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Despite the elevation of the opioid crisis in the U.S. to the level of a nationwide public health emergency in 2017, the number of opioid-involved overdose deaths has continued to rise. The impact of the opioid epidemic extends well beyond the tragedy of fatal overdose. Nonfatal overdose can result in brain injury and permanent disability, and research suggests that between 20 and 30 nonfatal overdoses occur for every overdose death. K-12 students affected by opioid abuse in the home face a number of challenges that can interfere with their educational engagement and success. Evidence indicates that children whose parents abuse opioids are at risk of experiencing trauma, school absences, behavioral issues, and even displacement from the home--all factors that can negatively affect educational and socioemotional outcomes. Similarly, research shows that college students who engage in drug use are more likely to experience gaps in enrollment, prolonged time to graduation, failure to graduate, and even lifelong struggles with addiction. Planning teams at K-12 schools and institutions of higher education (IHEs) can specifically address the risk of opioid-related emergencies, including overdose, in their emergency operations plans (EOPs) by including a Threat- and Hazard-Specific Annex for drug overdose. This fact sheet provides information and strategies for addressing opioid overdoses at K-12 schools and IHEs through EOPs and other preparedness activities.

In Pennsylvania, subgrantee Philadelphia Works, Inc. partnered with JEVS Human Services to implement the National Health Emergency (NHE) demonstration grant. JEVS Human Services offers both employment and training services and behavioral health treatment and recovery services. By developing partnerships with behavioral health providers, the workforce system can reduce barriers to accessing employment and training services for people in recovery by providing these services on-site at locations where potential participants already gather and are comfortable. This strategy spotlight highlights an innovative effort, funded through an NHE Dislocated Worker Demonstration Grant to Address the Opioid Crisis to the state of Pennsylvania, to provide employment services in opioid treatment clinics. It is part of a study funded by the U.S. Department of Labor's Chief Evaluation Office, and conducted in collaboration with the Office of Policy Development and Research within the Employment and Training Administration (ETA). The study explores the implementation of the NHE Dislocated Worker Demonstration Grants to Address the Opioid crisis, which six states received in 2018. These grants, funded by ETA's Office of Workforce Investment (OWI), encouraged states to test innovative approaches to address the economic and workforce-related impacts of the opioid epidemic. [This is the first report in a four-part series.]

The Pennsylvania Department of Labor and Industry (L&I) partnered with the Pennsylvania State College of Medicine (Penn State) to create a Project Extension for Community Healthcare Outcomes (ECHO) series for employers. The ECHO model, which originated in the medical field, provides virtual clinics led by expert specialist teams to discuss real-world health cases with community medical providers in underserved areas and work together to develop solutions. Employers seeking to have recovery-friendly workplaces might have questions about how to better support their employees who are recovering from a substance-use disorder. Small- and medium-sized employers, in particular, might not have sufficient capacity or expertise in human resources to address potential issues that can arise. This strategy spotlight highlights an innovative effort, funded through a National Health Emergency (NHE) Dislocated Worker Demonstration Grant to Address the Opioid Crisis, to provide Pennsylvania employers with free expert advice on how to address potential issues and support their employees in recovery. [This is the fourth report of a four-part series. For the third report, "Registered Apprenticeships for Community Health Workers and Dually Certified Peer Recovery Specialist-Community Health Workers," see ED617974.]

Community health workers (CHWs) and peer recovery specialists (PRSs) can play an important role in meeting the health care needs of people with opioid use disorder. Registered apprenticeship programs, an "earn while you learn" approach, can help build a certified workforce of CHWs and PRSs by providing classroom and on-the-job training. Apprenticeship RI, an initiative of Building Futures, develops registered apprenticeships in partnership with the Rhode Island Department of Labor. With funds from the National Health Emergency (NHE) demonstration grant, Building Futures, the subgrantee, worked with two partners to develop registered apprenticeship programs for two occupations that could help address the opioid crisis: CHWs and dually certified PRS-CHWs. This strategy spotlight highlights an innovative effort, funded through an NHE Dislocated Worker Demonstration Grant to Address the Opioid Crisis to the state of Rhode Island, to develop registered apprenticeships for CHWs and dually certified PRS-CHWs. [This is the third report of a four-part series. For the second report, "Adapting Work Readiness Training for People in Recovery," see ED617846.]

