Addiction Treatment for Methamphetamine Users a qualitative by hzd40617


									      Addiction Treatment for Methamphetamine Users:
       a qualitative survey of selected service providers

                                  R. B. Smith, M.A.
                                Robert J. Gallati, M.A.

                                     August 2005

                                 John A. Galea, Chief
                     Epidemiology, Ethnography, and Trend Analysis

Timothy P. Williams                                        Robert S. Ball
Acting Associate Commissioner                              Director, Planning and
Systems/Program Performance                                Applications Development
and Analysis

George E. Pataki                                                       Shari Noonan
Governor                                                        Acting Commissioner
                         Table of Contents

Executive Summary                                                   ii

Introduction                                                        1

Methodology                                                         1

   A. Southern Tier Urban Area Providers                            2
   B. Manhattan Providers                                           9
   C. Long Island Providers                                        16

Conclusion and Discussion                                          17

Appendix A: Telephone Survey Interview Guide                       19

Appendix B: Treatment Programs Participating in Methamphetamine    20
Telephone Survey

                Addiction Treatment for Methamphetamine Users:
                 a qualitative survey of selected service providers

                                    Executive Summary
        In order to obtain qualitative information about methamphetamine users entering
addiction treatment, including information on treatment issues, a telephone survey of program
directors and clinical supervisors was conducted. Treatment providers were selected in three
areas of the state which had experienced increased admissions of methamphetamine users: the
Southern Tier Urban area (Broome, Chemung, Tioga, and Tompkins counties), Manhattan, and
Long Island (Nassau and Suffolk). A semi-structured interview schedule was developed which
addressed the providers experience with methamphetamine patients, including the characteristics
of these patients, how they used the substance, what precipitated treatment entry and any
difficulties experienced in engaging and treating these patients. Interviews were conducted in
April 2005.

       The findings of this survey demonstrate that, while methamphetamine use in New York
State overall appears to be limited, it can have substantial health, social, and criminal justice
impacts on local communities. Given the apparent limited scope of its use, the existing treatment
service system appears to be adequate for responding to methamphetamine problems.
Nevertheless, local chemical dependence prevention and treatment service providers need to be
prepared for potential methamphetamine problems in their communities. The survey findings
demonstrate the response that treatment providers have made to these problems in the Southern
Tier Urban area and in Manhattan.

1. The Southern Tier Urban Area

   •   In the Southern Tier Urban area, seven program directors and clinical supervisors
       completed the interview, representing six different providers serving Broome, Chemung,
       and Tioga counties. (The two providers in Tompkins County could not complete the
       interview because they did not feel they had sufficient experience with methamphetamine
       clients.) Interviews were obtained from one medically-monitored withdrawal crisis
       service unit, two inpatient rehabilitation units, and four outpatient units.
       Methamphetamine users represented between one and 10 percent of admissions to these

   •   Providers indicated that they have experienced an increase in the number of patients
       reporting methamphetamine as their primary, secondary, or tertiary problem substance at
       entry. Providers attributed this increase principally to the fact that most
       methamphetamine users enter treatment through drug court and probation/parole
       referrals. These patients are predominately male, white, in their 20’s, residing in the more
       rural parts of the county, and employed in low wage jobs or unemployed.

   •   Some female methamphetamine users are referred for treatment as well but, more often
       than not, they are likely to enter treatment via social service agencies such as Child
       Protective Services.

   •   Long-time observers indicated that methamphetamine is a substance that has “always
       been around”; but now there are younger, relatively new users in contrast to older cohorts
       of users who have used it on an incidental basis over the years along with a variety of
       other drugs and alcohol. For males, methamphetamine use tends to occur in group
       settings while socializing; for females, use tends to be solitary.

   •   Since most methamphetamine patients are referred by local drug courts or other criminal
       justice sources, it is relatively easy to retain them in treatment and to minimize relapse.
       However, it is more difficult to motivate many of the young, mandated patients who have
       not yet experienced many negative consequences of protracted drug use and want to
       continue their “life style.”

   •   Methamphetamine clients often experience prolonged withdrawal and manifest severe
       paranoia and other mental health problems. Many of these patients are cross-addicted as
       well. In many cases, the potential for relapse is substantial because patients are returning
       to or living in families or households where other methamphetamine users are present.

   •   There is no specific treatment track for methamphetamine users. However, given the
       characteristics of these new, younger users, one provider suggested there should be age-
       specific treatment for 18-23 year-olds who have relatively short-term drug use experience
       and few negative consequences. This provider also suggested that limited economic
       opportunities for these youth contribute to the methamphetamine problem, making its
       production attractive.

2. Manhattan

  •    In Manhattan, four program directors or clinical supervisors completed the interview,
       representing four different providers. Programs included one inpatient medically-
       supervised withdrawal crisis service and three outpatient units. Methamphetamine patients
       represented less than 1 percent of the crisis service admissions and about 5 percent of
       admissions to the three outpatient units.

  •    Nearly all methamphetamine patients at the Manhattan sites were white gay or bisexual
       males ranging in age from 18 to their mid-40s. They are typically college-educated, often
       possessing post-graduate degrees, and had been employed in highly-skilled or professional
       occupations. Many are HIV-positive, often only recently sero-converted.

  •    Except for the crisis service, very few patients were referred from the criminal justice
       system. For the outpatient units, referrals come from a number of sources: from doctors
       who are already treating these patients for HIV; therapists who feel patients would be
       more comfortable talking about their methamphetamine use in a more specialized
       treatment setting; and by word of mouth in the gay community. Other sources included

    referrals from Crystal Meth Anonymous; from advertising in local specialized
    publications; and from insurance companies directing callers to a treatment program
    providing gay-sensitive services.

•   Methamphetamine is always used in group settings and serves as an important adjunct to
    sexual activity, usually in sex clubs, and, when injected, often involves needle sharing. It
    may be used along with other drugs including marijuana and alcohol, but also with ecstasy
    and “club drugs.”

•   At the point of entering treatment, many methamphetamine users are severely depressed,
    often suicidal. Many have experienced loss of self-esteem, tremendous guilt, and shame
    related to crossing boundaries they had set for themselves regarding their sexual behavior.

•   Programs address basic needs of those presenting for treatment, including nutritional,
    psychological, and medical needs. And, while the treatment approach used is basically
    comparable to what is provided for other drug users, the unique regimen for the
    methamphetamine users in Manhattan is geared to the special problems manifested by this
    sub-population. Generally speaking, the services provided depend on what is learned
    about the individual and the meaning of his or her drug use. For gay methamphetamine
    users, several providers mentioned use of antidepressants, which allows the body to
    recuperate by facilitating sleep. One byproduct of antidepressants, as noted by one
    provider, is the reduction of libido. That same respondent viewed this as a plus, allowing
    her patients time to address what she believed was her patients’ underlying problem of
    “sex addiction.”

