31Jul/15

How Governor Christie Can Redeem Himself (a little)

Governor Christie has almost no chance at becoming President. I thought this long before his administration backed up the George Washington Bridge (David Simon wrote my favorite take on it here). The Bridge exposed what a number of politically astute and connected individuals already knew to the rest of America – he’s a vindictive bully who sees slights that sometimes aren’t there.

Mr. Christie seemed to be an early favorite as Mr. Romney’s running mate. They met several times in the years running up to the 2012 election. But Romney’s people were appalled at what they found when they looked closely. Here is an excerpt from the excellent Double Down, published in 2013:

He (Christie) was also a fundraising dynamo, but he and his staff were overbearing and hard to work with, demanding in ways that would have been unthinkable from any other surrogate. Months earlier, Christie had banned Romney from raising money in New Jersey until Christie had given the O.K. to do so—a move Romney found galling, like something out of The Sopranos. Are you kidding me, Mitt thought. He’s going to do that? There were plenty of New Jersey donors who’d given money to Mitt in 2008; now Christie was trying to impose a gag order on talking to them?  “He sounds like the biggest asshole in the world,” Stevens griped to his partner, Russ Shriefer. More recently, Trenton insisted on private jets, lavish spreads of food, space for a massive entourage. Romney ally Wayne Berman looked at the bubble around Christie and thought, He’s not the President of the United States, you know.

Chronically behind schedule, Christie made a habit of showing up late to Romney fundraising events. In May he was so tardy to a donor reception at the Grand Hyatt New York that Mitt wound up taking the stage to speak before Christie arrived. When the Jersey governor finally made his grand entrance, it was as if Mitt had been his warm-up act.

Punctuality mattered to Romney. Christie’s lateness bugged him. Mitt also cared about fitness and was prone to poke fun at those who didn’t. (“Oh, there’s your date for tonight,” he would say to male members of his traveling crew when they spied a chunky lady on the street.) Romney marveled at Christie’s girth, his difficulties in making his way down the narrow aisle of the campaign bus. Watching a video of Christie without his suit jacket on, Romney cackled to his aides, “Guys! Look at that!”

But Mitt was grateful for Christie’s endorsement and everything else he’d done. He appreciated Chris’ persona, his shtick, his forcefulness, his intuitive connection with voters. That night at the Grand Hyatt, at a high-dollar dinner after the main event, Christie’s argument for Mitt was more compelling than anything the nominee could manage.

The list of questions Myers and her team had for Christie was extensive and troubling. More than once, Myers reported back that Trenton’s response was, in effect, Why do we need to give you that piece of information? Myers told her team, We have to assume if they’re not answering, it’s because the answer is bad.

The vetters were stunned by the garish controversies lurking in the shadows of his record. There was a 2010 Department of Justice inspector general’s investigation of Christie’s spending patterns in his job prior to the governorship, which criticized him for being “the U.S. attorney who most often exceeded the government [travel expense] rate without adequate justification” and for offering “insufficient, inaccurate, or no justification” for stays at swank hotels like the Four Seasons. There was the fact that Christie worked as a lobbyist on behalf of the Securities Industry Association at a time when Bernie Madoff was a senior SIA official—and sought an exemption from New Jersey’s Consumer Fraud Act. There was Christie’s decision to steer hefty government contracts to donors and political allies like former Attorney General John Ashcroft, which sparked a congressional hearing. There was a defamation lawsuit brought against Christie arising out of his successful 1994 run to oust an incumbent in a local Garden State race. Then there was Todd Christie, the Governor’s brother, who in 2008 agreed to a settlement of civil charges by the Securities and Exchange Commission in which he acknowledged making “hundreds of trades in which customers had been systematically overcharged.” (Todd also oversaw a family foundation whose activities and purpose raised eyebrows among the vetters.) And all that was on top of a litany of glaring matters that sparked concern on Myers’ team: Christie’s other lobbying clients, his investments overseas, the YouTube clips that helped make him a star but might call into doubt his presidential temperament, and the status of his health.

The Republican establishment was scared of him before the GW. Some argue that no one likes him. His popularity crashed after the mess on the Bridge, and paper after paper started writing articles about the fear-mongering and scandals. Some people were on him even before the 2009 election, and some started coming up with an amazingly detailed list of his scandals by 2010. In the past 18 months, the Governor appointed an ally to the ethics commission (which is supposed to investigate elected and appointed officials engaging in malfeasance), got free Cowboy tickets, oversaw the 9th credit downgrade during his tenure, and gave a sweetheart deal to Exxon at the expense of the environment and NJ taxpayers. He’s spent almost half of 2015 out-of-state, making Barbara Buono’s 2013 campaign statement that “I’m the only one in this race running for Governor” very prescient.

It is obvious that Mr. Christie is hoping that he can use the GOP debates (if he makes the top-10 cut) to MacGyver his way up the charts. While there might be some interesting fireworks, it’s incredibly unlikely. As the previous paragraphs lay out, Mr. Christie’s chances at the GOP nomination were dead before arrival. I’m hoping that he doesn’t hang around a la 2012 Rick Santorum. I’m sure it would be entertaining, but he still has a job. He’s supposed to govern NJ through the end of 2017.

