Crisis and suicide prevention services struggle with demand after celebrity suicides NIH study identifies importance of support for critical suicide prevention services.

Thoughts about this article? "The United States may lack the resources needed to meet increases in demand for suicide prevention services that occur after celebrity suicides, according to a recent study of crisis mental health services. The study, conducted by a team of researchers, which included scientists from the National Institute of Mental Health (NIMH), part of the National Institutes of Health, highlights the need for suicide prevention hotlines to procure additional funds, allocate existing funds more efficiently, and develop contingency plans to accommodate increases in call volumes, particularly for the first two days after a celebrity suicide. The findings appear in the journal Psychiatric Services. “Suicide prevention is a significant public health concern and a top priority for NIMH,” said Joshua A. Gordon, M.D., Ph.D., director of NIMH. “This study highlights the importance of the National Suicide Prevention Lifeline and other crisis mental health services, and the need to build surge capacity of these services that could help save lives.” 

Suicide is the second leading cause of death for people in the U.S. between the ages of 10 and 34, and the suicide rate continues to rise. Suicide rates generally follow predictable patterns, with increases in the spring and a second, smaller increase in early summer. But certain events, like highly-publicized celebrity suicides, can serve as “shocks” that cause a sudden spike in suicide deaths. To test the ability of crisis mental health services to meet a sudden increase in demand for help, this study looked at increases in suicide rates within 30 days of Robin Williams’ suicide on Aug. 11, 2014. It also looked at changes in help - and information-seeking related to suicide, and changes in the percent of calls the National Suicide Prevention Lifeline (NSPL) was able to answer after Williams’ death. Daily calls to the National Suicide Prevention Lifeline (including Veterans Crisis Line) initiated and answered, August 3 to September 7, 2014. Daily calls to the National Suicide Prevention Lifeline (including Veterans Crisis Line) initiated and answered, August 3 to September 7, 2014. American Psychiatric Association. The researchers used data from the Centers for Disease Control and Prevention National Center for Health Statistics’ Compressed Mortality File (link is external) to compare the number of suicide deaths and the method of suicide in the 30 days before and after Aug. 11, 2014, and for the same time period in 2012 and 2013. In 2012-2014, there was an average of 113-117 suicide deaths per day; after Williams’ suicide, the average rate increased to 142 suicide deaths per day, something not observed in 2012 or 2013. Approximately two-thirds of the people who died by suicide immediately after the actor’s death used the same method of suicide as Williams. The study also examined the number of calls placed to NSPL immediately before and after Williams ended his life to measure whether media coverage of his death prompted more people to reach out for help. The day after he died, the number of calls increased by up to 300 percent - from between 4,000 to 6,000 calls per day to 12,972. However, without capacity to respond to this increased demand for crisis services, the fraction of answered calls decreased from an average of 73 percent to 57 percent, which highlights a gap in the ability of the NSPL to respond to surges in calls for help. To measure information-seeking behavior, the study looked at visits to the Suicide Prevention Resource Center (SRPC) (link is external) and Suicide Awareness Voices of Education (SAVE) (link is external) websites. In the week before Williams died, the SPRC website averaged 2,315 visits per day. The day after his death, there were 5,981 visits to the site. The SAVE website averaged 4,239 visits per day in the week before he died, and 24,819 visits on August 12. Average daily visits to both sites remained consistently higher for the rest of the month of August. The study suggests that both efficient allocation of existing funds and procuring new funding will be critical to continue meeting the demand for crisis mental health services, including surge capacity.> “Crisis mental health services, such as suicide prevention hotlines and websites, provide effective counseling and vital resources for people in suicide distress. We need to ensure these services have sufficient resources to serve the public 24/7, especially in times of increased demand,” said Jane Pearson, Ph.D., chair of the Suicide Research Consortium in NIMH’s Division of Services and Intervention Research. “Shocking events, like Mr. Williams’ suicide, disrupt normal patterns in suicide rates, and cause an increase in both calls for help and imitative suicides,” said lead researcher Rajeev Ramchand, Ph.D (link is external)., of the Cohen Veterans Network. “This highlights the need for additional and consistent support for crisis mental health services, including hospital emergency departments, law enforcement, poison control centers, and health departments, as well as the mental health resources that serve as referral sources.” " Reference Ramchand, R., Cohen, E., Draper, J., Schoenbaum, M., Reidenberg, D., Colpe, L., Reed, J., & Pearson, J. (in press). Increases in demand for crisis and other suicide prevention services after a celebrity suicide. Psychiatric Services in Advance. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201900007 (link is external). For more information on this and other mental health continuing education, please visit, Psychologist Continuing Education

