Yet believe me when I tell you that our field does have a few items to look for- ward to. Several members of the Cali- fornia congressional delegation have remained dedicated to our issues, and there is legislation being introduced that reflects this commitment to behavioral health.

Rep. Grace Napolitano, who represents California‟s 38th district (La Puente, Haci- enda Heights, Montebello) has intro- duced H.R. 751, the “Mental Health in Schools Act.” (Although the title of the bill refers only to mental health, it does encompass addiction counseling as well.) As CAADAC‟s representative in Washing- ton, I have met with Ms. Napolitano‟s legislative staff to discuss the bill and how CAADAC can help advance it. It is the purpose of this Act to revise, increase funding for, and expand the scope of the Safe Schools-Healthy Students program in order to provide access to more com- prehensive school-based mental health services and supports; provide for comprehensive staff development for school and community service personnel working in the school; and provide for compre- hensive training for children with behav- ioral health disorders, for parents, sib- lings, and other family members of such children, and for concerned members of the community.

Under the legislation, the Secretary for Health and Human Services in collabora- tion with the Secretary of Education and in consultation with the Attorney General, shall, directly or through grants, con- tracts, or cooperative agreements awarded to public entities and local education agencies, assist local communi- ties and schools in applying a public health approach to mental health ser- vices both in schools and in the commu- nity. Mental health program funded un- der this section shall assist children in dealing with violence.

The law will also provide financial sup- port to enable local communities to im- plement a comprehensive culturally and linguistically appropriate, and age- appropriate, school mental health pro- gram that incorporates positive behav- ioral interventions and supports to foster the health and development of children. It would also provide assistance to local communities in the development of poli- cies to address child and adolescent mental health issues and violence when and if it occurs. The goal is to facilitate community partnerships among families, students, law enforcement agencies, edu- cation systems, mental health and sub- stance use disorder service systems, fam- ily-based mental health service systems, welfare agencies, health care service systems, and other community-based systems. Also, it would establish mecha- nisms for children and adolescents to report incidents of violence or plans by other children or adolescents to commit violence.

If the legislation passes, grants will be es- tablished so that school districts and commu- nities will be able to apply for funds in or- der to carry out the aforementioned ser- vices. Those who apply for grants, accord- ing to the legislation, must seek to promote the social, emotional, and behavioral health of all students in an environment that is con- ducive to learning, while striving for the re- duction in the likelihood of at risk students from developing social, emotional, behav- ioral health problems, or substance use dis- orders. The goal is the early identification of these dangers, the provision of early in- tervention services, and to establish the treatment or referral for treatment of stu- dents with these conditions.

In April, Rep. Lucille Roybal-Allard of Cali- fornia‟s 34th Congressional district (Metropolitan Los Angeles, including Boyle Heights, Westlake, and Bell Gardens) intro- duced the Sober Truth on Preventing (STOP) Underage Drinking Reauthorization Act. The legislation seeks to continue the programs of the original STOP Act, which became law in 2006. It seeks to reduce and prevent under- age drinking in the United States, and con- tinue initiatives begun with the original STOP Act.

These efforts include an interagency coordi- nating committee to address underage drinking; a multimedia campaign to educate parents and communities about the dangers of underage drinking; federal research on underage drinking prevention; and commu- nity grants to fight underage drinking. The new STOP Act reauthorization would further build upon these public health efforts by authorizing an Institute of Medicine re- port on the influence that drinking alcohol has on the development of the adolescent brain. The new bill would also establish grants to train pediatric health care provid- ers in how best to screen and treat children and teens that have had alcohol exposures.

Both these pieces of legislation face long odds, for two reasons: first, any bill that calls for any form of federal spending will face a challenge by conservatives, especially in the House of Representatives. Politics concerning fiscal policy threaten to trump any efforts to pass legislation, regardless of its benefit. Second, the calendar is the enemy. Legislation this specific, on an issue that is not con- sidered “big ticket,” only stands a chance if it can be attached to a larger piece of legislation. Because of the focus on fiscal policy, even large pieces of legislation have trouble getting on the calendar for a vote these days. We will continue to work with staff from the offices of Napolitano and Roybal-Allard to try and make this happen, and we‟ll be keeping you posted every step of the way.

