When pricing treatment,know your costs and set your profit margins

Billing, ethics and parity have been hot‐button issues for substance use disorder (SUD) treatment centers for years, but the National Association of Addiction Treatment Providers (NAATP) is getting closer to finding solutions. At its annual leadership meeting in Washington last month, members, not to be deterred by a surprise lawsuit on opening day from American Addiction Centers (see ADAW, May 20, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32368 ), gathered to hear from experts on how to properly conduct billing in a dynamic new environment.     

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Public Opinion Poll Shows Deep‐Seated Conflict About Addiction as a Disease Internet Addiction Gains Attention as It Intersects with Other Problems Poll Highlights Do You Believe That Addiction Is — or Is Not — a Disease? Factors in Family Member's Drug or Alcohol Addiction GAO Recommends Monitoring Funds Made to Faith‐Based Organizations What Is an FBO? Substance Abuse Counseling Written into Federal Disaster Response Bill Plan for Disaster New CASA Survey Finds Most Parents Don't Know Teens Are Drinking or Using Drugs Briefly Noted Resources Grants and Funding Coming Up     

Membership doubles,and NAATP plans more on ethics and outcomes for 2019

The National Association of Addiction Treatment Providers (NAATP) has culled its membership, removing members who don't comply with its ethics guidelines — mainly for marketing purposes. But rather than reducing its total numbers, this move has doubled membership, from 450 in the fall of 2015 to more than 900, NAATP Executive Director Marvin Ventrell told ADAW last week.     

DEA allows buprenorphine inductions based on telephone only

Last week, the Drug Enforcement Administration (DEA) said opioid treatment programs (OTPs) and Drug Addiction Treatment Act (DATA)–waived prescribers can treat new patients with buprenorphine based on a telephone call only. The Controlled Substances Act (CSA), enforced by the DEA, requires all new patients being treated with controlled substances to have an in‐person — or, for now, telemedicine — physical exam. Now, however, because of the coexisting COVID‐19 pandemic and opioid overdose crisis, the DEA has dropped this requirement. This follows the decision of the Substance Abuse and Mental Health Services Administration (SAMHSA) to allow exemptions from the OTP take‐home regulations allowing stable patients to be given 14 or 28 days of methadone doses, instead of coming in more frequently (see DEA, SAMHSA relax OTP/OBOT regulations due to COVID‐19, ADAW March 23, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32664 ).     

AUD researcher and pharma CEO develops new medication

Bankole Johnson, D.Sc., M.D., is the chairman of Adial Pharmaceuticals, which is developing a medication—AD04, a very low‐dose formulation of ondansetron—for the treatment of alcohol use disorders (AUDs). Johnson has long studied medications – ondansetron in particular ‐‐ to treat AUDs (see ADAW, Oct. 15, 2007, Feb. 11, 2008, June 16, 2008, Nov. 3, 2008, June 7, 2010, August 16, 2010, Jan. 31, 2011, Feb. 24, 2014), and most recently has been named the 2019 recipient of the American Society of Addiction Medicine's (ASAM's) R. Brinkley Smithers Distinguished Scientist Award, which will be presented, along with the accompanying lecture, at ASAM's annual conference in Orlando next month.     

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.     

Fiellin: Keep the prescriber training for buprenorphine

It seems that almost everyone wants to deregulate buprenorphine for opioid use disorder (OUD) — with proposed legislation focused on getting rid of the Drug Addiction Treatment Act of 2000 (DATA 2000) waiver altogether (see ADAW, Oct. 11, “Bill to deregulate buprenorphine raises concerns among OTPs,” https://onlinelibrary.wiley.com/doi/10.1002/adaw.32510 ).     

NAATP guidebook not only for residential care

The National Association of Addiction Treatment Providers (NAATP) has released its draft guidebook for minimum standards for members (see ADAW, April 22, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32334 ). NAATP is not only for residential treatment providers, however. “Our position at NAATP is that we are a membership association for providers along the entire continuum and that, while residential holds an important place in our work and is our historical foundation, our membership is in no way limited to residential,” NAATP Executive Director Marvin Ventrell told ADAW last week. “Even apart from our membership, we intend our resources, including ethics and the guidebook, to reach and guide the entire continuum. It is true that some of the guidelines have application more or less relative to type of care, but as a whole it should be viewed as a provider guide, not just a residential provider guide.” We regret any confusion. The field — and prominent organizations within it — is changing.     

