NEWS FLASH!!!  

The August 2007 e-MemberNews has been published and can be viewed by clicking on the following link:

http://www.eapassn.org/public/pages/index.cfm?pageid=885

This month's exciting and informative articles include:

NOTE!

Bi-partisan Legislation for Wellness Programs Introduced in Senate; Includes
Counseling and Support for Employees with Substance Use Disorders

On July 9th, Senators Tom Harkin (D-IA) and Gordon Smith (R-OR) introduced
S. 1753, the "Healthy Workforce Act of 2007." S. 1753 would amend the
Internal Revenue Code to provide a tax credit to employers for the costs of
implementing wellness programs.  Noting that chronic diseases such as heart
disease, stroke, cancer, obesity, and diabetes are the most prevalent and
costly worker health problems for employers, the legislation seeks to
improve employee attendance and productivity by encouraging the
implementation of wellness programs.  As defined by the legislation, such
wellness programs would offer counseling, seminars, on-line programs or
self-help materials related to alcohol and drug use, tobacco use, and mental
health promotion, among other health risks.

The Secretary of Health and Human Services would be required to approve each
wellness program prior to receipt of the tax credit.  For a wellness program
to receive qualification, it would require four provisions: health
awareness, an employee engagement component, a behavioral change component,
and a supportive environment.  Health awareness would be composed of health
education addressing the specific needs and health risks of employees and
health screenings with follow-up measures.  A committee would be established
to actively engage employees in the wellness programs through program
planning and tracking of employee participation.    Finally, the wellness
program would support healthy life-styles through policies related to the
use of tobacco, nutrition of food, and minimizing stress.  Additionally,
businesses would offer incentives for wellness through benefits, such as
adjustments in health insurance premiums or co-pays.

To encourage employers to implement a wellness program, the legislation
would offer a tax credit equal to fifty percent of the costs paid or
incurred by the employer in connection to a qualified wellness program.  For
businesses with less than 200 employees, the employer would receive a credit
of $200 per employee.  Businesses with more than 200 employees would receive
$200 for 200 employees and $100 for each additional employee.  After
implementing the wellness program, businesses could receive the tax credit
for ten years.

Following its introduction, S. 1753 was referred to the Senate Committee on
Finance where it awaits review.  Text and status of S. 1753 can be found at:
  http://thomas.loc.gov/.

It would be interesting to see this paper.


The complexities of undertaking counselling evaluation in the workplace
(Includes EAP from a UK perspective-DAP)
Authors: Linda P. Alker a; Cary Cooper b
Affiliations:    a Manchester Metropolitan University. Manchester
b University of Lancaster. Lancaster. UK

DOI: 10.1080/09515070701410054
Publication Frequency: 4 issues per year
Published in:  Counselling Psychology Quarterly, Volume 20, Issue 2 June
2007 , pages 177 - 190
Subjects: Counseling; Mental Health; Psychiatry & Clinical Psychology -
Adult;
Formats available: HTML (English) : PDF (English)

Abstract
There is a long-standing debate over whether evaluation is an art or a
science (Barker et al.: Research Methods in Clinical and Counselling
Psychology, Chichester, John Wiley & Sons, 1994). The "science" camp argues
for scientific rigour in methodology, whilst the "art" camp maintains that
evaluation should be tailored to the specific circumstances under
evaluation. The compromise proposed by Barker, Pistrang, & Elliot (1994)
suggests that evaluation should be as systematic as possible within the
practical and organizational constraints inherent in service settings. The
aim of this paper is to present a review of the literature on evaluation and
workplace counselling. The paper initially reviews the literature in the
counselling/psychotherapy field, and then explores studies on employee
assistance programmes. The themes that are explored are the relationship
between research and practices; the interactions with stakeholders in the
field; the use of control groups and the economic side of counselling.
Keywords: Employee Assistance Programmes; methodology; evaluation

Good news!
Searchable Version of the Big Book

Now here is something really useful.  Enjoy!

Epost from Dr. Steve:
A searchable version of the Big Book (minus the stories at the end) is here:

http://docs.google.com/View?docid=ddh9xk76_7ct3xt3

The phrase "spiritual advisor" isn't in it.  Neither is the word "sponsor,"
or even "advisor" for that matter.  If you take the sponsor idea as having
been derived from the chapter "Working With Others," then you wouldn't
expect these words to appear in the book.  As described by that chapter, a
sponsor is a messenger, not an advisor, guide, guru, or boss.  You wouldn't
know this from the culture of the rooms, though.

For extra credit:  find the phrase "work the steps."  Honors:  find 
"recovering."

Search with the search function built into your web browser.  Thus, for
Internet Explorer, go to Edit --> Find on this page).   The whole book is a
single web page, so when you search the page, you're searching the entire
Big Book.  I assembled it this way for this purpose, from other online
sites.

Note that the entire Big Book easily fits on a floppy disk.  Now you, too,
can amaze your AA friends with your knowledge of what isn't in the Big Book.
  No relationships in the first year?  Everyone must have a sponsor? 
Consult your sponsor for advice?  90 in 90?

SAMHSA Announces Availability of Enhancing Motivation for Change Inservice
Training -TIP 35

Excerpt:

"Participants will learn about change theory and motivational strategies,
learn to assess clients' readiness for change, and develop skills for
enhancing client motivation. Between-session exercises help participants
practice new skills and integrate learning into their practices."

and:

"The trainer's manual includes eleven 1½- to 2-hour modules and can be
delivered on consecutive days or can be offered over several weeks. Each
module includes presentation instructions, PowerPoint slides (that can be
copied onto overhead transparencies), homework assignments, and participant
handouts.


This manual (Treatment Improvement Protocol 35) includes materials for
substance abuse treatment supervisors to provide inservice staff training
for clinicians and other treatment professionals. This inservice training is
particularly useful for new counselors or for clinicians who are unfamiliar
with the basic concepts of motivational enhancement. Participants will learn
about change theory and motivational strategies, learn to assess clients'
readiness for change, and develop skills for enhancing client motivation.
Between-session exercises help participants practice new skills and
integrate learning into their practices.

The trainer's manual includes eleven 1½- to 2-hour modules and can be
delivered on consecutive days or can be offered over several weeks. Each
module includes presentation instructions, PowerPoint slides (that can be
copied onto overhead transparencies), homework assignments, and participant
handouts. The training approach includes presentation, discussion, group or
partnered practice exercises, and between-session assignments to enhance
participants' learning.

To order your FREE copy of the Enhancing Motivation for Change Inservice
Training manual, contact SAMHSA's National Clearinghouse for Alcohol and
Drug Information (NCADI). Ask for publication order number PHD1135.

View this publication at:

http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.61302

Phone: 800-729-6686 or 240-221-4017
           800-487-4889 (TDD hearing impaired)
           877-767-8432 (toll free) Hablamos Español
Web: www.ncadi.samhsa.gov

TAP 28 (The National Rural Alcohol and Drug Abuse Network Awards for
Excellence, 2004-Submitted and Award-Winning Papers) is also available
online at www.kap.samhsa.gov.

Webcast Video Editorials
Is America's Meth Scourge Really Coming to an End?
Barry Sample, PhD

Medscape General Medicine.  2006;8(4):62.  ©2006 Medscape
Posted 12/22/2006

Contrary to what's often portrayed in the media, the use of amphetamines and methamphetamine recently declined significantly among the general US workforce.