OxyContin® Abuse and Addiction Continuing Education CEUs

The media have issued numerous reports about the apparent increase in OxyContin® abuse and addiction. Some of these reports include the following:

• In Madison, Wisconsin, a task force reported a dramatic increase in OxyContin cases since 2003. Most OxyContin making its way onto the streets of Madison and nearby communities was believed to have been stolen from local pharmacies.1
• The police chief in Billerica, Massachusetts, reported a “dramatic increase in OxyContin abuse.”2
• The distribution of OxyContin in Virginia was reported to be well above the national average. In the counties of far southwest Virginia, where the hard physical labor of coal mining and farming leads to a higher incidence of injuries, OxyContin prescriptions were generally 500 percent above the national average.3
• Sixty-nine percent of police chiefs and sheriffs said they have witnessed an increase in the abuse of painkillers such as OxyContin. The areas most affected are eastern Kentucky, New Orleans, southern Maine, Philadelphia, southwestern Pennsylvania, southwestern Virginia, Cincinnati, and Phoenix.4

These reports may reflect some of your experiences: We know many of you are treating clients addicted to OxyContin.

OxyContin has been heralded as a miracle drug that allows patients with chronic pain to resume a normal life. It has also been called pharmaceutical heroin and is thought to have been responsible for a number of deaths and robberies in areas where its abuse has been reported. Patients who legitimately use OxyContin fear that the continuing controversy will mean tighter restrictions on the medication. Those who abuse OxyContin reportedly go to great lengths—legal or illegal—to obtain the powerful drug.

At the Center for Substance Abuse Treatment (CSAT), we are not interested in fueling the controversy about the use or abuse of OxyContin. As the Federal Government’s focal point for addiction treatment information, CSAT is instead interested in helping professionals on the front line of substance abuse treatment by providing you with the facts about OxyContin, its use and abuse, and how to treat individuals who present at your treatment facility with OxyContin concerns. Perhaps these individuals are taking medically prescribed OxyContin to manage pain and are concerned about their physical dependence on the medication. Perhaps you are faced with a young adult who thought that OxyContin was a “safe” recreational drug because, after all, doctors prescribe it. Possibly changes in the availability or quality of illicit opioid drugs in your community have led to abuse of and addiction to OxyContin.

Whatever the reason, OxyContin is being abused, and people are becoming addicted. And in many instances, these people are young adults unaware of the dangers of OxyContin. Many of these individuals mix OxyContin with alcohol and drugs, and the result is all too often tragic.

Abuse of prescription drugs is not a new phenomenon. You have undoubtedly heard about abuse of Percocet®, hydrocodone, and a host of other medications. What sets OxyContin abuse apart is the potency of the drug. Treatment providers in affected areas say that they were unprepared for the speed with which an OxyContin “epidemic” developed in their communities.

We at CSAT want to make sure that you are prepared if OxyContin abuse becomes a problem in your community. This revised issue of the original Substance Abuse Treatment Advisory on OxyContin will help prepare you by

• Answering frequently asked questions about OxyContin
• Providing you with general information about semisynthetic opioids and their addiction potential
• Summarizing evidence-based protocols for treatment
• Providing you with resources for further information

For more information about OxyContin abuse and treatment, see our resource boxes and end of this document. Feel free to copy the information in the Substance Abuse Treatment Advisory and share it with colleagues so that they, too, can have the most current information about this critically important topic.

OxyContin® Frequently Asked Questions

Q: What is OxyContin?

A: OxyContin is a semisynthetic opioid analgesic prescribed for chronic or long-lasting pain. The medication’s active ingredient is oxycodone, which is also found in drugs like Percodan® and Tylox®. However, OxyContin contains between 10 and 80 milligrams (mg) of oxycodone in a timed-release tablet. Painkillers such as Tylox contain 5 mg of oxycodone and often require repeated doses to bring about pain relief because they lack the timed-release formulation.

Q: How is OxyContin used?

A: OxyContin, also referred to as “Oxy,” “O.C.,” and “Oxycotton” on the street, is legitimately prescribed as a timed-release tablet, providing as many as 12 hours of relief from chronic pain. It is often prescribed for cancer patients or those with chronic, long-lasting back pain. The benefit of the medication to people who suffer from chronic pain is that they generally need to take the pill only twice a day, whereas a dosage of another medication would require more frequent use to control the pain. The goal of chronic pain treatment is to decrease pain and improve function.

Q: How is OxyContin abused?

A: People who abuse OxyContin either crush the tablet and ingest or snort it or dilute it in water and inject it. Crushing or diluting the tablet disarms the timed-release action of the medication and causes a quick, powerful high. Those who abuse OxyContin have compared this feeling to the euphoria they experience when taking heroin. In fact, in some areas, the use of heroin is overshadowed by the abuse of OxyContin.

