A Veteran Addiction Researcher Tells All
You have worked for both LA County and the State of California to upgrade the public addiction system. Can you tell us what you were able to accomplish and what proved challenging?
The work in California with the county and the state was focused on two different areas. One area or theme was trying to promote the use of data to guide policy. We were trying to work with counties and the state to look at the data that they collected on who their patients are, what their patients need, which treatments work and for whom. Based on that information, we wanted them to ask the question of how we should expand treatment.
The second theme was how to build a substance abuse treatment workforce and how to build an awareness of substance abuse disorders into the educational system, thus making a better trained and better educated workforce to provide treatment. I think we made progress in terms of the use of data and will continue to expand with the new Affordable Care Act. I believe the data we collected will be used more effectively and become more valuable in the coming years.
Around the treatment workforce issue, I feel less successful. We have not gotten the workforce to the point where the training and the minimal standards for professionals in the addiction workforce are comparable to any other area of healthcare. We still have in California no license for counselors working in substance abuse care. There is still a whole variety of certification bodies that have all kinds of different standards; some of which are so minimal as to be almost laughable. It makes no sense that people with virtually no professional training are providing treatment to people with a life-threatening disorder like addiction. I feel like we haven’t done a good job there and I hope there will be some pressure to upgrade that process in the state of California. At the present time, California is one of only two states in the entire country without a license for people who provide substance abuse counseling, and I think that really is a mistake.
I think this licensing situation contributed greatly to the recent problem we had with the Drug Medi-Cal fraud. I think when you have people working in treatment centers who have no training in ethics and no training in professional standards of behavior, you are much more likely to have fraud and all kind of shenanigans going on that you wouldn’t have if you had a licensed workforce.
As the Co-Director of UCLA Integrated Substance Abuse Programs and Professor-in-Residence at the UCLA Department of Psychiatry, you have experienced the academic difficulties of conducting substance abuse research first-hand. UCLA in particular seems to have been broken down into several fiefdoms of addiction study, rather than one integrated program. Why is this and what can be done to change the system?
UCLA has a long and storied history in addiction research going back to the 1960s when Sidney Cohen was one of the original directors of the National Institute of Mental Health and was one of the people who helped shape the development of the National Institute on Drug Abuse and the National Institute on Alcoholism and Alcohol Abuse. Tom Ungerleider at UCLA did some of the first research on marijuana. Jolly West, the Chair of Psychiatry at UCLA, notoriously did research on LSD that purportedly resulted in the death of an elephant in Oklahoma. He was quite an interesting man.
UCLA is a huge place, and it’s one of the largest public universities in the United States. It has close to fifty thousand students and there is limited campus space. Many of us are scattered around off-campus, and we have offices separated by crowded city miles that make daily integration of our work with each other somewhat challenging. As you start to develop bodies of work, you become specialized and particularly focused on the topic areas that you currently are working on. Your neighbor a mile away may be working on a variation of that work, but he has a whole different angle on it and different kinds of funding.
In the last several years, I think UCLA has tried to pull these different pieces of research closer together. For example, we work with Dr. Edith London, a brain imager at UCLA, and we’ve worked with her for well over a decade. We work with Steve Shoptaw in the Department of Family Medicine and Laura Ray in the Department of Psychology, however, at the end of the day, I work in my offices in Santa Monica and they are doing their work on campus in Westwood. There is a geographical issue that is characteristic of Los Angeles.
We are so spread out that we tend to develop our own little mini-silos of work. There are efforts to promote integration, but it certainly has a ways to go before it will be successful. There is a huge challenge to integrate our substance abuse disorder research with the medical research and the psychiatry research that is going on at the same university. It is a big challenge because the funding streams for research tend to foster the siloing because you tend to stay focused on a specialized area of research where you have access to funding. There is a lot of pressure to stay focused on your area in order to continue to be at the forefront of your field so it often makes lateral work with other groups somewhat challenging.
At this point in your career, about 50% of your time is spent out of the country. You have led addiction research and training projects for the United Nations, the World Health Organization, and the Drosos Foundation, exporting science-based knowledge to many parts of the world. Can you describe the motivation behind this international work?
The primary motivation was curiosity. I came out of school during the Vietnam war, an era when we were doing lots of protesting for peace. I was of a generation that really felt that we could do a better job with the image of America in the world. We wanted to do things that were more positive than invade countries. We didn’t want America to be solely identified by our weapons and uniforms.
One of the things that drew me to doing international work was the idea that if you could contribute useful information in different parts of the world as an American and providing it as a participant along with the local professionals, it may actually help to change the world’s perception of our country. When I first got invited to go to Israel and Palestine, it was right after the Oslo Accords and a lot of it was about building cooperation. The issue that we were talking about with the Israelis and Palestinians was addiction, but really the overarching goal was cooperation. Both the Israelis and the Palestinians had problems with drugs and alcohol that were damaging their respective societies. Since their societies are so intertwined, the question was how could they work together to address these problems. At the end of the day, both the Jews in Israel and the Muslims in Palestine don’t want their children to grow up with addiction problems.
Almost all of the work I have done internationally has been about addiction, but it also has been about building cooperation and fostering a positive image of the United States in relation to this goal in parts of the world where the reputation of our country has not been as popular as it could be.