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Director’s Corner

What a year we had in 2009! At ADP we faced furloughs, pay cuts, layoffs, challenges and change. It was a year of ongoing uncertainty. We had to do much more with much less–more work, less staff, less time, and fewer resources—and at times it was an uphill struggle.

The good news is that we made significant progress in achieving many of our goals, in spite of all the obstacles we faced. When I first came to ADP, I knew that raising the quality of care in the State of California was essential. To do that we needed to upgrade our counselor certification process and create treatment standards. Back in 2007 (feels like a lifetime ago!), I was told it would take at least five, possibly ten, years to accomplish those two goals alone. But, here we are, two and a half years later with a superb certification and licensing bill being introduced to the legislature and treatment standards that I believe are the best in the nation!

One thing I am particularly proud of this past year is our work to help our veterans returning from duty overseas. With great cooperation and very little money we launched our Veterans’ Initiative, collaborating not only with the California Department of Veterans Affairs, but also with the Federal VA. Our exceptionally useful Veterans’ webpage is one of our accomplishments. As witness to our achievement, the White House Office of National Drug Control Policy told me they want to use California as a model to show other states what can be accomplished on a very tight budget. I just about burst with pride over that compliment!

The year 2010 promises to be another year of challenge and change. But let’s pause a minute to be grateful for our successes in 2009. My best wishes to you all as we enter this new year, and, as the little fellow in Dickens’ story says, “God bless us everyone!”



Public Health Alert:
Life-Threatening Risk -- Cocaine Laced with Levamisole

Alcohol and other drug programs across California should be on the look out for a dangerous substance—levamisole—that is showing up with increasing frequency in illicit cocaine powder and crack cocaine, most recently in San Francisco and Los Angeles.

Levamisole—a veterinary anti-parasitic drug—severely reduces the number of white blood cells in humans leading to an acute condition called agranulocytosis that should be treated at a hospital. Ingesting cocaine mixed with levamisole suppresses immune function and the body's ability to fight off even minor infections. People who snort, smoke, or inject crack or powder cocaine contaminated by levamisole can experience overwhelming, rapidly-developing, life threatening infections.

Agranulocytosis manifests the following symptoms:
  • high fever, chills, or weakness
  • swollen glands
  • painful sores (mouth and anal)
  • infections that won’t go away or get worse very fast, including sore throat or mouth sores; skin infections; abscesses; thrush (white coating of the mouth, tongue or throat); pneumonia (fever, cough, shortness of breath)

Used in veterinary medicine, levamisole is currently approved for use in cattle, sheep and swine as an anti-parasitic agent. Formerly used in human medicine for treating autoimmune diseases and cancer, it is no longer approved for human use.

The Substance Abuse and Mental Health Services Administration (SAMHSA) began alerting medical professionals, substance abuse treatment centers, and other public health authorities in September about the risks.

SAMHSA is working with the U.S. Centers for Disease Control and Prevention (CDC), the Drug Enforcement Administration (DEA), the Food and Drug Administration, the Office of National Drug Control Policy, and other federal and international organizations, as well as state agencies to monitor the levamisole issue. CDC will publish a case report analysis in the Morbidity and Mortality Weekly Report and will work with state health departments to systematically collect information on cocaine-associated agranulocytosis cases. Information from this effort will be used to guide treatment and prevention initiatives to address the public health concern.

According to the DEA and state testing laboratories, the percentage of cocaine specimens containing levamisole has increased steadily since 2002, with levamisole now found in more than 70 percent of the illicit cocaine analyzed last July. In addition, a recent analysis in Seattle, Washington, found that almost 80 percent of individuals who test positive for cocaine also test positive for levamisole.

ADP is asking all providers to report suspected and confirmed cases of agranulocytosis associated with cocaine abuse to their local health departments. Cases can also be reported to local Poison Control Centers (1-800-222-1222), which may assist in clinical management and additional reporting. For further medical/technical information, contact Nicholas Reuter, SAMHSA Nicholas.reuter@samhsa.hhs.gov



ADP Conference Set for June 2010: Call for Presenters

Calling all presenters! Be a part of ADP’s 2010 conference set for June 15 -17 at the Radisson Hotel in Sacramento! With the theme, "Strongest Together: Building Quality Services During Challenging Times," the focus of the conference will be on building unity across the AOD field by providing a venue for shared language, learning, cross-training, and networking among prevention, treatment and recovery professionals. Share your knowledge and experience with a targeted presentation. The deadline for submitting your idea is January 29, 2010, at 5:00 p.m.

