The COMPA Bulletin
Volume I, Issue 8 December 6, 2001
Contents:
Holiday Greetings
Holidays are typically a hard time for many, but as we come to the end of 2001, with the images and consequences of the destruction of the Work Trade Center and the deaths of thousands still fresh in our minds, it is difficult to approach this holiday season with much joy and optimisim for the new year. The sadness and grief of those who experienced the loss of a loved one, and the needs of those directly affected continues with little end in sight, and the staff and patients of New York’s methadone treatment programs are no exception. Studies have shown an increase use of alcohol and drugs even amongst the general population, and programs are reporting increased relapses. Many people are also experiencing increased anxiety, depression and a tremendous uncertainty regarding the future, and those who have experienced past trauma and violence are particularly at risk. Many others, and in particular the working poor, have experienced the loss of jobs and income. Budget surpluses have also vanished and cuts are being proposed. And just last week the NYC Human Resources Administration moved to withdraw from the Memorandum of Understanding with OASAS, with the result that the Vocational II initiative will be scaled back by 50% come January, just as programs were beginning to see favorable results.
In spite of these adversities, however, we must not loose sight of the considerable change and progress that occurred within the methadone treatment field during 2001, for with the revision of the Federal Regulations and the move to an accreditation model, methadone treatment has taken a giant leap forward in gaining respectability and joining with mainstream medicine. The challenges ahead are many: adopting a comprehensive service delivery model, integrating methadone treatment into the continuum of care, increasing the involvement of our patients in their treatment as consumers, preparing for accreditation, reducing the stigma experienced by our patients and programs, improving access and capacity, upgrading our physical plants, siting new facilities, reducing patient staff ratios and enhancing staff competencies are but just a few. But we cannot allow ourselves to become overwhelmed or complacent, and as we look ahead to 2002 we must rededicate our efforts to the tasks ahead, and seek to keep up the momentum and build on our success of this past year. On that note, we wish everyone a safe, enjoyable holiday season with friends and loved ones, hope for the restoration of peace and security in the coming year, and look forward to continuing to experience progress and success in addressing the challenges facing our field. Happy Holidays!
Traumatic Moments End, but Reminders Still Linger
From the New York Times, November 6, 2001, By Erica Goode
Elizabeth Bakalar and Zoe Risutto both ran for their lives on the morning of Sept. 11, fleeing their office a few blocks from the World Trade Center. Eight weeks later, they are both surrounded by reminders of what they experienced. For Ms. Bakalar, 24, the memories are brought back by the smell that hits her each weekday as she emerges from the subway, by the tourists who snap pictures of ground zero, by the absence of the pharmacy where she used to shop at lunch. For Ms. Risutto, 28, the most difficult moments come not at work but on a quiet playground in Brooklyn, where her 2-year- old daughter climbs the jungle gym and airplanes fly overhead. "I hear a plane coming and I think, `How can I grab her and where can we go?' " Ms. Risutto said. "I just brace myself. Your limbs turn to jelly. It's the feeling that death is imminent."
Traumatic events achieve their potency by fusing memory and intense emotion. The responses of body and mind — feelings of terror or grief, a rush of stress hormones that sets the heart racing, the senses on full alert, the muscles ready to fight or flee — become inextricably entwined with the recollection of what occurred. The challenge for those who have survived horrifying experiences is to gradually tame the emotional storm aroused by the memories. For most people, emotional equilibrium returns in a period of weeks or months. For others, the struggle can last for years or even a lifetime. But for everyone, said Dr. Robert Pynoos, the director of the trauma psychiatry program at the University of California at Los Angeles, the task can be complicated by reminders — smells, sirens, television images, anniversaries, tall buildings, construction crews, a cry heard outside the window — that, by stimulating memory, turn the clock backward to the time of the trauma. Such reminders, Dr. Pynoos added, are ubiquitous in the aftermath of disasters, both natural and human-made. Their presence may add to people's anxiety and distress and in some cases slow recovery. In New York, he said, "people are now living in a world of reminders." Outside Washington, the Pentagon compels daily remembrance of another attack. And other researchers said the war in Afghanistan, the anthrax attacks at home and the continued warnings of "credible" but unspecified terrorist threats may test the recuperative powers of Americans across the country, especially those closely affected by the terrorist attacks, those with other major stresses in their lives and those who have histories of trauma or psychiatric illnesses. "We are seeing reminders not only of what happened but of how dangerous things are right now," said Dr. Alan Steinberg, a psychologist at the U.C.L.A. trauma program. Yet just as people respond differently to frightening events, the cues that elicit traumatic memories may differ for different people exposed to the same events.
