Substance abuse – NCSAPCB Tue, 22 Nov 2022 04:21:10 +0000 en-US hourly 1 Substance abuse – NCSAPCB 32 32 Employee fired for refusing to attend A.A. meetings gets $305,000 settlement Mon, 21 Nov 2022 20:27:25 +0000

Employers who require their employees to attend Alcoholics Anonymous (AA) meetings as part of rehabilitation programs should ensure that they have alternatives for employees with religious objections to AA. United Airlines failed to do so in at least one instance, according to the Equal Employment Opportunity Commission (EEOC). Now the company has agreed to settle a religious discrimination lawsuit by paying the pilot it allegedly refused to pay $305,000. We have collected articles on the news of SHRM online and other outlets.

Lost FAA medical certificate

The pilot was diagnosed with alcohol dependence and lost his Federal Aviation Administration (FAA) medical certificate. United’s program for pilots with substance abuse issues who want new FAA medical certificates requires them to attend AA meetings regularly. The pilot, who is a Buddhist, objected to the religious content of AA and sought to replace regular attendance at a Buddhism-based peer support group. United refused this request and the pilot was unable to obtain a new medical certificate from the FAA allowing him to fly again.

(Business Insider via Yahoo! Life)

AA program

The AA program was a religious organization, the pilot concluded after beginning to attend its meetings. The program’s 12 steps include giving oneself to God or “a power greater than oneself,” and its meetings were held at a Christian church. The pilot didn’t want to swear allegiance to religious views he didn’t hold in a place he didn’t feel comfortable with. He heard of an almost identical program called “Refuge Recovery” that was aimed at Buddhists. This is the program that United would have refused.

(Sky only)

Religious accommodations

United will re-enter the pilot into its Human Intervention Motivational Study (HIMS) program for pilots with substance abuse issues while allowing him to participate in a non-12-step peer recovery program. The company will also accept religious accommodation requests into its program going forward, institute a new religious accommodation policy, and train its employees.


United Declaration

“When it comes to the EEOC, safety is our top priority, and we have the utmost confidence in the HIMS program, considered our industry’s gold standard for substance abuse monitoring,” United said in a statement. a statement.

(HR Diving)

Court of Appeal decision involving another refusal to attend A.A. meetings

In a separate case, the US 7th Circuit Court of Appeals ruled that a former FAA employee who refused to attend AA meetings could be tried for retaliation. The employee, who was subject to a strict drug and alcohol policy, was arrested for drunk driving. The policy allowed the employee to avoid immediate discipline if she followed a rehabilitation plan designed by the FAA. Failure to adhere to the plan will result in termination.

The FAA had a rehabilitation plan that required the employee to obtain approval before taking medication and attending AA meetings. The employee objected to AA, which she felt violated her religious beliefs, and requested an accommodation. Her supervisor refused and the employee filed a formal complaint of religious discrimination. Meanwhile, the employee clashed with the FAA over how she was supposed to apply for drug approval. Following the discrimination complaint, the supervisor drafted a memorandum of non-compliance with the rehabilitation plan and HR terminated her based on this memorandum.

The district court granted summary judgment in favor of the FAA, but the appeals court determined that the FAA’s interpretation and application of its rehabilitation plan was so “objectively unreasonable” that a jury could rightly find them pretexts. The court also found that the dismissal was a disproportionately harsh sentence. The appeals court reversed the summary judgment and sent the case back to the district court for further litigation.

(SHRM online)

Americans plan to stake $1.8 billion Sat, 19 Nov 2022 15:00:01 +0000

This year’s FIFA World Cup is the first men’s tournament since the Supreme Court’s decision to end the federal ban on sports betting in 2018 allowed a growing list of states to legalize the activity .

An estimated 132 million Americans now live in states where sports betting is legal, up from just 10 million at the last World Cup four years ago.

Thus, 20.5 million Americans plan to bet a total of $1.8 billion on the football tournament which will start this weekend, according to estimates by the American Gaming Association (AGA).

It is encouraging to see bettors taking legality seriously. AGA reports that the majority of bettors – 78% – say it is important to place legal bets.

The AGA also encourages bettors to keep their financial security in mind.

“As the World Cup kicks off, anyone in the action should have a game plan to bet responsibly,” AGM Senior Vice President Casey Clark said in a press release. “That means setting a budget, keeping it fun, learning about probabilities, and playing with legal and regulated traders.”

Legal gambling means you can’t get in trouble with the law for betting on the World Cup or any other sporting event. But it also means it can be easier for bettors to fall into dangerous habits.

Just because it’s legal doesn’t mean it’s safe

While placing friendly or even serious bets on sports can be a fun way to get involved in gambling, routine gambling can quickly become a problem, before the bettor even realizes it.

“[Gambling] is a hidden addiction – there aren’t as many outward signs,” Keith Whyte, executive director of the National Council on Problem Gambling, told CNBC Make It.

Americans often recognize drug addiction because of the physical and visible effects substances can have on someone’s body, Whyte says. But, “there is no substance to the game, so people misunderstand it as low morals or willpower issues.”

Tracking the number of Americans with gambling problems or clinically defined gambling addictions is difficult due to a lack of reporting, stigma, and gaps in education about problem behaviors. But Whyte says the risk factors that can cause more people to have problems are on the rise.

Risk factors can include lying to loved ones about gambling or having difficulty cutting bets, which NCPG has been able to track through surveys.

These indicators have “rise by about 30% between 2018 and 2021”, specifies Whyte. “We have also seen a significant increase in calls, texts and chats to our national helpline – an increase of around 45% in calls between 2021 and 2022.”

While these reports don’t directly correlate with an increase in problem gambling or addictions, they still signal that an increase in gambling venues can lead to an increase in habits of concern, Whyte says.

“The odds are always stacked against you”

With sports betting, some might assume that the risk is lower than with games of chance like the lottery or slot machines because people can study the sports they watch. Or maybe they have some expertise as a player, which can help them better predict outcomes.

