3. Substance Abuse and Alcoholism Treatment Services

1) Treatment System
The service system in New York City is large and diverse. In 1999, there were 164 licensed alcoholism and substance abuse treatment service provider organizations in the City, operating 466 different programs. 131 of these programs are funded through contracts with the department. Most are supported through a variety of mechanisms such as state and/or federal funding; third party insurance (inc. Medicaid, Medicare, private insurance, HMO's); self-pay and private fund raising. Treatment programs in the City are licensed by OASAS. They include:

2) SERVICE CATEGORIES
(1) Crisis Service
Crisis service programs (detoxification) manage the treatment of alcohol and/or substance withdrawal, as well as acute disorders associated with alcohol and/or substance use, and are followed by a referral for continued care. Detoxification services are relatively short in duration, typically in the three to five day range. Outpatient medically supervised withdrawal from opiates using methadone may require up to 30 days.
(2) Inpatient Rehabilitation Services
Inpatient rehabilitation services provide intensive management of alcohol and substance dependence symptoms and medical management of physical or mental complications for clients who cannot be effectively served as outpatients. Lengths of stay are primarily in the 20-40 day range.
(3) Residential Services
Residential services assist individuals who suffer from alcohol and substance dependence, who are unable to maintain abstinence or participate in treatment without the structure of a 24-hour/day, 7 day/week residential setting and who are not in need of acute hospital or psychiatric care or inpatient services. Lengths of stay range from an average of four months in a community residential service to up to two years in other residential service categories.
• Intensive and Medically/Psychiatrically Enhanced Residential Services

These services provide a minimum of 40 hours/week of procedures within a therapeutic milieu. Individuals appropriate for this service category include persons unable to comply with treatment outside a 24 hour setting. Clients also have substantial deficits in functional skills or are in need of ongoing management of medical and/or psychiatric problems.
• Community Residential Services

These services provide a structured therapeutic milieu while residents are concurrently enrolled in an outpatient alcohol and/or substance dependence service that offers addiction counseling. Individuals appropriate for this level of care include persons who are homeless or whose living environment is not conducive to recovery and maintaining abstinence.
• Supportive Living Services

These services provide a minimum level of professional support that includes a weekly visit to the site and a weekly contact of the resident by a clinical staff member. Individuals appropriate for this service include persons who require an alcohol-and drug-free residential environment and the peer support of fellow residents to maintain abstinence.
(4) Outpatient Services
Outpatient services assist individuals who suffer from alcohol and substance abuse, their family members and significant others. Outpatient services may be delivered at different levels of intensity based on the severity of the problems. These services may be provided in a free-standing setting, or may be co-located in a variety of other health and human service settings. The length of stay and the intensity of services vary from one category of outpatient services to another. In general, persons are engaged in outpatient treatment up to a year and visits are more frequent earlier in the treatment process, becoming less frequent as treatment progresses.
All outpatient services offer group and individual counseling; linkage with self-help groups; relapse prevention; HIV and other communicable disease education; and family treatment. There are three outpatient service categories:
• Medically Supervised Outpatient Services

This type of service requires that medical staff be part of the multi-disciplinary team and the designation of a Medical Director, which provides for medical oversight and involvement in the provision of outpatient services.
• Outpatient Rehabilitation Services

This service level is designed to serve more chronically affected individuals who have inadequate support systems, and either have substantial deficits in functional skills or have health care needs requiring attention or monitoring by health care staff. These programs provide social and health care services, skill development in accessing community services, activity therapies, information and education about nutritional requirements, and vocational and educational evaluation. Clients initially receive these procedures five days a week for at least four hours per day. There is a richer staff to client ratio for these services compared to other outpatient levels.
• Non-Medically Supervised Outpatient Services

