Coordinated Training Services Articles RSS Feed

Coordinated Training Services Newsletter 26-Jul-10

Daniel LeFave — Mon, 26 Jul 2010 15:32:40 GMT

Hello,

Welcome to the Coordinated Training Services newsletter of upcoming events, articles, and more from our membership. As this is a new technique for sending out newsletters, there may be some bugs. Please let us know of any problems you have regarding this newsletter so we can continue to improve it. Thanks!

Also, be sure to check the link below for "Releases" to find out more about the new workplace trainings we are now offering.

Calendar Events
Articles
Releases

Calendar Events for 26-Jul-10 to 1-Sep-10

Peers Making Peace: Adult Training
Sponsor: paxUnited with Coordinated Training Services, A professional service of Workers Assistance Program, Inc.
Day: Tuesday 3-Aug-10 8:30 AM
Location: Nolan Estes Plaza 3434 So. R.L. Thornton Frwy Dallas, Texas 75224
Register Mapquest | Add to Calendar

CEPP: The Resilient Organization
Sponsor: Managed Care Center, Inc. with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Wednesday 4-Aug-10 8:30 AM
Location: Managed Care Center, Inc. 2345 50th Street Lubbock, Tx 79412
Register Mapquest | Add to Calendar

CEPP: Preparation Practice & Passion; a presentation skills workshop for prevention professionals
Sponsor: Managed Care Center, Inc. with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Wednesday 4-Aug-10 9:00 AM
Location: Managed Care Center, Inc. 2345 50th Street Lubbock, Tx 79412
Register Mapquest | Add to Calendar

CEPP: Hurt Hope & Healing; chemical dependency & its impact on the family
Sponsor: Managed Care Center, Inc. with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Wednesday 4-Aug-10 12:45 PM
Location: Managed Care Center, Inc. 2345 50th Street Lubbock, Tx 79412
Register Mapquest | Add to Calendar

CEPP: The Leaders of Tomorrow Today
Sponsor: Managed Care Center, Inc. with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Wednesday 4-Aug-10 12:45 PM
Location: Managed Care Center, Inc. 2345 50th Street Lubbock, Tx 79412
Register Mapquest | Add to Calendar

CEPP: Prevention in the Classroom; Mayhem or management
Sponsor: Managed Care Center, Inc. with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Wednesday 4-Aug-10 3:00 PM
Location: Managed Care Center, Inc. 2345 50th Street Lubbock, Tx 79412
Register Mapquest | Add to Calendar

CEPP: Managing Millennials; R U Ready?
Sponsor: Managed Care Center, Inc. with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Wednesday 4-Aug-10 3:00 PM
Location: Managed Care Center, Inc. 2345 50th Street Lubbock, Tx 79412
Register Mapquest | Add to Calendar

Project Toward No Drugs
Sponsor: Permian Basin Community Center with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Thursday 5-Aug-10 9:00 AM
Location: The Mullins Building 1012 West MacArthur Street Odessa, Tx 79763
Register Mapquest | Add to Calendar

CEPP: The Art of Group Facilitation
Sponsor: Managed Care Center, Inc. with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Thursday 5-Aug-10 9:00 AM
Location: Managed Care Center, Inc. 2345 50th Street Lubbock, Tx 79412
Register Mapquest | Add to Calendar

CEPP: This is Your Brain This is Your Brain on Drugs
Sponsor: Managed Care Center, Inc. with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Thursday 5-Aug-10 12:45 PM
Location: Managed Care Center, Inc. 2345 50th Street Lubbock, Tx 79412
Register Mapquest | Add to Calendar

CEPP: Child Traumatic Stress
Sponsor: Managed Care Center, Inc. with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Thursday 5-Aug-10 3:00 PM
Location: Managed Care Center, Inc. 2345 50th Street Lubbock, Tx 79412
Register Mapquest | Add to Calendar

Prevention Staff Training: Substance Abuse Prevention Across the Lifespan
Sponsor: Houston COADA with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Wednesday 11-Aug-10 8:30 AM
Location: Houston COADA 303 Jackson Hill St. Houston, Txq 77007
Register Mapquest | Add to Calendar

Prevention Staff Training: Risk & Protective Factors/Building Resiliency
Sponsor: Houston COADA with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Wednesday 11-Aug-10 1:00 PM
Location: Houston COADA 303 Jackson Hill St. Houston, Tx 77007
Register Mapquest | Add to Calendar

Prevention Staff Training: Enhancing Cultural Competency
Sponsor: Houston COADA with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Thursday 12-Aug-10 8:30 AM
Location: Houston COADA 303 Jackson Hill St. Houston, Tx 77007
Register Mapquest | Add to Calendar

Strengthening Families Program (ages 6-11 and 12-16)
Sponsor: Coastal Bend AIDS Foundation with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Thursday 12-Aug-10 8:30 AM
Location: Coastal Bend AIDS Foundation 400 Mann St. Suited 800 Corpus Christi, Tx 78401
Register Mapquest | Add to Calendar

Prevention Staff Training: Strategies for Strengthening Families
Sponsor: Houston COADA with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Thursday 12-Aug-10 1:00 PM
Location: Houston COADA 303 Jackson Hill St. Houston, Tx 77007
Register Mapquest | Add to Calendar

Prevention Staff Training: Child and Adolescent Development
Sponsor: Houston COADA with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Friday 13-Aug-10 8:30 AM
Location: Houston COADA 303 Jackson Hill St. Houston, Tx 77007
Register Mapquest | Add to Calendar

LifeSkills Training
Sponsor: JOVEN with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Monday 16-Aug-10 8:30 AM
Location: JOVEN 102 West White St. San Antonio, TX 78214
Register Mapquest | Add to Calendar

CEPP: Preparation Practice & Passion; a presentation skills workshop for prevention professionals
Sponsor: Mid-Coast Family Services with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Tuesday 17-Aug-10 9:00 AM
Location: Mid-Coast Family Services 1801 N. Laurent Ste. 200 Victoria, Tx 77901
Register Mapquest | Add to Calendar

Positive Action
Sponsor: Aliviane with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Tuesday 17-Aug-10 9:00 AM
Location: Aliviane 12380 Pine Springs El Paso, Tx 79936
Register Mapquest | Add to Calendar

CEPP: Hurt Hope & Healing; chemical dependency & its impact on the family
Sponsor: Mid-Coast Family Services with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Tuesday 17-Aug-10 12:45 PM
Location: Mid-Coast Family Services 1801 N. Laurent Ste. 200 Victoria, Tx 77901
Register Mapquest | Add to Calendar

CEPP: Prevention in the Classroom; Mayhem or management
Sponsor: Mid-Coast Family Services with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Tuesday 17-Aug-10 3:00 PM
Location: Mid-Coast Family Services 1801 N. Laurent Ste. 200 Victoria, Tx 77901
Register Mapquest | Add to Calendar

CEPP: The Art of Group Facilitation
Sponsor: Mid-Coast Family Services with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Wednesday 18-Aug-10 9:00 AM
Location: Mid-Coast Family Services 1801 N. Laurent Ste. 200 Victoria, Tx 77901
Register Mapquest | Add to Calendar

Positive Action
Sponsor: Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Wednesday 18-Aug-10 9:00 AM
Location: Boys and Girls Club of Greater Fort Worth 3218 East Belknap St. Fort Worth, Tx 76111
Register Mapquest | Add to Calendar

CEPP: This is Your Brain This is Your Brain on Drugs
Sponsor: Mid-Coast Family Services with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Wednesday 18-Aug-10 12:45 PM
Location: Mid-Coast Family Services 1801 N. Laurent Ste. 200 Victoria, Tx 77901
Register Mapquest | Add to Calendar

CEPP: Child Traumatic Stress
Sponsor: Mid-Coast Family Services with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Wednesday 18-Aug-10 3:00 PM
Location: Mid-Coast Family Services 1801 N. Laurent Ste. 200 Victoria, Tx 77901
Register Mapquest | Add to Calendar

Media Advocacy
Sponsor: The Coalition with Coordinated Training Services (CTS), A professional service of Workers Assistance Program (WAP), Inc.
Day: Sunday 29-Aug-10 8:30 AM
Location:
Add to Calendar

Articles for 27-May-10 to 26-Jul-10

SAMHSA and the Ad Council Launch National Campaign to Raise Awareness about Mental Health Problems in Hispanic/Latino Communities

New Series of Studies Show Suicide Attempts Constitute a Significant Portion of Drug-Related Hospital Emergency Department Visits -- Especially Among the Young

Nearly 1 in 10 drug-related hospital emergency department visits made by adolescents involved suicide attempts - with females making more than 72 percent of these attempts. A new series of studies analyzing drug-related hospital emergency department visits throughout the country during 2008 reveals a substantial percentage of these visits involve suicide attempts. According to these studies conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) more than one in... [More Info]

Key Facts about Hurricane Readiness

If you live in coastal areas at risk, the Centers for Disease Control and Prevention (CDC) encourages you to begin preparing yourself for hurricane season. The Atlantic hurricane season is June 1 through November 30 each year. Please follow the important preparedness tips CDC provides in Hurricane Readiness. These tips include Preparing for a Hurricane: Basic steps you can take now to ensure your safety should a storm hit. Emergency Supplies You Will Need: Stock your home... [More Info]

New Reports Highlight Important Substance Abuse Treatment Statistics in Key Metropolitan Areas across the Country

The Substance Abuse and Mental Health Services Administration (SAMHSA) has developed a series of Metro Briefs providing detailed statistical snapshots of substance abuse treatment activities occurring in 27 metropolitan areas. This series of briefs is based on SAMHSA’s Treatment Episode Data Set (TEDS) which collects information on the characteristics of persons admitted to substance abuse treatment, and the National Survey of Substance Abuse Treatment Services (N-SSATS), an annual... [More Info]

Releases for 26-Jun-10 to 26-Jul-10

New Workplace Trainings now available through CTS!