The conference will promote universal understanding and use of the public health, chronic care, and recovery support frameworks in the continuum of services. Plan on attending to…
  • Share new technologies, proven approaches and successes for instituting systemic, programmatic, and individual change to improve services.
  • Discuss the current environment and California's diverse service needs, interdependency and trends in other systems that impact the AOD field.
  • Share knowledge, skills and resources to address disparities, build alliances, and promote culturally responsive services and systems for California's diverse population.
  • Share knowledge and skills needed to develop new—and leverage existing—funding and resources.

Interested in participating as a presenter? The deadline for submitting your idea is January 29, 2010, at 5:00 p.m. For more information and submission instructions, visit http://www.cce.csus.edu/conferences/adp/10/



Want to Serve on the
Director’s Advisory Council?

Director Zito has gone “back to basics” with the Director’s Advisory Council (DAC) at ADP.

Originally created in 1992 as the Director’s Advice Seeking System, the primary focus was to advise the Department on ways to improve and expand services to unserved and underserved populations in the state. In the recent past, however, DAC meetings were mainly “report out” sessions with ADP staff giving updates on projects and programs with limited input from constituencies.

“It’s time to re-energize our Council and re-focus our efforts on the best ways to help the statewide communities we serve—those who need, seek, or have difficulty accessing prevention, treatment and recovery programs,” says Director Zito. “We want to increase the creative interaction part of the DAC with in-depth, meaningful discussions of key issues.”

The current Council membership includes the ADP Director, Chief Deputy Director, Deputy Director of the Office of Legislative and External Affairs, the chairperson for each of eight Constituent Committees, and the presidents of statewide provider organizations. The Council is not mandated by State law and its members serve at the pleasure of the Director.

ADP is currently recruiting new DAC and Constituent Committee members. Ideal candidates will…
  • Engage in dialogues with—and provide feedback from—stakeholder groups throughout the state on the effectiveness of current programs.
  • Build consensus in major policy areas that impact the Department’s service systems and clients.
  • Identify barriers to access for underserved populations.
  • Share information and ideas about prevention, treatment and recovery services statewide.
  • Represent stakeholders, identifying and discussing issues of concern within their communities and bringing those concerns to the Department with recommendations for changes in policy and/or programs.
Historically, DAC and Constituent Committee members appointed by the ADP Director have included…
  • Representatives from principal state agencies involved with alcohol and other drugs in the areas of prevention, treatment and recovery services, education, vocational rehabilitation, criminal justice, housing, welfare, child welfare, and social services.
  • Representatives from public and private entities concerned with the need, planning, operation, funding, and use of prevention, treatment and recovery services.
  • Individuals who are champions in their field with stature and influence among their peers.
  • Individuals who are receiving (or have received) prevention, treatment and recovery services.
  • Family members of individuals who are receiving (or have received) prevention, treatment and recovery services.
  • Providers of prevention, treatment and recovery services.

We need DAC members who are advisors with access to—and knowledge of—stakeholder communities to carry information from the Department to communities and bring back issues of concern. We want goodwill ambassadors who are committed to making a difference in their respective communities; who focus on situations and issues and not on individual people during discussions; who maintain constructive relationships with their peers; and who take initiative and lead by example.

If you are interested in serving, please contact Tina Chiginsky, Deputy Director of Legislative and External Affairs tchiginsky@adp.ca.gov, or Director Renée Zito tchiginsky@adp.ca.govADPDirector@adp.ca.gov and describe your area of interest and qualifications.



Women’s Health on the Web

Women’s health issues are up front and personal on ADP’s web site. One of several dynamic specialty pages, the Women’s Page is attracting a lot of attention from web browsers across California.