It’s no secret that the Governor has largely been a disappointment to me. His administration delayed the NJ Heroin and Other Opiate Task Force report for months, and then mostly ignored our recommendations. He has not supported the NJ Recovery High School with money nor words. When he does speak up in favor of an issue (college for prisoners – which reduces recidivism and saves money), he usually does not fund it with any money (big words, small deeds). Last October, he made a big announcement that he was allocating new money towards alcohol and drug prevention and treatment. It turned out that it was 12 million dollars, or .0037 of 1% of the state budget.

Despite all of this, I’m rooting for him to have a successful last two years as my Governor. I’m only going to address what he can do about mental health and addiction prevention, treatment and recovery support services (the budget, pensions, property taxes, economy, education, Hudson river crossings, Sandy and other issues I’ll beg off for now).

(1) Expand the drug courts and fund them.

(2) Develop and implement a prescription drug education program to be taught to students throughout NJ, starting at age 10

(3) Decriminalize marijuana.

(4) Mandate the prescription drug monitoring program (recently, he signed a bill that requires providers to check it every 3rd time, which is actually real progress).

(5) Consider early release of non-violent drug offenders who were given harsh sentences for possession of drugs (the Vera Institute of Justice estimates that it costs NJ between 50 and 60 thousand dollars to incarcerate someone here).

(6) Incentivize the creation of supportive housing for people with mental health and/or addiction disorders. Those houses need to be licensed or regulated though, as otherwise they’ll be full of abuse and neglect and will just add to the current problems.

(7) Speak out on behalf of the NJ Recovery High School in Union County. It bears Senator Ray Lesniak’s name (they hate each other), and by doing so it would show that the Governor can rise above petty feuds. It will also help get the word out about the school, which is suffering from low enrollment, despite the obvious need for it to exist.

Governor, you can play at being a candidate a little while longer while summer lingers. But come the fall, we need you back in Trenton working on these issues. Winter is coming (it’s partly your fault, but that’s not really helpful) and you have a brief opportunity at doing some good in the guaranteed twilight of your political life.

30Jul/15

It’s Time To Finish the Reconstruction of the South

In June, a white Southern terrorist killed nine black AME church members in Charleston, South Carolina. The shooter, an uneducated racist, purchased his gun legally. Within a few days, family members of the victims forgave the shooter. They demonstrated a grace that I respect but cannot comprehend. A national conversation about guns did not follow (this is unsurprising). There was much talk about race relations and the conditions of the South, but the only major changes we’ve seen are surrounding the Confederate Flag.

I’ve been a Civil War buff since I was 5 years old. When I was 10, my parents bought me a Civil War chess set. I’ve been to all of the major battlefields and a number of minor ones. My house is adorned with photographs of Lincoln and Grant, and I have a painting of Sherman as he marches through a burning Atlanta. I have been offended by the Confederate Flag my entire life. I’ve taken them off of people’s boats and houses – I ripped them up and threw them in the trash. When I was 22, I got into an argument with two Georgians over the Confederate Flag that hung on the back of their pickup. The situation escalated and one pulled a gun on me (it is the only time in my life that has happened – I’m wiser now).

The Confederate Flag represents slavery and treason. The South rebelled because their way of life was threatened, and they claimed that states’ rights were more important than Federal laws. States’ rights were (and are) the mask that reactionaries hide behind in order to protect the status quo – make no mistake that the war was fought over slavery (and I’m so tired of hearing people talk/write about this subject that have little or no knowledge about it). Those that bore arms against America and pledged allegiance to the Confederacy are traitors and they are guilty of high treason. Their flag represents their intense anti-American beliefs. Those that fought under the flag killed Americans. They should not be celebrated.

All that said, I am clearly ecstatic that South Carolina removed the flag from a momument near their state house. I was also pleased that Sears, Walmart, Ebay and Amazon announced that you could no longer buy Confederate Flags and Confederate Flag-laden procuts on their sites. Jon Oliver pointed out the one negative part of getting rid of Confederate Flag products: “the Confederate Flag should only be found on t-shirts, belt buckles and bumper stickers to help the rest of us identify the worst people in the world.” I’m happy to see America finally come around to this.

Early last week, there was a story in the Times about the battle over the what should be done with the statue of Nathan Bedford Forrest that proudly stands in a downtown Memphis, TN park. I saw that very statue in June of 2013 and was extremely offended by its presence. He is buried there as well. I spat on it and wished I could have torn down the statue and razed the grave. Besides being a traitor and defender of slavery, Bedford massacred black American troops that had surrendered at Ft. Pillow (his supporters deny this — seriously, he has supporters in 2015?) and he was an early, if not founding, member of the the Ku Klux Klan. He does not deserve a statue; only our scorn and antipathy.

I was pleased to learn that the Memphis City Council unanimously voted to move the grave and statue on July 7, 2015, and now there are a few more hurdles to overcome before the process can be moved along. That is an outstanding development, and one that I hope will be repeated throughout the South. In addition to removing the Confederate Flags from state houses and monuments (and banning its sale), I move that all the statues of Confederate politicians, officers and soldier’s should be torn down.

And that is still not enough. There are roads named after Confederates. It’s time to change their names. There are military bases named for Confederate Generals, such as Forts Pickett, Benning, Bragg, Polk, A.P. Hill, Rucker, Beauregard, Lee, and Hood. Two years ago, a man from NJ (not me) created a White House petition to change those names. It received less than a thousand signatures. We should try that again. In June, the Pentagon announced that the names of those bases won’t be changed. I’m quite sure that they eventually will be changed. It will not be fast enough for me, but it is going to happen. The history of America shows that she continually progresses forward, though sometimes it is slow, sloppy, violent and unfair.