Respectfully, Andrew

Just as any other health care profession, substance abuse counselors are regulated by their respective states. There are no federal guidelines as to who can practice substance abuse treatment, just as there are none for medicine, nursing, psychology, or social work. The Affordable Care Act did not change this. Nothing in the act mandates what level of education, or what level of certification, a substance abuse counselor must have in order to provide clinical services. The states remain the sole adjudicator when it comes to determining who may practice substance abuse treatment, and who may be reimbursed by Medicaid for it. Some states require licensure, some require a master’s degree, and, much to the dismay of some in the profession, some states have little or no standards. As the essential benefits to be provided by the ACA continue to be formulated, it remains to be seen what standards will be required of the profession by the newly formed insurance exchanges.

All of the aforementioned points force us to ask ourselves some interesting questions when it comes to formulating policy strategies and priorities. If we are to have unified standards, what should they be? A specific credential? A designated level of education? These are tough questions to answer. Tougher still would be figuring out how to transition to these standards, while still providing care to a desperate population. Our workforce is stretched thin, and is aging. There is a severe shortage, especially in rural and tribal areas.

So therein lays the paradox. Some believe we need to move forward as a field, with high standards of education and credentialing, if we want to be recognized on the same plane as other health professionals. Others point out that he need for services is so great, that if counselors to what it believes is a higher standard, there is the realistic possibility that the law will do more harm than good. There is already a workforce shortage in the state (and the rest of the nation) and those who already have trouble finding professional treatment will now face even more of an uphill climb.

Compounding the problem is misinformation: A March 11 article in The Oklahoman newspaper said that the rule changes were required by new federal Medicaid standards. But that was inaccurate. No such federal standard exists. Steven Buck, ODMHSAS Deputy Commissioner for Communications and Prevention, told ADAW that there are no new federal standards that require a master’s degree (see ADAW, March 21). “I’m not aware of any federal standards.” According to the Centers for Medicare and Medicaid Services (CMS), there are no such standards. “There is an Affordable Care Act modification to Public Health Services rules requiring Master’s degrees, but no revision to Title 19 of the Social Security Act, which is Medicaid,” said Mary Kahn, senior public affairs specialist for CMS. “States are allowed to determine who they want to be providers,” she told ADAW.

Of course, third-party payers can make their own rules, and set their own standards for who is reimbursed. Also, Federally Qualified Health Centers may establish their own regulations, as they answer to the Health Resources and Services Administration. Yet we see the damage that has been done as a result of misinformation: an entire state has made a regulatory change based on what some believed to be a federal regulation, which in reality never existed. Why the Oklahoma regulators and legislators thought there was a new federal policy is a question yet to be answered.

So the field is caught between the largest of rocks and the most immovable of hard places: do we advocate for higher standards, which may in the long run benefit the field and the consumer, or do we address the immediate need, which is a nation of consumers that urgently needs treatment? As Hamlet would say, “Ay, there’s the rub.” Ideally, the answer is both. This will take a tremendous amount of strategy, brainstorming, advocacy, and communication. We must deliver information to the field, and to policy makers, which is accurate and timely. National, state, and local organizations that represent the substance abuse counselor workforce can

lead the way, but are well aware of the challenges they face.

Andrew Kessler is the Principal at Slingshot Solutions LLC, a consulting firm specializing in behavioral health advocacy. He represents several associations involved in substance abuse workforce issues, including IC&RC and CAADAC.

Jeff Denham replaces the retiring Repub- lican George Radanovich in California’s 19th Congressional District, which con- tains Oakdale, Madera, and points west. He comes from a business background and ran on a platform of fiscal responsi- bility. There is not much information available concerning his record on sub- stance abuse issues. The only indicator we have is that Denham is not a sup- porter of the recently enacted Afford- able Care for America act. The man he replaced, Radanovich, was not a strong supporter of our field, as he opposed needle exchange programs, and favored enforcement offer treatment.

Rep. Diane Watson, a Democrat, retired, and she will be missed. A staunch advo- cate of mental health services, Watson was a school psychologist and a cham- pion for behavioral health issues. Karen Bass replaces the retiring Watson from Los Angeles, in California’s 33rd Congres- sional District, which contains Culver City and Ladera Height. Bass is a long-time champion of health care expansion, and worked hard on the issue in the Califor- nia State Legislature. Given that two of her top priorities are health care and employment, we hope she will be recep- tive to working with us to expand the substance abuse prevention and treat- ment workforce in California. Bass has a history of working on substance abuse issues: founded the nonprofit Community Coalition in 1990 in response to the crack cocaine epidemic of the 1980s and served as the organization’s execu- tive director for 14 years. A former phy- sician assistant, she has also been a clini- cal instructor in the Physician Assistant Program at the University of Southern California’s Keck School of Medicine. Even with only two new members in Con- gress, CAADAC has an opportunity to do what it does best in Washington: edu- cate. We plan on scheduling meetings in

the very near future with both of their offices, so they can learn more about our mission and workforce. As we know, many politicians do not offer their sup- port to our issues not because of a lack of interest, but because of a lack of knowledge.