Purdue Pharma, OxyContin’s manufacturer, has taken steps to reduce the potential for abuse of OxyContin and other pain medications. Its Web site lists the following initiatives: funding educational programs to teach healthcare professionals how to assess and treat patients suffering from pain, providing prescribers with tamper-proof prescription pads, developing and distributing more than 1 million brochures to pharmacists and healthcare professionals to help educate them about medication diversion, working with healthcare and law enforcement officials to address prescription drug abuse, and endorsing the development of State and national prescription drug monitoring programs to detect diversion. In addition, the company is attempting to research and develop other pain management products that will be more resistant to abuse and diversion. The company estimates that it will take significant time for such products to be brought to market. For more information, visit Purdue Pharma’s Web site at www.purduepharma.com or call the company at 203–588–8069.

Q: How does OxyContin abuse differ from abuse of other pain prescriptions?

A: Abuse of prescription pain medications is not new. Two primary factors, however, set OxyContin abuse apart from other prescription drug abuse. First, OxyContin is a powerful drug that contains a much larger amount of the active ingredient, oxycodone, than other prescription pain relievers. By crushing the tablet and either ingesting or snorting it, or by injecting diluted OxyContin, people who abuse the opioid feel its powerful effects in a short time, rather than over a 12-hour span. Second, great profits can be made in the illegal sale of OxyContin. A 40-mg pill costs approximately $4 by prescription, yet it may sell for $20 to $40 on the street, depending on the area of the country in which the drug is sold.5

OxyContin can be comparatively inexpensive if it is legitimately prescribed and if its cost is covered by insurance. However, the National Drug Intelligence Center reports that people who abuse OxyContin may use heroin if their insurance will no longer pay for their OxyContin prescription because heroin is less expensive than OxyContin that is purchased illegally.6

Q: Why are so many crimes reportedly associated with OxyContin abuse?

A: Many reports of OxyContin abuse have occurred in rural areas that have housed labor-intensive industries, such as logging or coal mining. These industries are often located in economically depressed areas, as well. Therefore, people for whom the drug may have been legitimately prescribed may be tempted to sell their prescriptions for profit. Substance abuse treatment providers say that the addiction is so strong that people will go to great lengths to get the drug, including robbing pharmacies and writing false prescriptions.

Q: What is the likelihood that a person for whom OxyContin is prescribed will become addicted?

A: Most people who take OxyContin as prescribed do not become addicted. The National Institute on Drug Abuse reports: “Long-term use [of opioids] can lead to physical dependence—the body adapts to the presence of the substance and withdrawal symptoms occur if use is reduced abruptly. This can also include tolerance, which means that higher doses of a medication must be taken to obtain the same initial effects. . . . Studies have shown that properly managed medical use of opioid analgesic compounds is safe and rarely causes addiction. Taken exactly as prescribed, opioids can be used to manage pain effectively.”7

One review found, “A multitude of studies indicate that the rate of opioid addiction in populations of chronic pain sufferers is similar to the rate of opioid addiction within the general population, falling in the range of 1 to 2 percent or less.”8

In short, most individuals who are prescribed OxyContin, or any other opioid, will not become addicted, although they may become dependent on the drug and will need to be withdrawn by a qualified physician. Individuals who are taking the drug as prescribed should continue to do so, as long as they and their physician agree that taking the drug is a medically appropriate way for them to manage pain.

Q: How can I determine whether a person who uses OxyContin is dependent on rather than addicted to OxyContin?

A: When pain patients take an opioid analgesic as directed, or to the point where their pain is adequately controlled, it is not abuse or addiction. Abuse occurs when patients take more than is needed for pain control, especially if they take it to get high. Patients who take their medication in a manner that grossly differs from a physician’s directions are probably abusing that drug.

If a patient continues to seek excessive pain medication after pain management is achieved, the patient may be addicted. Addiction is characterized by the repeated, compulsive use of a substance despite adverse social, psychological, and/or physical consequences. Addiction is often (but not always) accompanied by physical dependence, withdrawal syndrome, and tolerance. Physical dependence is defined as a physiologic state of adaptation to a substance. The absence of this substance produces symptoms and signs of withdrawal. Withdrawal syndrome is often characterized by overactivity of the physiological functions that were suppressed by the drug and/or depression of the functions that were stimulated by the drug. Opioids often cause sleepiness, calmness, and constipation, so opioid withdrawal often includes insomnia, anxiety, and diarrhea.