But Whyte says the opposite is true and sports betting can carry higher risk because of such confidence.

“Sports betting is considered a game of skill, some people think it’s better than others,” says Whyte. “But with that, more [frequently] they bet, the more skillful they become. This can encourage the continuation of your losses and the persistence of gambling behavior well beyond the limits you have set, well beyond reasonable losses and lead to significant financial damage.”

The ease of access has also made people more vulnerable to gambling problems, says Whyte. Before mobile sports betting became widely legal, bettors had to visit a physical bookmaker or work with a live bookmaker to place bets.

“It can be extremely high speed and high stakes, with around-the-clock or immediate access using electronic payments,” says Whyte. “The odds are always stacked against you in the long run – the more you play, the more likely you are to lose.”

Keep your bets friendly

While some states have passed regulations to try to address gambling problems, Whyte says they are the exception.

“Most states are either too ignorant of the problems they create or they’re just indifferent to the problems because their eyes are blinded by windfall tax revenue,” Whyte says of gambling guarantees.

“I think states don’t want to be responsible for something they see as an individual social problem,” he adds.

In this case, it is up to individuals to protect themselves to avoid placing risky bets or getting too into the habit of gambling. It’s one of the reasons why NCPR has created a website that offers tips and resources for bettors to gamble safely, such as setting a strict budget for your bets and encouraging the idea of ​​quitting when you don’t. is more of a fun experience.

As Kenny Rogers sang so well, “know when to walk away and know when to run away”.

If you or someone you know is showing signs of a gambling problem, you can call or text the National Problem Gambling Hotline at 1-800-522-4700 for free and confidential available 24 hours a day, 7 days a week.

Want to earn more and work less? Register for free CNBC Make It: Your Money Virtual Event on December 13 at 12 p.m. ET to learn from money masters like Kevin O’Leary how you can increase your earning power.

Don’t miss: 33% of Americans plan to go into debt after splurging on their favorite sports teams

Smoking and insurance coverage appear to be linked in people with mental disorders and substance abuse Thu, 17 Nov 2022 05:04:24 +0000 Policy reforms that expand insurance coverage can play a supportive role in discouraging smoking among adults with mental disorders and/or substance abuse.

Despite an overall decline in smoking in the United States over the past 50 years, people with mental health and substance use disorders (MH/SUD) have shown less reduction in smoking than people without HD/SUD.

A recent study analyzed trends in smoking and insurance coverage among US adults with and without HD/SUD, finding evidence that improved smoking and abstinence outcomes for adults with HD /SUD appears to be associated with increased health insurance coverage. Since 2014, the Affordable Care Act (ACA) has brought major changes to the US health insurance market that may impact smoking among people with HD/SUD.

“We hypothesized that insurance expansion would have a greater effect on insurance coverage among people with HD/SUD compared to those without HD/SUD; and that increased insurance coverage would be associated with better smoking outcomes in people with HD/SUD,” the study authors wrote.

Data for this study were obtained from records from 2008 to 2019 of the National Survey of Drug Use and Health, an annual cross-sectional survey. There were a total of 448,762 survey respondents, aged between 18 and 64.

Outcome variables were measured by recent cigarette use and previous year health insurance coverage.

Comparing pooled data from 2008-2009 and 2018-2019, current smoking rates of adults with HD/SUD decreased from 37.9% to 27.9%, while current smoking rates of adults without HD /SUD decreased from 21.4% to 16.3%.

During the 2008-2019 study period, adults with HD/SUD were more likely to report current smoking (34.2% vs. 19.0%) and daily smoking (24.2% vs. 13.5% ). Adults with HD/SUD were less likely to report abstaining from smoking (8.9% vs. 10.1%).

Additionally, adults with HD/SUD were more likely to be younger white, female, and non-Hispanic. They were less likely to be Hispanic, non-Hispanic Black, or non-Hispanic Asian. They were also less likely to have health insurance for at least 10 of the 12 months before the end of the survey (76.0% versus 80.4%).

Having health insurance for at least 10 of the 12 months preceding the survey was strongly associated with a reduced likelihood of current smoking (–14.2 points; 95% CI, –14.7 to –13.7) or smoking daily (–12.3 points; 95% CI, -12.8 to -11.8), and an increased likelihood of recent smoking abstinence (3.7 points; 95% CI, 3.2- 4.3).

From 2008 to 2009, the adjusted prevalence of insurance coverage was 6.2 points lower (95% CI, -7.6 to -14.8) for adults with HD/SUD compared to adults without. MH/SUD.

By 2018 to 2019, this gap had narrowed to –2.0 points (95% CI, –2.7 to –1.3). This equates to a 4.2 point increase in coverage (95% CI, 2.7 to -5.7) greater for people with HD/SUD (10.4 points; 95% CI, 9 ,0-11.8) than for those without HD/SUD (6.2 points; 95% CI, 5.4-7.0).

The authors suggest that the associations between insurance coverage gains and smoking outcomes may be explained by factors not examined in this analysis, including reduced financial stress, reduced negative social harms, and increased use. care.

Because the NSDUH relies on self-reported and recall-based measures, the authors acknowledge that the data may be vulnerable to bias.

Furthermore, since the NSDUH is a one-time cross-sectional survey and area-level variables were not available, the authors could not establish a causal relationship between the expansion of ACA insurance and the results studied.

“A substantial proportion of the estimated improvements in each smoking and abstinence outcome for people with HD/SUD were explained by increases in health insurance coverage,” the authors wrote.


Creedon TB, Wayne GF, Progovac AM, Levy DE, Cook BL. Trends in Cigarette Smoking and Health Insurance Coverage Among American Adults with Mental Disorders and Substance Abuse. Addiction. Published online November 17, 2022. doi:10.1111/add.16052

History of SUD linked to increased risk of death from other diseases Fri, 11 Nov 2022 22:33:15 +0000

Patients hospitalized with a substance use disorder (SUD) are much more likely to die of other medical conditions later in life, a new study has found.