These are symbolic changes. They don’t address the repealing of the Voting Rights Act, inadequate schools, disproportional arrests, draconian sentences and a vast array of other examples of institutionalized racism.

As a kid and young man, I despised the South. I was gruff with whites from South Carolina and Georgia, as their states were the worst actors before and during the Civil War. Mississippi and Alabama earned my disgust with their post-war actions and fights against progress. But generations die off and new ones replace them. The South is better than it was in 1860 and 1960. Change is coming (Strom Thurmond’s (!) son spoke out against the Confederate Flag). My stance towards the South has softened as well – I like their barbeque, some of their rock music (Skynyrd, Allman Brothers, Marshall Tucker) and the amazing Smokey Mountains. The region is worthy of redemption. It’s time to finish reconstruction.

 

22Jul/15

What is Multi-Family Therapy?

I would have liked to have worked with this family from Chicago.

I’ve been running multi-family therapy groups since 2005, and I think they are an essential part of any meaningful treatment for people that have either a substance misuse problem and/or a mental health concern. I ran the adult Multi-family group at Hunterdon Drug Awareness for 2.5 years and the adolescent one there for 5 years. For the last year, I’ve proudly co-facilitated the Multi-family group at College Recovery on Thursday nights. A strong Multi-family program has three parts:

(1) A group for clients-only that meets to discuss their own issues and their hopes/joys/concerns/fears/anger/resentment regarding their families.

(2) A group for family/friends/spouses only that meets to discuss their hopes/joys/concerns/fears/anger/resentments regarding their loved one who is in treatment. There should also be a strong element of psycho-education in this group, as well as an introduction to Al-Anon, Nar-Anon, Families Anonymous and a suggestion that family members get some individual, outside therapy as well. A lot of the advice that I’ve written for family members has sprung out of these groups.

(3) Groups 1 and 2 should happen at the same time and last 60 to 90 minutes. After a short break, the Multi-family group brings all the clients and all the family members together for 90 minutes.

Ideally, the Multi-family group should consist of 12 to 30 participants (it takes a strong facilitator to handle a group above 20). Each week, the following should happen at the start of group:

a) ground rules are set – members may not fight about what is talked about in group nor use it as a weapon against each other; cell phones off or on silent; one person speaks at a time; no yelling or cursing (well, I curse, but not at people…it’s part of the stand-up flavor of my groups)

b) confidentiality is explained – if members feel that other members have talked about them outside of group, they should talk to one of the counselors. There are five ways in which a counselor can talk about a client, and they include: a court order, record release, medical emergencies, elder/minor abuse, and threatening to harm oneself or others. If a member thinks that a therapist has talked about them outside of the program and it isn’t for one of the above five reasons, they should bring it up with the clinical director. This is important because people need to feel safe in a group. A good program explains confidentiality and group rules to all of its participants each week

c) introductions – everyone should state their name, where they are from, why they are here, how long they’ve been coming to group and then some kind of fun fact (it should be a theme each week – recently I’ve asked people to say their favorite condiment, time they were coldest, favorite charity/cause, and the actor/actress that they would cast to play themselves)

d) psychoeducation – each group should have a 10 to 30 minute educational component, where family roles, communication styles, brain chemistry, diagnoses, codependency, soft & hard skills, finances and/or other topics are covered

At this point, group turns to an activity or series of conversations. It can be daunting for first time attendees, so they are eased in very slowly (like a fish that you just brought home from a pet store – you let it sit in the bag of water for a while). Some people come every other week or once a month, and that can be helpful and therapeutic for their family. Without question though, Multi-family groups benefits clients and family members who show up on a weekly basis. Here are some of rewards:

a) normalization – Members realize that their problem is a common one, even universal. So often, families don’t discuss their problems because of shame. They think, “Our family is so screwed up,” and, “No one else goes through this,” or, “This is really embarrassing.” Watching and listening to other families talk about and work through these problems helps reduce the shame and stress and allows us to starting addressing the behaviors and emotions.

b) learning -This is a follow up to normalization. Families that come on a regular basis get to observe other families that come on a regular basis. Some of those families are ahead of them, and they can look to them to see the progress and hope. Other families come in after them, and they get to role model for them and also see just how far they have come. A 20 year old man may be extremely frustrated and annoyed by his mother, but he might be able to sympathize with someone else’s mother in the group when she talks about the sleepless nights, anxiety and heartache that she has experienced. By identifying with her, he is able to see his mother in a different light.

c) support – A new community (even culture) is created in the Multi-family group. Members watch, listen, share, laugh and cry together for a number of months. Bonding takes place. We root for each other, and celebrate when good things happen. It truly is a community.

d) practice - Multi-family group gives members a safe place to practice new forms of communication. They both watch others and practice themselves how to address someone without yelling, cursing or belittling and how to answer without rationalizing, excusing or blaming. Members are given multiple sessions on how to identify, acknowledge, accept and ultimately share their emotions. When people become more emotionally mature and supplied with better communication skills, they begin to see their relationships improve.

It is important that family group be long enough (I have found that 90 minutes is ideal). The group room needs to be large and comfortable. Staffing is crucial – a single staff member can handle a group up to 15 people, but anything more than that should have two counselors in it (but it is a good idea for any sized Multi-family group to have two therapists). Those counselors should work together well, observe all the group members (and constantly scan for non-verbal cues and inattention). Both should have a strong working knowledge of the clients and their family members and, perhaps most importantly, bring a strong sense of levity and humor to the situation.