Pain patients, however, may sometimes develop a physical dependence during treatment with opioids. This is not an addiction. A gradual decrease of the medication dose over time, as the pain is resolving, brings the former pain patient to a drug-free state without any craving for repeated doses of the drug. This is the difference between the patient treated for pain who was formerly dependent and has now been withdrawn from medication and the patient who is opioid addicted: The patient addicted to diverted pharmaceutical opioids continues to have a severe and uncontrollable craving that almost always leads to eventual relapse in the absence of adequate treatment. This uncontrollable craving for another “rush” of the drug differentiates the patient who is “detoxified” but opioid addicted from the former pain patient. Theoretically, a person who abuses opioids might develop a physical dependence but obtain treatment in the first few months of abuse, before becoming addicted. In this case, supervised withdrawal (detoxification) followed by a few months of abstinence-oriented treatment might be sufficient for the patient who is not addicted who abuses opioids. If, however, this patient subsequently relapses to opioid abuse, then that behavior would support a diagnosis of opioid addiction. If the patient has several relapses to opioid abuse, he or she will require long-term treatment for the opioid addiction. (See the section titled Treatment and Detoxification Protocols to learn more about treatment options.)

Q: I work at a facility that does not use medication-assisted treatment. What treatment should I provide to individuals addicted to or dependent on OxyContin?

A: The majority of U.S. treatment facilities do not offer medication-assisted treatment. However, because of the strength of OxyContin and its powerful addiction potential, medical complications may be increased by quickly withdrawing individuals from the drug. Premature withdrawal may cause individuals to seek heroin, and the quality of that heroin will not be known. In addition, these individuals, if injecting heroin, may also expose themselves to HIV and hepatitis. Most people addicted to OxyContin need medication-assisted treatment. Even if individuals have been taking OxyContin legitimately to manage pain, they should not stop taking the drug all at once. Instead, their dosages should be tapered down until medication is no longer needed. If you work in a drug-free or abstinence-based treatment facility, it is important to refer patients to facilities where they can receive appropriate treatment. (See SAMHSA Resources.)

Treatment and Detoxification Protocols

OxyContin® is a powerful drug that contains a much larger amount of the active ingredient, oxycodone, than other prescription opioid pain relievers. Whereas most people who take OxyContin as prescribed do not become addicted, those who abuse their pain medication or obtain it illegally may find themselves becoming rapidly dependent on, if not addicted to, the drug.

Two types of treatment have been documented as most effective for opioid addiction. One is a long-term, residential, therapeutic community type of treatment, and the other is long-term, medication-assisted outpatient treatment. Clinical trials using medications to treat opioid addiction have generally included subjects addicted to diverted pharmaceutical opioids as well as to illicit heroin. Therefore, there is no medical reason to suppose that the patient addicted to diverted pharmaceutical opioids is any less likely to benefit from medication-assisted treatment than the patient addicted to heroin.

Some patients who are opioid addicted who have very good social supports may occasionally be able to benefit from antagonist treatment with naltrexone. This treatment works best if the patient is highly motivated to participate in treatment and has undergone adequate detoxification from the opioid of abuse. Most patients who are opioid addicted in outpatient therapy, however, do best with medication that is either an agonist or a partial agonist. Methadone is the agonist medication most commonly prescribed for opioid addiction treatment in this country. Buprenorphine is the only partial agonist approved by the Food and Drug Administration for opioid addiction treatment.

The guidelines for treating OxyContin addiction or dependence are basically no different than the guidelines the Center for Substance Abuse Treatment (CSAT) uses for treating addiction to or dependence on any opioid. However, because OxyContin contains higher dose levels of opioid than are typically found in other oxycodone-containing pain medications, higher dosages of methadone or buprenorphine may be needed to appropriately treat patients who abuse OxyContin.

Methadone or buprenorphine may be used for OxyContin addiction treatment or, for that matter, treatment for addiction to any other opioid, including the semisynthetic opioids. Medication-assisted treatment for prescription opioid abuse is not a new treatment approach. For instance, in 2002, Alaska estimated that 15,000 people abused prescription opioids in the State and that most patients receiving methadone were not addicted to heroin. In addition, a significant percentage of patients in publicly supported methadone programs were not being treated for heroin addiction but for abuse of semisynthetic opioids (e.g., hydrocodone). The Substance Abuse and Mental Health Services Administration (SAMHSA) Drug Abuse Warning Network emergency room data show that both oxycodone and hydrocodone mentions increased dramatically in the United States between 1995 and 2002.9 And when Arkansas opened its first methadone maintenance clinic in December 1993, the vast majority of its clients were not admitted for heroin addiction but for semisynthetic opioid abuse. These individuals had been traveling to other States for treatment because methadone treatment was not available near their homes.