Researchers looked at mortality following a diagnosis of 28 different medical conditions, including heart failure, cancer, diabetes, multiple sclerosis and stroke, and found that patients with a history of alcohol or drug abusers had a significantly increased risk of death after diagnosis of these conditions. . For seven of the medical conditions studied, a prior SUD was associated with a doubling of mortality risk.

“Our study highlights in detail the scale of the problem of high mortality among people with substance use disorders. The study provides evidence that should, ideally, motivate immediate and comprehensive action,” said lead researcher Tomáš Formánek, MSc, a doctoral student in psychiatry at the University of Cambridge in Cambridge, England, and the National Institute of Mental Health in Klecany, Czechia, said Medscape Medical News.

The results were published online November 3 in Lancet Psychiatry.

The usual treatment is not enough

The retrospective cohort study relied on hospitalization data from national registries in Czechia between 1994 and 2017. Studies in other countries have yielded similar results, suggesting that the results are not limited to people in Czechia.

The analysis included 121,153 people who had been hospitalized for TUS and 6,742,134 who had not. Of these, 24.2% of those with SUD and 21.2% of those without were subsequently hospitalized with at least one of the 28 medical condition researchers examined.

Those with pre-existing SUD had an increased risk of all-cause mortality after the onset of 26 out of 28 physical health problems compared to those without a history of SUD. Adjusted odds ratios ranged from 1.15 (95% CI, 1.09, 1.21) for chronic liver disease to 3.86 (95% CI, 2.62, 5.67) for impaired thyroid.

People with a history of SUD were more than twice as likely to die from seven of the conditions studied – atrial fibrillation, diseases of the circulatory system, diverticular bowel disease, hypertension, ischemic heart disease, prostate disorders and disorders of the thyroid.

In men with anterior SUD, the largest losses of years of life were observed in people with heart failure with disease onset at age 30 (37.17 years of life lost; 95% CI, 32.26 – 41.88) and cancer with disease onset at age 45 (24.27 years of life lost; 95% CI, 23.82 – 24.72) .

For women with prior SUD, the greatest loss of years of life was seen in people with heart failure with disease onset at age 30 (41.49 years of life lost; 95% CI, 35.72 – 46.06) and heart failure with disease onset at age 45 (25.20 years of life lost; 95% CI, 21.15 – 29.41 ).

The researchers found no increased risk of death in just two conditions studied – multiple sclerosis and Parkinson’s disease.

There were no data on the type or frequency of patients receiving SUD treatment or whether they continued this treatment after discharge. There were also no data on subsequent SUD-related hospitalizations.

Global estimates suggest that more than 283 million people aged 15 or older suffer from alcohol use disorders. About 35.6 million have a drug use disorder.

Data from the World Mental Health Survey show that only 10 in 100 people with substance use disorders in high-income countries and 1 in 100 people with substance use disorders in low-income countries have access to even minimally adequate treatment.

“However, the results of our paper suggest that the problem could be deeper; even when people receive treatment for substance use disorders, there is still a huge gap in mortality following the development of health problems. physics,” Formánek said.

Although the study was not designed to reveal the reasons for the high mortality risk, the researchers say that the negative physical impact of SUD and low screening rates among people with SUD could be factors.

The findings offer several clinical and public health policy implications, the researchers note.

For clinicians, it is essential to be more proactive with patients with SUD, including helping patients access health screenings and prevention programs and treatments for SUD and other medical conditions .

“It seems that ‘usual treatment’ is not enough with this population and special attention is needed,” Formánek said.

“Interesting and Interesting”

In an accompanying editorial, Carsten Hjorthøj, Anne Emilie Stürup and Marie Starzer of the Copenhagen Center for Mental Health Research at the University of Copenhagen, Denmark, note that while the study results are not surprising , “the magnitude of 10 to 40 years of life lost for most of the physical health conditions they investigated is both compelling and concerning.”

While the study demonstrates that a public health response is needed, the comment’s authors note that a successful response should be comprehensive, including legislative approaches, early detection, risk reduction and broad efforts to de-stigmatize. South.

“Formánek and his colleagues have clearly demonstrated the problem,” they write. “The international community must lead the way by providing the necessary solutions.”

The study was funded by the National Institute for Health and Care Research Applied Research Collaboration East of England in Cambridge and Peterborough National Health Service Foundation Trust. The study authors and editorial writers reported no relevant financial relationships.

Lancet Psych. Published online November 3, 2022. Full Text, Editorial

Kelli Whitlock Burton is a reporter for Medscape Medical News covering psychiatry and neurology.

For more information about Medscape Psychiatry, join us on Twitter and Facebook.

Doctor Found Guilty in Trial for Illegally Distributing Oxycodone from Midtown Manhattan Practice | USAO-SDNY Fri, 04 Nov 2022 21:53:25 +0000

Damian Williams, the United States Attorney for the Southern District of New York, announced earlier today that a federal jury has found HOWARD ADELGLASS guilty of participating in a conspiracy to illegally prescribe oxycodone. The accused was found guilty after a two-week trial before U.S. District Judge Jed S. Rakoff. Sentencing is scheduled for March 8, 2023, before Judge Rakoff.

US Attorney Damian Williams said: ‘Doctor Howard Adelglass was a drug dealer, but instead of selling drugs around the corner, he dispensed drugs with a prescription pad from his ‘clinic’. Pain Management” from Central Park South. For years, the defendant prescribed huge amounts of highly addictive and deadly opioids to people he knew had substance abuse disorders or who were drug dealers. By distributing gigantic quantities of oxycodone tablets to people without a legitimate medical purpose, the defendant destroyed lives and families. Along with our law enforcement partners, we will continue to hold accountable those responsible for fueling the opioid crisis that is ravaging our community and nation.