You asked for it, and now you've got it! CTS has put together a great group of proven workplace... [More Info]

Stay up to date with our RSS feeds.

26-Jul-10 10:32 AM

SAMHSA and the Ad Council Launch National Campaign to Raise Awareness about Mental Health Problems in Hispanic/Latino Communities

Joseph Duarte — Thu, 15 Jul 2010 16:15:00 GMT

The Substance Abuse and Mental Health Services Administration (SAMHSA), in collaboration with The Advertising Council, announced today the launch of a national public service advertising (PSA) campaign to promote recovery from mental health problems within the Hispanic/Latino community by educating and inspiring young adults to talk openly about issues of mental health. The culturally-targeted PSAs seek to motivate societal change towards social acceptance and decrease negative attitudes that may surround mental illness. These PSAs are part of a larger multicultural public service effort designed to reach Hispanic/Latino, American Indian, Chinese Americanand African American communities during National Minority Mental Health Awareness Month. This effort was done in consultation with SAMHSA's National Network to Eliminate Disparities in Behavioral Health (NNED).

Mental illnesses, including depression, anxiety, bipolar disorder and schizophrenia, are widespread in the U.S. According to SAMHSA, from 2004 to 2007, an average of 15.6 percent of Hispanic/Latino 18-25 year olds reported serious psychological distress in the past year. Despite the high prevalence among this group, only slightly more than one in four (28.3 percent) of Hispanic/Latino young adults with serious psychological distress received care within the past 12 months. Overall the rates at which racial and ethnic minority young adults seek treatment are much lower than their Caucasian counterparts.

"Raising awareness that effective treatments for mental illnesses are available and that people recover, can encourage those in need to seek help," said SAMHSA Administrator Pamela S. Hyde, J.D. "This outreach to the Hispanic community will help open dialogue about supporting friends or family members with mental health problems in a culturally relevant way."

Created by Hispanic/Latino advertising agency Wing through the Ad Council, the new "Accept/Ignore" PSA campaign includes in-language radio, print, outdoor and Web banner ads, and directs young adults to visit the campaign Web site, www.aceptarignorar.samhsa.gov, where they can find tools to help support a friend in the recovery process and seek out additional resources.

"We are proud to continue our work with SAMHSA to broaden our campaign for mental health recovery into the Hispanic community," said Peggy Conlon, president & CEO of the Ad Council. "This multicultural advertising effort will help decrease the stereotypes surrounding mental illnesses while providing young adults with the resources they need to support their friends living with mental health problems."

Alain Groenendaal, president and CEO of Wing added, "For many Latinos, their immediate social network is very important to them and they use technology to enhance their connection to friends and family. By channeling a social media platform which is very familiar to them, we’re able to speak to young Hispanics directly. We’re delighted to partner with the Ad Council and SAMHSA to extend a message of acceptance throughout the Hispanic community."

The Ad Council and SAMHSA first launched the Campaign for Mental Health Recovery nationwide in December 2006. To view the ads, please visit www.adcouncil.org. The PSAs will air in advertising time that will be entirely donated by the media.

15-Jul-10 11:15 AM

HIV & Hepatitis C: Coping with Coinfection (Part 1)

Joseph Duarte — Thu, 15 Jul 2010 14:00:00 GMT

Bova, Ogawa, and Sullivan-Bolyai (2010) report that "an estimated 25% to 40% of HIV-infected patients are also infected with HCV [hepatitis C virus], and in some practices the prevalence is as high as 75% to 90%. . . . Recent estimates suggest that approximately 250,000 persons are coinfected with HIV and HCV in the United States" (p. 63), "and with HIV antiretroviral therapy (ART) extending the life of people living with HIV, end-stage liver disease is now a leading cause of death in this population. . . . Studies show that a majority of coinfected patients have at least moderate liver inflammation or other signs of disease progression, . . . however, several studies published over the past 5 years have shown that less than one third of HIV coinfected patients in the United States are deemed eligible for HCV treatment, and under 10% actually receive treatment" (Wagner et al., 2009, p. 715).

Increasing attention has been directed to individuals coinfected with HIV and HCV because

in patients infected only with HCV, the time between infection and development of fibrosis [scar tissue resulting from inflammation of the liver] averages 20 years, whereas in patients coinfected with HIV/HCV, liver disease may develop in 5 to 10 years. . . . [Additionally,] HCV infection . . . influences the course and management of HIV disease, particularly by increasing the risk of ART-induced hepatotoxicity [liver damage]. . . . The goal of HCV treatment is to achieve a sustained virologic response (SVR), which is defined as the absence of serum hepatitis C RNA for 24 weeks after treatment completion. . . . Without HCV treatment, increasing numbers of HIV-infected patients will die either from end-stage liver disease or from HIV-related complications resulting from the inability to use antiretroviral agents because of their hepatotoxicity. (Bova et al., 2010, p. 64)

This is the first of a two-part series. Part 1 provides a medical, psychiatric, psychosocial, and neuropsychological overview of HIV/HCV coinfection, the process of determining eligibility for HCV treatment, and the important role mental health clinicians play in assessing eligibility and intervening with clients who elect to receive treatment for HCV.

Part 2 (to be presented in the Summer 2010 issue of mental health AIDS) will expand on how providers make the decision to offer HCV treatment to individuals living with HIV and chronic HCV infection, how coinfected individuals make decisions to accept or defer treatment for HCV, and the latest thinking on HCV-treatment interventions.

The Chance of a Cure

"A patient's willingness to undergo HCV treatment is likely influenced by how the patient views the efficacy and burden or risk of treatment" (Osilla et al., 2009, p. 993).

On the question of efficacy, it's important to know that "at least six distinct genotypes (numbered 1-6) and more than 30 subtypes of HCV are known," but "the most common genotype present in the United States, genotype 1, is also the most resistant to treatment" (Bova et al., 2010, pp. 63-64). According to Osilla et al. (2009), "standard HCV treatment, which consists of 48 weeks of weekly pegylated interferon (PEG-IFN) injections in combination with daily ribavirin (RBV), . . . has demonstrated a success rate of 30%-45% among HIV coinfected patients across all genotypes, . . . but only 17%-29% among HIV patients with . . . HCV . . . genotype 1" (p. 993). Although "new treatment agents (e.g., protease and polymerase inhibitors) that may improve treatment efficacy are at various stages of development and testing, . . . [they] are not expected to be available for routine practice for at least a few years and [IFN] will remain a component of treatment" (Wagner et al., 2009, p. 715).

As for the risks involved, treatment for HCV has been characterized as "lengthy, rigorous, and associated with side effects that are difficult to manage" (Silberbogen, Ulloa, Janke, & Mori, 2009, p. 114). "Flu-like symptoms (nausea, diarrhea, weight loss)" and "fatigue associated with hematologic abnormalities (anemia, neutropenia) . . . [are] highly prevalent" (Wagner et al., 2009, pp. 715-716). "In addition to physiological side effects, there are also significant neuropsychiatric side effects, including depression, anxiety, irritability, psychosis, suicidality, apathy/malaise, fatigue, impaired concentration, anhedonia, and recurrence of posttraumatic stress disorder symptoms" (Silberbogen et al., 2009, p. 114).

"Not surprisingly, a general fear and apprehension regarding side effects and their impact on quality of life and functioning are common among patients considering treatment" (Osilla et al., 2009, p. 993), and Wagner and colleagues report "dropout rates as high as 40%-50% in community samples of coinfected patients" (p. 716). Yet, "despite these side effects and related patient concerns," proponents of HCV treatment "recommend early treatment for coinfected patients to prevent more serious disease development" (Osilla et al., 2009, pp. 993-994) and "can argue that PEG-IFN/RBV, unlike ART, has a limited duration and at least a chance of a cure" (Wagner et al., 2009, p. 716; see also neuropsychology sidebar).

