Tony Gwynn’s cancer: Time for big leaguers to take responsibility for youngsters using smokeless tobacco

Posted on October 19, 2010 by

Tony Gwynn thinks his cancer is caused by his smokeless tobacco addiction.

Tony Gwynn is San Diego’s favorite son. He’s like Ernie Banks to Chicago or Derek Jeter to New York, only San Diego is a smaller, more familiar kind of place, so our local heroes are much more real life-like. When news broke that he’s suffering from cancer of the parotid gland – the largest of the salivary glands located between the ear and the mouth — local news and sports websites were full of warm letters and comments wishing him well and telling him that the community has his back. And that’s great. But there’s more to the story.

Tony Gwynn believes his cancer is caused by his long-time smokeless tobacco use – or addiction, let’s call it what it is. So far, there’s no evidence that salivary gland cancer is caused by smokeless tobacco use. Several studies say that no such link has been found. However, studies have shown a “positive association” between smoking tobacco and parotid gland cancer. So the jury may still be out. Anyway, tobacco is definitely a dangerous carcinogen…

We know smokeless tobacco is linked to other types of cancer and to additional health problems (I won’t gross you out with the pictures, but the last link will). And we know that smokeless tobacco is a particular problem in baseball.  A study published in Tobacco Control of 39 high schools in California found that 45 percent of high school ball players had tried smokeless tobacco. Among all males ages 12-24, that figure is only about 3 percent to 4 percent.

Hey, big leaguers -- where do you think these kids learned it?

Why do so many more high school ballplayers chew tobacco compared to other boys and young men? It’s not rocket science: Young ballplayers chew because their role models — big leaguers — chew.

Tony Gwynn could help change all that. Everybody knows Tony Gwynn. He’s a Hall of Famer who is still very involved in baseball, including as coach at San Diego State University. Through coaching and scouting, he’s connected with young ballplayers across the country. He’s one of the most respected people in the game (and that’s not just my San Diego bias talking).

A public awareness campaign? No, that’s not going to solve this problem. The only way to stop teen ballplayers from chewing is for Major League Baseball to ban smokeless tobacco, just like the minor leagues and college ball already have done. Smokeless tobacco is still allowed in MLB because of the players union. There’s an effort in Congress to twist arms of MLB and the players union to ban the stuff, but that effort hasn’t gotten very far. If Tony Gwynn and other major leaguers got involved, and helped lean on the players union, maybe this could get done.

Major league ballplayers, including Tony Gwynn, need to face up to the fact that their tobacco addiction is the reason why so many young ballplayers get addicted to chewing tobacco. Big leaguers need to own up to that responsibility. Tony Gwynn could be a big help.

Posted in Addiction, Recovery, Smokeless tobacco, Substance abuse, Tobacco, Tobacco and kids, Tobacco marketing | Tagged , , , , , , , , | 3 Comments

Alcoholism isn’t the only alcohol problem: It’s not even the biggest alcohol problem

Posted on October 11, 2010 by

 

Alcohol paradox: Alcoholics cause more individual problems but non-alcoholics who binge drink cause more societal problems -- because there are so many more of them

 

“One in four US teens and young adults binge drink,” blared the headlines in USA Today. And many of those folks are imbibing a lot more than only five drinks in a couple of hours, the definition for binge drinking. The average binge drinker slams eight drinks in a couple of hours.

Wow, what a bunch of alcoholics, you say. But no, they’re not. According to CDC Director Thomas Frieden, 80 percent of binge drinkers are not alcoholics. A lot of them are light to moderate drinkers, maybe like you, who really tie one on every once in awhile. Others are folks who get drunk a lot but aren’t alcohol dependent, like some of your college buddies maybe.

The truth is that non-alcoholics who binge cause the majority of alcohol-related problems, because there are so many more of them. From “Screening and Brief Intervention: Making a public health difference” by JoinTogether:

Research shows that risky drinking causes more total harm than the heavy drinking of alcoholics. Though risky drinkers are individually less likely to cause alcohol-related problems, they make up a much greater portion of the general population than alcoholics, so the most significant amount of damage is caused by those who engage in risky drinking from time to time but are not dependent on alcohol.

