UConn Researchers Voice Concern Over Proposed Addiction Guideline Changes

By Lisa Catanese
UCONN Today
Originally published June 2, 2012

Two prominent University of Connecticut Health Center researchers are adding their voices to a chorus of other national experts who are questioning proposed changes regarding substance abuse guidelines in a manual used internationally in the diagnosis and treatment of mental illnesses.

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Babor’s reservations about the proposed changes concern the broadening of language defining addiction and the lowering of the threshold of what counts as a substance use disorder. The revisions would expand the number of symptoms of addiction, reduce the number required for a diagnosis, and introduce a “behavioral addiction” category – all of which could lead to millions more people being categorized as addicts when they in fact are simply unhealthy users. This could put a strain on already-limited resources in schools, prisons, and hospitals, he says.

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Kaminer is concerned about the impact of the proposed DSM changes from two perspectives – classifying too many people as having a problem while deterring adolescents from seeking treatment. “There are not enough resources right now,” he says. “This country is collapsing under the burden of health care. Is it necessary to expand diagnosis to include mild cases and yet push away prospective clients by calling them addicts?”

The entire story is here.

The D.S.M. Gets Addiction Right

By Howard Markel
The New York Times - Opinion
Orignally published June 5, 2012

WHEN we say that someone is “addicted” to a behavior like gambling or eating or playing video games, what does that mean? Are such compulsions really akin to dependencies like drug and alcohol addiction — or is that just loose talk?

This question arose recently after the committee writing the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), the standard reference work for psychiatric illnesses, announced updated definitions of substance abuse and addiction, including a new category of “behavioral addictions.” At the moment, the only disorder featured in this new category is pathological gambling, but the suggestion is that other behavioral disorders will be added in due course. Internet addiction, for instance, was initially considered for inclusion but was relegated to an appendix (as was sex addiction) pending further research.

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Disease definitions change over time because of new scientific evidence. This is what has happened with addiction. We should embrace the new D.S.M. criteria and attack all the substances and behaviors that inspire addiction with effective therapies and support.

The entire opinion is here.

Same-sex couples raising children on the rise

By Elaine Quijano
CBS Evening News
Originally published June 16, 2012

On this Father's Day Eve, we take notice of a sea change. The Census Bureau estimates that the percentage of same-sex couples raising children has more than doubled in just 10 years, from 8 percent in 2000, to 19 percent in 2010. We visit one of the couples behind the numbers.

As a same-sex couple, Sean McGill and Luigi Caiola say they never contemplated fatherhood.

"We never imagined or never thought that children would be an option for us," said McGill.

But after almost 10 years together, they were drawn to the idea of parenting.

The entire story is here.

Suicides Outpacing War Deaths for Troops

by Timothy Williams
The New York Times
Originally published on June 8, 2012

The suicide rate among the nation’s active-duty military personnel has spiked this year, eclipsing the number of troops dying in battle and on pace to set a record annual high since the start of the wars in Iraq and Afghanistan more than a decade ago, the Pentagon said Friday.

Suicides have increased even as the United States military has withdrawn from Iraq and stepped up efforts to provide mental health, drug and alcohol, and financial counseling services.
      

The military said Friday that there had been 154 suicides among active-duty troops through Thursday, a rate of nearly one each day this year. The figures were first reported this week by The Associated Press.

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Mr. Rieckhoff attributed the rise in military suicides to too few qualified mental health professionals, aggravated by the stigma of receiving counseling and further compounded by family stresses and financial problems. The unemployment rate among military families is a particular problem, he said.

The entire story is here.

Pentagon Chief Orders Review of Mental Diagnoses

By Donna Cassata
ABCNews.com
Originally published June 13, 2012

Under questioning from a Senate panel on Wednesday, Panetta disclosed that he had asked the Air Force and Navy, which includes the Marine Corps, to follow the lead of the Army in launching an independent study of how it evaluates soldiers with possible post-traumatic stress disorder. Panetta's answer marked the first time that the Pentagon chief had said publicly that he had requested the review by all the services.

Defense Secretary Leon Panetta

The Army review was prompted in part by reports that the forensic psychiatry unit at Madigan Army Medical Center at Joint Base Lewis-McChord in Washington state may have reversed PTSD diagnoses based on the expense of providing care and benefits to members of the military. In recent years, the number of PTSD and traumatic brain injury cases has increased significantly as the Iraq war drew to a close after nearly a decade and the Afghanistan conflict enters its second decade.

Th entire story is here.

Study Compares Effectiveness of Telephone-Administered vs. Face-to-Face Cognitive Behavioral Therapy for Depression

The JAMA Network
Originally published June 5, 2012

Patients with major depression who received telephone-administered cognitive behavioral therapy (T-CBT) had lower rates of discontinuing treatment compared to patients who received face-to-face CBT, and telephone administered treatment was not inferior to face-to-face treatment in terms of improvement in symptoms by the end of treatment; however, at 6-month follow-up, patients receiving face-to-face CBT were less depressed than those receiving telephone administered CBT, according to a study in the June 6 issue of JAMA.

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“The findings of this study suggest that telephone-delivered care has both advantages and disadvantages. The acceptability of delivering care over the telephone is growing, increasing the potential for individuals to continue with treatment,” the authors write. “The telephone offers the opportunity to extend care to populations that are difficult to reach, such as rural populations, patients with chronic illnesses and disabilities, and individuals who otherwise have barriers to treatment.

The entire release is here.

Thanks to Tom Fink for this information.