Correlates of Sexual Abuse in a Sample of Adolescent Girls Admitted to Psychiatric Inpatient Care

We examined correlations of child sexual abuse among 300 adolescent girls in psychiatric inpatient treatment. Diagnostic and Statistical Manual of Mental Disorders (4th ed.)-based psychiatric diagnoses were obtained from the Schedule for Affective Disorder and Schizophrenia for School-Age Children—Present and Lifetime and from data on family and behavioral characteristics from the European Addiction Severity Index (EuropASI). A total of 79 girls (26.3%) had experienced child sexual abuse during their lifetime. Child sexual abuse was associated with an adolescent’s home environment, sibling status, smoking, posttraumatic stress disorder diagnosis, self-mutilating behavior, and suicidal behavior. At least 62% of the perpetrators were acquaintances of the victims. Correlates of child sexual abuse can be used to identify child sexual abuse victims and persons at heightened risk for child sexual abuse.     

‘Hogwash’: Addiction Policy Foundation on opioid bill reports

Last week, as the Senate headed toward a vote on the opioid package, the Addiction Policy Forum was weathering an attack in the form of almost identical stories in Congressional Quarterly and Politico that said Democrats were opposed to a provision in the bill that favors the advocacy organization. According to both reports, which came out Sept. 5, Democrats objected to the language that would give $10 million a year for five years to an advocacy organization, language that would apply only to the Addiction Policy Forum. The unnamed Democrat staffers, according to the stories, pinned their criticism on the fact that the Addiction Policy Forum receives pharmaceutical funding, something the organization itself announced last December (see ADAW, Jan. 8) but created a minor ruckus after protesters from Minnesota accused the group of a conflict of interest in a story published in The New York Times (see ADAW, Feb. 19, 2018).     

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Field Pleased With Medical Management, Other Provisions of Interim Final Rule With Budget Favoring Broad Programs, Will Addiction Needs be Protected? SSI and SSDI — Will it be More Open to Addicts, or Less? Join Together and CASA go Separate Ways Ohio Survey: Many People Don't Think Addiction is a Disease Briefly Noted State News Coming up     

Alcohol reinforces both positively and negatively,complicating treatment

The Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act of 2010 require insurance companies to provide parity for mental health and substance use disorders, but these laws, on the books for a decade, aren't being enforced. And insurance companies are taking advantage of this, leaving treatment centers one choice, according to attorney Matthew Lavin: to appeal until they win, and if they don't win, to sue.     

CCAPP: Number of deaths from untreated addiction may rival those from COVID‐19

In a far‐reaching clarion call for attention to addiction in the midst of the COVID‐19 pandemic, Pete Nielsen, CEO of the California Consortium of Addiction Professionals and Programs (CCAPP), urges policymakers to recognize that the isolation required in shelter‐in‐place will fuel even more deaths from alcohol, drugs and suicide. In The Disease of Addiction Thrives on Isolation, released this month, Nielsen warns that these deaths were already “on track to break records in the number of victims in our state this year,” and goes on to say that those “who survive this year will face a second wave of death due to tobacco related diseases and or relapse to drug of choice unless tobacco is routinely treated in substance use disorder.”     

Briefly Noted

In 2020, 12 years after passage of the Mental Health Parity and Addiction Equity Act, treatment providers are still calling for parity for addiction treatment. The American Society of Addiction Medicine on April 24 issued a policy statement with specific recommendations for treatment coverage. Included in the recommendations: eliminating prior authorizations for medications, including addiction treatment as an essential health benefit, ensuring that provider networks are inclusive and more. For the recommendations, go to https://www.asam.org/Quality‐Science/publications/magazine/read/public‐policy‐statements/2020/04/24/third‐party‐payment‐for‐addiction‐treatment .     

