Archives for Public Policy

addiction

What we’re missing in treating addiction

Addiction is a disease of the brain. Over and over and over we heard this at the recent National RX Drug Abuse & Heroin Summit in Atlanta.

The president said it. His drug czar Michael Botticelli, said it. Dr. Nora Volkow, head of the National Institute on Drug Abuse, said it, along with the heads of the Centers for Disease Control, the Substance Abuse and Mental Health Service Administration,...
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Alcoholism

How private are a drug addict’s treatment records?

The confidentiality of alcohol and drug abuse patient records is under the government's microscope. The Substance Abuse and Mental Health Services Administration - SAMHSA - has filed notice of rule-making for such records. The proposed changes to 42 CFR Part 2- HIPPA - were published in Federal Register on Feb. 9. It's been 29 years since there have been any substantive updates to the Confidentiality of Alcohol and Drug Abuse Patient Records regulations. A lot has changed, especially the recent push for an integrated, continuum of care and the use of electronic medical records. I say changes are needed because you have a bunch of 20-something-year-old newly recovered addicts owning and operating some of the HIPPA-protected treatment programs, such as intensive outpatient programs, called IOPs. They, in turn, share a patient's health condition with their "clinical staff" - who are also newly recovered 20-something-year-old addicts who have little or no formal training and often no more than a high-school diploma.
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General

Why you don’t know how much mental illness and drug abuse is really in your community

It's Sunday night. I am sitting at my desk in the newsroom. I am a reporter and every couple of months I pull a weekend shift. The newsroom is quiet and I can hear the police scanners clearly. During the day, with all that's going on in the newsroom, the scanners are just white noise. The cop reporters pay attention but to the rest of us, they are annoying. If you want an idea of how much mental illness and substance abuse is out there, listen to the police scanners in a major metropolitan area, like South Florida, where I work. Some agencies use human dispatchers but many of the calls are announced by a computer with a Siri-esque voice. Rescue 12. Responding to area 19. Overdose intoxication. 123 Main Street. Tac 2a. Rescue 6. Responding to area 12. Suicide attempt. 456 Main Street. Tac 6.
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Public Policy

Mental health groups ask Kenneth Cole to remove billboard

Twenty-three mental health organizations delivered a letter to fashion designer Kenneth Cole this morning, protesting the bizarre billboard Cole posted on a New York City highway in August that was supposed to support  mental healthcare reform and gun reform.

Two comments:

1. Thank God the country's most prestigious mental health organizations have taken a strong, united stand in urging Cole to take down the billboard.

2. What the hell was Cole thinking?

When the words mental illness...
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Alcoholism

Drug treatment: How many times will you go to go to rehab before you realize it isn’t working?

This is going to make some people mad. I'm going to say it anyway. Why do addicts and alcoholics go to rehab over and over and over if it doesn't work for them? If you had cancer and you did 10 rounds of treatments and they weren't working, would you keep going? I know you are going to say relapse is part of the disease. But if you relapse over and over and over and over, why go back to the same treatment? At a certain point you have to stop blaming the disease for your relapse and realize the treatment you are doing for your disease simply isn't working. Stop going to rehab. Stop paying tens of thousands of dollars for a treatment protocol that isn't working for you. I'm not saying that rehabs don't work. They do - for some addicts and alcoholics. Treatment will work for the highly motivated addict or alcoholic who won't be distracted by the cushy, resort-like facilities that offer massages, tai chi, golf "therapy" and meditation on a Florida beach.
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Dual-Diagnosis

Why the religion of the Chattanooga shooter trumps his depression

Now we learn that Muhammad Abdulazeez, the gunman who fatally shot four Marines and a sailor at a recruiting office and naval reserve center in Chattanooga  last week, had depression and self-medicated with drugs an alcohol. Normally, this would spark the usual debate on whether depression can make someone homicidal. The media would tell us that yes, in very, very rare cases depression could cause homicidal thoughts but much more common are suicidal thughts. And the media would tell us that some anti-depressants can make depression worse and that Abdulazeez had taken anti-depressants. However, in this case the media is more focused on whether Abdulazeez was a Muslim terrorist whose alleged fanaticism was sparked by a lengthy trip to the Middle East last year. The media is throwing the word Isis into their coverage and voila! They've got a gazillion hits on social media.
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Alcoholism