Verification of Postdoctoral Experience: Pitfalls for Students

By Rachael Baturin, MPH, JD
The Pennsylvania Psychologist
June 2012

One of the requirements for students interested in becoming licensed in Pennsylvania is to complete one year of postdoctoral experience. It is very important for potential supervisees to review the postdoctoral experience requirements before they start this experience as there are a lot of nuances to the law, and the postdoctoral experience requirements vary from state to state. There have been cases where supervisees did not review the requirements before starting their experience, their experience did not qualify for the postdoctoral year, and they needed to repeat it.

This article will discuss some of the pitfalls that supervisees and supervisors have faced when trying to complete the verification of postdoctoral experience form, which must be sent to the State Board of Psychology upon completion of postdoctoral requirements. If readers would like to review all postdoctoral requirements in Pennsylvania, they can be found in the Pennsylvania State Board of Psychology’s regulations, Section 41.32 and Section 41.33, available on the State Board’s website: http://www.pacode.com/secure/data/049/chapter41/chap41toc.html.

Practical Issues

First, the supervisee should check to see whether the supervisor has been subject to any disciplinary actions by the State Board of Psychology. If they are currently being disciplined, they may not qualify as a supervisor. After December 1, 2015, postdoctoral supervisors must have completed either a course in supervision or 3 hours of continuing education in supervision.

Second, supervisees are required to have at least half of their training in diagnosis, assessment, therapy, other interventions, consultation, and individual supervision received as a supervisee, and the other half may be in teaching in association with either an organized psychology program preparing practicing psychologists and/or a postdoctoral training program, supervision provided as a supervisor, professional development, or research. For example, if a supervisee is doing 40 hours per week of research and 20 hours per week of direct services, the student should count 20 hours of research and 20 hours of direct services per week because at least half must be in direct services. There have been cases where the supervisee submitted a verification form on which it appeared as though 50% of the time was not in providing direct services because the supervisee was submitting too many research hours.

An hour of diagnosis, assessment, or therapy does not necessarily have to be an hour of direct patient contact. For example, a supervisee could spend an hour in therapy with a child and then spend another hour talking to the pediatrician and the school. Both of those hours should be counted toward fulfilling the 1,750-hour requirement for the postdoctoral year.

As another example, if the supervisee is just starting supervision and is seeing clients fewer than 15 hours per week, the supervisee could ask the supervisor for a research project to undertake in order to obtain additional hours, as long as they do not exceed 50% of the postdoctoral hours.

Next, supervisees are required to have 2 hours of face-to-face meetings with their supervisors per week. If you need to complete your experience in two different settings, you are still required to have 2 hours of face-to-face meetings with your supervisor at each site unless the sites are interrelated. For example, if one site is owned by ABC Corporation and the other is owned by XYZ Corporation, then the supervisee is required to get 2 hours of supervision at each site. However, if both sites were owned by ABC Corporation and one was the main office and the other a satellite office then the supervisee would be required to obtain only 2 hours of supervision for both sites. Also, supervisees must be present at each site for at least 6 consecutive months for the experience to count. There have been cases where students failed to meet this requirement and had to repeat the experience.

Last, the supervisor is required to maintain records or notes of the scheduled supervisory sessions, observe client/patient sessions of the supervisee or review verbatim recordings of these sessions on a regular basis and must prepare written evaluations or reports which are discussed with the supervisee. Once again, cases exist in which the supervisor failed to produce the written evaluations and the experience did not count.

Dual Relationships

The supervisor and supervisee must not be in a dual relationship. The supervisor cannot be related to the supervisee by blood or marriage, nor can the supervisor have a therapeutic relationship with the supervisee. In addition, supervisees are not allowed to pay supervisors for supervision (although supervision may be paid by a third party). The supervisor must be free from the supervisee’s control or influence and must be allowed to stop the supervisory relationship if necessary.

CU regent candidate raps "minutiae" amid false-degree claims

By Lynn Bartels
The Denver Post
Originally published June 8, 2012

A Republican running to sit on the governing board at the University of Colorado has erroneously told voters he has a master's degree in international economics from a prestigious East Coast university.

Matt Arnold

Called on it by critics, Matt Arnold mocked advanced degrees Thursday, explaining he completed the coursework but not his thesis.

"I was more interested in getting on with my life than trying to, quite frankly, waste more time in pursuit of academic BS that no one cares about," he said.

"I think that's one of the big problems, quite frankly, with education these days. We're graduating a bunch of people who hang letters after their names, but they have no useful skills."

The entire story is here.

Examination of the Effectiveness of the Mental Health Environment of Care Checklist in Reducing Suicide on Inpatient Mental Health Units

Archives of General Psychiatry
Bradley V. Watts, MD, MPH; Yinong Young-Xu, ScD, MA, MS; Peter D. Mills, PhD, MS; Joseph M. DeRosier, PE, CSP; Jan Kemp, RN, PhD; Brian Shiner, MD, MPH; William E. Duncan, MD, PhD
Arch Gen Psychiatry. 2012;69(6):588-592. doi:10.1001/archgenpsychiatry.2011.1514

Abstract

Objective  To evaluate the effect of identification and abatement of hazards on inpatient suicides in the Veterans Health Administration (VHA).

Design, Setting, and Patients  The effect of implementation of a checklist (the Mental Health Environment of Care Checklist) and abatement process designed to remove suicide hazards from inpatient mental health units in all VHA hospitals was examined by measuring change in the rate of suicides before and after the intervention.

Intervention  Implementation of the Mental Health Environment of Care Checklist.

Results  Implementation of the Mental Health Environment of Care Checklist was associated with a reduction in the rate of completed inpatient suicide in VHA hospitals nationally.

Conclusions  Use of the Mental Health Environment of Care Checklist was associated with a substantial reduction in the inpatient suicide rate occurring on VHA mental health units. Use of the checklist in non-VHA hospitals may be warranted.

The entire article is free here.

Thanks to Ken Pope for this information.

An article about psychologists using checklists to reduce treatment  failure is here.