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About Managed Care Center for Addictive/Other Disorders

Managed Care Center for Addictive/Other Disorders, Inc. (MCC) is a private, non-profit organization with a history of serving the South Plains, Panhandle, and state of Texas since 1994. We provide comprehensive in- and outpatient substance abuse treatment services for adults. MCC is one of the few affordable outpatient adolescent facilities in West Texas. We work with persons who contracted HIV to help them live a long and normal life. MCC provides free substance abuse and anti-bullying programs to schools and communities located within the 41 counties we serve. For any community or county that wants to create a school, town, or county-wide prevention coalition, MCC provides free research and prevention programming through our Prevention Department and the Prevention Resource Center housed within our facility. Primarily supported through contracts with the Texas Health and Human Services Commission, MCC has offered these free-to-low cost services to the almost one million citizens we serve living in an area equal to the state of Georgia in size. MCC is proud of its almost quarter-century of community service and growing to meet the demands of the citizens we serve. Vision Statement (MCC is) To be the epicenter for addiction research, intervention, prevention, and treatment services to the communities of the Texas Panhandle and South Plains.

Prevention The main focus of this program is to provide prevention education to a universal audience. There is no indication on level of risk for the individuals involved in our programs. All Stars and Life Skills Training are the two curriculum taught by our YPU Prevention Specialists. All stars All Stars is an evidence based curriculum that is implemented into 6th grade, and can be taught in Armstrong, Cochran, Crosby, Dickens, Floyd, Garza, Hale, Hockley,King, Lamb, Lubbock, Lynn, Motley, Potter, Randall, and Terry counties. The curriculum consists of thirteen 45 minute sessions over the course of a semester. This program focuses on character development in the form of decision making, goal setting, and planning for your future. Students are shown how high risk behaviors (i.e. drugs, alcohol, tobacco, and violence will reduce the likelihood of obtaining the ideal future they want. Life Skills Life Skills Training is also an evidence based curriculum, and part of our YPU expansion contract.This program can be taught in the following counties: Donley, Hansford, Ochiltree, Sherman, Bailey, Collingsworth, Swisher, Hemphill, Parmer, Dallam, Wheeler, Moore, Yoakum, Childress, and Hall. This program is implemented in 3rd grade.The curriculum consist of 8 sessions that are 30 minutes in duration, and taught once a week. Life Skills Training places an emphasis on teaching health information combined with general life skills and drug resistance skills. Students will be able to effectively communicate, develop strong self-esteem, and learn how to avoid the temptations of alcohol, tobacco, and substance use. 7

Life Skills Training Shields Teens From Prescription

Opioid Misuse e Life Skills Training (LST) prevention intervention, delivered in 7th grade classrooms, helps children avoid misusing prescription opioids throughout their teen years, NIDA-supported researchers report. Coupling LST with the Strengthening Families Program: for Parents and Youth 10–14 (SFP) enhances this protection. Dr. D. Max Crowley from Duke University, with colleagues from Pennsylvania State University, evaluated the impacts of LST and two other school-based interventions, All Stars (AS) and Project Alert (PA), on teens’ prescription opioid misuse. e researchers drew the data for the evaluation from a recent trial of the PROmoting School-community-university Partnerships to Enhance Resilience (PROSPER) prevention program. PROSPER is led jointly by Richard Spoth at Iowa State University and Mark Greenberg at Penn State University, with research funding from NIDA. In the PROSPER trial, 14 communities in Iowa and Pennsylvania each selected, from among LST, AS, and PA, the intervention they felt best t their resources and their youths’ risk prole for drug use and other unhealthy and delinquent behaviors. e interventions are all “universal,” meaning that they are delivered to all children, not just those who are judged to have elevated risk for problems. All the interventions involve multiple sessions of classroom instruction addressing the social and psychological factors that lead to experimentation with drugs and other undesirable behaviors. In addition, through games, discussion, role-playing, and other exercises, students practice refusing drugs, communicating with peers and adults, making choices in problem situations, and confronting peer pressure. e programs’ curricula focus on helping students to develop practical skills they can apply to resist drug use. Materials such as worksheets, online content, posters, and videos augment all three programs. Each intervention was delivered to all 7th graders in the schools of the PROSPER communities that selected it.