According to the allegations contained in the indictment, the evidence presented at trial and the matters included in the public documents:

HOWARD ADELGLASS was a licensed physician. Along with Marcello Sansone, the Defendant operated a pain management clinic located in Midtown Manhattan (the “Clinic”). The clinic served alleged patients seeking oxycodone and other painkillers commonly diverted for illicit purposes. In exchange for cash payments, and in some cases cocaine, ADELGLASS wrote thousands of prescriptions for large amounts of oxycodone, and he wrote many to people whom ADELGLASS knew did not need. pills for legitimate medical purposes. When they took place, the ADELGLASS examinations were superficial. The defendant’s alleged patients included people who were addicted to opioids and, in some cases, who sold oxycodone on the street. Even in the face of clear evidence of drug abuse and hijacking of his alleged patients, ADELGLASS continued to prescribe large amounts of oxycodone to them.

Initially, ADELGLASS staffed the clinic with young, inexperienced women, some of whom were dependent on oxycodone. Around October 2018, after serving as the primary source of patient referrals, Sansone took over as the clinic’s office manager. In this role, Sansone helped control access to ADELGLASS and the lucrative prescriptions he wrote for medically unnecessary oxycodone. With particularly vulnerable patients, the defendants solicited and, in some cases, received sexual acts in exchange for prescriptions of oxycodone.

Between or around November 2017 and around September 2020, ADELGLASS prescribed over 1.3 million tablets of oxycodone.

On October 13, 2022, Sansone pleaded guilty to conspiring to illegally distribute oxycodone. Sansone is expected to be sentenced on February 13, 2023, before Judge Rakoff.

* * *

ADELGLASS, 67, of New York, New York, was convicted of conspiring to illegally distribute oxycodone, which carries a maximum sentence of 20 years in prison.

The maximum potential sentence in this case is prescribed by Congress and is provided here for informational purposes only, as any sentencing of the defendants will be determined by the judge.

Mr. Williams praised the outstanding investigative work of the Federal Bureau of Investigation, the New York City Police Department and the Department of Health and Human Services, Office of Inspector General.

This case is handled by the Narcotics Unit of the Office. Assistant U.S. Attorneys Nicholas W. Chiuchiolo, Marguerite B. Colson, and Daniel G. Nessim are charged with the prosecution.

A fighting chance? | STLPR Wed, 02 Nov 2022 22:22:00 +0000

Department of Defense benefits from overseas slots as problem of gambling among military personnel goes largely undiagnosed

In August 2018, President Trump signed into law the National Defense Authorization Act (NDAA), to fund the country’s military operations for fiscal year 2019. It includes a provision that has been absent for about 15 years: mandatory screening. problem gambling for members of the Armed Forces.

The National Council on Problem Gambling (NCPG) reports that approximately 56,000 active duty service members are problem gamblers out of more than one million serving men and women. The Department of Defense (DoD) reports that about 120 active military personnel sought treatment in 2017. About 10 percent of veterans using Veterans Services are problem gamblers, according to the NCPG.

[Problem Gambling is] gambling behaviors that compromise, disrupt or interfere with personal, family or professional activities. Characterized by increasing preoccupation with gambling, a need to bet more money more frequently, restlessness or irritability when trying to stop and “chase” losses.

National Problem Gambling Council

Members of the Armed Forces serving overseas don’t have to look far to find ways to play. There are around 2,000 slot machines (not 3,000 as some have reported) at over 60 overseas bases. The DoD generates $100 million each year from active duty military personnel playing these slot machines.

No money goes to problem gambling treatment.

Who serves ? There are 1.2 million active duty military personnel. Racial and ethnic minority groups make up 40% of active duty military personnel.

defense department

Jessica Maxwell, a spokeswoman for the Secretary of Defense’s office, said the slot machines “are provided on overseas military installations as recreational options for eligible morale, welfare, and recreation (active duty, family members, DoD civilians, and foreign civilians.) Revenues are returned to programs to support other recreational activities.

US bases phased out slot machines in the 1950s, but bingo is played at 72 of the roughly 418 US bases, Maxwell said.

“It is clear that the Department of Defense is in some ways a large casino operator, given that they have thousands of slot machines on our bases overseas in addition to a huge amount of on-site bingo. across the continental United States,” Keith Whyte said. , CEO of the NCPG.

Biggest risk

Screening questions to detect problem gambling in the military were discontinued in the early 2000s. The NCPG has since lobbied to reinstate these questions, as military personnel tend to be at higher risk for problem gambling than some others. groups.

Maxwell contradicted the risk claim and said the screening questions were dropped “because the prevalence of disease in the military population was low.”

Screening questions are back now, in part, Maxwell said, because “problem gambling often heralds other treatable addictions and mental health issues. Additionally, problem gambling is a security threat in that those affected could be compromised by adversaries.

Today, it is estimated that approximately 2 million, or 1% of adults, in the United States meet the criteria for pathological (severe) gambling. Another 4-6 million would be considered problem gamblers.

About 2% of active military members meet the criteria for problem gambling.

“The other important part of screening is that unlike drug addiction or other disorders that have more outward physical signs, gambling addiction is what we often call hidden addiction,” Whyte said.

Why is gambling addictive? Gambling can stimulate the brain’s reward system just like drugs or alcohol, leading to addiction. We do not understand exactly what drives someone to gamble compulsively. Like many problems, problem gambling can result from a combination of biological, genetic and environmental factors.

Mayo Clinic

He said that because the military stopped testing, a whole generation went undiagnosed and untreated. And soldiers often suffer in silence.

“They don’t want to lose their security clearance,” Whyte said. “They may not even know that what they have is a treatable disorder. A lot of people on the outside think it’s just bad money management, or that you’re immoral for the game in the first place, or that you’re weak because you can’t stop.

These and other concerns – including separation from a unit or fear that a crime has been committed because of gambling – are the reasons addiction goes unreported in many cases.

Whyte and other advocates say veterans also have higher rates of problem gambling than the rest of the population. In 2012, he wrote a letter to US Secretary Eric Shinseki, then Chief of Veterans Affairs:

“Gaming addiction is a serious health issue that affects veterans and active duty military. It strongly co-exists with other serious conditions and complicates the treatment of these disorders,” the letter read.