In an as yet unpublished study of Bosnian adolescents, Dr. Christopher Layne, an assistant professor of psychology at Brigham Young University, said he and his colleagues found that the teenagers identified more than 200 sights, sounds and smells that reminded them of their most traumatic experiences during the war. Dr. Pynoos and Dr. Steinberg were collaborators on the study. Some things served as reminders for almost everyone they surveyed: many of the adolescents, for example, had to walk each day by places where large massacres had occurred. In the same way, the site of the World Trade Center is likely to stir disturbing memories for many Americans for decades to come. But in other cases, reminders reported by the teenagers were idiosyncratic: a song playing on the radio, the sound of someone crying, the click of a car starting. "Whenever I see the imprint carved out by an exploded grenade," one girl said, "I imagine how my father must have looked when he died and wonder whether this was the grenade that killed him." Another participant said graffiti recalled the puddles of blood that gathered under a slogan painted on a wall. Still another teenager reported that the whistling of the wind "can bring back memories of many bullets which were flying around me."
In similar fashion, Americans may find that the memories of what they experienced ambush them at unexpected times, while remaining subdued in more expected circumstances. Ms. Risutto, for example, thought going back to the office, as she did a few weeks ago, would overwhelm her with recollections. She thought about people who would no longer be there, like the workers at the World Trade Center who used to stand outside smoking cigarettes, and those who would be, like the man who warned her, after the planes hit, not to go to the West Side Highway, saying it was strewn with body parts. "I felt like returning to work would be like visiting the person who mugged you, going to their home and seeing them," Ms. Risutto said. But after the first day, being there was less difficult than she expected. "There is nothing left at work that I equate with that experience, there are no planes coming over, that neighborhood is a skeleton of what it once was," she said.
In some cases, Dr. Layne said, people may not even be conscious of the link between a traumatic experience and the cue that sets off a flood of memories. One teenager in Bosnia told a school counselor that she always felt sad on rainy days, he said. Only later, in a group therapy session, did the girl realize that she and her family had been driven from their home on a rainy day. It is no accident that the memories associated with a traumatic event can be summoned so vividly. Strong emotions release a flood of stress hormones in the body, including adrenaline and cortisol, said Dr. James L. McGaugh, director of the Center for the Neurobiology of Learning and Memory at the University of California at Irvine. And the presence of high levels of stress hormones, studies by Dr. McGaugh and others have shown, promotes the formation of memories that are long- lasting and easily recalled in the amygdala, a brain structure centrally involved in emotional response. "I know what I was doing the day that Kennedy was shot," Dr. McGaugh said. "I remember what I did the day my father died. And the emotion no doubt played a role in creating the strength of the memory." The images of the planes hitting the World Trade Center, Dr. McGaugh said, also will be remembered forever. Broadcasters should stop showing the images, he said, "because they are just too strong." In fact, researchers have found that the constant replaying of television images of a disaster may impede recovery, especially in children.
In a study of 3,218 middle school and high school students in Oklahoma City, Dr. Betty Pfefferbaum, a psychiatrist at the University of Oklahoma, and her colleagues found that television exposure after the 1995 bombing of the Alfred P. Murrah Federal Building was linked to post-traumatic stress symptoms like nightmares, emotional numbing and irritability seven weeks later. While many people gradually become desensitized to traumatic reminders — Ms. Risutto, for example, said her responses to airplanes and loud noises were slowly diminishing — other people's nervous systems remain hypersensitive, sometimes even after months or years have passed.
Studies by Dr. Roger K. Pitman, an associate professor of psychiatry at Harvard, have shown that people suffering from chronic post-traumatic stress disorder, a condition diagnosed when the symptoms persist for more than three months, showed greater signs of physiological distress while recounting what had happened to them than did people who did not have the disorder.
