Center for Substance Abuse Treatment (CSAT) National Advisory Council (NAC) held their meeting open to the public on January 26, 1999.

The meting was chaired by Dr. Westley Clark, Director of CSAT. This was his first NAC meeting. He opened the meeting by welcoming everyone and encouraging NAC members to spread the word that "treatment is available, and treatment leads to recovery." He specifically welcomed the newest member of the NAC, William Moyers, of the Hazelden Foundation, who commented that he was very excited about CSAT’s new Community Recovery Support Program which will help to put a "face on recovery."

Dr. Clark delivered the Director’s Report, describing his vision that CSAT play a central role in bridging the gap between research and treatment. One of his priorities included conducting effectiveness studies on adolescent treatment practices, and he emphasized our lack of knowledge in this area. He expressed great concern about the criminal justice system becoming the principle focus of intervention, leading to stigmatization, especially for young people of color. "Youthful indiscretions will become perpetual labels," he warned, urging that we make sure that young people are not forever stigmatized.

Several CSAT staff changes were mentioned, including the appointment of Warren Hewitt as the HIV/AIDS Coordinator who will lead an AIDS Task Force. Adolfo Mata, the previous HIV/AIDS Coordinator, has left CSAT to serve as Director of Migrant Affairs at the Health Resources and Services Administration.

Presentations were given by CSAT staff on three new major special initiatives:

1. Catherine Nugent gave an overview of the Recovery Community Support Program designed to encourage the recovery community to identify policies and practices that will meet their needs, and to promote having persons in recovery and their families provide a meaningful voice in the shaping of our substance abuse treatment system. CSAT awarded 19 grants to very diverse organizations in its first focused and systematic attempt to reach out to the recovery community.

2. Warren Hewitt gave an update on HIV/AIDS issues, indicating that with an allocation of $16 million of the $156 million dedicated by the President to address the AIDS crisis in minority communities, CSAT had an opportunity to play a key leadership role in this effort. He emphasized the need to redefine and reinvent treatment to address the confluence of substance abuse and infectious diseases, including HIV/AIDS, Hep C, TB and STDs. He stressed the need to identify infected substance abusers, get them into treatment as quickly as possible, and utilize treatment more widely to offer hope and opportunity to infected persons - "to go beyond where we have been."

3. Robert Lubran discussed CSAT’s role in the regulatory reform of methadone and other opioid treatment. CSAT has been pivotal in developing new treatment guidelines and accreditation standards, and is conducting an evaluation of the use of accreditation for methadone/LAAM programs. Working groups are studying physician office-based opioid treatment approaches using buprenorphine or medical maintenance with methadone. Buprenorphine is expected to be approved for use for opioid treatment by the FDA later this year. An afternoon session on buprenorphine issues was conducted for the NAC.

Following some SAMHSA Subcommittee Reports, Dr. Nelba Chavez, the Substance Abuse and Mental Health Services Administration (SAMHSA) Administrator, gave an update on SAMHSA activities. She became most impassioned when discussing the issue of stigma, referring to the criminalization of addictions and mental illness when "we are dealing with a public health issue."

During the Council Roundtable, NAC member Dr. Robert Millman expressed concern over his view that the slogan "Treatment Works" sounded defensive and did not convey a scientifically-based foundation for treatment effectiveness. CSAT Director of Communications, Ivette Torres, explained that CSAT’s strategy is to shift from the "Treatment Works Month" campaign to a focus on "Recovery Month."

Overall, it appears that CSAT and SAMHSA are placing much greater emphasis on "persons in recovery," denouncing stigmatization, and supporting a greater voice for people in recovery. Spread the word!

Westley Clark’s First Day On The Job

Sunday morning, September 27, 1998, H. Westley Clark, M.D., J.D., M.P.H., entered his new role as the Director of the Center for Substance Abuse Treatment with an Opening Plenary Address to the nearly 1,500 participants of the American Methadone Treatment Association Conference in NYC. After thanking Nelba Chavez, Administrator of the Substance Abuse and Mental Health Services Administration, for selecting him for the position, and the CSAT staff for supporting his nomination, he acknowledged Alan Leshner, Director of NIDA and also on the podium, as a "brilliant role model" who he will use as a consultant - "unpaid of course" - in his new job. He described himself as someone who has had "a career in the trenches, as a provider, a researcher, a clinician" - who has watched his "patients struggle with alcohol and drugs of abuse, with domestic violence and child neglect, with criminal careers and brushes with the law, with job problems and joblessness." "I’ve seen them struggle with co-morbid psychiatric and medical problems," he said - "I know first hand that what we do as providers is underappreciated."