The workforce system offers work readiness training through nearly 2,400 American Job Centers (AJCs) nationwide. However, people in recovery can face unique barriers to employment not covered in traditional work readiness curricula. New Hampshire has a work readiness program called WorkReadyNH, which it offered free of charge to customers receiving services through AJCs. Before shifting to a virtual format during the COVID-19 pandemic, WorkReadyNH was offered at community colleges in the state. The program consisted of a 60-hour course offered over a three-week period: it covered soft skills as well as online math and reading tutorials, and included an assessment at the end that enabled participants to earn a National Career Readiness Certificate issued through American College Testing (ACT). This strategy spotlight focuses on an innovative effort, funded through a National Health Emergency (NHE) Dislocated Worker Demonstration Grant to Address the Opioid Crisis to the state of New Hampshire, to adapt work readiness training for people in recovery. [This is the second report of a four-part series. For the first report, "Embedding Employment Services in an Opioid Treatment Facility," see ED617973.]

"Budget of the United States Government, Fiscal Year 2019" contains the Budget Message of the President, information on the President's priorities, and summary tables. 2018 has seen boosted economic growth, the creation of more than two million jobs, and the addition of nearly $5 trillion in new wealth to the stock market. Unemployment is at a 17-year low, wages are rising, and jobs are returning to America. Starting soon, hardworking Americans are going to see increased take home pay because of the massive tax cuts and tax reform legislation that was enacted at the end of last year. President Trump's 2019 Budget builds upon the successes over the past year and rests on the following pillars of reform: (1) Ending wasteful spending; (2) Expanding economic growth and opportunity; (3) Preserving peace through strength; (4) Building the wall, dismantling transnational criminal organizations, and enforcing immigration laws; (5) Rebuilding Infrastructure; (6) Supporting American working families; (7) Protecting veterans; (8) Combating opioid addiction; (9) Fighting high medical drug prices; (10) Moving from welfare to work; (11) More pathways to affordable education and well-paying jobs; and (11) Promoting school choice. [For the 2018 Budget, see ED576938.]

The Office of Juvenile Justice and Delinquency Prevention (OJJDP) invests in mentoring programs and services to help ensure positive outcomes for youth. Successful mentoring relationships have been shown to increase youth's self-esteem, improve academic achievement, and steer them away from delinquency, substance use, and other high-risk behaviors. The Office works with its partners to boost mentor recruitment, enhance mentor-mentee matches, and increase the number of youth who have mentors. From 2017 through the first half of 2021, OJJDP's programs recruited nearly 143,000 new mentors and served more than 971,000 youth nationwide. Diverse populations of youth benefit from OJJDP's mentoring programs, including those impacted by opioids and drug addiction, youth in rural communities, American Indian and Alaska Native youth, children of parents on active military duty, and children of incarcerated parents.

This report addresses the question: "Where do interventions for concerns about substance use fit into the work of schools?" By way of background, we begin by differentiating between use and abuse and briefly summarizing some major issues and data relevant to substance use and treatment of abuse and dependency. And, to highlight the importance of adopting a broad perspective in understanding the causes of substance problems seen at schools, we outline a reciprocal determinist paradigm. Then, given increasing calls for interventions that go beyond basic direct treatment for substance abuse and dependency, a sample of such intervention needs is highlighted. These were chosen because they are likely candidates for school involvement. We follow this with a discussion of the negatives that arise when schools are asked to add interventions in an ad hoc, piecemeal manner and when the interventions are mainly framed in the context of a system of care model. Recognizing that multifaceted nature of youth problems, we outline the need to fit substance use concerns into efforts to move schools forward in establishing a comprehensive, cohesive approach that can more effectively address the range of student problems with which schools are faced. We conclude with a discussion of some key implications for school policy and implementation of innovative practices, including those that are evidence-based. Appended are: (1) Enhancing the Blueprint for School Improvement in the ESEA ["Elementary and Secondary Education Act"] Reauthorization: Moving from a Two to a Three-Component Approach; (2) Frameworks for "Reworking Infrastructure" at School, Feeder Patterns, District Levels, and for School-Community Collaboratives; and (3) Background on Initiatives for Connecting School-Community-Home Resources. (Contains 4 exhibits.)

Preventing and treating inhalant use problems, as well as raising awareness about the dangers of inhalant use, are important ongoing goals of the Substance Abuse and Mental Health Services Administration (SAMHSA). Monitoring trends in inhalant use is vital to assessing policies intended to reduce inhalant use. This issue of "The NSDUH Report" examines trends in the use, dependence or abuse, and initiation of inhalants among adolescents (i.e., youths aged 12 to 17). The National Survey on Drug Use and Health (NSDUH) defines inhalants as "liquids, sprays, and gases that people sniff or inhale to get high or to make them feel good." NSDUH collects data not only about the use of any inhalant, but also about the use of specific types of inhalants. Respondents who used inhalants were asked when they first used them, and responses to this question were used to identify persons who had initiated use in the 12 months before the survey. This report uses data from the 2002 through 2007 NSDUHs. (Contains 2 tables, 2 figures., and 3 endnotes, )

This report presents the 2008 National Drug Control Strategy of the White House Office of National Drug Control Policy. The overarching goal of the President's Strategy is to reduce drug use in America through a balanced approach that focuses on stopping use before it starts, healing America's drug users, and disrupting the market for illegal drugs. Chapter 1 addresses the prevention priority, stopping drug use before it starts, and details efforts to expand and amplify the cultural shift away from drug use, especially among young people. Chapter 2 details efforts to implement the treatment priority, intervening and healing those who have already succumbed to drug use and addiction. Finally, Chapter 3 focuses on U.S. initiatives to disrupt the market for illicit drugs--our supply reduction effort. (Contains 25 figures.)