The antidote to the anxiety imposed by traumatic reminders, experts say, is not to avoid situations that recall the events — a strategy that can make symptoms worse — but to limit exposure when possible. Watching the news on television or reading the newspaper, for example, might be restricted to one hour a day, and avoided just before bedtime. And places that stir upsetting memories — buildings, elevators, airports — may become less anxiety- provoking if a friend or family member is there to offer support.
But the capacity of reminders to plunge people back into distress can make their presence an issue for communities as well as for individuals. Asked if he would attend the memorial service held at ground zero on Oct. 28, for example, a father told a television reporter that the site of his still-missing son's death was the last place he wanted to be. Yet other family members flocked to the service and found comfort in visiting what might prove to be their loved ones' only grave site. At some point, New Yorkers will have to decide how to mark the place where, on a clear, sunny September morning, thousands died. Should new skyscrapers be built? What form should a memorial take? The residents of an Armenian town, Dr. Steinberg of U.C.L.A. said, faced the same question in different form: what should they do with the town clock, which had stopped at 11:41 a.m. on Dec. 7, 1988, the moment when a catastrophic earthquake hit the region, killing 25,000 people and collapsing homes, schools and hospitals? The town was split. Some people wanted the clock to remain as it was, a permanent reminder of what had happened. Others wanted to fix it. For six years, the townspeople talked, and the clock stayed broken. But finally, they decided that the horrors of that day were already burned into their memories. And the hands on the clock began moving forward.
Attacks Hit Low-Pay Jobs the Hardest
From the New York Times, November 6, 2001, by Leslie Eaton and Edward Wyatt
The terrorists who attacked the World Trade Center may have been trying to crush American capitalism and its masters of the universe on Wall Street. But the economic impact of the attack is felling a very different group of people: cooks, cabdrivers, sales clerks and seamstresses.
Workers in traditionally low-wage industries, like restaurants and hotels, retailing and transportation, have been hit hard in the fallout from Sept. 11, according to a new analysis from the New York State Department of Labor. And a report released yesterday by the labor-backed Fiscal Policy Institute forecasts that almost 80,000 people will have lost their jobs by the end of the year and that 60 percent of these positions paid an average of $23,000 a year. That is far below the citywide average salary of roughly $58,000. "The spillover effects hit the retail and service industries very hard in New York City," said James Parrott, the chief economist for the institute. "And those tend to be lower-wage jobs."
The sudden decline in these jobs marks a sea change in the economy since Sept. 11. Earlier this year, while the job market was softening, the losses were concentrated among white-collar workers like dot-com programmers, stockbrokers and advertising executives. Now, they are concentrated among people like Kim Daily. A single mother of two, Ms. Daily worked her way up from a $6-an-hour- job picking up room-service trays to a $15- an-hour job stocking minibars at the World Trade Center Marriott. When the hotel was destroyed on Sept. 11, so was her job. And she has not been able to find another one. It is not for lack of trying; she stood in line for four hours outside a city-sponsored job fair but never even made it in the door. She has been talking to her union, but the only position available so far was so tip-dependent that she worried it would not cover her $700-a-month rent. A job bank had only a few hotel positions, and none paid anywhere near the $25,000 she earned at the Marriott last year. "I don't want to go for less money," she said.
The changed job market raises huge challenges for the city at a time when hundreds of thousands of families have moved off the welfare rolls. The most successful of these former welfare recipients, as well as many newcomers to this country, found jobs at hotels and restaurants, as cleaners at office buildings and as messengers in Lower Manhattan. "Now that the economy has exploded along with the World Trade Center, their prospects of staying in the world of work have diminished," said David R. Jones, president of the Community Service Society of New York, which has been helping workers who lost their jobs after Sept. 11. His group is recommending a government-financed jobs program, he said. "Otherwise, we'll have people sitting on stoops, getting a little check and doing nothing," he said.
How many New Yorkers are unemployed is unclear. In a government survey taken in the week of Sept. 11, in which anyone who worked at all was counted as employed, 223,100 people in New York City were looking for work (after adjustments for seasonal factors). That was an increase of almost 20,000 people in a month. The unemployment rate hit 6.3 percent. The October survey will not be released for several weeks, but its results are included in federal figures, released Friday, that showed a surge in national unemployment, which rose by half a percentage point, to 5.4 percent. Unemployment insurance covers only about a third of unemployed workers, but the number of people applying for benefits in the city has soared. In the last month, an average of 12,745 people a week has applied; a year ago, that figure was 5,616. A special program, Disaster Unemployment Assistance, is supposed to help those who are not eligible for unemployment insurance (usually because they worked part time or were self-employed). But only 2,350 people are now getting those benefits.