•   Two of the three outpatient providers acknowledged the importance of group therapy
    designed specifically for gay men so they can feel comfortable talking about their unique
    situations and the role of drugs. For these users, methamphetamine has become so
    intertwined with their gay lifestyle and identity that their focal concern is the fear of losing
    their social life when they stop using the drug. The popularity of twelve-step groups at the
    three outpatient units may lie in their promise of providing a new, alternative social life
    with those in similar predicaments but without methamphetamine.

3. Long Island

•   On Long Island, none of the five providers identified had sufficient experience with
    methamphetamine patients to complete the survey. (Methamphetamine users were spread
    thinly across many providers in these two counties.)

•   After survey data collection was concluded, information was received about a recent
    influx of methamphetamine users, most of whom were injecting, to a hospital-based,
    outpatient chemical dependency treatment clinic. Corroborative information obtained
    regarding these patients’ characteristics indicated that the lifestyles of these users, many
    of whom were sero-converted, appeared to mirror those of the patients served by the
    Manhattan providers.

                Addiction Treatment for Methamphetamine Users:
                 a qualitative survey of selected service providers

1. Introduction:

Over the past several years there has been increased interest in methamphetamine in New York
State. Law enforcement officials in the southern tier region, encompassing primarily a four-
county area (i.e., Broome, Chemung, Tioga, and Tompkins counties), and in several northern and
central New York counties, have closed numerous methamphetamine laboratories. In New York
City, concern mounted among health officials with regard to the spread of HIV in the gay
community where reports of unsafe sex practices, often linked to crystal methamphetamine use,
rekindled fears of a new epidemic of HIV. And the very recent discovery of a new, drug resistant
strain of HIV has generated added importance to monitoring developments more closely along
with reviewing the capability of treatment providers to respond where appropriate.

In response to these developments, the New York State Office of Alcohol and Substance Abuse
Services (OASAS) convened a work group for the purposes of examining the scope of the
methamphetamine problem in selected areas of the State and developing appropriate prevention
and treatment service responses.

As part of this effort, the Epidemiology, Ethnography, and Trends Analysis (EETA) unit of
OASAS analyzed trends in methamphetamine treatment admissions as well as data obtained
from the 2004 round of Regional Epidemiology Focus Groups that were convened throughout
the State for the purposes of monitoring local substance abuse trends. This report presents the
findings from a recently concluded telephone survey of selected substance abuse treatment
providers in three distinct geographic areas of New York State where an analysis of county-level
data from the OASAS’ Client Data System (CDS) indicated that relatively large numbers of the
methamphetamine users had entered treatment in 2004:

       •   Southern Tier Urban Area (i.e., Broome, Chemung, Tioga, and Tompkins counties);
       •   Manhattan; and
       •   Long Island (i.e., Nassau and Suffolk counties)

The three areas selected were believed to be sufficiently diverse in terms of both socio-
demographics and lifestyle differences so that the types of methamphetamine users presenting
for treatment could be expected to impact local providers in quite different ways.

2. Methodology:

A semi-structured, open-ended telephone interview guide was drafted which addressed the
characteristics of methamphetamine-using patients, provider perceptions regarding changes
observed over time, specific difficulties providers may have experienced in treating these users,
events precipitating treatment entry, and any specific treatment practices or procedures utilized
for methamphetamine users. The interview was expected to take about 20 minutes to complete.

The instrument was finalized after review by OASAS staff and county Local Governmental Unit
(LGU) representatives for the areas targeted. (See Appendix A for a copy of the interview

Providers were selected based on the extent of their experience with treating patients whose
problem substance(s) included methamphetamines. This was determined through analysis of
admission data in combination with recommendations from OASAS field office coordinators.
The survey protocol and program units selected for study were reviewed with county LGUs. (See
Appendix B for a list of participating program units.) Program directors for each selected unit
were asked to designate appropriate staff to complete the interview. The interview guide was
provided to program directors for review and preparation prior to the actual interview. Data
collection was initiated and completed in April 2005.

3. Findings:

A total of 11 interviews were completed. Seven providers were unable to complete the interview
because they did not feel they had sufficient experience with methamphetamine-using patients.
In these cases, only partial information was obtained.

A. Southern Tier Urban Area Providers

Interviews were conducted with seven staff members affiliated with six different treatment
providers in three of the four counties comprising the southern tier urban area. (In Tioga County,
the respondent interviewed served as the Director of Clinical Services for the provider’s two
program units, which were located in towns 20 miles apart.) The interviews included one
chemical dependency crisis unit, two inpatient rehabilitation units, and four outpatient treatment
units. The proportion of methamphetamine-related admissions to all admissions in this area
during 2004 ranged from a low of 1 percent for a Tompkins County outpatient unit to a high of
10 percent for the Tioga County outpatient units. Overall, methamphetamine users represented
about 3 percent of all admissions among the participating treatment providers in the Southern
Tier Urban area. In Tompkins County, the numbers of methamphetamine clients in the two
outpatient units were considered too small by the providers to meaningfully respond to most
questions in the interview guide. However, even in those instances where little information could
be provided based on relatively limited experience with methamphetamine users in their
programs, important corroborative information was obtained from appropriate staff regarding the
characteristics of the few users who entered those programs and the events leading to their
seeking treatment.

1) Perception of Change in Numbers of Methamphetamine Users Seeking Treatment Entry
and Events Precipitating Admission in the Southern Tier Urban Area

Five of the seven respondents interviewed noticed some increase in methamphetamine users
entering treatment. The most dramatic increase noted was reported by the respondent in Tioga
Co., where the most intense police activity in closing methamphetamine laboratories occurred
between 2000 and 2002. The two respondents who reported no increases in methamphetamine
admissions were staff representing Inpatient Rehabilitation units in Broome and Chemung

Counties. In the case of the Chemung provider, the outpatient program spokesperson reported
increases in methamphetamine admissions over the past three years. The one crisis service
provider in Broome Co. reported a gradual increase over the past year and a half. All outpatient
units reported either a slight increase over a two- to three-year period or, in the case of the Tioga
Co. provider, a dramatic increase observed over the last three years.

Most respondents attributed the increases to referrals from the local drug treatment courts in their
counties or from probation and parole referrals. All participating providers contacted in the
southern tier area indicated that they received at least half of all their treatment referrals from
the criminal justice system, with most reporting percentages of 80 percent or higher. Patients
either have cases pending or there is a connection with probation or parole that brings them into
treatment. And, methamphetamine users were even more likely to have been referred from
criminal justice sources. In the case of female methamphetamine users seeking treatment, most
providers indicated that social service referrals, usually local child protective service agencies,
were responsible for generating the pressure to get them to enter treatment. The Tioga County
provider described the treatment entry process there in the following way:

       “We’ve noticed a dramatic increase here. Three years ago we had none
       [Methamphetamine users in treatment]. In the last 2 years we began noticing an
       increase…. There’s more [crystal meth] available in the community…. There is local
       consumption from the labs here as a result of their proximity. So first, the labs are busted.
       The “cooks” are apprehended first, then the users are rounded up as well. Many wind up
       in treatment as a result of referrals from probation, parole, etc. That’s how many get

Another outpatient unit respondent in neighboring Chemung County described it the following

       “There’s been an increase over the last few years. Yes, ever since the legal system started
       sending folks. Eighty percent of all our treatment referrals come by way of the drug
       courts. But more methamphetamine users than other drug users come via the drug
       treatment courts.”