The Offer of Treatment

"Upon detection of HCV infection, for treatment to be provided, providers must first consider a patient an appropriate treatment candidate, and multiple medical and psychosocial factors can contribute to a provider's reluctance to recommend or offer treatment to a patient" (Osilla et al., 2009, p. 993). In a Seattle HIV-specialty clinic, for example, among 248 predominantly white and male, HCV/HIV-coinfected patients,

fewer than half . . . were evaluated for possible [IFN]-based HCV treatment. Only 16% received treatment, and only 2.4% of the entire cohort achieved an SVR. The median time to evaluation for treatment was almost 3 years, a significant period of delay in patients who may have a much more rapid progression to cirrhosis [the final stage of fibrosis], compared to patients without HIV. . . . Similarly, the median time elapsing between evaluation and treatment initiation was 1.4 years. Substance abuse and advanced HIV infection were the primary reasons for nonevaluation. (Scott et al., 2009, p. 928)

According to Wagner and colleagues (2009),

substance abuse and mental illness each account for 20%-30% of coinfected patients being deemed ineligible for treatment, as clinicians are concerned that the side effects of HCV treatment may lead to psychiatric deterioration, relapse into substance abuse, poor adherence, and treatment discontinuation. . . . Psychiatric and substance abuse patients have been excluded from most clinical trials, but the little data available show mixed results; some studies find that such patients do equally as well in terms of ability to complete and respond to treatment, . . . while others suggest that patients with active substance abuse and psychiatric problems are less likely to respond and more likely to drop out of treatment. (p. 716)

For this reason, mental health clinicians

are often called upon to conduct a psychological evaluation to determine appropriateness for this course of treatment. . . . A pre-treatment psychological evaluation should assess for those factors that will maximize the likelihood of a successful treatment course. Therefore, clinicians should assess for: psychiatric stability and safety (e.g., suicidal ideation, uncontrolled depression), current and past substance use and abuse, knowledge and expectations about treatment for HCV, motivation and ability to adhere to treatment, and psychosocial support.1 . . . After an assessment, clinicians can help prepare patients for treatment by providing education, establishing realistic expectations of treatment success, developing stress-management skills, and identifying areas of concern that patients and/or providers can monitor throughout the course of treatment. Also, a clinician can discuss the potential benefits of a referral for psychiatry consultation to consider psychotropic medication. However, it is important to note that there have been few large-sample, controlled studies evaluating the benefits of prophylactic psychotropic medications in HCV patients on IFN treatment, and that studies with small sample sizes have found inconsistent results. (Silberbogen et al., 2009, p. 117; see also psychiatry sidebar)

The Role of the Mental Health Clinician

Silberbogen and colleagues (2009) "have identified areas in which clinicians can intervene [with patients diagnosed with HCV]; these include adjustment to having a chronic medical illness, coping with stigma and relationship changes, management of side effects, and implementing healthy lifestyle changes" (p. 114). Some of the recommendations from these authors in each of these areas follow:

Adjustment to having a chronic medical illness – At the time of diagnosis with HCV, "a mental health clinician can help a patient to process this new diagnosis, generate effective coping strategies, facilitate communication between the patient and hepatologists, and serve as a resource for patients' questions and concerns while providing stability and support" (p. 115). In fact,

a key role for the mental health clinician is to ensure that HCV-positive patients have a thorough understanding of their diagnosis and to help translate this knowledge into behavioral change. A well-informed clinician can assess patients' current level of understanding, correct inaccurate beliefs, increase their base of knowledge, and help patients set behaviorally-based goals consistent with treatment recommendations.

Although education may be sufficient to assist some during this adjustment process, other patients may benefit from counseling that helps them to make sense of this diagnosis. Cognitive-behavioral stress-management interventions have proven effective in reducing depressive symptoms and enhancing benefit-finding, positive reframing, and perceived social support in chronic medical populations, including those with HIV. . . . Stress- and anger-management interventions are likely to benefit patients struggling with the unpredictability that often accompanies the diagnosis of a chronic illness. Mental health clinicians can also help patients to identify areas of their life in which they can exert some control (i.e., response to stressors) that may counterbalance these negative psychological sequelae. (pp. 115-116)

Coping with stigma and relationship changes – Clinician can help individuals living with HCV to "identity ways to buffer themselves from the impact of stigmatization, such as building a supportive network of friends, family, and medical providers, advocating assertively for . . . [their] needs, and learning how to disclose information while being self-protective. Therapy can also focus on enhancing patients' self-esteem by identifying and building on their positive attributes. Some patients may find value in activities that give them a sense of purpose (e.g., public-awareness programs, political advocacy)" (p. 116). In addition, "mental health clinicians can assist individuals with HCV to navigate . . . changes within their social support network. Communication and problem-solving skills training specifically focused on managing role-changes may prove beneficial, as well as acceptance-based work. Also, participation in couples or family therapy can allow patients to practice these skills in a supportive environment" (p. 116). Finally,

clinicians can help patients build their social support networks by treating mood disorders that interfere with social efforts and by setting small goals toward increased socialization. Clinicians can also assist HCV patients to identify and enhance existing relationships that they may initially overlook or discount. Patients may find it beneficial to engage in "safer" outlets for social interaction, such as online support communities, volunteer positions, or psycho-educational/support groups for patients with HCV, liver disease, or chronic medical conditions. Support groups can be a useful source of information and connection for patients with chronic illness. Mental health providers can make an important contribution to the care of patients with HCV by organizing and/or facilitating support groups focused on issues relevant to this patient population. In addition to providing much-needed social support, these groups can provide education, promote positive health behaviors, and moderate experiences of stigma or discrimination. (p. 117)2

Management of side effects – Once treatment has been initiated,

mental health clinicians can use brief standardized measures (e.g., the Beck Depression Inventory) . . . to monitor the presence and severity of psychiatric symptoms . . . and can address specific symptoms in the context of therapy. Stress-management (e.g., relaxation exercises, problem-solving practice), behavioral activation, cognitive restructuring, and enhancement of self-care behaviors (e.g., exercise, proper diet, sleep hygiene) are useful strategies for minimizing potential side effects. Clinicians are also in an excellent position to provide feedback to medical staff, such as psychiatrists, should greater intervention be necessary (i.e., psychotropic medications). (pp. 117-118)

In the area of medication adherence, "clinicians can help patients to identify and problem-solve barriers to treatment-adherence, assist in the organization and scheduling of medications, manage side effects, and facilitate access to medical providers" (p. 118).

Implementing healthy lifestyle changes – Because alcohol has a detrimental effect on liver functioning, "reduction in alcohol use is one of the most important behavioral changes patients can make to slow the rate of HCV progression" (p. 118), and "patients with an understanding of the relationship between HCV and alcohol use may be increasingly motivated to make and sustain healthy lifestyle changes" (p. 119). In support of this effort,

mental health clinicians can work with patients to develop a concrete change plan based on their stated goals for treatment and anticipate challenges that may interfere with the execution of these goals. Also, patients on IFN treatment who have a history of alcohol abuse or dependence may benefit from ongoing monitoring and support from a clinician with experience in substance-abuse counseling, because the side effects of treatment may result in increased urges and cravings. . . .

Several standardized instruments, such as the Alcohol Use Disorders Identification Test (AUDIT) . . . or the Alcohol Abstinence Self-Efficacy Scale, . . . may prove useful to the clinician assessing and monitoring alcohol intake for patients with HCV. These brief measures are easy to administer and can be used to identify patients in need of additional intervention. All patients should be educated regarding the effects of alcohol on the course of HCV, and, when appropriate, should be evaluated by a chemical-dependency specialist. (p. 118)

Because cigarette-smoking can affect "liver health, treatment efficacy, and quality of life," clinicians are encouraged to review "evidence-based recommendations from research in general populations that can be used as guides for . . . assisting . . . HCV-positive patient[s] to quit smoking or reduce the amount that they smoke. . . . Goals of these recommendations are to increase screening, enhance motivation, and assist patients to reduce tobacco use through problem-solving techniques" (p. 119).

Since "it is likely that improved nutritional status will have a positive effect on disease-progression and long-term outcome for HCV-positive patients," mental health clinicians

can take several steps to assist the HCV-positive patient to achieve his or her individual dietary goals. First, clinicians should encourage all HCV-positive patients to pursue a healthy diet and educate patients about how diet can affect their disease progression and quality of life. Unhealthy diet patterns should be identified (e.g., high-sugar and high-fat diets, high daily caloric intake, frequent fast-food consumption, limited fruit and vegetable intake) and addressed. Finally, referrals to nutrition services may be appropriate for some patients, particularly for cases in which the nutritional needs may require a unique or intensive intervention, such as with HCV-positive patients who are overweight/obese, those for whom there are concerns about iron overload, and those who have comorbid metabolic concerns, such as diabetes. (p. 119)

Additionally,

with medical-provider approval, HCV-positive patients should be encouraged to participate in regular physical activity to address weight-management, quality of life, and symptom-management. Clinicians can assist HCV patients with setting exercise goals, enhancing motivation to exercise, addressing barriers to activities, and challenging any unhelpful thoughts that interfere with exercise. Devices such as pedometers may motivate patients who are ready to make changes in activity levels. When appropriate, a referral to rehabilitation or physical therapy services for exercise recommendations can be extremely useful. (p. 119)

----Compiled by Abraham Feingold, Psy.D.

References

Bova, C., Ogawa, L.F., & Sullivan-Bolyai, S. (2010). Hepatitis C treatment experiences and decision making among patients living with HIV infection.Journal of the Association of Nurses in AIDS Care, 21(1), 63-74.

