6A Unit Council News

Focus on the Patient Experience.

This month the Unit Council News is pleased to bring you a special issue on the Patient Ex‐

perience in healthcare. From first hand coverage of a landmark conference in Cleveland Ohio,

to the expose’ on the new drugs that are hitting the market. This month the focus is on the

experience of a person and how that experience impacts the individual , family, the commu‐

nity, and the world.

Our experiences shape our futures and define our pasts.

And so our charge, from the Caritas theory of Dr. Jean Watson, to the practicality of the Recov‐

ery movement; is to help the veterans experience the breath and width of life.

And it is your responsibility as caring staff and partners in wellness to talk to talk of recovery,

to walk the walk of recovery, and to help the people that come to our ward experience the life

fulfilling promise of recovery and not the stigma of “mental Illness”. The recovery model takes

us beyond just “managing” an illness. It brings us face to face with the experience of wellness.

Welcome to the new face of the patient experience. Welcome to Unit Council News.

this issue

Letter from the Editor P.2 Employee of the Issue P.3

MedWatch : Special Focus P.6 Calling Volunteers P.19

Find out what

our reporter had

to say about

what is in your

local head‐

shop...the find‐

ings may sur‐

prise you.

1 in

MedWatch

K2: Incense, Legal Pot, or a Reason for Psychosis

6A Unit Council News Michael E DeBakey Veterans Administration

Volume 3 July/August 2010

Does Marijuana with‐

drawal syndrome exist?

2

Conference Coverage at the Cleveland Clinic

6A Unit Council News (UCN) is pro‐

duced as part of the Unit Council on

unit 6A. We are pleased to accept

submissions pertaining to the focus

of Nursing, health information, tech‐

nology, opinion, mental health is‐

sues, medical issues, medication

information, jokes, poems, photo‐

graphs, and scholarly writings.

Submission must include your name,

your credentials, and your unit. All

submissions become the property of

UCN news and publishing is at the

discretion of the editor.

Submissions must be submitted by

the last Wednesday of the Month

for inclusion into the next issue.

UCN is produced 10 times a year

with double issues and special in‐

serts at the discretion of the editor.

Nominations for “Employee of the

Issue” must be forwarded to Kevin

Badon as UCN does not pick the

winners.

Anyone who would like to write a

regular or guest column please send

letter of inquiry via email to:

[email protected] or

[email protected]

Writers are not paid for articles, (all

we can do is make you famous), and

UCN accepts no responsibility for

non‐evidenced based information.

Please check your sources to ensure

accurate and fair reporting of your

event or idea or issue.

SUBMIT TO :

[email protected]

By Frances Hodgkins, RN, PMHN‐BC ,Editor of UCN

The Patient Experience Summit:

Empathy and Innovat ion .

Cleveland, Ohio May 2010.

Think of the biggest names in business today

and you have the line‐up at the Cleveland

Clinic’s landmark summit on the Patient Ex‐

perience. The CEO of Enterprise Rent a Car,

representatives from the Disney Institute,

The CEO of Key Bank. Siegfried (of Siegfried

and Roy), Press Ganey, Dr. Jean Watson, Dr.

Mary Bennett, and Gallup Polling were some

of the illustrious speakers.

Countless others from hospital magistrates,

working nurses, and concerned persons

filled the packed auditorium at the Intercon‐

tinental Hotel in Cleveland, Ohio.

The Focus?

The experience of the patient in

health care.

Many individual lectures and

panel discussions from some of

the worlds leading experts on

customer experiences were there.

Sharing their insights on the impact of the

customer experience.

But how does Enterprise Rent‐a‐car fit in

with all the healthcare guru’s? What about

the Disney institute? How does a giant in

the hospitality industry be asked to attend

and speak at a health care conference?

The Reason.

They are the experts in the experiences of

people.

And they are very good a making people

happy.

The Quiz

Here’s a one question quiz of your general

knowledge about experiences.

Why do hotels place mirrors in the eleva‐

tors lobbies?

(You’ve all seen them there...but is it just a

coincidence, or a shared decorating idea?)

It is there because the hospitality industry

knows something about waiting.

Waiting produces anxiety, and hotels do

not want you feeling anxious even the least

little but, because if you get anxious while

waiting for the elevator, that anxiety will

stay with you, and disturb the relaxation you

have gained by being at the hotel.

Now that’s customer

serv ice. Cri t ica l

thinking down to the

very last detail that

you d idn ’ t even

know was making

you anxious.

For me, that’s true

customer service.

Now, on the business end of customer ex‐

periences, Enterprise Rental has the insight

on the employees that provide great cus‐

tomer service.

Enterprise rental, (the largest car rental

company in the world), promotes the man‐

agers that have high customers satisfaction

scores, even though the manager down the

street may have more financial savvy.

There is a lesson there...saying, if you have a

total customer experience, then the rewards

(Continued on page 4)

UCN Editor‐In‐Chief goes to Cleveland Clinic to bring back the cutting

edge discussion in healthcare today. Empathy and Innovation

Submission Guidelines

Interactive Art at Cleveland Clinic

4

(One of the Gallery’s at Cleveland Clinic)

are personal such as pay and promotion,

and fiscal because you have repeat custom‐

ers throughout the organization. Repeat

customers means the business is growing.

Simple Math

The VA staff needs to

know and understand

the simple math. Our

patients can choose to

go anywhere they like.

But if they all go to

Methodist or Memorial

Herman, where are all

those dollars going? Not

into to your paycheck.

And now with health‐care reform and Presi‐

dent Obama giving citizens more control

over their healthcare options, it does not

take a fortune‐teller to understand that the

consequences might be disastrous for the

future of Government‐run health care, if

other options are more attractive to the

consumer, even if they cost the same.

(But I digress...)

Art and the Patient Experience

Included in the Cleveland Clinic’s patient

experience is the addition of interactive art.

The picture on page 2 is a “still shot” of an

interactive art instillation. The tree is com‐

puter generated and on the wall via a projec‐

tor mounted to the ceiling.

The tree twists and turns in the breeze ,and

the leaves rustle and turn colors in relation‐

ship to a “season” of time.

Cleveland Clinic has done research as to the

efficacy of interac‐

tive art and the

results are clear.

Art reduces anxiety.

6A already knows

that from our own

art experiments

with the veteran

space, and the vet‐

eran experiences on

6A. Our art projects

have met with myriad responses and most

always evoke a positive emotional response.

And that, my friends, is what we are good at;

emotions. And that is where the patient

experience lies.

In emotions.

The ability to appreciate music, art, card

playing, movies, bowling, outings, and learn‐

ing to laugh and play is just as important in

the patient experience, and recovery, as

going to groups, taking medications, and

being up for meals.

So how can you enhance your patient

experience, today?


Our “EYES” are on IT

Art Therapy on 6A

Submitted by: Sandra Brooks RN BSN Unit 6A

According to the American Art Therapy Association “The creative process in‐volved in making art is healing and life enhancing.” On 6A we strive to en‐hance the lives of our patient’s through Art Therapy, as one of many therapeu‐tic tools used by our staff. We use the creative process of art making, to im‐prove and enhance the physical, men‐tal and emotional well‐being of our veterans. The art activities are based on the belief that the creative process involved in artistic self‐expression helps people to resolve conflicts and problems, develop interpersonal skill, manage behavior, reduce stress, in‐crease self‐esteem, self‐awareness, and achieve insight. It is our belief that the creative processes involved in art making is healing and life enhancing. It is our mission to serve the veterans by providing and promoting knowledge in the area of art therapy.

(Human Figure made of Steel Letters on Natural Rock)

In Lobby of Cleveland Clinic

(Whispering Wall)

5

5 WAYS TO THINK LIKE A CHAMPION

I meet and learn from Champions every day.

Not just in locker rooms but in classrooms, hospitals, homeless shelters, homes and of-fice buildings. I've learned that to be a cham-

pion you must Think Like a Champion. Cham-pions think differently than everyone else.

They approach their life and work with a different mindset and belief system that sepa-rates them from the pack.

Champions Expect to Win - When they walk on the court, on the field,

into a meeting or in a classroom they expect to win. In fact they are surprised when they

don't win. They expect success and their positive beliefs often lead to positive actions and outcomes. They win in their mind first

and then they win in the hearts and minds of their customers, students or fans.

