ATTENTION INTERNET USERS:
DADS WEBSITE PROMOTES PREVENTION, TREATMENT, AND TRAINING INFORMATION
By Charito Abordo, B.S.C.S.
Information Systems Analyst, DADS Administration

Since July 1998, DADS has been operating a website in conjunction with Santa Clara County’s Data Processing Center and as part of the Santa Clara Valley Health & Hospital (HHS) site. As a key resource for information on various DADS services, the site targets all HHS employees; key people at other County agencies; local service-providers and contractors; and anyone else with access to the Internet.

Although the site is in only its second edition, plans are underway to update information every four months. Currently, the site features the following:

• DADS Mission Statement
• "At Your Service" Newsletter
  (highlights various articles)
• Adult Managed Care: Important information about services and how to obtain them through Gateway (1-800-488-9919)
• Frequently Asked Questions
• What’s New? Training Institute: General information, training calendar, and registration form; Non-Alcoholic Beverages
• Other Links

To reach the site, type this address:
http://santaclaracounty.org/dads/index.htm

Through December 1998, there have been 275 "hits" on this site, mostly from universities, military and other governmental agencies, businesses, and non-profit organizations. Please e-mail Charito Abordo ([email protected]) with feedback on what you see and suggestions for future material for the website.

THE BOOZE BLUES
By Suma Singh, M.D.
DADS Staff Physician

Alcohol is a legally available sedative-hypnotic--and one of the oldest drugs of use and abuse. Recent research reveals that alcoholism is a brain disease which is strongly influenced by social and environmental factors. Unlike non-alcoholics, alcoholics are biologically susceptible to alcohol. Alcohol acts on specific areas in the brain to release dopamine, the chemical which produces the euphoria of addictive drugs. In alcoholics, each drink causes chemical changes in the brain which facilitate addiction--a biological phenomenon called "kindling."

Alcohol abuse and alcoholism are relatively common: Up to 40% of patients who see doctors for medical or surgical problems also have alcohol problems. The stereotype of the skid-row alcoholic is misleading, because 95% of alcoholics are not unemployed, homeless, destitute, or criminal. Alcohol use results in $100 billion economic cost in the United States annually.

There are many physical, psychological, and social consequences to alcoholism. Alcohol affects every major organ system in the body and causes problems such as fatty liver and cirrhosis, neurological impairment, malnutrition, immune compromise, heart disease, gastritis, and cancer. It can also worsen anxiety and depression; and can increase aggression, violence, family dysfunction, and vocational impairment.

Alcohol withdrawal syndrome typically develops within 24 hours of the last drink. This includes sweating, rapid pulse, hand tremors, insomnia, nausea, vomiting, anxiety, and agitation. In severe cases, it progresses to seizures and delirium tremens: central nervous system hyperactivity, agitation, delirium, and hallucinations. Moderate to severe withdrawal requires medication to alleviate symptoms and prevent worsening; benzodiazepines are generally the safest and most effective. Some medications may also be helpful in preventing relapse. Naltrexone can decrease alcohol cravings. Disulfiram (Antabuse�) causes a highly aversive reaction if alcohol is taken. This reaction includes warmth, skin flushing, lightheadedness, nausea, severe vomiting, palpitations, and fainting. Antidepressants can help maintain sobriety by treating underlying depression.

Treatment for alcoholism is usually multi-modal, and abstinence is the preferred goal. The intensity of psychological treatment depends on disease severity, ranging from individual and group psychotherapy, behavioral therapy, and family therapy to self-help groups. Most programs also involve family members, to address issues of codependency and family trauma.

Counseling is available in residential, day-treatment, or office-/clinic-based settings. Self-help organizations like Alcoholics Anonymous and Rational Recovery conduct more than 96 thousand groups in 46 countries, and serve more than two million alcoholics.

Alcoholism is not a character flaw or a moral affliction, but rather a complex brain disease which can be successfully treated with a variety of interventions. Once achieved, the commitment to sobriety becomes a lifelong responsibility. Treatment works: Millions of people worldwide now live fuller lives through the recovery process.

PERFORMANCE-BASED CONTRACTING:
A "FEE-FOR-GOOD-SERVICE" SYSTEM
By Christine Kilgore, B.S.

DADS contractors traditionally have been reimbursed based on fixed costs, with little attention paid to performance. Now, however, they’re in the throes of a dramatically new reimbursement system. As of July 1998, 15% of their pay depends on their "quality achievement score"--a measure of operational guidelines and how well clients do when discharged. In time, scores will also take clinical outcomes into account. The new reimbursement system is a major element of the Adult Managed-Care System and an effort to deliver more cost-efficient, high-quality care.

Providers’ scores reflect eleven performance measures each for residential and outpatient treatment services, and eight for detoxification services. DADS’ Quality Improvement Division monitors scores by assessing utilization data that providers routinely enter into DADS’ management information system, and by reviewing treatment plans and other documents in clients’ records. Typically, they look at length of stay in treatment, completion of the treatment/recovery process, and various procedural issues; e.g., one standard for residential treatment is that 90% of clients who stay three days or more will sign an initial treatment plan within nine days of admission.

Providers must achieve certain scores to receive their full 15% of payment, or payment is reduced proportionally. Scores will be measured quarterly and averaged over the year, with payment reconciled at the end. To introduce the process this fiscal year, scores from only the last three quarters will be used.

Providers have been integrally involved in developing the new system. For example, a committee met with a treatment researcher to assess how treatment is delivered, what desired outcomes should be, and how they should be measured. They have also met individually with DADS management to discuss internal changes which must be made to meet new, uniform expectations. For the first time, DADS has measures to define high-quality care--which "raise the bar"--and a reimbursement system based on performance.

COUNTY GETS ON-LINE
HUMAN-SERVICES DIRECTORY
By Marilyn Pitman-Waite, M.A.
Health Ed. Specialist, DADS Prevention Division

If you need services for clients but don’t know what’s available, there will soon be a new County web site for health and human services. In June 1998, the Santa Clara County Board of Supervisors unanimously endorsed the On-line Services Directory Project and allocated $67,000 to jump-start it. The Community Technology Alliance (CTA) is the lead agency both for this project and for a $1.3 million Housing and Urban Development (HUD) federal grant. CTA has already used HUD funds to create a web infrastructure and search engine to provide information to the homeless and other at-risk populations in a nine-county area.

Because the County is the initial funder, County agencies will be the first to put information and referral databases on line. We will then seek other community databases. The result: A searchable, updated listing of every kind of health and human service in the county--for agencies, clients, and the public. This service offers those who wish to create their own directories of more specific services a more comprehensive resource from which to start.

The On-line Services Directory Project has moved from concept to actualization by using County seed-money to hire Carol Hoshizaki, Data Manager. In January, the project applied Packard Foundation planning-grant funds to hire Susan Silveira, Community Research Consultant. This team will contact all known entities with human-resources directories in Santa Clara County for inclusion in the database. To recommend databases that should be included in this site, please call Carol or Susan at CTA (408-437-9171); or Project Co-chairs Judy Kramer (Aide to Supervisor Joe Simitian, 408-299-3540) and Marilyn Waite (DADS Prevention Division, 408-378-6805). You can visit the website at www.baha.org.