NAATP members work to support staff during changes of pandemic

Members of the National Association of Addiction Treatment Providers (NAATP) — treatment programs both inpatient and outpatient — are still open for business. In fact, business is booming, NAATP told ADAW last week. This is good for patients, and good for providers, but at the same time, it's stressful for staff. Employers are working to combat this stress by helping to obtain personal protective equipment (PPE) — masks and gloves — for staff. In addition, they are trying to ramp up with telehealth, provide supports for staff and keep paying attention to the needs of patients. Demand for treatment is increasing, as drinking is going up as well.     

Saffron as good as methylphenidate in treating ADHD

Short‐term treatment with saffron — which comes from the crocus plant and is known to cooks as one of the most important and expensive ingredients of various dishes — is as effective in treatment of attention deficit hyperactivity disorder (ADHD) as methylphenidate, researchers have found in one small trial. The study, “Crocus sativus L. Versus Methylphenidate in Treatment of Children with Attention‐Deficit/Hyperactivity Disorder: A Randomized Double‐Blind Pilot Study,” was published in the February issue of the Journal of the American Academy of Child and Adolescent Psychopharmacology. Methylphenidate is a controlled substance, a stimulant with addictive properties.     

Student Participation in Decision-Making in Schools of Social Work

This paper discusses the concept of sociatrogenic dysfunctions—negative consequences resulting from the efforts of the social healer. This concept is applicable to all levels of social work practice —individual, group, organizational, and societal. Instances of sociatrogenic dysfunctions in psychotherapy, corrections, mental hospitals, dropout campaigns, and urban renewal are cited The possible occurrence of sociatrogenic dysfunctions challenges the notion that doing something is always better than doing nothing and emphasizes the necessity of critically evaluating the role of the social worker in change efforts. The implications for social work education and the importance of educating students to evaluate approaches to treatment are discussed.     

Politics and Philosophy in Russian Social Democracy: Alexander Bogdanov and the Sociotheoretical Foundations of Vpered

Il’f and Petrov’s travel memoir, Odnoetazhnaia Amerika (One-Storied America), is an account of their travels across the United States in the mid-thirties. This work—much edited and censored for changing political climates—was a state-sponsored attempt to reveal the “real” America to the Soviet reader. Although many critics have asserted that Il’f and Petrov’s treatment of America is surprisingly positive, regarding the work as “positive satire” ignores important stylistic and rhetorical devices operational in the text. The authors’ positive assessments of America are invariably about services, behaviours or habits they judge to be potentially useful in the building of socialism. More interesting is how the text reflects on Soviet culture; One-Storied America is an instrument of mythologization of the authors’ native land in the tradition of much travel literature. Their frame of reference for the observations about the exotic, alien world they encounter is their own culture and establishing difference, in this case, entails value judgement: what is svoi is superior. The foreignness of the other (America) is established by Il’f and Petrov through plot structure and through linguistic tropes. Average Americans— those who are not politically conscious—are characterized as limited, prejudiced and lacking taste, and this is reflected in their primitive language. Those who are ideologically sympathetic (either Americans or displaced Russians) speak excellent Russian; their speech is not marked as other. One-Storied America can thus be read as Il’f and Petrov’s attempt to exploit the foreignness of American culture in the service of Soviet cultural construction. They are particularly concerned with the construction of image and perception—and misapprehension and fear of the other are effective tools.     

Effectiveness and feasibility of a 10-minute employee stress intervention: Outdoor Booster Break

There is a growing recognition that workplace environments affect employee health. Nature contact exposures in the workplace have been shown to be healthful for employees. This pilot study was designed to test the feasibility and efficacy of a daily outdoor work break (Outdoor Booster Break) compared to a daily indoor break. A census of university office staff was invited to participate (N?=?244). Phase 1 focused on feasibility—participants (n?=?119) reported that the Outdoor Booster Break was feasible (74%), practical (80%), and worthwhile (83%). During Phase II we used a single-site randomized controlled trial (RCT) to examine the effects of an Outdoor Booster Break—compared with a control indoor work break group—for 4 weeks on employee stress. Perceived stress was measured at pretest and posttest for both conditions. Mean posttest stress scores were lower for both the control group (n?=?19) and the treatment group (n?=?18). A main effects ANCOVA model controlling for baseline stress revealed posttest stress was lower for the treatment group compared to controls (p?=?.041). Taking a work break appears to have stress-reducing benefits, but the Outdoor Booster Break reduced stress significantly more than an indoor break. Implications for employers, worksite health promoters, and future research are discussed.     