According to results of more than 10.4 million workplace drug tests
performed by Quest Diagnostics in all 50 states and Washington, DC, there was a downward trend in positive test results for amphetamines and methamphetamine in the general US workforce in 2005 and 2006. The detection
of amphetamines actually showed an 8% decline for all of 2005.[1] Incidence of much-hyped methamphetamine positives - as a proportion of drug tests that look for amphetamines, among a large group of General Workforce employees - showed a 31% decrease in the first 5 months of 2006 compared with 2005[2] and a 45% decrease since 2004.[3]

The Drug Testing Index compares positivity rates for various drugs by
calculating the proportion of positive results for each drug to the total number of drug tests performed. In June 2006, Quest Diagnostics also released 2005 data compiled from more than 7.3 million workplace drug tests for substances such as marijuana, cocaine, opiates, and PCP.[3] The 2005 Drug Testing Index data showed that positive drug tests in the workplace fell to the lowest level since Quest began publishing the data in 1988. For the combined US workforce, 4.1% had positive results in 2005, compared with 4.5% in 2004 and 13.6% in 1988.[4]

Alarmists will be dismayed. However, this is good news for health
clinicians, physicians who provide occupational health services, employers, and the general public who may be concerned about amphetamine and methamphetamine use as well other illegal substances. We're optimistic that federal, state, and local efforts to decrease both dem and and supply will continue to trend in the right direction. In the meantime, for those who want to review the results, details are available at www.questdiagnostics.com.

That's my opinion. I'm Dr. Barry Sample, Director of Science and Technology for Quest Diagnostics, Employer Solutions division.

NOTE: To view the article with Web enhancements, go to:
http://www.medscape.com/viewarticle/548896   or
http://www.medscape.com/viewarticle/548896?src=mp

NOTE!

SAMHSA Announces Availability of Two Treatment Improvement Protocols on
Issues in Outpatient Treatment

The Substance Abuse and Mental Health Services Administration (SAMHSA)
announces the availability of two new Treatment Improvement Protocols (TIPs)
that address issues in outpatient treatment. TIP 46, Substance Abuse:
Administrative Issues in Outpatient Treatment, is designed for
administrative audiences and was written to help administrators address the
changing environment in which outpatient treatment programs operate. TIP 46
provides basic administrative information about running an outpatient
treatment program, including strategic planning and partnerships, working
with a board of directors, hiring and retaining employees, outcomes
monitoring, and promotion to potential clients, funding agencies, and
government officials. More specialized sections address challenges such as
preparing a program to provide culturally competent treatment to an
increasingly diverse client population and succeeding in a managed
care-dominated world by diversifying funding sources. NCADI Publication No.
BKD545.

TIP 47, Substance Abuse: Clinical Issues in Intensive Outpatient Treatment,
is written for clinicians and addresses the practical needs of treatment
providers as they design and implement intensive outpatient treatment
programs. It provides specific information on the principles of intensive
outpatient treatment; services and treatment models; modifications for
distinct population groups; culturally competent treatment; screening and
patient placement criteria; counseling methods and techniques, including
involvement of families; and the continuum of care. TIP 47 also covers
issues such as how to improve early retention, provide the appropriate
length and intensity of services, and provide the most promising mix of
wrap-around services for positive client outcomes. NCADI Publication No.
BKD551.

To order your FREE copies of TIPs 46 and 47, contact SAMHSA's National
Clearinghouse for Alcohol and Drug Information (NCADI). Ask for publication
order numbers listed above.

Phone: 800-729-6686 or 240-221-4017
800-487-4889 (TDD hearing impaired)
877-767-8432 (toll free) Hablamos Español
Web: www.ncadi.samhsa.gov

TIPs 46 and 47 are also available online at www.kap.samhsa.gov.

More News You can use!    

Dr. Mee-Lee's latest Enewsletter just came out.  While the entire newsletter is excellent, I thought the following quote applied equally well to clients with SUDs, MH concerns or co-occurring disorders.

There are connections to his web site to review the entire Enewsletter or subscribe. It is free.  Subject -- What research tells us about how well we do.

"TIPS & TOPICS from David Mee-Lee, M.D.
Volume 4, No.7
December 2006

SAVVY
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This month I was invited to speak at the Third Annual Joint Commission Conference on Behavioral Health Care in Chicago. ......... I heard about topics I don't often see on other conference agendas.
Here are some nuggets that caught my attention.

Tips:
Listen to research findings even if they may clash with conventional wisdom and shake up your ideology.

Michael J. Lambert, Ph.D. Professor, Department of Psychology at Brigham Young University opened with this common problem we have heard before:
Research often just stays in the journals, and is not used to make a difference to patient care. Then he quoted from Michael L. Millenson's book titled: "Demanding Medical Excellence: Doctors and Accountability in the Information Age".

"The research documenting that the wrong choice of hospital could triple a surgical patient's chance of dying was not used to improve the care of a single patient." (page 159)  Moreover, he reported that such knowledge didn't even affect the hospital
where the research was published. We marvel at this. But before you judge the hospital, consider that the mental health and addiction fields have done the same thing. Conclusions from decades of psychotherapy research have still not been widely  embraced and used.

Dr. Lambert summarized conclusions from the psychotherapy research:

--> Clinicians can be confident that we have an overall positive effect on client functioning (We like that finding).

--> Our treatments are efficient for many clients, and lead to lasting changes in a variety of important areas (That's a finding we like too).

--> Outcome is largely due to client capacities and factors (such as severity of illness, motivation, capacity to relate, ego strength,
psychological mindedness and ability to identify a focal problem).  (We give lip service to a strength-based, empowerment, client-centered approach, but usually treat clients from a pathology-oriented, clinician and program-centered perspective).

--> Specific techniques are not the most important avenue to getting results (We definitely don't like that finding. We believe that the program, the model and the techniques account for much more of the change than they
actually do).

How well do practitioners predict treatment failure?

Dr. Lambert summarized these findings:

--> Clinicians are very optimistic about their clients. They believe that their treatments will produce a good outcome. (That is good, because you want clinicians and counselors to believe in what they are doing, and to feel that they can help their clients).

--> However, clinicians are usually wrong and don't predict accurately which clients are not doing well in treatment. (That's not so good. If you don't pick up that your client is not getting much from treatment, you cannot intervene and tweak what you are doing. And you won't fashion a more effective service plan. Think about the clients you treated who dropped out.
How accurate were you ahead of time to know that they would drop out or relapse?)

--> In one study of 550 clients, therapists were asked to predict who would benefit from psychotherapy or not. (Hannan, Lambert, Harmon et al 2005)

--> Clinicians predicted that 3 would have a negative outcome when actually 40 had a negative outcome.

--> Of the 40 with the poor outcome, the staff had accurately predicted only one client.

--> In contrast, algorithms were correct 77% of the time in predicting deteriorated patients. (Algorithms are decision rules, based on a client's expected progress, that help clinicians prevent treatment deterioration.  Clinicians use formal measurements of client engagement and outcome; and monitor client progress on a session by session basis. Using the data from formal client feedback, the decision rules help identify which clients need special attention to tweak their treatment plan.)


How well can we predict treatment failure using real-time monitoring of alliance and outcome measures?

Dr. Lambert referred to this study:

--> Lambert, Whipple, Bishop et al (2002) studied 492 treated clients, and their response to treatment was categorized based on their scores on the Outcome Questionnaire-45 (OQ-45).

--> Practitioners were given feedback on which of their clients were not progressing well, so that something different in treatment could be tried to prevent deterioration.

--> 36 of these clients deteriorated, and formal client feedback measures predicted 100% of these worsening clients.

--> The predictions were sensitive, but not very specific, as 82 additional clients were predicted to deteriorate by the response categories based on the OQ-45, but did not deteriorate. (false positives).