Most of the children and their families also received the SFP program during the prior year, when the children were in 6th grade. In SFP, families gather together to watch videos providing advice and instruction toward enhancing family relationships and communication, fostering parenting skills, improving academic performance, and preventing risky behaviors. Group leaders then conduct follow-up lessons and practice exercises. Dr. Crowley and colleagues previously reported that smaller percentages of children from the 14 PROSPER communities reported illicit drug use and problematic alcohol use in annual follow-up visits conducted through 11th grade, compared to children from 14 matched control communities that did not use any evidence-based prevention program. As well, fewer PROSPER children reported marijuana use in 12th grade. In their new analysis, the researchers isolated the eects of the three interventions on misuse of prescription opioids. eir analysis showed that LST-only recipients were less likely to report ever having misused these medications than were children in control communities, throughout middle and high school. e prevalence advantage with LST reached 20.2 percent versus 25.9 percent in 12th grade. Pairing LST with SFP increased the advantage to 16.3 percent versus 25.9 percent in 12th grade. This work illustrates that not only can existing universal prevention programs effectively prevent prescription drug misuse, they can also do so in a cost-effective manner. Our research demonstrates the unique opportunities to combine prevention across school and family settings to augment the larger prevention impact.

Numerous studies have shown that LST shields children against other substance use and problem behaviors in addition to LST.

A study by researchers from Iowa State University led by Dr. Richard Spoth yielded results consistent with those of Dr. Crowley’s team, providing further support for LST as an effective tool for preventing substance use among youth. Dr. Spoth and colleagues randomized students from 36 Iowa schools into three experimental groups: LST alone, LST plus SFP, and a control group. Dr. Spoth’s team periodically collected questionnaire data from the study participants from 7th grade through age 22.

Boom, Bust, and Drugs Study says economic downturn leads to increase in substance use disorders When the economy tanks, drug abuse goes up.That’s the finding of a new study which shows the state of the economy is closely linked with substance abuse disorder rates for a variety of substances. The study, conducted by researchers from Vanderbilt University, the University of Colorado and the Substance Abuse and Mental Health Services Administration (SAMHSA), found the use of substances like ecstasy becomes more prevalent during economic downturns. Researchers also found that other drugs like LSD and PCP see increased use only when the economy is strong. But for overall substance use disorders, the findings were clear.

“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens,” says Christopher Carpenter, one of the lead researchers. “Our results are more limited in telling us why this happens.” Researchers say it’s possible that people turn to substance use as a means of coping with a job loss or other major life changes caused by economic pressures, but their particular study did not pinpoint an exact cause and effect. Not all drugs are equal The study showed that a downward shift in the economy has the biggest impact on painkillers and hallucinogens. Rates of substance abuse disorders were significantly higher for those two categories than any other class of drug.

Researchers also found the change in disorder rates was highest for white adult males, a group which was one of the hardest hit during the Great Recession.They say more research is needed to determine exactly how the economy and drug use are related, but they say the study highlighted some key groups for prevention and treatment workers to target during future economic downturns.

“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens.” - Christopher Carpenter, Vanderbilt University

Slippery slope Despite some lingering questions, researchers were able to show the significance of the economy’s role in problematic substance use.The study showed that even a small change in the unemployment rate can have a tremendous impact on the risks for substance abuse disorders. “For each percentage point increase in the state unemployment rate, these estimates represent about a 6 percent increase in the likelihood of having a disorder involving analgesics and an 11 percent increase in the likelihood of having a disorder involving hallucinogens,” the authors write. Previous studies have focused on the economy’s link to marijuana and alcohol, with many looking at young people in particular.This study is one of the first to highlight illicit drugs, which given the current opioid epidemic, holds important lessons for those working to curb problematic drug use.

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When it’s needed most The study bears significant weight for treatment facilities and public policy makers in particular. During economic downturns, government agencies typically look to cut spending on treatment programs as a way to save money, something researchers say may be more costly in the end. “Our results suggest that this is unwise,” Carpenter says. “Such spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise, at least for disorders involving prescription painkillers and hallucinogens.”

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“Spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise.”

Who Is at Risk for HIV Infection and Which Populations Are Most Affected?