14Jul/15

So You Want To Be A Therapist

I love teaching. I’ve taught one or two classes a semester at the Rutgers School of Social Work since 2011 and have co-taught a senior seminar at the Rutgers School of Communications each semester since 2011 as well. On top of that, I also teach professional courses for the Rutgers Center of Alcohol Studies and the National Association of Social Workers. I talk to a lot of aspiring therapists. A number of them express their doubts, concerns and fears to me about becoming a counselor. I received three emails from endeavoring professionals today, and each one of them clearly needed a little pep talk. Let’s get some help from William Shakespeare:

Our doubts are traitors, and make us lose the good we oft might win, by fearing to attempt. – Measure For Measure, Act I Scene IV

Last fall, I wrote a post about what people can do to help when it comes to alcohol and drug problems. Points 7, 8, 11 and 12 were specifically for people who want to become therapists – but those points just instructed people on how to go about becoming a therapist, and not how to deal with the doubts nor how to avoid some of the most common pitfalls. The Rutgers Center of Alcohol Studies Summer School is an extremely important institution to me. I took classes there from 1998 thru 2007 (and again in 2012) and I have taught there for six of the last eight years. I learned a great deal from both the instructors and the other students. At a meeting there in 1998, about a half dozen therapists told me that:

- No one wants a 22 year old therapist, and they especially don’t want one whose only work and life experience involves training to be a therapist. We need to bring a variety of life and work experiences to the table.

- Your first few supervisors will have a profound affect on your style and career. You need to approach the decision of whom to work for like you would when buying a house or choosing a spouse. You need to find someone who is skilled, ethical, hard working, well respected and even-keeled. As a new therapist, you are supposed to lack skills and have doubts. Your supervisor will help you through this period. Choose wisely.

- Do not use the job as substitute for therapy and/or 12-step meetings. Many therapists are terrible at self-care.

- Every therapist should be in therapy, at least for a few years (I prescribe to the notion of on-going therapy). Every counselor gets into this line of work for a reason, usually because of some intense personal experience or because of a friend or family member. We need to continually address and take care of that issue(s), or else it will bleed out in our work and make us less effective.

- Do not think that you have all the answers. Be confident enough to tell people that when you don’t know something and consult with other therapists on a regular basis. Be ready to refer clients to other therapists who specialize in areas that you lack expertise in.

- Try not to become power hungry, and watch this especially in your own relationships.

If you don’t follow this advice, you will risk ending up like this guy or this guy.

14Jul/15

Rutgers Stories of Recovery

On July 3, 2015, a new book about addiction and recovery was released. It is titled Voices of Recovery from the Campus: Stories of and by College Students in Recovery from Addiction. It is available on Amazon for $11.95. It is a collection of 12 stories by students and alumni that are in recovery that went to Rutgers. Some of them showed up at Rutgers as sober 18 year-olds, while others showed up at age 23 with nine months of sobriety and a host of legal troubles and 15 credits from two other schools. A number of the writers drank and drugged and bottomed out at Rutgers, got clean, turned their behaviors around and graduated with a degree. These are their stories.

Lisa Laitman is one of the editors of the book. She began working at Rutgers in 1983 and in 1988 she created the first recovery house on a college campus in the world. All the money from the sale of the book will be used to fund the scholarships and activities for students in recovery at Rutgers.

01Jul/15

What is this black Spider-Man?

Four years ago this summer, a new Spider-Man appeared in Marvel Comics. His name is Miles Morales and he is a half-black, half-Puerto Rican 13-year old from Brooklyn. This new Spider-Man was immediately met with vitriol from reactionary idealogues (here’s a clip from Glenn Beck’s radio show), and more than a few complained about Marvel’s left-wing turn. A lot of irritated fans complained on message boards that this was a publicity stunt or just another way for Marvel to go politically correct. The publicity stunt charges are fair – comics all too often announce big changes in classic characters and then reverse them a  year or two later after the surge in sales dries up. Unlike the momentary changes to the status quo from the temporary deaths of other superheroes or their short-term replacements, this new Spider-Man has remained, and now he is going completely mainstream.

A little background first…(if you don’t have it in you to read 3 paragraphs on the history of comics and Spider-Man, then just skip to the last paragraph)

Spider-Man was created by Stan Lee and Steve Ditko for Marvel Comics in 1962. He’s the most recognizable of all the Marvel characters, and his alter-ego Peter Parker is one of the most developed in all of comics. By the time I picked up comics in the mid-80′s, Marvel’s heroes had been around for over 20 years. In order to deeply follow the stories, I had to read and learn the histories of all of them. The stories build on each other, year after year, decade after decade. This is called “continuity” by the devout (on the flipside, critics have stated that continuity makes it difficult for the new or casual reader to pick up comics). DC Comics handles the problem of continuity by blowing up its universe every 25 years and rebooting (1986 was the biggest one). Marvel has remained adamant that everything that has been published since 1962 is (more or less) canon.

In 2000, amidst sagging sales and claims that comics were a dying form of entertainment, Marvel hired Rutgers alumnus (and history major) Bill Jemas as its new president. He argued that the medium was fine and that the stories were either bad or hard to follow (a great exchange from the history of Marvel: “I have a law degree from Harvard. If I can’t follow a story, it’s not my problem”). He hired a bunch of new writers who had made their bones in independent comics and he helped usher in the Ultimate Universe, where the biggest Marvel icons were rebooted with their origins taking place in the year 2000: X-Men, Fantastic Four, Avengers and Spider-Man. Brian Michael Bendis was tasked with writing Ultimate Spider-Man.

