DRUG REHAB: Counselors included sex offenders, embezzlers

DRUG REHAB: Counselors include sex offenders, embezzlers

California is one of two states that don’t do background inquiries on people registering to do drug and alcohol rehab therapy

 

An officer checks a motorist at a DUI checkpoint in 2009.

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BY JIM MILLERThe Press Enterprise

BY JIM MILLER

SACRAMENTO BUREAU

Published: May 13, 2013; 10:14 AM

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SACRAMENTO — California’s lax system of credentialing drug and alcohol counselors has allowed convicted sex offenders, embezzlers and people with their own substance-abuse problems to work with vulnerable clients, according to a new report from the state Senate’s oversight office.
With demand for treatment services expected to grow as the federal health care law takes effect, Monday’s report by the Senate Office of Oversight and Outcomes found that California is virtually alone among states in not requiring criminal background checks for people registering to be substance-abuse counselors, or even asking applicants to disclose past trouble with the law.
The Senate investigation found 23 sex offenders who have been registered or certified to work as substance-abuse counselors since 2005. Those are just the counselors with unusual names who could be matched against the state’s sex-offender database; the actual total is likely much larger, the report said.
“Obviously, the main risk is that you could have someone in a counseling position who has quite a bit of control over a client,” Maia Christopher, executive director of the Oregon-based Association for the Treatment of Sexual Offenders, said in the report.
A “balkanized” network of seven accrediting organizations largely fails to detect such problems. Counselors jump from organization to organization to avoid scrutiny of criminal convictions or when they are in danger of missing a certification deadline, the report found.
The Department of Alcohol and Drug Programs, which oversees the counseling industry, is scheduled to disappear in July and its responsibilities folded into the Department of Health Care Services. Monday’s report recommends that lawmakers consider “drastic changes” to repair the system before then, including creating a centralized database to flag people with high-risk backgrounds who seek to become counselors.
The Senate office’s investigation did not include full names. It highlighted several cases in Inland Southern California, including some in which people lost licenses to work in other professions before registering as substance-abuse counselors.
A Redlands doctor identified in the report as “E. W.” surrendered his medical license in 2005 when authorities concluded that he had been prescribing dangerous medicines over the Internet to patients he had never met. The state medical board’s investigation also cited a 1993 case in which E. W. was found to have engaged in sexual conduct with two patients.
In 2011, E.W. registered to work as a counselor with the Sacramento-based Breining Institute, one of seven certifying organizations in the state. His registration expired in January 2013.
In Murrieta, “S. N.” lost his nursing license in 2001 after he was convicted of child molestation. The man also had a history of drug use.
S. N. registered with the Sacramento-based California Association of Alcoholism and Drug Abuse Counselors in 2005 and was certified as a counselor five years later. In 2011, he passed the test to become a higher-level counselor. He works for a substance-abuse treatment program in Murrieta.
Bob Dorris, chairman of the certification board for the California Association of Drinking Driver Treatment Programs, a certifying organization, said he was still reviewing the Senate office’s findings but added that “the problem is not new to us.”
“A this point I don’t think there’s any question that background checks should become a reality — including fingerprint-based background checks,” Dorris said.
Senate President Pro Tem Darrell Steinberg, D-Sacramento, said the report shows a need for more state oversight “to ensure better safety for people, especially children, who are particularly vulnerable.”