--> Nevertheless, these kind of real-time alliance and outcome measures do far better than practitioners at predicting treatment failure."

Contact Information
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
email: info@dmlmd.com
phone: 530-753-4300
web: http://www.dmlmd.com
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

NOTE!

Join Together just posted there list of top US addiction stories of the
year.  In case you missed any.....

2006: Year in Review
Join Together is on holiday break, but we didn't want your inbox to be
lonely. So here are some of the top stories from 2006.  Enjoy the look back
over the year, or catch one you missed the
first time. We'll be back next week!

====================================================
TOP FEATURES

Parity Doesn't Raise Insurance Costs, Study Says
http://members.jointogether.org/ct/rdSXHp71MznS/
Mandating that insurance policies treat addiction and mental health on par
with other illnesses does not raise health costs according to a
comprehensive new study that also found that parity did not result in
greater utilization of services when coupled with managed care.
03/31/2006

Study Shows Most Treatment Effective Against Alcoholism
http://members.jointogether.org/ct/r7SXHp71MznL/
A complex study of alcoholism treatment medications and counseling has found
that most standalone and combined therapies were effective in promoting
short-term abstinence, with only the
drug acamprosate (Campral) proving to be disappointing.
05/05/2006

Town Hall Meetings Tackle Underage Drinking
http://members.jointogether.org/ct/f1SXHp71MznA/
A series of more than 1,200 town-hall meetings on underage drinking held in
late March and April largely succeeded in their main goal of raising
community awareness about the problem of youth alcohol use.
05/09/2006

Panel Debates Merits of Age 21 Drinking Law
http://members.jointogether.org/ct/r1SXHp71Mznz/
The proposal to lower the U.S. minimum drinking age from 21 to 18 may be, in
the words of New Hampshire State Liquor Commissioner John Byrne -- a 'third
rail.' But that doesn't mean that many alcohol sellers, and perhaps some
state liquor officials, wouldn't like to see it happen.
06/14/2006

Panel Calls for States to Take Lead on Addiction Policy
http://members.jointogether.org/ct/4pSXHp71Mzna/
Citing the 'almost incalculable' toll that alcohol and other drug addiction
takes on society, a Join Together policy panel called on states to take a
leadership role in addressing the need for more drug treatment and
prevention.
06/26/2006

Mission Accomplished in War on Drugs?
http://members.jointogether.org/ct/47SXHp71Mznq/
A mostly overlooked newspaper article recounting a recent meeting of seven
former U.S. drug czars put forth an interesting proposition: the U.S. war on
drugs has already been won. We spoke with three czars who remember the
meeting differently.
08/04/2006

Annual National Survey on Drug Use Released
http://members.jointogether.org/ct/X1SXHp71ARkK/
The annual National Survey on Drug Use and Health was released this week
and, as usual, whether the report represented good or bad news on drug-use
trends largely depends on which statistics
you pull from the sprawling findings.
09/08/2006

Medicaid Will Pay for Addiction Screening; Advocates Seek AMA
Action, Too
http://members.jointogether.org/ct/4dSXHp71Mzn1/
Starting in January 2007, the federal Medicaid program will pay for
screening and brief intervention programs for alcohol and other drug
addiction.
10/05/2006

Aaron's House: Building a Legacy of Recovery and Hope
http://members.jointogether.org/ct/XdSXHp71ARkZ/
Usually, stories like Aaron Meyer's have a sadly predictable arc: A young
man or woman gets hopelessly involved with alcohol or other drugs and dies
of an overdose, suicide, or in a drug-related accident. Aaron's story,
however, is different.
010/27/2006

Ballot Questions: Marijuana Legalization Fails in Colorado, Nevada; Ohio
Passes Comprehensive Smoking Ban
http://members.jointogether.org/ct/X7SXHp71ARkV/
Voters from California to Florida made their decisions on ballot questions
related to alcohol, tobacco and other drugs, handing a victory to health
groups in Ohio on the issue of public smoking and defeating a bid to make
Colorado and Nevada the first U.S. states to legalize the possession of
marijuana.
11/08/2006

The Case For Lowering Legal BAC Levels Even More
http://members.jointogether.org/ct/rpSXHp71Mzn_/
All 50 states, the District of Columbia and Puerto Rico now make it a crime
to drive with a blood-alcohol concentration of .08 percent or more. And, a
new review of research from around the
world makes a case for lowering the limit even more. 11/22/2006

Going for STOP: Congress Passes First Major Underage-Drinking
Law
http://members.jointogether.org/ct/XpSXHp71ARkC/
A bill that's being called an important first step towards addressing the
national problem of underage drinking was approved by both the U.S. Senate
and House this week, and heads to President Bush's desk for approval.
12/08/2006

Commentator back.  Perhaps the most bizarre story of the year is the one about the
meeting of former drug czars where three of them reportedly declared the War
on Drugs won.  Gives one a sense of the fragile grasp that many of them may
have had on reality.  Of course, there should never be a War on a
social/medical problem.  Dumb!  Dumb!  Dumb!

The National Addiction Technology Transfer Center publishes a monthly
newsletter "Eye on the Field".  It includes updates on breaking news,
research, publications, funding, conferences, training in-person and
on-line, etc.  It is the best kind -- free.  The latest issue can be
reviewed at:

http://www.nattc.org/newsField.html

There is a link to subscribe.

The Costs and Benefits of Enhanced Depression Care to Employers

All,
When I retired in 1996 there was a push on to develop interventions for depression in the workplace.  Guess it's still going on.

There is no mention in this article about possible cost savings from preventing SUDs through early intervention in depression.

A thought did occur to me while reading this -- with the co-occurring aspects of MH and SUDs should we not be doing formal depression screening about 4 to 8 weeks into recovery (abstinence) from SUD -- such screens done by the Treating agency or the employee assistance program.  Or perhaps we are?  Don

Employer-Sponsored Depression Screening Seen as Saving

By Neil Osterweil, MedPage Today Staff Writer Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of
Pennsylvania School of Medicine.
December 04, 2006

MedPage Today Action Points

Explain to patients who ask that this study using a computer model suggests that an employer-based program that includes a one-time depression screening coupled with telephone counseling and other services can benefit both employees and the companies they work for.

Review
BETHESDA, Md., Dec. 4 -- Employers including depression screening with care management as a benefit could help improve workers' lives and the company's bottom line, researchers have concluded.

By screening all employees once and then providing depression management services for those who need it, employers could save about $3,000 for every 1,000 workers over five years, reported Philip S. Wang, M.D., Dr.P.H., of the National Institute of Mental Health and Harvard Medical School in Boston, and colleagues.

Although the cost savings, which amount to $3 per worker over five years, might be considered minor from the employer's perspective, such a view overlooks other benefits of such a program, the investigators wrote in the December issue of the Archives of General Psychiatry.

"Analyses from just the employer's perspective miss important improvements beyond increased productivity and job retention, such as positive effects on non-labor outcomes of workers (e.g., diminished suffering, increased marital stability, and decreased needs for caregiver time) and employees' contributions outside the workplace," they wrote.

Dr. Wang and colleagues created a computer model to estimate the costs and benefits of enhanced depression care for workers from the perspectives of societal good and employer/healthcare-purchaser needs.