Public health researchers have known for a long time that non-alcoholics cause more

 

Percentages of Persons Aged 12 to 20 and Aged 21 or Older Reporting Past Month Binge Alcohol Use, by Age: 2002 and 2003 -- SAMHSA

 

alcohol-related problems than alcoholics. But, unfortunately, they never imparted this wisdom to the public. Too bad; the main purpose of social science research should be to help craft sensible public policy. How can we craft sensible alcohol policy if nobody knows who is causing most of the alcohol-related problems?

Anyway, so what if normal drinkers have a few too many once in awhile? Why should we care? Two reasons:

  1. Binge drinking causes a lot of problems – car crashes, domestic violence, fights, shootings, sexual assaults, stabbings, drownings, house fires, falls, injuries, unintended pregnancies, STDs, alcohol poisoning, high blood pressure, heart attacks, etc. All these and more are much more likely to happen around people who are drunk – whether they are hard-core alcoholics or moderate drinkers who drink too much once in awhile.
  2. We need to spend taxpayer dollars on the the right interventions. Treatment for alcoholism isn’t appropriate for most binge drinkers. Right now, we spend a lot more money treating alcoholism than on reducing intoxication. I’m not saying we should spend less on treating alcoholism. In fact, we should spend a lot more. But we also should spend a lot more on prevention methods that are shown to be effective.

In the past few years, screening and brief intervention (SBI) of intoxicated people in emergency rooms and other health care settings has shown to be very effective in reducing dangerous drinking and repeated hospitalizations. SBI should be done in every hospital and primary care setting. But it’s slow getting off the ground. I think the reason is that most people – including most people in the medical establishment – still think that people with alcohol problems are alcoholics, and they don’t see how a brief intervention can help an alcoholic.

There are plenty of other prevention methods that have been shown to be very effective in reducing dangerous drinking, such increasing DUI enforcement, reducing the urban density of bars and liquor stores, enforcing responsible alcohol sales and service laws and raising alcohol taxes. Very little taxpayer money is spent on these interventions.

If the public and policy makers recognize who is causing all these alcohol-related problems like drunk driving and such, then maybe they’ll start implementing policies that reduce the incidence of people getting drunk. That doesn’t mean wagging our finger at moderate drinkers, which would never work. It means implementing policies like SBI and fully enforcing existing alcohol laws to help convince non-alcoholics to drink moderately.

Posted in Alcohol, Alcohol abuse, Binge drinking, Prevention, SBI, Substance abuse, Substance use disorder treatment, Underage drinking | Tagged , , , , , , | 1 Comment

Medical associations coming out against medical marijuana as the reality of state pot laws gets silly

Posted on October 1, 2010 by

 

Sickly children demand their medicine at a medical marijuana rally in Colorado

 

Medical marijuana is getting more and more ridiculous. And the news media, finally, is finally taking a more discriminating look at the whole issue. In the beginning, the media took a “wow, cool…” view of the subject, succumbing to that pervasive baby boomer marijuana romance that afflicts so many people, including reporters and editors. But now, the silliness of state medical marijuana laws is becoming overwhelming. It’s become obvious to nearly everyone that this is only about smoking pot.

For example:

  • In downtown Boulder, Colorado, adjacent to the University of Colorado and where businesses cater to college students, medical marijuana dispensaries are out of control. There are dozens of them, and they cater to young people, mostly students, who are usually very healthy and don’t need medical treatment for anything. Read this New York Times story and tell me if this is what medical marijuana laws intended.
  • In Montana, 90 percent of medical marijuana card holders are on the registry because of “chronic pain”, not for a serious medical illness. Less than 3 percent have cancer, AIDS or glaucoma. Chronic pain cannot be adequately diagnosed in the minute-long meetings with a pot doc that are the norm in medical marijuana states. Real chronic pain doctors do not recommend marijuana use.
  • DUI arrests involving marijuana have skyrocketed in Montana at the same time 

    California's biggest pot doc: Dr Jean Talleyrand made over $10 million in 5 years authorizing "patients" to smoke pot

     

    that the number of registered medical marijuana users rose from about 3,000 to 15,000.

