Drug and Alcohol Addiction Treatment Research
The purpose of this project was to determine if the New York State Office of Alcoholism and Substance Abuse Services (OASAS) provides a service that benefits the residents of New York State. It's important to note in advance that OASAS' influence is far reaching. The organization was born out of Mental Hygiene legislation and oversees all organizations that treat individuals with substance abuse problems. While volumes of additional information exist to support the idea that OASAS is contributing to the substance abuse problem more then helping to curb it, this report is an attempt to summarize and present a succinct overview of the current performance and activities of OASAS and affiliated organizations. Alcoholism research.
The current budget for the certifying agency that oversees treatment and educational programs in the state of New York is approximately one billion dollars a year. 1Approximately half of the New York State Office of Alcoholism and Substance Services (OASAS) funding comes from the State of New York and the other half from the Federal Government. As New York struggles with budgetary problems in many areas, independent research has shown that the programs certified by OASAS are ineffective in the treatment of the majority of clients exposed to them. In fact, to put things in prospective, the most commonly practiced forms of treatment in the United States have been proven ineffective for the majority. OASAS is granted taxpayer dollars to "fulfill its statutory responsibility under the Mental Hygiene Law to regulate and provide quality control of alcoholism and substance abuse services.2" The only problem is that this billion dollar institution is not fulfilling its statutory responsibility with regards to the programs certified and lacks any research that conclusively demonstrates any benefit from the programs provided under certification by OASAS.
Initially the project seemed relatively straight forward. Most of the information was accessible through OASAS and affiliated organizations. After delving into Mental Hygiene Law it was evident that OASAS' influence reached across the state affecting many venues. The regulations and policies set forth under Mental Hygiene Law are far reaching and give OASAS almost unlimited reign over any organization dealing with a substance abusing or using population. The regulations sanctioned, encouraged and enforced by OASAS effect Social Services, the Department of Motor Vehicles, Department of Probation, the Department of Corrections, and Drunk Driving Programs to name a few.
It became apparent at this point that there was much more information needed to truly assess the situation than initially thought and in order to honestly report on the current situation concerning OASAS and the State of New York much more information would have to be included in this report.
When contacting many of the aforementioned offices or the counties' equivalents, the information requests were met with stiff resistance. It seems written public policy and department regulations are difficult to come by when the inquiry comes from an individual and not a government organization. Due to the resistance and lack of cooperation FOIL requests were sent out to 6 different offices in order to obtain the information needed.3
The reason for issuing FOIL requests to these offices was to find out if Mental Hygiene Law in New York State is in fact constitutional and if OASAS' influence is justified. After rooting through information received in a separate FOIL request from OASAS, it appeared that many procedures followed by offices under the purview of OASAS exercise unwritten procedures which made it practically impossible to gather documents outlining said procedures.
Upon reading through many of these documents, it has become apparent that citizen's constitutional rights are being infringed regularly. The current organization of these offices has led to a number of additional problems and raises more concerns about how our government is governing. Many citizens charged with relatively minor infractions are forced to seek medical treatment for their "afflictions." The state cannot mandate treatment for people with the AIDS virus yet even social services can require the completion of medical treatment for substance abuse issues for people in need of financial help (Social Services Law Ã‚Â§158[a]. But Social Services is not the only government organization that seems to be infringing on constitutional rights.
Probation departments require medical treatment for people under their supervision. Probationers who have been charged with drug related crimes are required to have an evaluation for their "problem." Many are mandated to treatment. If they do not cooperate individuals are incarcerated.4
Individuals who are charged with a DWI are also required to have medical evaluations. After placement in a Drunk Driving Program an assessment tool (RIASI) is used to evaluate the seriousness of the client's problem. The problem with this evaluation tool is that it is an inaccurate measure of a substance abuse problem. After contacting Tom Nochajski from the University of Buffalo,5 one of the creators of the RIASI test, my office obtained a copy of the test and the accompanying research information backing up its efficacy and information pertaining to how it's administered. After handing out the RIASI to 9 employees of Baldwin Research Institute, Inc. and tallying the results not a single person passed. What makes this result completely erroneous is that, to date, not a single person who took the test uses drugs or drinks and not a single person passed the test. Failing the tests is an indication that substance abuse treatment is necessary.
