Hospitalizations from prescribed drugs is rising faster than from illicit substances

Psychiatric News reports in its May 21, 2010 issue that hospitalizations are rising faster for abuse of prescribed drugs than for illicit substances.

You can learn more by clicking here.

The effects of heroin

High for a night; slow for a month

Orleans County DWI Poster Contest Winners celebrated on May 25th

From the Daily News article in part:

HOLLEY -- An annual poster contest is just one way GCASA attempts to spread the word about substance abuse to youths in Orleans and Genesee counties.

Tuesday night at Hickory Ridge Golf and Country Club, 13 students received awards for their posters which completed the sentence, "I want to be drug-free so I can ..."

All of us use drugs, but only some of us go to jail

Why is Deshawn Joseph in jail and Rush Limbaugh still on the radio?

To read the brief article click here.

Non-profit funding is not outcome based

How does a non profit substance abuse agency measure its success and determine whether it is great?

Many agencies historically reported on outputs: number of clients served, number of counseling visits provided, number of bed days utilized, etc.

In the 1990s there was quite a revolution in the human service field when the focus shifted from outputs to outcomes; in other words what difference do the outputs make?

At GCASA, we are asked if the substance abuse rates are coming down? We are also asked how many clients "do you cure?"

The answer is that prevalence rates of substance abuse are coming down. DWI fatality rates are at an all time low and are the lowest in New York State than any state in the country, and about 2/3rd of GCASA's clients discontinue their drug of choice by the end of their treatment at GCASA.

These outcomes are accomplished with the most cost effective programming in the country and the state.

GCASA has a three part goal: to provide good outcomes, cost effectively, that are customer satisfying - good, cheap, fast: pick two.

The ironic thing is that even though GCASA has produced exceptional results, very cost effectively, and with excellent customer satisfaction, there is no money in it. GCASA's continuing access to resources is constantly being threatened and diminished. Working in the nonprofit sector is unlike working in the profit making sector. As Jim Collins writes in his booklet "Good To Great and The Social Sectors",

"In the social sectors, the critical question is not 'How much money do we make per dollar of invested capital?' but "How effectively do we deliver on our mission and make a distinctive impact, relative to resources?'"

The answer is that GCASA delivers tremendously on its mission relative to resources. While it costs over $35,000.00 per year to keep a person in County jail or State prison, it costs less than $1,600.00 for a single episode of substance abuse outpatient treatment.

According to the recent OASAS scorecard, GCASA performed at higher than average levels when compared to other OASAS licensed facilities and yet it receives less resources than other similarly licensed programs. It is not clear why other than that GCASA's superior performance has required less support up until now. It is not unusual in the nonprofit world for State funders to cannibalize its best performing agencies. High performing agencies appear to have less need and therefore obtain less support. It is counter intuitive and many citizens and board members don't understand how non profit funding really works.

While GCASA has better than average outcomes and can prove it, it does not mean that GCASA obtains more resources to sustain its high level of performance. This is a shame and endangers the whole broader system of care.

What's wrong with the nonprofit sector?

I am reading Jim Collins little companion booklet, Good To Great And The Social Sectors, which is a companion to his hugely successful business book, From Good To Great, and here is what he writes in part:

"In the social sectors, by contrast, there is no guaranteed relationship between exceptional results and sustained access to resources."

When GCASA responded to Wyoming County's RFP for substance abuse providers in Wyoming County, GCASA learned that OASAS deficit funding to Wyoming County is approximately three times the deficit funding to Orleans County even though the operations are approximately the same size. Why would one county get three times the state deficit funding? No one seems to know.

Through the decade of 1999-2009, GCASA performed exceptionally well in Orleans and Genesee Counties with increased productivity which allowed GCASA to return almost $500,000.00 back to the OASAS system in the Western New York regional office. This was money which was used for Horizons and other agencies that compete with GCASA. It seems odd that OASAS would cannibalize one of its best performing agencies, but that is exactly what happened so that in 2009 - 2010, with no increase in deficit funding and reimbursement rates, GCASA has had to cut some of its core services such as satellite offices, crisis services, and voc rehab services.

Collins goes on to write:

"As Clara Miller shows in her superb article, 'Hidden In Plain Sight', nonprofit funding tends to favor programmatic funding, not building great organizations: 'If you have a surplus, why should I give you a grant.'"

GCASA has become a great organization with National recognition from CADCA, NASADAD, Alcohol and Substance Abuse Counselors of New York State, etc., and yet ongoing support from collaborative partners who perceive the agency,erroneously, as being rich, is challenging for agency growth.

GCASA looks forward to continuing to grow and prosper and yet it cannot depend on its previously supportive partners to do the right thing. More immediate concerns and short sighted considerations often take precedence.

GCASA Cares poll shows overwhelming support for raising taxes on alcohol to pay for substance abuse prevention and treatment services

In the last GCASA Cares poll asking if taxes on alcohol should be raised to pay for substance abuse prevention and treatment services, 100% of the respondents said, "Yes".