Using the criteria above describing the difference between addiction to and dependence on OxyContin, you may be able to determine whether a patient requires treatment for opioid addiction. If this is the case, methadone or buprenorphine may be used for withdrawal. For certain patient populations, including those with many treatment failures, methadone or buprenorphine is the treatment of choice.10

“As substance abuse treatment professionals, we have the responsibility for learning as much as we can about OxyContin and then providing appropriate treatment for people addicted to it. Appropriate treatment will nearly always involve prescribing methadone, buprenorphine, or, in some cases, naltrexone,” says H. Westley Clark, M.D., J.D., Director of CSAT. “Programs that do not offer medication-assisted treatment will need to refer patients who are addicted to OxyContin to programs that do,” he adds.

It is important to assess an individual’s eligibility for medication-assisted treatment with methadone or buprenorphine to determine whether he or she is eligible for this type of treatment and whether it would be appropriate. The assessment may take place in a hospital emergency department, central intake unit, or similar place. Final assessment of an individual’s eligibility for medication-assisted treatment must be completed by treatment program staff. The preliminary assessment should include the following areas:11

• Determining the need for emergency care
• Diagnosing the presence and severity of opioid dependence
• Determining the extent of alcohol and drug abuse
• Screening for co-occurring medical and psychiatric conditions
• Evaluating an individual’s living situation, family and social problems, and legal problems

“. . . we have the responsibility for learning as much as we can about OxyContin, and then providing appropriate treatment for people who are addicted to it.”

H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM
Director, CSAT

Treatment Improvement Protocols (TIPs) and Collateral Products Addressing Opioid Addiction Treatment

TIP 40 Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction BKD500

Quick Guide for Physicians Based on TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction QGPT40

KAP Keys for Physicians Based on TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction KAPT40

TIP 43 Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs BKD524

Quick Guide for Clinicians Based on TIP 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs QGCT43

KAP Keys for Clinicians Based on TIP 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs KAPT43

SAMHSA Resources

To find a substance abuse treatment facility near you, visit the Substance Abuse Treatment Facility Locator at www.findtreatment.samhsa.gov. Call the Substance Abuse and Mental Health Services Administration Substance Abuse Treatment Hotline at 800–662–HELP for substance abuse treatment referral information.

For More Information About Treatment for Opioid Addiction

Sign up for SAMHSA’s Information Mailing System (SIMS) to receive information about the following topics:

• Grant announcements
• Funding opportunities such as competitive contract announcements
• Prevention materials and publications
• Treatment- and provider-oriented materials and publications
• Research findings and reports
• Announcements of available research data sets
• Policy announcements and materials

To sign up for this free service, use one of the following methods to contact SIMS:

Web: http://sims.health.org
Mail: SAMHSA’s National Clearinghouse for Alcohol and Drug Information (NCADI)
Attn: Mailing List Manager
P.O. Box 2345
Rockville, MD 20847–2345
Phone: 800–729–6686
Fax: 301–468–6433
Attn: Mailing List Manager

Three Ways To Obtain Free Copies of All CSAT Products:

1. Call SAMHSA’s NCADI at 800–729–6686; TDD (hearing impaired) 800–487–4889
2. Visit NCADI’s Web site, www.ncadi.samhsa.gov
3. Access TIPs on line at www.kap.samhsa.gov


Substance Abuse Treatment Advisory

Substance Abuse Treatment Advisory—published on an as-needed basis for treatment providers—was written and produced under contract number 270-04-7049 by the Knowledge Application Program (KAP), a Joint Venture of JBS International, Inc., and The CDM Group, Inc., for the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). The content of this publication does not necessarily reflect the views or policies of SAMHSA or HHS.

Public Domain Notice: All material in this report is in the public domain and may be reproduced or copied without permission; citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication: This publication can be accessed electronically through the Internet at www.kap.samhsa.gov. Additional free print copies can be ordered from SAMHSA’s National Clearinghouse for Alcohol and Drug Information at 800–729–6686.

Recommended Citation: Center for Substance Abuse Treatment. “OxyContin®: Prescription Drug Abuse—2006 Revision.” Substance Abuse Treatment Advisory, Volume 5, Issue 1. Rockville, MD: Substance Abuse and Mental Health Services Administration, April 2006.