PUBLIC AND PRIVATE

There are about 36,000 registered or certified counselors who work in 2,534 private and publicly funded substance-abuse programs. They range from outpatient treatment to upscale inpatient programs, such as the Betty Ford Center in Rancho Mirage.
Some counselors are former substance abusers, the report found. That can help counselors connect with their troubled clients. But California lacks any system to track counselors’ DUI arrests or other brushes with the law.
“Many have struggled with their own addictions. If they relapse as counselors, professionals in the field consider it crucial to keep them away from clients who are trying to stay sober themselves,” the report said.
In another Inland case cited in the report, “G. Y.” was a licensed vocational nurse in 2003 when officers arrested her for stealing from patients at the Riverside hospital where she worked. The nurse eventually accepted a plea deal and was sentenced to three years in prison.
The Senate oversight office cites news media coverage of the case. In 2005, The Press-Enterprise reported that Gemma Lou Yuman, of San Bernardino, started stealing from patients to support a methamphetamine habit.
As of Monday, Yuman was listed on the Breining Institute’s website as having an active certification. The Breining Institute did not return a call for comment.
In a statement late Monday afternoon, the Department of Drug and Alcohol Programs said it was still reviewing the report. “The department remains committed to protecting the health and safety of all clients served in the facilities we license and will take all appropriate action within our authority to do so,” it read.

LENIENT OVERSIGHT

Other states’ oversight of substance-abuse counselors runs the gamut, but almost none have as lenient a system as California.
In Texas, for example, certain crimes such as sex offenses against children or clients disqualify a person from ever working as a counselor, according to the report.
Pennsylvania is the only other state that does not conduct criminal-background checks or ask applicants about their criminal history.
Past legislation to toughen up California’s system, including a bill backed by the certifying organizations, stalled in committee.
Applicants for other professional licenses in California, ranging from doctors to accountants, get much more scrutiny, such as fingerprint checks.
“If you’re a sex offender, you’re not going to be a nurse or a dentist,” Russ Heimerich, spokesman for the Department of Consumer Affairs, said in the report.
CERTIFYING ORGANIZATIONS
There are seven organizations that register and certify substance-abuse counselors in California.

• Addiction Counselor Certification Board of California (Lakewood)
• American Academy of Health Care Providers in Addictive Disorders (Solano Beach)
• Board of Certification of Addiction Specialists (Sacramento)
• Breining Institute (Sacramento)
• California Association of Drinking Driver Treatment Programs (Sacramento)
• California Certification Board of Alcohol and Drug Counselors (Sacramento)
• Indian Alcoholism Commission of California Inc. (Redding)

Bills Target Alcohol Abuse

 

BILLS TARGET ALCOHOL ABUSE

Written by

Queenie Wong

Statesman Journal

Public intoxication and alcohol abuse have long irked the police and city officials who have to clean up the mess drunks leave behind.

Now they’re asking the Legislature to give the Oregon Liquor Control Commission the authority to designate “alcohol impact areas,” which would allow cities to limit or ban the sale of low-cost drinks with high alcohol content.

“Having worked in a crowded urban environment, I’ve seen first-hand the assault, sex crimes, vandalism and disruption of public order attributed to chronic alcohol abuse,” Sgt. Kevin Hogan with the Portland Police Bureau’s Drug and Vice Division told lawmakers Friday.
Under House Bill 2702, municipalities would have to prove to the OLCC that the particular area had repeated disturbances or crimes tied to alcohol use.

Business groups, grocery stores, wine associations and retailers are pushing back.
Erez Klein, the beer and wine buyer for Whole Foods Market in the Pacific Northwest region, said while they support the goal of increasing public safety the approach in the bill is too broad and unfairly punishes businesses.

“The effort should be on enforcing illegal drinking laws and providing substance abuse treatment for those in need — not banning alcohol products,” Klein told the House Committee on Business and Labor.

Even if the state restricts certain alcoholic beverages, residents would simply shift to a place across the street outside of the alcohol impact area, opponents said.
The lead sponsor of the bill, Rep. Carolyn Tomei, D-Milwaukie, pointed to Washington where there are alcohol impact areas in Seattle, Tacoma and Spokane. In 2011, Seattle Police Department saw a significant decrease in adult liquor violations, park exclusions and trespass offenses in those areas, according to a report submitted to the Washington Liquor Control Commission.

While the report stated it is difficult to determine the direct impact of the alcohol impact areas, it concluded that it was “reasonable to assume” the restrictions did have positive effects on curbing public intoxication.