Now, the real medical and patient organizations are coming out against medical marijuana.

In August, The Glaucoma Foundation warned patients against medical marijuana, stating that “medical experts believe that marijuana could actually prove harmful for glaucoma patients.”

Glaucoma is often cited by medical marijuana advocates because THC can lower the pressure inside the eye. But medical experts now say that marijuana could actually prove harmful for glaucoma patients:

“Marijuana only lowers pressure for several hours, requiring patients to continuously medicate day and night. Failing to do so can lead to a rebound spike in eye pressure, which can be damaging. There is also growing evidence that inadequate blood supply to the optic nerve may contribute to glaucoma damage. Since marijuana given systemically is known to lower blood pressure, it is possible that such an effect could lead to optic nerve damage.”

The American Glaucoma Society published an editorial in the February issue of the Journal of Glaucoma, stating that “marijuana… cannot be recommended without a long term trial which evaluates the health of the optic nerve.” The Glaucoma Society issued a position paper last year detailing its opposition to medical marijuana treatment for glaucoma.

The National Multiple Sclerosis Society similarly has warned patients away from medical marijuana, following continued claims by medical marijuana advocates that it is a viable treatment for that disease.

The Society cannot at this time recommend that medical marijuana be made widely available to people with MS for symptom management. This decision was not only based on existing legal barriers to its use but, even more importantly, because studies to date do not demonstrate a clear benefit compared to existing symptomatic therapies and because issues of side effects, systemic effects, and long-term effects are not yet clear.

New research also is raising questions about using marijuana to treat HIV/AIDS-related symptoms. A Harvard study found that THC could enhance the ability of the virus that causes Kaposi’s Sarcoma to infect cells and multiply. AIDS patients are susceptible to developing Kaposi’s Sarcoma.

What about chronic pain, which is the most popular quickie diagnosis for marijuana cards?

 

Has any other medicine been regulated like this?

 

The National Pain Foundation says pain patients should avoid marijuana because it interferes with restful sleep. The foundation also says that while there may be a future in cannabinoid-based medications for pain, smoked marijuana has too many side effects and its hard to find the optimal dose for pain.

Anxiety is another common pot clinic diagnosis. But marijuana causes anxiety, rather than curing it. Lots of research shows this, but perhaps the best is a long-range study of teenagers in Australia published in the British Medical Journal. It showed that teens who smoked pot daily were five times more likely to develop anxiety and depressive disorders, while those who used the drug weekly were twice as likely. Psychiatrists do not recommend marijuana for patients with anxiety disorder.

The Food and Drug Administration and the National Institutes of Health have both said that smoked marijuana is not medicine. Burning leaves of anything and inhaling the smoke is carcinogenic. Besides, there are so many compounds within marijuana smoke, it’s very difficult to do rigorous scientific evaluations about the benefits of smoking marijuana. Cannabinoids have been found to have medicinal properties if they are separated out, tested and synthesized.

The AMA put it most clearly:

The patchwork of state-based systems that have been established for “medical marijuana” is woefully inadequate in establishing even rudimentary safeguards that normally would be applied to the appropriate clinical use of psychoactive substances. The future of cannabinoid-based medicine lies in the rapidly evolving field of botanical drug substance development, as well as the design of molecules that target various aspects of the endocannabinoid system.

 

Exactly who benefits from state medical marijuana laws?

 

Real science, real medicines and real medical treatment are the last things that medical marijuana advocates are interested in. They could care less about synthesized cannabinoid-based medications. They want to smoke marijuana, period. The media is finally taking a serious look at the hypocrisy of state medical marijuana laws, although the media itself helped create this monster.