From the vantage point of one working in an inpatient rehabilitation unit at the same provider,
another spokesperson, a long-time observer of local drug use developments, said the following:

       “We’ve been hearing more patients talking about it….their previous experiences with it,
       etc…because it’s all around—housewives, teenagers. But it’s not their primary drug. It’s
       not that there are that many more methamphetamine users really so much as it is that
       there are more labs…. As we go through patient psycho-socials we’re more sensitized to
       paying attention to it than before (but we always asked about it). Methamphetamine is
       something that has kind of always been around…. I hear them talking about where the
       labs are all the time. The primary drugs here are alcohol, then coke, and marijuana. A
       small percentage are using methamphetamine”

2) Socio-demographic and Lifestyle Characteristics of Methamphetamine Users Treated

All southern tier providers described the methamphetamine users they see as predominantly
male; white; in their early 20s; residing in the more rural areas of the county; usually from a
lower class background; possessing a high school diploma or less; employed in low wage jobs if
they’re working at all when they see them in treatment; with many using marijuana and alcohol
as other substances upon entry. Not infrequently there’s a family history of addiction and many
crystal meth users are believed to be cross-addicted (i.e., typically involving alcohol, with
cocaine/marijuana, or, more rarely, with other amphetamines or opiate analgesics). Finally, all
are connected to the criminal justice system upon admission.

A number of long-term observers working in the treatment field in the southern tier indicated
that methamphetamine “has kind of always been around” in the area. They point to the younger,
relatively new users described above as one type but also describe an older cohort of “career,”
multiple-drug or polydrug users in their late 30s to early 40s who have used methamphetamine
off and on in the past, along with a variety of other drugs and alcohol, and have resumed
methamphetamine use more recently with its increased availability and resurgence in popularity.
For this latter cohort of older, long-term users, methamphetamine is part of an array of
substances used along with alcohol.

Generally, the female users seen in treatment are described as in their 20s and 30s; often with
children; also low income and possessing no more than a high school diploma; also residing in
rural areas; and usually having a case open with the local child protective service agency. For
many of the women, methamphetamine was initially viewed as a way to increase energy (i.e.,
become “super moms”) and/or to lose weight rapidly. Initially thinking they could control their
usage, they too subsequently lost control and began experiencing problems which culminated in
intervention by social service agencies such as child protective services. For these new drug-
using women, often their only previous substance use experience involved little more than
alcohol and maybe some marijuana. Other female users were described by respondents as
showing more extensive histories of using crack or cocaine as well as crystal meth depending on
what was available locally.

3) Differences from Other Users Treated and Changes Noted among Methamphetamine
Users admitted over Time

The methamphetamine users are generally viewed as somewhat younger than other drug users in
treatment on average and the providers were unanimous in describing them as exclusively white
males residing in the more rural areas surrounding Binghamton and Elmira. By and large, the
male to female ratio was generally viewed as far greater among crystal meth users than was the
case among other drug users in treatment. The higher proportion of those cross-addicted among
crystal meth users was also mentioned as a characteristic differentiating them from other drug
users in treatment.

With respect to changes noted over time, some say there have been no changes in those they see
in treatment over the past few years. Others mentioned they were seeing the same types of
crystal meth users as before but just more of them. Another respondent said they were now

“seeing more who reported crystal meth as their primary drug whereas before it was indicated as
their secondary or tertiary substance at admission.” And, only in the case of Tioga County did
the respondent indicate that he was beginning to see “more women and couples—the latter of
whom were usually involved in ‘cooking’—among the methamphetamine users coming into
treatment now” than was the case previously. Again, the proximity of the labs in Tioga County
and the way in which users come to the attention of law enforcement and social service agencies
there and are then compelled into treatment are likely responsible for this observation. Other
respondents commented in a more general way on what seemed to them to be the growing
popularity of a drug which has been basically just re-discovered by a new generation that
currently finds it socially acceptable as a new “recreational” drug, and which middle class users
are reportedly beginning to experiment with.

4) Length of Time Using Crystal Meth, Age at Onset, History of Other Drug Use, Modes of
Use, Concurrent Drug Use, Where Obtained, and the Social Contexts of Use

The range of time given for how long crystal meth has been used was described by most
providers as from one to three years. But the two providers who made a distinction between the
young, relatively new users of methamphetamine and an older cohort of “career,” poly-drug
users quite expectably gave different answers depending on which cohort one was talking about.
The older users were seen as having experience with it off and on for decades. The age of onset
was usually given as early 20s. The drug use histories of many of the young, relatively new
methamphetamine users was often described as including little more than alcohol and marijuana.
For those providers who described an older, multiple- or polydrug using cohort as well, a much
broader assortment of other drugs had typically been used, along with alcohol.

Not all respondents could comment on how crystal meth was being used. For those that could
(n=5), three mentioned snorting and smoking with one of these quite adamant in saying no
injection. The remaining includes two who cited injection as well as other modes of use. For the
two respondents indicating injection as a mode of use, both reported that crystal meth use among
the males was used usually in a group situation, “with groups of friends.” Neither could say with
any certainty whether these males shared their needles. Among the females, however, their use
was described as essentially a solitary enterprise. While using methamphetamine, most providers
indicated that alcohol was the one substance used most often concurrently with
methamphetamine, followed by marijuana.

With respect to where crystal methamphetamine was obtained, providers were unanimous in
mentioning local laboratories as the source, with some pointing to home-made, “bathtub”
methamphetamine. Given the large number of lab closures in the area and the close relationship
between the drug courts and local providers, it shouldn’t come as a surprise that many of the
crystal meth users in treatment were either “cooks” themselves or were otherwise involved in
some other way with the manufacturing of methamphetamine. Some indicated that youth have
attempted to access ingredients in an attempt to make it themselves. For the most part,
respondents described the sources as entirely local. As one Chemung County provider described

       “It’s all locally made—some users are making it; some (treatment) referrals are from
       labs—‘cooks’—and all are criminal justice system referrals.”

Or, as described by the Tioga Co respondent:

       “‘bathtub meth’—all locally-made. The lab closures brought some in [to treatment], both
       users and sellers.”

Two Broome County respondents said the following: “It’s from labs in Tioga and the rural parts
of Broome County.” while another claimed that “Crystal meth is all locally made, many [here in
treatment] are connected with manufacturing it.”

