The Effect of ObamaCare on Treatment
The Affordable Care Act has gotten a lot of attention since it was first introduced, but how does it change options for treating substance abuse? The Fix offers some practical information.



Does it care for addicts? Shutterstock


By Marissa Rosado

04/21/14
Source The  FIX
The course of events that add up to a substance abuse problem are often complicated and traumatic. The acknowledgment of the problem and the decision to enter a treatment program can be more difficult. And yet the most challenging part of this process, for many, is life after rehab: addiction resolution and continued sobriety.

Rehab can be like a cocoon. But once treatment has ended and the addict returns to society without the structure and support of the facility, he or she often relapses. For recovering addicts, the maintenance of their sobriety is a challenge that dominates their life. Will addicts be able to find continuing care from programs covered by their health insurance plans? With the landscape of health insurance options changing rapidly within the last year, what exactly can recovering addicts count on?

Previous healthcare reforms for the treatment of substance abuse

Alcoholics Anonymous was founded in the US in 1935, but it took the American Medical Association until 1952 to define and acknowledge alcoholism. Case in point: we are used to a government that falls short and lags behind the issues regarding substance abuse.

After mental health insurance coverage was protected with the enactment of 1996’s Mental Health Parity Act, it took another 12 years to get it amended to include the Addiction Equity Act (its name in total, the MHPAEA). The act placed annual or lifetime dollar limits on the cost of treatment for recovering substance abuse addicts. This was a landmark move not only because it recognized the importance of supporting recovering addicts under current insurance plans, but also because it also prevented insurance companies from taking advantage of insured parties. Care for recovering addicts was guaranteed, and it looked like it wouldn’t cost an arm and a leg.

Thanks to this legislation, the cost of substance abuse treatment was no more than the coverage for medical/surgical treatments allotted for in health insurance plans. While this doesn’t necessarily mean the treatments are affordable (especially for many in recovery, money is tight), it does provide a safety net for those seeking help. Copays, coinsurance, and out-of-pocket maximums are the same for someone treating heroin addiction as they are for someone with persistent seasonal allergies.

However: the MHPAEA did not make treatment for substance abuse a mandatory point of coverage for insurance providers. It also did not require plans to offer copays or any financial help for specific treatment of substance abuse, such as rehab programs or addiction resolution. So here is this terrific landmark legislation with giant loopholes embedded in it. This left a gap that left many in recovery without help or care.

The Affordable Care Act

In 2010, President Obama signed the Affordable Care Act (“Obamacare” or “ACA”) into law. In late 2013 and continuing this year, the law has finally been put into practice. Millions (7.5 million, actually) of previously uninsured Americans now have health insurance. One of the tenets of the ACA is to increase the quality and affordability of health insurance. Another is to reduce the cost of healthcare for the government and insurable parties. So what does this mean for those seeking substance abuse treatment?

The good news

In a groundbreaking move, the ACA has declared the treatment of substance use disorders an essential health benefit. Where the MHPAEA fell short, the ACA is picking up the slack. Addiction recovery is now seen as a critical component to physical health. Now many more will have access to rehab programs. More in need of that treatment will receive it, which will decrease the number of abusers and, hopefully, the number of relapses.

The logic behind the ACA’s prioritization of treating substance abuse is simple dollars and cents: previously untreated addiction costs the tax payers billions of dollars accrued through privatized health care and law enforcement. Ideally, having addiction treatment covered will eventually save this country money and diminish the strain on law enforcement occupied with drug related crimes.

The methods of treating people with substance abuse under the ACA reflect a new approach. The law largely promotes the idea of preventative care. Previously, addicts were treated when they “hit bottom," when it was apparent to every outside perspective that the person needed help. Moving forward, the ACA will treat substance abuse the way it should be treated. This will include disease prevention. Think of all the campaigning to prevent obesity that’s sprung up in the last decade. Now think of that attention applied to preventing substance abuse. The ACA also promotes earlier intervention to prevent the addicted person from ever hitting bottom. The act also offers several treatment options when the insured party seeks care for their addiction.