Almost 25,000 people told the New York State Department of Labor that they lost their jobs because of the trade center disaster. An analysis of the first 22,000 of those claims found that about 16 percent worked at bars and restaurants, 14 percent worked at hotels and 5 percent worked in air transportation. Only 4 percent worked at Wall Street brokerage firms (many of which simply relocated workers to Midtown or New Jersey). The largest group of people — 21 percent — worked in a category called business services. Many of them were temporary workers, like Lisa Mendes, a single mother who lost her job as an accounting clerk on Sept. 12. In years past, when one temporary job ended, she could pick and choose among the offerings at the agencies. Now, "there's just nothing there," she said. "It's scary." Ms. Mendes is typical of the unemployed in another way — she lives in Brooklyn. The Labor Department analysis found that almost 26 percent of those who said they were jobless because of the twin towers collapse live in Brooklyn; 24 percent live in Queens, and 12 percent live in the Bronx. Just 18 percent live in Manhattan. But Ms. Mendes, who is from Jamaica, is luckier than many of the unemployed because she speaks English and can use a computer. The Consortium for Worker Education, which runs a special program for people unemployed because of the disaster (and has already counseled more than 3,200 of them) has 5,000 jobs in its special job bank. "Most of them are back-office jobs, data entry, word processing, administrative assistants," said Saul Rosen, associate executive director of the group.
Hotel and restaurant employment has been devastated by the destruction of the trade center and the steep drop in tourism that followed. Most restaurants are not unionized, but Local 100 of the Hotel Employees and Restaurant Employees Union, which represents about 6,000 restaurant workers, says that 10 percent of its membership lost jobs immediately after Sept. 11. About 200 of those 600 have since found work, but not necessarily restaurant work. John Haynes has a short-term job at the Immigrant Workers Assistance Alliance, helping undocumented workers. Until Sept. 11, he cooked meals on the 106th floor of the World Trade Center for the 250 employees of Windows on the World. He said he earned $488.80 a week before taxes, or about $25,400 a year, and he lives in public housing in the Bronx. He does not think he will be able to go back into restaurant work, he says. "They are not hiring right now," he said. `So I'm going to go for job training, either in computers or photo imaging."
The tourist and travel drought has hit many businesses in Queens, according to a new report by the Center for an Urban Future, a public policy group. Airline workers, freight forwarders, truckers and limousine drivers are all hurting. Listen to Greg Buttle, who operates valet parking lots at the three major New York area airports: You park at these lots and workers will shuttle you to and from the terminal for about $13 a day plus tax. (They will also wash your car, change the oil, rotate or replace the tires, even pick up your dry cleaning.) Before, he normally had more than 150 cars in the lots; now, there are about 50, he said. Mr. Buttle said he employed 45 people before Sept. 11; now he employs 30. "I tried to make sure that the part-timers who have come in most recently are the first ones to go," he said. "But some of our employees have worked for us for eight or nine years."
For more evidence of the spillover effect, look at Chinatown. Business has plunged at many of the more than 200 sewing shops below Houston Street and at least 20 went out of business in October, said May Chen, a vice president of Unite, the garment workers' union. At least a thousand of her 10,000 members have lost their jobs as stores and clothing companies have canceled orders. Others are working reduced hours. Their job prospects are not good. "Because of the language barrier, sewing is about the only skill they have," said Susan Cowell, another union official. Unite also represents workers at commercial laundries; because of the declines at many restaurants, about 600 of these workers have also been laid off.
With the public's attention riveted to the sad stories of the dead and the heroism of the rescuers, some workers fear that their plights will be ignored. "No one wants to hear our stories," said Asmat M. Ali, a former captain at Windows on the World. "About a busboy or the dishwasher making $250 a week and raising three kids in an apartment in the Bronx or Brooklyn. But 80 percent of the people who worked in the World Trade Center fell in that category."