Mr. Bendis has written Ultimate Spider-Man for 15 years (if you want to get a smart young person into comics, go with the first volume of this series). In 2011, he wrote the gut-wrenching death of Peter Parker. A few months later, Miles Morales arrived. He became Spider-Man after being bit by a radioactive spider that escaped from a reverse-engineering experiment in Norman Osborn’s lab. Miles, like Peter before him, is a great kid. He wants to do the right thing. He’s confused, and only has a few people that he can talk to and rely on. His father hates superheroes, his mother just wants him to make it, and his best friend is a Ganke, chubby Asian kid (who, at the age of 13, still plays with legos). Ganke is a friend worthy of Horatio.

Miles is a wonderful human-being and a fabulous character. We get to watch him struggle and grow. I don’t think of him as a bi-racial superhero, but rather a superhero who happens to be bi-racial. More significantly, all of those aforementioned critics and fans were wrong about the motivations behind the creation of Miles Morales. This recent interview on NPR with Brian Michale Bendis sums it up:

Bendis tells NPR’s Arun Rath that being a part of this shift in the comics universe has been a personal journey as well; two of his four children are adopted, one African and one African-American.

“You realize from a first seat that your kids do not have the same representation and things available to them as I did,” Bendis says. “It’s not like I stood up and said ‘I’m going to be more diverse in my writing,’ you just become more diverse because you realize things are needed.”

Adhering to a famed Spider-Man adage — “With great power comes great responsibility” — Bendis says that with the stage he has at Marvel, it’s partly his responsibility to create work that represents what he thinks the world should look like.

23Jun/15

The Legislative History of the Nasty Fight to Get Insurance Companies to Pay for Mental Health and Addiction Treatment

 

There is an interesting bill before Congress right now that attempts to address a number of issues regarding addiction and recovery that I believe make a great deal of sense. It is both forward thinking and comprehensive, but it does not address what I view to be the biggest issue facing addiction treatment and recovery support in this country – the reluctance of insurance companies to pay for addiction treatment. This is not the fault of the lawmakers and policy wonks who wrote this bill, but rather the failure to implement and enforce the Mental Health Parity Act of 1996, the Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act of 2010. Each act attempted to address the fact that insurance companies either  (a) do not pay for mental health and/or addiction treatment or  (b) pay for treatment but to a much lesser extent than other illnesses.

Since I chaired the Task Force on Heroin and Other Opiates in 2012, I have heard from at least one parent a week of a young person who died – all of the stories are heart wrenching and a number of the deaths were because the patient was either discharged from treatment too early when insurance ran out or they never could get treatment paid for by their insurance companies in the first place. I spent the last four years working on a Masters in Public Policy in my spare time, and all my work for one class was devoted to the history and implementation of the aforementioned bills.

Both papers are well over 20 pages long. If you are interested in this kind of minutia, you can find both the history and the implementation paper on the policy section of my site (click here). For those of you that want an executive summary, read on.

_________________________________________________

Third-party payers (including insurance companies) began to pay for mental health treatment after World War II . At that time, people either (a) were treated at in-patient mental health hospitals that were run for and paid for by the state or (b) rarely got treatment. The late 1950’s through the mid-1970’s brought a period of deinstitutionalization, which involved the closing of in-patient mental health hospitals and sending patients to community mental health centers. Deinstitutionalization caused a rise in third-party payments for treatment and a resultant restriction on services. In 1961, President John F. Kennedy forced the Federal Employees Health Benefits Program (FEHBP) to cover mental health treatment with the same level that physical medical care was covered. Federal employees enjoyed this unique benefit until 1975, when it was severely cut back.
The first major national law that set aside funds for addiction treatment was the Comprehensive Drug Abuse Prevention and Control Act of 1970. It was championed by Senator Harold Hughes, passed by the 91st Congress and signed into law by President Richard M. Nixon. Senator Hughes was an Army veteran and a trucker who had a drinking problem and almost committed suicide in 1952. He joined Alcoholics Anonymous and eventually went into politics. He created a treatment program for people with alcohol dependence while he has Governor of Iowa during the 1960’s. His willingness to talk about his own experiences and his work helping others moved other members of Congress and President Nixon into passing the CDAPCA . This would be the last major national legislation that addressed substance abuse treatment for a few decades.

During the 1970’s and 1980’s and early 1990’s, a number of state legislatures made attempts to address parity by creating minimum benefits for mental health (17 states), drug treatment (24 states) and alcoholism (37 states). In 1992, Senator John Danforth (R-MO) and Senator Domenici introduced the first bill that proposed mental health parity. It did not go anywhere, but their ideas were co-opted by President William J. Clinton into his health care plan in 1993-94 . President Clinton’s health care policy would eventually fail to pass as well. In 1995 Senator Domenici partnered with Senator Paul Wellstone (D-MIN) to craft a wide-ranging parity bill and attach it to the Health Insurance Portability and Accountability Act (HIPAA). The Congressional Budget Office reported that the bill would add costs of 4% to private health plans. The bill died.