Posted in Drug abuse, Marijuana, Marijuana legalization, Medical marijuana, MJ lobby, Pot doc, Substance abuse | Tagged , , , , | 12 Comments

How smokefree laws for adults protect children

Posted on September 22, 2010 by

A funny thing happened with Scotlands’ smokefree law, which banned smoking in public places such as restaurants, bars, shops, cinemas, offices, hospitals, work vehicles and sports centers.

Research published in the New England Journal of Medicine showed that this law has reduced the rate of children going to the hospital because of severe asthma attacks by 18 percent a year since the the law was passed in 2006.

But why? Kids don’t spend a lot of time in restaurants, bars, shops, cinemas, offices, work vehicles, etc. The overwhelming number of people who go to these places are adults. And critics of the law said that when smoking was banned in these public places, more adults would be smoking in their homes, and that would be worse for kids.

Those critics were exactly wrong, as are most special interests who argue about tobacco, alcohol and drug laws from their own special interest – and without any evidence to back up their opinions.

Smoke-free laws have another – perhaps more important – impact beyond immediately protecting people from second-hand smoke: They change the cultural norm about tobacco. This from the WHO Report on the Global Tobacco Epidemic 2009 says:

Smoke-free environments not only protect non-smokers, they reduce tobacco use in continuing smokers by 2–4 cigarettes a day and help smokers who want to quit, as well as former smokers who have already stopped, to quit successfully over the long term. Per capita cigarette consumption in the United States is between 5% and 20% lower in states with comprehensive smoke-free laws than in states without such laws. Complete workplace smoking bans implemented in several industrialized nations are estimated to have reduced smoking prevalence among workers by an average of 3.8%, reduced average tobacco consumption by 3.1 cigarettes per day among workers who continue to smoke, and reduced total tobacco consumption among workers by an average of 29%. People who work in environments with smoke-free policies are nearly twice as likely to quit smoking as those in worksites without such policies, and people who continue to smoke decrease their average daily consumption by nearly four cigarettes per day.

Smoke-free laws make more people want to quit. They make smokers cut back on their smoking. They make more people cognizant of the impact of smoking on children and others.

 

From WHO Report on the Global Tobacco Epidemic, 2009

 

This shouldn’t be surprising. Most people who smoke want to quit. Smokers are normal, caring people who happen to be addicted to nicotine. They need help and support, which cessation treatment and smokefree laws provide. Smokers are not sociopaths who don’t care whether they hurt others, especially children, as critics of smoke-free laws (namely the tobacco industry and its minions) apparently think.

 

Next stop for protecting kids -- smokefree multiunit housing

 

The findings in the NEJM show that smoke-free laws should be expanded to endow a global norm against tobacco use. Next stop needs to be smoke-free multifamilty housing – apartment and condo complexes.

From the New England Journal of Medicine:

A resident who smokes in a single unit within a multiunit residential building puts the residents of the other units at risk. Tobacco smoke can move along air ducts, through cracks in the walls and floors, through elevator shafts, and along plumbing and electrical lines to affect units on other floors. High levels of tobacco toxins can persist in the indoor environment long after the period of active smoking — a phenomenon known as third-hand smoke.

Not only does cigarettes smoke from one unit infect all other nearby units, but apartments are where so many children live. Smoke-free housing will help even more people quit as they recognize their personal responsibility to protect others – and especially children.

Posted in Big Tobacco, Prevention, Second-hand smoke, Smoke-free, Substance abuse, Tobacco, Tobacco and kids, Tobacco marketing | Tagged , , , , , , , | Leave a comment

The war Down Under: Big Tobacco’s assault on Australia

Posted on September 17, 2010 by

 

Unbranded cigarette packs: They have that... j' ne se qua

 

You’d think it would be tough marketing a product that kills half the people who use it as directed. The fact that it’s the most addictive substance on the planet helps. Still, you have to get new customers somehow, when your existing ones die or quit.  And that’s why the global tobacco industry has some of the best marketing people on the planet, who are fighting a desperate battle in Australia to hang on to their best remaining marketing tool – the brand.