And finally, with respect to those youth attempting to make it themselves:

       “…local labs as sole source…. Some youth access ingredients (Sudafed) though and
       might try to get stuff from the internet to try making it. You can’t get pseudo-ephedrine
       over the counter up here. It’s all been pulled from the shelves.”

5) Specific Treatment Difficulties Emerging with Crystal Meth Users compared to Other
Drug Users Treated

With respect to the kinds of specific difficulties probed, very few respondents in the southern tier
area noted any problems of this sort and this was largely attributable to the very manner in which
these predominantly young and relatively new, short-term methamphetamine users came into
treatment—the close working relationship existing between the treatment providers and the drug
courts in this area. As one outpatient unit respondent described it:

       “Given the ways they come here…there’s immediate intervention by the drug courts—
       they respond immediately—it holds them in treatment and they don’t relapse…. Because
       of the drug court leverage we have with them it works better…it reduces recidivism; they
       don’t drop out. The consequences of not attending treatment are great so they always
       report when they should.”

But there are limits to its effectiveness, as one outpatient unit respondent described it:

       “There are no differences in recidivism, really. It’s usually the first time in treatment for
       these younger folks. And since there’s a criminal justice system connection for them,
       dropping out is not an issue. There’s a problem with motivation. It’s almost a lifestyle
       issue among many of the meth users. They’re young and there have not been many
       consequences yet. There seems to be less motivation to change. They’re almost defiant,
       like ‘it’s my right to do what I’m doing—I’m only here because my PO [probation
       officer] made me come here’ kind of attitude. This complicates treatment—becomes hard
       to make an impact. With ‘career’ users there’s a lifetime of consequences already.”

Another outpatient unit respondent, one who also had primarily young, relatively new crystal
meth users, pointed out the limits of outpatient treatment even with forced compliance generated

by having a legal “hook” tying them to treatment and a quick recognition that they indeed had a
drug problem. The difficulty as he saw it was one of returning patients to a family situation
where crystal meth use had become a family affair, not uncommon in this area:

       “There are only a few ‘career’ users here [among those using methamphetamine], in
       contrast to other [drug using] patients. They start using meth recreationally, and then
       become addicted. The women see it as a fast way of dieting, thinking they can control it,
       and then lose control.”

       “The biggest difference between meth users [here] and others is that they come in saying
       ‘I want to get off of this stuff’.… It’s how quickly they recognize they have a problem—
       much sooner than with other users. [But] we have a harder time keeping them clean once
       they get here. You spend so much of your time convincing people they have a problem—
       here, they already know it and want to do something.”

With respect to the problem of getting them to stay clean once in treatment, the same outpatient
unit respondent continued with the following comment:

       “Assessing their situation is important. Where there’s meth use in the family, cousins,
       other family members, relapse is a problem…. [We] have to worry about getting them
       into a halfway house—somewhere where meth is just not around…. There has to be a
       stronger component [for] getting them out of their living situation, to halfway houses if

But apart from the specific treatment difficulties probed in this question, other respondents did
mention some unique problems facing crystal meth users in treatment. For example, the one
crisis unit respondent said the following:

       “They come here in an emergency [directly from Hospital Emergency Rooms]. They
       need medical monitoring: meth withdrawal lasts longer than with crack. The main
       difficulty lies with keeping them focused in the first 3-5 days. Also, its hard keeping them
       clean, especially if not criminal justice system-connected.”

And, according to another outpatient unit respondent:

       “We’ve learned that methamphetamine’s side effects make it more difficult to treat them:
       the paranoia; the prolonged withdrawal; the problems with cross-addiction…. From what
       we’ve seen, methamphetamine is 10 times more addictive than crack or cocaine.
       Everyone has mental health issues. [We] need more mental health screening [for the
       crystal meth users]…. The distinctions between meth versus crack and cocaine—in terms
       of withdrawal alone—meth lasts much longer (lasts 2 months) and it’s more visible—the
       twitching, and there’s more paranoia.”

On mental health screening for methamphetamine users, the Tioga County provider added:

       “There’s a need for more mental health evaluation and more attention paid to dual
       diagnoses—all as a consequence of methamphetamine use.”

6) Other Comments Regarding Meth Users Entering Treatment or Using Any Specific
Treatment for Those with Methamphetamine Abuse Problems?

Responses to this open-ended question resulted in a range of answers. Only a few providers
responded directly to this question regarding specific treatment for methamphetamine users.
Others addressed the age cohort of the young users coming to their attention. Others alluded to
the family history of involvement with methamphetamine use, and even its manufacture at the
home of patients in treatment, and how this interferes with successful outcomes. One, in
acknowledging the patient’s situation at home, focused on the economic underpinnings of
methamphetamine manufacturing in an economically depressed area where the users’ family is
poorly equipped for economic advancement in whatever legitimate opportunity structure still
exists locally.

Several providers make the point regarding the absence of specific treatment approaches for the
crystal methamphetamine users they see in the following ways. According to one inpatient
rehabilitation unit provider:

       “There’s no specific track of treatment for this population (meth users). Most of those
       seen are cross-addicted. The focus has to be on this difficulty.”

Another administrator describes it this way:

       “There’s no special programming for methamphetamine users. Detox is available at the
       hospital. It is available on a scatter bed basis.”

A third stated the following:

       “We’re not doing anything differently with them (i.e., crystal meth users) than with other
       drug users. But because of the drug court leverage we have with them (what we’re doing)
       works better…”

And, finally, a crisis unit coordinator admitted the following:

       “The crisis unit’s services remain basically the same. For methamphetamine users
       coming here from emergency rooms for medical monitoring, sometimes they’re given
       medication to induce sleep.

Other respondents, while acknowledging the absence of any specific treatments for patients with
methamphetamine abuse problems, focused on broader issues facing the particular “age cohort”
of the young users coming to their attention while alluding to their family history of involvement
with methamphetamine use, even its manufacture, at the homes of some patients as well as the
larger picture regarding the economic underpinnings of methamphetamine manufacturing. One
particularly outspoken provider stated the following:

       “We’re not doing anything differently really. We don’t address the 18-23 yr. age group.
       There’s a lack of age-specific treatment for that group…. So, one treatment issue is
       this—there should be “age cohort” specific treatment because of their relatively short-
       term drug use experience and the lack of an accumulation of negative consequences that
       typically accrue only over time. This age group gets crushed—can’t get social services if
       they don’t return home, and what’s at home anyway? ‘Pop is making it—my brother and
       cousins are using it’. The economic underpinnings to this are revealed clearly when you
       see that unemployment and prospects for work are not good for them. Other youth their
       age are moving ahead with their lives—for these young crystal meth users the future is
       bleak. They should be thinking about preparing a future.”