Champions Celebrate the Small Wins - By celebrating the small wins champions gain

the confidence to go after the big wins. Big wins and big success happen through the accumulation of many small victories. This

doesn't mean champions become compla-cent. Rather, with the right kind of celebra-tion and reinforcement, champions work

harder, practice more and believe they can do greater things.

Champions Don't Make Excuses When

They Don't Win -

They don't focus on the faults of others. They focus on what they can do better. They see their mistakes and defeats as opportuni-

By: Jon Gordon By: Jon Gordon ties for growth. As a result they become stronger, wiser and better.

Champions Focus on What They Get To

Do, Not What They Have To Do - They see their life and work as a gift not an obligation. They know that if they want to

achieve a certain outcome they must commit to and appreciate the process. They may not love every minute of their journey but their

attitude and will helps them develop their skill.

Champions Believe They Will Experi-

ence More Wins in the Future -

Their faith is greater than their fear. Their positive energy is greater than the chorus of negativity. Their certainty is greater than all

the doubt. Their passion and purpose are greater than their challenges. In spite of their

situation champions believe their best days are ahead of them, not behind them.

If you don’t think you have what it takes to be a champion, think again. Champions aren’t born. They are shaped and molded. And as

iron sharpens iron you can develop your mindset and the mindset of your team with

the right thinking, beliefs and expectations that lead to powerful actions.

A great example of this is John Wooden, the legendary UCLA basketball coach who passed away at the age of 99. He was one of

my heroes and someone who not only thought like a champion, but lived like a

champion, taught like a champion and devel-oped champions. Visit http://www.coachwooden.com/ to learn more.

Kudos and Congratu-lations to:

Emmanuel Ekhator for finishing his BSN;

Shirley Collins for getting her Board Certifi-cation in Psych!

The following excerpt is from a lar‐

ger article from NCPEA about the

theory of transformational leader‐

ship.

Transformational Leadership (TL) is

also in the GAP Analysis we worked

on with Kevin. 6A will be addressing

the GAPs that were observed in TL.

The theoretical framework for this

study is transformational leadership

theory, otherwise known as charismatic

leadership theory or social entrepre‐

neurship (Purdue, 2001). According to

Aldoory & Toth (20004) and

Mackenzie, Podsacoff and Rich (2001),

transformational leadership theory is

the most widely used, widely studied

and positively effective leadership the‐

ory. T

he skill‐set characteristic for these lead‐

ers is proficiency in articulating their

vision and/or missions verbally, and

particularly nonverbally, for resonance

and change in followers as described by

Axelsson, Kullen‐Engstrom and Edgren

(2000) and Bennis (2007).

Transformational leaders create trust

and enthusiasm to motivate followers

to change or persevere through dark

times by appealing to and sharing in

their high ideals, moral values and opti‐

mism about the future (Burns, 1978;

Mackenzie et al. 2001). There is an as‐

sumed promise that followers somehow

will be transformed by the leader’s vi‐

sion and/or mission, becoming some‐

what a spiritual product of the leader’s

collaborative purpose with which they

have identified and internalized.

For example, Senge (1990) states that

shared vision is not an idea but rather a

force in people’s hearts. The adoration

of Nelson Mandela and the slave gladia‐

tor Spartacus was not due to their

status as people but rather as icons or

symbols of liberation and autonomy –

core values – with which their followers

identified.

The transformational leader’s personal

integrity is critical in the process of

leading by example – walking the talk –

according to Burns (1978), Mackenzie et

al. (2001) and Wendt & Fairhurst (1994).

The transformational leader is always

visible and his or her attitudes and ac‐

tions model proper behavior to every‐

one else. Mackenzie et al. (2001); Bass,

(1995) and Popper (2004) state that the

transformational leader becomes an

image, identity or an appropriate role

model to guide and symbolize expected

values and behaviors of followers; es‐

sentially crafting a vision, which is a

symbolic process of lacing the message

with metaphors, stories and other col‐

orful emotional language, according to

Aldoory & Toth (2004); Axelsson et. al.

(2000); and Hoy & Miskel (2001).

Deal (1985) as cited in Hoy & Miskel

(2001) asserted that principals of effec‐

tive schools take up the hero or heroine

role that embodies core values. Takala

(1998) describes the transformational

style of leadership as “symbolic leading”

evoking patterns of meaning by creat‐

ing symbolic reality (p. 796). Hoy &

Miskel stress that leaders are managers

of meaning who exhibit “inspirational,

visionary and symbolic or less rational‐

istic aspects of behavior” (2001p.409);

for example:

“Leaders are managers of

meaning” (p.409)

“Meaning is transferred sym‐

bolically” (p.185)

“Leadership is a symbolic activ‐

ity” (p.437)

http://cnx.org/content/m26728/latest/

What is Transformational Leadership?

Four elements of transformational leadership:

Individualized Consideration – the degree to which the leader attends to each follower's needs, acts as a men‐tor or coach to the follower and lis‐tens to the follower's concerns and needs. The leader gives empathy and support, keeps communication open and places challenges before the fol‐lowers. This also encompasses the need for respect and celebrates the individual contribution that each follower can make to the team. The followers have a will and aspirations for self development and have intrin‐sic motivation for their tasks.

Intellectual Stimulation – the de‐gree to which the leader challenges assumptions, takes risks and solicits followers' ideas. Leaders with this style stimulate and encourage crea‐tivity in their followers. They nurture and develop people who think inde‐pendently. For such a leader, learning is a value and unexpected situations are seen as opportunities to learn. The followers ask questions, think deeply about things and figure out better ways to execute their tasks.

Inspirational Motivation – the de‐gree to which the leader articulates a vision that is appealing and inspiring to followers. Leaders with inspira‐tional motivation challenge followers with high standards, communicate optimism about future goals, and provide meaning for the task at hand. Followers need to have a strong sense of purpose if they are to be motivated to act. Purpose and meaning provide the energy that drives a group for‐ward. The visionary aspects of leader‐ship are supported by communica‐tion skills that make the vision un‐derstandable, precise, powerful and engaging. The followers are willing to invest more effort in their tasks, they are encouraged and optimistic about the future and believe in their abili‐ties.

Idealized Influence – Provides a

role model for high ethical behavior,

instills pride, gains respect and trust.

6

Old Drugs/New Drugs:Same Problems

MedWatch 2010

MICHAEL E DEBAKEY VA MEDICAL CENTER

Unit Council News

Dear Readers,

This month MedWatch is please to bring you the latest

news from the drug world. Heroin, meth, marijuana

and the newest kids on the block, K2 and meow meow.

Every special issue of MedWatch strives to bring you

breaking news from the pharma industry,

and you must be in tune to what your pa‐

tients are buying and experiencing on their

own.

Addiction is a severe problem with many

facets, and ones that are not always obvious.

Any addict can tell you what

makes them happy, and many

were not ever happy until they

started using drugs.

Our mission is to help them with Recovery, extending

hope in the darkness and ushering them toward well‐

ness. Drugs are powerful, but they can not stand up to

hope. You are the hope for our patients.

This month take the time to read the latest

from the street and walk a mile in your veter‐

ans shoes.

And please consider joining the National Alco‐

hol and drug addiction recovery month cele‐

bration planning committee.

We have lots of free materials to

get you started. Please see your

unit reps ,and till then,

Be Well.

Fran

7

Study Shows 111 Percent Increase in Emergency Department Visits In‐volving Nonmedical Use of Pre‐scription Opioid Pain Relievers in Five‐Year Period

From 2004 to 2008 the estimated number of emergency department visits linked to the nonmedical use of prescrip‐tion pain relievers rose from 144,644 visits to 305,885 visits a year.

Visits to hospital emergency departments involving non‐medical use of prescription narcotic pain relievers more than doubled, rising 111 percent, between 2004 and 2008, according to a study by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Cen‐ters for Disease Control and Prevention. The study used data from SAMHSA's Drug Abuse Warning Network (DAWN) emergency department system. It examined emergency department visits for nonmedical use of legal drugs, such as using them without a prescription.