The model included the following variables:
~~Employees were 40 years-old, the median age of the U.S. workforce.
~~Workers were divided into five healthcare states, according to population-based percentages: never depressed; depressed but not in treatment; depressed and in treatment; recovered and in treatment; recovered but not in treatment. There was also a group who had died.
~~At the end of each three-month period, workers could move between the healthcare states on the basis of estimates drawn from previous studies.
~~Therapy for depression could be characterized as either adequate or substandard, to reflect realistic quality variations.
~~Costs of administering screening were based on the cost of adding questions to existing health risk assessments for companies that already conducted them, and the costs or initiating such assessment for those that did not.
~~The costs of therapy and care management were based on averages from clinical literature and health plan data.

The presumed intervention consisted of a one-time workplace-based depression screen for all employees, and care management for those who test positive for depression. The care management program was assumed to be a telephone-based program using masters-level clinicians (e.g., nurses, medical assistants).

"The generally lower intensity of this depression intervention and the greater feasibility of its implementation may make it more desirable to employers, who are sensitive to resource requirements when purchasing benefits," the authors noted. "However, we also assumed lower rates of treatment initiation and treatment adequacy resulting from this intervention vs. more intensive ones."

They defined usual care as "care-seeking and treatment patterns that would occur in the absence of depression screening or care management."

For both the employer-based intervention and usual care, treatment for depression was assumed to consist of visits to a primary care practitioner or psychiatrist and a prescription for a selective serotonin reuptake inhibitor (SSRI).

In the societal analysis, in which the employees would receive usual care or the intervention and would then be followed until their deaths, the intervention was determined to cost $19,976 more per quality-adjusted life year (QALY) than standard care.

The results are consistent with those from primary care effectiveness trials, and fall within the range for medical interventions that are usually covered by employer-sponsored insurance, the authors noted.

In the analysis from the employer's perspective, they found that intervention would save $2,895 per 1,000 workers over five year.

"Our employer's perspective analyses show results that may seem counterintuitive at first -- namely, that a screening and care management intervention designed to increase the use and intensity of treatment for depression may actually save employers money," the authors wrote. "However, as our results suggest, the expected higher direct treatment costs are more than offset by savings from reduced absenteeism, presenteeism, and employee turnover costs."

The investigators noted that the savings from the employer-sponsored intervention could be even greater as more SSRIs come off patent and become available generically.

They acknowledged that the study was limited by a lack of standard methods for estimating the value of lost employee productivity, and the uncertainties of generalizing earlier studies of the effectiveness of primary care interventions to depression.

Despite these limitations, "results from this study suggest that enhanced depression care for workers is cost-beneficial from both the employer's and societal perspectives," they wrote. "If replicated in upcoming effectiveness trials that directly assess intervention effects on work outcomes, these findings suggest that it may be in society's and purchasers' interests to more widely disseminate successful programs of outreach and improved treatment quality for depression."

The study was supported by grants from the National Institute of Mental Health and the Robert Wood Johnson Foundation. One of the co-authors, Gregory Simon, M.D., has received research grants from Organon and Eli Lilly and Company.

Abstract:
The Costs and Benefits of Enhanced Depression Care to Employers, Philip S. Wang, MD, DrPH; Amanda Patrick, MS; Jerry Avorn, MD; Francisca Azocar, PhD; Evette Ludman, PhD; Joyce McCulloch, MS; Gregory Simon, MD, MPH; Ronald Kessler, PhD

Arch Gen Psychiatry. 2006;63:1345-1353.
Context  Although outreach and enhanced treatment interventions improve depression outcomes, uptake has been poor in part because purchasers lack information on their return on investment.

Objective  To estimate the costs and benefits of enhanced depression care for workers from the societal and employer-purchaser perspectives.

Design  Cost-effectiveness and cost-benefit analyses using state-transition Markov models. Simulated movements between health states were based on probabilities drawn from the clinical literature.

Participants  Hypothetical cohort of 40-year-old workers.

Intervention  Enhanced depression care consisting of a depression screen and care management for those depressed vs. usual care.

Main Outcome Measures  Our base-case cost-effectiveness analysis was from the societal perspective; costs and quality-adjusted life-years were used to compute the incremental cost-effectiveness of the intervention relative to
usual care. A secondary cost-benefit analysis from the employer's perspective tracked monetary costs and monetary benefits accruing to employers during a 5-year time horizon.

Results  From the societal perspective, screening and depression care management for workers result in an incremental cost-effectiveness ratio of $19 976 per quality-adjusted life-year relative to usual care. These results are consistent with recent primary care effectiveness trials and within the range for medical interventions usually covered by employer-sponsored
insurance. From the employer's perspective, enhanced depression care yields a net cumulative benefit of $2895 after 5 years. In 1-way and probabilistic sensitivity analyses, these findings were robust to a variety of assumptions.

Conclusion  If these results can be replicated in effectiveness trials directly assessing effects on work outcomes, they suggest that enhanced treatment quality programs for depression are cost-beneficial to purchasers.

Author Affiliations: Department of Psychiatry (Dr Wang) and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (Drs. Wang and Avorn and Ms Patrick), Brigham and Women's Hospital, Boston, Mass;
Department of Health Care Policy, Harvard Medical School, Boston (Drs. Wang and Kessler); United Behavioral Health, San Francisco, Calif (Dr Azocar and Ms McCulloch); Center for Health Studies, Group Health Cooperative, Seattle, Wash (Drs Ludman and Simon); and National Institute of Mental Health, Bethesda, Md (Dr Wang).

**************************************************************************

More News You can use!    

This is to advise you that the AT Forum website http://www.atforum.com/
has been updated to include the NEW WINTER 2007 NEWSLETTER.

Articles in this issue include:

- Risk in Perspective... from the Editor:

- New Survey: Guarding Heart Health

- Sidebar:
    Register for ...
    Europad Journal ...

-Feedback: Dose Induction ...

- Events to Note ...And More ...

**************************************************************************

What will be the next big push -- mental health and SUDs perhaps -- and, ta-da, teletherapy (TT)?  TT can come from anywhere.  Big hang-up though -- the importance of a shared world view (Re:  E. Fuller Torrey, MD - The Mind Game).

October 11, 2006
Union Disrupts Plan to Send Ailing Workers to India for Cheaper Medical Care By SARITHA RAI BANGALORE, India, Oct. 10 - A few weeks ago, Carl Garrett, a 60-year-old North Carolina resident, was packing his bags to fly to New Delhi and check into the plush Indraprastha Apollo Hospital to have his gall bladder removed and the painful muscles in his left shoulder repaired. Mr. Garrett was to be a test case, the first company-sponsored worker in the United States to receive medical treatment in low-cost India.

But instead of making the 20-hour flight, Mr. Garrett was grounded by a stormy debate between his employer, which saw the benefits of using the less expensive hospitals in India, and his union, which raised questions about the quality of overseas health care and the issue of medical liability should anything go wrong.

"I was looking forward to the adventure of being treated in India," Mr. Garrett said the other day. "But my company dropped the ball."

The union, the United Steelworkers, stepped in after it heard about Mr. Garrett's plans, saying it deplored a "shocking new approach" of sending workers to low-cost countries as a way to cut health care costs. Its officials insisted that Mr. Garrett be offered a health care option within the United States.

"No U.S. citizen should be exposed to the risks involved in traveling
internationally for health care services," Leo W. Gerard, the president of the union, said in a recent letter to the Senate and House committees that oversee health care. He expressed his concern about the willingness of employers to offer incentives to employees to go overseas.

Mr. Garrett, who works for Blue Ridge Paper Products in Canton, N.C., had volunteered to get his treatments in India in return for a share in the company's savings. Blue Ridge now says it will find Mr. Garrett a treatment alternative in the United States and will offer the overseas option only to its salaried employees.