In September 2010, the city of Portland filed a petition with the OLCC to establish an alcohol impact area in the downtown core.
But the OLCC told the city in 2012 they did not have the authority to establish an alcohol impact area and would need approval from the Legislature.

“We have consulted with counsel on the issue of authority,” the letter stated. “Unexpectedly, we have determined that establishing an AIA under our current rule is not an option.”
The letter never stated why OLCC, which supports the bill, legally did not have the authority to create an alcohol impact area.
OLCC would not release the opinion from the Attorney General’s Office on Friday, citing attorney-client privilege.
qwong@statesmanjournal .com, (503) 399-6694, or follow at Twitter.com/QWongSJ

The addict's stigma: Perception of weakness hampers treatment: Editorial

By Star-Ledger Editorial BoardThe Star-Ledger
on February 24, 2013 at 7:10 AM, updated February 25, 2013 at 11:54 AM

 

The first time a person sips a drink, takes a painkiller or shoots heroin, there'™s no addiction. Over time, however, the substance takes hold and dependency develops. Hardliners say it'™s weak willpower; medicine says addicts no longer have a choice.File photo

If you’re diabetic and binge on birthday cake, you can go to the emergency room for treatment — and health insurance will pay for it. You get the same medical care for your third heart attack that you did for the first two, again, with full coverage.
But the underlying attitude in the United States, clouded by social and legal stigma, is that addicts get one shot. Get clean, but fall off the wagon, and you’re on your own.
And, as The Star-Ledger’s Dan Goldberg reported in last Sunday’s editions, many families find convincing their health insurers to cover addiction treatment is a life-and-death struggle. Some commit fraud, lying their way into inpatient rehab programs.
Diseases afflicting the body — diabetes, heart disease, cancer — have clear paths for treatment, as recommended by your physician. Depending on your policy, doctors and insurers might quibble over details, but care is typically covered.
Addiction, on the other hand, is stigmatized as a personality weakness. Just as marijuana’s medicinal value was ignored because pot’s illegal, the perception of people addicted to drugs such as heroin is clouded by law, too.
The first time a person sips a drink, takes a painkiller or shoots heroin, there’s no addiction. Over time, however, the substance takes hold and dependency develops. Hardliners say it’s weak willpower; medicine says addicts no longer have a choice.

Insurers told The Star-Ledger cost-benefit calls are made on all medical treatments, including addiction. They might cover less expensive outpatient rehab, even when doctors recommend costlier inpatient stays. In that respect, critics say, addiction is treated differently, and parity laws are needed to ensure addiction has equal access to care.

If a diabetic misses an insulin shot, doctors restore the blood-sugar balance. If an addict slips, we call it relapse and say treatment didn't work.

The Affordable Care Act requires addiction and mental health parity, but it’s still part of the law’s interim rules, and advocates worry there’s too much wiggle room for insurers to deny coverage.
In New Jersey, where heroin addiction is rising at double-digit rates, parity laws have failed to advance in past legislative sessions, though a bill mandating parity in state employee health plans is moving through the Legislature.
Like diabetes, addiction is chronic, forcing patients to make lifestyle changes. When a diabetic misses an insulin shot, doctors try to restore the blood-sugar balance. When an addict slips, we call it a “relapse” and say treatment didn’t work. Both patients need — and deserve — lifetime care to maintain balance.
The “addicts brought this on themselves” argument can be made about overeaters who get diabetes or smokers who get lung cancer. Addictions deserve the same access to insurance coverage. It’s the right path, medically and morally.

Intervention for High-Risk Teens Can Reduce Alcohol Abuse

By Rick Nauert PhDSenior News Editor
Reviewed by John M. Grohol, Psy.D. on January 25, 2013

Mental health interventions directed toward high-risk teenagers significantly reduces their drinking behavior and that of their schoolmates.