Osilla, K.C., Ryan, G., Bhatti, L., Goetz, M., Witt, M., & Wagner, G. (2009). Factors that influence an HIV coinfected patient's decision to start hepatitis C treatment. AIDS Patient Care & STDs, 23(12), 993-999.

Scott, J.D., Wald, A., Kitahata, M., Krantz, E., Drolette, L., Corey, L., & Wang, C.C. (2009). Hepatitis C virus is infrequently evaluated and treated in an urban HIV clinic population. AIDS Patient Care & STDs, 23(11), 925-929.

Silberbogen, A.K., Mori, D.L., & Sogg, S. (2005). The Structured Interview for the Treatment of the Hepatitis C Virus (SIT-HCV). Journal of Clinical Psychology in Medical Settings, 12(1), 57-69.

Silberbogen, A.K., Ulloa, E.W., Janke, E.A., & Mori, D.L. (2009). Psychosocial issues and mental health treatment recommendations for patients with hepatitis C. Psychosomatics 50(2), 114-122.

Wagner, G., Ryan, G., Osilla, K.C., Bhatti, L., Goetz, M., & Witt, M. (2009). Treat early or wait and monitor? A qualitative analysis of provider hepatitis C virus treatment decision-making in the context of HIV coinfection. AIDS Patient Care & STDs, 23(9), 715-725.
--------------------
1 One version of the pre-treatment psychological evaluation, "the Structured Interview for the Treatment of the Hepatitis C Virus (SIT-HCV), developed by the Medical Psychology Service at the VA Boston Healthcare System in collaboration with the VA Liver Clinic[,] . . . expands upon a standard psychiatric interview by addressing those psychological and behavioral factors that are unique to this population and essential to consider prior to recommending a patient for IFN therapy. . . . On the basis of the information gathered during the administration of the SIT-HCV, clinicians can make behavioral recommendations that will enhance a patient's likelihood of attaining an optimal treatment outcome while minimizing the impact of incapacitating side effects" (Silberbogen, Mori, & Sogg, 2005, p. 58). The complete protocol can be found in the appendix of Silberbogen and colleagues' article.

2 "As the nation's largest care-provider of patients with HCV, the [Department of Veterans Affairs] has developed a comprehensive website designed to meet both patients' and providers' needs (www.hepatitis.va.gov). . . . Available resources for mental health providers include a 'how-to' program guide that outlines the basic steps for initiating and maintaining a hepatitis C support group. This valuable resource includes a discussion of issues to consider when developing a group, suggestions for group topics, descriptions of therapeutic and facilitation techniques, and sample forms and handouts" (Silberbogen, Ulloa, Janke, & Mori, 2009, p. 117).

Neuropsychology of HIV/HCV Coinfection

"HCV mono-infection is associated with significant impairment in neuropsychological domains typically characterized as 'subcortical' in nature, with predominant impact on attention, information processing speed, and verbal memory. Further, evidence of neuropsychological impairment among HCV mono-infected individuals exists independent of comorbid substance abuse and severe liver disease, raising the possibility of direct brain involvement from HCV" (Martin-Thormeyer & Paul, 2009, p. 223). Moreover,

individuals infected with both HCV and HIV express more severe neuropsychological impairment than individuals with HIV alone but the mechanisms underlying these effects remain unclear. To date a handful of studies have examined neuropsychological function among individuals co-infected with HCV and HIV. Among these studies there is notable variability in the methods to examine neuropsychological function, the use of various comparison groups (e.g., HCV alone, HIV alone, both mono-infected groups compared to co-infected patients), and the focus on various laboratory indices of disease burden. These methodological differences require some caution when drawing conclusions regarding the impact of co-infection on cognitive outcome. For example, a number of studies did not involve a comprehensive neuropsychological assessment, and therefore, conclusions regarding the neuropsychological pattern associated with co-infection remains premature. With that caveat noted, there is some suggestion in the literature that several domains of cognitive function are more likely impacted by co-infection than others.

Decreased processing speed and psychomotor speed among co-infected individuals is a commonly reported outcome of the studies . . . [although e]vidence of selective impairment in psychomotor speed/information processing is not universal. . . . [In fact, n]ot all studies have reported greater cognitive impairment among co-infected patients. . . . When taken collectively the majority of studies have reported more severe neuropsychological impairment among co-infected patients than mono-infected patients. (Martin-Thormeyer & Paul, 2009, pp. 224-225)

Importantly, "recent studies of dually infected subjects indicate that neurocognitive function may improve with successful therapy for either disorder" (Gonzalez, Quartana, & Martin, 2009, p. 223).

References

Gonzalez, R., Quartana, P.J., & Martin, E.M. (2009). Co-occurrence of HIV, hepatitis C, and substance use disorders: Effects on brain functioning. In R.H. Paul, N.C. Sacktor, V. Valcour, & K.T. Tashima (Eds.), HIV and the brain: New challenges in the modern era (pp. 213-233). Totowa, NJ: Humana Press.

Martin-Thormeyer, E.M., & Paul, R.H. (2009). Drug abuse and hepatitis C infection as comorbid features of HIV associated neurocognitive disorder: Neurocognitive and neuroimaging features [Review]. Neuropsychology Review, 19(2), 215-231.

Psychiatry & HIV/HCV Coinfection

According to Silberbogen and colleagues (2009), "numerous studies . . . document high prevalence rates of preexisting psychiatric disorders among patients with HCV. . . . Within the HCV-positive population, approximately 27%-78% of patients are diagnosed with past or current substance abuse, 15%-62% with mood disorders, and 30%-40% with anxiety disorders such as PTSD [posttraumatic stress disorder]" (p. 115).

With regard to the population of co-infected individuals, however, and "in the absence of established guidelines for the management of [the] psychiatric status of HIV/HCV-coinfected patients initiating PEG-IFN/RBV therapy," Weiss and Morgello (2009) "sought to determine what the state of practice is for providers actively engaged in the care of these patients" (p. 532). The investigators developed and reported on "a provider survey designed to determine whether consensus exists in the management of these patients and what factors might impact differing treatment approaches taken by health care providers" (p. 532). They focused in particular on "the use of prophylactic treatment with antidepressants [to] prevent . . . the development of depressive side effects during HCV treatment" (p. 532).

From a pool of 236 "expert" providers invited to participate, the sample consisted of 92 providers who completed the anonymous online survey, 26% of whom were psychiatrists. With regard to practice setting and provider discipline, Weiss and Morgello found that "the psychiatric management of HIV-coinfected patients being treated for HCV occurs in multiple contexts (varying from comprehensive integrated clinics to individual practices) and is done by providers from a wide range of disciplines (infectious disease, psychiatry, internal medicine, nurse practitioner). The survey was able to establish the practice patterns of expert providers who are predominantly physicians working in varied practice settings internationally" (p. 535).1Notably, most of the nonpsychiatrist survey respondents have "very limited access to psychiatric consultation" (p. 535).

With regard to these practice patterns,

more than one third of providers indicate[d] that they use or offer the option of antidepressant use prophylactically in HIV-positive patients with no past or current depression beginning HCV treatment, and more than three quarters do so in patients with a history of depression but no current symptoms of depression. The most experienced nonpsychiatrist providers were more likely to use antidepressants prior to the start of treatment in HIV-coinfected patients as compared to in HCV mono[-]infected patients. There . . . [wa]s consensus among providers to leave psychiatric medication unchanged in patients currently treated for unipolar depression. (p. 531)

Weiss and Morgello conclude that "many expert providers prescribe antidepressants to HIV/HCV-coinfected patients initiating [HCV] treatment in the absence of symptoms of depression, despite the lack of data supporting this approach in this population" (p. 531). The investigators surmise that "this pattern of prescribing . . . may be related to . . . limited access to psychiatric consultation, with providers viewing the prophylactic use of antidepressants as the safest and most cautious treatment approach" (p. 536). Weiss and Morgello advocate for "increasing [nonpsychiatrist] provider skills and competence through advanced training in psychiatric assessment and management[, because this] would likely reduce the extent to which these providers use antidepressants prophylactically and could potentially lead to better HCV treatment outcomes" (p. 536). Additionally (and importantly), "research is needed to provide an evidence base to guide the optimal psychiatric management of HIV/HCV-coinfected patients beginning [HCV] treatment" (p. 531).

15-Jul-10 9:00 AM

New Series of Studies Show Suicide Attempts Constitute a Significant Portion of Drug-Related Hospital Emergency Department Visits -- Especially Among the Young

Daniel LeFave — Tue, 13 Jul 2010 20:00:00 GMT

Nearly 1 in 10 drug-related hospital emergency department visits made by adolescents involved suicide attempts – with females making more than 72 percent of these attempts.

A new series of studies analyzing drug-related hospital emergency department visits throughout the country during 2008 reveals a substantial percentage of these visits involve suicide attempts. According to these studies conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) more than one in every twelve (8.8 percent) drug-related hospital emergency department visit by an adolescent is a suicide attempt – double the rate found among cases involving those age 25 and older (4.4 percent). Among cases involving young adults aged 18 to 25 the attempted suicide rate was 6.6 percent.

The vast majority of these suicide attempts by adolescents were made by females (72.3 percent). Females constituted a majority of cases among young adults and those over age 25 as well, but at significantly lower levels (57.6 percent and 57.7 percent, respectively).