Maintained by ADP’s Office of Women’s and Perinatal Services (OWPS), the colorful and newsy feature is designed to attract women and keep them interested in improving their health with a variety of topic areas. The main page offers information and links for Alcohol Use and Pregnancy; Parenting; Domestic Violence and an assortment of associated reports and documents that back up the research. Crawling deeper into the website, a viewer finds more extensive information on subjects such as Fetal Alcohol Spectrum Disorders (FASD)—a serious issue that needs more public attention.

The Fetal Alcohol Spectrum Disorders section is directed not only at pregnant women and mothers, but also at fathers, care-takers, educators, and health care providers. Research addressing FASD has been increasing in recent years. The Women’s Page provides information and links to policy recommendations, promising practices in the prevention and treatment of FASD, and research linking conduct disorders to maternal alcohol consumption.

With the belief that every woman in California should have access to high quality, gender responsive and trauma informed alcohol and drug services, the Office of Women’s and Perinatal Services works to identify barriers to successful treatment and ways to improve treatment retention rates and outcomes.

Find more information on women’s health on ADP’s Women’s Page, visit http://www.adp.ca.gov/women/index.shtml



New Statewide Program to Treat Problem Gamblers

ADP’s Office of Problem Gambling (OPG) recently launched the California Problem Gambling Treatment Service Program—a first-of-its-kind, state-funded program for problem gamblers. Key goals of the program are to increase the number of individual therapists qualified with enhanced knowledge and skills to treat problem and pathological gamblers and to create a statewide network of treatment providers. The program focuses on evidence-based treatment for this specific addiction.

OPG, in partnership with the UCLA Gambling Studies Program, held the first training sessions for therapists in Los Angeles and San Francisco in October and November and a third session in Sacramento in December.

A fourth training session will be held in San Diego on January 20-23, 2010. OPG is actively recruiting licensed therapists to participate in these training sessions and to become part of the treatment network. There is no charge for the training, but pre-registration and qualification are required.

See the following links for requirements, the training pre-registration form, and an application to enter the program. For more information, visit www.problemgambling.ca.gov or email OPG at opg@adp.ca.gov



California Veterans’ Awareness Initiative

A year ago, a call to action came out of Washington and the Substance Abuse Mental Health Services Administration asking state health organizations to focus on the unique needs of military veterans returning from the wars in Iraq and Afghanistan.

Facing devastating consequences from substance abuse and co-occurring disorders—some experiencing post traumatic stress disorder or traumatic brain injury—our servicemen and women were having difficulty finding and getting treatment. Too often post deployment coverage and eligibility for health care ended just when they needed it most. And those who could access treatment services often found themselves on long waiting lists.

Director Zito immediately took up the cause by appointing former ADP deputy director Carmen Delgado to head up the California Veterans’ Awareness Initiative (VAI). Carmen gathered a group of stakeholders and set to work to develop a Commitment Plan for the department working in collaboration with the California Department of Veterans Affairs, the California National Guard, the federal Department of Veterans Affairs, CADPAAC and a number of community organizations.

ADP can look with pride at the VAI’s accomplishments this year, especially the dynamic, user-friendly veterans’ web pages on ADP’s website and a series of provider training sessions that focused on the unique needs of veterans.

The veterans’ web pages provide a wealth of local, state, and federal resources for military personnel and their families. Visit the website and then share it with others who may be looking for help: www.adp.ca.gov/veteran/index.shtml



A Brief Look Back at 2009

Change was the rule at ADP during 2009! California’s fiscal crisis and changing political climate had their affects on programs as well as staff in the department. However, with the help of many stakeholders from around the state—most of whom experienced the same changing environments—we were able to move forward.