Hepatitis C and Co-Infection with HIV

Anyone can contract HIV, and while IDUs are at great risk because of practices related to their drug use, anyone who engages in unsafe sex (e.g., unprotected sex with an infected partner) could be exposed to HIV infection. However, while all groups are affected by HIV, some are more vulnerable than others, as summarized below. Injection drug use has long been associated directly or indirectly with approximately one-third of AIDS cases in the United States. e fact that IDUs made up only 8 percent of new HIV infections in 2010 versus 23 percent in 1994–2000 demonstrates the progress made in HIV prevention and treatment within this population. Still, much work remains; while there may be fewer new infections among IDUs, in 2009, nearly one-half of those who were HIV+ were unaware they were infected. main way that women contract the virus (see gure), especially within ethnic minority communities. Regional variations of HIV incidence in women have changed over time. In the early years of the epidemic, incidence in women predominated in the Northeast, but infection rates and mortality have been steadily increasing in the southern United States.19 Although injection drug use has declined as a means of HIV transmission over recent years, it is still responsible for 14 percent of HIV diagnoses in women. A recent study conducted by the Massachusetts Department of Public Health reported 40 percent of White women contracted HIV through injection drug use.20 Another factor contributing to HIV disease in women is trauma. Trauma resulting from sexual or physical abuse experienced during childhood or adulthood is increasingly associated with rising prevalence of HIV infection and poor health outcomes in HIV+ women.21 Comprehensive HIV treatment regimens that include mental health services are critical for this population. 12 Heterosexual contact with an HIV+ partner accounted for over one-quarter of all new infections in 2010 and is the

Hepatitis C virus (HCV), a leading cause of liver disease, is highly prevalent among injection drug users and often co-occurs with HIV. In the United States, an estimated 3.2 million people are chronically infected with HCV,22 with injection drug use being the main driver. Nearly one-quarter of HIV patients and over one-half (50–80 percent) of IDUs are infected with both viruses. Chronic HCV and HIV co-infection results in an accelerated progression to end-stage liver disease, with HCV infection being a leading cause of non–AIDS-related deaths among HIV+ individuals. Injection drug use, HIV, and HCV create a complicated tapestry of ailments that present a variety of challenges to healthcare providers. Although HAART medications can eectively treat people infected with HIV, HAART provides only modest benet for co-occurring HCV. HCV infection, like HIV infection, can be successfully managed if detected early. e newer HCV medications boceprevir and telaprevir — approved by the U.S. Food and Drug Administration (FDA) in 2011 — increase cure rates and decrease treatment length when combined with standard HCV drug regimens,23 but they must be carefully coordinated with HAART for those co-infected. e added

burden of drug addiction further complicates treatment regimens.

HIV surveillance data show that the rates of new HIV infection are disproportionately highest within ethnic minority populations. African- Americans account for a higher proportion of HIV infections than any other population at all stages of the disease from initial infection to death (see text box). Moreover, specic minority subgroups are at particular risk. Nearly two-thirds (64 percent) of new HIV infections among MSM occurred in minority men (Black/African-American, Hispanic/Latino, Asian/Pacic Islanders, and Native American/ Hawaiian). In addition, young minority men (13–24 years old) had the greatest increase (53 percent) of HIV infections of all groups studied between the years 2006 and 2009, occurring predominantly in the South. Young people are also at risk for HIV infection. Approximately 9,800 people aged 13–24 were diagnosed with HIV in 2010, representing 20 percent of newly diagnosed cases, with the highest rate occurring among those aged 20–24. Particular HIV risk behaviors within this age group include sexual experimentation and drug abuse, which are often inuenced by strong peer group relationships. Compounding this vulnerability is “generational forgetting”: Studies show that today’s youth may be less likely to perceive the dangers associated with HIV than are older Americans, who witnessed a higher AIDS mortality rate associated with the rapid progression from HIV to AIDS in the early years of the epidemic. Young people are also at risk for HIV infection. Approximately 9,800 people aged 13–24 were diagnosed with HIV in 2010, representing 20 percent of newly diagnosed cases, with the highest rate occurring among those aged 20–24. Particular HIV risk behaviors within this age group include sexual experimentation and drug abuse, which are often inuenced by strong peer group relationships. Compounding this vulnerability is “generational forgetting”: Studies show that today’s youth may be less likely to perceive the dangers associated with HIV than are older Americans, who witnessed a higher AIDS mortality rate associated with the rapid progression from HIV to AIDS in the early years of the epidemic. e growing number of people contracting HIV later in life, combined with the prolonged survival made possible by HAART, has contributed to an increasing number of people over the age of 50 living with HIV. is trend will continue, and by 2015, the over-50 population is predicted to represent one-half of all HIV/AIDS cases.27 e aging population presents a variety of treatment challenges. Older adults progress more rapidly to AIDS, have a greater number of age-related comorbidities (e.g., cardiovascular disease, limited mobility), and report smaller support networks than their younger counterparts.