An example of the advanced perspective of the ACA can be found in the way alcohol abuse is addressed. Screening and counseling for alcohol abuse is now considered preventative care, and under the ACA, preventative care must be fully covered. That means no deductible, co-pay or co-insurance for an insured party. People seeking care for alcohol abuse won’t be penalized or unnecessarily charged.

More good news: if someone has a history of substance abuse and is afraid of being disqualified from eligibility, there’s nothing to fear. Under the ACA, an applicant cannot be deemed ineligible for insurance based on a pre-existing condition. Under this law, substance abuse counts as a pre-existing condition; candidates cannot be rejected from the exchange based on previous drug abuse. Think of what this will mean to thousands battling drug and alcohol abuse: full health insurance, access to proper care, and a fresh start.

Are Online Pharmacies Fueling the Prescription Drug Abuse Epidemic?
The Ryan Haight Act of 2008 gave the DEA the power to prosecute and shut down illegal online pharmacies. So why are so many still in business?



Shutterstock


By Allison McCabe

04/23/14
Source The Fix

On the morning of February 12, 2001, Francine Haight found her 18 year old son, Ryan, lying lifeless in his bed. Francine, a nurse, tried to resuscitate her son but it was too late. Ryan was dead of a Vicodin overdose.

“I was in shock,” Francine recounts. “Just the night before, we had dinner together after he came home from work at a nearby retail store. He used my Jacuzzi tub because he said his back bothered him from lifting things at work. At midnight I had kissed him goodnight and he said ‘love you, Mom.’”

After asking Ryan’s friends about the drugs and finding out that he had purchased them on the Internet, Francine sent Ryan’s computer to the DEA. The DEA found that Ryan had purchased the Vicodin from an online pharmacy which had then delivered the drugs directly to the Haights’ home.

If you look in your spam folder, you will probably find an ad for an online pharmacy. The majority advertise Viagra and Cialis and maybe some cholesterol drugs; drugs that require prescriptions but are not controlled substances restricted by the federal government. If you dig deeper, however, you can very quickly find whatever you’re looking for.

I once tried to score on the Internet. Many years ago, mid-kick and desperate, I searched online classifieds, looking for hidden code or secret meanings in every post; I was sure I could find someone discreetly selling heroin or other strong opiates. Why wouldn’t a dealer exploit the new global access of the web? I followed a “Pain Relief, all kinds” to a trailer park in the valley. The woman who answered the door was disheveled and her place was stacked floor to ceiling with newspapers, electronics, clothing. “Do you have the money?” She asked. Turned out she didn’t have the dope, but if I gave her my money she would “make some calls.”

These days you no longer have to wait around for an unreliable dealer, forge prescriptions, doctor shop, or engage in some other hustle to score your dope. While the FBI goes after deep underground drug selling sites like Silk Road, illegal online pharmacies have sprung up on every virtual corner. All you have to do is visit a website, make your choices, give your credit card info, and you’re set with a month’s (or more) supply of Ambien, Xanax, Ritalin, or morphine.

Jennifer was addicted to Ambien. She was the kind of drug addict who would take a handful of pills, lose consciousness, and wake up on the sidewalk in the middle of the night half-dressed. Or she would walk into a favorite restaurant, sober, and find that she’d been 86’d because of some Ambien-induced behavior that she didn’t remember.

“I was getting them prescribed by three doctors with refills, but my tolerance was so high and my body needed them so I wouldn’t go into withdrawal.” Jennifer was constantly requesting early refills and she knew that her behavior was sending up red flags at the pharmacies, so last year she decided to try her luck online.

Jennifer did a search and clicked on the first online pharmacy that popped up. She placed her order and the pharmacy called her back to get her debit card info. There was no request for a prescription, no doctor’s consultation. It was as easy to order Ambien, a federally controlled schedule 4 drug, as it was to order aspirin. Jennifer’s problems getting early refills were over. “This pharmacy doesn’t care about when you order. If I ordered 200 pills on a Tuesday, I could order another 200 on that Friday. They didn’t care, they were all about the money.”