The Impact of Disaster, Trauma, and Terrorism on Alcohol and Other Drug Use, Abuse and Dependence: An Examination of the Current Literature for New York State Planning
Prepared by Cheryl A. Backus , OASAS, November 28, 2001
This review began at the web site of the National Center for Post-Traumatic Stress Disorders (NCPTSD). In particular, it began with one of the Fact Sheets posted at their site, "Disasters and Substance Abuse or Dependence". This sheet cited literature documenting the aftermath of various large-scale traumatic events, such as the Oklahoma City Bombing, Hurricane Andrew, mass shootings, and earthquakes. This Fact Sheet was a brief review of a small number of studies (8) conducted by a six researchers and highlights mental health disorders (specifically PTSD) rather than alcohol and other drug (AOD) use disorders. This is not surprising since the author of an excellent review of disaster literature (posted on the web after 9-11) states that, "This is an area that overall has not been studied as much as some others." (personal communication, Fran Norris, PhD, November 9, 2001). In fact, in her review Norris (2001) points out that only 25% of published studies even measured health issues, of which a very small percentage measured AOD issues, most of which only measured use. After reviewing the original studies cited in this fact sheet and reviewing other relevant literature, a broader picture emerged of the relationship between AOD and disaster trauma. This relationship may be more complex than can be conveyed succinctly in a fact sheet.
The main issues we address in this short review and response to the NCPTSD cited above are:
Alcohol
In the recent literature review by Norris (September 2001), these studies by North and collegues also found a 1-2% new onset alcohol use disorder. In New York State this would translate into approximately 136,000 to 275,000 new cases of alcohol use disorders.
The research of Smith, et al (1999) compared alcohol use estimates in Oklahoma City and Indianapolis a few months after the 1995 bombing of the Murrah Federal Building and again about a year later in 1996. The results of this study indicated that there was an increased use of alcohol in Oklahoma City at both points in time (5.0% in 1995 and 3.0% in 1996) as compared to the increases found in Indianapolis (2.0% in 1995 and 0.9% in 1996). Increases in the use of alcohol and medications were also documented in a study of German professional firefighters (Wagner, Heinrichs & Ehlert, 1998).
According to the NCPTSD fact sheet cited above, the "…only survivors who used alcohol as a way of coping to a significant degree were those who were suffering from some other psychological disorder", the implication being that alcohol is therefore not a significant problem. A report posted on the web site of the National Institute for Mental Health in January 2001, and updated October 2001, Reliving Trauma: Post-Traumatic Stress Disorder states that alcohol and other drug problems are "not uncommon" in conjunction with PTSD, and that "The likelihood of treatment success is increased when these other conditions are appropriately diagnosed and treated as well." As research has shown, and providers in both the mental health and addictions fields know, dual-disorder individuals are extremely difficult to treat and show very little progress in treatment if both disorders are not addressed clinically. To be effective, treatment of clients with comorbid disorders must involve treatment for both disorders (Brady, 2001; Korn, 2000; NMHA web site Fact Sheets; Pepper, 1991).Thus, regardless of any direct changes in alcohol and other drug use, abuse or dependence, treatment for addiction will play a significant role in the healing process of the state.
Although the treatment of alcohol problems in conjunction with other psychiatric disorders is essential to positive treatment outcomes, studies reviewed in the Fact Sheet present an indication of the sheer magnitude of the problem this population will pose for the providers of AOD services in New York. The percentages of survivors that used alcohol to cope with the aftermath of a disaster ranged from 13% to 40% of those with a post-event psychological disorder. The estimate for a post-event psychological disorder was approximately 1/3. In New York these proportions represent an astounding number of individuals who may need treatment for a psychiatric disorder and who are using alcohol to cope with the aftermath of this disaster. If we restrict our estimates to adult population in New York City and the surrounding suburban area (the areas directly affected by the World Trade Center disaster) then the range of the number of people who may be in need of treatment for a dual-diagnosis would be 375,469 – 1,155,288
A study of Swedish soldiers involved in peacekeeping operations found that soldiers who were heavy drinkers had a higher risk of developing "…psycho-social problems or psychiatric disorders with a delayed onset." (Lundin & Otto, 1996) The Trauma Response Infosheet on the web site of The American Academy of Experts in Traumatic Stress, Inc. also lists substance involvement as a high risk indicator for PTSD.