The dramatic rise in emergency department visits associ‐ated with nonmedical use of these drugs occurred among men and women, as well as among those younger than age 21 and those 21 and older.

"The abuse of prescription drugs is our nation's fastest‐growing drug problem. And this new study shows it is a problem that affects men and women, people under 21, and those over 21," said Office of National Drug Control Policy Director Gil Kerlikowske. "The newly released Na‐tional Drug Control Strategy contains specific steps that all of us can take to address this issue."

The three prescription opioid pain relievers most fre‐quently involved in hospital emergency department visits from 2004 to 2008 were:

Oxycodone products – ED visits involving non‐medical use rose 152 percent, to 105,214.

Hydrocodone products – emergency department visits involving nonmedical use rose 123 percent, to 89,051.

Methadone products – emergency department visits involving nonmedical use rose 73 percent, to 63,629.

"These alarming findings provide one more example of how the misuse of prescription pain relievers is impacting lives and our health care system," said SAMHSA Adminis‐trator Pamela S. Hyde. "This public health threat requires an all‐out effort to raise awareness of the public about proper use, storage, and disposal of these powerful drugs."

The numbers of emergency department visits involving nonmedical use of other types of prescription pain reliev‐ers such as morphine, fentanyl and hydromorphone were lower, but they also showed sharp rises during this period – for example, hydromorphone‐related nonmedical use visits rose 259 percent from 2004, to 12,142 in 2008. These upward trends reflect in part dramatic increases in the rate at which these drugs are prescribed in the United States.

"We urgently need to take action," said CDC director Dr. Thomas Frieden. "Emergency department visits involving non‐medical use of these prescription drugs are now as common as emergency department visits for use of illicit drugs. These prescriptions medicines help many people, but we need to be sure they are used properly and safely."

The study is being co‐released in SAMHSA's survey report, Trends in Emergency Department Visits Involving Non‐medical Use of Narcotic Pain Relievers and CDC's MMWR "Emergency Department Visits Involving Nonmedical Use of Selected Prescription Drugs – United States, 2004‐2008." The reports are based on data from SAMHSA's Drug Abuse Warning Network (DAWN) for 2004 to 2008. DAWN is a public health information system that moni‐tors drug‐related ED visits throughout the United States.

The full reports are available at: CDC MMWR www.cdc.gov/mmwr. The SAMHSA report can also be obtained by calling the SAMHSA Health Information Net‐work at 1‐877‐SAMHSA‐7 (1‐877‐726‐4727). For related publications and information, visit http://www.samhsa.gov/.

CDC recently released an issue brief, "Unintentional Drug

Poisoning in the United States," showing more than

26,000 deaths from unintentional drug poisoning in the

United States in 2006 – more than 70 each day. The issue

brief provides recommendations on how health care pro‐

viders, private insurance providers, and state and federal

agencies can work to prevent unintentional drug over‐

doses. For a copy of the issue brief, please visit http://

www.cdc.gov/HomeandRecreationalSafety/Poisoning/

brief.htm

8

9

Does Marijuana

Withdrawal

Syndrome Exist?

By Elena M. Kouri, Ph.D. | February 1, 2002

The question of whether a clinically significant

marijuana (cannabis) withdrawal syndrome

exists remains controversial. In spite of the

mounting clinical and preclinical evidence sug‐

gesting that such a syndrome exists (Beardsley

et al., 1986; Budney et al., 2001; Holson et al.,

1989; Huestis et al., 2001), the DSM‐IV does not

include marijuana withdrawal as a diagnostic

category. The clinical syndrome has been char‐

acterized by restlessness, anorexia, irritability

and insomnia that begin less than 24 hours after

discontinuation of marijuana, peak in intensity

on days 2 to 4, and last for seven to 10 days

(Budney et al., 1999; Haney et al., 1999; Mendel‐

son et al., 1984).

The question of whether this syndrome is clini‐

cally significant is important, not only because

marijuana is the most commonly used illicit

drug in the United States (Johnston et al., 2001),

but also because marijuana has been shown to

produce dependence at rates comparable to

other drugs of abuse (Kandel et al., 1997; Kessler

et al., 1994) and because relapse rates among

individuals seeking treatment for marijuana

dependence are similar to those with other

drugs of abuse (Budney et al., 1998; Stephens et

al., 1993). Furthermore, many violent crimes are

committed by individuals undergoing with‐

drawal from drugs of abuse, including mari‐

juana (Kouri et al., 1997; Peters and Kearns,

1992). If a clinically significant marijuana with‐

drawal syndrome does exist, the omission of

this syndrome from the DSM‐IV might contrib‐

ute to the perception that behavioral or phar‐

macological treatment regimens for marijuana

dependence are not necessary.

We conducted two studies in our laboratory to

determine whether abstinence from marijuana

after long‐term use results in withdrawal symp‐

Dr. Kouri is assistant professor of psychiatry at

Harvard Medical School in Boston, Mass.

Dr. Kouri is assistant professor of psychiatry at

Harvard Medical School in Boston, Mass.

toms, to identify those symptoms and to quan‐

tify their severity (Kouri and Pope, 2000; Kouri

et al., 1999). The first study focused specifically

on whether abrupt discontinuation of mari‐

juana following chronic use results in changes

in aggressive behavior (Kouri et al., 1999). To

measure aggressive behavior, we used the Point

Subtraction Aggression Paradigm (PSAP). This

computer test has been used to detect changes

in aggressive responses following acute admini‐

stration of a number of drugs, and its external

validity has been demonstrated in a number of

studies of male and female parolees with histo‐

ries of violent behavior (Cherek and Lane, 1999;

Cherek et al., 1996).

Subjects in our study were long‐term heavy

users of marijuana who reported a history of at

least 5,000 separate episodes of marijuana use

in their lifetime (the equivalent to smoking

once per day for 13.7 years), were smoking at

least once daily at the time of recruitment and

met DSM‐IV criteria for marijuana dependence

without meeting criteria for a current Axis I

disorder. Subjects were excluded if they re‐

ported that they had used another class of drugs

more than 100 times in their lifetimes or had

consumed more than five alcoholic drinks per

day continuously for one month or more in

their lifetimes.

The controls were composed of two groups: 1)

individuals who had not smoked marijuana

more than 50 times in their lives and had not

smoked more than once per month in the last

year and 2) individuals who had formerly

smoked marijuana on a daily basis but who had

not smoked more than once per week during

the last three months. The rationale for using

infrequent or former smokers rather than mari‐

juana‐naive subjects as controls was to mini‐

mize possible confounding variables that might


10

differentiate individuals who had never tried

marijuana from those who had. We based this

decision on data from our laboratory demon‐

strating that heavy marijuana users do not differ

from occasional users in a wide range of demo‐

graphic and psychiatric measures (Kouri et al.,

1995).

During the study, subjects were required to

abstain from smoking marijuana and using any

other drugs for 28 consecutive days. To verify

abstinence, subjects had to come to the labora‐

tory every day to provide supervised urine sam‐

ples that we analyzed quantitatively for tetrahy‐

drocannabinol (THC) metabolites. We meas‐

ured aggressive responses with the PSAP on

study days 0 (before abstinence), 1 (after 24

hours of abstinence), 3, 7 and 28.

Subjects were told they would be playing a com‐

puter game against an anonymous same‐sex

subject from the study. In fact, however, this

second subject was actually a computer. During

the course of each 20‐minute computer session,

subjects had the option of pressing one of two

buttons on the PSAP response panel (labeled

"A" or "B"). Pressing button A resulted in the

accumulation of points that were exchanged for

money at the end of the study. Pressing this

button was defined as a non‐aggressive re‐

sponse. By pressing button B, subjects could

subtract points from the fictitious opponent.

Points taken from the opponent, however, were

not added to the subject's counter, and pressing

button B was defined as an aggressive response.

Aggressive responding was provoked by random

subtractions of the subject's points, which were

attributed to the fictitious opponent.

On study day 0 (before marijuana abstinence)

and study day 1 (24 hours of marijuana absti‐

nence), the current marijuana users did not

differ from past heavy users or light users in the

number of aggressive or non‐aggressive re‐

sponses they made. However, current marijuana

users were significantly more aggressive on days

3 and 7 of marijuana abstinence compared to

their pre‐withdrawal levels of aggression and

compared to the controls. By day 28, the num‐

ber of aggressive responses from the current

marijuana users was not different from their pre

‐withdrawal baseline levels or the controls

(Figure).