Although pharmaceutical drugs were involved in more than 9 out of 10 of these drug-related suicide attempt cases, there were considerable differences in the patterns of substances used among various age and gender groups.

For example, acetaminophen products were the most commonly used substances involved in hospital emergency department visits by female adolescents attempting suicide (28.5 percent) while anti-anxiety drugs were the most commonly used substances in cases involving females age 25 or older (49.9 percent). Similarly, adolescent males admitted for drug-related suicides were more than three times as likely to have used antipsychotic drugs as their female counterparts (14.3 percent versus 4.3 percent).

The studies also reveal significant differences in the level of follow up care (e.g., inpatient admission, transfer to another hospital facility or referral to detoxification) given in these cases -- differences often associated with the type of substance used and the age of those attempting suicide.

For example, while over 90.2 percent of adolescents who visited hospital emergency departments for attempting suicide with antidepressants received follow up care, only 52.4 percent of adolescent cases involving ibuprofen received it. Similarly, 83.1 percent of the cases involving adolescents using alcohol received follow up care while only 59.4 percent of alcohol related cases among those age 25 or older received it.

In 2007 (the most recent year for which figures are available), suicides in the United States accounted for 34,598 deaths - almost twice the number of homicides (18,361). To help address this problem, SAMHSA sponsors the National Suicide Prevention Lifeline (Lifeline) 1-800-273-TALK (8255), a network of crisis call centers located throughout the nation that can immediately link a caller seeking help to a trained counselor closest to the caller’s location, 24 hours a day, seven days a week. Calls to the toll-free Lifeline are confidential.

“The sheer numbers of young people that continue to end up in costly hospital emergency rooms as a result of substance abuse and suicide is truly alarming and is a clear signal that we must continue to evaluate the impact of behavioral health on health and health care costs,” said SAMHSA Administrator Pamela S. Hyde, J.D. “The studies also point out the need to provide better follow up services after visits to emergency departments and other healthcare settings in working with people who have attempted suicide.”

In an effort to provide support for teens who may be contemplating suicide, SAMHSA and the Ad Council recently launched the Teen Suicide Prevention campaign. The We Can Help Us effort includes television, radio, print and interactive PSAs, as well as in-school and mall posters, directed at 13-17 year-olds. Young people seeking help are urged to visit www.reachout.com, where they can hear success stories and strategies from teens.

Additional information about all these aspects of SAMHSA’s National Suicide Prevention Lifeline and the Veterans Suicide Prevention Hotline can be accessed at: http://www.suicidepreventionlifeline.org/. Additional information about other SAMHSA suicide prevention programs can be obtained by visiting SAMHSA’s Web site, http://www.samhsa.gov.

The series of studies, Emergency Department Visits for Drug-Related Suicide Attempts by Adolescents: 2008, Emergency Department Visits for Drug-Related Suicide Attempts by Young Adults Aged 18 to 24: 2008 and Emergency Department Visits for Drug-Related Suicide Attempts by Adults Aged 25 or Older: 2008 was developed as part of SAMHSA’s strategic initiative on data, outcomes, and quality – an effort to inform policy makers and service providers on the nature and scope of behavioral health issues. Their data came from the 2008 Drug Abuse Warning Network (DAWN) report. DAWN is a public health surveillance system that monitors drug-related hospital emergency department visits reported throughout the nation.

The studies are available on line at

http://www.oas.samhsa.gov/2k10/DAWN001/SuicideAttempts.cfm

http://www.oas.samhsa.gov/2k10/DAWN002/SuicideAttemptsYoungAdults.cfm

http://oas.samhsa.gov/2k10/AdultSuicide/AdultSuicide.cfm

Copies may also be obtained by calling SAMHSA’s Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727). For related publications and information, visit http://www.samhsa.gov/ .

SAMHSA is a public health agency within the Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities.

13-Jul-10 3:00 PM

SAMHSA and the Ad Council Launch National Campaign to Raise Awareness about Mental Health Problems in Hispanic/Latino Communities

Daniel LeFave — Tue, 13 Jul 2010 19:00:00 GMT

The Substance Abuse and Mental Health Services Administration (SAMHSA), in collaboration with The Advertising Council, announced today the launch of a national public service advertising (PSA) campaign to promote recovery from mental health problems within the Hispanic/Latino community by educating and inspiring young adults to talk openly about issues of mental health. The culturally-targeted PSAs seek to motivate societal change towards social acceptance and decrease negative attitudes that may surround mental illness. These PSAs are part of a larger multicultural public service effort designed to reachHispanic/Latino, American Indian, Chinese American and African American communities during National Minority Mental Health Awareness Month. This effort was done in consultation with SAMHSA's National Network to Eliminate Disparities in Behavioral Health (NNED).

The Ad Council and SAMHSA first launched the Campaign for Mental Health Recovery nationwide in December 2006. To view the ads, please visitwww.adcouncil.org. The PSAs will air in advertising time that will be entirely donated by the media.

The Ad Council ( www.adcouncil.org ) is a private, non-profit organization that marshals talent from the advertising and communications industries, the facilities of the media, and the resources of the business and non-profit communities to produce, distribute and promote public service campaigns on behalf of non-profit organizations and government agencies. The Ad Council addresses issue areas such as improving the quality of life for children, preventive health, education, community well-being, environmental preservation and strengthening families.

SAMHSA is a public health agency within the Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities.

13-Jul-10 2:00 PM

Key Facts about Hurricane Readiness

Joseph Duarte — Thu, 08 Jul 2010 18:00:00 GMT

Please follow the important preparedness tips CDC provides in Hurricane Readiness. These tips include

Preparing for a Hurricane: Basic steps you can take now to ensure your safety should a storm hit.
Emergency Supplies You Will Need: Stock your home and your car with supplies.
Make a Plan: Learn the basic steps you can take to prepare for a storm
Prepare to Evacuate: Never ignore an evacuation order.
If You Are Ordered NOT to Evacuate: Things you can do to get through the storm in the safest possible manner.
Protecting Pets: Ensure your pet's safety before, during, and after an emergency.

After you have read these tips, please review the other resources available on the CDC Hurricanes Web site.

CDC strongly recommends that you print all important resources before a hurricane strikes. Power outages during and after a hurricane can prevent you from accessing information online when you most need it. Preparing now can help keep you and your family safe.

You can receive weekly tips from CDC throughout hurricane season by signing up for the following:

CDC Hurricane Health and Safety Updates — subscribe and get tips of the week sent to your email or mobile phone.
CDC Hurricane Public Service Announcements (PSAs) and Podcasts

8-Jul-10 1:00 PM

Hemochromatosis (Iron Storage Disease) Awareness

Joseph Duarte — Thu, 08 Jul 2010 18:00:00 GMT

What is hemochromatosis?

Hemochromatosis occurs when the body absorbs too much iron from foods (and other sources such as vitamins containing iron). This disease causes extra iron to gradually build up in the body's tissues and organs, a term called iron overload. If this iron buildup is untreated, it can, over many years, damage the body's organs.

What are the causes?

Although hemochromatosis can have other causes, in the United States the disease is usually caused by a genetic disorder. A person who inherits the defective gene from both parents may develop hemochromatosis. The genetic defect of hemochromatosis is present at birth, but symptoms rarely appear before adulthood. Because one inherits genes from his or her parents, this type of the disease is also called hereditary hemochromatosis.

What are the symptoms?

Early indications of hemochromatosis include the following symptoms:

Fatigue (feeling very tired)
Weakness
Weight loss
Abdominal pain
Joint pain

Because these symptoms also occur with other diseases, hemochromatosis can be difficult to diagnose in its early stages.

How is it detected?

If your doctor suspects you have iron overload associated with hemochromatosis, there are two blood tests – serum transferrin saturation and ferritin levels – which may be used to help make the diagnosis. The tests measure how much iron is in the body. You can have these tests done in your doctor's office.

If hemochromatosis is detected early, treatment can slow its progress and prevent serious problems. However, if the disease is not detected and treated early, it can cause more serious problems. These problems include arthritis, heart problems, and liver problems (such as cirrhosis and liver cancer).

If you think you have symptoms like those of hemochromatosis or if you have a close blood relative who has hemochromatosis, you should ask your health care provider to check the amount of iron in your blood.

What is the treatment?

Treatment consists of periodically taking blood from the arm, much like giving blood. The treatment is safe and effective. Patients can expect a normal life span if they start treatment before organ damage has begun.

Most people with hemochromatosis should be checked at least once a year to be sure that their iron level is within the normal range. If the iron level is too high, phlebotomy treatments are needed to keep extra iron from building up in the body.

Tips for Living Well with Hemochromatosis

There is much you can do to make sure your life is as normal and healthy as possible.