With this information in hand, accompanied by representatives of Baldwin Research Institute, Inc., a not-for-profit research organization located in Amsterdam, New York, we approached the law offices of O'Connell and Aronowitz. The purpose of our meeting6 was to determine the legality of the current procedures and regulations concerning the substance abusing population and to determine if OASAS has the power to legally monopolize the substance abuse industry in the State of New York. The case is currently under review.7
Each department guided by OASAS exercises its power and influence without sound scientific research backing up the purported benefits of the procedures. Probation departments mandate treatment programs that do not work, Social Services requires medical evaluations and treatment in order to grant State Aid and the treatment and evaluations required are based on faulty and misguided research. OASAS oversees these organizations with respect to the substance abusing or using populations and supplies the information as well as lobbies for the laws that give them that power. But, as you will read, a lack of accountability, a lack of proper action and irresponsible research can, and has, led to disastrous consequence.
A topic of much debate is what the successful treatment of a patient actually is. For individuals on the outside looking in the obvious answer would be sobriety. But, for those within the current treatment paradigm the answer to that question seems to be a mystery.
The majority of reported success rates are based on program completion or short follow up periods. Anyone with a background in research and anyone familiar with the scientific method could easily understand why these parameters are inapplicable and misleading when it comes to organizations testifying success based on these research methods. Short follow up periods do not allow for long term outcome results and program completion does not testify to anything but retention. These two research methods do not accurately measure the impact of the programs offered but in fact paint an inaccurate picture of the results.
These non-scientific proclamations are so common and so ludicrous that the scientific community is now publishing articles ridiculing these reports. For example the article "An Invitation to Debate: How to have a high success rate in treatment: advice for evaluators of alcoholism programs" by William R. Miller and Martha Sanchez-Craig.8
The abstract reads as follows: "Two seasoned alcohol treatment researchers offer tongue-in-cheek advice to novice program evaluators faced with increasing pressure to show high success rates. Based on published examples, they advise: (1) choose only good prognosis cases to evaluate, (2) keep follow-up periods as short as possible, (3) avoid control and comparison groups, (4) choose measures carefully, (5) focus only on alcohol outcomes, (6) use liberal definitions of success, (7) rely on self-reporting and (8)always declare victory regardless of finding."
There are an estimated 12,000 treatment centers in the United States and 97 percent of these treatment centers use a modality that contradicts the approaches responsible research would recommend. Most follow the same "one size fits all" approach that has been a detriment to those who actually want to achieve sobriety and change their lives. As a result, successful outcomes are few and far between. On any given day 700,000 people are subjected to ineffective treatment programs. It is not only the patients who suffer: in the United States each year over 160 billion dollars is wasted paying for alcohol related problems. Alcohol is the third leading cause of preventable deaths, 38.6% of traffic fatalities are alcohol related, 42% of adults are exposed to alcoholism in the family, 37% of sexual assaults, 50% of homicides, 27% of aggravated assaults and 25% of simple assaults are alcohol related.9 With better programs in place, programs that are proven to "cure" or prevent substance abuse, the money once wasted could be spent fixing more important problems. That's not to say that better treatment programs will be a cure all, better programs are just one piece of a more involved solution but nonetheless a step in the right direction. In the early 1990's, Dr. Diana Chapman Walsh of the Harvard School of Public Health reported that after two years it was 10% less expensive to refer people to Alcoholics Anonymous directly without any treatment. The significance of this study is that it did head to head comparison between AA and professional treatment and concluded that the benefits of professional treatment programs are questionable. The average cost of a treatment program in the United States is over $18,000 for a 28 day program.10 Alcoholics Anonymous, although ineffective, is free.