These data demonstrate that abstinence from

marijuana after chronic use is associated with

increases in aggressive responding following

provocation. Specifically, during the first week

of abstinence, current marijuana users dis‐

played levels of aggression that were signifi‐

cantly higher than before abstinence and higher

than the levels displayed by matched controls.

Interestingly, the increases in aggressive re‐

sponding followed a specific time course and

then returned to pre‐withdrawal levels after 28

days of abstinence. The transient nature of

these changes is consistent with other reports of

marijuana withdrawal.

The second study was designed to further char‐

acterize symptoms of marijuana withdrawal and

to quantify their magnitude (Kouri and Pope,

2000). We used the same study entry criteria as

in the first study and subjects were required to

come to the laboratory every day to provide

urine samples and to fill out a daily diary.

The items assessed in the daily diaries were:

mood, appetite, sleep, anxiety, irritability,

physical tension or agitation, physical symp‐

toms, ability to concentrate, desire to use mari‐

juana, and desire to resume using marijuana at

the end of the study. The questions were pre‐

sented on a 10‐point Likert scale with the quali‐

fiers "extremely low" at the zero end of the scale

and "extremely high" at the 10‐point end of the

scale. We obtained pre‐withdrawal baseline

levels for all of the diary items via a personal

interview with each subject before the begin‐

ning of the withdrawal period.

Thirty current marijuana users and 30 controls

(16 former heavy users and 14 light users) par‐

ticipated in the study. Before the beginning of

the abstinence period, the current marijuana

users were not different from the former users

or the light users on any of the items assessed in

the diaries except for the ability to concentrate

item. The current users reported a lower ability

to concentrate than the controls. Interestingly,

the former heavy users were not different from

the light users on any of the diary scores during

the course of the study. In contrast, the current

users reported increases in irritability, anxiety,

physical tension and physical symptoms, and

decreases in mood and appetite starting on day

1 and peaking between days 7 and 10 of mari‐

juana abstinence.

It is important to note that although, as a

group, the current marijuana users experienced

an increase in withdrawal symptoms compared

to the controls, only 60% of the subjects in the

current users group reported a change in symp‐

toms of at least three points in magnitude. The

fact that 40% of subjects who had used mari‐

juana regularly for an average of 22 years did

not report experiencing severe withdrawal

symptoms during abstinence might suggest that

physical dependence on marijuana is not as

strong as that observed with other drugs of

abuse. This may be due, at least in part, to the

long half‐life of THC. However, many subjects

reported that when trying to remain abstinent

in the past, the presence of withdrawal

symp

toms had played an important role in

their relapse. Thus, alleviation of absti‐

nence symptoms may contribute to the

maintenance of daily marijuana use in

chronic users.

Another significant finding is that after

28 days of marijuana abstinence, all of

the symptoms returned to pre‐

withdrawal levels except for irritability

and physical tension. It is possible that

these two symptoms remained slightly

elevated because they represented a

premorbid characteristic of the current

users and were not a result of marijuana

withdrawal. If this is the case, the fact

that the former users did not have ele‐

vated scores on these two items may

reflect a characteristic that potentially

differentiates individuals with a history

of heavy marijuana use who have suc‐

cessfully stopped from individuals who

continue to smoke regularly.

Taken together, the data from these two

studies provide further evidence of the

existence of a marijuana withdrawal

syndrome. An important aspect of both

of our studies is that we used two con‐

trol groups: 1) former heavy marijuana

users and 2) individuals who had rarely

smoked marijuana during their lives.

It is noteworthy that these control

groups were indistinguishable from one

another in diary scores or number of

aggressive responses on the PSAP,

whereas both were significantly distin‐

guishable from the current marijuana

users. This observation argues that the

elevated diary scores and aggressive

responses of the current marijuana us‐

ers were attributable to marijuana with‐

drawal, rather than a mere history of

marijuana use or some other aspect of

subject selection or study design. Future

studies should focus not on whether a

marijuana withdrawal syndrome exists

but rather on determining the clinical

significance of this syndrome and the

role withdrawal symptoms play in per‐

petuating marijuana use. Acknowledgement:These studies were supported by NIDA grants

DA10346, DA03994, DA00343. References:Beardsley PM, Balster RL,

Harris LS (1986), Dependence on tetrahydrocannabinol in rhesus

monkeys. J Pharmacol Exp Ther 239(2):311‐319.iBudney AJ, Hughes

JR, Moore BA, Novy PL (2001), Marijuana abstinence effects n

marijuana smokers maintained in their home environment. Arch

Gen Psychiatry 58(10):917‐924.Budney AJ, Novy PL, Hughes JR

(1999), Marijuana withdrawal among adults seeking treatment for

marijuana dependence. Addiction 94(9):1311‐1322.Budney AJ,

Radonovich KJ, Higgins ST, Wong CJ (1998), Adults seeking

treatment for marijuana dependence: a comparison with cocaine‐

dependent treatment seekers. Exp Clin Psychopharmacol 6(4):419‐

426.

“K2,” the brand name for a product that’s been sold since

2008 and marketed as incense, is a dried herb that has been

sprayed with a chemical compound that when smoked cre‐

ates a high similar to inhaling marijuana.

And in spite of the claims made on the multiple Internet

sites where it’s sold that is it is “the perfect incense mixture”

and is not meant for human consumption, law enforcement

calls it fake weed.

The problem? It’s legal in most states, including Michigan.

Kalamazoo Department of Public Safety Capt. Joseph Taylor,

commander of the Kalama‐

zoo Valley Enforcement

Team, which targets illegal

drug use in Kalamazoo

County, said his agency has‐

n’t come into contact with

K2. But it’s effects concern

him.

“There is no legitimate pur‐

pose for this,” Taylor said.

“It appears only to have

negative results and seems

intended on trying to surpass marijuana laws. The only real

design seems to be in the form of a drug.”

K2, also known as “Mr. Smiley” and “Spice,” is manufactured

in China and South Korea and is sprayed with a chemical

compound similar to THC, the psychoactive ingredient in

marijuana.

Sold over the Internet and in some head shops across the

state, K2 can be purchased for $30 to $50 for 3 grams. Web

sites that sell K2, which comes in blends called “Summit,”

“Sex,” “Blonde” and “Ultra,” claim that it is purely an incense

product.

“K2 incense smoke blends are a mix of hand‐selected herbs

and proprietary synthetic ingredients that create the perfect

incense mixture,” states a description of K2 on a wholesaler

website. “Each of the unique blends … create a robust smoke

coupled with a bouquet of unique aromas. These aromatic

scents are so flawless, consumers long to enjoy the K2 prod‐

uct time and time again.”

“Like playing Russian Roullette”

John Huffman, a professor of organic chemistry at Clemson

University, developed the chemical substances found in K2,

JWH‐018 and JWH‐073, in 1995 while doing research on the

effects of cannabinoids on brain.

He’s not sure how the recipes got picked‐up, but he is taken

aback in how they are being used.

“The real problem is that we really don’t know anything

about it,” he said during a phone interview from his office in

Clemson, S.C. Consuming it “is like playing Russian Roul‐

lette.”

USA Today in a report on K2

quoted Anthony Scalzo, director

of the Missouri Poison Center in

St. Louis, as saying that since he

notified poison centers nation‐

wide about K2 in early February

following reports of sick patients

in Missouri, poison centers na‐

tionwide have had more than 350

reports of illnesses from it. Pa‐

tients often have a rapid heart

rate, dangerously high blood pressure and sometimes hallu‐

cinations or paranoia, the USA Today story said.

Huffman said the active ingredient in K2 can be 10 times as

potent as marijuana, and in large doses can cause hallucina‐

tions and disorientation that can last for days. He said he got

an e‐mail from a young woman who smoked K2 and said she

was disoriented for a week and felt electric shocks pulsating

up and down her back.

Huffman said he’s been in touch with the U.S. Drug Enforce‐

ment Agency, the U.S. Dept. of Homeland Security and the

National Institutes of Health, advising the agencies on the

substance in K2.