B. Manhattan Providers

When attention is turned to the experiences of Manhattan providers the characteristics of the
crystal methamphetamine users seen in treatment here are entirely different, as is the role
methamphetamine has played in their lifestyle, and, consequently, the ways in which they end up
seeking treatment.

Four interviews were conducted with four different providers—one with the director of a crisis
unit, and three with either the program director or clinical service supervisor for outpatient
service units. The proportion of methamphetamine-related admissions to all admissions for the
four participating providers during 2004 ranged from a low of less than 0.5 percent for the high
volume crisis service unit to about 5 percent for the three outpatient units.

1) Perception of Change in Numbers of Methamphetamine Users Seeking Treatment Entry
and Events Precipitating Admission among Participating Manhattan Providers

All respondents representing the four Manhattan providers, regardless of modality, have noticed
either a gradual or steady increase in the number of admissions reporting methamphetamine use
over the past two to four years. As the director of the outpatient clinic at St. Luke’s/Roosevelt
described it:

       “Yes—over the past 3 to 4 years we’ve seen an increase. We use a urine screen and
       toxicology work-up—have been using the same screen for years. Methamphetamine has
       always been included.”

And, according to the director of another Manhattan clinic:

       “…have seen a steady increase over the past few years—it’s an all gay (and bisexual)
       population. Only occasionally do we see a heterosexual male or a female.”

Finally, the director of clinical services for a long standing social service provider in lower
Manhattan reported the following:

       “We’ve had some—more in our mental health population though…but all are gay males
       here. This (increase) has been over the course of the last 2 years.”

In sharp contrast to the programs treating methamphetamine users upstate, however, all four
Manhattan providers attributed this increase to the consequences of the growing popularity of
crystal meth in segments of the gay community in New York City. And, most importantly,
almost all patients seeking admission in Manhattan were not referred by the criminal justice
system. The sole exception to this rule was the particular crisis service provider selected among
the Manhattan sites. In the case of A.R.E.B.A. Casriel’s inpatient-residential crisis unit, the
director described his clinic’s referral sources in the following manner:

       “We have other sources of referral than criminal justice system connections—maybe
       about 50 percent of all our patients come by way of the criminal justice system. For those
       using methamphetamine here, all have come by way of the prisons (Federal Bureau of
       Prisons).… [They are] serving out their sentences or as part of pre-trial [diversion].The
       one female was an ACS (NYC’s Administration for Children’s Services) referral.”

For the three outpatient providers selected, however, the following responses were more
characteristic of how methamphetamine users having problems with this substance arrived at
their clinics:

       “For the methamphetamine patients, the CJS hook accounts for only about 10 percent
       here. Get a lot of CMA (Crystal Meth Anonymous) referrals and through our
       advertisements in specialized local publications…maybe 60 percent come in this way.
       Also, insurance companies’ ‘1-800’ line where callers are directed to a program that is
       ‘gay-sensitive’; and doctors treating them for their HIV also refer them here.”

Or, for a new, recently funded demonstration grant program at a hospital-based outpatient clinic
at St. Luke’s/Roosevelt—

       “There’s No CJS ‘hook’ among these patients. The males come as a result of referrals
       from their therapists or by word of mouth—don’t feel comfortable talking about their
       meth use in a different type setting. They may be in therapy already elsewhere, get
       referred to this unit, which now specializes in treating gay methamphetamine users.”

Or, more generally, the Greenwich House respondent described the process as follows:

       “Something is ‘pushing’ them into treatment—a therapist, problems at work, a
       relationship perhaps—something has happened, loss is experienced—have to do
       something about it.”

This is in marked contrast to both the kinds of crystal methamphetamine users described in the
southern tier area and the manner in which they enter treatment. In effect, there is rarely any
criminal justice system intervention compelling these crystal methamphetamine users into
treatment at the Manhattan sites. To understand why requires some further description of these

particular users, their socio-demographic characteristics, and the role methamphetamine has
played in their lifestyle.

2) Socio-demographic and Lifestyle Characteristics of Methamphetamine Users Treated

Unlike the methamphetamine users upstate, the Manhattan providers described those they are
treating as almost exclusively white males; with ages ranging from 18 to mid-40s; predominantly
gay but with some bisexuals; college graduates but often with post-graduate training/degrees;
employed full-time as professionals and earning upper-middle to high incomes; with many not
working when they first enter treatment because they are either on leaves of absence or have
been recently fired; with many presently HIV+ and often only recently sero-converted. As one
outpatient provider described the crystal meth users at her clinic:

       “All the gay meth users are white males…occasionally see a hetero male….just got a
       female who’s returned from California. They’re all gay with a mean age of 32 years;
       range from 18 to around 42 years… all white; from middle- to upper-middle class
       background; predominantly college grads with post-graduate training; professionals with
       a professional-level work history and income—though many are not working when
       they first come. Many are HIV+ and are sero-converted.”

Or, as described by the respondent representing another provider,

       “They’re all males; 30s to 40s; white; HIV+; most have had a work history prior to
       contracting AIDS with some working at present; and most are college educated.”

3) Differences from Other Users Treated and Changes Noted among Methamphetamine
Users admitted over Time

When asked to describe differences between the crystal methamphetamine users they see at their
clinics and other patients treated, some differences were noted as follows by all providers:

       “Compared to crack and cocaine users—crack and cocaine users are mixed gay and
       straight. They include some white patients but are mostly black and Latino.”

And, according to a clinician at another outpatient clinic:

       “When compared to cocaine and crack users, meth users tend to be much more social—
       methamphetamine is used in the context of relationships…partying with other people. It’s
       very hard to engage them in treatment because of this—the role methamphetamine plays
       in their social lives.”

When asked about changes noted among the crystal meth users entering treatment over time, two
providers were not able to comment on any changes observed. One outpatient unit director,
however, made the following remark:

       “We’ve been dealing with this since 2001. Now, the ones we see are sicker than before—
       they’re HIV+; all are sero-converted [i.e., become HIV+]. And, along with the hyper-
       sexual activity they’re severely depressed, suicidal, and severely de-hydrated. There are
       tremendous problems with guilt over the extreme forms of sexual activity they’ve
       engaged in—they’ve have crossed lines they had previously drawn for themselves (limits
       to their behavior).”

4) Length of Time Using Crystal Meth, Age at Onset, History of Other Drug Use, Modes of
Use, Concurrent Drug Use, Where Obtained, and the Social Contexts of Use

The four Manhattan providers showed some variation when asked how long patients had been
using methamphetamine. Responses ranged from one to two years; three to four years according
to another provider; with five to ten years reported by a third. Most providers did indicate that
age of onset for methamphetamine use seems to have occurred in their patients’ early 20s to
early 30s. The initiation process was described by one provider as follows:

       “[They’ve used] about 3-4 years. Initially believing they have control—it’s used on
       weekends—in party situations, etc. Then they lose control over it”.