The Hispanic population accounted for 1 in 5 new HIV infections in the United States in 2009 — a rate 3 times that of the White community. 13

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1715 26th St Lubbock, TX 79411

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PRESCRIPTION DRUG DEATHS IN TEXAS VASTLY UNDERCOUNTED Legislature seeks to learn true toll from an epidemic Fatalities from prescription drugs are widely undercounted in Texas and in many other states, obscuring a growing overdose problem that is one of the nation's leading causes of preventable death. e Texas legislature is working on reforms to crack down on overprescribing and prescription drug dealing, which contribute to the toll. But without an accurate tally of drug deaths, lawmakers and health ocials in Texas have no way to know the true impact of the prescription drug epidemic - or where to target prevention and treatment programs that can save lives - even as they publicly declare such deaths have declined. Only 622 deaths reported across Texas in 2013 were specically blamed on opioids - mostly painkillers, based on death certicate data cited by Lakey's department. But 798 prescription-drug related deaths were recorded by local medical examiners that year in just 17 of the state's 254 counties, the Chronicle and Statesman found. e newspapers found that medical examiner reports in Harris, Travis, Dallas, Tarrant and El Paso counties, as well as some smaller counties, attribute many more deaths to prescription drug overdoses than the state has counted in opioid overdoses. Out the state's method of tracking the problem undercounts deaths in every major county across Texas, the newspapers found. Often, those deaths involve multiple medicines or prescription drugs mixed with alcohol or illegal substances. In 2013, the state report tallied 179 deaths from pain pills in Harris County; the medical examiner's oce reported 275 deaths involving all prescription drugs that year. Six of those happened in one 48-hour period that November. In Travis County, which includes Austin, the state reported 17 deaths from prescription painkillers in its preliminary count of death certicates for 2013, but the administrator of the county's Medical Examiner's Oce hand-counted 114 deaths involving all prescription drugs that year.

Experts say it matters greatly who's investigating the death, how it ends up being classied and who's doing the counting. Many Texas counties, even populous suburban ones like Fort Bend, have no medical examiner. In those places, the cause of death is determined by about 860 justices of the peace who also sign death certicates, and their opinions can vary widely. A late-stage cancer patient who takes too many prescription drugs could be classied as a natural death by one justice or a prescription drug overdose by another, said Janice Sons, a justice of the peace in Wichita County and president of the Justices of the Peace and Constables Association of Texas. "We have ve justices of the peace in Wichita County, and you present this to them and you will get ve dierent opinions," Sons said. "With medical examiners, it's pretty cut and dried." Many justices of the peace hail from counties with tight budgets, so there can be pressure to reduce the number of cases they send to a medical examiner for an autopsy, Sons said. And some justices face families who don't want a drug overdose on the death certicate, she said. e bottom line, she said, is: "We're all human, and you make the best decisions you can." Without investigators, medical information and testing, it's often impossible to know whether "a dead guy on a couch" died from a prescription drug overdose or from natural causes, said Dr. Dwayne Wolf, deputy chief medical examiner of Harris County's Institute of Forensic Sciences. Even when a toxicology screen turns up evidence of an overdose, a process that can take weeks or months, the death certicate has already been led and often is not updated. Without a standardized system, there is room for variation, opinion and error. Even when a medical examiner nds that certain drugs caused a death, the death certicate might be vague - listing the cause as multi-drug intoxication - so it's not clear whether hydrocodone, a common prescription pain medicine, or heroin was at fault.