And as much as he created the substance for research, he’s

not surprised that it’s gotten into the hands of those who

want to make a quick buck. The active substance in K2 is

easy to make, the raw materials are cheap and the profit

margin is high.


K2: Substance on the Street

11

“If I were a young entrepreneur in China and I knew enough

science, this would be a way to make good money,” Huff‐

man said. “These people are sophisticated. They’re coming

up with compounds we’ve never seen.”

Regulation sought

Richard Tooker, Kalamazoo County’s chief medical officer,

said that K2 has a “real potential for danger.”

“Anytime you’ve got something like this that’s unregulated,

you just don’t know what it is,” he said. “It’s not controlled,

it’s not licensed. There’s no question that it’s dangerous.”

Tooker likened K2 to Ecstacy, a drug that was once legal but

was eventually outlawed after its negative effects were made

known.

“Adolescents want to experiment,” he said. “So there’s the

potential for injury. This (K2) needs to be quickly regulated

and controlled.”

Michigan is one of 11 states across the nation that have ei‐

ther banned K2 or have legislation introduced that aims to

ban it. So far, Kansas and Kentucky are the only states to

outlaw K2.Republican State Rep. Rick Jones, of Grand

Ledge, introduced a bill in April that would make K2 illegal

in Michigan. His office said that a hearing on the measure

could take place this fall.

K2, which has been banned on U.S. military bases, is not on

the DEA’s Schedule I list of controlled substances, such as

cocaine, heroin, mescaline and several others, but the

agency does consider it a “drug or chemical of concern.”

For his part, KVET’s Taylor would like to see the drug out‐

lawed.

“Do kids really know what they’re putting in their bodies?,”

the drug unit commander said of K2. “They try these things

without being aware of the final outcome.”

Greg Francisco, executive director of the Michigan Medical

Marijuana Association, acknowledged that K2 is a poten‐

tially dangerous substance to consume, but said there

would not even be a discussion about it if marijuana were

legal.

“This is one more artifact of prohibition,” Francisco said.

“It’s no different than during prohibition when people

turned to wood alcohol. So what we now see is people turn‐

ing to inferior substitutions. It’s another example of why we

should legalize marijuana so we can finally control it.”

Store refuses to sell K2

From dried herbs to glass pipes to homemade soy candles,

the husband and wife team of Angel and Jeff Justice sell

several eccentric items at their Allegan store, Cloud 10, on

M‐40.

K2 isn’t one of them.

Employees at the Glass Onion, a popular head shop on

West Main Street in Kalamazoo, said K2 isn’t sold there

either.

Jeff Justice said he gets about three to four calls per week

from wholesalers looking to sell him K2. He always declines,

he said.

“It’s got chemicals in it or whatever else is in it,” Justice said.

“People don’t know what hell it is and no one wants to give

up the

ghost.”

This picture is from an actual web‐

site selling the K2 product.

http://www.k2cafe.org/

Consider the stereotypical represen‐

tation of a drug dealer, and ask

yourself, how does this relate with incense?

To me the message is

clear, this is not mark‐

ing incense, it is mar‐

keting a drug lifestyle.

What do you think?

Check it for yourself.

12

WINFIELD, Mo. — Mexican drug smugglers are increasingly

peddling a form of ultra‐potent heroin that sells for as little

as $10 a bag and is so pure it can kill unsuspecting users in‐

stantly, sometimes before they even remove the syringe from

their veins.

An Associated Press review of drug overdose data shows that

so‐called “black tar” heroin — named for its dark, gooey con‐

sistency — and other forms of the drug are contributing to a

spike in overdose deaths across the nation and attracting a

new generation of users who are caught off guard by its po‐

tency.

“We found people who snorted it lying face‐down with the

straw lying next to them,” said Patrick O'Neil, coroner in

suburban Chicago's Will County, where annual heroin

deaths have nearly tripled — from 10 to 29 — since 2006.

“It's so potent that we occasionally find

the needle in the arm at the death

scene.”

Authorities are concerned that the po‐

tency and price of the heroin from

Mexico and Colombia could widen the

drug's appeal, just as crack did for co‐

caine decades ago.

The Latin American heroin comes in

the form of black tar or brown powder, and it has proven

especially popular in rural and suburban areas.

Originally associated with rock stars, hippies and inner‐city

junkies, heroin in the 1970s was usually smuggled from Asia

and the Middle East and was around 5 percent pure. The rest

was “filler” such as sugar, starch, powdered milk, even brick

dust. The low potency meant that many users injected the

drug to maximize the effect.

But in recent years, Mexican drug dealers have improved the

way they process poppies, the brightly colored flowers sup‐

plied by drug farmers that provide the raw ingredients for

heroin, opium and painkillers such as morphine. Purity lev‐

els have increased, and prices have fallen.

Federal agents now commonly find heroin that is 50 percent

pure and sometimes as much as 80 percent pure.

The greater potency allows more heroin users to snort the

drug or smoke it and still achieve a sustained high — an at‐

tractive alternative for teenagers and suburbanites who don't

want the HIV risk or the track marks on their arms that

come with repeated injections.

“That has opened up heroin to a whole different group of

users,” said Harry Sommers, the agent in charge of the Drug

Enforcement Agency office in St. Louis.

Among the drug's casualties was William Henderson, a 29‐

year‐old welder from rural Missouri who died in his sleep in

2009, hours after snorting heroin. A bear of a man at 6‐foot‐1

and 300 pounds, he had tried the drug only a few times.

His wife recalled waking up to find the alarm buzzing. Her

husband's body had turned blue, and his stomach was cold

to the touch.

“I kept telling him, ‘Will, you're late — get up!” said Amanda

Henderson of Winfield, Mo., northwest of St. Louis. “But he

wasn't moving, wasn't breathing. I called 911, but I knew it

was too late.” She and her three small boys were left desti‐

tute.

An increasing amount of the deadliest heroin ap‐

pears to be coming from Mexico. Although the

vast majority still arrives from overseas, Mexican

dealers appear to be chipping away at the U.S.

market.

New priorities for smugglers

As recently as two years ago, state and federal

drug agents saw heroin arriving from Colombia,

Asia and Mexico. But as the availability and quality of co‐

caine and methamphetamine have declined, Mexican smug‐

glers have stepped up heroin shipments to the U.S.

Independent Mexican smugglers have the market largely to

themselves because the major drug cartels only dabble in

heroin, preferring to focus on locally grown marijuana and

Colombian cocaine, according to a DEA official in El Paso,

Texas. The agent spoke on the condition of anonymity, cit‐

ing security concerns and his ongoing role in active drug

investigations.

Heroin metabolizes in the body so quickly that medical ex‐

aminers often cannot pinpoint the drug as a cause of death

unless there is other evidence to back it up — say, a needle

or a syringe found near the body. Also, many victims use

multiple drugs and alcohol, so citing a specific substance is

often impossible.

At the start of the decade, roughly 2,000 people a year died

from heroin overdoses nationwide, according to records kept

by the Centers for Disease Control. By 2008, the drug was

blamed for at least 3,000 deaths in the 36 states that re‐

sponded to records requests from the AP. Deaths from 2009

Ultra‐Pure Heroin Hits US Markets

13

have not yet been compiled.

The AP contacted agencies in all 50 states, as well as offi‐

cials in the District of Columbia and New York City, includ‐

ing medical examiners, coroners and health departments.

The survey showed that heroin deaths rose 18.2 percent

from 2007 to 2008, and 20.3 percent from 2006 to 2008.

Law enforcement officials and drug‐treatment experts be‐

lieve those statistics woefully undercount the actual number

of deaths. And they fear the problem is getting worse: Sei‐

zures of heroin along the U.S.‐Mexico border quadrupled

from 2008 to 2009, from about 44 pounds (20 kilograms) to

more than 190 pounds (86 kilograms).

In the Minneapolis‐St. Paul area, more than 20 deaths were

blamed on heroin in 2009. DEA analysis of heroin pur‐

chased undercover found the drug was nearly 60 percent

pure — the highest average purity in the U.S. At the same

time, the price was among the lowest.