DHHS Publication No. (SMA) 06-4138
Substance Abuse and Mental Health Services Administration
Printed 2006

Notes

1. WISC-TV. OxyContin: The Good, The Bad, The Deadly. Broadcast transcript. Madison, WI: WISC-TV, February 14, 2006. www.channel3000.com/health/7013912/detail.html [accessed March 2, 2006].
2. Crane, J.P. Drug use by young raises flag. The Boston Globe, February 5, 2006. www.boston.com/news/local/articles/2006/02/05/drug_use_by_young_raises_flag [accessed March 2, 2006].
3. Hammack, L. Painkiller prescriptions up significantly in region. The Roanoke Times, March 28, 2004. www.roanoke.com/roatimes/news/story164817.html [accessed March 2, 2006].
4. Reuters. Powerful painkillers fueling U.S. crime rate. Redmond, WA: MSNBC.com., March 10, 2005. www.msnbc.msn.com/id/7141313 [accessed March 2, 2006].
5. National Drug Intelligence Center. Intelligence Bulletin: OxyContin Diversion, Availability, and Abuse. Johnstown, PA: National Drug Intelligence Center, U.S. Department of Justice, August 2004. www.usdoj.gov/ndic/pubs10/10550/10550p.pdf [accessed March 3, 2006].
6. National Drug Intelligence Center. Pharmaceuticals. In: National Drug Threat Assessment 2004. Johnstown, PA: National Drug Intelligence Center, U.S. Department of Justice, April 2004. www.usdoj.gov/ndic/pubs8/8731/8731p.pdf [accessed March 3, 2006].
7. National Institute on Drug Abuse (NIDA). NIDA Infofacts: Prescription Pain and Other Medications. Washington, DC: NIDA, National Institutes of Health, 2005. www.drugabuse.gov/infofacts/PainMed.html [accessed March 3, 2006].
8. Fisher, F.B. Interpretation of “aberrant” drug-related behaviors. Journal of American Physicians and Surgeons 9(1):25–28, 2004.
9. Substance Abuse and Mental Health Services Administration (SAMHSA). Emergency Department Trends From the Drug Abuse Warning Network: Final Estimates 1995–2002. DAWN Series D-24. DHHS Publication No. (SMA) 03-3780. Rockville, MD: SAMHSA, 2003. dawninfo.samhsa.gov/old_dawn/pubs_94_02/edpubs/2002final [accessed March 2, 2006].
10. Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series 45. DHHS Publication No. (SMA) 06-4131. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2006.
11. Center for Substance Abuse Treatment. Initial screening, admission procedures, and assessment techniques. In: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Treatment Improvement Protocol (TIP) Series 43. DHHS Publication No. (SMA) 05-4048. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2005, pp. 43–61.