Results from the randomized study were so strong that UK researchers believe the intervention should be administered throughout the country to help prevent teenage alcohol abuse.
The study is published in JAMA Psychiatry.

The research effort, termed the “Adventure Trial,” involved 21 schools in London that were randomly allocated to either receive the intervention, or the UK statutory drug and alcohol education curriculum.

A total of 2,548 year-10 students (average age 13.8 years) were classed as high or low-risk of developing future alcohol dependency. Those classed as high-risk fit one of four personality risk profiles: anxiety, hopelessness, impulsivity or sensation-seeking.

Eleven students were monitored for their drinking behavior over two years. Four members of staff in each intervention school were trained to deliver group workshops targeting the different personality profiles. Eleven schools also received the intervention where 709 high-risk teenagers were invited to attend two workshops that guided them in learning cognitive-behavioral strategies for coping with their particular personality profiles.

Clinical psychologist Dr. Patricia Conrod, from King’s Institute of Psychiatry and lead author of the paper, said: “Through the workshops, the teenagers learn to better manage their personality traits and individual tendencies, helping them to make good decisions for themselves.
Researchers discovered cognitive-behavioral strategies helped some students better manage high levels of anxiety, reduce their tendency to have pessimistic reactions to certain situations, and helped to control their tendency to react impulsively or aggressively.

“Our study shows that this mental health approach to alcohol prevention is much more successful in reducing drinking behavior than giving teenagers general information on the dangers of alcohol.”
After two years, high-risk students in intervention schools were at a 29 percent reduced risk of drinking, 43 percent reduced risk of binge drinking and 29 percent reduced risk of problem drinking compared to high-risk students in control schools.

The intervention also significantly delayed the natural progression to more risky drinking behavior (such as frequent binge drinking, greater quantity of drinking, and severity of problem drinking) in the high-risk students over the two years.

Additionally, over the two year period, low-risk teenagers in the intervention schools, who did not receive the intervention, were at a 29 percent reduced risk of taking up drinking and 35 percent reduced risk of binge drinking compared to the low-risk group in the non-intervention schools, indicating a possible ‘herd effect’ in this population.

An excellent upside of the intervention is the carry-over effect reducing unhealthy behavior among friends and peers of the youth receiving the intensive counseling.

“This ‘herd effect’ is very important from a public health perspective as it suggests that the benefits of mental health interventions on drinking behaviour also extend to the general population, possibly by reducing the number of drinking occasions young people are exposed to in early adolescence.”
Said Conrod, “This intervention could be widely administered to schools: it is successful from a public health perspective, appreciated by students and staff, and because we train school staff rather than professional psychologists, the intervention remains relatively inexpensive to roll-out.”
Drinking is a significant issue in England as approximately 6 out of 10 people aged 11-15 in England drink and approximately 5,000 teenagers are admitted to hospital every year for alcohol related reasons.

Across the developed world, alcohol accounts for approximately 9 percent of all deaths of people aged 15-29, and so far, universal community or school-based interventions have proven difficult to implement and shown limited success.

Nick Barton, chief executive of Action on Addiction, said: “Dr. Conrod’s study, which helps young people reduce their chances of developing an addiction to alcohol and/or drugs in the future, is an exciting development for prevention work in the UK.

“This is generally recognized as inadequate, and as we see regularly in the media, currently fails to address binge drinking and drug taking among young people. We treat a large number of people who began misusing substances in their school years, and we welcome any evidence-based research which may help to reverse this trend.”

Source: King’s College London

World's first alcoholism vaccine to run preclinical trial in Chile

World’s first alcoholism vaccine to run preclinical trial in Chile

Tuesday, 22 January 2013 19:57

Written by Katie Manning  

 

Vaccine promises to cure alcoholism, but without mental health treatment, could society swap one addiction for another?