A Social Comparison Perspective of Treatment Seeking by the Homeless

The homeless will readily list ailments they claim to have, yet they will also claim that such ailments are not a problem and do not warrant treatmente In an attempt to understand this apparent paradox, data from a sampLe of homeless individuals were re-analyzed from a social comparison perspective. It was hypothesized that increased entrenchment in homelessness (increased isolation from “nonhomeless” environments and further involvement in the homeless environment) — operationalized by longer time spent on the street and a greater number of street friends — would lead homeless individuals to alter their perceptions of what constitutes a problem worthy of treatment. Results supported this hypothesis, in direction, and in almost all tests conducted. The involvement of adaptation level theory in such a social comparison process and the implications for intelVention and treatment are discussed.     

Self‐Destructive Symptomatic Frames in Clinical Adolescents: Is the Same Different?

This study examines individual and family predictors of different self‐destructive patterns—only suicidal ideation, only nonsuicidal self‐injury (NSSI), or suicide attempts (that may also include both suicide ideation (SI) and NSSI)—in a sample of outpatient adolescents (N = 42; 86% females) with mean age of 16 years (SD = 1.86). Results indicated that there are differences in youngsters with self‐destructive behaviors in their perception of paternal rejection and maternal control, when compared with youngsters reporting only SI. Adolescents from the groups with self‐destructive behaviors differ only in age. Together, these data highlight the relevance of adopting an ecosystemic perspective, which includes both the patients and their families, regarding treatment and prevention of self‐destructive symptomatic frames.     

LAC and RTI: Eliminate Medicaid prior auth for bupe

Since April 2018, Medicare limited utilization management — most often done via prior authorization requirements — for buprenorphine to treat opioid use disorder (OUD). In response, virtually all plans that covered this treatment removed prior authorization requirements. Medicaid plans should do the same, according to RTI, writing in the July 9 issue of the Journal of the American Medical Association (JAMA).     

Briefly Noted

We asked Jerry Rhodes, former top executive at CRC (now Acadia) and a leader in opioid treatment program management, what he thinks of methadone as a medication to be used in primary care to treat opioid use disorder (OUD), as some people — including former Office of National Drug Control Policy Director Michael Botticelli — recommended last year (see ADAW, July 16, 2018). “I take issue with that,” said Rhodes. “Methadone is a dangerous drug in an unregulated environment,” he told ADAW. Buprenorphine is prescribed this way, but “buprenorphine is a relatively safe drug, and methadone isn't,” he said. A veteran of many battles over methadone, including the near‐elimination of opioid treatment programs, Rhodes told ADAW that “you don't give unfettered access to methadone” to patients with OUD. “Be careful what you wish for” is his advice. This has the potential to cause harm, he said. “Only people who don't understand the history of its utilization would recommend this.”     

Mallinckrodt donates hand sanitizers to all OTPs

Mallinckrodt, a pharmaceutical company that makes methadone and buprenorphine for opioid treatment programs (OTPs) as well as many other medications, started out making hand sanitizer for its own plant employees when the pandemic began this winter. It wasn't long, however, before the company recognized that OTPs needed hand sanitizer — like everyone else, they were unable to get it. So last month, the St. Louis–based company started distributing it — for free — to all OTPs, not only its customers.     

How to Sharpen Words: Mayakovsky’s Machines of Poetic Humour

Analysis of Mayakovsky’s prose writings of the mid-1920s on the craft of satire reveals that he understood it to be a scientific discipline subject to strict cause-and-effect relationships: if the satirical treatment of a theme — any theme — is correct, then the piece will produce ‘involuntary laughter’ (neproizvol’nyi smekh). As an example, he puts forward his 1923 poem ‘Schematic of Laughter’ (Skhema smekha) — a text he claims contains no comic ideas, but only the correct satirical sharpening of discourse. As a barebones inventory of comic devices, the poem is a perfect place to begin an examination of Mayakovsky’s poetics of humour. But it is not alone; in a note to the 1925 poem ‘Shallow Philosophy in Deep Places’ (Melkaia filosofiia na glubokikh mestakh), Mayakovsky explains that it too is a ‘skeleton poem’ (stikh-skelet), just like the ‘Schematic’, and another compendium of humorous devices. Together, then, these poems represent the purest and most concentrated expression of Mayakovsky’s understanding of the mechanics of poetic humour. Sustained close reading of both poems reveals that his humorous devices, ranging from formal to narrative, all serve to establish and then deceive expectations in the reader.     

NASADAD requests $250 million for Phase 4 stimulus

If there will be a Phase 4, as Rep. Nancy Pelosi (D‐California) has promised, of stimulus money to help America cope with the fallout from COVID‐19, the substance use disorder (SUD) treatment field hopes to get some of it this time. Publicly funded SUD treatment and prevention got nothing — nothing — from the $2 trillion CARES Act passed at the end of March (see “In case you haven't heard,” ADAW, April 3, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32684 ).     

