Studying addiction is comparatively recent as a field of scientific enquiry.  Still, our knowledge is increasing rapidly.  Check out the National Institute of Drug Abuse to get a sense of the explosion in research http://www.drugabuse.gov/.  And they have pretty pictures of brains and nice statistics!  If you really want to learn about the cutting edge of research, check out the College on Problems of Drug Dependence http://www.cpdd.vcu.edu/.  A weird name, but CPDD is NIDA’s primary research conference. It’s usually in June, usually in a warm weather location.  This year it’s in Palm Springs.   I’ve gone several times and highly recommend it, although I confess that Lisa, my colleague at Signal, attended and didn’t care for it.  To like CPDD, I guess you have to be at least a little nerdy.  Okay, a lot nerdy, and really like data and stats.

But, and it’s a big but, one area where there has been little study is recovery.  What happens after people leave treatment? How are some people able to deal with drug and alcohol problems without treatment?  What are the characteristics of people who have been in recovery for decades?  All questions with little scrutiny so far.  So, I was very pleased to see that The Partnership at Drugfree.org and the New York State Office of Alcoholism and Substance Abuse Services (OASAS) just released the results of a nationally representative survey that asked “Did you once have a problem with drugs or alcohol, but no longer do?”  A simple way to start to look at the national landscape of recovery.  10 percent of adults answered “Yes” to that question, which translates into 23.5 million Americans.  More details at http://www.drugfree.org/.  To quote Tom McLellan, “…this additional work provides fundamental information on how many people are in recovery. These are not only the building blocks for the ‘recovery science’ that have been called for, but they are the foundation for public understanding, acceptance and ultimately, the celebration of recovery.”  An important step, indeed.

I love the internet, I love email.  Twitter, Facebook, Reddit….not so much.  I did finally get a Twitter account, mainly to follow health care reform news.  Honest!  Absolutely no Kardashian tweets!  But I keep forgetting to check my account.  Maybe increasing my Twitter consumption should be a New Year’s resolution.

I have started to listen to podcasts, mainly audio podcasts – not exactly cutting edge, I know.  Does fit better into my daily routine.  I can drive to work, putter around the house, do yard work, and listen to whatever podcast has caught my attention.  Although it really annoys my wife as it’s harder for her to yell at me from another room.

What does this have to do with addiction and Christmas?  Well, I was looking around in iTunes and discovered all of these podcasts related to addiction.  The description of one of the free podcasts in the Addicted to Addicts series starts with “What do you buy an addict for Christmas?”  A very thought provoking question that I’d never thought about.  So, I started listening and heard powerful stories of recovery and helpful advice for families of addict.  Didn’t agree with everything I heard, but worth a listen.  And then I checked out the Medical University of South Carolina, which has a series of 20 podcasts on alcohol and drug dependency.  Good interviews, good information with a research focus.  And then I decided that I needed to stop fooling around on iTunes and get back to work.  Still, I think podcasts can be a useful resource.  Books and reading are good; sometimes listening is even better.

In this holiday season, consider a donation to Faces and Voices of Recovery http://www.facesandvoicesofrecovery.org/.  FAVOR is the only national recovery advocacy organization and is celebrating their 10^th anniversary.  A worthy cause for your dollars.  And they are able to match all donations through December 31, so twice the bang for your bucks.  Plus they have opened a webstore.  Pretty limited so far, but perhaps you’ve been wanting a “Got recovery?” tee shirt.

Wednesday, I went to a meeting on the 2011 Colorado Health Access Survey, which looks at health insurance status, access to health care, and utilization of health care services.  Very nice presentation at the Colorado Trust building – good breakfast, excellent Powerpoint, some jokes about how data is sexy.  And it’s a good telephone survey of over 10,000 households. It’s the results that are disturbing and a little depressing.  The big take home is that 15.8% of Colorado residents have no health insurance coverage, an increase from 13.5% in the 2009 Survey.  That’s an increase from 675,000 to 829,000!  And more than 60% of the uninsured have been uninsured for at least one year. Shows you why people want changes in health care.  Go to http://www.cohealthaccesssurvey.org/ for more info.