Here’s a brief run-down of some of ADP’s accomplishments during this trying year:
  • We advanced the goal of statewide standards for alcohol and drug treatment counselors in California: ADP is sponsoring Senate Bill 707—authored by Senator Mark DeSaulnier—that will create a new alcohol and other drug (AOD) counselor certification and licensing system for those who work in AOD treatment programs or in private practice. The bill gives the state greater counselor oversight and stronger tools to ensure standards of practice and ethics within the discipline and lays the groundwork needed to measure treatment outcomes. The bill also offers a career path to counselors with a tiered system that recognizes levels of education, responsibility, and experience. It provides the state greater opportunity to become involved in workforce development, including education in best practices, training, recruitment and retention.
  • We retooled the AOD problems response system: ADP continued working through the phases of The Continuum of Services System Re-Engineering (COSSR), a multi-year effort to develop and implement a comprehensive and integrated alcohol and other drug prevention and treatment system in California. The initiative recognizes alcohol and other drug problems as chronic conditions requiring prevention, treatment and recovery support. COSSR will result in readily available and accessible services, a well-trained workforce, improved outcomes, and public understanding about the chronicity of addiction.
  • We launched an initiative to enhance services for military veterans: ADP launched the California Veterans’ Awareness Initiative in response to the unique alcohol and substance abuse needs of military men and women returning from war. The Initiative comprises a Commitment Plan to reach out to veterans that includes 1) a comprehensive web site offering valuable local, state and national resources, 2) training for treatment providers to increase the AOD field’s capabilities on veteran’s issues, and 3) ongoing collaboration with community and military organizations across the state.
  • We tackled prescription drug misuse and abuse: ADP convened a national Prescription Drug Task Force to address the increase in prescription drug misuse and abuse. The Task Force produced a final report—Summary Report and Recommendations on Prescription Drugs: Misuse, Abuse and Dependency—that includes eighteen recommendations focusing on five broad areas that require action: 1) lack of awareness, 2) training and education, 3) availability and access, 4) tracking information on prescription drug use, and 5) policies for identifying and treating prescription drug abuse. The report was distributed throughout California and the nation. Current efforts focus on implementing the first category of recommendations—lack of awareness of prescription drug abuse. Eighteen recommendations lay the foundation for future efforts addressing the complex issue of prescription drug misuse and abuse.
  • We embraced cultural competency: ADP completed work on a cultural competency strategic plan that provides a roadmap for better understanding and interaction with people of different cultures. Our ultimate goal is to deliver services that are culturally appropriate for the diverse clients served by the department within the state.
  • We implemented operational efficiencies to reduce contract expenditures: ADP reduced its personal service contracts for new information management system development, system maintenance, infrastructure support, and project management from nearly fifty full- and part-time staff to zero! The reduction eliminated approximately $2.1 million in contract expenses; eliminated dependence on contractors; ensured continuity of service; and provided opportunities for enhancing the skills of ADP staff.
  • We improved the quality of substance abuse treatment in California’s publicly-funded programs: Responding to observations and comments about the need to improve the quality of substance abuse treatment of multiple oversight bodies, ADP defined, in broad terms, the essential components of an effective substance abuse treatment program. The goal was to help Californians understand and determine their own best choices when accessing this health care service.
  • We launched a first-of-its-kind statewide training program for therapists who treat problem and pathological gamblers: ADP’s Office of Problem Gambling launched the first statewide effort to train therapists to treat California citizens and their families troubled by problem and pathological gambling. The training program focuses on enhancing the knowledge and skills—and increasing the number—of therapists trained in evidence-based treatment. In partnership with the University of California at Los Angeles Gambling Studies Program, ADP also set up a network of therapists throughout the state to serve problem gamblers.
  • We increased the effectiveness of prevention planning: ADP integrated the Strategic Prevention Framework, a planning design promoted nationally by the Center for Substance Abuse Prevention, into its programs. Using this framework, California counties prepared AOD prevention plans based on local data, priorities and capacity to address needs in their communities. Counties set objectives and tasks to attain their goals and then assigned providers explicit tasks to accomplish and on which to report data. The dynamic design allows for continuous quality improvement through mid-course adjustments increasing the effectiveness and outcomes of prevention programs throughout California.


Why does California need Senate Bill 707?

    Because California’s alcohol and drug abuse treatment system is in crisis. It’s a system mired in confusion for consumers, their families, providers and tax payers.

In Governor Schwarzenegger’s veto response to Assembly Bill 239 in 2008, he ordered the development of a legislative proposal containing uniform standards for alcohol and drug counselors that would offer individuals seeking treatment “the same quality of care across all sectors, whether in a public or private facility.”