IndUShealth, a company based in North Carolina that arranges health care in India for Americans, would have made Mr. Garrett's medical arrangements. The company acknowledged that its plan to send Blue Ridge workers to India was "on hold" but said it was exploring deals with other employers.

The union's resistance has brought to the fore a critical question in the path of the globalization of the health care industry - who is liable if something goes wrong in an overseas hospital? And underlying all this is the even more explosive issue of potential job losses in the American health care industry, in an economy already sensitive to the large-scale shift of jobs to cheaper overseas locations.

Even as the debate continues about insurers' role in health care
outsourcing, hundreds of uninsured and under-insured Americans have already gone on their own to India for treatments.

With medical costs in India routinely 80 percent lower than in the United States, experts predict that globally standardized health care delivered in countries like India and Thailand will eventually change the face of the health care business.

Providing health care to foreigners could generate $20 billion for India by 2012, according to a study by McKinsey & Company, the consulting firm, although McKinsey did not say how many patients that figure represents. With 150,000 overseas patients last year - though only a small fraction of them Americans - India is already the global leader in importing foreign patients for low-cost treatment. Its best hospitals have Western-trained doctors and are equipped with modern equipment.

Still, cross-border medical liability in countries like India could prove to be a major hurdle, the experts say. In the case of Mr. Garrett, Blue Ridge Paper asked him to sign a release saying that he was "on his own as far as medical liability," said Bonnie Blackley, the benefits director at Blue Ridge.

Tom Keesling, president of IndUShealth, said "the Indian physician and hospital would be directly responsible for any malpractice."

Zubin Daruwalla, health care analyst at the consulting firm Frost &
Sullivan, said there was no uniform code in India on what could be
considered medical negligence and what compensation ought to be paid.
"Compared with the huge payouts in the United States, Indian courts award small amounts," Mr. Daruwalla said.

So, as Mr. Daruwalla noted, in addition to traveling back and forth to India to fight a legal battle, an American patient might have to be content with a few thousand dollars of compensation in case of a problem.

Employers have been trying to get their workers' health care costs under control, and the pressure to outsource health care is inevitable, said Aaditya Mattoo, an economist with the World Bank in Washington who specializes in global services trade.

But United Steelworkers, the largest industrial union in North America with over 850,000 members, said it would fight any effort by American companies to send employees abroad for treatments. "We are confident that we are in a position to block any employees being exported to India, Thailand or Mexico," said Stan Johnson, a spokesman. "The ailing American health care system cannot be cured by sending patients abroad."

But Harpal Singh, chairman of Fortis Healthcare, a large New Delhi-based chain of hospitals, said American corporations would not be able to resist for long the lure of overseas hospitals offering first-world health care delivered at third-world costs.

McKinsey has forecast that by 2008, top companies in the United States firms would spend as much on health care on average as they made in profits. As insurance costs become unaffordable, companies are scaling back or dropping health benefits.

"The health care opportunity has the potential to outshine outsourcing and deliver big advantages for both Indian and U.S. businesses," said Mr. Singh, who is also co-chairman of the Working Group on Healthcare, which was set up by two influential trade groups, the United States-India Business Council and Confederation of Indian Industry.

Fortis, Mr. Singh's company, runs a dozen hospitals in and around New Delhi, including a modern 250-bed cardiac hospital in neighboring Mohali where uninsured American patients represent a fifth of all patients. The chain plans to add 35 hospitals in the next five years. Many of these, and those run by rival hospital chains like Wockhardt and Apollo, will be built to the specifications of international hospital certification agencies.

To be sure, swarms of employer-sponsored patients are unlikely to descend on Delhi or Mumbai any time soon. Crowded airports, traffic-clogged streets, distressing poverty and a reputation for grime can put off even the average Western tourist, let alone a patient arriving for treatment.

Mr. Johnson of United Steelworkers said Mr. Garrett had been saved from the hazards of international travel and being treated in an alien culture, in addition to the malpractice risk. "Cost may be a downside but there are many upsides to his not going to India," he said.

If there was an upside to staying home, Mr. Garrett said he could not see it. He was all set to go to India with his fiancée and then return in good health to marry her later this year. Instead, his treatment has been delayed and he is now left to pay high incidental expenses and a higher co-pay for his treatment in the United States. "I've been left out in the cold," Mr. Garrett said.

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Do you or a colleague of yours need a Scholarship to attend the BEST EAP Training in Florida?

NOW is the Time to APPLY:

EAP FLORIDA'S Annual Conference is:

16 - 18, April 2008

SEE SCHOLARSHIP PAGE for APPLICATION!

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The latest "TEST" for "A Drug-Free Workplace"

Excerpt:
"The sting triggered heated debates about censorship and the accuracy of "drug-wipe" tests."

TV prank targets drug-using MPs Italian show exposes pot, cocaine use Bogus makeup artist collected skin cells Oct. 11, 2006. 06:42 AM
SANDRO CONTENTA
EUROPEAN BUREAU CHIEF

LONDON - Secret drug tests by a popular TV show have apparently revealed that some Italian MPs are running on more than good food and fine wine.

In a sting operation that has the country buzzing, the show secretly tested 50 lawmakers and found almost a third had taken drugs in the previous 36 hours - 12 testing positive for marijuana and four for cocaine.

The results seemed to confirm widespread rumours about rampant drug use in the hallowed halls of Italian power. In a country where the previous government passed a "zero tolerance" drug law last February, the sting dominated yesterday's newscasts.

But the country's privacy authority banned the satirical TV show, Le Iene (The Hyenas), from broadcasting its research last night, citing the fact the drug tests were conducted without the politicians' consent.

The sting was simple: the show sent a "reporter" to interview deputies in Italy's lower house of parliament in Rome about the draft 2007 budget. A bogus makeup artist dabbed the politician's brow and the body cells collected were sent for drug testing.

Davide Parente, the show's producer, denounced the broadcast ban as unjustified censorship. The tests were conducted in a way that made it impossible to link the result to a specific politician, he said. The show was only interested in the results, he insisted.

"We caught the sin, not the sinners," he told La Repubblica newspaper's website yesterday.

But Rome, like most capitals, can seem a very small place when scandal hits the fan. Few expect the identities of the 50 politicians to remain secret for long. In a bid to avoid being tainted by association, some MPs went public yesterday to insist they were clean.

Said Green party MP Tommasso Pellegrino: "I don't use drugs and I'll even take part in other tests."

Franco Grillini, a member of the Democratic Left, said: "I have nothing to hide. I've done drugs in the past but now my preferred drugs are good wine and sex. Each to his own vice."

Paolo Ferrero, welfare minister in Italy's centre-left governing coalition, recently caused a storm when he said many politicians and professionals use cocaine. But MPs who weren't part of the drug sting suggested they were stunned by the scandal.

"I cannot believe that one in three of my colleagues is a drug user," said Daniela Santanche, an MP with the right-wing National Alliance.

"Where on Earth have I ended up?" said Communist MP Francesco Caruso, elected to parliament for the first time in April. "You've got Mafiosi, you've got people on the take - only coke-heads were missing."

Italians aren't likely to find the scandal too shocking. Their opinion of politicians is already as low as it can get.

"It's a bit depressing," Green party MP Tana de Zulueta said in an
interview. "It will confirm a public perception that we're a bunch of
overpaid, depraved, good for nothings.

The sting triggered heated debates about censorship and the accuracy of "drug-wipe" tests. But MPs in Prime Minister Romano Prodi's governing coalition saw the scandal as more ammunition for their plan to ease Italy's drug law.

The "zero tolerance" legislation was one of the last acts of the
centre-right government before losing last April's election.

