment for people wishing to quit using tobacco.

4. This coming fall GCASA will not admit any patient to its residential services program that tests positive for tobacco use.

5. Tobacco is the most addictive and deadly drug in America. 410,000 Americans die from tobacco every year, while 100,000 die from alcohol, and only 30,000 from street drugs. Policies and community norms and attitudes are slowly changing to reflect the reality, but as a society we still have a long way to go.

Bobby's coming!

Bobby Militello is coming to Batavia on April, 24th for the First Annual GCASA Evening of Jazz at GCC. For more information click here.

1 in 10 adolescents in New York State has a gambling problem

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Inside McPike Alcohol Treatment Center in Utica, NY

Video lasts 9:58