With respect to previous drug use, most providers indicated that the adult gay crystal meth users
they see have histories involving not just alcohol and marijuana but some experience with
cocaine as well. In the case of the one Crisis Unit, where all of the crystal meth users have come
by way of the prisons, the drug use histories were reported to be more extensive.

        Modes of use reported generally covered the full spectrum for the Manhattan patients—
i.e., snorting, smoking, which then moves to injecting, with the last stage involving “topical”
use—rectally, “booty bumping.” Not infrequently, other drugs used concurrently included mostly
alcohol and marijuana, but also ecstasy, GHB and ketamine. One provider noted concurrent use
of benzodiazepines as well. Again, it is important to remember the particular social context of
crystal meth use among the gay users in Manhattan, as distinct from the young males who might
be injecting with “groups of friends” upstate. As one provider described it:

       “other party drugs along with methamphetamine would get used—mostly MJ, drinking,
       ecstasy, possibly using GHB and ketamine also as adjuncts (to partying).”

And, while such use always occurred in a group context, as it did with most of the young male
users described previously upstate, in Manhattan this always seemed to be involved only in
sexual situations. As the three outpatient providers described it:

       “sharing needles (occurs) in a group context…almost always used in group situation—
       never solitary like with heroin—because it’s used in sex clubs—in group situations where
       sexual activity is going on. The sex is often unprotected and many are sero-converted

       “[It’s] used in a group situation. If injecting and ‘bare backing,’ all are contracting AIDS.
       There’s no solitary use with these meth users.”

       “[It’s] used almost entirely in a group situations. It’s not a solitary enterprise. Crystal
       methamphetamine is used always in sexual situations—with benzodiazepines.”

Responses to the question of where crystal methamphetamine was obtained differed considerably
from what was found in the southern tier where numerous laboratories have flourished in largely
rural areas. One provider indicated the following:

       “[They] get it from out West or from Long Island...sometimes through the mail. They’re
       copping over on 8th Ave…over in Chelsea—you can see them there.”

Another reported:

       “All [of it is] home-made/local—‘bathtub meth’…. [They] have found a way to make it
       on a small-scale. It’s made in apartments.”

While a third indicated the following:

       “They make it in a hotel room—don’t need to get it through the mail or from labs”.

5) Specific Treatment Difficulties Emerging with Crystal Meth Users compared to Other
Drug Users Treated

        Some providers confined their responses to the specific probes in the question while
others also provided more general answers that revolved around the gay identity of crystal meth
users or their program’s particular treatment philosophy and how that gets applied to a different
group of drug users. For example, the director of the St. Luke’s-Roosevelt outpatient clinic, one
that has just received New York City Council funding as a demonstration project, indicated the

       “No—we’re doing ok with rates. The program here is designed for a specific target—
       specifically for gay men using crystal methamphetamine. They feel comfortable here—in
       talking about their situations and the role of drugs. They felt awkward talking about it

But the fact that this one program has only recently started to receive funding for services
targeting this special population led the director there to make the following comment:

       “I don’t know where all this will go—may have different responses one year from now if
       you were to talk to me”

The one Manhattan crisis unit, because of its tie with the criminal justice system and thus the
types of crystal meth users it treats, reported few problems with respect to retention, though not
necessarily with relapse.

       “Well, dropping out is not a problem because all are here through criminal justice system
       as I said—they’re serving out their in halfway houses. The one female,
       who came here because of an ACS [Administration for Children’s Services] referral
       remains, but she has relapsed—is using coke now. Probably she didn’t want to go
       through the hassle of getting a steady connection for methamphetamine [here in NYC].”

A more general response regarding treatment difficulties, one directed more to the nature of
those using methamphetamine in the Manhattan treatment population and its importance to
users’ gay lifestyle and identity, was presented as follows:

       “They are resistant to treatment—not eager for it, can’t be touched, etc. They are very
       social. They lose their social life when they stop using meth. The social context is so
       important to them—to who they are, and thus, controlling meth use is so difficult.”

On a more optimistic note, however, the same provider said the following:

       “They seem to want 12-step groups though. It becomes a substitute social life for them
       now—can replace the all-important social life they’ve lost when they stop meth use.”

It’s important to note that two of the three Manhattan outpatient clinic respondents
acknowledged the importance of 12-step groups to the gay methamphetamine users they were
treating. Having lost their social life upon cessation of meth use, a new one can begin to emerge
from their cohort of treatment admissions as they move through treatment in an attempt to
experience life without crystal meth.

Finally, one outpatient clinic director’s response when describing the difficulties of treating
crystal meth users was placed in the context of her program’s philosophy as follows:

       “You have to understand [this] program’s philosophy—how we operate. We’re very
       structured here and the focus here is on the underlying basic needs. Program is centered
       on several aspects of treating the individual. There’s the nutritional aspect, the
       psychological need, and the medical part…. We focus on the basic behaviors in
       understanding the patient. For example, if it’s the ‘sex addiction’ that’s driving the drug
       use, deal with that. ‘If can’t control the sexual urge, methamphetamine use is hard to
       stop…then sex leads back to crystal….’ ‘Have to deal with the loss of self-esteem—and
       the tremendous guilt and shame…because they’ve crossed boundaries,’ limits they once
       set for themselves regarding sexual behavior.”

With regard to retention, dropping out, and the circumstances, that same provider indicated the
following, an observation critical to understanding the role of substance abuse for anyone
entering treatment almost anywhere:

       “..drop out rate among the crystal meth users is about 1 percent. High retention rate—if
       last the first 3 months, only 1 percent drop out [thereafter]. The high retention rate has to
       do with our philosophy here. It’s very structured. Focus on what it is that led them to
       become meth addicts in the first place. Have to engage them in treatment—see what

       needs are met by [their] meth use. Have to find out what holds them. Knowing the
       individual is critical.”

6) Other Comments Regarding Meth Users Entering Treatment or Using Any Specific
Treatment for Those with Methamphetamine Abuse Problems?

Generally, the providers interviewed in Manhattan described their approach in treating crystal
methamphetamine users as basically comparable to what is provided for other drug users in their
programs. However, there were some interesting variations noted in two instances that was not
unexpected given the lifestyle of those being treated for crystal meth use in Manhattan and the
important role methamphetamine had come to play in their socializing.

Three providers mentioned occasional use of anti-depressants in treating methamphetamine
patients. One clinic director described the general use of antidepressants as follows:

       “[We] improve nutrition—but [we] do that for all those entering—whether alcoholics,
       heroin addicts, crack addicts, induce much needed sleep so the body can recover—anti-
       depressants help here…. [They] calm the individual and facilitate sleep. The basic
       services are here; what gets provided depends on what is learned about the individual and
       the meaning of his/her drug use.”