The understanding that treatment doesn't work is not an idea exclusive to those outside of the existing treatment paradigm. Those within it, and promoting it, are also well aware of treatment's ineptitude and damage. Enoch Gordis, Director of the NIAAA (National Institute of Alcoholism and Alcohol Abuse) stated the following: "In the case of alcoholism, our whole treatment system, with its innumerable therapies, armies of therapists, large and expensive programs, endless conferences, innovation and public relations activities is founded on hunch not evidence, and not determine whether treatment accomplishes anything, we have to know how similar patients who have not received the treatment fare. Perhaps untreated patients do just as well. This would mean that the treatment does not influence outcomes at all. Perhaps treated patients do worse: that is perhaps treatment is really harmful in unexpected ways so that patients who are not treated get better more often. Perhaps even if the treatment is helpful, a little bit of it is just as useful as a lot of it." This coming from the head of an organization partly responsible for pioneering the current model of substance abuse treatment says a lot.
Repeated studies have shown that the average person, who could be diagnosed with a substance abuse problem,11 will discontinue use on their own 20-30% of the time. But, those who are exposed to AA and treatment, and who are taught the disease concept, have a drastically decreased chance of achieving sobriety. While treatment professionals are aware of program failure, governing organizations support and promote the adoption of 12 Step tenets into treatment programs for substance abusers. Families pay tens of thousands of dollars to help their loved ones only to place them in programs that follow the guidelines of another failing program. Any program based on a program that fails will inevitably fail.
While honest scientific studies are lacking, treatment professionals, through personal experience do have an estimate for conventional program success. Surprisingly, the treatment community actually uses the low success rate to motivate patients. Credentialed alcoholism counselors typically tell their patients that only 1 in 12 (many counselors use the ratio of 1 in 30) will "make it." The theory is that if only one in twelve (or thirty) patients are going to get well, each one wants to be the one who gets well. Whether the patients try or not seems to have little impact on the outcome of their treatment, and it is of more than passing interestthat independent studies confirm that, indeed, the success rate for these programs range from 3% to 8% at 5 years post treatment. Treatment professionals tell their patients and the public that 1 out of 10 to 1 out of 30 "will make it". 1 out of 10 is 10% and 1 out of 30 is around 3% (some numbers are higher or lower, but on average these are the excepted numbers).
Research for alcoholism
The obvious contrast is that those who enter treatment have 20-27% less of a chance to recover then those who never enter treatment. Treatment programs actually lessen the chances of success for their patients.
Deborah Dawson of the NIAAA, an epidemiologist, analyzed 4,585 interviews from those who at one time had been alcohol dependent. Dawson's study conclusively showed that untreated alcoholics are approximately 2 times more likely to get sober and stay sober than alcoholics subjected to treatment. William R. Miller of the University of New Mexico in Albuquerque has concluded much of the same. "In 1995 William R. Miller and his colleagues rated forty-three kinds of treatment by combining the results of 211 controlled trials that had compared the effectiveness of a treatment [method] with either no treatment or with other alcoholism therapies. The treatment with by far the best score was 'brief intervention'-followed by social-skills training and motivational enhancements... The Miller report described the standard treatment in the United States as 'a milieu advocating a spiritual twelve-step (AA) philosophy, typically augmented with group psychotherapy, educational lectures and films, and...general alcoholism counseling, often of a confrontational nature."
A report by Linda C. Sobell, PhD, John A Cunningham, PhD, and Mark B. Sobell, PhD called Recovery from Alcohol Problems With and Without Treatment: Prevalence in Two Population Surveys also confirms the previous statement. This is a published report presented in the American Journal of Public Health, July 1996, Vol. 86, No. 7. This report demonstrates that more alcoholics recover without treatment than do those who receive treatment, at a rate of more than 3:1. To say that "Treatment Doesn't Work" according to this study, and many others would grossly understating he impact of treatment.