It makes possession of tiny amounts of drugs a criminal offence. Critics say the threshold for possession is so low that the law treats consumers in the same way as pushers.

"I have always said that if a police dog went into certain venues where official politics are conducted, its nose would go on the blink" from the overload, said Radical Party leader Daniele Capezzone, a member of the governing coalition campaigning for less restrictive drug laws.

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Mood Disorders and Workplace Performance

One of the editorials (viewable) in this month's American Journal of
Psychiatry (September, 2006) is on Mood Disorders and Workplace Performance.
  There are also two research articles on the same subject.  The abstracts are listed below.

To access the editorial go to:

http://ajp.psychiatryonline.org/current.shtml

Prevalence and Effects of Mood Disorders on Work Performance in a Nationally Representative Sample of U.S. Workers

Ronald C. Kessler, Ph.D., Hagop S. Akiskal, M.D., Minnie Ames, Ph.D., Howard Birnbaum, Ph.D., Paul Greenberg, M.A., Robert M.A.  Hirschfeld, M.D., Robert Jin, M.S., Kathleen R. Merikangas, Ph.D., Gregory E. Simon, M.D. and Philip S. Wang, M.D., Dr.P.H.

OBJECTIVE: Research on the workplace costs of mood disorders has focused largely on major depressive episodes. Bipolar disorder has been overlooked both because of the failure to distinguish between major depressive disorder and bipolar disorder and by the failure to evaluate the workplace costs of mania/hypomania.
METHOD: The National Comorbidity Survey Replication assessed major depressive disorder and bipolar disorder with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and work impairment with the WHO Health and Work Performance Questionnaire. A regression analysis of major depressive disorder and bipolar disorder predicting Health and Work Performance Questionnaire scores among 3,378 workers was used to estimate the workplace costs of mood disorders.
RESULTS: A total of 1.1% of the workers met CIDI criteria for 12-month bipolar disorder (I or II), and 6.4% meet criteria for 12-month major depressive disorder. Bipolar disorder was associated with 65.5 and major depressive disorder with 27.2 lost workdays per ill worker per year.
Subgroup analysis showed that the higher work loss associated with bipolar disorder than with major depressive disorder was due to more severe and persistent depressive episodes in those with bipolar disorder than in those with major depressive disorder rather than to stronger effects of mania/hypomania than depression.
CONCLUSIONS: Employer interest in workplace costs of mood disorders should be broadened beyond major depressive disorder to include bipolar disorder.
Effectiveness trials are needed to study the return on employer investment of coordinated programs for workplace screening and treatment of bipolar disorder and major depressive disorder.

Job Performance Deficits Due to Depression

David A. Adler, M.D., Thomas J. McLaughlin, Sc.D., William H. Rogers, Ph.D., Hong Chang, Ph.D., Leueen Lapitsky, M.P.H. and Debra Lerner, M.S., Ph.D.

OBJECTIVE: This study assessed the relationship between depression severity and job performance among employed primary care patients.

METHOD: In a 2001-2004 longitudinal observational study of depression's affect on work productivity, 286 patients with DSM-IV major depressive disorder and/or dysthymia were compared to 93 individuals with rheumatoid arthritis, a condition associated with work disability, and 193 depression-free healthy control subjects. Participants were employed at least 15 hours per week, did not plan to stop working, and had no major medical comorbidities. Measures at baseline, six, 12, and 18 months included the Work Limitations Questionnaire for work outcomes, and the Patient Health
Questionnaire-9 for depression.

RESULTS: At baseline and each follow-up, the depression group had
significantly greater deficits in managing mental-interpersonal, time, and output tasks, as measured by the Work Limitations Questionnaire: The rheumatoid arthritis group's deficits in managing physical job demands surpassed those of either the depression or comparison groups. Improvements in job performance were predicted by symptom severity. However, the job performance of even the "clinically improved" subset of depressed patients remained consistently worse than the control groups.

CONCLUSIONS: Multiple dimensions of job performance are impaired by depression. This impact persisted after symptoms have improved. Efforts to reduce work-impairment secondary to depression are needed.

Medicaid Will Reimburse for Alcohol, Drug Screening and Brief Intervention

**************************************************************************

Laurie Barclay, MD
Medscape Medical News 2006. © 2006 Medscape

September 13, 2006 - Effective January 2007, the US Centers for Medicare and Medicaid Services (CMS) will reimburse for alcohol and drug screening and brief intervention (SBI). Experts interviewed by Medscape hope that the new policy will help identify and treat people with substance use disorders, thereby improving public health.

"The impetus behind the Medicaid decision to reimburse for alcohol and drug screening services was the recognition of the number of people who go unidentified who are in need of an intervention or treatment," Bertha Madras, deputy director of Demand Reduction from the White House Office of National Drug Control Policy, told Medscape. "About 22 million Americans have abuse and/or addiction problems; of these, about 10% are in treatment, and the vast majority of the rest are not in treatment, not because there is
a problem with the system, but because they don't recognize the fact that they have a problem. Most do not seek help and remain unidentified."

The new reimbursement schedule adds 2 new codes to the level II Health Care Service Procedures Coding System (HCSPCS) used by Medicaid, Medicare and other third-party payors: one code for drug and alcohol screening, and the other for brief intervention and counseling. Leading medical research groups have recommended SBI, which is known to be effective for addressing alcohol and substance abuse problems, as standard protocol. By creating these codes,
CMS and the Office of National Drug Control Policy will allow SBI to become a routine addition to primary and emergency medical care.

Screening Expands to More Clinical Settings, Overcomes Obstacles

"In current clinical practice, SBI does not occur frequently, at least in part due to the absence of reimbursement," Eric Goplerud, PhD, research professor in health policy and director of Ensuring Solutions to Alcohol Problems at George Washington University Medical Center in Washington, DC, told Medscape. "Currently, substance use screening and treatment is reimbursed as specialty substance use treatments. Payors fail to recognize that SBI is a primary care service that can be performed in ambulatory, emergency department, and inpatient settings."

Forcomplete article go to:

http://www.medscape.com/viewarticle/544548

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The Keeley Cure, by:   Leslie E. Keeley

(1832–1900). The 19th-century U.S. physician Leslie E. Keeley developed a controversial treatment for alcoholism and drug addiction known as the Keeley Cure. The popularity of his treatment made him a millionaire.

Leslie Enraught Keeley was born in 1832 in St. Lawrence County, N.Y. In 1864 he received a degree in medicine from Rush Medical College in Chicago. Soon he joined the army and served as acting assistant surgeon during the American Civil War. After the war he settled in Dwight, Ill., and began a medical practice.

Keeley began his treatment of alcoholism and drug addiction by opening a sanitarium in Dwight in 1879. By 1890, the success of this institution and the Keeley Cure enabled Keeley to hatch expansion plans. Soon franchises began springing up throughout the country and Keeley was a millionaire.

The Keeley Cure consisted of hypodermic injections of the double chloride of gold. Keeley claimed that by 1895 his treatment had cured 250,000 people. The medical profession thought that the cure was bogus and attributed his success largely to the power of suggestion.

Keeley is also known for his belief that alcoholism is a disease, not a vice. His only major work is The Non-Heredity of Inebriety (1896). In 1900 Keeley became ill and moved to Los Angeles. He put himself under the care of mental-treatment cultists who apparently used suggestion in their attempts to cure him. Keeley died of heart disease in Los Angeles on Feb. 21, 1900.