In the study conducted by North and her colleagues (1999) 4-8 months after the Oklahoma City bombing, it was found that 16% of the survivors in the study used alcohol to cope, including 9% with no post-event mental health disorder. Again, if we restrict our estimates to only those areas that are unequivocally affected by the 9-11 terrorist attacks, we would then expect to see approximately 779,819 people without a psychiatric diagnosis, using alcohol to cope and another 606,528 individuals with a psychiatric disorder who are using alcohol to cope. One may not expect to see many, if any, cases of new abuse or dependence within 6 months following an event. Development of abuse or dependence takes time and starts with problematic use, such as drinking to cope (as seen in Vietnam Veterans, Schnitt & Nocks, 1984).
As the National Center for Post-Traumatic Stress Disorders states in another document on their site, "…alcohol can be serious trouble for the trauma survivor…" and in this instance, the entire population can be considered trauma survivors.
Prescription Drugs
North and her colleagues (1999) found that 40% of the survivors of the Oklahoma City bombing used medication to "cope", including 25% of survivors who did not have a post-event mental health disorder. In the weeks following the fall of the WTC towers, prescription drug sales in New York City rose 25% for anti-anxiety drugs, 17% for anti-depressants and 27.5% for sleep aids (reported by the Associated Press, October 12th 2001). According to NIDA, most of these drugs have a high potential for misuse, and potentially abuse and dependence (NIDA Research Report, Prescription Drugs: Abuse and Addiction, also see Mitka, 2000; Vastag, 2001).
An article posted on the BBC News web site (October 2, 2001) reported interviews with a number of physicians and hospitals across the U.S. concerning patients presenting with increased physical pain after 9-11. According to this report, a definite increase (up to three times higher) in patients’ pain levels was observed, even for those who had been stable on pain medication for years. If this is the case, there is a danger of the misuse of pain medication, a phenomenon already of concern. See the NIDA web site for a discussion of the dangers of potential abuse of oxycontin.
Illicit Drugs
In past studies, there has been little evidence found that illicit drug use disorders are changed following a disaster. However, the research conducted on post-disaster populations has generally had small samples and few have even measured illicit drug use. These factors should lead to caution in anticipating no change in illicit drug use, especially since those with stress and PTSD have been found to increase use of drugs for self-medication (NIDA, 2001;) and for "numbing" (Hoffman & Sasaki, 1997). Also of note is that PTSD is common among substance abusers (Brown, Recupero & Stout, 1995; Cottler, Compton, Mager, Spitznagel & Janca, 1992).
In one area, research on the substance use patterns of Vietnam Veterans, a high comorbidity of substance abuse and dependence, and PTSD has been reliably established--although many of the studies refer to alcohol, not necessarily illicit drugs, when reporting "substance abuse" comorbidity (Hyer, Leach, Boudewyns & Davis, 1991, Kenderdine, Phillips & Scurfield, 1992; Penk et al, 1989a; Penk et al, 1989b; Satel, Becker & Dan, 1993). However, this research does not address the potentially confounding cohort issues, such as that the war occurred during the 60’s and 70’s when drug use was more prevalent among this age cohort and that the war occurred in a part of the world where drugs were readily available. This may restrict these results to the population of Vietnam veterans.
Many studies of substance abuse and PTSD comorbidity find a complex interaction among these disorders within the substance abusing population that will require further research (see for reviews Brown & Wolfe, 1994; Jacobsen, Southwick & Kosten, 2001; Meisler, 1996). For a complete picture of this complex relationship, this research may require very large samples to adequately assess substance abuse disorders among the PTSD diagnosed populations, PTSD disorder among substance abusing populations, the causal direction of the relationship, and whether any of these are moderated by consistent demographic and/or personality factors.
Relapse
One issue rarely addressed in the literature was that of relapse even though the National Institute on Drug Abuse (2001) web site reports that "Many clinicians and addiction medicine specialists suggest that stress is the number one cause of relapse to drug abuse,…" Relapse may be more likely following a disaster such as that experienced on 9/11, or types of drugs used and levels of use may change. Further research following crises must be conducted to provide answers to questions, such as "Do disasters and trauma interfere with the recovery process? Is relapse more likely following a disaster? Are the types of substances used affected by traumatic events? Does the amount of a substance used change?" (Brown & Wolfe, 1994, also call for research addressing these and similar questions.)