Australia is pushing for plain packaging for cigarettes in brown packaging beginning in 2012. Each pack will include only graphic health warnings and the brand in black typeface.

The tobacco industry says that violates its trademark rights. Government attorneys say that’s nonsense. How important is this to the tobacco industry? Enough to pull out all stops. This from Australia’s ABC News:

The Alliance of Australian Retailers was then formed in August, purporting to represent thousands of ordinary shopkeepers. On the day the alliance was set up, documents show it became the instant beneficiary of millions of dollars from the world’s top cigarette manufacturers: Philip Morris – $2.1 million; Imperial Tobacco Australia – $1.08 million; and British American Tobacco – $2.2 million

One argument we keep hearing from the industry is that there is no evidence that plain

 

Here's a popular brand...

 

packaging works. In ATOD work, we often hear this argument: “there’s no proof that etc…,” which usually means that there’s plenty of research evidence, but the special interest refuses to recognize it. Of course, if there was no evidence that plain packaging works, then why is Philip Morris desperately fighting to stop it in Australia?

But there is research evidence dating back for decades that plain packaging works. I suggest Google scholaring plain packaging and tobacco.  Also, Smokefree Action UK, has pages of evidence.

Here’s what marketing experts say about the cigarette pack:

  • “It is the communication life-blood of the firm… the silent salesman”
  • “It is a promotional tool in its own right”
  • “It is a total opportunity for communications¦ a carefully planned brand or information communications campaign”
  • “In this struggle to win over smokers, the pack and its messages have become increasingly important weapons.”

And here’s what tobacco industry analysts from Citigroup say:

“Plain packaging would significantly reduce the power of tobacco brands… The industry is so profitable only because consumers are willing to pay a premium of £1.50 for certain brands. We think this measure would cause a rapid worsening of the downtrading trend. Over time this would hurt profitability significantly.”

 

And then there's Gangrene. Who knew?

 

But the most important reasons come from the tobacco industry itself. Brands are crucial to getting new smokers.

“The teen-age years are important because those are the years during which most smokers begin to smoke, the years in which initial brand selections are made…”

1975 report from Philip Morris researcher Myron E. Johnston to Robert B. Seligman in the Richmond Times-Dispatch 05/09/98

The tobacco industry is fighting so hard because Australia is an educated, industrialized nation that’s in the forefront of tobacco control. Other countries will certainly follow suit – as they should – once plain packaging passes Down Under.

Posted in Big Tobacco, Prevention, Smoke-free, Smokeless tobacco, Substance abuse, Tobacco, Tobacco and kids, Tobacco marketing | Tagged , , , , | Leave a comment

UK media fall for alcohol industry press release

Posted on September 8, 2010 by

 

There's that picture again: The one that's defining a new era of UK alcohol excess.

 

“Big drop in alcohol consumption,” the Independent blared. “Alcohol drinking in Britain sees sharpest fall since 1948,” the Telegraph trumpeted. “Record fall in alcohol consumption,” the Mirror shouted.  “Alcohol drinking continues fall,” the BBC chimed in.

We have an idiom for all that on our side of the pond. We call it, “falling hook, line and sinker.”

The British media swallowed whole last week an alcohol industry press release suggesting that UK’s notorious drinking problems actually are on the mend. This would be funny if it weren’t so tragic, particularly for Britain’s young people, whose health, safety and lives are under assault from alcohol.

The real story was told in a chart, which the “drinks” industry is obviously quite proud of,  because it shows how volume and sales must equal profits. 

Anyway, here’s the chart:

Does that look like a problem on the wane to you, as the headlines proclaim? Because it doesn’t to me. It looks like a blip within a consistent, dangerous but quite profitable rise in alcohol consumption.

The alcohol industry routinely has its way with British public policy. And the results can be quite disastrous. The alcohol industry-supported Licensing Act of 2003 allowed 24-hour alcohol service, which was sold as a way to reduce dangerous drinking.