Like the rise of crack

“This is consistent with how crack cocaine was introduced

in the 1970s, when it was a high‐purity product sold at a low

price,” said Carol Falkowski, director of the alcohol and

drug abuse division for the Minnesota Department of Hu‐

man Services.

To hook new users, dealers are selling heroin cheap — often

around $10 a bag. The new users included Billy Roberts, the

19‐year‐old son of a retired Chicago police officer. Last Sep‐

tember, he slumped over dead of a heroin overdose at a

friend's house.

John Roberts had moved his family to Will County when

Billy was just entering high school.

“I thought I was moving away from problems like that,”

Roberts said. “These kids out here are being introduced to

real serious drugs, dirt cheap, and they don't know how

pure and dangerous they are.”

Roberts now speaks to high school and civic groups about

the dangers of heroin.

Independent Mexican smugglers like Jose Antonio Medina

Arreguin pay the cartels for access to lucrative trade routes

used to sneak drugs across the border and along U.S. high‐

ways.

Medina, also known as “Don Pepe,” was arrested earlier this

year in Mexico on suspicion of running a $10 million‐a‐

month heroin smuggling business from the western Mexico

state of Michoacan. With the permission of the area's pow‐

erful La Familia cartel, he is believed to have shipped as

much as 440 pounds a month into the U.S. for street

sales from San Diego to San Jose.

Glendale, Calif., often ranks among the safest cities of

its size. But police are concerned about a growing her‐

oin problem tied to Mexican street gangs from nearby

Los Angeles. Gang members make the quick drive up

Interstate 5 to deliver heroin straight to high school

kids.

“They tell them, ‘Just smoke it. It's just like smoking a

cigarette. It's just like smoking marijuana,'” said Glen‐

dale police Sgt. Tom Lorenz. Once the kids are hooked,

“they've got a customer forever.”

The trip up I‐5 also leads to Oregon, where state Medi‐

cal Examiner Karen Gunson said the heroin problem is

worst in communities along the interstate. The state

had 131 heroin‐related overdose deaths last year — 42

more than three years earlier.

The dead simply didn't know the risks of the heroin

they used, she said.

“We're seeing it sometimes 80 percent pure,” Gunson

said. “There's no FDA approval on this stuff. If you're

using it every day, your chances grow and grow that it's

going to kill you.”

That's what happened to Nikki Tayon. A decade ago,

she helped lead the high school softball team from

Winfield to second place in the state. But it wasn't long

after high school that she began using drugs such as

marijuana and meth. A couple of years ago, she turned

to heroin.

Last April, her mother, Sue Tayon, got a call from a

ranger at Cuivre River State Park. Nikki's purse and cell

phone had been found, and rangers were looking for

her. Hours later came the gruesome news: Nikki's body

was discovered in a ditch. She was 28.

She had overdosed on heroin that was 90 percent pure,

her mother said. Police said her boyfriend panicked and

dumped Nikki from the car. No charges were filed.

“I know she was doing it,” Sue Tayon said. “But she did‐

n't deserve to die this way.”

14

4‐methylmethcathinone [Mephedrone, 4‐MMC, meow meow, m‐CAT, bounce, bubbles, mad cow]

July 2010 DEA/OD/ODE

Introduction

4-Methylmethcathinone (mephedrone) is a designer drug of the phenethylamine class and shares substantial structural similari-ties with methcathinone (Schedule I). Evidence of mephedrone use and associated toxicity has been increasing, in 2009 and 2010, particularly in the United Kingdom and other European countries. To date, one confirmed and several suspected deaths related to mephedrone have been reported by Europol-EMCDDA Joint report on mephedrone 2010. In recent years, law en-forcement agencies have documented seizures (Oregon, Illinois and Alabama) associated with mephedrone in the United States.

Licit Uses

Mephedrone is not approved for medical use in the United States.

Chemistry

The core chemical structure of mephedrone identifies it as a phenethylamine, and is related in chemical structure to meth-cathinone differing only by a methyl group (CH3) on the ring. It is a solid at room temperature.

Pharmacology

Structure-activity relationship studies allow to predict that the pharmacology of mephedrone is similar to methcathinone as well as other substances of phenethylamine chemical class. The compounds having similar structure (e.g., methampheta-mine, methylone, 3,4-methylenedioxymethamphetamine, cathinone and methcathinone) have been used to assess the phar-macological profile of mephedrone. This class of compounds is known to produce central nervous system stimulation, psy-choactivity and hallucinations.

The adverse health effects caused by mephedrone are broadly similar to those seen with other stimulant drugs. Adverse ef-fects produced by phenethylamines are increased heart rate, chest pain, agitation, irritability, dizziness, delusions, nose bleed-ing, nausea and vomiting. Consistent with the above discussion, mephedrone was reported to produce agitation, dilated pu-pils, increased heart rate and blood pressure in a 22-year-old man who used it for recreational purpose.

User Population

It is predominantly used by youth population (15-24 years), higher in males than females, from urban areas, who frequent clubs, discos and dance events (Europol-EMCDDA Joint report on Mephedrone, 2010).

Illicit Distribution

Mephedrone is sold over the internet and is promoted as a “research chemical”, “bath salts” or “plant food.”

Control Status

Mephedrone is not scheduled under Controlled Substance Act (CSA). However, it can be considered an analogue of methcathi-none (schedule I substance) under the analogue provision of the CSA (Title 21 United States Code 813). Therefore, law enforce-ment cases involving mephedrone can be prosecuted under the Federal Analog Act of the CSA. Comments and additional infor-mation are welcomed by the Drug and Chemical Evaluation Section, Fax 202-353-1263, Telephone 202-307-7183, or E-mail [email protected].

New Drugs on

the Horizon

Freely available on

the internet...you

must call for pricing

15

Methamphetamine Availability From mid-2008 through 2009, methamphetamine availability increased in the United States. Drug availability indicator data show that methamphetamine prices, which peaked in 2007, declined significantly during 2008 and 2009, while metham-

phetamine purity increased.

Impact on Health and

Health Care Systems

In 2008, NSDUH estimated that 7 million individu-als aged 12 and older were dependent on or had abused illicit drugs in the past year, compared with 6.9 million in 2007. The drugs with the highest dependence or abuse levels were marijuana, pre-scription pain relievers, and cocaine. The number of individuals reporting past year marijuana abuse or dependence was 4.2 million in 2008, compared with 3.9 million in 2007; the number of individuals re-porting past year prescription pain reliever abuse or dependence was 1.7 million in both 2007 and 2008; and the number of individuals reporting past year cocaine abuse or dependence was 1.4 million in 2008, compared with 1.6 million in 2007. Many individuals who become dependent on illicit

drugs eventually seek treatment. The Treatment Episode Data Set (TEDS) provides information regarding the demographics and substance abuse patterns of treatment admissions to state-licensed treatment facilities for drug dependence. In 2007, there were approximately 1.8 million admissions to state-licensed treatment facilities for illicit drug dependence or abuse. The highest percent-age of admissions reported opiates as the primary drug of choice (31%, primarily heroin) followed by marijuana/hashish (27%), cocaine (22%), and stimulants (13%). Although approaches to treatment vary by drug, more than half of the admissions were to ambulatory (outpatient, intensive outpatient, and detox) facilities rather than residential facilities. (See Table B2 in Appendix B for data on admissions for specific drugs.) Individuals often experience adverse reactions to drugs--including nonfatal overdoses--that require them to go to the hospital. In 2006, the Drug Abuse Warning Network (DAWN) reported that of 113 million hospital ED visits--1,742,887 (1.5%)--were related to drug misuse or drug abuse. An estimated 31 percent of these visits involved illicit drugs only, 28 percent involved CPDs, and 13 percent involved illicit drugs in combination with alcohol. When drug misuse or abuse plays a role in these ED visits, the most commonly reported substances are cocaine, marijuana, heroin, and stimulants (typically amphetamines or methamphetamine).A 2007 DAWN survey of 63 metropolitan areas found an average of 12.1 deaths per 100,000 persons related to drug use.5 Rates of drug-related deaths range from 1.1 per 100,000 in Sioux Falls, South Dakota, to 26.1 per 100,000 in the New Orleans area. DAWN also records the number of drug-related suicide deaths. In 2007, the number of drug-related suicides per 100,000 persons ranged from less than one in several jurisdictions (including Chicago, Dallas-Fort Worth, and Minneapolis) to 6.2 per 100,000 in Fargo, North Dakota. To put these statistics in perspective, the Centers for Disease Control and Prevention (CDC) reports other nonnatural death rates as follows: Motor vehicle accidents, 15.1 per 100,000; nontransport accidents (e.g., falls, accidental drownings), 24.4 per 100,000; suicide, 11.1 per 100,000; and homicides, 6.2 per 100,000. The consequences of drug use usually are not limited to the user and often extend to the user's family and the greater community. According to SAMHSA, combined data from 2002 to 2007 indicate that during the prior year, an estimated 2.1 million American children (3%) lived with at least one parent who was dependent on or abused illicit drugs, and 1 in 10 children under 18 lived with a substance-addicted or substance-abusing parent.6 Moreover, the U.S. Department of Health and Human Services estimated in 1999 that substance abuse was a factor in two-thirds of all foster care placements.Many states have enacted drug-endangered children laws to protect children from the consequences of drug production, trafficking, and abuse. Typically associated with methampheta-mine production, drug-endangered children are exposed not only to abuse and neglect but also to fires, explosions, and physical health hazards such as toxic chemicals. In 2009, 980 children were reported to the El Paso Intelligence Center (EPIC) as present at or affected by methamphetamine laboratories, including 8 who were injured and 2 who were killed at the laboratories. These statis-tics do not include children killed by random gunfire associated with drug activity or who were physically or sexually abused by a "caretaker" involved in drug trafficking or under the influence of drugs.