This same clinic director described a clinically important side effect of antidepressants in treating
gay methamphetamine users:

       “[We] use anti-depressants (MAO inhibitors) and medications to help them sleep. Anti-
       depressants have the important benefit of reducing libido in these users...long enough so
       that other basic issues in what’s driving crystal meth use in the first place [i.e., their sex
       addiction] can be dealt with.”

As mentioned earlier, two providers indicated that replacing that all important part of one’s
social life that is often lost with cessation of crystal methamphetamine use among these users can
begin with the treatment cohort itself. However, as one clinician pointed out, there is evidence
that severe damage has occurred in some cases that may not be reversible. As one outpatient
clinician, who also heads that provider’s AIDS Mental Health program,, observed:

       “There’s evidence of brain damage and PTSD [post-traumatic stress syndrome].... The
       withdrawal effects last longer and users have flashbacks that last for years. In the Mental
       Health clinic, we’re seeing MICA [mentally ill chemical abuser] clients that have been
       using methamphetamine as well.”

C. Long Island Providers

Although OASAS data systems indicated that a relatively substantial number of
methamphetamine users were admitted to treatment services in Nassau and Suffolk counties,
these admissions were spread thinly across many providers. County Local Government Units
(LGUs) were asked to identify programs that might have recent experience with at least a few

methamphetamine users who were either enrolled in treatment or had come to the attention of
emergency room medical staff.

1) Suffolk County:

The Suffolk County LGU suggested four providers likely to serve methamphetamine users
seeking emergency help or treatment. Three of the four providers suggested were OASAS-
certified providers; the fourth was the emergency room of a hospital. All four providers
suggested were geographically dispersed within Suffolk County. (See Appendix B.)

The emergency room and medically managed detoxification unit at St Catherine of Siena
Hospital in Smithtown had little information to provide regarding methamphetamine users. At
the inpatient rehabilitation and outpatient units of Eastern Long Island Hospital in Greenport and
Riverhead, the appearance of methamphetamine there was viewed as extremely rare. The
supervisor for outpatient services in Greenport indicated:

       “We get alcohol, marijuana and cocaine with narcotic analgesics fourth or fifth.
       Methamphetamine is very rare and when we do see it, it’s usually that they’ve just
       experimented with it.”

The director of Daytop Village’s adolescent outpatient program in Huntington reported:

       “We’ve had one or two kids with methamphetamine use in the past year. One was living
       with her grandmother [in Suffolk County] for awhile but when she turned 18 she returned
       to Michigan right away—there was no longer any legal hold on her. The other was living
       in Texas, visiting here for a month, and then went back to Colorado.”

2) Nassau County:

In Nassau County, the LGU suggested interviewing the director of their Treatment Intake &
Placement Services (TIPS) Unit. This unit facilitates many chemical dependence treatment
admissions in Nassau County, especially for youth adjudicated as Persons in Need of
Supervision (PINS) and others processed by the courts. The director of the TIPS unit indicated:

       “[We] have only seen 3 cases (through TIPS). Two were youth returning to live with
       parents on Long Island, one was from Colorado and one from California. The third was a
       white male professional who had moved here from Atlanta. He might have been gay.”

The Nassau County LGU also suggested interviewing the director of the methadone treatment
program at Nassau University Hospital, who stated the following:

       “We’ve had 132 admissions in past year—we have ‘quick tox’ [i.e., a drug screen], which
       can detect methamphetamine—but we have seen no positives for methamphetamine.”

After survey data collection was concluded, information was received about methamphetamine
users recently admitted to a hospital-based outpatient program in Manhasset (Nassau County).

Twenty-eight methamphetamine users had been admitted in the past few months, 20 of whom
were reportedly injecting. (In 2004, this program unit had reported only 2 methamphetamine
admissions to the OASAS Client Data System.) Many of these cases were believed to be HIV+
as well. The limited information available suggests that these users may be similar to those
described earlier by the Manhattan providers surveyed.

4. Conclusion and Discussion:

While there was no evidence of any substantive difference in the basic types of services provided
to methamphetamine users in either the Southern Tier Urban area or Manhattan, careful
assessments of differences in these patients’ individual needs and circumstances dictated how the
course of treatment would proceed. Treatment issues that providers faced in the Southern Tier
were somewhat different from those faced by their counterparts in Manhattan; those issues had to
do with differences the characteristics and social circumstances of those presenting for treatment
and the conditions under which they entered treatment, e.g., the referral source.

Problems of cross-addiction were reported more often in the Southern Tier among the
predominantly working class, multiple- or polydrug users, while problems associated with
protracted withdrawal from methamphetamine were reported in Manhattan as well as the
Southern Tier. The appearance of young, relatively new crystal meth users who have not yet
experienced the consequences accompanying long-term substance abuse seems to characterize
many meth users admitted to treatment in the Southern Tier. In contrast, the unique role played
by methamphetamine use in the lives of patients admitted to the Manhattan programs surveyed
was not found in Southern Tier. Co-occurring mental health symptoms resulting from, or related
to, sustained methamphetamine use were reported in both areas.

While only five of the seven providers interviewed in the southern tier could speak to their
patients’ modes of crystal meth use, two indicated that some of their patients were injecting in a
group setting as well as smoking and snorting it. In neither instance, however, could these two
providers say whether needle sharing occurred among injectors. In Manhattan, all four providers
reported injection by some of their predominantly gay patients with two reporting needle sharing.
Thus, the risk for HIV transmission, while far higher among the Manhattan users given the group
context in which crystal meth is used and their involvement in unprotected sexual activity in
group settings, cannot be ruled out among methamphetamine users in the Southern Tier.

Retention in treatment posed little if any problem in the Southern Tier since there was often a
criminal justice system “hook” holding them. Relapse was an issue there, particularly where
family involvement with crystal meth was evident. In contrast, what is holding the Manhattan
patients in treatment has more to do with their recognition of the impact methamphetamine has
had in ruining their lives. Their likelihood of relapse would depend more on dealing with their
underlying behavior that drives crystal meth use and finding alternatives for socializing,
something 12-step groups could possibly offer them.

The findings of this survey demonstrate that, while methamphetamine use in New York State
overall appears to be limited, it can have substantial health, social, and criminal justice impacts
on local communities. Given the apparent limited scope of its use, the existing treatment service

system appears to be adequate for responding to methamphetamine problems. Nevertheless, local
chemical dependence prevention and treatment service providers need to be prepared for
potential methamphetamine problems in their communities. The survey findings demonstrate the
response that treatment providers have made to these problems in the Southern Tier Urban area
and in Manhattan.

                                              Appendix A

Telephone Survey Interview Guide for Local Treatment Providers re: Methamphetamine Users Presenting
for Treatment/Crisis Services

Service Provider’s Name: ________________________________         Date: ______________
                 Position: _______________________________        County: ______________
Program Name:________________________________________             PRU# ______________
Modality/Environment:__________________ Specify Services at Site: ________________________

1. Have you noticed any changes over time in the numbers of methamphetamine users entering your
   program(s)/facility(ies)? (Probe for: info. sources used; are you examining other drugs used by
   enrollees more closely —i.e., methamphetamine?)