 A key part of health care reform is the “essential health benefits.”   The ACA requires that most insurance plans - including those participating in the state exchanges – cover a minimum set of diagnostic, preventive, and therapeutic services and products. In the addiction treatment field, my experience is that most insurance doesn’t provide addiction treatment coverage, or does so minimally.  So, will addiction treatment services be part of the essential benefits?  Well…..let’s hope so.

There are 10 benefits specifically mentioned in the ACA.  One is “Mental health and substance use disorder ser­vices, including behavioral health treatment.”  So, it’s covered, right?  Ah…but this has not yet been defined.  Will outpatient services be part of the benefit?  Almost certainly.  Will residential services be covered?  Much more iffy.  Recovery support services? Even iffier.  And the IOM report which lays out the process for defining in detail the benefit package is recommending that Health and Human Services use the typical benefit package for small employer health plans as the base. We all know how good those plans are at covering addiction treatment!

HHS wants to complete the definition of the essential benefits by the middle of 2012 and is doing a series of “listening” meetings to get input.  The Denver one is November 18 from 10 AM to Noon at 999 18th St. South Terrace, Suite 400, Denver.  If you want to attend, RSVP to Ezra.Watland@hhs.gov. Hopefully there is still space available.

And if you are closely following health care reform, try the Kaiser quiz.  Thanks to Michael Allen to sending this link to me.

“Thinking outside the box” is popular.  Personally, I’m comfortable inside the box – dry, warm, and safe.  But stuff happens, we think new thoughts, and we’re forced to at least peek over the edge of the box.  Which happened the other day.  I was wandering through the Internet and came upon an article on 15-minute methadone.  A Baltimore provider has started dosing clients within 15-minutes of showing up at the front door.  My immediate reaction was “No way!”  The client has to have a physical, has to see the doctor, has to do the confidentiality form, has to do a UA, ….  Of course, if you do all of that, the client has to wait hours before getting methadone, which is the norm for Colorado providers.  Not a pleasant thing when you’re in withdrawal.  And why make all potential clients wait?  If you show up at the ER in pain, you can get pain meds quickly while the docs figure out what to do next.  I can imagine many problems with 15-minute methadone; the challenge for me is to imagine the positives.

And there are many, many changes on the horizon.  NIATx is testing ACHESS, a mobile phone-based relapse-prevention system.  Recovery community centers are popping up across the country.  NIDA is even testing buprenorphine as a treatment for cocaine dependence.  None of this was even dreamed of when I first entered the field.  Maybe I’ll have to climb out of the box soon!

Signal is improving its web presence, and has required asked me to do a blog, something about my known abilities to rant, pontificate, and bloviate without provocation.  So I’ve been obsessing about what to write.  Something funny?  Some ponderous editorial on the state of addiction treatment?  A dry as dust post on the latest evidence-based practice? Snarky links to cat videos?

Yesterday, in the Signal Quality Management Committee meeting, there was talk about how our clients have grown sicker over the years – more problems, greater severity, more isolated from their families.  An all too common complaint, I’m afraid.  And one that I’ve been hearing for some time.  But then they went on about how resources are drying up and how hard it is on staff to not be able to help a client, to have to say “I can’t find a safe place for you to stay tonight.”  To say “I can’t help you find food today.”  That touched my heart deeply and unexpectedly.

At Signal, we usually deal with organizations, not the individuals actually providing care and treatment.  It’s easy for us, for me, to be distant and detached, to look only at the “big picture.”  I don’t have solutions to the many difficulties we face in our field.  I do want to say “Thank you” to all the people who help those struggling with addiction – those taking vitals in detox, dispensing methadone, leading DUI groups, doing individual counseling, facilitating groups, calming angry clients, cheering sad clients….  I am profoundly grateful for the work that you do, each day, every day.  I firmly believe that it does make a significant difference in the world, that clients do start on the road to recovery every day.  Thank you again for your caring, your daily work.

And, if this was too sad for you, check out http://cuteoverload.com, the finest pictures of cute animals on the Internet.