16

SAMHSA Joins Together with National Behavioral Health

Provider Associations to Promote Health Recovery

The Substance Abuse and Mental Health Services Administration (SAMHSA) recently approved awards to five national behavioral healthcare provider associations to hasten awareness, acceptance, and adoption of recovery-based practices in the delivery of mental health services. The five awards represent a major new outreach by SAMHSA to directly engage key behavioral health professional groups in its on-going efforts to fundamentally improve the provision of behavioral healthcare services. The following national profes-sional organizations will receive funding for the next 5 years to develop recovery-oriented educational materials and train thousands of psychiatrists, psychologists, psychiatric nurses, social workers, and peer specialists:

American Psychiatric Association American Psychological Association American Psychiatric Nurses Association

Council on Social Work Education National Association of Peer Specialists

The five awards are part of SAMHSA’s new Recovery to Practice project that is in support of the agency’s strategic initiative to enhance the nation’s behavioral health workforce. “Through this new initiative we are retooling the behavioral health workforce by applying the principles of recovery to direct care practice,” said SAMHSA Administrator Pamela S. Hyde, J.D. “Critical components of mental health recovery such as peer support and self-empowerment will be expanded in the workforce to help clients build on their own strengths and create positive life changes.” In addition to material development and professional training, the Recovery to Practice effort will establish an on-line recovery resource center for behavioral health professionals that will enable them to access important research and practical information on mental health recovery-based practices and receive publications and participate in periodic web-based training seminars to enhance their clinical practices.

The project builds on SAMHSA’s National Consensus Statement on Mental Health Recovery (http://mentalhealth.samhsa.gov/

Call for Volunteers!

6A is looking for volunteers that would like to help promote the 21st Annual Recov-ery Month here at the VA.

If you would like to see what is going on, please talk to Fran Hodgkins , or Hal Sykes, or Daisy Coleman.

We have lots of free materials for you to get started.

We will be having a planning meeting soon!...September is only 3 months away! Sign up now!

17

18

Non‐Recovery Based Interactions

Practice Scripts for July

1.PRAISING APPROPRIATE BEHAVIOR

“When we reinforce adaptive behav‐

iors, they are more likely to occur.”

•Positive Verbal's

•Example: “You did a great job!”

•Example: “It’s great to see you see

you doing that!”

•Positive Non‐verbal's

•Example: smiling, thumbs up, nod‐

ding of head.

2. PROMPTING

•Instead of using Activity Demand or

Limit Setting.

Used when behavior maladaptive to

context or content (e.g., talking

loudly, making demands, odd behav‐

ior, etc.). Gives Veterans CHOICES.

• Example: “Specify X, if X then

something bad happens. However, if

Y, something good happens.”

• Example: Joe yells during a conver‐

sation.

• Staff: “Joe, you are yelling. If you

continue to yell, I can’t talk to you;

however, if you speak more softly,

I’ll be happy to keep talking.”

Next month 2 more practice scripts

will be featured for you to practice.

If you want to learn more, please

see the ARTE book at the nurses’

stations. Thank You...Fran

From a PowerPoint by: Dr. Justin Springer PhD

1) Negative Non‐Verbals—

Frowning, grimacing, scowling. If we demon‐

strate a negative affect, we are modeling

this behavior for Veterans.

2) Job Irrelevant Activity—

Engaging in behaviors that are not related to

treatment services. This takes away opportu‐

nities to assist and to interact with Veterans.

3) Ignoring Veterans with Appropriate Re‐

quests—

When we provide timely responses to Vet‐

eran requests, we encourage Veterans to ask

appropriately and model professionalism.

4) Negative Group References—

Statements with negative reference to a

group to which the individual belongs. Exam‐

ple: "You all are just so loud today.“

5) Negative Statements—

Giving negative expectations before the be‐

havior occurs. Example: "You can't do that

by yourself.“

6) Negative Verbals—

Any comment given in a negative, sarcastic,

or condescending tone; reprimands. Exam‐

ples: “That's a lousy idea;” “Can’t you see

that I’m busy.”

7) Activity Demand (do)/Limit Setting (stop)

Any request or demand requiring the Vet‐

eran to perform some sort of activity or to

stop doing something. Can be stated in a

positive or negative way [LS = 64% of aggres‐

sive indicents; AD = 34% aggressive incidents

(see Cheung, et al., 1996; Bjorkly, 1999;

Marth, 2009)].

Examples: “Lets take a walk down the hall‐

way and talk,”

“You need to go and take your medication

now.”

“Come here, I need to check your vitals.”

“Please don’t do that anymore.”

“You need to take your jacket off.”

From the Editor,

Remember, changing patters of communica‐

tion takes a focused effort. However, if you

can master the communication skills that are

needed in the ARTE then you will be able to

communicate in a recovery oriented way

that helps the veterans and supports their

wellness. AND you will be a better communi‐

cator with your friends and your family. It is

a win/win situation. Try it, you’ll like it!....Ed.

Things not to do when working with our veterans in the recovery environment

Recovery Model Behaviors

19

Parts of MH Handbook on Recovery

EYE ON IT:

Relapse Prevention

Recovery Moment

Monthly Pick

Recovery Is...

“What people believe because of a

diagnosis of a mental illness is often

more disabling than the illness itself.”

“It is about serving America’s Veterans

and partnering with them to restore

and improve their lives.”

Recovery is not “something else to do.”

Recovery is the point and organizing

principle of all our work.

5Patient Care ServicesDepartment of Veterans Affairs

…A Continuum of Care

Uniform MH Services Handbook

General specifications state:Mental health is essential to overall health…, andmental health services must be recovery oriented.

This applies to all VA mental health services Built upon the 2003 President’s New Freedom

Commission Report, and the 2004 VA Comprehensive Mental Health Strategic Plan

Lays a strong foundation for current goals of providing Veteran-centric, results-driven, and forward-looking services

8

Uniform MH Services Handbook

Emphasizes rehabilitation and recovery for all, and everywhere (inpatient, outpatient, residential)

Strongly encourages the formation of local Veterans Mental Health Councils to give input about local needs and operations

Includes a special section outlining core psychosocial rehab principles and services including:

Local Recovery Coordinators PRRC

Peer Support Services Family Involvement

CWT: TWE and SE MHICM

12

Recovery

“Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of the person's choice while striving to achieve ... full potential.”

Relapse Prevention: A cognitive‐

behavioral therapy developed for the

treatment of problem drinking and

adapted later for cocaine addicts. Cog‐

nitive‐behavioral strategies are based

on the theory that learning processes

play a critical role in the development

of maladaptive behavioral patterns. In

Relapse Prevention Therapy, individu‐

als learn to identify and correct prob‐

lematic behaviors. RPT encompasses

several cognitive‐behavioral strategies

that facilitate abstinence as well as

provide help for people who experi‐

ence relapse.