Title: The Leslie E. Keeley Institutes of the Maritime Provinces Company (Fredericton, N.B.) fonds. -- 1894-1895. -- 2.5 cm of textual material

Administrative History: Leslie E. Keeley, 1832-1900, served as a surgeon in the Union Army during the Civil War following his medical education at Rush Medical College in Chicago (1864). In 1866, he settled in Dwight, Illinois as a surgeon for the Chicago and Alton Railroad. Keeley's interest in alcoholism led to the opening his first clinic, the Keeley Institute, in Dwight, 1879. He claimed to have discovered a specific remedy for alcohol and drug addictions and began treating patients with his "Double Chloride of Gold Cure," the ingredients of which included gold salts with other compounds.

By 1890, the success of the Institute encouraged Dr. Keeley to establish franchised branches. By 1893, there were 92 Keeley Institutes in the United States, Canada, and Mexico. The first Leslie E. Keeley Institute of the Maritime Provinces was incorporated in Fredericton, New Brunswick on October 2, 1894. Some of the Directors of the Fredericton branch included Archibald Fitz Randolph, Fredericton's leading wholesale merchant and founder of the People's Bank of New Brunswick; George Frederick Gregory, Mayor of Fredericton for five years; John James Fraser, New Brunswick's Lieutenant Governor; Charles Nelson Skinner, Q.C., of Saint John, who served as a member of both the provincial and federal legislatures, and as a probate Judge of Saint John; and Willard Kitchen, also a Mayor of Fredericton, who operated the largest furniture emporium in the city.

Funding for the Keeley Institute in Fredericton came from the board of directors, physicians, and other potential backers who believed in Keeley's remedies. The money that was received went towards the purchase of "the sole right to use the Dr. Leslie E. Keeley remedies within the provinces of New Brunswick, Nova Scotia, and Prince Edward Island" from the Dwight company and from George Parent of Montreal, owner of the Canadian rights, for $14,000. The Board of Directors of the Keeley Institute in Fredericton purchased the Elmcroft property located on the Saint John River, just outside the city, to house their treatment center.

The Board of Directors attempted to take an active role in the Institute's management. However, mismanagement and immorality, withholding payments to the Dwight company and Parent, and the disappearance of the house physician made this impossible. As a result, the Keeley Institute in Fredericton closed its doors in March 1896. The North American Keeley movement outlived the Fredericton collapse by a few years, but other institutes were shut down due to an increase in opposition of the medical profession. By 1900, the majority of the Keeley Institutes were shut down after the death of Leslie E. Keeley. The last institute to close its doors was in Dwight, Illinois in 1966.

Source: Warsh, Cheryl Krasnick. "Adventures in Maritime Quackery: The Leslie E. Keeley Gold Cure Institute of Fredericton, N.B." Acadiensis, Vol. XVII, No. 2, Spring 1988.

Scope and Content: This fonds contains minutes of the Board of Directors and Stockholders, memos regarding upcoming meetings, a listing of stock holders of the Leslie E. Keeley Institute in Fredericton, N.B., and some correspondence, 1894-1895.

Leslie E. Keeley (1832-1900), attended Rush Medical College in Chicago, and served as an assistant surgeon in the Civil War. Discouraged by drinking in the armed forces, he began to search for a cure to drunkenness. "I started working on a theory that alcoholism/addiction was a disease."

Working with a young Irish chemist name J.R. Oughton, he developed a formula that seemed to cure those susceptible to alcoholism. His "cure" was tested many times, most notably by Joseph Medill publisher of the Chicago tribune, who sent "six of the worst drunkards" he could find and had them returned "looking as if a veritable miracle had been wrought upon them."  Keeley charged $25.00 a week from $8.00 to $21.00 a week for board.

Success was more than the little town of Dwight could handle, and Keeley began establishing clinics in other areas. By 1895, there were more than 80 Keeley clinics across the nation; and a special "Keeley Day" was declared at the Columbian Exposition, held in Chicago in 1893.

Keeley noted that, in 1892, his "company not only built an accommodation for women," in Dwight, but also "established institutes in Russia, Denmark, Sweden and Norway." In that same year, "there were 800 passengers a week coming to and from the Keeley" on more than 20 trains a day.

The good doctor, who died away from his beloved Dwight, was shipped here for burial in a large stone mausoleum, where his remains are accompanied by a life-size bust done by Leonard Wells Volk.

Keeley's partner and friend John R. Oughton (1857-1925) was an Iris native and graduate of the University of Dublin, J.R. remembered how Oak Lawn cemetery was created :  "I arrived in Dwight in 1879... sixty bodies were moved from the Dwight Cemetery on current Route 66 here to the new Oak Lawn Cemetery. Everyone in town was buzzing" about it.

Approached by Dr. Keeley for assistance in developing his cure for alcoholism, Oughton "perfected a formula using double chloride of gold which we bottled for the cure of our patients."

After Keeley's death, in 1900, Oughton became president of the corporation. When the first Keeley Insitute was destroyed by fire in 1902, J.R. quickly rebuilt, "using the best materials money could buy." The building, which is now the Fox Developmental Center, opened in 1903, "at which time our beloved President Theodore Roosevelt pushed a switch from his train to turn the electric lights on."

Excerpt
"They also suggest that health professionals pay more attention to recovery
of work function and that workplace supports be developed, perhaps through
employee assistance programs and worksite occupational health clinics, to
help depressed patients better manage job demands."

Press Release - Harvard Medical School
BIPOLAR DISORDER EXACTS TWICE DEPRESSION'S TOLL IN WORKPLACE

Productivity Lags Even After Mood Lifts

Boston, MA-September 1, 2006-Bipolar disorder costs twice as much in lost
productivity as major depressive disorder, a Harvard Medical School (HMS)
study funded by the National Institutes of Health's (NIH) National Institute
of Mental Health (NIMH) has found. Each U.S. worker with bipolar disorder
averaged 65.5 lost workdays in a year, compared to 27.2 for major
depression.

Even though major depression is more than six times as prevalent, bipolar
disorder costs the U.S. workplace nearly half as much - a disproportionately
high $14.1 billion annually. Researchers traced the higher toll mostly to
bipolar disorder's more severe depressive episodes rather than to its
agitated manic periods. The study, by Ronald Kessler, professor of health
care policy at HMS, Philip Wang, associate professor of psychiatry at HMS,
and colleagues, is among two on mood disorders in the workplace published in
the September 2006 issue of the American Journal of Psychiatry.

Their study is the first to distinguish the impact of depressive episodes
due to bipolar disorder from those due to major depressive disorder on the
workplace. It is based on one-year data from 3378 employed respondents to
the National Co-morbidity Survey Replication, a nationally representative
household survey of 9,282 U.S. adults, conducted in 2001-2003.

The researchers measured the persistence of the disorders by asking
respondents how many days during the past year they experienced an episode
of mood disorder. They judged the severity based on symptoms during a worst
month. Lost work days due to absence or poor functioning on the job,
combined with salary data, yielded an estimate of lost productivity due to
the disorders.

Poor functioning while at work accounted for more lost days than
absenteeism. Although only about 1 percent of workers have bipolar disorder
in a year, compared to 6.4 percent with major depression, the researchers
projected that bipolar disorder accounts for 96.2 million lost workdays and
$14.1 billion in lost salary-equivalent productivity, compared to 225
million workdays and $36.6 billion for major depression annually in the
United States.

About three-fourths of bipolar respondents had experienced depressive
episodes over the past year, with about 63 percent also having agitated
manic or hypomanic episodes. The bipolar-associated depressive episodes were
much more persistent, affecting 134-164 days, compared to only 98 days for
major depression. The bipolar-associated depressive episodes were also more
severe. All measures of lost work performance were consistently higher among
workers with bipolar disorder who had major depressive episodes than those
who reported only manic or hypomanic episodes. The latter workers' lost
performance was on a par with workers who had major depressive disorder.

