Inside McPike Alcohol Treatment Center in Utica, NY

Video lasts 9:58

Would you want to be called a "drunk", a "crack head", a "doper"? Watch your language!

How important is language in the substance abuse field? Very important according to Dr. Norman Hoffman, Ph.D. His is part of what he writes in his editorial on BHC Journal.

Equally disturbing are the research reports on treatment outcomes for samples composed of a mixture of abuse and dependent cases. A variety of research studies have shown consistently that dependence is distinct from abuse.2,3 One would be horrified to find an oncologist reporting on the prognoses of patients with “lumps” without differentiating cysts or benign growths from malignancies. We should be equally horrified to find addiction researchers who fail to differentiate dependence from abuse. Failure to distinguish abuse and dependent cases is not just sloppy word usage; it is sloppy science.

Another way dependence is trivialized is by using abuse as the generic term to include both substance dependence and substance abuse. Abuse used as the generic term makes policy makers, elected officials and members of the general public think of all substance use disorders as willful behavior, minor conditions, or “habits” — not serious conditions requiring treatment services. Abuse implies that the person is in control and willfully abusing the substance. Perception becomes reality in the minds of the uninformed. The worst consequence would be to support the contention that public policies just need to make “those people” want to stop by criminalizing that behavior. As for prevention, all we have to do is promote “Just say no.” Remember how that slogan did nothing to cut drug use among the youth of our nation? “Just say no” did for the substance dependent youth what “Have a nice day” did for the clinically depressed.

If addictions and the treatment of substance use disorders are to be taken seriously, we need to call substance use disorders by their formal and technical names — all the time. Addiction to alcohol is alcohol dependence; not alcohol abuse; not problem drinking. Heroin dependence is heroin dependence; not a habit.

Discussions concerning substance use disorders require using the appropriate terms for the conditions in question. Those words need to be used when making the case for why adequate funding of treatment is important.

If professionals in the field do not take addictions seriously enough to use the correct and appropriate terms for substance use disorders, how can they expect the public to take addictions seriously enough to support funding for treatment and prevention?

At GCASA we strive to provide high quality, professional services. Using the professional terminology in appropriate ways is important in communicating with clients, colleagues, referral agents, families, and other community members.

I personally don't like to call people "alcoholics" any more than I would call someone a "diabetic", an "autistic", a "schizophrenic", and/or a "depressive". It is more correct to say that this is a person suffering from diabetes, or schizophrenia, or alcoholism. The disease is not the primary attribute of the person's identity. It is a disease that the person is suffering from. The problem is the problem, the person is not the problem. It is important for us to use appropriate language because it has implications for understandings and for functioning.

71% of Americans say that health insurance should cover substance abuse treatment according to survey done by the Hazelton Foundation

On February 3, 2009 the Hazelton Foundation reported on a survey they did of 1,000 families and found that 71% agree that health insurance should cover the cost of treatment but most did not know if their own insurance would cover it.

Even more interesting is that 56% stated that their employer did not offer Employee Assistance Services for employees suffering from substance abuse, mental health, or personal problems.

About 1/3 or the respondents reported that someone in their immediate family has had a problem with substance abuse.

Here is a snippet from the Hazelton Foundation web site report:

Nearly three out of four Americans (71 percent) agree that health insurance should cover the cost of addiction treatment - yet most consumers have no idea if their own health insurance would pay for substance abuse treatment, according to the first-ever "Public Attitudes Toward Addiction Survey" from Hazelden, the national nonprofit organization that helps people reclaim their lives from drug addiction.

With the passage of the U.S. Mental Health Parity Law last October and the Obama administration now designing its agenda on healthcare issues, it's striking that most Americans (77 percent) agree that addiction treatment should be part of healthcare reform. Hazelden's new survey also found that: most Americans (78 percent ) understand that drug addiction is a chronic disease rather than a personal failing; and more than half (56 percent) say their company doesn't have an Employee Assistance Program to help employees deal with problems involving alcohol or other drugs.

Addiction Still Widespread in American Families
Among the most dramatic of Hazelden's survey findings was the prevalence of addiction within American families:

Nearly one-third of Americans responding reported past abuse of alcohol or drugs in their immediate family - and of those households with an immediate family member who had an addiction problem, nearly half (44 percent) reported more than one family member with a drug problem.
A third of the families which reported a drug problem in their immediate family say that a majority of their family members have problems with drugs. With one in six of the respondents dealing with substance abuse in their family, every member of the family has a problem with drugs or alcohol.
When you expand the questions to include both immediate and extended family, virtually half of Americans surveyed reported three or more family members have experienced a problem with drugs during their lives.

Payors increasingly require accountability for outcomes for substance abuse treatment

The New York Times had a interesting article published on 12/22/08 entitled, "Drug Rehabilitation or Revolving Door?" which discusses the fact that 20 billion dollars per year is spent on substance abuse treatment and there doesn't seem to be clear evidence that it works.

There has been a movement toward evidenced based practice methods to standardize treatment and produce better outcomes.

My problem has been that often in substance abuse treatment there is a one size fits all attitude which counselors articulate defensively as "A drug is a drug is a drug" and yet we are learning continually that drugs are different in many important ways as treatment increasingly is.