BUSINESS AND PROFESSIONS CODE OF CALIFORNIA

BUSINESS AND PROFESSIONS CODE OF CALIFORNIA
CHAPTER 13. MARRIAGE AND FAMILY THERAPISTS
ARTICLE 1. REGULATION
§4980. NECESSITY OF LICENSE
(a) Many California families and many individual Californians are experiencing difficulty and distress, and are in need of wise, competent, caring, compassionate, and effective counseling in order to enable them to improve and maintain healthy family relationships. Healthy individuals and healthy families and healthy relationships are inherently beneficial and crucial to a healthy society, and are our most precious and valuable natural resource. Marriage and family therapists provide a crucial support for the well-being of the people and the State of California. (b) No person may engage in the practice of marriage and family therapy as defined by Section 4980.02, unless he or she holds a valid license as a marriage and family therapist, or unless he or she is specifically exempted from that requirement, nor may any person advertise himself or herself as performing the services of a marriage, family, child, domestic, or marital consultant, or in any way use these or any similar titles, including the letters “M.F.T.” or “M.F.C.C.,” or other name, word initial, or symbol in connection with or following his or her name to imply that he or she performs these services without a license as provided by this chapter. Persons licensed under Article 4 (commencing with Section 4996) of Chapter 14 of Division 2, or under Chapter 6.6 (commencing with Section 2900) may engage in such practice or advertise that they practice marriage and family therapy but may not advertise that they hold the marriage and family therapist’s license.
§4980.01. CONSTRUCTION WITH OTHER LAWS; NONAPPLICATION TO CERTAIN PROFESSIONALS AND EMPLOYEES
(a) Nothing in this chapter shall be construed to constrict, limit, or withdraw the Medical Practice Act, the Social Work Licensing Law, the Nursing Practice Act, or the Psychology Licensing Act. (b) This chapter shall not apply to any priest, rabbi, or minister of the gospel of any religious denomination when performing counseling services as part of his or her pastoral or professional duties, or to any person who is admitted to practice law in the state, or who is licensed to practice medicine, when providing counseling services as part of his or her professional practice. (c) (1) This chapter shall not apply to an employee working in any of the following settings if his or her work is performed solely under the supervision of the employer: (A) A governmental entity. (B) A school, college, or university. (C) An institution that is both nonprofit and charitable. (2) This chapter shall not apply to a volunteer working in any of the settings described in paragraph (1) if his or her work is performed solely under the supervision of the entity, school, or institution.
10
(d) A marriage and family therapist licensed under this chapter is a licentiate for purposes of paragraph (2) of subdivision (a) of Section 805, and thus is a health care practitioner subject to the provisions of Section 2290.5 pursuant to subdivision (b) of that section. (e) Notwithstanding subdivisions (b) and (c), all persons registered as interns or licensed under this chapter shall not be exempt from this chapter or the jurisdiction of the board
§4980.02. PRACTICE OF MARRIAGE, FAMILY AND CHILD COUNSELING; APPLICATION OF PRINCIPLES AND METHODS
For the purposes of this chapter, the practice of marriage and family therapy shall mean that service performed with individuals, couples, or groups wherein interpersonal relationships are examined for the purpose of achieving more adequate, satisfying, and productive marriage and family adjustments. This practice includes relationship and pre-marriage counseling. The application of marriage and family therapy principles and methods includes, but is not limited to, the use of applied psychotherapeutic techniques, to enable individuals to mature and grow within marriage and the family, the provision of explanations and interpretations of the psychosexual and psychosocial aspects of relationships, and the use, application, and integration of the coursework and training required by Sections 4980.36, 4980.37, and 4980.41.
§4980.03. DEFINITIONS
(a) "Board," as used in this chapter, means the Board of Behavioral Sciences. (b) "Intern," as used in this chapter, means an unlicensed person who has earned his or her master's or doctor's degree qualifying him or her for licensure and is registered with the board. (c) "Trainee," as used in this chapter, means an unlicensed person who is currently enrolled in a master's or doctor's degree program, as specified in Section 4980.36 and 4980.37, that is designed to qualify him or her for licensure under this chapter, and who has completed no less than 12 semester units or 18 quarter units of coursework in any qualifying degree program. (d) "Applicant," as used in this chapter, means an unlicensed person who has completed a master's or doctoral degree program, as specified in Section 4980.36 and 4980.37, and whose application for registration as an intern is pending, or an unlicensed person who has completed the requirements for licensure as specified in this chapter, is no longer registered with the board as an intern, and is currently in the examination process. (e) "Advertise," as used in this chapter, includes, but is not limited to, any public communication, as define din subdivision (a) of Section 651, the issuance of any card, sign, or device to any person, or the causing, permitting, or allowing of any sign or marking on, or in, any building or structure, or in any newspaper or magazine or in any directory, or any printed matter whatsoever, with or without any limiting qualification. Signs within church buildings or notices in church bulletins mailed to a congregation shall not be construed as advertising within the meaning of this chapter. (f) "Experience," as used in this chapter, means experience in interpersonal relationships, psychotherapy, marriage and family therapy, and professional enrichment activities that satisfies the requirement for licensure as a marriage and family therapist pursuant to Section 4980.40. (g) "Supervisor," as used in this chapter, means an individual who meets all of the following requirements:
(1) Has been licensed by a state regulatory agency for at least two years as a marriage and family therapist,
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licensed clinical social worker, licensed psychologist, or licensed physician certified in psychiatry by the American Board of Psychiatry and Neurology. (2) Has not provided therapeutic services to the trainee or intern. (3) Has a current and valid license that is not under suspension or probation. (4) Complies with supervision requirements established by this chapter and by board regulations. (h) "Client centered advocacy," as used in this chapter, includes, but is not limited to, researching, identifying, and accessing resources, or other activities, related to obtaining or providing services and supports for clients or groups of clients receiving psychotherapy or counseling services.
§4980.04. MARRIAGE AND FAMILY THERAPIST ACT
This chapter shall be known and may be cited as the Marriage and Family Therapist Act.
§4980.07. ADMINISTRATION OF CHAPTER
The board shall administer the provisions of this chapter.
§4980.08. LICENSE TITLE NAME CHANGE
(a) The title “licensed marriage, family and child counselor” or “marriage, family and child counselor” is hereby renamed “licensed marriage and family therapist” or “marriage and family therapist,” respectively. Any reference in any statute or regulation to a “licensed marriage, family and child counselor” or “marriage, family and child counselor” shall be deemed a reference to a “licensed marriage and family therapist” or “marriage and family therapist”. (b) Nothing in this section shall be construed to expand or constrict the scope of practice of a person licensed pursuant to this chapter. (c) This section shall become operative July 1, 1999.
§4980.10. ENGAGING IN PRACTICE
A person engages in the practice of marriage and family therapy who performs or offers to perform or holds himself or herself out as able to perform this service for remuneration in any form, including donations.
§4980.30. APPLICATION FOR LICENSE; PAYMENT OF FEE
Except as otherwise provided herein, a person desiring to practice and to advertise the performance of marriage and family therapy services shall apply to the board for a license, pay the license fee required by this chapter, and obtain a license from the board.
§4980.31. DISPLAY OF LICENSE
A licensee shall display his or her license in a conspicuous place in the licensee’s primary place of practice.