These services do not require the designation of a Medical Director or that medical staff be part of the multi-disciplinary team. Medical oversight or involvement in the provision of services is not required. Services may be provided in a more or less intensive manner as determined by client need.
(5) Methadone Treatment Services
Methadone treatment is a medical service designed to manage heroin addiction. Methadone is administered by prescription, in conjunction with a variety of other rehabilitative assistance services. Methadone treatment is delivered primarily on an ambulatory basis, although some specialized programs deliver services in a residential or prison setting. Rehabilitative assistance includes primary medical care, counseling and support services:
1. Methadone-to-Abstinence utilizes methadone in gradually decreasing doses to the point of abstinence, followed by continued drug-free treatment.
2. Maintenance utilizes methadone administered daily at stabilized doses over an extended period of time.
3. Medically-Supervised Withdrawal is a short-term (not more than 30 days) or long-term (not more than 180 days) protocol that utilizes methadone to alleviate withdrawal symptoms caused by the use of opiates.
(6) Prevention and Education
There are 100 prevention service providers in the City operating 1,137 program units, of which 1,034 are school-based and 103 are community-based. The New York City Board of Education is the largest provider of school-based prevention and intervention programs. In addition, there are alcohol and drug abuse prevention programs in parochial and other private schools. The school, workplace and community are the primary settings where targeted prevention services are delivered.
Prevention and education activities of the Bureau of Alcoholism and Substance Abuse Services include:
• Coordinating "April is Alcoholism and Substance Abuse Awareness Month" activities.
• Providing information about alcohol and other drugs through presentations, consultations, the Bureau's annual plan and informational mailings.
• Sponsoring training sessions for providers and consumers.
(7) Community Participation
Active citizen participation in the planning process is key to user friendly services. In order to plan effectively for client-focused alcoholism and substance abuse services, it is important to gather information and get input from consumers of services, family members, community residents and interested professionals. As part of the Department's overall citizen participation structure, the New York City Federation for Mental Health, Mental Retardation and Alcoholism Services has councils in each of the City's five boroughs that help inform the Bureau and the public about the costs of alcohol and substance abuse and the availability and efficacy of treatment. These advisory bodies work with the Bureau to identify community needs, determine planning priorities, establish necessary inter-program linkages and advocate for effective prevention and treatment efforts. The public is invited to participate in the borough where they live or work.
To find out more about the borough councils and to place your name on the mailing list, call the Bureau at (212) 219-5380, or for borough-specific information, call:
• Bronx Advisory Council on Alcoholism and Substance Abuse: (212) 219-5389
• Brooklyn Committee on Alcoholism: (212) 219-5382
• Manhattan Committee on Alcoholism: (212) 219-5396
• Queens County Council on Alcoholism and Substance Abuse: (212) 219-5382
• Staten Island Committee on Alcoholism and Substance Abuse: (212) 219-5402
3) Getting Help
A variety of professional treatment programs are available for persons with alcohol and substance abuse problems. These services are designed to help individuals move toward a drug-free lifestyle. Programs are staffed by trained clinicians and counselors who can identify the signs and symptoms of possible problems with alcohol or other drugs, assess the type and severity of the problems, explain the options available for intervention or treatment, and assist clients in achieving and maintaining their recovery goals. To arrange help for yourself or someone in need, contact:
• LIFENET @ 1-800-LIFENET (1-800-543-3638) or in Spanish @ 1-877-AYUDESE 1-877-298-3373)
• The Alcoholism Council of New York Help Line @ (212) 252-7022
• NYS Office of Alcoholism and Substance Abuse Services Hot Line @ 1-800-522-5353
• NYC Department of Mental Health, Mental Retardation and Alcoholism Services @ (212) 219-5380
4) Self Help Groups
• Alcoholics Anonymous (Intergroup) @ (212) 647-1680 or (212) 870-3400
• Al-Anon Infocenter @ (212) 254-7320/6 or (800) 344-2666
• Cocaine Anonymous @ (212) 262-2463 (212- COCAINE)
• Narcotics Anonymous @ (212) 929-6262
• Pills Anonymous @ (212) 874-0700
• Tough Love (for parents) @ (212) 713-5056