The Community Reinforcement Approach (CRA) and Community Reinforcement and Family Training (CRAFT) are both highly effective and empirically validated psychosocial approaches to the treatment of addictions whose unique designs may help achieve certain public health objectives. Literature will be reviewed to examine the potential impact of CRA and CRAFT on the dissemination of evidenced-based practice at a public policy level. Through developing relationships with one another, practitioners, social scientists and policy makers may find that they can assist each other in advancing public health through the de-stigmatization of addictions and the promotion of evidence-based practices.

People with alcohol or other drug disease face public and private policies that restrict their access to appropriate health care, employment, and public benefits, discouraging them from seeking treatment, robbing them of hope for recovery, and costing society millions of dollars. Join Together, a project of Boston University School of Public Health, formed a national policy panel in the spring of 2002 to address this discrimination. The panelists developed the two principles and ten recommendations contained in this report, relying principally upon the written and oral testimony which they received. Join Together was assisted in this effort by the American Bar Association's Standing Committee on Substance Abuse, which facilitated the panel's initial hearing at the ABA's Annual Meeting in August 2002. Includes a list of resources and selected readings. (GCP)

Previous research has found that 80 percent of all adults incarcerated for felonies either had regularly used illegal drugs or abused alcohol, been convicted of a drug or alcohol violation, were under the influence of drugs and/or alcohol at the time of their crime, committed a crime to support their habit, or exhibited some combination of these characteristics. The key to reducing crime, the prison population and the enormous associated costs is to reduce the substance abuse among offenders. The Drug Treatment Alternative-to-Prison (DTAP) Program in Brooklyn, New York gives every indication of doing just this with some of the most difficult offenders who have not been convicted of violent crimes. The program is open to addicts who have repeatedly sold drugs, have not been convicted of a violent crime, are willing to engage in treatment and communal living, do not have a history of violence or severe mental disorder, and are facing a mandatory prison sentence. CASA's five-year evaluation of the program reveals the following: DTAP participants have rearrest rates that are 26 percent lower and reconviction rates that are 36 percent lower two years after leaving the program than those of the matched comparison group; participants are 67 percent less likely to return to prison; DTAP graduates had rearrest rates that were 33 percent lower, re conviction rates that were 45 percent lower, and were 87 percent less likely to return to prison; and graduates are three and one-half times likelier to be employed than they were before arrest. DTAP is proposed as a promising example of what law enforcement can do to reduce the number of addicted drug offenders in America's prisons. (Contains 56 references and 3 tables.) (GCP)

The use of tobacco products is one of the most critical health problems facing the country. Through the use of neuroimaging technologies, it is now possible to see some of the changes in brain functioning that occur from smoking. There may be other chemicals in cigarette smoke that contribute to addiction. The improved understanding of addiction, along with the identification of nicotine as an addictive drug, has been instrumental in the development of medications and behavioral management treatments for nicotine addiction. The combination of scientific information and treatment strategies presented in this report provide current knowledge needed for intervention and prevention efforts in the medical and mental health services. (Contains 14 references.) (JDM)

This paper presents the results of a development and psychometric evaluation of the Addiction Counselor Evaluation Scale (ACES), an instrument designed for the evaluation and supervision of entry level Alcoholism and Other Drug Abuse (AODA) counselors based on the Technical Assistance Publication Series (TAP) 21. The domains of the competence of an AODA counselor were delineated by TAP 21, which lists 124 competencies in 4 transdisciplinary foundations and 13 practice dimensions and subdimensions. The use of ACES in training, supervision, and evaluation suggested that there would be a value in using it as both a self evaluation tool and as a supervisor-completed evaluation tool. To evaluate the psychometric properties of the instrument student data and intern and supervisor data were collected. Results indicated strong test-retest and internal reliability for student and intern self evaluations and for supervisor-completed evaluations. Student self evaluations demonstrated construct validity in the form of convergent and discriminate validity. Construct validity for intern self evaluations and supervisor-completed evaluations was also consistent. These results support the use of self ratings and supervisor ratings to evaluate the intern or the training program. In addition, the use of the ACES to structure feedback and discussion of intern performance may enhance the training experience and subsequent competence of AODA counselors. (Author/JDM)