Often the cause of an overdose death - whether an accident or the more unusual suicides - isn't limited to one drug. While painkillers are most commonly involved, other legal drugs also can kill. President Obama has proposed a 2016 budget that includes funds to get "real-time" mortality data, with electronic reporting on fatal overdoses, and grants to help states do better at tracking fatalities. "You want to have a really good understanding of who is overdosing, where it's happening and what drugs they were taking," Michael Botticelli, director of the White House Oce of National Drug Control Policy, said in an interview Friday. Data from Harris County, which keeps highly detailed records, show that hydrocodone and anti-anxiety drugs are the most commonly linked to overdoses. We are still a developing nation when it comes to death certificates. 17 "It happens all the time," said the daughter of a man who accidentally overdosed in Houston in 2013. But not even his closest friends know her father died from his medications, the daughter said. His obituary said nothing about it. Others who lost relatives have faced lawsuits from doctors after ling complaints or speaking out. Another mother who lost her daughter to an overdose in Harris County declined comment for that reason. An eort by the CDC to capture all prescription drug-related deaths turned up 980 in Texas for 2013. But that didn't include another 1,215 overdose deaths for which no legal or illegal drug was specied, according to the CDC. Together, that's more than four times the number the state reported for that year. e federal government has no way to capture complete data from the approximately 2,300 medical examiners, justices of the peace and coroners all over the country, said Bob Anderson, chief of mortality statistics for the National Center for Health Statistics at the CDC. A voluntary federal program in which some medical examiners participated was discontinued in 2010.

Discrimination, whether based on race, gender, or sexual orientation, has long been thought to be a contributor to substance abuse. Now a new study has confirmed the relationship between discrimination and addiction, but it’s also brought up many more questions that still need to be answered in order to improve treatment outcomes. Researchers at the University of Iowa recently completed a peer review study in which they looked at 97 previous studies on discrimination and alcohol use. Their goal was to summarize the collective knowledge researchers have uncovered throughout the years, and what they found confirmed in more detail what many had previously suspected.

“Generally there is good scientific support, but the evidence is mixed for different groups

and for types of discrimination.” - Dr.Paul Gilbert, University of Iowa

overtly racist or sexist to another person. But less research has been done on what are known as micro-aggressions, small everyday occurrences that can rub a person the wrong way. That research is improving, but there are other factors that need to be more fully explored. While studies have looked at historical trauma in the African-American population, the concept has not been fully investigated with regards to Hispanic and Asian populations. “This notion of historic trauma could be really relevant to other groups, but it hasn't received much attention at all,” Dr. Gilbert says. “This is something we should pay attention to.” All of this adds up to the fact that treatment providers may be missing a key piece of the substance abuse puzzle.

The team found that discrimination did indeed lead to an increase in drinking frequency, quantity of alcohol consumed, and in the risk for alcohol use disorders. Researchers say drinking can represent a coping mechanism in response to the stress caused by discrimination, and several studies showed clients acknowledging this direct link themselves. But when looking at specific populations and types of discrimination, the picture becomes less clear. “The story is that generally there is good scientific support, but the evidence is mixed for different groups and for types of discrimination,” says Dr. Paul Gilbert, the study’s lead author. “We don’t really know comparing one type or one level to another.” For example, much research has been done on interpersonal discrimination where someone is

But just because the intricacies of how discrimination affects drinking aren’t yet fully understood, that doesn’t mean our current knowledge base can’t be helpful. Dr. Gilbert says simply knowing that experiences with discrimination can drive drinking could inform the way treatment providers interact with clients, opening new areas of their lives to explore during treatment. “It can serve as sort of an early warning or indicator,” Dr. Gilbert says. “For treatment providers, it’s worth looking at: is there something that may be keeping folks from accessing services or affecting outcomes?”

Dr. Gilbert says treatment providers should continue to address discrimination as part of a holistic approach to recovery. He says it will be up to researchers to fill

in the gaps to find the precise ways that discrimination affects drinking behavior. “We’ve got good evidence on this level of interpersonal discrimination,” Dr. Gilbert says. “We’ve gotten the low-hanging fruit, now it’s time to start working on the stuff that’s a little further up the tree.”

“It can serve as sort of an early warning or indicator.”

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1715 26th St Lubbock, TX 79411

WITH ADDICTION... NOTHING CHANGES... IF NOTHING CHANGES TOWARDS RECOVERY LET’S WORK TOGETHER ON YOUR CHANGE

YOU ARE NOT WHAT YOU HAVE DONE.

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You are what you have overcome.

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