Reference List
Disaster Assistance
Disaster Assistance Centers
Disaster assistance is available for those who lost someone in the World Trade Disaster at the NYC Family Assistance Center, located at Pier 94, at 54th Street and 12th Avenue. The Center is open 9 a.m. to 6 p.m., seven days a week (beginning Sunday, October 7, 2001).
Additionally, disaster assistance is available for those living or employed in Lower Manhattan who were affected by the WTC disaster at the FEMA Disaster Assistance Center located at 141 Worth Street. Hours currently are Monday - Friday, 10:00 am to 6:00 pm. On Saturdays, the Center will be open from 10:00 am to 2:00 pm. It will be closed on Sundays.
Family Assistance Center Hotline 646-710-6245
Governor George E. Pataki and Mayor Rudolph W. Giuliani have created the Twin Towers Job Centers to help those displaced or unemployed as a result of the World Trade Center tragedy find temporary or permanent jobs and other benefits. These centers provide job search and employment services: access to phone lines, fax machine, Internet access, resume preparation, and connections to available jobs through job banks.
The centers are at the following locations:
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Twin Towers Job Center - Queens |
Twin Towers Job Center - Lower Manhattan |
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Twin Towers Job Center - Midtown Manhattan |
Twin Towers Job Center - Brooklyn |
1-800-LIFENET
The crisis, information and referral network for emotional and substance abuse problems. Callers will speak to an experienced referral specialist who will listen to the problem, assess the situation, and then provide information and a recommended referral if needed. LIFENET is free and available 24 hours a day. Provided by the Mental Health Association of NYC in collaboration with the NYC Department of Mental Health, Mental Retardation and Alcoholism Services.
OASAS Hotline
1-800-522-5353
JCAHO Perspectives: Special Issue on Emergency Management Planning
The Joint Commission on Accreditation of Health Care Organizations (JCAHO) recently released a special 24-page issue of Perspectives, the Joint Commission's official newsletter, that provides guidance to health care organizations in preparing for terrorists attacks that may involve nuclear, biological, and/or chemical incidents. It also offers lessons learned from hospitals located near the World Trade Center and the Pentagon. As part of this effort, JCAHO is paying particular attention to emergency management planning during its ongoing, onsite evaluations of hospitals and other health care organizations.
Included in this issue is a comprehensive review of what the JCAHO survey process expects of organizations in terms of emergency management plans, a copy of the revised Environment of Care standards (which require that methadone programs ensure emergency dosing capabilities, 24 hour telephone answering capabilities, and accessibility to updates patient rosters and medication dosage logs), guidance on how to use the standards to develop a emergency management plan, and check lists to assist with analyzing program vulnerability and develop emergency management education plans. To read the special issue of Perspectives, go to: http://www.jcrinc.com/perspectivesspecialissue
Dr. Leshner Leaves NIDA
Dr. Alan I. Leshner, Director of the National Institute on Drug Abuse (NIDA) since 1994, was recently appointed chief executive officer of the American Association for the Advancement of Science (AAAS), the world's largest general science organization and publisher of the peer-reviewed journal Science (www.aaas.org). He will officially begin on Dec. 3, 2001
During his tenure at NIDA, Dr. Leshner worked to achieve the Institute's overarching goal of bringing the full power of science to bear on drug abuse by supporting research across a broad range of disciplines and ensuring the rapid and effective dissemination and use of research findings to improve the prevention, treatment, and policy of drug abuse and addiction. Dr. Leshner was particularly active in disseminating the results of the science of drug abuse to both practitioners and the general public.
Dr. Leshner's leadership led to significant advances in the understanding of the effects of drugs on the brain, related health consequences, and new and innovative approaches to prevention and treatment. In 1999, he launched the National Drug Abuse Treatment Clinical Trials Network (CTN) to test the effectiveness of behavioral and pharmacological therapies for drug addiction in real-life settings with diverse populations. The CTN now consists of 14 nodes around the country, including over 100 community-based treatment programs participating in over a dozen treatment research protocols. Most recently, he initiated the launch of the National Drug Abuse Prevention Research System, a multi-disciplinary approach to accelerate research on the causes and prevention of drug use and to foster the adoption of science-based prevention interventions in diverse communities nationwide.
