Long an advocate of certification of substance abuse professionals, of substance abuse treatment for prisoners, and other issues, he has become a familiar figure in the halls of the legislature. Tony is also known as a frequent convenor of people to wrestle with thorny issues, such as the thirty-six Outer Banks Conferences that have been held over twenty-four years.

As Executive Director of the Alcohol and Drug Council of North Carolina in Durham (a statewide United Way agency) since 1971 and as a member of the N.C. Commission on Substance Abuse Treatment and Prevention, and numerous other committees, Tony has been a constant reminder that substance abuse is a societal problem that needs more public discussion and political action. Perhaps his training as a Marine gave him the mettle to address uncomfortable issues. His education at Georgetown and subsequent work for Robert Kennedy and Paul Douglas gave him the courage to confront politicians. His diligence in asking hard questions again and again until he gets answers has been a valuable service to the field of substance abuse in North Carolina. His work has been recognized through awards given by the APNC and NC Association of Alcoholic Residential Facilities.

James H. Carter, M.D.
Editor

Since that dream, I have thought a lot about what is needed to imbed addiction prevention and treatment in the mainstream of health care and get the public thinking more clearly about alcohol and drugs. I have divided the areas for growth and change into three segments: clinical services, professional development, and support for the field.

Clinical Services

1. Integrate addiction into primary health care as a preventable, chronic disease services to include prevention, diagnosis, treatment for addicts and their families

2. Establish a system of secondary and tertiary services

a. special populations (dual diagnosed, pregnant women, HIV+, IV drug users)
b. hospital and residential treatment, structured halfway house and long term continuing care treatment programs

4. Implement practice standards and levels of care established by Single State Agency

5. Establish a uniform system of quality assurance

a. program accreditation
b. outcomes measures (electronic and other tracking)
c. process evaluation (participation in continuum)
d. client satisfaction survey

a. biological
b. psychological
c. social

Professional Development

1. Expand professional education of medical personnel (MDs, FNPs, PAs, RNs, others)

2. Expand professional education of non-medical personnel (PhDs, JDs, clergy, MPHs, MSWs, SA Counselors, and others)

3. Strengthen continuing education for medical and non-medical professionals

4. Strengthen and encourage licensure and certification

5. Develop recruitment system for field

6. Secure comparable pay and benefits in public and private personnel systems

Support for Cutting the Cost of Addiction and Abuse and for Alcohol/Drug Field (with the general public, decision maker, media)

1. Expand public education

a. implement awareness campaigns e.g. "prevention works", "treatment works", "drunken driving kills"
b. strengthen health curriculum, kindergarten up
c. combat underage drinking
d. develop internet sites, and materials for libraries, religious institutions, schools, and health care provider sites

a. mandate insurance coverage (at parity)
b. increase appropriations at all levels of government to treat indigent clients
c. create more awareness and financial participation among foundations
d. generate more support from business and industry, particularly for insurance coverage, EAPs and prevention
e. elicit better support from United Ways and other workplace giving programs

These items are not in any priority, nor is it a definitive list. Obviously, most of the efforts need to be concurrent.

Universal health care is coming in some form. The addiction field’s day is coming, too, probably sooner rather than later, because so much suffering and so much money is involved. What we, as interested citizens and professionals, must do is set aside our differences and stand on common ground and bring change, sooner rather than later. We must push ahead to produce the clinical services, develop professionals and professionalism, and spawn the advocacy needed to cut the horrible human suffering and financial loss caused by alcohol and other drug addiction and abuse. This way, perhaps nobody from an insurance company or HMO will have to call around to find out who knows anything about addiction and where one gets services.

Tony Mulvihill
Executive Director
Alcohol and Drug Council of North Carolina
Durham, NC

Seventy-two patients (43 males, 29 females), about 41% of the clinic registry, returned completed forms. Fifty-seven percent of respondents reported pre-AIDS drug use: alcohol 44%; marijuana 42%; cocaine 21%; amphetamines 18%; tranquilizers or "downers" 17%; LSD 12%, and prescription drug 12%. Four patients used heroin, two used PCP, and 3% used other drugs. Sixty-one percent used more than one drug. Nine patients used only alcohol, seven marijuana alone.

Twenty-six patients "had ever used" marijuana for a medical or psychological problem. Fifty-eight percent of these sought help for depression and 31% for anxiety. Other uses for marijuana included: gastrointestinal symptoms (nausea, N=6, appetite=6, vomiting=2); and headache, cough, or anger (N=3 or less for each). Nine listed "recreational," "mental," or "get high" in addition to one or more medical or psychological symptoms. Eighty-five percent achieved the "expected benefit."

