DRUG TREATMENT RECONSIDERED:
HARM REDUCTION PERSPECTIVES

The Lindesmith Center is presenting a special seminar series on the
relationship between drug treatment and harm reduction. Harm
reduction services focus on reducing the negative consequences of drug
use among those unwilling or unable to abstain. Traditional drug
services – including methadone maintenance and drug free modalities –
have focused on attaining abstinence from all illicit drugs. Though
the objectives of harm reduction and drug treatment services often
seem at odds with one another, there is increasing evidence in the US
and abroad that they can be successfully integrated. These seminars
will take a new look at drug treatment from a harm reduction
perspective, examining current approaches and asking how the scope of
treatment services can be broadened, how services can become more
accessible, and how they must be altered to achieve harm reduction
goals.

With the exception of presentations on foreign treatment models,
sessions will be structured as discussions between treatment providers
and their patients, patient advocates, and drug users. These special
seminars will run through late-1996, with future subjects including
rapid outpatient heroin detox, controlled drinking therapy, and
research on new developments in methadone provision.

Oral methadone and beyond: Diversified drug prescription in
Switzerland

Andr Seidenberg, MD, a general practitioner and former head of the
ARUD clinic in Zurich, will present a clinical perspective on
diversified drug prescription, based on the experience of the Swiss
heroin maintenance trial. Dr. Seidenberg will discuss the clinical,
pharmacological, and organizational issues surrounding the
prescription of maintenance drugs in addition to, and instead of, oral
methadone. A thirty-minute video on the Zurich drug scene and Swiss
drug policy will precede the oral presentation.

Methadone treatment as part of normal health care: The Amsterdam
experience

Gerrit van Santen, MD, speaks on integrating methadone maintenance
treatment with existing health care services. Since the early 1980s
in Amsterdam, methadone has been provided by primary care doctors,
medical specialists, and hospitals, working in cooperation with
specialized drug clinics. Dr. van Santen, originally a family doctor
and now of the Institute for Public Health for the City of Amsterdam,
is one of the designers and developers of the Amsterdam model.

A harm reduction analysis of traditional drug treatment

Edith Springer, ACSW, is Clinical Director of the New York Peer Aids
Education Coalition (NYPAEC) and a harm reduction trainer. Speaking
from her experience working in the New York City drug treatment system
and as an internationally known harm reduction educator, consultant,
and service provider, she will discuss drug treatment, self-help, and
other interventions for drug users. A panel of NYPAEC peer educators
will join Ms. Springer in articulating the difference between harm
reduction models and moral, criminal, and disease models.

Methadone clinics: An informed critique

Robert Maslansky, MD, Medical Director of the Addiction Rehabilitation
Program, a methadone maintenance treatment program at NYU-Bellevue
Medical Center, will discuss the struggle to provide appropriate,
individualized care within a standard methadone clinic. Joined by
patients from the NYU-Bellevue MMTP, Dr. Maslansky will explore ways
of providing better quality treatment within the constraints of the
often “user unfriendly” methadone treatment system.

Medical maintenance: A doctor’s experience with methadone
prescription

Edwin Salsitz, MD, of Beth Israel Medical Center, will discuss the
prescription of methadone for addiction treatment in a private
practice setting. Dr. Salsitz is one of the few doctors in general
medical practice in the US who has experience with methadone
maintenance in a general practice setting. With a panel of current
medical maintenance patients, discussion will focus on the experience
of medical maintenance and the misconceptions about methadone still
held by many doctors and methadone patients.

How are therapeutic communities changing with changing times?

Dr. Jerome Carroll, Chief Clinical Officer at Project Return, will
talk about the role of the therapeutic community (TC) given changing
client needs and the political and fiscal climate. Project Return
Foundation (PRF) runs one of the four largest therapeutic community
programs in the country. PRF, a multi-human services agency with 17
distinct programs, serves nearly 1,000 men, women, and children daily.
Dr. Carroll, joined by Project Return former client panelists, will
focus discussion on where common ground might be found between harm
reduction and TCs.

Acupuncture treatment modality: Working with prenatal/postpartum
cocaine using women

Nancy Smalls, Coordinator of Maternal Substance abuse Services at
Lincoln Hospital, and Mindy Fullilove, MD, Associate Professor of
Clinical Psychiatry and Public Health, Columbia University, will lead
a panel discussion with cocaine using patients. The panel will focus
on acupuncture treatment, its effects, and its usefulness in treating
symptoms of trauma and post traumatic stress disorder in cocaine using
women. The panel will present the “Lincoln Model” which highlights
harm reduction and a tolerant approach to the recovery process.

Methadone advocacy comes of age: Bringing patients and providers
together

A panel discussion between the most prominent national methadone
patient and methadone provider advocacy groups. Joyce Woods, Stan
Novick, and Hector Maldonado of the National Alliance of Methadone
Advocates (NAMA) and Mark Parrino, President of the American Methadone
Treatment Association (AMTA) will lay out the patient and provider
advocacy agendas, and discuss how their efforts have succeeded, and
where they’ve failed, to meet the needs of methadone patients.

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