There are other changes in Congress that CAADAC members should be aware of as well. The House Appropriations Com- mittee, responsible for establishing fund- ing levels for every federal program, will be chaired by Hal Rogers of Ken- tucky. While Mr. Rogers does not have an impressive record of supporting La- bor/HHS programs in the past, he is a dedicated founder of the newly estab- lished House Caucus on Prescription Drug Abuse. Mr. Rogers has been a strong voice for establishing policies that can cut prescription drug abuse and illegal traf- ficking. However, most of his work thus far has focused on law enforcement and their involvement in this issue. It remains to be seen if this zeal carries over to funding research and services that are connected to this issue. His co-chair on the Prescription Drug Abuse Caucus is Califor- nia’s own Rep. Mary Bono-Mack.

The subcommittee responsible for appro- priations to the Department of Health and Human Services, and in turn agencies such as NIDA and SAMHSA, will be Denny Re- hberg of Montana. He has a mixed re- cord on health and substance abuse issues, but only an 11% rating from the American Public Health Association. He cast a “no” vote on the House bill to enact the Wellstone/Domenici Parity act. He later voted “yes” on the final version, but the intitial “no” vote is making many in the advocacy community very cautious.

A notable absence in the 112th congress will be that of Rep. Patrick Kennedy, the undeniable Congressional champion for substance abuse treatment over the last decade. Following closely on the heels of Rep. Jim Ramstad’s retirement after the 111th Congress, the Addiction, Treatment, and Recovery Caucus has lost both its De- mocrat and Republican chairmen in a span of just two years. This means that Con- gress is now without a member whose top priority is substance abuse treatment and prevention. Rep. Tim Ryan of Ohio will be taking over as the Democratic chairman of the ATR caucus, joining Rep. Mike Sullivan of Oklahoma as the Republican chairman. One thing is for sure: Our work is cut out for us! So let’s get started. CapWiz is going to be working overtime this spring!

Regards,

Andrew

The Director of ONDCP — also referred to as the “Drug Czar” — is Gil Kerlikowske, the former chief of police in Seattle. In introducing the strategy to Congress, he presented it as informed by scientific breakthroughs in the fields of treatment and prevention; innovations in law enforcement; and the input of both the federal government and local agencies. Kerlikowske, and the ONDCP deputy director, A. Thomas McLellan, brought with them to Washington the hope that the ONDCP could shift its focus away from the “supply” aspect of drug control, which entails law enforcement, to the “demand” reduction aspect, which includes prevention and treatment.

While Kerlikowske and McLellan appear to be sincere about this shift in direction, the budget of ONDCP has not reflected such a change in course. Despite President Obama’s statement that “I directed the ONDCP to re-engage in efforts to prevent drug use and addiction, and to make treatment available for those who seek recovery,” the budget is still weighted heavily on the demand side. Some experts, such as John Carnavale of Carnavale Associates, have pointed out that at least in the Reagan White House the budget matched the rhetoric — the “War on Drugs” was aimed at busts and harsh jail sentences for traffickers, and had the supply-side budget to match.

“The administration’s drug strategy is largely similar to President Bush’s failed strategy, especially when it comes to short-changing drug treatment while wasting money on ineffective supply-side programs,” said Bill Piper, Director of National Policy at the Drug Policy Alliance. “It does, however, break from the past in several important respects. Most notably by setting numeric goals for reducing fatal drug overdoses, embracing needle exchange, and supporting reform of the crack/powder cocaine sentencing disparity. Combined, these changes could be a first step to implementing a new bottom line in U.S. drug policy; one that focuses on reducing the problems associated with both drugs and the war on drugs.”

The strategy focuses heavily on prevention, which aligns it well with the Obama White House’s emphasis on prevention of chronic diseases in its health care reform efforts. To achieve this, ONDCP places an emphasis on community involvement. Among its highest priorities, the strategy calls for the development of a community-oriented national prevention system, and providing scientifically supported information via the National Youth Anti-Drug Media Campaign. There would also be support for mentoring initiatives, and the fostering of collaboration between public health and public safety organizations.

The plan also emphasizes a desire to see primary care as a bigger part of the solution, as it would increase early interventions. ONDCP would like to see increased screenings in all healthcare settings, which would in turn require more education for health professionals so they can recognize the warning signs of substance abuse. As prescription drug abuse remains a rampant problem, drug monitoring programs are also part of the strategy for primary care settings.