The United States government spends tens of billions of dollars in support of treatment programs and certifying agencies completely ignorant to valid and repeated studies refuting the efficacy of current programs. It's apparent that those who oversee treatment in the United States, who have the capacity to think critically, are at a loss for what to do. The current paradigm views the out-of-the-box thinker as a danger to individuals in need of help. There is also the financial aspect of it all. The programs that do exist fail, but the market produces billions in revenue for private and public enterprise. Many organizations trying to provide responsible programs for those in need are destroyed by the advocates of the existing approaches. That is, government agencies and members of Alcoholics Anonymous have in documented cases slandered and defamed businesses attempting to deviate from the 12 Step methodologies or exclude Alcoholics Anonymous from their programs.12
In 1990, Alcoholic's Anonymous General Services Office or AA GSO, the governing organization overseeing all "autonomous" meetings, published an internal memo for the employees of its offices. It was an analysis of a survey period between 1977 and 1989. The results were in absolute contrast to the public perception of AA. "After just one month in the fellowship [group members], 81% of the new members have already dropped out. After three months, 90% have left, and a full 95% have disappeared inside one year!" (Kolenda, 2003, Golden Text Publishing Company) That means that in under a year, 95% of the people seeking help from AA leave the program. While this only speaks for attendance, it has further implications. AA surveyors do not include dropouts in their sobriety statistics, which is a deceptive, if not an outright dishonest practice.
Using the AA GSO statistics, and including the program dropouts, the success rate of AA, as a whole total averages of sobriety for the total AA membership become 3.7% for one year [of sobriety], and 2.5% over five years."13 It's important to understand that 97% of all substance abuse treatment centers in the United States are 12 step based programs. Thus, the failures of AA are also the failure of treatment.
As previously stated the majority of studies for treatment efficacy are based on short term follow up periods of less than one year after program completion. Although an estimated 90 percent return to substance abuse shortly after leaving conventional programs, the majority of the remaining graduates relapse within the first year. This makes the practice of short follow-up periods an exercise in futility and outright deceit.
The truth is that there are effective methodologies that exist internationally but are rarely practiced in the United States. It appears that the 12 Step approach has a firm grip, a strong hold on the American treatment field. And, while this methodology dominates..."Only two controlled trials were found in which AA was studied as a distinct alternative, both with offender populations required to attend AA or other conditions, and both findings reported no beneficial effect." (William R. Miller, 1995)
The most common forms of treatment in the United States, which have been dubbed "conventional," are the methodologies where the least amount of empirical and controlled studies exist to back up their effectiveness. In other words: "The Negative correlation between scientific evidence and application in standard practice remains striking, and could hardly be larger if one intentionally constructed treatment programs from those programs with the least evidence of success." (William R. Miller, 1995)
A research organization in Amsterdam, New York has provided OASAS with information on dozens of studies over the years that indicate that the efficacy of OASAS style treatment results in less than 30% of those treated remaining sober and drug free for six months and less than 14% remain sober and drug free for five years or more. The company provided OASAS the results of a New York State adolescent study they conducted in 1993 where 100% of the 30 subjects from three different school districts relapsed within 14 months post treatment. All thirty adolescents were treated at OASAS type treatment programs. OASAS did not respond. This same company provides an alternative to conventional treatment that follows an educational model that includes elements of cognitive behavioral therapy to curb and cure substance abuse problems. This same company advertises a success rate averaging over 78%. With permission I was allowed to review the company's database and oversee an annual survey the company conducts every six months. The company uses a random sampling technique and includes 200 guests per survey.
The company followed all proper study protocols and reported an 80.1% (August 20 th 2004). The same studies and success have been reported to OASAS to no avail. In fact the companie's attempts to bring about positive change in the treatment industry has been met with an effort to shut down the company.
After reviewing a report by OASAS entitled: "OASAS Evaluation Systems: Preliminary Analysis of Behaviors of Clients Remaining in Treatment at Least Six Months" there were some striking facts between the lines. The report asserted some rather remarkable conclusions that supported OASAS treatment programs but failed to be as persuasive as an unbiased, scientific study. Section IV of this report states: "Although an experimental design was not employed and a control group was not utilized, the data presented in this report convincingly demonstrate the effectiveness of the four [programs for] drug/alcohol use."