The Mental Health Parity Act (MPA) of 1996 was introduced and championed by Senators Domenici and Wellstone. It was both a political and a personal issue for them, as Senator Domenici’s daughter lived with schizophrenia and Senator Wellstone’s brother had been hospitalized for depression for two years in college. After much debate and negotiation, a very limited bill was passed that did not mandate mental health coverage (and did not address substance abuse coverage at all). A disappointed but resolute Senator Wellstone acknowledged that it was just a “first step” toward full parity.

Over the next twelve years, the battle for parity was taken up by grass roots organizations such as the National Alliance of the Mentally Ill (NAMI), governmental research organizations like the National Institute of Mental Health (NIMH), professional organizations including the National Association of Social Workers (NASW), the American Psychological Association (APA) and the American Society of Addiction Medicine (ASAM) , as well as a new generation of politicians including Representatives Patrick Kennedy (D-RI) and Jim Ramstad (R-MN), both of whom were public about being recovering alcoholics .

A common refrain argued by those that opposed parity was that it would drive up costs. Those opponents included insurance companies and employer groups, and they were able to defeat a couple of lesser attempts at expanding parity with the rejection of the Mental Health Equitable Treatment Act (MHETA) of 2001 and again in 2002. Undaunted, parity advocates pushed for more and better research and eventually the Congressional Budget Office (CBO) published a report that took into account the effects of managed care and showed that parity did not lead to an increase in health care costs.

This (and other) research combined with the public testimony of the personal experiences of Senator Domenici, Senator Ted Kennedy (D-MA), Representatives Kennedy and Ramstad, and a collapsing economy in the fall of 2008 were able to get the Mental Health and Addiction Parity Act (MHPAEA) passed by the 110th Congress and signed into law by President George W. Bush as a rider on the Emergency Economic Stabilization Act of 2008. “The MHPAEA prohibited differences in treatment limits, cost sharing, and in- and out- of network coverage. It also applied to the treatment of substance disorders, which the MHPA did not address.”

It was hailed as a major victory by parity advocates. And then it got bogged down in the rule-making process. Despite leaving public office at the end of 2010, Patrick Kennedy has continued to advocate for parity. In October of 2013, he announced a new collaboration of stakeholders, political figures and experts called the Kennedy Forum. In a speech before the Senate on November 7, 2013, he lamented the delays of the previous five years:

Five years ago, when my father and I sponsored the Mental Health Parity and Addiction Equity Act (MHPAEA) and shepherded it through the House and Senate, we thought its signing by President Bush was the end of a process. In fact, it was barely the beginning… Just to recap, MHPAEA was passed and signed into law on October 3, 2008, and its provisions became effective exactly one year later. Many insurance plans follow the calendar year; the effective date for them was January 1, 2010. The Interim Final Rule for MHPAEA was issued on February 2, 2010, effective April 5, 2010, and applicable to plans beginning on or after July 1, 2010. We have been waiting for the Final Rule ever since then – over three years.

It has been 6 ½ years since the MHPAEA was signed into law by President Bush, 5 ½ years since it became an active law, 5 years since the Interim Final Rules were released and 1 ½ since the Final Rules were published. The lag between the signing of the law and the release of the final rules led to a prolonged period of murkiness. Additionally, the passage of the Affordable Care Act in 2010, the antipathy of the post-2010-election Republican dominated House of Representatives towards the ACA, and the two year wait until the Supreme Court issued its decision upholding the ACA added to the confusion regarding parity. Employer groups and insurance companies sometimes used these lags, legislative turmoil and legal battles to delay implementation of parity. That said, some of them have offered assistance to the public. In order to help providers and consumers understand this complex law and its constant updates, insurance companies like Aetna and advocacy organizations such as NAMI have posted instructions and frequently asked question pages.

The future of parity can probably be best summed up by an exchange that took place at a panel discussion at the 2014 annual conference of the New Jersey Association of Mental Health and Addiction Agencies (NJAMHAA). The panel was on the Governor’s Task Force on Heroin and Opiate’s report, but a number of questions were asked about parity. The following conversation took place between an Executive Director of a hospital based in-patient mental health program and Dr. Louis Baxter, the past-president of the American Society of Addiction Medicine (ASAM – he is also my friend):
ED: Will the Affordable Care Act actually ensure that insurance companies pay for the treatment of my patients?
Dr. Baxter: Yes.
ED: Multiple insurance companies are continuing to deny coverage, despite the fact that I have a number of well-regarded licensed professionals that have fully documented why our patients need treatment.
Dr. Baxter: I know. It is unfortunate. The delays and lack of instruction from the feds encouraged the insurance companies to drag their feet. But the law is there and they must obey.
ED: They are not…
Dr. Baxter: (interrupting) I know. I know what you are going to say. They are still not paying. They are denying claims. They are clearly violating the Parity Act and the Affordable Care Act. The answer is a combination of litigation and enforcement. A number of consumers and providers will have to sue insurance companies in order to get them to follow the laws.
ED: (interrupting) That could take years.
Dr. Baxter: Yes, probably five or so. But the insurance companies will lose and the government will do a better job of enforcing it. It’s a process. A long one. I know that this is discouraging folks, but parity will happen. It will just require the great American tradition of litigation.

As in the cases of other rule making, implementation will depend upon litigation (that happens to be the case with most rule-making; it’s true of stream pollution and other environmental and ecological violations, although in many of those cases the suit is brought by state and federal agencies). In the matter of health care it’s the individual who has been slighted that is going to have to sue. That places an unfair burden on the individual, but that has been the case before, during and after the parity law movement.