Splitting headaches and waves of nausea – a drinker’s worst enemy – may soon provide alcoholics with an unlikely rescue from a crippling addiction. A preclinical trial for the Universidad de Chile’s alcoholism vaccine, set to break ground in February, will use mice to determine dosing. Researchers will apply the findings to a human trial in November this year.

Photo courtesy of Imagens Evangélicas/Flickr.

Dr. Juan Asenjo, director of the Institute for Cell Dynamics and Biotechnology at Universidad de Chile, thinks that although the vaccine is not a cure-all, it could provide an important first step.

“People who end up alcoholic have a social problem; a personality problem because they’re shy, whatever, and then they are depressed, so it’s not so simple,” Asenjo said. “But if we can solve the chemical, the basic part of the problem, I think it could help quite a bit.”

The preclinical trial precludes the phase one clinical trial in India, when doctors will inject people with the vaccine for the first time. If all goes well, the vaccination could be available as soon as two years from now, according to Asenjo.

The vaccine could affect hundreds of millions of alcoholics worldwide. In Chile, one in 15 men have an alcohol use disorder, according to the most recent 2011 study from the World Health Organization (WHO).

“If it works, it’s going to have a worldwide impact, but with many vaccines one has to test them carefully. I think the chances that this one will work are quite high,” said Asenjo.

Normally, the liver turns alcohol into the compound acetaldehyde, which can be thanked for the vicious hangovers that often follow heavy drinking. An alcohol-metabolizing enzyme then breaks the compound down.

The vaccine would work for six months to one year through RNA, which can control gene expression. The so-called anti-aldh2 antisense RNA acts as a messenger to tell the liver not to express genes that metabolize alcohol. In other words, the vaccine ups the ante on hangovers in order to discourage consumption.

Asenjo said his research team in Chile is heading up the only trial of alcohol vaccines in the world, but the concept isn’t new.

Nearly a century ago, a drug called Disul?ram hit the shelves. Disulfiram blocks the enzyme from breaking down alcohol, thus intensifying the body’s negative response to alcohol.

The drug doesn’t ease intense cravings and has a high toxicity level. Coping with harsher hangovers is apparently a tough pill to swallow as patients often don’t continue taking the medicine as directed.

The vaccine, once injected, can’t be reversed until completion.

Inspiration for the vaccine struck from the far East, said Asenjo. Some hangover-prone individuals have a gene mutation that, like Disulfiram, inhibits the breakdown of alcohol and subsequently slashes alcoholism rates among those with the gene.

“People who are Japanese, Chinese or Korean and have this mutation – Let’s say 15 to 20 percent of the population – they don’t touch alcohol, and that’s because they feel bad with the vomit and the nausea,” Asenjo said.

Chile’s National Commission for Scientific and Technological Research’s (CONICYT) Fondef program, which gives money to develop science and technology, financed researchers at Universidad de Chile to look into this phenomenon. They found a way to alter a person’s gene expression to mimic this gene mutation, thus providing a long-term treatment.

The only lasting treatment currently available demands an iron will, according to the director of general services at Alcoholics Anonymous (AA) Chile. He said hasn’t picked up a drink in the past 36 of his 75 years.

The recovering alcoholic, who asked to remain anonymous, agreed that a vaccine alone can’t solve addiction.

“Personally, I hope it works, but it’s not so easy for the person who already has alcoholism,” said the director. “Once you have this problem. You don’t have a solution. You pick up a drink, think you can handle a few, but it’s not possible.”

He leafed through a long list of AA’s sister organizations from Neurotics Anonymous, Smokers Anonymous to Compulsive Shoppers Anonymous. A vaccine, he said, can’t cure all. It won’t fix the mental challenges that plague addicts. They might latch onto an even more lethal substance with alcohol out of the picture.

“I had a friend. He quit drinking. Then he became a terrible smoker. He was connected to an oxygen tank for two months to keep him alive,” said the director.

“A person needs to confront themselves,” he added.

By Katie Manning (manning@santiagotimes.cl)Copyright 2013 - The Santiago Times

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