The current system is sorely lacking—the state has no authority to insure uniform quality of care. Within existing regulations, nine different certifying organizations use a variety of certification levels and a variety of education requirements for counselors. The current lack of uniform standards and accountability undermines consumer confidence in alcohol and drug abuse services in both public and private programs across the state.

SB 707 will remedy that!

SB 707 will …
  • increase and standardize the required education and clinically supervised experience of alcohol and other drug (AOD) counselors to assure Californians that they will receive the same quality of care across all sectors;
  • establish a single code of conduct for all AOD counselors in the state;
  • require the Department of Alcohol and Drug Programs (ADP) to investigate complaints and, if warranted, discipline counselors;
  • require ADP to create and maintain a single database for all counselor information;
  • grandparent existing counselors into the new counseling tiers;
  • ensure the health and safety of Californians by requiring all individuals seeking AOD counselor registration, certification, or licensure to submit to a criminal background check.

AOD counselors are currently treating alcoholism and other drug abuse without a clearly defined scope of practice and without required, appropriate referrals to other trained healthcare professionals for underlying and co-occurring issues

SB 707 will remedy that!

SB 707 will …
  • establish a clearly defined scope of practice for registered, certified, and licensed alcohol and other drug counselors;
  • require completion of training in recognizing co-occurring disorders and referral processes to other trained healthcare professionals for underlying and co-occurring issues.

SB 707 was introduced by Senator Mark DeSaulnier in January 2009 to advance the profession of alcohol and other drug counselors and improve the treatment system. Throughout 2009, Senator DeSaulnier and representatives from the California Department of Alcohol and Drug Programs—the bill’s sponsor—met with stakeholders from every corner of California to iron out issues and concerns. Legions of counselors, providers, administrators, researchers and private citizens have offered comments. Their input has been instrumental in amending the bill. Together we will create the best treatment system for the chronic illness of alcohol and other drug addiction.

Support for SB 707 is coming from all around the state: legislators, county administrators, law enforcement, the courts, large and small program providers, AOD counselors, AOD nonprofit organizations and associations, and private citizens.

Here is just a sampling of the comments ADP has received recently:

California Assemblymember Jim Beall, Chair of the Assembly Select Committee on Drug and Alcohol Abuse and a strong supporter of SB 707. “I believe this legislation is crucial to the standardization and improvement of the counselor certification process California currently has in place,” says Beall. “For many years, I have admired the fine work of so many of our AOD counselors. SB 707 burnishes the respect conferred on these hard-working and caring individuals by creating a standardized level of professionalism they can point to with pride. This bill raises the bar for the quality of care provided to those in treatment for substance abuse, and functions to reassure consumers that they will receive only the best level of care. Currently, California suffers from a fragmented certification and oversight system. By creating a uniform training base for substance abuse counselors, SB 707 will help the field of addiction treatment earn the respect of the public and the healthcare industry at large. The need for SB 707 is greater than ever. With the passage of the Federal Parity Act of 2008, more Californians will be able to access mental health and substance abuse treatment. This will generate a higher demand for well-trained drug and alcohol counselors. SB 707 creates a career path for counselors ensuring a highly skilled group of qualified counselors are available to meet the growing need. It is for all of these reasons that now is the time to pass SB 707.”

A respected and admired member of the California bench, the Honorable Wendy Lindley, Judge of the Superior Court of California in Orange County, says, “SB 707 is essential for improving drug and alcohol and co-occurring disorder services in the State of California. The bill will set requirements for counselors, will require law and ethics and co-occurring disorders education and will create disciplinary authority. This legislation will ensure that criminal offenders receive appropriate and high quality treatment to enable them to successfully complete counseling which will reduce recidivism and result in a safer community.”

Albert M. Senella, President and Chief Operating Officer at Tarzana Treatment Centers in Los Angeles, has decades of perspective on the issue. “Some years back, when the current legislation was passed, it was only the first small step,” he reports. “SB 707 builds on that step by creating a desperately needed single state authority for issuance and enforcement of certificates; by creating a career path needed to draw and retain more qualified individuals to the field; and by creating a licensed addiction counselor who can operate independently in private practice. SB 707 calls for a uniformed code of conduct and improved public safety.”