Prior to working at NIDA, Dr. Leshner had been the Deputy Director and Acting Director of the National Institute of Mental Health. He has also worked at the National Science Foundation, where he held a variety of senior positions focusing on basic research in the biological, behavioral and social sciences, and on education. Earlier, Dr. Leshner was on the faculty at Bucknell University and held appointments at the Postgraduate Medical School in Budapest, Hungary, the Wisconsin Regional Primate Research Center and as a Fulbright Scholar in Israel. His research has focused on the biological bases of behavior. He received his undergraduate degree in psychology from Franklin and Marshall College and the M.S. and Ph.D. degrees in physiological psychology from Rutgers University.
UDL Acquired By VistaPharm
VistaPharm, Inc., located in Birmingham Alabama, has acquired UDL Laboratories, including its manufacturing facilities and the marketing rights to Methadone. VistaPharm has also purchased UDL’s existing inventory, which will result in orders continuing to carry the UDL label for the time being. However, orders submitted on Form 222 should immediately reflect VistaPharm as the supplier. Ray Pora and Keven Meisel have also elected to continue with VistaPharm as customer service representatives for the methadone treatment field, so all phone numbers and addresses remain unchanged. Questions may be addressed to Ray or Kevin or programs may contact VistaPharm at info@vistapharm.com.
ABOUT COMPA
The Committee of Methadone Program Administrators of New York State is a not-for-profit coalition representing New York State’s methadone treatment system which serves over 46,000 individuals suffering from opioid addiction and other substance abuse disorders.
Opioid addiction is a chronic, relapsing medical disorder, with serious consequences related to public health and safety. Methadone treatment has proven to be the most effective means of treating this disorder.
COMPA’s mission is to further the treatment of opioid addiction and other substance abuse disorders in order to address the medical, social and psychological consequences of use, prevent the spread of HIV and other infectious diseases, reduce criminal behavior, promote employment and self-sufficiency, and support the return to a healthy and productive lifestyle.
In order to support this mission, COMPA and its member organizations are committed to the promotion and expansion of methadone treatment through education of elected officials, providers, consumers, and the public at large. COMPA advocates for expanded models of service delivery, co-located services and consumer empowerment to provide increased access to treatment. COMPA supports enhanced services, a comprehensive continuum of care, the provision of high quality treatment and ongoing professional staff development. COMPA encourages the involvement of membership in the development of public policy, standards of care, and regulatory oversight.
COMPA Board of Directors
Peter Coleman, NYC Health and Hospitals Corporation, President
Ira Marion, AECOM-Montefiore, Vice President
Johanne Morne, Whitney Young MMTP, Secretary
Richard Woytek, Long Island Jewish MMTP, Treasurer
Herbert Barish, Lower Eastside Service Center
Willard Campbell, Suffolk County Division of Alcohol and Substance Abuse Services
Robert Krauss, Long Beach Hospital MMTP
Robert Sage, A.R.T.C.
Sheila Tierney, Crouse Hospital
Ira Wolfe, St. Luke’s Hospital
COMPA Executive Director
Henry Bartlett
COMPA has established this newsletter to ensure that New York State providers of opioid treatment services have an effective mechanism of communication which facilitates the dissemination of information, encourages dialogue and the adaptation of best practices, promotes staff development and retention, and assists in the effort to reduce stigma. The COMPA Bulletin includes information regarding best practices, research, demonstration projects, accreditation, training opportunities, conferences, and other items of interest to the field and will be distributed via email on a monthly basis.
COMPA encourages readers to submit news, articles, research, and other items of interest for possible inclusion. Submissions should be titled "COMPA Bulletin Submission" and directed to info@compa-ny.org.
Want to receive the COMPA Bulletin directly? Send your email address to us and we will be happy to add your name to our list. Addresses should be titled "Subscription List" and directed to info@compa-ny.org.
Past issues of the COMPA Bulletin are available on our web site www.compa-ny.com.
The COMPA Bulletin is compiled, written and distributed by:
The Committee of Methadone Program Administrators of NYS Inc.
250 Fifth Avenue, Suite 210
New York, N.Y. 10001
518-281-8965
PLEASE COPY AND DISTRIBUTE