“Hope is Faith

holding out it’s

hand in the

dark.” ~George Iles~

20

(OAKBROOK TERRACE, Ill. – June 3, 2010) FOR IMMEDIATE RELEASE

A new Joint Commission Sentinel Event Alert warns that health care facilities today are being confronted with steadily increasing rates of crime, including

assault, rape and murder.

The Sentinel Event Alert urges greater attention to the issue of violence and to controlling access to facilities to protect patients, staff and visi‐

tors, noting that assault, rape and homicide are consistently in the top 10 types of serious events reported to The Joint Commission. The Alert

cautions that the actual number of violent incidents is significantly under‐

reported and ad‐ vises organizations to mandate the reporting of all real

or perceived threats.

To prevent vio‐ lence in health care facilities, The Joint Commission’s

Sentinel Event Alert newsletter suggests that facilities take a series of

13 specific steps, including the following:

Evaluate the facil‐ ity’s risk for violence examining the campus, reviewing

crime rates and surveying employees about their perceptions of risk.

Take extra security precautions in the emergency department, especially if

the facility is in an area with a high crime rate or gang activity. Precau‐

tions might include uniformed security guards, scanning people entering

the building for weapons and inspecting bags.

Conduct thorough background checks of prospective employees and staff.

Report crime to law enforcement.

“Health care facilities should be places of healing, not harm. But, unfortunately, health care settings are not immune from the types of vio‐

lence that are found in the other areas of our lives,” says Mark R. Chassin, M.D., M.P.P., M.P.H., president, The Joint Commission. “The recom‐

mendations in this Alert give health care institutions and caregivers specific strategies to take action that will keep everyone safer.”

In addition to the specific recommendations contained in the Alert, The Joint Commission urges hospitals to comply with the requirements

described in its accreditation standards to prevent violence. The standards require accredited health care facilities to have a security plan as

well as conduct violence risk assessments, develop strategies to prevent violence and have a response plan when a violent episode occurs. The

Joint Commission’s standards also are clear that patients have a right to be free from neglect, exploitation, and verbal, mental, physical and

sexual abuse.

The warning about violence in health care facilities is part of a series of Alerts issued by The Joint Commission. Much of the information

and guidance provided in these Alerts is drawn from The Joint Commission’s Sentinel Event Database, one of the nation’s most comprehensive

voluntary reporting systems for serious adverse events in health care. The database includes detailed information about both adverse events

and their underlying causes. Previous Alerts have addressed maternal deaths, health care technology, anticoagulants, wrong‐site surgery,

medication mix‐ups, health care‐associated infections, and patient suicides, among others. The complete list and text of past issues of Sentinel

Event Alert can be found on The Joint Commission Web site at www.jointcommission.org.

NEWS RELEASE Media Contact: FOR IMMEDIATE RELEASE

Elizabeth Eaken Zhani

Media Relations Manager

630.792.5914

[email protected]

Joint Commission Alert: Violence Rising at Health Care Facilities

Controlling access, greater staff vigilance urged

For more information on violence in the workplace and for questions about annual training for the prevention and management of disruptive behaviors:

Please See: Diane Toca, 6A Staff Trainer for PMDB

21

I’ll take care of you...

I’ll help you find the right per‐

son...

That sounds really rough...

Today, let’s see if we can make

that different...

What do you think will help

make you feel better?

When would you like to get this

done?

Your nurse is “…”, but we all

take care of everyone around

here.

Today is a good day for you!

Are you warm enough?

Would you like a beverage and

a snack while you are waiting?

Are you comfortable?

Do you need anything else?

These comments and many others

like these are the basis of good cus‐

tomer service and the reason for

CARITALK.

When focusing on the “YOU”, the

concepts of the Acute Recovery

Treatment Environment is realized.

We are not here to be control freaks.

We are not here to judge.

We ARE here to teach and to heal;

through the experiences of each

other.

Follow the guidelines from Dr. Springer. And

use them for CARITALK.

CARITALK

You can start with improving your patient

experience by using talking with your heart.

I call it CARITALK©.

CARITALK is the synthesis of the Caritas The‐

ory, Recovery interventions, and Heart‐

Math™ all rolled into one. It is an easy way

to communicate empathy, attunement, and

caring to your veterans and to each other.

How many times have you heard a veteran

say to you

“I’m in pain...I need more medications!”

You respond,

“Where is it? Rate your pain on a scale

of One to Ten, and /or I’ll call the doc‐

tor.”

Your response is not wrong, but it does not

convey caring and warmth the patients need

or expect. That’s because you were talking

out of your “headspace” and not your

heartspace”.

A CARITALK response would start with an

empathetic reflection:

“That must be so uncomfortable for

you.” (Reflecting with your heart)

Can you tell me Where is it? Rate your

pain on a scale of One to Ten, and I’ll

get you some medicine or call the doc‐

tor.” (Head = Assessment)

Then close it with another heart statement

like,

(Continued from page 4) “I will take care of you, so let me find

out what we can do.” (Cooperative

Planning with reassurance from the

heart)

I this manner the patient “feels” the caring

from the heart, not just the impersonal

“head” content.

Every wonder why doctors used to be so

bad at bedside manners and why nurses are

getting worse all the time? Because of all

the intellectual “head” statements they use.

For this month I challenge you to try some

CARITALK, as see what it does for you, and

your veterans.

In the end, it’s all about the veteran experi‐

ence here at the VA. It’s all about the ability

to decrease anxiety as much as possible to

help the veterans heal.

And the message from Cleveland was loud

and clear...the patient experience heals. We

are but one isolated incident in the lives of

our veterans, and yet a momentous person

in the extended stay of a hospitalization.

You have the control over the experience

your patient receives.

You are the healers, and you are the gate‐

keepers of the human experience on this

locked ward.

You are the secretaries and nurses, doctors

and technicians, food service workers and

service chiefs of the VA.

You are the experience of the VA., and with‐

out you the VA is merely a big empty build‐

ing.

What you fill it with … is up to you.

Namaste` …………………………………...Fran

CARITALK Phrases

Conference Coverage at the Cleveland Clinic

Continued from

22

A note from the internet @

VAnursescare.com

From: andrea Message: I met Jean Watson. She is caring and noted the spirit in me immediately. I am

so happy that nurses are remembering the way to nourish our own souls from the souls within the wrecked bodies of our

patients. We receive gifts of this from the patients, and they receive our gift. So grateful to be of sound enough mind and body to be the caretaker/caregiver...of the bodies which may be close to death....within the hands of suffer‐ing.....maybe even unrecognizable to their loved ones......so grateful to be able to witness and advocate......so grateful to recieve the gifts of wisdom from the bar‐dos of hell...so grateful to irm the hu‐manity and the god within all of us. The patient nurse relationship is a sacred bond. I pray I may execute it with the fullest prescence every day. ( It would also be nice to spell correctly some‐times).......I love you all...........

Join the American Psychiatric Nurses Association (APNA)

Fran Hodgkins is on the Board of Directors for APNA‐Texas and invites all interested nurses to join APNA.

APNA‐Texas has revitalized this year, and now working with APNA National in Arlington, VA., have created a

wonderful on‐line website designed to help you, the practicing nurse, with networking, advocacy, and more.

Membership information is available from Fran or on the web at APNA.org

This year to be held in Louisville ,Kentucky. October 13‐16

American Psychaitric Nurses Association National Conference

To see an instillation of Dale Chihuly glass sculpture in person is like falling through the looking

glass and landing in a kaleidoscope of color. His organic and flowing designs installed in the

Creekwood Botanical Garden, (just outside of Nashville, TN), are a compliment to the famous

garden built by the heiress of the Maxwell House fortune.

If you are able to travel to Nashville this summer, I suggest that you take the time to see this

amazing instillation. I really has an inspirational quality.

Dale Chihuly at Creekwood

Upcoming Events

2002 Holcombe Blvd

Houston, Texas 77586

713‐791‐1414 ph

Extension 6804

www.vanursescare.com

6A Unit Council News

Documents

Transcript of 6A Unit Council News