Government scrubs substance-abuse data but doesn’t tell researchers

What if the government decided to withhold the data it gathers on an insidious mental illness that affects nearly one in ten Americans and did not bother to tell researchers it had done so? It happened. The data are collected by the Centers for Medicare and Medicaid Services. The mental illness - substance abuse. The New England Journal of Medicine exposed these shenanigans and explained the consequences in an article published in April: Protection or Harm? Suppressing Substance-Use Data, by Austin B. Frakt and Nicholas Bagley. According to the authors, the CMS began to withhold from its data sets, called the Research Identifiable Files, any Medicare or Medicaid claim with a substance abuse diagnosis. Why? Patient privacy concerns. Why didn't the CMS tell researchers? Good question.
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Public Policy

Why the military can’t get suicide prevention right

Last Friday, the Inspector General of the Department of Defense released a report called the Suicide Event Report Data Quality Assessment. I had no idea what the assessment was about but I am devoted to suicide prevention and intrigued by data so I gave the 100-page report a read. When an active service member commits suicide or attempts suicide, a Suicide Event Report is compiled. The report is an investigation of the suicide and circumstances leading up to it. It is a sort of psychological autopsy that is supposed to provide military leaders with reliable information on suicide risk factors that will assist in designing effective suicide prevention efforts. The IG decided to investigate how Suicide Event Reports are compiled after finding a high number of  "don't know/data unavailable" responses to questions in the 2011 Annual Report - the most recent year available.  Here are the questions that received the most "don't know/data unavailable" reponses: You would think that these are among the most important questions in determining why someone committed suicide. So, why couldn't the folks assigned to complete these reports answer these questions?
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In My Experience

How the Media Covers Suicide: Day 2

Covering Suicide and Mental Illness is a three-day seminar for journalists sponsored by The Poynter Institute, The McCormick Specialized Reporting Institute and the Action Alliance for Suicide Prevention. Here are my thoughts on issues covered during today's session. #suicidereporting Today we learned some really wonderful techniques on how to cover suicide. Unfortunately, they aren't very practical. For example, it was suggested that we not use the word "suicide" in a headline. Really? Not only does it become impossibly difficult to write a headline about a suicide and not use the word "suicide," in these days of SEO-driven journalism, you must put the word "suicide" in the headline or your editor will. Headlines are no longer about the sexiest verb we can find. Headlines are about SEO and using words that Google Trend tells us will attract readers. Suicide is one of those words. We were also given suggestions on how to speak with family members at the scene. First of all, if you go to a suicide scene and there are any family members present, the cops aren't going to let you speak with them until they have ruled the death a suicide and not a homicide. This means you won't have a prayer of getting an interview with a family member until the cops have finished their interviews. I've been doing this for 30+ years and the chances of  family members wanting to speak with you after what they have been through - the suicide itself and then an interview with the cops - are slim to none. With homicides, you can often get a family member to talk and even give you a photo of the victim. But suicide - no way.
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General

Justifying late-term abortions: Mother’s mental health is not enough

Last week Florida lawmakers passed a law banning most abortions during the third-trimester. A doctor who performs an abortion during the third trimester and anyone who assists can be charged with the third-degree felony. However, the law makes an exception when a "physician certifies in writing that, in reasonable medical judgment, there is a medical necessity for legitimate emergency medical procedures for termination of the pregnancy to save the pregnant woman's life or avert a serious risk of imminent substantial and irreversible physical impairment of a major bodily function of the pregnant woman other than a psychological condition." Without wading into the debate over abortion, I would like to weigh in on the exception in the exception of  "a psychological condition."
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