The other problem is that for some folks substance abuse is an acute illness which responds well to treatment and for others it is more chronic and persistant and will require ongoing treatment for most of the patient's life much like diabetes or high blood pressure. In this context payors expectations may be unrealistic and inappropriate. Patients require care not cure.

If you would like to read more, you can access the New York Times article by clicking here.

Substance Abuse: A Family Disease - Kathleen Hodgins, B.S.W., CASAC

Kathleen Susan Hodgins, B.S.W., CASAC discusses substance abuse a family disease. Kathy is one of GCASA's Assistant Director of Treatment in Albion, NY.

The video lasts 8:45.

Charles Evans, CASAC-T, GCASA Drug Court Laison

Charles Evans, CASAC-T, has worked at GCASA almost 2 years as a substance abuse counselor in GCASA's Batavia Clinic. Charles is the laison to Genesee County Drug Court, to Genesee Justice which provides pre-trial diversion services, and Charles works in GCASA's Batavia clinic as a substance abuse counselor. Video lasts 6:47.

Cheryle McCann, RN, CASAC describes GCASA's Opiate Treatment Program

Cheryle MCann, RN, CASAC gave a great presentation to the GCASA board at their board meeting on 09/24/08 on the Opiate Treatment Services program offered by GCASA. Cheryle is the Opiate Treatment Services Coordinator for GCASA. She works closely with Dr. Charles King, GCASA's medical director, Barb Bowman, CASAC-T the Opiate Treatment Specialist in the Batavia clinic and all the treatment staff in both Genesee and Orleans Counties.

Here is the outline that Cheryle distributed to board members to follow along as she gave her talk.

Click on image to enlarge for easier reading.

Page one



Page 2



The video of Cheryle's presentation is in 3 parts and takes about 21 minutes altogether.

Part 1 takes about 8:41



Part 2 takes about 9:58



Part 3 takes about 1:48

GCASA's Albion Clinic - Meet Roxanne Muoio, Assistant Director of Treatment

You can click on images to enlarge.

GCASA serves primarily Genesee and Orleans counties. It's main clinics are in Batavia, NY and Albion, NY the county seats of Genesee and Orleans Counties respectively. GCASA also has satellite clinics in LeRoy and Indian Falls in Genesee County, and in Holley and Medina in Orleans County.

Today, I visited our Albion clinic, saw a client, and then talked briefly with Roxanne Muoio, the Assistant Director of Treatment for Orleans County. Roxanne and her staff do a great job.

Here is a video of her chat with me. I will post our interviews with her two new staff, Rebecca Carr, and Dawn Bumburger in later posts to the blog.

Video lasts about 4:00

Substance abuse treatment can save later medical costs

Susan Brink wrote a brief article in the June 30, 2008 Los Angeles Times based on a study reported in the Journal of Substance Abuse Treatment which found that substance abuse treatment can save on medical treatment on down the line.

Subtance abuse professionals have known this for years, but HMO's ignore these findings because they are mostly interested in short term savings since so many people change their health coverage from year to year. However, as a nation it would make good economic as well as human sense to treat substance abuse disorders earlier rather than later. Here is a snippet of Susan Brink's article.

DRUG AND alcohol abuse sets people on a path toward heart disease, cancer and other chronic illnesses. A study in the Journal of Substance Abuse Treatment reports that hospital costs for this medical fallout can be substantial -- and could be avoided with more drug and alcohol treatment.

Lead author Patricia Santora of Johns Hopkins University School of Medicine and colleagues found that 14% of people admitted to Johns Hopkins Hospital from 1994 to 2002 were alcohol or drug abusers. Of these more than 43,000 patients, the researchers found, about half abused two or more drugs, resulting in hospital costs in 2002 of $28 million. An additional 25% abused alcohol only, incurring $20 million in hospital costs in 2002. (Treatment costs rose in each year of the study period.) "Virtually all . . . were admitted for the medical and psychiatric consequences of their abuse," Santora says.

Patients with drug problems were more likely to be on Medicaid or Medicare; alcoholic patients were more likely to have private insurance. Researchers noted that both types of insurers spend very little on addiction treatment to prevent medical consequences of abuse -- less than 1% of private insurance claims and less than 2% of Medicaid claims. "This is one university hospital," Santora says, "but you know it's being repeated at thousands of hospitals across the country."

DePaul to withdraw from providing addiction services. RFQ issued by Monroe County

DePaul Addiction services will be closing their inpatient beds in mid-August. Monroe County has contracted with Coordinated Care Services, Inc. (CCSI) to issue an RFQ (Request For Qualifications) to providers who might want to operate the inpatient rehabilitation, detox, outpatient clinic, community residences, and supportive living programs. GCASA is considering submitting an application to operate the outpatient clinic, community residences, and supportive living programs.

The RFQ states that Monroe County substance abuse programs will be given preferred provider status, but regional and other providers' applications will also be considered. Should GCASA apply? Leave your comments or send them to me at dmarkham@gcasa.org.

Click on image to enlarge for easier reading.