After Ryan’s death, Francine Haight found that there were hundreds of online pharmacies (as of 2013, more than 34,000) selling prescription drugs. These pharmacies were able to dispense federally controlled drugs because there was never any explicit law against it. Laws governing the distribution of controlled substances were written in the 1970s, when no one could have predicted that one day sales could be made over a computer network. Consequently the law included no explicit prohibition against online pharmacies prescribing and distributing controlled substances. If prosecutors wanted to convict, they had to rely on an implicit prohibition, and do some tricky maneuvering in order to prove that online pharmacists’ methods “fall outside the usual course of professional practice.” This argument was used successfully in Ryan Haight’s case, and the online pharmacist and associated doctor were sentenced to prison.

The Ryan Haight Act and the DEA

As a result of Ryan’s case, Congress passed the Ryan Haight Online Pharmacy Consumer Protection Act of 2008. The act went into effect in April of 2009 and states that “No controlled substance that is a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act may be delivered, distributed, or dispensed by means of the Internet without a valid prescription.” “Valid” means that the person writing the prescription has had at least one in-person visit with the recipient of the prescription. Also, each online pharmacy is required to list, on its homepage, the name of the affiliated pharmacist, his or her licensing info, the full name and address and phone number of the pharmacy, and a certification that the pharmacy is licensed to deliver controlled substances through the Internet.

Shortly after the Ryan Haight Act was made law, the DEA announced that the online pharmacy problem was close to being solved. According to a senior DEA official, “The Ryan Haight Act has pretty much eliminated the online business in the United States [and] the DEA hasn’t found a large number of foreign sites selling controlled substances to the U.S." In 2010, the DEA’s pharmaceutical investigations chief said that “(t)he Internet is not as big of a problem as we all think it is…especially dealing with controlled substances.” He added that he thought that the illegal pharmacies that were still in business were probably selling fake and counterfeit drugs. He went on to claim that the lack of any prosecutions (there have since been a couple of successful prosecutions, but they are drops in an ocean of illegal online pharmacies) under the Ryan Haight Act was due to the law having a successful deterrent effect.

Is Social Media Dependence a Mental Health Issue?
Selfie addiction or the inability to stop fishing for likes on Facebook may seem ridiculous, but could they actually be the new addictions of the 21st century?



Shutterstock


By Emma Stein

04/24/14

With the recent traumatic news of Danny Bowman, the 19-year-old UK resident who attempted suicide after being obsessed with taking ‘selfies,’ the general public has vocalized strong opinions on both sides of the social media debate. It’s no question that we are developing a dependence on the technological advance that unifies billions of people, but are we addicted? The Fix spoke with four different leaders in the field to uncover the growing obsession with status updates, and what this means for our psychological well-being.

“In moderation, social media can be a great way for teens to connect to others, to relate to their peers, and to express themselves,” Dr. Karrie Lager, a child psychologist practicing in Los Angeles, says. “However, excessive internet use can have serious negative consequences,” she explains in response to a survey published by CASA Columbia. The survey explores the relationship between teenagers, social media use, and drug abuse. They found that 70% of teenagers age 12-17 spend time on a social media site in a typical day, which amounts to 17 million teenage users. Those that interact via social media on a daily basis are five times likelier to use tobacco, three times likelier to use alcohol, and twice as likely to use marijuana. 40% of these teens surveyed admit to having seen pictures of people under the influence, and are four times likelier to use marijuana than those who haven’t scrolled through these images. The data makes sense: those exposed to pictures of drugs and alcohol are more inclined to seek and experiment with it themselves.

Dr. Charles Sophy, a Los Angeles-based psychiatrist and Medical Director for the Los Angeles Department of Children and Family Services, explains that “no matter what genetics a teen may possess, they are impressionable and adding social media to the already prevalent peer pressure only ramps that pressure up further.” He has treated several young adults that are now confronting the aftermath of prolonged social media exposure.


There is a small minority of people addicted and the good thing is that they can be helped. For some, social media is addictive and can be absolutely lethal.

The danger, Dr. Lager says, is that constant exposure to pictures of teens under the influence glamorizes the use of alcohol and drugs. “Teens may become desensitized and believe that since everyone else is trying them, they should too.” In terms of whether social media addiction exists, she explains that researchers have found some behavioral similarities between excessive Internet use and substance abuse, “including tolerance, withdrawal, unsuccessful attempts to cut back, and impairment in functioning.” However, Dr. Lager clarifies that additional research needs to be done before defining “social media addiction” as a distinct diagnosis.