The result? A report by the Home Office shows what everybody in Britain already knows. These policies are failed: Hospitalizations related to alcohol have shot up. Public drunkenness and especially binge drinking among young people have become a national disgrace. Police and health costs created by this policy have been sloughed off on local governments.

Any preventionist could have told the government how ridiculous it was to think you could reduce binge drinking by allowing 24-hour sales and access. Many health and research experts did tell the Labour government, but it wouldn’t listen. This benighted policy has now brought renunciations from around the world.

The British Home Secretary admitted the failure:

The promised “café-culture” from 24-hour licences has not materialised, instead in 2009/10 almost one million violent crimes were alcohol-related and 47% of all violent crime was fuelled by alcohol. A fifth of all violent incidents took place in or around a pub or club, and almost two-thirds at night or in the evening.

But now, the UK cannot simply reverse course, as it obviously should, because there is one player who benefits from it. That’s right, the so-called “drinks” industry. Instead, government is looking at how the Licensing Act can be modified, while at the same time urging people to drink responsibly, an utterly valueless exhort. Preventionists know – and by rights so does government — that telling people to drink responsibly doesn’t work. Policy change and enforcement work. (See Youth Drinking Prevention Logic Model from PIRE, Fig. 1, over in the Blogroll)

Last week’s press release from the so-called drinks industry was an attempt to use the media to distract the British public and policy makers from the licensing disaster and the binge drinking epidemic it caused. Here’s hoping it doesn’t work.

Oh, and look at this below — a drunkenness survey among 15-year olds:

 

Big problems for UK youth: Data from Organization for Economic Cooperation and Development -- Drunkenness among 15-year-olds, 2005-06

 

Posted in Alcohol, Alcohol abuse, Binge drinking, Prevention, Substance abuse, Underage drinking | Tagged , , , , , , , , , , , , , | 4 Comments

Treating addiction as a chronic disease, or how can something that makes so much sense be so impossible to achieve?

Posted on September 2, 2010 by

 

A declaration ten years ago that substance use disorders must receive treatment as chronic conditions...

 

It’s been ten years since a special communication in the Journal of the American Medical Association by four leading experts declared that drug dependence (including alcohol) should be treated as a chronic medical problem, not a social problem. This was not a brand new idea, but seeing it in JAMA was like the golden seal of approval. Or it should have been.

Ten years later, are we closer to that goal? There’s been a lot more thinking about how we should integrate treatment of substance use disorders into primary care and public health systems. A few places are doing it, including some pilot projects. But when it comes to health system-wide, daily clinical level — that remains abysmal.

 

...Today, not much has changed

 

Here’s what the White House Office of National Drug Control Policy’s National Drug Control Strategy 2010 says about the failure to integrate treatment into health care:

“…addiction treatment is the only specialty in medicine that is not an integral part of the rest of the healthcare system There is a great divide between addiction treatment programs and mainstream health care.”

The 2000 JAMA article broke ground because it showed that chronic conditions such as diabetes, hypertension and asthma were very similar to drug dependence but treated entirely differently. Drug dependence was treated as an acute rather than chronic problem – quick detox, short rehab (that’s all insurers cover), here’s an AA meeting list, good-bye — and results were disappointing. The best outcomes were when substance use disorders received the same long-term care we use for diabetes, hypertension and asthma.

One problem the 2000 article noted was that the medical establishment itself didn’t agree that substance use disorders should be medical issues.

“Few medical schools or residency programs have an adequate required course in addiction. Most physicians fail to screen for alcohol or drug dependence during routine examinations. Many health professionals view such screening efforts as a waste of time.”