Opioids,cannabis, confidentiality,ethics, buprenorphine among highlights of 2019

Opioids are still the dominant news story in the substance use disorder (SUD) field. Last year saw continued funding from the Substance Abuse and Mental Health Services Administration — and, of course, Congress — for the treatment field. Formulations of buprenorphine, the looming loss of confidentiality protections, the growing acceptance of cannabis, and a focus on quality and ethics were among the important stories for ADAW readers.     

Sublocade: Why a placebo arm?

In a time when people are dying from illicit fentanyl overdoses, why would a trial for a new medication to treat opioid use disorder — a formulation of buprenorphine, already proven to be safe and effective in oral form — include a placebo arm? This was the question asked by many when the results of Indivior's trial for Sublocade, a buprenorphine injection that lasts a month, were published last month in The Lancet (see ADAW, Feb. 25). The trial results were what led to Sublocade's approval by the Food and Drug Administration (FDA) for the treatment of opioid use disorder more than a year ago (see ADAW, Dec. 11, 2017).     

The sexuality of men and the sociology of gender

In recent years writers in the field of the sociology of gender have turned to psychoanalysis for insights into the psychological dimensions of female sexuality. The same insights are now being applied to the analysis of masculinity. This paper argues that the full advantages of this are undermined by the adoption of an object-relations perspective which restores the social determinism from which many such writers seek to escape. This argument is pursued through a detailed analysis of one recent text in the field —The Sexuality of Men (eds) A. Metcalf and M. Humphries (1985) — but is applied more widely to the treatment of sexuality in the sociology of gender.     

Onslaught against 42 CFR Part 2 continues in Congress

With the opposition of the American Medical Association (AMA) last fall, any moves in Congress and the federal government to weaken the patient consent provisions of 42 CFR Part 2, the regulation protecting the confidentiality of substance use disorder (SUD) treatment records, were stopped in their tracks — and in the nick of time (see ADAW, Oct. 1, 2018; Oct. 15, 2018). But the groups promoting the complete abandonment of 42 CFR Part 2, replacing it with the Health Insurance Portability and Accountability Act, which itself is targeted for at least partial destruction (see ADAW, Jan. 21, Jan. 28, Feb. 25), are back. There's a new push to try to overhaul 42 CFR Part 2.     

Briefly Noted

The biennial International Drug Policy Reform Conference, sponsored by the Drug Policy Alliance and held Nov. 7–9 in St. Louis, Missouri, was full of varying sessions on harm reduction and reform — 45 of them in all. An article by Filter editor Will Godfrey summed up his perspective — he was the only print reporter so far to have covered the entire conference. We asked him what his feeling was about the prospects for treatment and harm reduction working together, as they have in the past. “There's plenty of friction, but there can and should be rapprochement between the harm‐reduction and traditional treatment communities,” he told ADAW. “Many people in the harm‐reduction movement pursue traditional recovery, and there are treatment folks who support harm reduction. All should be trying to save lives and empower people. Harm reductionists' legitimate concerns about mainstream treatment include its coercive or controlling deployment, its frequent eschewal of evidence‐based practices and its promotion of abstinence at the expense of stigmatizing people who use drugs. Treatment advocates often overlook that most people who use drugs are fine. And in any case, everyone must be free to choose their own path.” But the fact that two approaches — one more radical than the other — coexist still is bound to make some treatment providers uncomfortable. After all, some of the speakers said that even supervised consumption sites are unfair to drug users, who have no need to be “supervised,” and instead should be free to use drugs. All viewpoints were there. “There's constant debate in the harm‐reduction movement about working to change systems that inflict harm from the inside, versus calling for radical reforms from the outside,” said Godfrey. “I think both approaches are simultaneously necessary.” Not everyone saw the conflict. “I have to say that I didn't see an anti‐public health movement there at all,” Maia Szalavitz, who is writing a history of harm reduction and is respected in both harm reduction and some, at least, treatment camps, told ADAW. “There has always, of course, been tension between activists and researchers and between people who want to fight within the system and those who want to tear it all down.” For the Filter article, go to https://filtermag.org/drug‐policy‐reform‐movement/ .     

Alcoholism starts in youth,so it should be screened for

Alcohol use disorder (AUD) — what used to be called alcoholism, but a condition which by definition is sometimes used to apply to everyone who drinks alcohol and is underage — is not a disease of adults only. It starts in childhood, and that's why Scott E. Hadland, M.D., and colleagues argue for screening in the February issue of Pediatrics.