Behavioural Addictions in Adolescents and Young Adults: Results from a Prevalence Study

Our study aims to assess the prevalence of behavioural addictions in an adolescent population, evaluating the effects of gender and age, and to assess the correlations among different behavioural addictions. 2853 high school students were assessed in order to evaluate the prevalence of behavioural addictions such as Pathological Gambling (PG), Compulsive Buying (CB), Exercise Addiction (EA), Internet Addiction (IA), and Work Addiction (WA), in a population of Italian adolescents. The South Oaks Gambling Screen-Revised Adolescent (SOGS-RA), the Compulsive Buying Scale (CBS), the Exercise Addiction Inventory (EAI), the Internet Addiction Test (IAT), and the Work Addiction Risk Test (WART), were compiled anonymously by the students. Overall prevalence was 7.0% for PG, 11.3% for CB, 1.2% for IA, 7.6% for WA, 8.5% for EA. PG and EA were more common among boys, while gender had no effect on the other conditions. CB was more common among younger (<18 years old) students. The scores of all of these scales were significantly correlated. The strong correlation among different addictive behaviours is in line with the hypothesis of a common psychopathological dimension underlying these phenomena. Further studies are needed to assess personality traits and other clinical disorders associated with these problems behaviours.     

Spanish version of the Dispositional Empathy with Nature scale / Versión española de la escala de Empatía Disposicional hacia la Naturaleza

The Dispositional Empathy with Nature scale (DEN) — dispositional tendency to understand and share the emotional experience of the natural world — offers a methodological tool for the study of the affective component of environmental concern. In this paper, the factor structure of the Spanish version of the DEN scale is tested (N = 394). The originally proposed one-factor structure is found using exploratory factor analysis — FACTOR program — with Unweighted Least Squares procedure and optimal implementation of parallel analysis (GFI = .99), along with high internal consistency (α = .93). The Spanish DEN scale shows moderate correlations between environmental concern measures (r = .36 – .44, p < .01) and low-to-moderate correlations with dispositional empathy with humans (r = .30 – .42, p < .05), indicating the distinctiveness of the scale. The Spanish version of the DEN scale is an adequate and reliable instrument for the measurement of empathic tendencies towards nature. Some recommendations regarding its future use are made.     

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Addiction Medication Marketplace: Opportunities for Drug Developers New SAMHSA Administrator Says Addiction Field not Secondary to MH Prospects Seem Promising for addictiona's Inclusion in Parity Bills Co‐Dependent No More celebrates 20th Anniversary Mental Health vs. Addiction Expenditures Briefly Noted Resources Coming up     

“I’ve changed my mind; I don’t want to go home”

Abstract

This article considers the motif of porosity and its opposite, impenetrability, in relation to the home or places where we feel at home. It discusses ambiguities in how the physical boundaries of the home—but also of the perceived human subject—are portrayed in the technology-pervaded world of the dystopian science fiction narrative Total Recall. Tracing the story from the 1966 novel by Philip K. Dick, through the 1990 film to the recent remake (2012), allows for a consideration of the changes in our understanding of how the boundaries between the home and its other are culturally conceived and what happens when the integrity of these boundaries are put into question. Despite their differences, we argue that all three narratives use the built structures of walls and the imagery of the container as a way of portraying the basic conflict of an outer world that tries to take possession of the protagonist’s inner life. Tracing narrative shifts, we suggest, can become a vehicle for understanding the ongoing negotiation of boundaries of the “self,” the human body, the home and even the city, and the implications these cultural negotiations have across the period from 1966 to 2012.     

AATOD,supporter of the MATE Act,fact‐checks the MAT Act

It's no secret that the American Association for the Treatment of Opioid Dependence (AATOD) is opposed to the Mainstreaming Addiction Treatment (MAT) Act — S. 2074 and H.R. 2482.     

AAC statement on NAATP lawsuit

As the National Association of Addiction Treatment Providers (NAATP) was beginning its annual leadership meeting May 6, American Addiction Centers sued the organization in federal court (see “AAC sues NAATP for defamation,” ADAW, May 13, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32362 ). We wanted to provide further information on the lawsuit (which we linked to in our story last week). Below is a statement provided exclusively to ADAW by AAC May 15.