"Major depressive episodes due to bipolar disorder are sometimes incorrectly
treated as major depressive disorder," noted Wang. "Since antidepressants
can trigger the onset of mania, workplace programs should first rule out the
possibility that a depressive episode may be due to bipolar disorder."

Future effectiveness trials could gauge the return on investment for
employers offering coordinated evaluations and treatment for both mood
disorders, he said.

Also participating in the study were: Dr. Kathleen Merikangas, NIMH; Dr.
Minnie Ames and Robert Jin, Harvard University; Dr. Howard Birnbaum, Paul
Greenberg, Analysis Group Inc.; Dr. Robert Hirschfeld, University of Texas;
Dr. Hagop Akiskal, University of California San Diego.

The National Institute on Drug Abuse (NIDA), Substance Abuse and Mental
Health Services Administration (SAMHSA), Robert Wood Johnson Foundation and
John W. Alden Trust provided supplemental funding.

In a related NIMH-funded study in the same issue of the American Journal of
Psychiatry, Drs. Debra Lerner, David Adler, and colleagues, Tufts University
School of Medicine and Tufts-New England Medical Center, found that many
aspects of job performance are impaired by depression and that the effects
linger even after symptoms have improved.

The researchers tracked the job performance and productivity of 286 employed
patients with depression and dysthymia, 93 with rheumatoid arthritis and 193
healthy controls recruited from primary care physician practices for 18
months. While job performance improved as depression symptoms waned, even
clinically improved depressed patients performed worse than healthy controls
on mental, interpersonal, time management, output and physical tasks. The
arthritis patients showed greater impairment, compared to healthy controls,
only for physical job demands.

Noting that 44 percent of the depressed patients were already taking
antidepressants when they began the study and still met clinical criteria
for depression, and that job performance continued to suffer despite some
clinical improvement, the researchers recommended that the goal of
depression treatment should be remission. They also suggest that health
professionals pay more attention to recovery of work function and that
workplace supports be developed, perhaps through employee assistance
programs and worksite occupational health clinics, to help depressed
patients better manage job demands.

Also participating in the study were: Dr. William Rogers, Dr. Hong Chang,
Leueen Lapitsky, Tufts-New England Medical Center; Dr. Thomas McLaughlin,
University of Massachusetts Medical School.

The Tufts-New England Medical Center General Clinical Research Center is
funded by the NIH's National Center for Research Resources.


Contact information:
John Lacey or Leah Gourley, 617-432-0442, public_affairs@hms.harvard.edu

For those of you interested, here is the link for the September 2006, E-member news from the Employee Assistance Professionals Association (EAPA).

Compliments of:

Jenene Case Pease, PhD, President,
Big Bend/Tri-State EAPA Chapter

The December 2006, e-Member News is now available online at:

http://www.eapassn.org/public/pages/index.cfm?pageid=827

Scholarships available...

 Is Sponsoring 2 EAP Scholarships to the 

Florida School of Addictions Studies

July 22 - 26, 2007

University of North Florida

Jacksonville, Florida

The Annual Ray Hellier Memorial Scholarship 

Sponsored by the Hellier Family & 

Corporate Care Works 

Provides Fully Paid Tuition plus a stipend of over

 $200.00 to help with Travel, Lodging & Food.

NOTE: The new FSAS application form for July 22 - 26, 2007 is posted below.

SCHOLARSHIP APPLICATION

26^th Annual Florida School of Addictions Studies

July 22 through July 26, 2007—University of North Florida, Jacksonville, FL

A limited number of scholarships are available from the Florida School of Addictions Studies.  Each scholarship covers the full cost of tuition plus meals and other activities that are part of the FSAS.  Scholarships DO NOT INCLUDE THE COST OF DORM OR HOTEL ACCOMMODATIONS. Criteria for awarding the scholarships are: demonstrated financial need, interest, activity in the addictions field and willingness to share knowledge and experience gained with others.  Applicants must agree to share their observations and impressions regarding the FSAS experience with the Scholarship Committee IN WRITING, at the end of the school and meet the criteria specified by the various agencies that donate scholarship funds (see details on reverse side).

To apply, please complete this form and return it to the FSAS Registrar by May 1, 2007.  All applicants will be notified of the Scholarship Committee’s decision by Friday, June 15, 2007.   INFORMATION BELOW MUST BE LIGIBLE

Name: _____________________________________________ Degrees/Certificates:______________________________

            (first)                   (middle)               (last)        

Address:___________________________________________________________________________________________

                (street)                 (apt. #)                             (city)                                              (state)                                 (zip)

Home Phone:  (___)_________________________ Home E-Mail:______________________________________________

                                                                                                            (print legible)

Employer and/or School:________________________________ Program Name:__________________________________

Work Phone:(____)__________________________Work E-mail:_______________________________________________

                                                                                                (print legible)

Address:______________________________________________  City:____________________State:_____ Zip:_______                                                                                                                                                                                                                                                                        

Supervisor’s Name:_______________________________________

 I would like to attend the 26^h  Annual Florida School of Addictions Studies because: _______________________________

___________________________________________________________________________________________________

How many years have you attended the FSAS?  #______             How many FSAS did you attend on scholarship? #______

My career goals in the field of addictions are: _______________________________________________________________

___________________________________________________________________________________________________

I need financial assistance to attend the Florida School of Addictions Studies because: ______________________________

___________________________________________________________________________________________________

Do you plan to attend a full 20-hour track or one or two 10-hour mini tracks?: 20-hour track:_____; 1 mini:____; 2 mini’s____

Applicant’s Signature:_________________________________________  Date:___________________________________

Attached is________Letter(s) of Recommendation from: _____________________________________________________

                  (number)                                                                 (list individual(s) supporting application for scholarship)

Acceptance of this scholarship binds the applicant to share his/her observations and impressions regarding the FSAS experience with the Scholarship Committee, in writing by July 26, 2007 (the close of the school).  For consideration, please return this completed form and letter(s) of recommendation by Tuesday, May 1, 2007 to:

FSAS Scholarship Chair

1725 Art Museum Drive

Jacksonville, FL 32207

Telephone: 1-888-933-FSAS           E-mail: fsas@nefsc.org                 Web Site:  www.fsas.org

                                                                                (See Reverse side for course information)

FSAS SCHOLARSHIP INFORMATION FOR 2006

Sunday, July 22 through Thursday, July 26, 2007—Univ. North FL, Jacksonville, FL

Florida School of Addictions Studies is pleased to announce that a limited number of scholarships are again available for students who demonstrate financial need and meet the criteria specified by the various agencies who donate scholarship funds.   Scholarships include full tuition, breakfast & lunch Mon. through Wed. and breakfast Thursday, as well as Tuesday evening’s dinner and special activities.   Scholarships DO NOT INCLUDE the cost of dorm or hotel rooms for the four days.

            Although some changes may occur, at present, course offerings include:

Full courses:  Mon. thru. Thurs.   

 #101 Addictions A-Z , Knorp & Moorehouse                         

 #102, Psychopharmacology, Carmine Pecoraro

 #103 Motivational Therapy, Nancy Hamilton                                          

 #104 A Journey into Creativity, Piper and Davila                            

 #105 Advanced Group Therapy, Garrett                                   

 #106 Depression & Relapse Prevention, Terry Gorski

Mini courses:  Mon./Tues.                                                                                            Wed./Thurs.