While many are quick to praise Facebook for transforming our social landscape by connecting millions of people, the conversation that examines whether our dependence on it is reaching destructive levels is a few steps behind. The University of Michigan addressed this issue in a study published in August of 2013 that observed the relationship between Facebook use and well-being. By texting study participants five times a day over two weeks about how they felt after using Facebook and how satisfied they were with their lives after the two-week period, their study found that Facebook negatively impacted them with each variable. The more people used Facebook “the worse they felt” and “the more their life satisfaction levels declined over time." If Facebook makes us feel worse, why can’t we stop ourselves from going back for more?

The reason we can’t keep our thumbs away from updating, liking, and hashtagging was explored in a study conducted by Harvard University’s Psychology Department that found that there is a biological reward that happens when people disclose information about themselves. “Self-disclosure was strongly associated with increased activation in brain regions that form the mesolimbic dopamine system, including the nucleus accumbens and ventral tegmental area,” the study reported. Rewards were magnified when participants knew that their thoughts would be communicated to another person. So why are we so enmeshed in the allure of social media? It’s because we’re programmed that way.

Our desire to disclose personal information about ourselves to others is ingrained in the human condition—it’s not just a product of social media. It’s so ingrained, in fact, that people would actually forgo money to talk about themselves instead of discussing other people or answering fact questions. While this may not be a phenomenon specific to social media, social media does supply the platform to self-disclose to the masses and receive immediate feedback. Dr. Adi Jaffe, who holds a Ph.D in Psychology and serves as the Director of Research, Education, and Innovation at Alternatives, an addiction treatment program, comments on the downside to this phenomenon. “The immediacy and reward associated with social media (especially through mobile avenues) can be thought of as a ‘quick hit’ and would be expected to result in a minority of users experiencing ‘addiction-like’ symptoms,” he says.

Meet Alex, a graduate of the Narconon Program who has been living a happy, healthy and sober life for over 3 years since graduating the Narconon Program.

 ”My name is Alex and I used to be a drug addict.  I was addicted to Opiates and Benzos for almost 10 years.  I was born and raised in West Palm Beach Florida.  I had a pretty normal childhood growing up and was a pretty happy kid.  Right before high school I started to run into certain things in life that I simply couldn’t handle or couldn’t figure out a solution to.  Around this time I was introduced to drugs and they became a great solution to those issues…so I thought.  I could be more social, more confident, work longer, be happier, and just feel “normal”.  All I was actually doing was making it harder and harder to function in life without using drugs.”

Like us on Facebook                                    www.councilsepa.org                              Follow us on Twitter

"OUR STORIES HAVE POWER"   A free training for people in recovery from addiction, family members and supporters of recovery, designed to reduce stigma by learning the language of recovery!    Be an advocate for recovery!        Saturday, April 26, 2014 9:00 am - 1:00 pm Everyone welcome! This event is free of charge but you are encouraged to preregister for this training  by calling Karen at 215-788-3738, ext. 100   Location: Southern Bucks Recovery Community Center/PRO-ACT 1286 Veterans Highway, Suite D-6, Bristol, PA 19007    Presenter: Aaron Kucharski, NCADD-NJ Recovery Community Organizer   Join thousands of advocates who have taken this training across the country   This training is in cooperation with

    

	Friday, May 2: Celebration
	You're Invited to an   Overdose Prevention Act   Commemorative Celebration   Friday, May 2, 2014 7:00 pm to 10:00 pm  at the    Old York Country Club  228 Old York Road Chesterfield, NJ 08515    Hors d'oeuvres to be served *** Cash Bar will be available  RSVP TO PAUL RESSLER BY MONDAY, APRIL 28, 2014 press27148@aol.com or by phone at 609-581-0600 (office), 609-947-4296 (cell) _________________________________________ This event commemorates the first anniversary of the signing of this life-saving legislation, honoring those we have lost, and spending time in fellowship with others who  are committed to preventing needless overdose deaths in New Jersey.