Discussing a patient in methadone treatment, Clark asked the question, "What, in the community’s perspective, is the more moral situation - being on methadone, being productive, being a student, being a father, contributing to society, paying taxes - or being off of methadone, dropping out of school, getting into domestic violence conflicts, getting arrested, and consuming taxes. In my mind - the more moral position is assisting the person to increase his level of functioning."

Clark emphasized the need to draw from the research of NIDA and NIAAA to develop and implement "best clinical practices" in the field, and the need for researchers to draw from the experience of practitioners in the field to develop the research agenda. He further underscored his collaborative approach stating: "What we will do, CSAT, is continue to build on what we have been doing in working with all of you, and working with the states, counties, and the politicians."

Clark concluded his address: "I want to thank you for welcoming me - I look forward to working with you." We look forward to working with you, Dr. Clark.

New Report:

BRIDGING THE GAP BETWEEN PRACTICE AND RESEARCH: Forging Partnerships with Community-Based Drug and Alcohol Treatment

Sara Lamb, Merwyn R. Greenlick, and Dennis McCarty, Editors
Committee on Community-Based Drug Treatment
Division of Neuroscience and Behavioral Health
Institute of Medicine

Sponsored by both the Center for Substance Abuse Treatment and the National Institute on Drug Abuse, the Institute of Medicine recently produced a report designed to improve the effectiveness and efficiency of the treatment of addictive disorders in the United States. In the spirit of fostering collaborative relationships between the drug abuse research community and the world of community-based treatment programs, this report analyzes the current status of the linkage between research and practice in the field. The study produced several recommendations:

1. Develop research infrastructure and network of community-based drug treatment organizations (CBOs)
   
2. Research initiative for collaborative studies within CBOs
   
3. Promote university/CBO studies and develop treatment research agenda
   
4. CBO incentives to implement targeted treatments
   
5. Assist states to develop treatment and outcomes monitoring system
   
6. Support services research and cost-effectiveness studies
   
7. Coordinate activities to synthesize research and provide information to payers
   
8. Develop evidence-based treatment recommendations—with broad constituency participation
   
9. Develop public awareness programs to increase demand for proven treatment
   
10. Support pre/post doctoral training for community-based research collaboration
    
11. Provide teaching, supervised clinical experience and CME in addiction treatment—for all  health professions
    
12. Create research training programs for CBO staff through fellowships and other incentives

For more information or to order the full report go to: http://www.nap.edu/readingroom/enter2.cgi?0309065658.html

Good work IOM!

NIDA National Advisory Council on Drug Abuse Meeting, September 16, 1998

Alan Leshner, Ph.D., Director of NIDA, opened the meeting with a few comments. He mentioned a number of staff changes at NIDA - most noteworthy Leshner expressed a sense of great loss over the retirement of Zili Sloboda, Sc.D., Director of the Division of Epidemiology and Prevention Research, who has made a major contribution to NIDA over the years. He discussed NIDA's budget projections, which are favorable, with a projected increase in FY99 of 9.2 to 14.4 percent. He described the growing popularity of NIDA's website and the NIDA fax at 1-888-nih-nida. When asked whether NIDA can give guidance to schools for policies related to student drug use, Leshner responded, "We try very hard not to give any advice that is not based on research," and acknowledged the lack of research on how to address or treat drug use among youth.

June Osborn, M.D., Council Member, gave a presentation on the Physician Leadership Group for National Drug Policy. This group of leading high profile physicians has been formed to give the medical community a greater role in national drug policy, emphasizing treatment and prevention as cost-effective responses to the nation's drug problem. She showed a 17 minute video they have produced to educate political leaders and the public. Leshner commented that the organization of this group "is a very significant event ... the first time the medical community has stood up and challenged the stigma of addiction."