Because substance abuse in America is as much a criminal justice issue as a health issue, there is also a fair amount of the strategy dedicated to the criminal justice system, and reforms that would advance new directions in drug policy. ONDCP wants to promote alternatives to incarceration through a variety of methods. These would include encouraging partnerships between law enforcement and community organizations, mandating treatment for chronic offenders that “disproportionately burden the health care and criminal justice systems,” and supporting post incarceration re-entry efforts, such as job placement and access to drug-free housing.

There is also commitment to working on the international level, since the U.S. is one of the most lucrative markets for illegal drugs. In addition to conducting joint law enforcement operations with other nations, the ONDCP aims to expand support for international prevention and treatment initiatives. Partners for this effort would include the United Nations and the Organization of American States.

“As Director Kerlikowske has witnessed in his listening sessions with the recovery community, there’s more to recovery than not using alcohol or other drugs,” said Pat Taylor, Executive Director of Faces and Voices of Recovery. “We salute the agency’s recently released strategy’s attention to the barriers to recovery that are keeping people from housing, jobs and driver’s licenses as they work to get their lives back on track…With the “War on Drugs” over and a renewed emphasis on prevention, treatment and recovery, the strategy is identifying long-overdue solutions that address addiction as the public health crisis that it is.”

Included in the coalition are such prominent advocacy organizations as the American Psychological Association, the National Association of State Alcohol and Drug Abuse Directors (NASADAD), Community Anti-Drug Coalitions of America (CADCA,) the American Psychiatric Association, The American Society of Addiction Medicine (ASAM) and the International Certification and Reciprocity Consortium (IC&RC.)

“The Friends of NIDA is an organization that is organized around a consensus message about drug abuse and what needs to be done to understand and treat it,” said Marie Dyak, Executive Director of the Entertainment Industries Council. “It does what it is designed to do: advocate for science-based research to treat a very complex disease, aspects of which do not exist in so many other chronic illnesses.”

The Friends are most well known for its briefings on Capitol Hill. Always well attended—sometimes by more than a hundred Congressional staff—it seeks to inform policy-makers of the benefits of NIDA research, as well as its “real-world” applications. Briefings almost always include an introduction by NIDA Director, Dr. Nora Volkow, and feature one or two NIDA-funded scientists who explain their research. Often, someone who has benefited from treatment based on NIDA research also speaks. Briefing subjects try to blend NIDA research priorities with important political topics, such as treatment for veterans, prescription drug abuse and methamphetamine addiction. Other briefing topics include drug use and HIV, the role of genetics in substance abuse, and treatment in the criminal justice system. The briefings are always presented in conjunction with the Congressional Addiction, Treatment and Recovery Caucus. Members of Congress, including ATR Caucus chair Rep. Patrick Kennedy, Rep. Grace Napolitano, Rep. Brian Baird and Rep. Rick Larsen, have frequently attended and spoken at the briefings.

One memorable briefing, on the subject of prescription drug abuse, featured a 19 year old from Massachusetts named Nick, who spoke about his addiction to prescription drugs, how it led to other abuses and its effect on his life and his family. As he paused several times to compose himself, he worked his way through his story and clearly made an impact on almost everyone in attendance. He courageously told his compelling story of becoming addicted to Vicodin and OxyContin. He noted that over time, he also became addicted to heroin and found that he no longer recognized his life. Nick also spent time in the criminal justice system and was at one point pronounced dead in an emergency room. At that point, he said that he chose to muster his strength to dedicate himself to a treatment regimen that included the medication buprenorphine as an adjunct to counseling. Since then, Nick said that he is growing stronger every day and is appreciative of the opportunity to be an active and important part of society.

Nick was asked to review for the audience core “take home messages.” Nick called on a strong investment in prevention programming—from the elementary grades through high school. In addition, he explained that addiction “does not discriminate” and noted that the treatment protocols made possible through the research at NIDA literally saved his life.

It is these presentations, unfiltered and unpolished, that give a human face to the benefits of NIDA research. Other memorable speakers include those who partook in a briefing on nicotine and tobacco addiction, including Shirley Reimer, a patient who quit smoking through the National Quitline, and shared the story of her success, and Preston Young, a patient who quit smoking during a translational clinical research study funded by NIDA, who spoke about his personal experience with nicotine addiction.

“The Friends of NIDA has done an excellent job educating Congress on the benefits of investing federal resources into addiction research,” said Rob Morrison, Executive Director of NASADAD. “Through Hill briefings that feature NIDA-funded researchers and people in recovery telling their stories, policymakers make the connection between the front-end investment and the dividends seen in their District.”