“Despite overwhelming evidence that pathological gambling is a common and complicated comorbidity, veterans who seek mental health or addictions care in VHA are generally not screened for problem gambling and problem gambling has not been integrated into substance use disorders, co-occurring disorders or mental health treatment programs.”

The NDAA provision for screening does not include veterans.

In the first line

The VA Hospital in St. Louis, Missouri.

Marcena Gunter, a spokesperson for Veterans Affairs (VA), said internet gambling also allows members of overseas armed forces easy access to the game. Once they leave the military , many veterans the agency works with become addicted to video slots. Homeless veterans seem to be more addicted to scratch cards and the lottery, she said.

One counseling service that helps drug addicts who are veterans and active military members is the Life Crisis Center housed at Provident, Inc., in St. Louis.

People struggling with a variety of mental health issues can call the 24-hour helpline for free advice over the phone. The hotline is funded in part by money provided by the state gaming commission.

Missouri spends an average of 4 cents per capita, or $258,000 per year, on problem gambling services and treatment. The national average is 37 cents per capita.

2016 Survey of Problem Gambling Services in the United States

The center receives hundreds of calls a day through Missouri’s 1-888BetsOff hotline, operated by an alliance of public agencies. On a Friday afternoon in early October, counselors at the center had responded to 77 calls since midnight. That’s about six calls per hour.

Clinician Jessica Vance pointed to her computer screen to show questions asked by counselors, including whether callers are at risk for suicide. According to the Nevada Council on Problem Gambling, up to half of people in treatment for problem gambling disorder have thought about suicide and about 17% have attempted it.

“We try to assess suicide on as many gambling calls as possible because it’s often symptomatic of a struggle with gambling addiction,” Vance said. “And I don’t know the stats on the part of our play callers that are veterans, but I would say that’s a good part of them.”

Clinician Mallory Price explains how she handles a call.

Provident clinicians who handle calls from problem gamblers said one of the biggest barriers for callers is shame. They say callers struggle to understand that gambling is a valid addiction similar to other addiction issues.

“Maybe there’s a traumatic story, maybe something horrible that they witnessed in the line of duty,” Vance said. “But sometimes that’s not the case. Sometimes people play just because it’s fun. It is legal. It is a stress release. Sometimes it’s something people do to deal with loneliness, and then it can spiral out of control and turn into an addiction.

A victory?

It took about a decade for lawmakers and the federal government to turn their attention to problem gambling among active military personnel.

Senator Elizabeth Warren speaking before the Armed Services Committee,

In November 2018, Senator Elizabeth Warren (D-MA) asked Thomas McCaffery, candidate for Deputy Secretary of Defense for Health Affairs, about problem gambling and the military.

In 2015, the Senate passed an amendment introduced by Senator Elizabeth Warren (D-MA) requiring the Government Accountability Office (GAO) to produce a study on problem gambling in the military.

Two years later, the GAO released this report, which sheds light on the fact that there are thousands of slot machines on military installations overseas, but the DoD does not routinely screen military personnel for unrest. The GAO has recommended that the DoD incorporate questions about gambling disorders into its annual health assessments and DoD-wide surveys.

In June 2017, Warren introduced the Prevention and Treatment of Gambling Disorders into the 2017 Military Act, which would require the DoD to screen service members for gambling disorders and include gambling disorders in certain investigations.

This provision was not included in the Senate version of the 2018 NDAA. In 2018, Warren tried again, working with Senator Ted Daines (R-MT) to introduce a new bill, the addiction prevention, which included the provision requiring the DoD to screen and interview service members for gambling disorders, as well as a new provision requiring the DoD to develop policies and programs to prevent and treat gambling problems. This measure was incorporated into the 2019 NDAA which was adopted and signed by the President.

In November, Warren interviewed Thomas McCaffery, candidate for Assistant Secretary of Defense for Health Affairs, on the issue of problem gambling and the military.

Referring to overseas slots, she asked, “Do you think it’s a good idea to have slots on these bases to fund other recreational activities?”

McCaffery said he was unaware of the slots on the bases, but pledged to give his attention to the issue and how it “links to some of the [Sen. Warren’s] concerns about gambling disorders. He then pledged to enforce the provision of the NDAA.

NCPG’s Whyte would like to see the government go even further.

“Our call (in addition to testing) is simply that they dedicate some of that money to making sure that, again, their own troops and dependents get prevention education and treatment. adequate and effective,” Whyte said. “It’s a simple proposition if you’re exploiting profits through gambling, you need to minimize the damage.”

Opioid overdose deaths nearly tripled among black Virginians Sun, 30 Oct 2022 13:01:00 +0000

By LUCA POWELL, Richmond Times-Dispatch

RICHMOND, Va. (AP) — Darryl Cousins ​​has three friends who died of drug overdoses in the past two months.

Some were people he dated years ago when he was in active addiction. He tried to help others in his role as a counselor in several East End recovery homes.

“You get three or four deaths, maybe in a week now, in Richmond, Henrico and Chesterfield, instead of one or two a month,” Cousins ​​said. “There is not much light on the situation.”

The largest spike was recorded in the black population of Virginia. Over the past four years, the state has seen more than triple opioid overdose deaths among black Virginians — the highest death rate, by far, of any demographic group. The figures underscore the lethality of a fentanyl-polluted drug supply, as well as the structural barriers to entry into recovery – an essential first step in preventing a fatal overdose.

political cartoons

The figures – made public by the Centers for Disease Control and Prevention’s Death Certificate Database – tell the story of a stark increase, particularly in the Richmond metro area. Chesterfield County recorded 34 deaths in 2021, compared to 11 in 2018. Henrico County saw a similar spike, up to 44 of 14 deaths, and Richmond recorded 135 deaths, compared to 41 deaths in 2018.

The spike was sharper in Richmond than in any other county in the state.

“It desensitizes you to death,” Cousins ​​said.

Cousins, a black man, works for Starfish Recovery and Wellness, a Richmond-based addiction recovery residence. He was born in the South End of Richmond, where he attended George Wythe High School. He’s been sober for 15 years, he says, and shares a long view of how the city has changed in that time. The scariest thing is the drugs that seem to be everywhere these days.