Without a study, it is reasonable to expect that while in treatment, particularly residential treatment, measurements such as arrests, incarceration, detoxification services, hospitalizations, ER episodes and drug and alcohol use would decline. However, to suggest the decline is the result of a specific type of treatment, such as psychological or medical treatments, would not be true. OASAS offers programs identical to those studied in the CALDATA Study.14 Because the same types of treatment have the same outcomes, the assertion that certain programs licensed by OASAS fare better than others would not be accurate.
Further, in section IV of this report it states: "The analysis demonstrates that clients retained in treatment at least six months produced significance savings to New York State taxpayers." These "savings" may be far more elusive than the report indicates. The author points out "that the cost of treatment was not factored into the savings figures." The author suggests that because the benefits are so great, accounting for the cost of treatment would not appreciably change the results. Although interesting, such a conclusion is not accurate.
Conservatively, the average cost (average of all four programs types) of six months of treatment can be estimated at $3,600 per individual. Thus, the cost of treatment for the entire client sample would be approximately $67 million or a loss to the taxpayers of $16.8 million. If one extrapolates the purported savings from the 58% sample to all the clients expected to stay in treatment at least six months the total savings would not be $87 million but a loss of more than $30 million.
It is disturbing that the report measures the efficacy of the programs using pre-existing conditions in its favor. For example, the report indicated that Alcoholism Outpatient Clinic programs were 52% effective in "Maintaining Full-Time or Improving Employments-Related Status." If people were employed at the time of entry into the program, there is no evidence that suggests that they would not have been employed six-months later without attending the program. What's more, it is likely that 45% or more of the 52% were already employed and would have remained that way without treatment. Thus, the "real" impact of the treatment may have been 4% or 5% not taking into account the margin of error.
Probably the most disturbing information is the report of "% Discontinued Use of Primary Substance." This category implies that one measure of efficacy of treatment is the reduction in use of the clients' primary substance while in treatment. While it would be good if clients refrained from using their drug of choice during the time they are in treatment, the goal of treatment programs is usually thought to provide methods and skills for clients to refrain from using their drug of choice when they are not in treatment.
After a recent request for program outcome studies or success rates for OASAS certified programs I received this response from Alan Kott, Director for Evaluation for the New York State Office of Alcoholism and Substance Abuse Services on December 29, 2003:
"Your information request was forwarded to me by our Communications Office. OASAS traditionally did not conduct post-treatment outcome studies. We do have one such study currently underway in the Northeast Region, but results are not yet available. However, we continually monitor program performance utilizing retention rates, completion rates, employment-related involvement and abstinence measures. This information is collected at client discharge. So, whether we can provide you with the information being requested will depend on how you are defining 'success.'"
Without a success rate from OASAS it would have been difficult to be sure about the benefits or detriments of the programs offered. After contacting OASAS' certifying agency I was provided with a list of every certified treatment program in New York State.15 Breaking down the list I compiled the addresses of 502 certified providers. While there are 1,139 certificates, many offices oversee a number of treatment centers under the same corporate name. Surveying every office for every certificate would have been unnecessary.
A questionnaire was mailed to each individual office (502) that asked the head of each corporation or department 20 questions. The name of the facility, how many facilities the office oversees, a description of the services provided, a check list of which services are provided, if they track patients after graduation, for what period they are tracked, who tracks them, what success is based on, what the success rate is, if they did not track what the estimated success rate is, what the retention rate is, what the recidivism rate is, if they receive federal or state funding, if OASAS ever requested a success rate, what the cost of the program is, what the average length of stay is, if they are twelve step based, if they teach the disease concept and if they would like to receive a copy of the publication upon its completion.
Out of 502 surveys mailed I received 125 responses. While I did not receive a response from every organization surveyed, the number of organizations that did respond is statistically representative of the entire state. In other words, the responses I did receive safely represent the information that would have been gathered had I received information from every surveyed organization.