Elliot Postrow, Ph.D., Director of the NIH Division of Molecular and Cellular Mechanisms, Center for Scientific Review, described recent changes in the scientific review process for grant applications. The median score for applications has been re-calibrated from 250 to 300, effectively raising the bar. Wide variation between review committees in scores and percentiles continues to be a problem. Council members expressed concern about anecdotal reports of an increased culture of "meaness and pettiness" of the review committee. They recommended setting up a Council Subcommittee to monitor the review process, which Leshner approved.

Henry Francis, M.D., Director of the NIDA Center for AIDS and Other Medical Consequences of Drug Abuse (CAMCODA), described the goals for this new exciting Center, including becoming the place where the national and international community can come for guidance on dealing with issues relating to the intersection of drug abuse and AIDS and other infectious diseases and health consequences. The Center will also serve as a coordinating point for other related NIH agencies, as well as a source of direct research funding and support.

Robert Lubran, M.S., M.P.A., Acting Director of the CSAT Office of Pharmacologic and Alternative Therapies, described the efforts underway to consider transfer of oversight responsibilities for methadone and other medical treatments for addiction from the FDA to SAMHSA, and the move from heavy regulation to a mix of regulation and accreditation. He described CSAT's pilot methadone accreditation study underway and referred people to the Draft Accreditation Guidlines at CSAT's website.

Barry Hoffer, M.D., Ph.D., Director of the NIDA Division of Intramural Research, described a number of their research initiatives and new hires. Leshner congratulated Hoffer on his recruitment success saying he recruited some of the "best thinkers and researchers," including some "young superstars, or at least near superstars," such as Roy Wise, Ph.D., an expert on reward circuitry in the brain. Hoffer said of young recruit Eric Moolchan, M.D., an expert on nicotine treatment for adolescents, that "even though there is a ban on human cloning, if it were possible to clone him we would."

Andrea Baruchin, Ph.D, Chief of the NIDA Science Policy Branch, and Cathrine Sasek, Ph.D., Science Education Coordinator, gave a dynamic presentation on NIDA's new science education initiatives to improve science education on drug abuse, and spark interest in drug abuse research, especially among minority investigators. The new "Mind Over Matter" series of creative instructional materials is available in print and can be found at NIDA's home webpage They demonstrated a new CD-ROM (ATOD-TV) developed by grantee Danny Wedding, Ph.D. from the Missouri Institute of Mental Health which is an interactive multimedia program focused on neurobiology, prevention and treatment. The demo of the "Wheel of Misfortune" got some laughs and the product has received tremendous reviews. NIDA's new initiative "NIDA Goes to School" will include a mass mailing to all middle schools in the country of the Mind Over Matter series, the ATOD-TV CD and other materials. They are also developing a website for teachers, students and parents which will be launched at the Nov. 21, 1998 CADCA National Leadership Forum. Council member's commented that NIDA's educational slide presentation (also available at their website) is useful not only for students, but can be repackaged for treatment professionals, drug court judges, welfare-to-work folks, union EAPs, etc. Leshner joked that their next initiative will be "NIDA Goes to Court."

Thomas McLellan, Ph.D., Council Member, reported from the Council Treatment Research Subcommittee on their discussions to develop a national Clinical Trials Network. He described the need to transfer promising research-based treatment methods to real world practice settings. Under discussion is the possibility of awarding Cooperative Agreements for clinical trial centers to transfer research to practice settings. Leshner stated that through a "true collaboration" NIDA wants to develop a "stable research infrastructure that will serve both treatment providers and researchers." Funding options are being explored.

Public Comment: The meeting was closed with a few public comments. Jim Callahan and Terry Schultz from the American Society of Addiction Medicine thanked Leshner and NIDA, and singled-out NIDA's Dorynne Czechowicz, M.D., for their important role in preparing the Second Edition of the ASAM Principles of Addiction Medicine - for more information see http://www.asam.org/. Chuck Thomas from the Marijuana Policy Project Foundation accused Leshner and NIDA of not providing marijuana for medical treatment research without going through the FDA approval process. He threatened to "turn up the heat" with a negative smear campaign against Leshner and NIDA. Overall, NIDA seems to be advancing many exciting and outstanding research and educational initiatives - Go NIDA!

These selected notes were prepared by Jeffrey A. Hoffman, Ph.D. for the Drug and Alcohol Treatment and Prevention Global Network .