A message from Kaytee Riek and the Health GAP (Global Access Project).

Friends-

All over the world, drug users have been tortured or otherwise discriminated against by governments, all in the name of "drug treatment". These abuses, which have been documented in a recent report, include caging, caning, chaining, forced labor and other forms of punishment. Not only is this a violation of the human rights of drug users, but it further marginalizes people who are already at high risk of contracting HIV.

This week is the Int'l Harm Reduction Conference in Bangkok, Thailand. Hundreds of drug users and advocates from all over the world are demonstrating and calling for the United Nations to take action to fight the torture of drug users. We will be presenting a petition to UN Office of Drugs and Crime officials to call on all UN agencies and bilateral donors working on drug issues to go further to denounce and address the deadly conflict between public health and law enforcement approaches to drug use.

Please join allies from around the world by signing this petition by the end of the day Wednesday, April 22nd, when the petition will be presented to UNODC officials.

http://org2.democracyinaction.org/dia/track.jsp?v=2&c=YCFuqkKIjja3iOdnrjZRVsStnAhhgPCq

And, if you're interested, check out this article in The Nation, Bangkok's largest English language paper, about the rally yesterday. You can see photos of the rally here, too. Thank you for taking action!-

Kaytee Riek

New study demonstrates that Men in Sweden have the lowest level of smoking in the Western world

Bangkok, Wednesday April 22, 2009-- Men in Sweden have the lowest level of smoking in the Western world, thanks to the substitution of low-risk smokeless tobacco, researchers have told the Harm Reduction 2009 conference.

"The anti-harm-reduction activists who dominate the discourse about tobacco have tried numerous tactics to deny that tobacco harm reduction has been effective in Sweden,” said Lisa Cockburn of the University of Lapland and a co-author of the study. “Our research makes specific statistical comparisons that clearly show the benefits Swedish men have experienced by switching from smoking to smokeless tobacco.”

Evidence from epidemiology clearly shows that switching to Western smokeless tobacco (ST) offers a huge health benefit to smokers. Studies of the nicotine delivery and other aspects of consumer appeal suggests that many smokers might be willing to make the switch. Swedish men have extremely low rates of the deadly diseases that are caused by smoking, and show no increase in any disease that might have been caused by smokeless tobacco use.

"It is difficult to imagine a more impressive harm reduction success for any substance use behaviour. No such evidence exists to suggest that any other method will work at the population level,” concluded Cockburn.

Highlights of Harm Reduction 2009 Day 3:

Parliamentary Panel Discussion: The Decriminalisation of Drug Use

Organised by the Asian Forum of Parliamentarians on Population and Development (AFPPD) and supported by UNAIDS

Panel:

Dr. Pinit Kullavanijaya
Senator, Thailand (Member of Health and SportCommittee and Secretary General of AFPPD)

Dr. Laode Ida
MP, Deputy Speaker of the Upper House, Indonesia

Dr. Tien Nguyen
Vice-Chair, Committee on Social Affairs of NationalAssembly of Vietnam

Hon. Dr. Ouk Damry
MP, Cambodia

Dr. Donya Aziz
Chair of HIV/AIDS Parliamentary Committee, Pakistan

About the International Harm Reduction Association:

The International Harm Reduction Association (IHRA) is the leading organisation promoting a harm reduction approach to all psychoactive substances on a global basis. IHRA exists to prevent the negative social, health, economic and criminal impacts of illicit drugs, alcohol and tobacco for individuals, communities and society.

About the conference:

Harm Reduction 2009 www.ihra.net/Thailand/MediaCentre is expected to attract some 1000 delegates from around 80 countries. The event has become the focal point for knowledge sharing, networking and promoting evidence-based best practice in the field20of harm reduction. The delegates include front line workers, researchers, policy makers, politicians, people from international organisations, people who use drugs and people working in criminal justice. These events have helped to put harm reduction on the map and to coordinate advances, innovations, evidence and advocacy in this field for the last two decades.

Where: Imperial Queen's Park Hotel, 199 Sukhumvit Soi 22, Bangkok 10110, Thailand

When: Monday April 20 - Thursday April 23, 2009

Further information:

In Bangkok:
Michael Kessler, Harm Reduction 2009 Media Relations
Mobile +66 (0) 845 311 327
Email: press@ihraconferences.org
Skype: mickgpi

Media Release, Drug users have human rights too, says Global Fund head, Bangkok

MEDIA RELEASE

Drug users have human rights too, saysGlobal Fund head

Bangkok
Monday April 20, 2009

Recognising the human rights of drugusers is essential to preventing HIV and mitigatingthe public health impact of drug use, Professor Michel Kazatchkine, Executive Director of the Global Fundto Fight AIDS, Tuberculosis and Malaria said today at the opening ofthe International Harm Reduction Conference in Bangkok.