LPCC and MFTs

LPCC Track for Pre-Licensed MFTs

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CE Courses for MFT Interns
and LMFTs
In 2009, the Licensed Professional Clinical Counselor licensure law was passed and signed here in California . For already licensed MFTs, grandparenting is available from January 1, 2011 through June 30, 2011. For interns who expect to be licensed before June 30, 2011, they too will have the option to apply for LPCC grandparenting. However, pre-licensed members who wish to obtain their LPCC license, and who are already in the pipeline (but will not be licensed by June 30, 2011) will need to adhere to specific education and experience requirements, as well as take the required licensing examinations.



For those who are outside of the grandparenting timeframe, the required education and experience is reviewed below. However, the specific regulations still need to be drafted by the Board of Behavioral Sciences. For example, can you count any and all supervised hours of experience towards both LPCC and MFT licensure? Will the BBS require national and/or state-developed examinations? Will the BBS allow more than one course to satisfy a particular required core course content area? These types of questions still need to be addressed through regulation, and we will share that information as the regulations evolve. As to the general education and experience required, please see the summary below[i]:





Education Requirements
Experience Requirements



· Masters or doctoral degree that is counseling or psychotherapy in content obtained from an accredited or approved institution containing not less than 48 graduate semester or 72 graduate quarter units of instruction.

· Three semester units or four and one-half quarter units of graduate study in each of following nine (9) areas: counseling and psychotherapeutic theories and techniques; human growth and development; career development; group counseling; assessment, appraisal, and testing of individuals; multicultural counseling; principles of the diagnostic process; research and evaluation; and, law and ethics.[ii] NOTE: An applicant whose degree is deficient in no more than two of the required nine (9) areas of study listed above, may satisfy those deficiencies by successfully completing post-master’s or postdoctoral degree coursework at an accredited or approved institution.

· A minimum of 12 semester units or 18 quarter units of advanced coursework to develop knowledge of specific treatment issues, special populations, application of counseling constructs, assessment and treatment planning, clinical interventions, therapeutic relationships, psychopathology, or other clinical topics.

· Six semester units or nine quarter units of supervised practicum or field study experience.[iii]
· A minimum of 15 contact hours of instruction in alcoholism and other chemical substance abuse dependency.

· A minimum of 10 contact hours of training or coursework in human sexuality.

· A two semester unit or three quarter unit survey course in psychopharmacology (at an accredited or approved institution).

· A minimum of 15 contact hours of instruction in spousal or partner abuse assessment, detection, and intervention strategies.

· A minimum of seven contact hours of training or coursework in child abuse assessment and reporting.

· A minimum of 18 contact hours of instruction in California law and ethics (school coursework may count towards this requirement.)

· A minimum of 10 contact hours of instruction in aging and long-term care.

· A minimum of 15 contact hours of instruction in crisis or trauma counseling.

Social Worker, MFT, LCSW, LPC and Counselor CEUs

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CEU's

CEU's

Main articles: Professional development and Continuing Professional Development
Within the domain of Continuing Education, professional continuing education is a specific learning activity generally characterized by the issuance of a certificate or continuing education units (CEU) for the purpose of documenting attendance at a designated seminar or course of instruction. Licensing bodies in a number of fields impose continuing education requirements on members who hold licenses to practice within a particular profession. These requirements are intended to encourage professionals to expand their knowledge base and stay up-to-date on new developments. Depending on the field, these requirements may be satisfied through college or university coursework, extension courses or conferences and seminars attendance. Although individual professions may have different standards, the most widely accepted standard, developed by the International Association for Continuing Education & Training, is that ten contact hours equals one Continuing Education Unit.

Method and format of continuing education
The method of delivery of continuing education can include traditional types of classroom lectures and laboratories. However, much continuing education makes heavy use of distance learning, which not only includes independent study, but which can include videotaped/CD-ROM material, broadcast programming, online/Internet delivery and online Interactive Courses.

In addition to independent study, the use of conference-type group study, which can include study networks (which can, in many instances, meet together online) as well as different types of seminars/workshops, can be used to facilitate learning. A combination of traditional, distance, and conference-type study, or two of these three types, may be used for a particular continuing education course or program.