Today? The ONDCP National Drug Control Policy 2010 sounds the same ten-year old deprecations:

“The mainstream healthcare system has little knowledge of addiction as a disease, nor has it dedicated sufficient resources to responding to addiction…”

Some things are happening, like the screening and brief intervention movement, which identifies people with substance use disorders in trauma and emergency settings. And some wrap-around HMOs like Kaiser Permanente integrate chemical dependency and other behavioral care in primary care, though at different levels in different locations. Other organizations develop systems on paper and push them out as pilot projects.

My problem is that all this is going on above the heads of patients (as usual) and nobody’s bothering to explain it to them. So, here goes. The National Institute on Alcoholism and Alcohol Abuse has an old set of four questions for clinicians; it’s as good a place to start as any:

Doctor: Tell me, have you ever felt you should cut down on your drinking?

Patient: Huh? Well… my wife thinks I should. She tells me about it pretty regular. So yeah, I guess I think about it.

Doctor: Have people annoyed you by criticizing your drinking?

Patient: Like I said, my wife. And my oldest daughter. She thinks I’m an idiot sometimes on Sundays after we go to a barbeque. My brother says I need to knock it off. But I’m not hurting any of them.

Doctor: Have you ever felt bad or guilty about your drinking?

Patient: I mean, hasn’t everybody? Like when my wife tells me something that I said the next day and I know I only said it because I had a few too many. You know…

Doctor:  Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

Patient: Now I’m not like that, Doc. I haven’t done that in awhile. I can keep it under control better than that.

Doctor: Well, I’m going to refer you to a specialist about this. I’ll have my assistant make an appointment for you.

Patient: I know what you’re getting at, and I’m not an alcoholic. I’m positive of that.

Doctor: It’s not that. We’re just going to have you screened for now. If you had recurrent headaches, we’d send you to a neurologist, right? That’s what you’d want, isn’t it?

Patient: I guess so, but I’m not an alcoholic.

Doctor: So no problem going to a specialist.

Then, an addiction specialist screens the patient, diagnoses him and develops a plan for – and these are the important words — treatment until recovery. Just like for any other chronic disorder. That treatment might include individual counseling, group counseling, outpatient treatment, inpatient treatment, medication, psychiatry, AA or NA meetings, the whole panoply of treatment possibilities. And it would be integrated with care received by any other clinicians.

And this same could be done for people with addictive disorders co-occurring with other disorders, such as bipolar, which happens a lot.

Noncompliant substance use disorder patients would be treated the same as noncompliant diabetes patients. We try to get them to be compliant. Pretty much all patients are noncompliant at some point. We don’t throw up our hands and say it’s all a failure like we do with substance use disorders. Instead, we continue treatment until recovery.

Sounds simple, doesn’t it? Yet so far it’s been impossible. Insurers and other special interests say it’s too expensive. They team up with these behavioral health carve-outs – you’ll find their phone number on the back of your HMO card – which are one of the biggest impediments to integrating treatment and behavior health into primary care. They must be eliminated.

Also, the social model recovery movement – recovery programs usually based on 12-step or therapeutic community models – fear that integrating treatment with health care will put them out of business. I don’t agree. Social model programs provide excellent, affordable inpatient and outpatient treatment services that always will be necessary.

Oh, by the way, integrating medical and substance use disorder  treatment save a bundle of money. It would be cheaper than the system we have now, according to a utilization and cost review:

“…among the subset of patients with substance abuse related medical conditions, integrated care patients had significant decreases in hospitalization rates, inpatient days and ER use. Total medical costs per member month declined from $431.12 to $200.03…”

Integration of treatment and medical care is endorsed in Obama health care reform, and some states are passing their own laws. But it’s all been promised before in parity legislation yet never seems to happen. As the Obama health care plan gets closer, expect a full frontal assault against integration by insurers and other special interests.

So, are we closer to the vision expressed by the authors of the JAMA article a decade ago? Maybe those more optimistic than me will say so.

Posted in Addiction, Alcohol, Alcohol abuse, Drug abuse, Integrated treatment, Parity, Recovery, Substance abuse, Substance use disorder treatment, Treatment, Treatment until recovery | Tagged , , , , , , , , , , , , , , | 2 Comments