|
|||||||
|
|
|
|||||
|
|
|||||||
|
Chemical Dependency Research Working Group |
Literature produced by the Chemical Dependency Research Working Group (CDRWG, formerly the Cocaine/Crack Research Working Group, C/CRWG) is published by the New York State Office of Alcoholism and Substance Abuse Services (OASAS). Resources for literature production and mailing were provided by the Aaron Diamond Foundation, Inc. through a grant to Medical and Health Research Association of New York City, Inc. (MHRA).
For further information about the activities of the Chemical Dependency Research Working Group contact Dr. Herman Joseph at (646) 728-4523.
Opinions contained in this compendium are those of the author(s) and are not necessarily endorsed by the Aaron Diamond Foundation, Medical and Health Research Association of New York City, Inc. (MHRA), or the New York State Office of Alcoholism and Substance Abuse Services (OASAS).
The primary purpose of the Chemical Dependency Research Working Group (CDRWG) is to encourage collaborative research by institutions and to bring together professionals from diverse disciplines including researchers, clinicians, policy makers, community groups, methadone patients and consumers of drug related services. The CDRWG, formerly the Cocaine/Crack Research Working Group was initially conceptualized to address the growing problems associated with the use of cocaine and crack. However, in 1993 the scope of the project was expanded to include all chemical dependency-related issues. An important mission of the CDRWG is to not only enhance treatment, but to find better and more effective strategies and solutions to the drug-related problems that are negatively impacting our communities and reduce the quality of life for all. Presently the CDRWG has undertaken over twenty-five symposia and published timely materials to address the many difficult issues and problems that have become associated with drug use. A final change is the monograph format for publications with articles that focus on a single topic, instead of the previous newsletters.
The recently formed Bureau of Methadone Planning and Policy is dedicated to the many issues and concerns that effect the quality of methadone treatment. It is the purpose of the Bureau to assist programs and thus enhance the recovery of methadone patients and their integration into society. To reduce the stigma and provide effective treatment it has become the responsibility of OASAS to make information regarding methadone treatment available and accurate.
This compendium was developed as a resource for researchers, providers, clinicians, policy makers and patients. It may also serve as an educational tool for communities, and the family and friends of methadone patients. The New York State Office of Alcoholism and Substance Abuse Services (OASAS) has been committed to providing effective methadone treatment and to ensure that former chemically dependent individuals will become contributing citizens of their communities. For this purpose OASAS works to provide accurate information about methadone treatment and in dispelling the many misconceptions and myths about it that hinder quality treatment and the progress of methadone patients. We at OASAS regard methadone maintenance as an important treatment to ensure recovery from heroin addiction.
The information presented in this publication is based on thirty years of scientific research which forms the medical basis of methadone treatment. With the emergence of exceptionally pure heroin it is important that people associated with drug treatment and prevention and AIDS outreach understand the basic scientific principles upon which methadone maintenance has been developed. An anticipated forthcoming compendium (Part II) will focus on social issues that impact on the functioning of programs and the subsequent adjustment of methadone patients.
During the past year, the Cocaine/Crack Research Working Group (C/CRWG) changed its name to the Chemical Dependency Research Working Group (CDRWG) of the New York State Office of Alcoholism and Substance Abuse Services (OASAS). The CDRWG is now part of the OASAS Bureau of Methadone Planning and Policy which has allowed us to enlarge the scope of our interests. The CDRWG is funded by the Aaron Diamond Foundation through a grant to Medical and Health Research Association of New York City, Inc. (MHRA). With such diversified support the CDRWG will continue publishing timely information and organizing symposia around medical and social issues related to chemical dependency.
This compendium is devoted to scientific and selected clinical issues involved in methadone maintenance treatment. Although methadone maintenance was developed thirty years ago at The Rockefeller University, it remains a controversial and misunderstood approach to the treatment of heroin addiction. This compendium presents information to help persons involved with the treatment of addiction and policy decisions to understand some of the complicated, yet important scientific concepts that have evolved over the past thirty years.
Articles in the first section of the compendium focus on recent neuroscience discoveries and their relationship to the biological theory of addiction. The section begins with two articles by Joycelyn Woods that introduce the reader to a variety of difficult scientific topics including pharmacology, neuroscience and the endogenous opiate receptor-ligand system. The introductory material is followed by Dr. Vincent P. Dole's article, Implications of Methadone Maintenance for Theories of Narcotic Addiction which has been reprinted with the permission of the Journal of the American Medical Association (JAMA). This paper presents a summary of research issues involved in addiction theory and methadone maintenance treatment and was written for JAMA by Dr. Dole when he received the Lasker Award for Clinical Medical Research in 1988. Following the article by Dr. Dole is a Comparison Chart of Illicit Heroin Addiction and Stabilized Methadone Maintenance that compares the profound differences between illicit heroin addiction and methadone maintenance. The chart was developed by CDRWG staff as a response to the oft quoted criticism of methadone maintenance as "just substituting one addiction for another." In reality methadone maintenance has been a thoroughly researched and, when implemented correctly, the most effective treatment for heroin addiction. This section ends with Defining an Addiction which is reprinted from the Diagnostic and Statistical Manual of Mental Disorders.
The second section by this writer summarizes the basic information necessary to understand the rationale behind methadone maintenance treatment Topics included are history, methadone dosage, medical safety, adjustment of patients in treatment, review of follow up studies, AIDS and pregnancy. The information in this section is arranged so the compendium can be used as a resource manual and reference guide.
The third section presents special topics written especially for this compendium. The first article, written by Drs. J. Thomas Payte, Elizabeth Khuri and the CDRWG staff discusses the prescribing of pain medication to methadone patients and provides several clinical procedures. The second paper, by Dr. Norman Gordon, Functional Potential of the Methadone Maintained Patient, demonstrates that methadone patients function within the normal range in tests that measure ability, intelligence and coordination. The final paper by Dr. Ann Rosenberg, Selective Attention in Opiate Dependent Individuals: A Pilot Study Investigating the Effects of Endorphin Levels on Attention, shows that there are similar trends on performance tasks of selective attention in methadone patients and persons who do not use opiates.
It is our hope that this compendium will begin to break through many of the stereotypes and mythologies that are directed towards methadone programs and especially patients. In the final analysis it is the patients who are unjustly stigmatized by misinformation and a poor understanding of the complex issues involved in heroin addiction and methadone maintenance treatment. Communities are also adversely impacted by a lack of methadone treatment; properly administered programs have the potential to reduce drug-related crime, lessen the transmission of HIV and drug resistant TB, improve the patient's employment possibilities and assist patients in becoming contributing members of their community. Thus, the presence of well administered methadone programs improves the quality of life for all in the community.
A forthcoming and anticipated second compendium on methadone treatment will address poly drug use and social issues, including articles on cocaine/crack use, alcoholism, counseling, unemployment, vocational rehabilitation, homelessness, stigma and patient advocacy. The CDRWG will continue to publish articles on topics that are timely and of great concern. Through this monograph format, organizing articles around a specific issue, the CDRWG will be able to cover areas from various aspects and disciplines. The CDRWG will continue to present symposia and to facilitate the formation of committees to investigate and consider solutions to issues related to chemical dependency.
|
Last Update: March 15, 2001 |
.