 

18Jun/15

What is Synthetic Weed? What is Synthetic Marijuana? What is K2? What is Spice?

Synthetic marijuana is in the news again, as the Center for Disease Control (CDC) released a report that calls to US poison control centers regarding negative reactions to the drug increased by 229% from the first half of 2014 to the first half of 2015. Newsweek also reported that 15 people have died in 2015 as a direct result of using synthetic marijuana, which is triple the number from the previous year.

Since 2007, I have been asked “what is synthetic marijuana?” and “what is K2?” and “what is spice?” They are different names for the same chemical group, which acts like marijuana but is sprayed on flora to make this new drug. Just like marijuana, it is smoked. It has some similar effects, including the much desired psycho-tropic euphoria. According to the CDC, the most commonly reported negative side effects are: agitation, tachycardia (rapid heartbeats, which people sometimes freak out over and then they go clog up the emergency room), drowsiness or lethargy, vomiting, and confusion.  I began training people on this in 2009, and in addition to the aforementioned names, I have discovered that it also goes by: Pep Spice, Spice Gold, Spice Silver, Sence, Yucatan Fire, Skunk, Orange Dragon Smoke, Black Mamba, RedX Dawn, Zohai, Mr. Nice Guy, Bayou Blaster, Euphoria, Home Spice, Ultra Cloud Ten, and Genie.

The original chemical formula was created by John W. Huffman, a chemist from Clemson University. He was doing research on marijuana that was funded by NIDA and when he created the new compound, he named it after himself: JWH-018. It was introduced in America in the early 2000′s, and was sold in bodegas, gas stations and head shops. It became particularly popular with people who were regularly drug tested (people on probation, some athletes), as it took a few years before a urine screen was developed to detect it. For several years, it was sold in packages as incense with a message on it that read “not for human consumption.” This allowed the burgeoning industry to evade FDA detection for a little bit and shrug their shoulders and say they were shocked when people were ingesting it (no company has openly manufactured it, so I think the “shocked” clip works well when juxtaposed with “not for human consumption,” because it is absolutely made for human consumption).

Because it was legal and easily accessible, use in the late 2000′s and early 2010′s skyrocketed. The FDA acted swiftly and put a temporary ban in place on the 5 most common synthetic marijuana compounds on March 1, 2011. One year later, a full federal ban was enacted and it was made a schedule I drug (highly addictive, no medical value, completely illegal) in July of 2012.

Early on, a number of other countries banned it, including (but not limited to) the United Kingdom, Ireland, Germany, Chile, New Zealand, Japan, and Romania. Surprisingly, synthetic marijuana has not been outlawed in Canada. It has been pushed out of the head shops, but it can easily be found on the internet. A harrowing tale of a professional couple’s addiction to the drug made headlines this past March in Edmonton.

A 2012 Federal Survey reported that 1 in 9 high school seniors had tried it, making it the fourth most familiar substance in high school after tobacco, alcohol, and marijuana. Use went down significantly after the federal ban, but over the last two years it has been making a comeback. It was very much in the news in NJ in March of 2013, as a car with 16 pounds of synthetic marijuana was pulled over in Hunterdon County, a 17 year-old from New Providence was hospitalized after using it, and Governor Christie signed a bill into law that gave harsh penalties to those that manufacture or sell it.

I have provided a few images below.

Synthetic marijuana is packaged in a way to appeal to a younger crowd.

 

http://wkrg.images.worldnow.com/images/7553983_G.jpg

Clearly, this image appeals to both young people and the stoner crowd.

It’s basically flora that is sprayed with a chemical. Synthetic marijuana can be composed of almost any vegetation, as long as it has the chemical spray on it.

 

 

 

 

 

 

 

 

 

 

18Jun/15

Yale University Fixes a 53-Year Old Mistake and Returns to Alcohol Research & Policy

Yale Medical School issued a press release yesterday about the opening of a new addiction research and policy center:

The National Center on Addiction and Substance Abuse at Columbia University (CASAColumbia), a leading national organization whose mission is to educate the public and improve the prevention and treatment of addiction, has partnered with Yale School of Medicine and Yale School of Public Health to form a new addiction research and policy center based in New Haven. The Yale–CASA center-of-excellence will expand critically important work to shape public policy, disseminate evidence-based practices, and educate families, providers, and policymakers.

It’s good news, and it was very smart of them to partner with Columbia, which has been one of the universities at the forefront on these issues. The ironic aspect of this is that they once had the premier alcohol research center in the country. This history is provided from the Rutgers Center of Alcohol Studies history page:

The Center of Alcohol Studies is the first interdisciplinary research center devoted to alcohol use and alcohol-related problems and treatment. Evolving in the late 1930s and 1940s at the Yale University Laboratory of Applied Physiology and Biodynamics, which was directed by Yale physician Howard W. Haggard, the Section on Alcohol Studies, headed by E.M. Jellinek, pursued studies of the effects of alcohol on the body, which broadened into a wide perspective of alcohol-related problems. The increasing demand for information about alcoholism led the Center to found the Summer School of Alcohol Studies in 1943. In 1944, the Center also began the Yale Plan Clinics, the first ever outpatient facilities for the treatment of alcoholism. The Yale Plan for Business and Industry, forerunner of current-day employee assistance programs, also began in the mid-1940s, in response to requests from business and industry having to cope with employment shortages during World War II. Another of Dr. Haggard’s contributions to the field was the founding of the Quarterly Journal of Studies on Alcohol in 1940. Today the Journal of Studies on Alcohol and Drugs remains a foremost journal in the field and is one of the top ten most cited substance-abuse journals.