Check-ups: Have the amount of iron in your blood checked regularly.
Phlebotomy: Make sure to get phlebotomies when you need them. Phlebotomy is the best treatment for hemochromatosis. Hemochromatosis cannot be treated by changing your diet alone.
Iron pills: Don't take iron pills, supplements, or multivitamin supplements that have iron in them. Eating foods that contain iron is fine.
Vitamin C: Vitamin C increases the amount of iron your body absorbs. Avoid taking pills with more than 500 mg of vitamin C per day. Eating foods with vitamin C (such as oranges) is fine.
Food: Don't eat raw fish or raw shellfish. Cooking destroys germs harmful to people with hemochromatosis. People with hemochromatosis are at greater risk for bacteremia, a bacterial infection of the blood stream.
Alcohol: If you choose to drink alcohol, drink very little. Women should have no more than one drink a day. Men should have no more than two drinks a day. However, if you have liver damage, do not drink any alcohol.
Exercise: You can exercise as much as you want. The CDC and the American College of Sports Medicine offers the following physical activity recommendations:
- Adults should engage in moderate-intensity physical activities (indicated by some increase in breathing or heart rate) for at least 30 minutes on preferably all days of the week.

8-Jul-10 1:00 PM

Congenital Syphilis — United States, 2003–2008

Thu, 03 Jun 2010 21:00:00 GMT

CDC National Center for HIV/AIDS, Viral Hepatitis, STD, and TB

A CDC analysis of mother-to-child syphilis transmission (congenital syphilis) finds that while the number of congenital syphilis (CS) infections remains relatively small, concerning increases occurred between 2005 and 2008. CS rate increases were primarily found among infants born in the South (9.6 per 100,000 in 2005 to 15.7 in 2008). CS rate increases were also seen in the United States among infants born to white and African-American women. Between 2005 and 2008, rates among infants born to white women more than doubled (1.3 to 2.8), and rates among black women increased more than 30 percent (26.6 to 34.6). No clear increases were observed for the same time period among infants born to Hispanic, Asian Pacific Islander (API), and American Indian/Alaska Native (AIN) women. In 2008, the CS rate for infants born to Hispanic women was 12.8, the CS rate for infants born to API women was 3.0, and the rate for infants born to AIN women was 14.0. While the number of CS cases reported nationally remains relatively low (431 in 2008), recent CS rate increases underscore the importance of early prenatal care and syphilis testing for pregnant women. CS can result in neurologic impairment and infant death, but it is preventable with early prenatal diagnosis and treatment.

3-Jun-10 4:00 PM

New Reports Highlight Important Substance Abuse Treatment Statistics in Key Metropolitan Areas across the Country

Thu, 03 Jun 2010 21:00:00 GMT

Each brief provides the a wide range of information about the nature and scope of substance abuse treatment admissions in a metropolitan area through a variety of charts, graphs and accompanying text.

Brief for Houston, TX: http://oas.samhsa.gov/metro/Houston/508HTML_Houston.htm

Brief for Dallas, TX: http://oas.samhsa.gov/metro/Dallas/508HTML_Dallas.htm

3-Jun-10 4:00 PM

National Homelessness and Hunger Awareness Week

Wed, 21 Oct 2009 14:00:00 GMT

Co-sponsored by: National Coalition for the Homeless and

National Student Campaign Against Hunger & Homelessness

For more information, please visit: http://www.nationalhomeless.org/projects/awareness/awareness.html

November 15-21, 2009

Each year, one week before Thanksgiving, National Coalition for the Homeless and the National Student Campaign Against Hunger and Homelessness co-sponsor National Hunger and Homelessness Awareness Week. During this week, a number of schools, communities and cities take part in a nationwide effort to bring greater awareness to the problems of hunger and homelessness.

21-Oct-09 9:00 AM

Public Smoking in Nacogdoches Ends Tuesday

Maggie Wilhite — Tue, 29 Jul 2008 20:00:00 GMT

Public smoking in Nacogdoches ends Tuesday

By MATTHEW STOFF
The Daily Sentinel
Sunday, June 29, 2008

Effective Tuesday, July 1, smoking in all of Nacogdoches' public buildings, workplaces, offices, bars and restaurants will be prohibited, punishable by a fine up to $2,000 in municipal court. With the new law in place, Nacogdoches joins other East Texas communities like Marshall and Tyler and at least 20 states that have banned public smoking in the name of health.

Private homes, fraternal organizations, tobacco retail stores and a percentage of hotel and nursing home rooms are excepted from the law, but all other businesses, including their outdoor patios and areas 20 feet from public entrances, must comply with the ordinance.

Nacogdoches joins other East Texas communities like Marshall and Tyler and at least 20 states that have banned public smoking in the name of health.

For more than two months, city staff has been working with business owners to iron out details of enforcing the new law aimed at protecting workers and patrons at nearly all establishments in the city. Individual businesses will be primarily responsible for posting "no smoking" signs at their entrances and for ensuring their employees and patrons do not smoke on the premise.

Both Nacogdoches police and the city code enforcement office will address violations of the ordinance.

"We believe the ordinance has received wide approval from the community and are expecting few, if any, problems," Police Chief Jim Sevey said last week. "We will of course assist any business owner who requests assistance."

The ordinance prohibiting public smoking passed in April after city commissioners heard input from citizens. Many spoke in favor of the ordinance, citing medical studies that document the carcinogenic effects of second-hand smoke as well as anecdotes about the unpleasantness of dining in smoking establishments. Few opposed the ban entirely, though some business owners sought relief from the requirements that will have patrons standing at least 20 feet away from the building to light up.

The Healthy Nacogdoches Coalition, a group of local businesses, health organizations and others concerned about public wellness, conducted much of the initial research for the ordinance as part of its goal of becoming a recognized heart and stroke healthy community, a designation bestowed by the state department of health.

Citizens wishing to report violations of the ordinance may contact the city inspections department at 559-2558 or the police department's non-emergency line at 559-2607. Questions may be directed to the inspections department.

Matthew Stoff's e-mail address

is mstoff@coxnews.com.

29-Jul-08 3:00 PM

Cigarette Use Among High School Students: 1991-1997

Maggie Wilhite — Thu, 26 Jun 2008 20:00:00 GMT

Cigarette Use Among High School Students --- United States, 1991--2007

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5725a3.htm?s_cid=mm5725a3_e

Cigarette use is the leading preventable cause of death in the United States (1). A national health objective for 2010 is to reduce the prevalence of current cigarette use among high school students to 16% or less (27-2b) (1). To examine changes in cigarette use among high school students in the United States during 1991--2007, CDC analyzed data from the national Youth Risk Behavior Survey (YRBS). This report summarizes the results of that analysis, which indicated that the prevalence of lifetime cigarette use was stable during 1991--1999 and then declined from 70.4% in 1999 to 50.3% in 2007. The prevalence of current cigarette use increased from 27.5% in 1991 to 36.4% in 1997, declined to 21.9% in 2003, and remained stable from 2003 to 2007. The prevalence of current frequent cigarette use increased from 12.7% in 1991 to 16.8% in 1999 and then declined to 8.1% in 2007. To resume the declines observed in current cigarette use during 1997--2003 and achieve the 2010 objective, communitywide comprehensive tobacco-control programs that use coordinated evidence-based strategies should be implemented and revitalized.

The biennial national YRBS, a component of CDC's Youth Risk Behavior Surveillance System, used independent, three-stage cluster samples for the 1991--2007 surveys to obtain cross-sectional data representative of public and private school students in grades 9--12 in all 50 states and the District of Columbia (2). Sample sizes ranged from 10,904 to 16,296. For each cross-sectional national survey, students completed anonymous, self-administered questionnaires that included identically worded questions about cigarette use. School response rates ranged from 70% to 81%, and student response rates ranged from 83% to 90%; therefore, overall response rates for the surveys ranged from 60% to 70%.

For this analysis, temporal changes for three behaviors were assessed: lifetime cigarette use (i.e., ever tried cigarette smoking, even one or two puffs), current cigarette use (i.e., smoked cigarettes on at least 1 day during the 30 days before the survey), and current frequent cigarette use (i.e., smoked cigarettes on 20 or more days during the 30 days before the survey). Race/ethnicity data are presented only for non-Hispanic black, non-Hispanic white, and Hispanic students (who might be of any race); the numbers of students from other racial/ethnic groups were too small for meaningful analysis.

Data were weighted to provide national estimates, and statistical software used for all data analyses accounted for the complex sample design. Temporal changes were analyzed using logistic regression analyses, which controlled for sex, race/ethnicity, and grade and simultaneously assessed linear, quadratic, and cubic time effects (p<0.05).*

Significant linear and quadratic trends were detected for lifetime and current frequent cigarette use (Table 1). The prevalence of lifetime cigarette use was stable during 1991--1999 and then declined from 70.4% in 1999 to 50.3% in 2007. The prevalence of current frequent cigarette use increased from 12.7% in 1991 to 16.8% in 1999 and then declined to 8.1% in 2007.

Significant linear, quadratic, and cubic trends were detected for current cigarette use. The prevalence of current cigarette use increased from 27.5% in 1991 to 36.4% in 1997, declined to 21.9% in 2003, and remained stable from 2003 to 2007. For current cigarette use, similar patterns were detected among the sex subgroups overall, all grade subgroups, and white and Hispanic students (Table 2).