Like many advocacy-based coalitions in Washington, the Friends are almost always most busy during the appropriations season. Thanks in large part to Ed Long of Van Scoyoc Associates, the Friends are always successful in including comments in the reports accompanying both House and Senate appropriations legislation. This “report language,” as it is called in D.C., expresses support from the committees for specific work being done at NIDA, and encourages it to continue in the future. Such congressional support is critical to a government agency such as NIDA, as continued funding is a large part of the recipe for progress.

The Friends also receive leadership and advice from a very knowledgeable and influential Board of Advisors. Many former ONDCP and NIDA directors sit on the board, including General Barry McCaffery, Dr. Alan Leshner (Currently the CEO of The American Association for the Advancement of Science), Dr. Bob Dupont and Dr. Charles Schuster. Also on the board is former U.S. Representative and Chair of the House Committee on Commerce, Thomas Bliley.

The leadership of NIDA has always been appreciative of the Friends efforts. Cindy Miner, Director of the NIDA Science Policy Division, remarked, “Through their educational efforts, the Friends of NIDA have been an important ally in raising the public’s awareness of NIDA’s scientific achievements in addiction research, and consequently helping to reduce the stigma of addiction.”

(Materials from all Friends of NIDA briefings can be found athttp://thefriendsofnida.org/events.asp)

One of the new relationships we made, and hope to develop, is with the Hispanic Associa- tion of Colleges and Universities (HACU.) We met with Laura Maristany, HACU’s Federal Policy Director. Our goal in meeting with HACU was to establish a relationship, both in Washington and California, so that we had a network of universities to work with in order to expand the number of schools with a curriculum for the training of substance abuse counselors. There are over 70 HACU schools in California, including community colleges. HACU can also be a great partner in work- force recruitment, as they carefully track funding opportunities for workforce training in the Latino community. This is a top priority for CAADAC, as only 2-5% of our counselors are Latino, and the issue of cultural competencies in treatment cannot afford to be overlooked. HACU also invited us to partner with them when it comes to re-authorizing the Work- force Investment Act, which could provide the field with some excellent new opportunities. Their next annual conference will take place in San Diego in September, so CAADAC will have an opportunity to send a delegation.

Several new relationships were forged at Capitol Hill, perhaps the most important being with Speaker Nancy Pelosi’s office. Peggy Wilmoth, a Robert Wood Johnson Fellow on the Speaker’s legislative staff, expressed an interest in working with CAADAC on two sub- jects: Tobacco cessation, and drug abuse in the U.S. Military Reserves. She informed us that a staggering 34% of all military reserv- ists who are habitual smokers did not pick up the habit until they joined the service. She also expressed concern over the lack of a structured referral service for reservists who require care for substance abuse. As Ms. Wilmoth is a nurse, we also discussed the importance of training the nursing workforce in how to better handle the screening and treatment of substance abuse.

We also met with staff for Rep. Grace Nepo- litano, a key figure in the Congressional His- panic Caucus, as well as a staunch supporter of mental health services. We entered the meeting in the hopes of gaining her support for substance abuse treatment issues, and met with some moderate success. The Congres- sional Hispanic Caucus Institute will be hosting a summit next fall, where CAADAC might have the opportunity to make a presentation.

As for solidifying old relationships, we did a bit of that as well. We were sure to stop in on our biggest supporter in Congress, Rep. Mary Bono-Mack. Our meeting with her legislative director, Chris Foster, was as pro- ductive as any we’ve ever had. We dis- cussed the rising problem of prescription drug abuse, as well as the oversight of SAMHSA and ONDCP in Washington. As regular readers of the Freedom will recall, Rep. Bono- Mack is one of the true champions of substance abuse treatment on Capitol Hill.

Another old friend who had time for us in Washington was Geoff Laredo of the National Institute on Drug Abuse, where he is Senior Advisor to Director Dr. Nora Volkow. We spoke with Geoff about our continued interest in applying the best and latest science from NIDA on addiction and the brain to the prac- tice of substance abuse treatment. NIDA re- mains committed to this endeavor.

Also receiving visits were the office of Rep. Harry Waxman (chairman of the powerful Energy & Commerce committee,) Rep. Adam Schiff, and Rep. Tom McClintock. And how did I fare, babysitting Joe and Warren for two and a half days? Let’s just say they get to return the favor at the CAADAC annual confer- ence next fall. See you there!

Respectfully,

Andrew