Perinatal Effects of Maternal Marijuana Use

Editor’s note: ADP’s State Medical Director Team headed by Elinore F. McCance-Katz M.D., Ph.D., regularly contributes content specific articles for the alcohol and other drug field. The Team’s latest contribution centers on the perinatal effects of marijuana used by pregnant women.

Research indicates that perinatal use of marijuana has multiple effects on human offspring

Effects on birth weight are conflicting: some research indicates no effects while other reports describe significant negative effects on birth weight and length (see footnotes 1-4 listed below).

Effects in newborns include altered responses to visual stimuli, tremulousness, and high-pitched crying indicating possible neurological problems (footnotes 5, 6). In one study of three-year-old children, in utero marijuana exposure indicated increased nighttime arousal and more awake time (footnote 7). Reports indicate psychological problems in older children including depressive symptoms at age ten (footnote 8), and cognitive difficulties with problem-solving, memory, and attention in school-age children (footnotes 9, 10).

In one study, in utero exposed 9- and 12-year-olds performed cognitive processes less well (footnote 10). Problems with abstract and visual reasoning, inattention and impulsivity have also been observed in 10-year-olds (footnote 3).

Anecdotal and research evidence suggest that marijuana use while breastfeeding can reduce the production, volume, and ejection of breast milk (footnote 11). Retrospective study designs, inaccurate assessments of actual level of exposure, adverse postnatal environments, and negative parenting behaviors are known to confound research on perinatal marijuana use. However, sufficient data is available to recommend abstinence from marijuana during pregnancy and while breast feeding.

  1. Fried, P.A. & O’Connell, CM (1989). A comparison of the effects of prenatal exposure to tobacco, alcohol, cannabis and caffeine on birth size and subsequent growth. Neurotoxicology and Teratology, Mar-Apr 9 (2), 79-85.
  2. Bada, H.S., et al. (2005). Low birth weight and preterm births: Etiological fraction attributable to prenatal drug exposure. J. Perinatology. 25:631-637.
  3. Huizink, A.C. & Mulder, E.J.H. (2006). Maternal smoking, drinking or cannabis use during pregnancy and neurobehavioral and cognitive functioning in human offspring. Neuroscience and Behavioral R. 30: 24-41.
  4. Fried, P.A. et al. (1999). Growth from birth to early adolescence in offspring prenatally exposed to cigarettes and marijuana. Neurotoxicology and Teratology. 21, 5: 513-525.
  5. Fried P.A., Watkinson B., Gray R., Differential effects on cognitive functioning in 9- to 12-year olds prenatally exposed to cigarettes and marihuana. Neurotoxicology and Teratology (1998) 20: pp 293-306.
  6. Fried, P.A.; and Makin, J.E. Neonatal behavioral correlates of prenatal exposure to marihuana, cigarettes and alcohol in a low risk population. Neurotoxicology and Teratology 9(1):1-7, 1987.
  7. Dahl RE, Scher MS, Williamson DE, Robles N, Day N. Arch Pediatric Adolescent Med. 1995 Feb;149(2):145-50.
  8. Gray, K.A. et al. (2005). Prenatal marijuana exposure: Effects on child depressive symptoms at ten years of age. Neurotoxicology and Teratology. 27: 439-448.
  9. Fried, P.A. The Ottawa prenatal prospective study (OPPS): Methodological issues and findings. It's easy to throw the baby out with the bath water. Life Sciences 56:2159-2168, 1995.
  10. Fried, P.A.; and Smith, A.M. A literature review of the consequences of prenatal marihuana exposure: An emerging theme of a deficiency in aspects of executive function. Neurotoxicology and Teratology 23(1): 1-11, 2001.
  11. Liston, J. (1998). Breast feeding and the use of recreational drugs—alcohol, caffeine, nicotine and marijuana. Breastfeed R. Aug: 6 (2): 27-30.
Note: Text and research for this article was provided by ADP’s State Medical Director Team, which includes Elinore F. McCance-Katz, MD, PhD, (Medical Director); Martha A. Jessup RN, PhD, CNS (Principle Investigator); Vicki Smith, RN, MS, NP-C (Project Coordinator); Marie Christine Yue, MA (Administrative Analyst)