The 125 responses came from offices overseeing a total of 383 facilities. Of the responses from the 383 facilities 59 provided counseling, 34 were residential treatment programs, 21 were referral agencies, 72 out-patient facilities, 37 were prevention programs, 12 were detoxification facilities, 10 were methadone maintenance, 1 shelter, 1 transitional living facility, 4 intervention programs, 6 therapeutic communities, 1 halfway house, 42 provided evaluations, 3 provided supportive living, and 1 provided an adolescent program. The program types do not add up to the total number of facilities because certain responses excluded the type of program or the office oversaw programs as opposed to directly participating in the day to day activities.
As Alan Kott stated in our correspondence, OASAS has made an effort to track and confirm the "success" of the programs they oversee. But, OASAS attempts fall short because of the study parameters exercised. Although 92 of 121 (76%) reported that their organization received federal or state funding only 70 of 116 (60%) reported that OASAS requested a success rate or retention rate. Another interesting piece of information has to do with the number of credible follow-up surveys. Not a single organization had a success rate based on abstinence for more than a year. Not a single organization seemed to grasp the importance of a success rate, and very few organizations overseen by OASAS followed the same study parameters. OASAS only requests a retention rate and a success rate based on discontinued use of primary substance while in treatment. Also, while OASAS requests a success rate based on the preceding factors OASAS does not require, nor do they enforce accurate research techniques. One organization determined success based on the attendance to an annual Christmas Party.
The data tracking system used by OASAS that exists to track patients is called the IPMAS. While the proper use of such a system could prove incredibly beneficial for the treatment community, without stressing survey parameters or without asking how each individual organization gathers the data they report, the IPMAS is a complete waste of time and money and ineffective at properly gathering accurate information for use.
The average success rate for all the facilities who reported a "verifiable" success rate was 60.8%, which means that 60.8% completed a program and/or stayed sober while in a program which means that 39.2%, a rather large number, got high or drunk in the program or left before completing it.
The organizations who reported an estimated success rate averaged 53.9% success. Of course the preceding number was a "best guess" and not based on any study.
When thinking about this out of the box the best comparison to make is to look at any other service industry. If the Hilton could only retain 60% of their guests they would go out of business. If a child's toy broke 40% of the time we would have hundreds if not thousands of lawsuits filed.
Now take statistics from independent research and apply them the same way. If a car was driven right off the lot and only worked 5% of the time no one would buy that car. And, because no one would buy the car the company providing the shotty automobiles would have to make a better product in order to stay in business. Treatment programs, private and public organizations, provide programs that do not work yet instead of being held accountable the treatment industry remains stagnant and unchanged. Treatment professionals can blame failure on the people they are trying to help. It's a convenient situation for those working in the current treatment paradigm but it is a danger to everyone else.
The legislated methods of treatment were implemented without any clinical evidence supporting the notion that alcoholics and drug addicts could benefit from group therapy, counseling, and other psychological techniques. As time has gone by and few have recovered, the mental health community has concluded that alcoholics and drug addicts could never completely recover and relapse has become an unexpectedcharacteristic of the "disease." Rather than improving the treatment methods or trying alternative methods to medical and psychological methods, the treatment community changed its understanding of the malady to fit the poor results achieved by the treatment offered.
Out of 118 organizations 95% teach the disease concept even though research does not support it. Many facilities teach the disease concept and help patients realize the seriousness of their substance abuse problem but repeated research has shown that the disease concept is damaging because it takes away control and for some, it is an excuse for failure. The other problem is the intermingling of psychological approaches and Twelve Step programs. Out of 139 programs 62% are Twelve Step based programs, meaning that program directors push 12 Step meeting attendance. Of course this number is not exactly accurate.