Among black students overall and black male students, significant quadratic and cubic trends were detected. The prevalence of current cigarette use among black students overall increased from 12.6% in 1991 to 22.7% in 1997, declined to 14.7% in 2001, and then declined more gradually to 11.6% in 2007. Among black male students, the prevalence of current cigarette use increased from 14.1% in 1991 to 28.2% in 1997, declined to 16.3% in 2001, and then remained stable from 2001 to 2007. Among black female students, a significant linear and quadratic trend was detected. The prevalence of current cigarette use increased from 11.3% in 1991 to 17.7% in 1999 and then declined to 8.4% in 2007.

Reported by: Office on Smoking and Health, Div of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note:

The findings in this report show that current cigarette use among high school students declined from 1997 to 2003, but rates remained stable from 2003 to 2007. This trend is consistent with 30-day cigarette use trends reported from the Monitoring the Future survey (an ongoing national study of the behaviors, attitudes, and values of 8th, 10th, and 12th grade students), which also show declines starting in the late 1990s and stable rates more recently (3).

The sharp increase in cigarette use during the early to mid-1990s observed in this and other surveys might have resulted from expanded tobacco company promotional efforts, including discounted prices on cigarette brands most often smoked by adolescents, product placement in movies, development of nontobacco product lines with company symbols (e.g., hats and t-shirts), and sponsorship of music concerts and other youth-focused events (4). Evidence suggests that exposure to pro-tobacco marketing and depictions of tobacco use in films and videos and on television more than doubles the odds of adolescents initiating tobacco use (5). Communitywide programs to counteract pro-tobacco marketing and resume the declines in youth tobacco use observed during 1997--2003 should include combinations of counter-advertising mass media campaigns; comprehensive school-based tobacco-use prevention policies and programs; community interventions that reduce tobacco advertising, promotions, and commercial availability of tobacco products; and higher prices for tobacco products through increases in unit prices and excise taxes (5--7).

The differences in current cigarette use among racial/ethnic subgroups suggest that lower rates of current cigarette use among high school students are achievable. The data in this analysis show that current cigarette use remained stable among white and Hispanic students overall from 2003 to 2007, but among black students overall, current cigarette use continued to decline. This decline can be attributed largely to declines among black female students. Whereas rates among black male students remained stable from 2001 to 2007, black female students showed a continued decline in current cigarette use from 1999 to 2007. In 2007, black female students had the lowest rate of current cigarette use among all sex and racial/ethnic subgroups.

The findings in this report are subject to at least two limitations. First, these data apply only to youths who attend school and, therefore, are not representative of all persons in this age group. Nationwide, in 2005, of persons aged 16--17 years, approximately 3% were not enrolled in a high school program and had not completed high school (8). Second, the extent of underreporting or overreporting of cigarette use cannot be determined, although the survey questions demonstrate good test-retest reliability (9), and high school students do not tend to underreport cigarette use (10).

The national health objective for 2010 of reducing current cigarette use among high school students to less than 16% can be achieved if the declines in current cigarette observed during 1997--2003 resume. Communitywide, comprehensive tobacco-control programs that use coordinated evidence-based strategies should be implemented and revitalized to further limit cigarette use by high school students. A better understanding of the factors responsible for the continued decline and low rate of current cigarette use among black female students can help guide and strengthen comprehensive tobacco-control efforts in the future for all use.

References

US Department of Health and Human Services. Tobacco use; 27-2: reduce tobacco use by adolescents. In: Healthy people 2010: understanding and improving health. 2nd ed. Washington, DC: US Department of Health and Human Services; 2000. Available at http://www.healthypeople.gov/document/pdf/volume2/27tobacco.pdf.
CDC. Methodology of the Youth Risk Behavior Surveillance System. MMWR 2004;53(No. RR-12).
Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE. Trends on cigarette smoking and smokeless tobacco, table 1. Ann Arbor, MI: University of Michigan; 2007. Available at http://monitoringthefuture.org/data/07data/pr07cig1.pdf.
Nelson DE, Mowery P, Asman K, et al. Long-term trends in adolescent and young adult smoking in the United States: metapatterns and implications. Am J Public Health 2008;98:905--15.
Wellman RJ, Sugarman DB, DiFranza JR, Winickoff JP. The extent to which tobacco marketing and tobacco use in films contribute to children's use of tobacco. Arch Pediatr Adolesc Med 2006;160:1285--96.
Zaza S, Briss PA, Harris KW, eds. Tobacco. In: The guide to community preventive services: what works to promote health? New York, NY: Oxford University Press; 2005. Available at http://www.thecommunityguide.org/tobacco/default.htm.
CDC. Best practices for comprehensive tobacco control programs---2007. Atlanta, GA: US Department of Health and Human Services, CDC; 2007. Available at http://www.cdc.gov/tobacco/tobacco_control_programs/stateandcommunity/best_practices.
Laird J, Kienzl G, DeBell M, Chapman C. Dropout rates in the United States: 2005. Washington, DC: US Department of Education, National Center for Education Statistics, 2007. NCES publication no. 2007--059.
Brener ND, Kann L, McManus T, Kinchen SA, Sundberg EC, Ross JG. Reliability of the 1999 Youth Risk Behavior Survey questionnaire. J Adolesc Health 2002;31:336--42.
Messeri PA, Allen JA, Mowery PD, et al. Do tobacco countermarketing campaigns increase adolescent under-reporting of smoking? Addict Beh 2007;32:1532--6.
* Quadratic and cubic trends indicate a significant but nonlinear trend in the data over time (e.g., whereas a linear trend is depicted with a straight line, a quadratic trend is depicted with a curve with one bend and a cubic trend with a curve with two bends). Trends that include significant cubic or quadratic and linear components demonstrate nonlinear variation in addition to an overall increase or decrease over time.

26-Jun-08 3:00 PM

CASA Releases Marijuana Report

Wed, 18 Jun 2008 14:00:00 GMT

NEW YORK, NY, June 18, 2008 From 1992 to 2006, as the potency of
seized marijuana almost tripled (3.2 to 8.8 percent THC
concentration), medical diagnoses of marijuana abuse and dependence
for teen admissions to treatment increased 492 percent according to
Non-Medical Marijuana III: Rite of Passage or Russian Roulette?, a new
report by The National Center on Addiction and Substance Abuse (CASA)
at Columbia University.

The report reveals that while such medical diagnoses of marijuana
abuse and dependence soared, the number of medical diagnoses for abuse
and dependence involving alcohol and all other drugs declined 37
percent.

For more of the press release follow this link:

http://www.casacolumbia.org/absolutenm/templates/PressReleases.aspx?arti
cleid=527&zoneid=66

To download the report directly please follow
this link:

http://www.casacolumbia.org/ViewProduct.aspx?PRODUCTID=7962e2a3-b250-4ac
b-ad2e-6157d44b7657

where you will see a button that says 'Download for Free'.

18-Jun-08 9:00 AM

US state smoking restrictions in bars, worksites, etc. (MMWR brief report)

Maggie Wilhite — Thu, 22 May 2008 21:00:00 GMT

"State Smoking Restrictions for Private-Sector Worksites, Restaurants,
and Bars --- United States, 2004 and 2007

MMWR Weekly Report, Volume 57, Number 20

This report summarizes the changes in state smoking restrictions for
private-sector worksites, restaurants, and bars that occurred from 2004
to 2007. The findings indicated a substantial increase in the number and
restrictiveness of state laws regulating smoking in these three
settings, providing nonsmokers with increased protection from the health
risks posed by SHS. If current trends continue, achieving the national
health objective by 2010 might be possible.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5720a3.htm

22-May-08 4:00 PM

21st Birthday Binge Drinking

Maggie Wilhite — Tue, 20 May 2008 21:45:00 GMT

Fun at 21? Drinking to excess on one's 21st birthday has become a tradition
Tragically, some don't live to regret their binge.
Tuesday, May 20, 2008 4:34 AM

By Kathy Lynn Gray
The Columbus Dispatch

According to a 2006 study of 164 students, 34% blacked out on their 21st birthday.
The Hot Issue

Did you overindulge on your 21st birthday?
When a young woman enters a bar wearing a glittery crown and a beauty-queen sash, bartenders know what to do: Pour a free shot; someone's turning 21.
"They're very eager," said bartender John Cordas of the Ugly Tuna Saloona near the Ohio State University campus. "You can always tell, because they come in with a group of friends (who) sit at the bar and take turns buying shots for that person."

Those turning 21 arrive at the Saloona nightly at midnight, but few try to drink their age in shots, a fad glorified in drunken videos on YouTube and MySpace.

"I've only seen one kid try it, and he didn't get very far before he got pretty sick," Cordas said. "After eight or nine shots, you're pretty drunk."

Twenty-one shots, at 1.5 ounces a glass, would be more than a fifth of liquor.

Every year, 21-year-olds drink themselves to death.

"It's probably the most dangerous drinking occasion for students," said Steven W. Clarke, director of the Campus Alcohol Abuse Prevention Center at Virginia Tech.

Clarke has studied 21st-birthday celebrations to determine why they encourage excessive drinking and how to make them less dangerous.

Free drinks are a major contributor to the problem, he found. Bars often give a free shot or drink to the newly legal, and then friends start buying the booze.

"College students don't typically buy drinks for each other, so they feel it would be rude not to consume them," Clarke said.