"Human rights are drug users’ rights, as well. Because in too many countries, still,in too many police cells, in too many health services, and in too many prisons,drug users are treated as less than human," said Kazatchkine.

Thailand is the recent recipient ofa US$100 million grant from the Global Fund with the goal of reducing new HIV infections by providing universalaccess to HIV prevention services in selected provinces for most at risk populations:female sex workers, men who have sex with men (MSM), injecting drug users (IDU)and migrant workers.

Kazatchkine said it was encouraging to see that some countries who had traditionally employed a lawenforcement approach to drug control were now moving cautiously towards apublic health approach, including many countries in Asia.

“Let us say, to China,to Malaysia, to Vietnam and to Thailand: keep up the good work. Byembracing harm reduction, you are on the right side of history,” he added.

The lack of comprehensive harm reduction services for injecting drug users in Thailand leavesHIV prevalence among that group at high levels of 30-50 % during the past 15years.

“Thailand needs to learn from the success of its HIV/AIDS campaign in the 1990’s whenHIV/AIDS was accepted as a problem and addressed openly and successfully,” saidPratin Dharmarak, Country Representative of PSI. “Yet, today there is verylimited understanding about drug use in Thai society. While injecting drugusers are at the highest risk of HIV,they are among the most stigmatized and hardest to reach populations,” sheadded.

Injecting drug use accounts for 10 per cent of HIVcases globally and 30 per cent outside sub-Saharan Africa,yet resources for prevention of HIV transmission among injecting drugs users isnot commensurate with need.

“Only 2-3 percent (US$200m to US300 million per year),of all the available resources for AIDS is spent on harm reduction. It isclearly not enough. If we are serious about reducing HIV infection amongstinjecting drug users then we are going to need between US$2 and US$3 billionthis year and next to get anywhere near the kind of coverage that is going tomake an impact,” said Professor Gerry Stimson, Executive Director of theInternational Harm Reduction Association.

About the International Harm Reduction Association:

TheInternational Harm Reduction Association (IHRA) is the leading organisationpromoting a harm reduction approach to all psychoactive substances on a global basis. IHRA existsto prevent the negative social, health, economic and criminal impacts ofillicit drugs, alcohol and tobacco for individuals, communities and society.

About the conference:

HarmReduction 2009 www.ihra.net/Thailand/MediaCentre isexpected to attract some 1000 delegates from around 80 countries. The event hasbecome the focal point for knowledge sharing, networking and promotingevidence-based best practice in the field of harm reduction. The delegatesinclude front line workers, researchers, policy makers, politicians, peoplefrom international organisations, people who use drugs and people working incriminal justice. These events have helped to put harm reduction on the map andto coordinate advances, innovations, evidence and advocacy in this field forthe last two decades.

Where:

Imperial Queen's Park Hotel, 199 Sukhumvit Soi 22, Bangkok 10110, Thailand

When:

Monday April 20 - Thursday April 23, 2009

Further information: In Bangkok: Michael Kessler, Harm Reduction 2009 Media Relations
Mobile+66 (0) 845 311 327
Email:press@ihraconferences.org
Skype:mickgpi

McLellan Announced as Deputy Drug Czar

April 13, 2009
Join Together.org


A. Thomas McLellan, a noted addiction researcher, has been nominated as deputy director of the Obama administration's Office of National Drug Control Policy (ONDCP), the Chicago Tribune reported April 10.

If confirmed, McLellan will serve as the chief deputy to presumptive drug czar Gil Kerlikowske, who also must be confirmed by the Senate.

McLellan, 59, has been involved in some of the most important addiction research in recent decades, including the development of the Addiction Severity Index and studies comparing addiction with other chronic health conditions. Most recently, he headed the Treatment Research Institute at the University of Pennsylvania.

"I think [McLellan's] long and rigorous examination of how drug-abuse treatment is delivered is pretty unique," said David Friedman, director of addiction studies at Wake Forest University's medical school. Friedman added that recent comments by Obama administration officials about the role that demand reduction needs to play in fighting Mexican drug cartels indicates that McLellan's job could become very high-profile.

Obama Administration Names A. Thomas McLellan Deputy ONDCP Director

Appointment of Treatment Research Institute Co-Founder and Noted Drug/Alcohol Expert Signals National Shift in Addiction Policy

Philadelphia, PA - April 10, 2009: The Obama/Biden Administration has named A. Thomas McLellan, Ph.D. to the post of Deputy Director of the White House Office of National Drug Control Policy. McLellan is one of the nation's leading drug and alcohol experts.

McLellan got his start in the 1980s as a scientist with the Veterans Administration and University of Pennsylvania where he led development of the Addiction Severity Index and Treatment Services Review, two measurement instruments premised on the then-novel view that addiction was a multi-dimensional condition, with impairments in other life functions that had to be concurrently addressed for treatment to be effective. Eventually, the premise came to be embraced, with the instruments becoming widely used to measure and improve the effectiveness of many forms of treatment.