“All of a sudden, it’s in every drug sold,” Cousins ​​said. “Fentanyl has taken the drug world by storm.”

Fentanyl, a synthetic opioid developed in the 1950s for the management of severe pain, has overtaken the illicit drug supply.

At 50 times the potency of morphine, it is deadly and easily overconsumed in powder form.

The drug delivers a stronger version of the same full body euphoria associated with heroin. At the same time, it depresses respiration in the lungs to dangerously low levels, depriving the body of oxygen.

“This explains why fentanyl is so deadly: it stops people breathing before they even realize it,” said Dr. Patrick L. Purdon, lead author of a fentanyl lethality study conducted. by doctors at Massachusetts General Hospital and published in August.

This year, Virginia epidemiologists have linked the drug to 76% of fatal overdoses in Virginia. Every day, more than five Virginians die from overdoses explicitly linked to fentanyl.

Forensic scientists have come to expect fentanyl, finding it often mixed with the drugs that were once thought to be the most deadly, such as heroin, cocaine and methamphetamine.

Overdoses of these drugs have also increased, but now four out of five toxicology reports of cocaine overdoses show that fentanyl also played a role.

What’s also scary is how the drug is researched, Cousins ​​said. Active addicts seek heroin containing fentanyl, he said, because their bodies have normalized heroin in its most regular form.

“I was trying to figure out too, I was trying to figure out, why would you go looking for something that literally takes you to the edge of death?” said the cousins.

Tisha Wiley, a researcher at the National Institute on Drug Abuse, says the path to the current opioid crisis in the black community has been paved by historic racism in health care.

As white patients were easily prescribed drugs like OxyContin in the late 1990s and early 2000s, black patients had a much harder time convincing doctors of the legitimacy of their pain, Wiley said.

“One of the things we hypothesized at the start of the pandemic was that black patients were less likely to be prescribed pain medication, which would translate to black patients having a harder time getting medication. prescribed” for opioid use disorder, Wiley said. “It amounts to an implicit bias.”

The practice is continuing into 2021, according to a recent study published in the New England Journal of Medicine, and has disturbing second-order effects.

Pain patients sought doctors more willing to write prescriptions or cheap street substitutes, such as heroin.

The bias, Wiley said, also arises when addicted black people seek medically assisted treatment for addiction, such as drugs like methadone, an FDA-approved opioid used to curb cravings.

And while white drug addicts are more likely to be diverted to treatment, such as rehab, black and Hispanic drug addicts are more likely to be arrested, Wiley said.

This has made prisons a key focus in reducing and equalizing the opioid epidemic.

The resources needed to recover, such as housing and insurance, are also skewed along racially divided lines. Walter Randall, recovery facilitator at High Council Services, said Richmond’s main recovery residences target what he described as “a white demographic”: patients with private insurance or the ability to pay out of pocket. .

Many don’t take Medicaid, said Randall, who is black and has been recovering for 22 years. He says the downwind effect of this choice has been a separate recovery space.

“White has McShin, True Recovery, Starfish,” Randall said.

“Black people have” Narcotics Anonymous and community service advice.

Jimmy Christmas, a licensed therapist with River City Comprehensive Counseling Services, which provides addiction and mental health services in Richmond, said some of those divisions are blurring as the opioid epidemic in the black community has received More attention.

“When I look at what the white community has had access to, this physical apparatus of recovery homes, compared to the black population — it even makes me sad to look at that,” said Christmas, who is black and in recovery. “I sit here and watch our country fail.”

Christmas says Richmond’s black community needs “guerrilla outreach,” not just to warn of the lethality of fentanyl, but to build community buy-in that recovery works.

“What’s missing is that some of these pockets, like the East End, need more outreach,” said Christmas, who is 61 and has treated generations of drug addicts in the Richmond area.

“For 20 or 30 years in the white community, there have been white families willing to pay for the treatment of their loved ones. I would like to believe that there is a pocket in the black community that is willing and able to pay for their treatment as well,” he said.

Christmas said recovery residences, the “gold standard” of addiction treatment, cost around $5,000 a month — a price that can be prohibitive without a family to foot the bill. And most have white owners and staff, he said.

But increasingly, more funds have become available to state legislators and health agencies. Through several grants, Virginia has already received more than $70 million in federal funds intended to support recovery services. These funds have been essential in breaking down the financial barriers that have entrenched the racial divide in access to care.

The grant money helped the Virginia Association of Recovery Residences diversify its customer base by establishing a fund for indigent customers.

Recent data shared by the organization shows that more than 40% of admissions are for non-white people.

Millions of dollars have also been directed to jails and prisons, which have begun providing drug withdrawal treatments for inmates with opioid use disorder.

But the lion’s share of incoming funds intended to curb Virginia’s opioid epidemic has yet to be distributed. That money, about $610 million, will come from opioid distributors and manufacturers, such as Purdue Pharma, Janssen Pharmaceuticals and others.

Beneficiaries, like the City of Richmond, will decide how it should be used.

Jim Nolan, a city spokesman, said decisions on the money would be made in the coming weeks, pending an appropriation process and approval from the mayor and city council members.

The city is expected to receive at least $4 million over 16 years, according to records shared by the Virginia Attorney General’s Office, which funnels funds to Virginia locations from distributors.

Copyright 2022 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Medicare’s Mental Health Proposals Expand Addiction Help Fri, 28 Oct 2022 08:58:38 +0000

The opioid crisis in the United States and the Covid pandemic have renewed calls from lawmakers and advocates to modernize and expand Medicare behavioral health coverage. And the Biden administration is listening.

The proposed rule for Medicare’s 2023 Physician Fee Schedule suggests changes will be made to Medicare’s coverage for treatment of mental health and substance abuse disorders when the final rule is released. It’s scheduled for next week.

About 1.7 million Medicare beneficiaries have had a substance use disorder in the past year, according to a recent study. And although they were much more likely to have had severe psychological distress and suicidal thoughts, only 11% received treatment. It’s not a new problem.