New drinkers also drain their glasses quickly, he said. They often start at midnight and try to down as many drinks as they can before the bar closes at 1 or 2 a.m.

Two states have found the practice so alarming that they outlawed it. Bars in Minnesota and North Dakota can't serve 21-year-olds until 8 a.m. on their birthday.

Ohio State junior Jeffy Mai said he doesn't know anyone who drank "21 at 21," but he said drinking on your 21st birthday is "a big thing" on campus. When he turned 21 in December, his friends bought all the drinks, he said. He drank enough to do a "weird chicken dance" at Hooters.

Toben Nelson, an assistant professor of epidemiology at the University of Minnesota, said about 1,700 college students die each year of alcohol-related causes. About 300 of those deaths are from falls or alcohol poisoning, he said.

At least two 21-year-olds have died in Franklin County from drinking too much on their birthdays, according to the coroner's office.

OSU student Adam Boncela had a blood-alcohol content of 0.37 percent when he died on July 25, 2005; that's the equivalent of drinking about 18 shots in two hours. Blackouts and nausea are common with a blood-alcohol content of 0.16 percent to 0.19 percent; death can occur at a level of 0.30 percent.

Ohio University junior Nathan A. Roberts of Findlay died of acute intoxication in a house near Ohio State after drinking heavily on his 21st birthday in 2001. His blood-alcohol content was 0.36 percent.

One way to reduce deaths is for bars and servers to be more accountable, said Nelson, who has written extensively about student drinking.

"There are laws about not serving someone who's obviously intoxicated, but they're rarely enforced," he said. "We've done studies by having people go into bars and act intoxicated, and three-fourths of the time they're served alcohol."

Ohio State sends an e-mail to students about to turn 21. The message is from the sister of OSU student Joey Upshaw, who died after ingesting drugs and alcohol in 2000. Erica Upshaw urges students: "Be careful on your 21st birthday" and "do not feel like you have to take 21 shots."

But Virginia Tech's Clarke said such warnings have "no significant effect" on how much students drink.

"We also tried weekly e-mails for four weeks before their birthdays, and that had no significant effect, either," he said.

Parents should encourage their children to take charge of their birthday celebration, Clarke said.

"Set a specific limit on drinks or the amount of time you're drinking," Clarke said. "Friends will be saying, 'We're going to take you out and get drunk.' It's your birthday. You'd think you could take control."

For more information, visit www.alcohol.vt.edu or www.swc.osu.edu/alcohol.asp.

20-May-08 4:45 PM

Test Article for Tendenci Training

kim lange — Fri, 14 Jan 2005 16:00:00 GMT

TestTestTestTestTestTestTest

14-Jan-05 10:00 AM

Brief Encounters can Provide Motivation to Reduce or Stop Drug Use

kim lange — Thu, 06 Jan 2005 17:00:00 GMT

Brief Encounters can Provide Motivation to Reduce or Stop Drug Use 1/5/2005 Press Release National Institute on Drug Abuse National Institutes of Health 6001 Executive Boulevard, Room 5213 Bethesda, MD 20892 www.drugabuse.gov New research supported by the National Institute on Drug Abuse (NIDA), National Institutes of Health, shows that meeting with an addiction peer counselor just once at the time of a routine doctor visit with a followup booster phone call can motivate abusers of cocaine and heroin to reduce their drug use. The study, by husband and wife research team Dr. Judith Bernstein and Dr. Edward Bernstein and their colleagues at Boston University Schools of Medicine and Public Health, is published in the January 2005 issue of "Drug and Alcohol Dependence". "Brief interventions have proven effective in initiating positive behavior changes in people who are dependent on alcohol," notes NIDA Director Dr. Nora D. Volkow. "Preliminary assessments of this process in drug abusers have been encouraging enough to investigate it more thoroughly as a therapeutic tool to enhance treatment." The motivational interview used in this study was designed to establish rapport with the participant and covered such areas as asking permission to discuss drugs, exploring the pros and cons of drug use, eliciting the gap between real and desired quality of life, and assessing readiness to change. This 20-minute intervention also included development of an action plan. The study was conducted among 1,175 men and women who had tested positive for cocaine or heroin abuse. Participants were randomly assigned to an intervention group or a control group. Intervention consisted of a motivational interview with a substance abuse outreach worker who also was a recovering addict, referrals to active drug abuse treatment programs, a written list of treatment options, and a followup telephone call 10 days later. Members of the control group received only the written list. Six months following enrollment, the researchers found that among those who abused cocaine, 22.3 percent of the intervention group were abstinent from the drug, compared with 16.9 percent of the control group; among those who abused heroin, 40.2 percent of the intervention group were abstinent from the drug, compared with 30.6 percent of the control group. As for people who used both drugs, 17.4 percent of the intervention group were drug free, compared with 12.8 percent of the control group. "This study not only shows that this type of intervention provides true benefits in reducing cocaine and heroin abuse, it also suggests that peer interventionists can play an important role in busy clinical environments," says Dr. Volkow.

6-Jan-05 11:00 AM

ER Patients with Addictions Cost More

kim lange — Thu, 06 Jan 2005 17:00:00 GMT

ER Patients with Addictions Cost More 1/5/2005 A new study examining emergency department patients finds that those with unmet addiction treatment needs incur higher hospital and emergency department charges than other patients, Medical News Today reported Dec. 21. According to the study, "Unmet Substance Abuse Treatment Need, Health Services Utilization, and Cost: A Population-Based Emergency Department Study," ER patients with unmet treatment needs are 81 percent more likely to be admitted during their emergency visit, and 46 percent more likely to have reported making at least one emergency department visit in the previous 12 months. The study, led by Ian Rockett, Ph.D., from the West Virginia University Department of Community Medicine and Center for Rural Emergency Medicine, focused on emergency-room patients in Tennessee, where less than 10 percent of patients needing addiction treatment were currently receiving it. According to the research, Tennessee patients with unmet treatment needs who received emergency medical services accounted for $777.2 million in extra hospital charges for the state in 2000, which translates to an additional $1,568 for each emergency patient with an addiction problem that wasn't addressed. "We predict that systematically addressing substance-abuse problems in emergency departments would produce major savings in time, resources, and costs," Rockett said. "In exacerbating the workloads of very busy hospital staff, emergency patients with unmet substance-abuse treatment need add many millions of dollars to annual healthcare costs. Our research findings speak to the importance of identifying them as substance abusers -- either for a brief intervention or to refer them to substance-abuse treatment as appropriate. The emergency department visit itself can represent a teachable moment for a patient." The study's findings are published in the online edition of Annals of Emergency Medicine.

6-Jan-05 11:00 AM

Study: Only Moderate Drinking Prevents Stroke

kim lange — Thu, 06 Jan 2005 17:00:00 GMT

Study: Only Moderate Drinking Prevents Stroke 1/5/2005 A new study says that one drink every other day of red wine is the best way to lower the risk of stroke, Health Day News reported Jan. 3. According to researchers at Harvard Medical School, men who consumed no more than one alcoholic drink every other day had a 32 percent lower risk of stroke compared with nondrinkers. Furthermore, red wine offers the most benefits. The 14-year study was based on data collected on 38,156 men who participated in the Harvard School of Public Health's Health Professionals Follow-up Study. Every four years from 1986 to 2000, participants completed questionnaires about their diet and how much they drank. Those who drank more, the study showed, had an increased risk for cardiovascular problems. For instance, men who drank three or more glasses of alcohol a day increased their risk of stroke by nearly 45 percent, compared with nondrinkers. "There has been an assumption that moderate drinking prevents heart attacks and prevents strokes," said study author Dr. Kenneth Mukamal, an associate professor of medicine at Harvard Medical School. "In the last few years, it has become increasingly clear that that might not be the case for stroke. As men drink more, the risk for stroke becomes particularly clear." Mukamal said the findings would likely hold true for women, as well. The study's findings are published in the Jan. 4 issue of the Annals of Internal Medicine.

6-Jan-05 11:00 AM

Tucson City Buses Help Youngsters Find Safe Haven

kim lange — Thu, 06 Jan 2005 17:00:00 GMT

Tucson City Buses Help Youngsters Find Safe Haven 1/5/2005 The city bus authority in Tucson, Ariz., has partnered with Project Safe Place's Open Inn initiative, which helps young people in an effort to prevent homelessness, drug use, and other problems, the Tucson Citizen reported Jan. 5. Under the program, drivers of the city's 189 buses will provide young people in distress with a free ride while they radio their dispatcher to contact Open Inn, which provides social services to youths and families in crisis. Once contacted, an Open Inn outreach worker will meet the youth at a bus stop along the driver's route. "We're trying to catch folks before they run away," said Jason Thorpe, Open Inn's community education and outreach coordinator. "If they stay on the streets for 48 hours, they stay there longer. There's so much substance abuse and so many predatory adults who victimize young people on the streets. The culture so quickly grabs them in." Open Inn assigns a counselor and provides referrals for shelter and other services. According to Thorpe, Project Safe Place is aimed at young people up to age 18 who have been sexually, physically, or verbally abused, who are at risk for alcohol or other drug addiction, and may be a runaway or facing homelessness.

6-Jan-05 11:00 AM