The Center of Alcohol Studies was the leader of the movement to recognize alcoholism as a major public health problem and to have the American Medical Association accept alcoholism as a treatable illness, a policy it formally adopted in the 1950s.

And then in 1962 the Center of Alcohol Studies left Yale and moved to Rutgers. Over the last 17 years, multiple sources have told me that by the early 1960′s Yale had decided that it was beneath them to be in Alcohol Studies. Fortunately, my alma mater was willing to adopt it (full disclosure: I took courses at the Summer School of Alcohol Studies from 1998 through 2007 and I began working there as an instructor in 2008. This summer, I will teach two courses there).

I am glad that Yale made such an egregious error all of those years ago, because the Center of Alcohol Studies (CAS) helped shape the course of my career. Back in 1998, Gail Milgrim (who was in the middle of a 30-year run as the Director of the Education and Training Program), gave me a scholarship to attend the summer school and said, “I think you’d be good in this field.” It hasn’t only helped me though – thousands upon thousands of professionals have been trained by their faculty and CAS is the acknowledged leader in the alcohol research field.

Yale has finally seen the error of their ways. Kudos.

11Jun/15

Alcoholics Anonymous Turns 80…But Not Today

AOL (they still exist…I have an email account to prove it) congratulated AA for turning 80 today. In fact, the day that is celebrated as Founder’s Day (June 10) each year by grateful alcoholics is not actually the day AA was created. Bill Wilson (a New York stockbroker) and Dr. Bob Smith (an Akron doctor) met on May 12, 1935 and they discussed their drinking problems with each other. Both left that meeting feeling connected to someone else and hopeful that they could remain abstinent from booze. I view that as the first AA meeting and that date as the founding of Alcoholics Anonymous.

Most people, including Alcohol Anonymous World Services, go with June 10, 1935, which is the last day that Dr. Bob drank. From their website:

Dr. Bob lapses into drinking again but quickly recovers. The day widely known as the date of Dr. Bob’s last drink, June 10, 1935, is celebrated as the founding date of Alcoholics Anonymous. Dr. Bob and Bill spend hours working out the best approach to alcoholics, a group known to be averse to taking directions. Realizing that thinking of sobriety for a day at a time makes it seem more achievable than facing a lifetime of struggle, they hit on the twenty-four hour concept.

But it turns out that his last drink wasn’t June 10 but rather one week later on June 17. After his initial meeting with Bill Wilson, Dr. Bob was able to put a few weeks of continuous sobriety together. He felt so good that he decided to attend the AMA (American Medical Association) Conference in Atlantic City that June. His wife was concerned, but he assured her he would be fine (early recovery people are so similar). This site provides the rest of the story:

That is, until he boarded the train to Atlantic City. Once on the train Dr. Bob began to drink in earnest. He drank all the way to Atlantic City, purchased more bottles prior to checking in to the hotel. That was on a Sunday evening. Dr. Bob stayed sober on Monday until after dinner. He then resumed his drinking. Upon awakening Tuesday morning his drinking continued until noon. He then realized that he was about to disgrace himself by showing up at the convention drunk. He decided to check out of the hotel and return home. He purchased more alcohol on the way to the train depot. He waited for the train for a long time and continued to drink. That was all he remembered until waking up in the home of his office nurse and her husband back in Ohio.

Dr. Bob’s blackout lasted over 24 hours. There was a five-day period from when Dr. Bob left for the convention to when the nurse called Anne and Bill. They took Dr. Bob home and put him to bed. The detoxification process began once again. That process usually lasted three days according to Bill. They tapered Dr. Bob off of alcohol and fed him a diet of sauerkraut, tomato juice and Karo Syrup.

Bill had remembered that in three days, Dr. Bob was scheduled to perform surgery. On the day of the surgery, Dr. Bob had recovered sufficiently to go to work. In order to insure the steadiness of Dr. Bob’s hands during the operation Bill gave him a bottle of beer. That was to be Dr. Bob’s last drink and the “official” Founding date of Alcoholics Anonymous. The operation was a success and Dr. Bob did not return home right after it. Both Bill and Anne were concerned to say the least. They later found out, after Dr. Bob had returned, that he was out making amends. Not drunk as they may have surmised, but happy and sober. That date according to the AA literature was June 10, 1935.

The Archives of the American Medical Association reportedly show that their convention in Atlantic City, in the year 1935 did not start until June 10th. How could Dr. Bob have gone to the convention, by train – check into a hotel – attend the convention on Monday – check out on Tuesday – be in a blackout for 24 hours – go through a three -day detoxification – perform surgery on the day of his last drink – June 10, 1935? Five days had passed since Dr. Bob left for the convention and returned to Akron. There was the three-day detoxification process and then there was the day of the surgery. Approximately nine days had passed from when he left and the date of his last drink. If the records of the American Medical Association are in error as to the date of their convention it is possible that June 10, 1935 was the date of Dr. Bob’s last drink. If the records are in error, the 1935 convention would have been the only one in the history of the American Medical Association that was listed with the wrong date.

I quit the debating society over a decade ago, but I am a history buff and I think it is important that facts be correct. From my viewpoint, AA started on May 12, 1935. If you and yours think that AA started on Dr. Bob’s last drink, then it is June 17, 1935. Regardless of your belief, it is not June 10, 1935.