Medicare does not cover the full range of services, providers, and facilities for the treatment of substance use disorders, or “SUDs.”

According to a recent study, it “effectively excludes coverage” of treatment for substance use disorders in intensive outpatient programs, outpatient addiction clinics, and residential addiction programs. Medicare also does not allow billing by the addiction specialists who dominate the SUD treatment workforce: licensed counselors, certified addiction counselors, and peer counselors.

And because the Mental Health Parity and Addiction Equity Act does not apply to Medicare, the program is not required to provide benefits for substance use disorders and mental health on the same level as medical and surgical care benefits. This is in stark contrast to most private and employment-based health insurance — and even Medicaid plans — that are covered by law.

Attention of legislators, regulators

As Covid-19 and opioid overdose deaths rise, the Medicare coverage gap for behavioral health services is attracting new attention from regulators and lawmakers.

Last month, the House Ways and Means Committee drafted six bills aimed at bolstering Medicare mental health coverage. And last week, Sen. Richard Durbin and Rep. Lauren Underwood, both Democrats from Illinois, called on Medicare to act “swiftly and comprehensively” to “explore avenues to expand access to residential services.” treatment for substance use disorders provided by treatment programs that offer evidence”. care-based.

The Biden administration is also looking into the matter. Buried in Medicare’s proposed 2,000-page rule, the Centers for Medicare & Medicaid Services is seeking comment on whether a “loophole” in Medicare’s coding and payment mechanisms “may limit access to levels care necessary for the treatment of mental health or substance use disorders treatment, including and especially substance use disorders, for Medicare beneficiaries.

“We are particularly interested in the extent to which any potential gaps would be better addressed by the creation of new ‘billing codes’, or the ‘revision of particular billing rules for certain types of care in specific contexts,’ the proposal states.

The agency also asked if further coding adjustments were needed “to better reflect the relative resource costs involved in providing intensive outpatient mental health services.”

Continuum of care

Intensive outpatient mental health services are part of a “continuum of care” developed by the American Society of Addiction Medicine. Medicare now covers only the least intensive types of treatment on the continuum: early intervention and outpatient services, as well as the most intensive type: inpatient services, said Deborah Steinberg, health policy attorney at the Legal Action Center. , a non-profit organization. .

Adding Medicare coverage of “intensive outpatient” services, which involve nine to 19 hours of treatment services per week, would fill a big void in the program’s current coverage offerings, she said.

“It’s a bit more intensive than someone just getting weekly counseling, but not to the level where someone is in residential treatment. And that’s something that we’re very confident CMS could do on its own without needing congressional approval,” Steinberg said.

CMS does not comment on proposals during the rulemaking process.

People participating in intensive outpatient programs for substance use disorders receive an individualized treatment plan, individual and group counseling, medication management, family therapy, and participate in education groups and counseling. occupational therapy and recreation.

Intensive outpatient services

On another front, Rep. Judy Chu (D-California) introduced HR 8878, which would create a category of Medicare benefits for intensive outpatient services.

At a recent House Ways and Means Committee hearing, Chu’s bill passed the committee favorably. Chu, a psychologist, told the hearing that Medicare applies significant restrictions — like requiring beneficiaries to be eligible for hospital care — before covering interim treatment services for enrollees with substance use disorders. substances.

“This has the unintended consequence of excluding many Medicare patients from the type of mental health services most appropriate for their condition and level of care,” Chu said. “This is one of the many glaring flaws in the Medicare program that keeps mental health coverage from being on par with physical health.”

Chu’s legislation would allow outpatient hospitals, community mental health centers, rural health centers and federally licensed health centers to provide intensive outpatient services so that “patients can access care at facilities that best meet their needs,” she said during the hearing.

Rep. Adrian Smith (R-Neb.), a co-sponsor of the bill, told the hearing that he “hopes to see its eventual enactment into a broader bipartisan package of mental health care before the end of the year”.

Savings can offset change costs

It would cost about $928 million a year to provide intensive outpatient coverage for more than 116,000 beneficiaries with substance use disorders, according to a study by RTI International, a nonprofit research institute, in partnership with the Legal Action Center.

Adding nearly 76,000 residential treatment stays would cost $935 million, and nearly 59,000 sessions with counselors would cost an additional $66 million, the study estimates.

But those expenses would be nearly offset by savings of about $1.6 billion a year in spending on drug-related conditions, hospitalizations and emergency room visits, the study estimates.

Of the 1.7 million recipients with SUD, an estimated 77% had alcohol use problems, 16% with prescription drugs, and 10% with a marijuana use condition. Forty-one percent cited lack of motivation as the reason they did not seek treatment, 33% were concerned about what others might think, and 24% identified logistical barriers, such as transportation.

The SUPPORT for Patients and Communities Act of 2018 created a new category of benefits that, in 2020, enabled Medicare coverage for opioid treatment programs that provide methadone and other drugs that treat disorders related to the use of opioids.

But of more than one million beneficiaries with opioid use disorder in 2021, less than 20% received medication to treat it, the Department of Health and Health’s Office of Inspector General reported. of Social Services in September. “This low proportion may indicate that recipients are having difficulty accessing treatment,” the OIG data note states.

US Attorney Josh Hurwit Hosts Domestic Violence Awareness Month Event | USAO ID Tue, 25 Oct 2022 18:24:28 +0000

BOISE – U.S. Attorney Josh Hurwit yesterday brought together more than 50 representatives from victim advocacy groups, domestic violence organizations, tribal communities and law enforcement agencies across the country. idaho to commemorate Domestic Violence Awareness Month. U.S. Attorney Hurwit and other federal prosecutors in his office presented training on federal tools to prosecute perpetrators of domestic violence and reduce their ability to reoffend, including prosecuting offenders who are prohibited from possessing firearms. fire.

The event was part of the U.S. Department of Justice’s efforts to bring together advocates, survivors, victim service providers, justice professionals, law enforcement and first responders and communities across the United States to observe October as Domestic Violence Awareness Month.