Although the participation was low, only 7 people voted, and are probably biased since they visited the GCASA Cares blog, nonetheless, it was interesting that in our small part of the world, people are for raising taxes on alcohol.

Thanks to all those who participated.

GCASA's annual meeting will be on 05/26/10

Click on image to enlarge for easier reading.

Joe Califano on The View discusses how to raise kids to be drug free

Joseph Califano, the President of the Columbia Center on Alcoholism and Substance Abuse on the View.

Over 25% of females aged 12-17 have engaged in violent behavior in the previous 12 months

GCASA staff noticed at the Darien Lake Senior Day compliance checks that females apprehended were much more violent and verbally abusive than the boys. Now there is some data to back up that anecdotal observation.

SAMSHA's National Drug Abuse and Household Survey found that over 25% of girls aged 12 - 17 have been involved in violent behavior in the past 12 months. The prevalence in violent behavior increases with a decrease in socio-economic status.

You can read the brief article by clicking here.

Senior drug abuse

I have always gotten a kick out of the fact that so many substance abuse prevention programs focus on kids while the elephant in the living room is the adult substance abuse. Here is a chart from SAMSHA which graphically portrays the problem.

Washington DC approved the use of medical marijuana

The New York Times reported on May 4, 2010, that the Washington, DC city council will aprove medical marijuana. Here is what the article says in part:

The District of Columbia Council approved a measure on Tuesday that would allow people with certain chronic illnesses to obtain medical marijuana from a handful of dispensaries regulated by the city.

The 13-member Council voted unanimously to allow doctors to recommend marijuana for people who are infected with H.I.V., as well as people with glaucoma, cancer or a “chronic and lasting disease.”

The legislation permits Mayor Adrian M. Fenty to establish up to eight dispensaries where patients could receive two ounces of marijuana a month. The measure gives the mayor the option of raising the amount to four ounces without further council action.

Some doctors say marijuana helps relieve nausea, vomiting, certain AIDS symptoms and some side effects of chemotherapy. For glaucoma patients, the drug is believed to help lower eye pressure.

Most teens killed in car crashes except for black teens who are murdered

The CDC (Center For Disease Control) reported on May 5, 2010 that about 16,00 teenagers die in the United States every year and most of them are killed in auto crashes.

The largest number of teens to die by race are African American males and the majority of them are killed by homicide. If these were white kids being murdered would society have a different response?

From the CDC web site:

Of the more than 16,000 teenagers who die in the United States each year, most are killed in automobile accidents, but murder, suicide, cancer and heart disease also take their toll, a new government report finds.

In fact, among black male teens, homicide is the leading cause of death, said report author Arialdi M. Minino, a statistician at the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics.

"This is a group of people we don't pay much attention to when we talk about mortality," Minino said. Teen deaths account for less than 1 percent of all deaths per year in the United States, he noted.

Still, Minino thinks that more needs to be done to cut the number of teenage deaths.
"These are preventable causes of death," he said. "So, this is a group where we can extend ourselves so kids won't die, by extending common sense ideas."
Each year in the United States, an estimated 16,375 children between the ages of 12 and 19 die. Nearly 50 percent die in accidents, with car crashes accounting for more than one-third of all deaths, Minino found.

But among black male teens, murder is the leading cause of death. Moreover, the highest teen death rate is among black males at 94.1 deaths per 100,000 people. "That's 50 times more than among white males. That's a very large disparity," Minino said.

While I don't have data collected, I anecdotally know several teens who have been killed in car crashes in the last decade and several murdered. These deaths, of course, are totally preventable.

Who's smoking in New York?

In April, 2010, GCASA was informed by the New York State Department Of Health Tobacco Control Program that it has been awarded a grant for $170,000.00 to resume the Smoke Free NOW coalition in Orleans, Genesee, and Wyoming Counties.

The smoking prevalence rate in New York State has dropped to about 16-18%. New York will not meet the Healthy People 2010 goal set by the US Health and Human Services of 12% but there has been a big decrease in smoking prevalence rates in the last decade.

To learn more about who is smoking in New York click here for the report published in October, 2007, by the New York State Department Of Health.

Adolescent binge drinking

Drop in percentage of 11th graders in Genesee County who binge drink

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 33.8% of 11th graders in Genesee County reported that they had binge drank (5 or more drinks on a single occassion) in the previous two weeks.

2002, the rate dropped to 29.5%.
in 2004, to 29.2%,
in 2006, 24.6%,
and in 2008, 23%.

In 8 years that is a drop from 33.9% of kids to 23%.

Could it be that the Tip Line, compliance checks, sticker shock, schools enforcing their Code of Conduct, and increased police interventions are making a difference?

This is article #3 in a series on Prevention Statistics.

Are genes to blame for bad behavior?