In 1997 and 2001 the New York State Supreme Court ruled that 12 Step programs are inherently religious in nature and that mandating attendance is a violation of our constitutional rights. As a result of this decision OASAS was required to offer 12 Step alternatives, one in particular, SOS (Secular Organizations for Sobriety), seems to be one of the more available alternatives. But, there is a problem. SOS is a relatively new organization and there are very few meetings in the State of New York. While treatment professionals require some sort of meeting attendance the result is generally 12 Step meeting attendance due to a lack of available alternatives. So while OASAS complied with the ruling essentially very little has changed. The organizations that received government funding who reported that they were not 12 Step technically did not require 12 Step meeting attendance but did require some sort of meeting attendance. It was only after calling these programs, after receiving their responses, that we found out that legally they could not requireattendance to 12 Step meetings but the people in the programs were "encouraged" to attend some sort of meeting. The problem, as explained earlier is that 12 Step Programs do not work for the majority of people who use that methodology when attempting to get and stay sober.
In a final assessment of the survey it's obvious that OASAS loosely tracks program graduates and the "tracking" is not scientific and the results mislead the public. The providers in the State of New York still provide ineffective treatment methodologies which results in a substantial loss of tax-payer dollars as well as failure for persons trying to get and stay sober.
A few factors that may have contributed to inaccuracy in our survey of certified providers were: some individuals taking the survey did not understand the questions, a number of people guessed the answers instead of researching the answers, some institutions were offended by the questions and refused tocooperate, some had contradictory answers, a few had retention rates that made the success rate impossible and a number of people who received a follow up call changed their answers and admitted guessing.
In conclusion, while the law allows for certain entities to monopolize the market when it is in the best interest of the public (See Generally, Rotunda and Nowak, Treatise on Constitutional Law, Ã‚Â§ 3.1 at 337 (The West Group, 1999)), there is no evidence to support the need for such a monopoly in the State of New York. More specifically, there is no evidence to support the need for the monopolistic control the New York State Office of Alcoholism and Substance Abuse Services has over substance abuse services in New York State. In fact, based on the outcome studies measuring program success it seems that the existence of OASAS as it is organized today does more harm then good.
1. From OASAS budget supplied by Senator Hugh T. Farley in September of 2004.
Drinking behaviour research
2. Letter from Mary Ann Crotty assistant to Governor Cuomo, April 24, 1994
3. Under the precepts of the Freedom of Information Law I requested information from the New York State Department of Motor Vehicles, the New York State Department of Corrections, the Montgomery County Department of Social Services, the New York State Division of Probation and Correctional Alternatives, the New York State Department of Motor Vehicles Division of Driver Program Regulations, and the Town of Amsterdam.
4. Information came from numerous interviews of probationers and was affirmed by Officer Cynthia Lenon of the Montgomery County Probation Department on July 8, 2004
5. Correspondence took place August 20, 2004.
6. Meeting took place on September 17 th 2004.
7. Confidential grant source retained O'Connell and Aronowitz to research case law in an attempt to bring suit against the State of New York for violation of citizens' rights granted by the Constitution.
8. An Invitation to Debate: How to have a high success rate in treatment: advice for evaluators of alcoholism programs by William R. Miller (Department of Psychology, University of New Mexico) and Martha Sanchez-Craig (Addiction Research Foundation, Toronto, Ontario, Canada. This article appeared in Addiction (1996) 91(6), 779-785.
9. Department of Justice 2002.
10. 2003 project surveying 38 treatment programs in 36 states
11. As defined by the Diagnostic and Statistical Manual version IV.
12. Saint Jude Retreat House v. New York State Office of Alcoholism and Substance Abuse Services.
13. Kolenda, 2003, Golden Text Publishing Company
14. The 2-year CALDATA study examined outcomes for a sample of nearly 150,000 persons who received substance abuse treatment in California in 1992. The study found that no matter the treatment modality the outcomes were all the same.
15. Certified provider list provided by Karen Esposito of the Certification Bureau of the New York State Office of Alcoholism and Substance Abuse Services on June 27 th 2004.
Copyright 2004 Baldwin Research Institute, Inc.
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