Domestic violence is more prevalent than many realize. About one in four women and one in seven men will experience serious domestic violence in their lifetime. Rates are disproportionately higher for Native American and Alaska Native populations, women of color, the LGBTQ+ community, and people with disabilities. The devastating consequences of domestic violence can span generations and last a lifetime. Domestic Violence Awareness Month provides an opportunity to raise awareness about domestic violence and encourage everyone to play a role in ending gender-based violence.

“Our office is committed to prosecuting domestic violence crimes and supporting victims and survivors in Idaho,” U.S. Attorney Hurwit said. “We want the community to know that we are here to help in these areas. But lawsuits alone cannot fully address the fundamental underlying issues that can lead to domestic violence. That’s why I’m so grateful to the attendees of our event for sharing their stories and inspiring collaboration between law enforcement, advocates, and social service providers.

All attendees joined in a conversation about how to support survivors of domestic violence and break the cycles of abuse that too often affect generations of families and communities. Participants collectively agreed that more in-depth communication about trends in domestic violence, as well as related issues, such as drug abuse and human trafficking, would benefit their communities.

If you or someone you know is or has been a victim of domestic violence, you are not alone and there are many services available to help you including the National Domestic Violence Helpline, 1- 800-799-SAFE (7233), the National Center for Victims of Crime and the National Coalition Against Domestic Violence


Transcranial magnetic stimulation appears effective in patients with adverse childhood experiences Sat, 22 Oct 2022 19:01:10 +0000

A retrospective analysis conducted at Sunnybrook Health Sciences Center in Toronto evaluated the effectiveness of repetitive high-frequency transcranial magnetic stimulation (rTMS) for depression. The results, published in the Journal of Affective Diseasessuggest that rTMS may be effective in the treatment of depression in patients with adverse childhood experiences (ACE).

In general, a “history of negative childhood experiences (ACE) is associated with poorer treatment outcomes in depression,” the researchers wrote.

The Adverse Childhood Experiences Questionnaire (ACE-10) assesses stressful living environments (e.g., parental conflict, substance abuse, mental illness), as well as abuse or neglect by a caregiver that results in harm, threat of harm or potential harm before departure. the age of 18.

Men and women 16 years of age or older with a history of major depressive disorder or bipolar disorder participated in this study, receiving approximately 20 treatments of open high-frequency rTMS to the left dorsolateral prefrontal cortex (DLPFC) 5 times per week for 4 to 6 weeks. The stimulation given was either deep TMS or intermittent theta stimulation, depending on patient preference.

Of 176 eligible treated patients, researchers analyzed data from 116 participants who had a baseline ACE score, a baseline Hamilton Rating Scale for Depression (HAMD-17) score, and a HAMD-17 score. at the end of acute treatment. Of these, 99 patients had information on the variables or covariates. The average age was 40 and the majority were women.

The mean self-reported ACE score was 2.4, the mean baseline HAMD-17 score was 20.9, the mean number of trials of adequate antidepressants was 4.5, and the mean CIRS-G score (to measure medical comorbidity) was 3.6.

Multiple linear regression analysis assessed the impact of ACE score on improvements in HAMD-17 score at the end of treatment, while controlling for covariates, such as age, gender, refractory, and depression initial. The authors also used multiple logistic regression analysis to assess whether the ACE score affected remission and patient response.

The researchers found that patients’ HAMD-17 scores improved by an average of 8.1 points from the start to the end of acute treatment at 4 or 6 weeks. Continuous ACE was not associated with a significant improvement in HAMD-17 score (0.24; SE=0.33; P > .05). Higher initial depression (0.40; SE = 0.11; P < 0.001) was associated with greater improvement in HAMD-17 score between the start and end of acute treatment.

At the end of acute treatment, 26 of 99 (26.3%) patients were in remission. A higher ACE score was not significantly associated with the odds of remission (odds ratio, 1.12; 95% CI, 0.98-1.35; P > .05). In addition, men had a lower chance of remission than women.

Additionally, using a categorical ACE variable, the researchers found that ACE score at any level (0, 1, 2, 3, ≥4 ACE) was not associated with significant changes in HAMD- 17. A higher baseline HAMD-17 score was associated with improved HAMD-17 (0.35 SE, 0.11, P <.01). Additionally, having 1, 2, 3, or 4 or more ACEs did not significantly alter the odds of remission compared to those with 0 ACEs.

However, in an alternative model including all covariates, perceived social status was associated with higher odds of remission, baseline depression was associated with lower odds of remission, and having 4 or more ACEs was associated to higher chances of remission. No variable was found to be significantly associated with response status.

Controlling for age, gender, MSD type, and likely post-traumatic stress disorder (PTSD) status, researchers found that HAMD-17 scores were significantly lower than baseline at week 2, which continued through weeks 4 and 6.

Using ACE subscales based on type of adversity, the researchers found that the presence or absence of neglect, abuse, or dysfunction did not significantly impact the HAMD-17 trajectory at over time taking into account age, sex, type of MSD and likely PTSD status.

The study was limited by the absence of a placebo group. The researchers noted that “although causation cannot be determined from this study, the efficacy of rTMS treatment has already been demonstrated in other randomized trials and meta-analyses.”

Additionally, another limitation was that the ACE questionnaire does not measure the severity, frequency, or duration of adverse events.

Despite the limitations, this study suggests that rTMS may prove effective in treating depression in patients with ACE.

“High levels of self-reported childhood adverse experiences were not associated with worse antidepressant outcomes in MDD patients receiving high-frequency rTMS on the left DLPFC,” the researchers said. “A history of childhood adversity should not prevent patients with MDD from receiving rTMS treatment for depression.”


Ng E, Wong EHY, Lipsman N, Nestor SM, Giacobbe P. Adverse childhood experiences and outcomes of repetitive transcranial magnetic stimulation for depression. J affect disorder. 2022;320:716-724. doi:10.1016/j.jad.2022.09.153