2. How would you characterize the socio-demographics of the methamphetamine users at your
   program(s)/facility(ies)? (Probe for: age, gender, race/ethnicity, employment status & income, family
   composition/presence of children, lifestyles—e.g., sexual orientation, bikers, “ravers” etc.)

3. Are there any differences in socio-demographics between those methamphetamine users and other
   drug using admissions to your program(s)/facility(ies)? (Probe for: comparisons with users of other
   stimulants such as cocaine, crack, other stimulants/amphetamines, etc.)

        (a) Any changes noticed over time in the characteristics of those methamphetamine users
            entering your program(s)/facility(ies)?

4. Based on what you’ve seen with these clients, have you formed any impressions about how they use
   methamphetamine? (Probe for: a)How long they’ve been using it? b) Age at onset? c) Any history of
   other drug use? d) Modes of administering methamphetamine—specifically, sniffing, smoking,
   injecting, oral, or “topical” applications? e) Use of other drugs, either singly or in combination with
   methamphetamine? f) Where obtained—i.e., home-made/locally-made vs. California/Mexico as
   sources; internet, etc. g) How much of the use occurs within a group context, which, for injectors,
   may be conducive to needle sharing? How much of the use is solitary?)

5. Have you learned of any specific treatment difficulties that may have emerged re: methamphetamine
   users? How does this compare with others you treat? (Probe for: recidivism, drop-out rate, dropout
   circumstances, when they drop out?)

6. How would you characterize the events precipitating their entry into treatment/crisis services? (Probe
   for: If same as other drug users, how?/ If different, how so?)

7. Any other comments regarding methamphetamine users entering treatment/crisis services? (Probe for:
    Are you using any specific treatment for patients with Methamphetamine abuse problems, i.e. detox,
    group, individual, etc?)

                                                  - 19 -
                                                                       Appendix B

                                   Treatment Programs Participating in Methamphetamine Telephone Survey
                                                     Chemical Dependence                County/         2004 Admissions           Interviews
    Area                   Provider                                                                                                                   Status
                                                              Service                Town or City       Total   “Meth”           Conducted 1
Southern        Fairview Recovery Services, Inc     Crisis: Medically               Broome Co.          1,390      23         Program               complete
Tier Urban                                          Monitored Withdrawal            Binghamton                   (1.7%)       Coordinator
                United Health Services              Inpatient Rehabilitation        Broome Co.           341        9         Coordinator of        complete
                Hospitals, Inc., New Horizons                                       Binghamton                   (2.6%)       Behavioral Health
                Program                                                                                                       Services
                Addiction Center of Broome          Outpatient Services             Broome Co.           354          12      Executive             complete
                County, Inc.                                                        Binghamton                      (3.4%)    Director
                St. Joseph’s Hospital               Inpatient Rehabilitation        Chemung Co.          202           3      Admin. Director       complete
                New Dawn STARS                                                      Elmira                          (1.5%)    & Counselor/
                                                    Outpatient Services             Chemung Co.          404          10      Counselor/            complete
                                                                                    Elmira                          (2.5%)    Nursing
                Tioga County Community              Outpatient Services             Tioga Co. 2          241          23      Director of           complete
                Services Board                                                      Owego &                         (9.5%)    Clinical Services
                Economic Opportunity Program        Outpatient Services             Chemung Co.          196           7      Program Director      complete
                Alcoholism and Drug Rehab Ctr.                                      Elmira                          (3.6%)
                Alcoholism and Drug Council of      Outpatient Services             Tompkins Co.         369           4      Program Director      partial
                Tompkins Co.                                                        Ithaca                          (1.1%)    & Clinical
                                                                                                                              Services Director
                Ithaca Alpha House, Inc., Cayuga    Outpatient Services             Tompkins Co.         374           6      Clinical Director     partial
                Addiction Recovery Services                                         Ithaca                          (1.6%)

  Significant communication and information sharing regarding methamphetamine users in treatment occurred with direct service providers in Tompkins County,
but the numbers of methamphetamine patients were considered too small to meaningfully respond to most interview questions; thus the status of these interviews
is listed as “partial.”
  This interview covered two program units: one in each of the locations specified. Admission data for the two program units is combined.

providersurvey2005.doc                                                         20
                                       Treatment Programs Participating in Methamphetamine Telephone Survey
                                                    Chemical Dependence                County/        2004 Admissions           Interviews
    Area                    Provider                                                                                                                Status
                                                            Service                 Town or City      Total   “Meth”            Conducted 1
Manhattan       A.R.E.B.A. Casriel, Inc.           Crisis: Medically Superv.       New York Co.       2,952      11          Program Director     complete
(New York                                          Withdrawal Inpatient            Manhattan                   (0.4%)
City)           Realization Ctr., Inc.             Outpatient Services             New York Co.       1,060      57          Exec. Director &     complete
                                                                                   Manhattan                    (5%)         CEO
                St. Luke’s/Roosevelt Hospital      Outpatient Services             New York Co.        330       17          Clinic Director      complete
                Center                                                             Manhattan                    (5%)
                Greenwich House., Inc.             Outpatient Services             New York Co.        480       17          Clinic Director      complete
                                                                                   Manhattan                    (4%)
Long            Nassau County Department of        Screening and Placement         Nassau Co.          n/a       n/a         TIPS Unit            partial
Island 2        Drug and Alcohol Addiction         (TIPS Unit)                     East Meadow                               Director
                St. Catherine of Siena Hospital    Emergency Room &                Suffolk Co.          840          0       Unit Director        partial
                                                   Crisis Service (Medically       Smithtown
                                                   Managed Detoxification)
                Daytop Village, Inc.               Outpatient Services             Suffolk Co.          229          0       Clinic Director      partial
                Eastern Long Island Hospital       Inpatient Rehabilitation        Suffolk Co.          417          1       Inpatient Services   partial
                Association                        Outpatient Services             Greenport and                  (0.2%)     Supervisor and
                                                                                   Riverhead            164          0       Outpatient
                                                                                                                             Services Director
                Outreach Development               Intensive Residential           Suffolk Co.          127          1       Program Director     partial
                Corporation                        Services                        Brentwood                      (0.8%)

  Significant communication and information sharing regarding methamphetamine users in treatment occurred with county Local Governmental Unit (LGU) staff
and providers in Nassau and Suffolk counties, but the numbers of such clients were considered too small to meaningfully respond to most interview questions;
thus the status of these interviews is listed as “partial.”
  No programs in either Nassau or Suffolk counties reported more than two or three methamphetamine cases over the past year. The LGU referred us to the
following treatment professionals for relevant information on whatever was known regarding methamphetamine users in treatment.

providersurvey2005.doc                                                        21

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