Although substance abuse affects the family, the children of substance abusers suffer the most. When parents are unable to care for their children because of their untreated addiction, the children are at risk for social and health problems that include alcohol and drug use, delinquency, depression, and poor school performance. One approach to supporting families with substance abuse problems involves fostering and establishing collaborative relationships with agencies responsible for child welfare, social services, prevention programs, and mental health organizations. This action kit provides resources and action steps that can be taken to start or further efforts to raise awareness in a community about the effects of substance abuse. It suggests ways to create linkages between the child welfare system and substance abuse prevention and treatment systems. Successful community interventions are described to provide ideas on how to solve problems. A list is included of organizations that treat parents with substance abuse problems and addictions. (JDM)

Although heroin use has decreased in the general population during the last few years, a troubling new trend is emerging. Use is up among school-age children and they are now subject to a popular culture in music and films that glamorizes its use. This trend along with increased availability and purity of heroin has created a major health concern for mental health workers and educators. This publication aims to present the latest research findings about heroin abuse and addiction. It explains about the known health repercussions that extend beyond the user. The health and social consequences of drug abuse in family, educational, and work environments have a devastating impact on society and cost billions of dollars. On a hopeful note, treatment for opiate addiction is more available and is becoming more effective. This publication provides information and guidance for health workers and educators in their preventive efforts in drug education. (Contains 24 references.) (JDM)

This paper was developed as a result of a 1999 conference on substance abuse and learning disabilities. An introductory chapter urges early identification of learning disabilities and appropriate treatment for both problems when they co-exist. The second chapter discusses the differences between learning disabilities and behavioral disorders, the size of the problem of substance abuse in this population, financial and social costs to society, and possible negative outcomes of unnecessary drug treatment of children with learning disabilities. The third chapter examines the question of whether substance abuse leads to learning disabilities and/or behavioral disorders or the reverse. Evidence for the following three theories is reviewed: (1) behavioral effects of learning disabilities are also risk factors for substance abuse; (2) learning disabled children turn to drugs for self medication; and (3) children on psychoactive medication are more likely to believe in the positive effects of drugs. Also examined are the possibilities that behavioral disorders among children lead to parental substance abuse and that learning disabilities and substance abuse are the result of a common cause. The paper urges research with refined diagnostic criteria and greater efforts to inform parents, physicians, teachers, and treatment providers. (Contains approximately 210 references and 101 notes.) (DB)

A national representative survey of primary care physicians (N=648) was conducted to determine how they deal with patients who have substance abuse problems. The survey revealed how physicians identify substance abuse in their patients, what efforts they make to help these patients, and what barriers they find to effective diagnosis and treatment. The most troubling finding of the survey was that 94 percent of the physicians failed to include substance abuse among the five diagnoses they offered when presented with early symptoms of alcohol abuse in an adult patient. Also surveyed were 510 adults currently receiving treatment for substance abuse. Most patients said their physicians did nothing about their substance abuse. These findings add up to an enormous lost opportunity. Substance abuse and addiction are the leading cause of death, disability, and disease in the United States. Primary care physicians have a unique opportunity to intervene to avoid these consequences. To avoid the missed opportunity, this report recommends that medical schools increase training in substance abuse, that primary care physicians screen patients for substance abuse, and that insurers provide for physicians talking to patients about substance abuse. (Contains 3 appendixes, 27 figures, and 30 references.) (JDM)

Hong Kong's Department of Information Services has been producing and systematically airing public service announcements (known as announcements in the public interest, or APIs) on a variety of selected themes such as cleaning up Hong Kong, road safety, crime, drugs, and health issues for over 20 years. The television announcements are shown every day during mandatory time slots within every prime time commercial break period. These announcements represent the most important means by which the Hong Kong government has consistently communicated directly to the public. In carrying out their task of encouraging citizen cooperation with anti-drug efforts, the APIs produce particular characterizations of drug users, potential drug users, and families of those who use drugs. These characterizations are central to the ability of APIs to engage members of their audience and work persuasively. This paper traces the development of depictions of the drug addict in Hong Kong's anti-drug API campaign from its inception in 1976 to the present, illustrating various stages of alteration that this image has undergone. The paper argues that the depiction of drug addicts in the earlier examples was very similar to the historically shameful image of the opium addict, which had been widely circulated throughout earlier decades of the 20th century. It finds that later announcements that make use of other visual and persuasive strategies such as metaphors and testimonials (which allow for some discussion of physical and health effects) do not directly call to mind the history of opium use by the Chinese. Contains 13 references and 2 illustrations. (NKA)