Twenty-three patients (32%) currently used marijuana to benefit a medical or psychological condition: appetite, N=21; nausea, vomiting, or indigestion=11; depression=6; anxiety=2. Four patients used 6-10 times weekly, seventeen 1-5 times weekly, the rest monthly. Twenty-one patients abused marijuana pre-AIDS, with eight no longer using. One patient each reported alcohol, cocaine or dronabinol currently, the latter also using marijuana.

Nine drug categories were listed and patients asked if any use since developing AIDS had helped, produced no change, or worsened any medical or psychological condition for which the drug was intended to help. Forty-two (58%) responded. Alcohol: 5 were helped, 2 no change, 22 got worse; cocaine: one helped, one no change, 9 worse. Respective numbers for amphetamines: 3, 1, 4; marijuana: 28, 3, 2; dronabinol: 4, 1, 1. Heroin/other narcotics, LSD, and PCP were each used by 2 patients, one used inhalants; all reported worsened conditions.

The survey identified three points of interest. First, pre-AIDS recreational drug use/abuse in 57% of the sample compared with a 25% national rate for AIDS from injecting drug use (IDU). Few in the sample used cocaine (N=15, uncertain as to smoked or injected) or heroine (N=4). Second, 42 of 72 respondents attempted to self-medicate with recreational drugs after developing AIDS. Thirty-six admitted to pre-AIDS drug or alcohol abuse, but six did not. Finally, there was a high rate (79%) of post-AIDS self-medication with marijuana, with 85% perceiving a positive benefit. This contrasted with no change or worsening in the vast majority of self-medication attempts with other recreational drugs.

Physicians treating AIDS patients should be aware of continued use of recreational drugs by patients, even if "therapeutic." It may contribute to increased risk for unsafe sex, interactions with prescribed medications, or worsened medical or psychological symptoms.

Daniel A. Dansak, MD
Department of Psychiatry
College of Medicine
University of South Alabama
Mobile, Alabama

For both white and African-American women, regardless of martial status, marijuana prevalence rates increased with age for publicly assisted women but decreased with age for those not publicly assisted. Alcohol prevalence increased with age for African-American and white women who were publicly assisted, but decreased with age for all others. Marital status yielded no significant effect on alcohol prevalence rates. Findings for alcohol and marijuana generally followed the same risk adjusted patterns for African American and white women but with different prevalence levels. However, cocaine use had a unique pattern with higher prevalence among African-American women in mid-adulthood, and higher prevalence vis-à-vis white women, regardless of risk level.

William A. Vega, Director
Metropolitan Research and Policy Institute
The University of Texas at San Antonio

SOURCE: Adapted by the Center for Substance Abuse Research at the University of Maryland, College Park, from data from Substance Abuse and Mental Health Services Administration, Office of Applied Studies, "Preliminary Results from the 1996 National Household Survey on Drug Abuse," WWW document; URL http://www.samhsa.gov/oas/nhsda/pe1996/httoc.htm (accessed 9/4/97). For more information, contact SAMHSA’s Office of Applied Studies at 301-443-6239.

Joshua S. Rodefer, Ph.D.
Modulation of mu-Opioid Analgesia by delta-Opioids
University of North Carolina - Chapel Hill
Award: $9,000
Mentor: Linda Dykstra, Ph.D., Professor, Departments of Psychology and Pharmacology

Shawn Acheson, Ph.D.
The Effect of Chronic Binge-Pattern Ethanol Exposure on the Acquisition and Retention of Spatial and Non-Spatial Memory in Adolescent and Adult Rats
Duke University Medical Center
Award: $9,000
Mentor: H. Scott Swartzwelder, Ph.D., Clinical Professor of Psychiatry

Karamarie Fecho, Ph.D.
Impact of Morphine Administration on Leukocyte Trafficking: Implications for Health and Disease
University of North Carolina - Chapel Hill
Award: $6,000
Mentor: Donald T. Lysle, Ph.D., Associate Professor and Director of Experimental and Biological Training Program

Laura J. Sim, Ph.D.
Effects of Chronic Ethanol Self-Administration on Receptor-G Coupling
Wake Forest University School of Medicine
Award: $6,000
Mentor: Steven R. Childers, Ph.D., Professor, Department of Physiology and Pharmacology

James J. Kiddle, Ph.D.
Cyclopropane Analogues of Cocaine: New Biological Probes for the Dopamine Transporter
University of North Carolina - Wilmington
Award: $5,000
Mentor: William J. Cooper, Ph.D., Professor and Chair, Department of Chemistry

Maria Arolfo, Ph.D.
Antipsychotic Drugs and a Natural Antidepressant as Potential Treatments for Cocaine Abuse: An Animal Model
East Carolina University
Award: $5,000
Mentor: Brian McMillen, Ph.D., Professor, Department of Pharmacology