In 2000, McLellan and three other experts authored a report in JAMA pointing out the similarities between addiction and commonly recognized, chronically relapsing medical diseases like hypertension, type II diabetes and asthma, arguing that like these other illnesses, serious addictive disorders cannot be cured but can be effectively managed. The implications proved to be significant. Today, most experts refer to addiction as a chronic illness and call for longer-term care strategies patterned after medical models.

A firm believer in the transformative power of science, in 1992 McLellan co-founded the non-profit TRI as a translational center that would adapt and engineer promising scientific findings into useful products and services that could be broadly used throughout the field. Over the next seventeen years, McLellan assembled a team of researchers and entered into intertwining collaborations with universities, major treatment and prevention groups, and legal groups. TRI became known for practical models of continuing care and monitoring; criminal justice strategies as an alternative to jailing drug-involved offenders; revitalizing the nation's public system of addiction treatment; engaging doctors and other primary care providers; and helping parents learn skills to protect children from drugs and alcohol.

Beginning in 2006, McLellan recruited policy experts to TRI to help state and local governments promote quality improvement by revamping their purchasing, regulatory, and other administrative structures.

"We're sorry to lose Tom McLellan to higher office, but we're not surprised an innovation-minded Administration would recruit someone like him for national drug policy," said Constance Pechura, Ph.D., TRI's second-in-command who will assume leadership of TRI. "With his presence, the Administration has created a formidable drug control team predisposed to evidence and policies that 'work,'" she said.

"Tom McLellan has been a leader in advancing the science of addiction treatment and improving access to effective care," said Carolyn Asbury, Senior Consultant to the Dana Foundation and Chair of the TRI Board of Directors. "He has pioneered the translation of research into more effective clinical practices that have helped to achieve better outcomes for individuals and their families. No one is better equipped to help transform the nation's response to its drug problems," she said.

ONDCP was established in 1988 to advise the President and Vice President on a drug control program for the nation, coordinating the activities of multiple federal agencies toward that end. With Gil Kerlikowske, the President's pick for ONDCP Director, McLellan's appointment signals a shift to science-based treatment and prevention strategies - including what McLellan calls "a long-overdue national look at our prison policies; collaborative strategies among the prevention, treatment, criminal justice, healthcare and education fields, and continued modernization of specialty treatment and prevention centers."

************************************************************

The Treatment Research Institute is a non-profit research and development organization specializing in science-driven reform of policy and practice in substance use and abuse. For more information contact Bonnie Catone, TRI Director of Communications, at bcatone@tresearch.org or visit the TRI website at www.tresearch.org.

'Wet' Homeless Shelters Can Save Public Money, Study Says

The following study reports on a "wet" shelter for homeless heavy drinkers that finds costs to society declines as does drinking in its residents. This harm reduction approach is being instituted in several other organizations including one here in NYC called the Bowery Residents Committee. This study supports the basic tenets of harm reduction: starting where the patient is, assuming the patient has strengths that can be built on, focusing on reducing harm rather than a sole requirement for abstinence before anything else can be addressed, embracing small incremental change as success all enhance the alliance with treatment, build self esteem and self-efficacy and are best suited to facilitate positive change. Not only is this good for the individual, it is good for society at large.

Andrew Tatarsky, PhD

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'Wet' Homeless Shelters Can Save Public Money, Study Says

April 2, 2009
Research Summary
JoinTogether.org

A new study finds that homeless shelters that allow alcoholic residents to continue to drink alcohol can save taxpayers money and still facilitate declines in alcohol consumption.
Reuters reported March 31 that the study from Mary Larimer of the University of Washington and colleagues found that homeless alcoholics admitted to shelters without being forced to quit drinking or enter into treatment were more likely to stay out of jail and emergency rooms than those on shelter waiting lists.

Researchers estimated that public costs related to the 95 individuals enrolled in a Seattle program called Housing First were reduced by more than $4 million during the yearlong study period.

Before getting housing, study participants were racking up an average of $4,000 each per month in jail, detox, hospital, and other services; that figure fell to $1,492 after six months in the program and $958 after a year, the study found. Residency at Housing First costs $1,120 per person per month, including meals and housing.

"These benefits increase over time and they are possible without requiring that participants stop drinking," Larimer said. "And yet, the longer the participants stay in the housing program, the less they drink." Housing First residents' drinking decreased from a median of 15.7 drinks daily at the start of the study to 14 after six months and 10 after a year.

The research was published in the April 1, 2009 issue of the Journal of the American Medical Association.

Click here for article source

UCLA issues new report on Prop. 36

Dear Colleague,

I am copying below a very interesting and timely report on the effectiveness of California's Prop. 36, a ballot measure approved by California voters in 2000 that offers treatment instead of incarceration for nonviolent drug offenders. The report finds that the ballot initiative is being undermined by inadequate funding, participants dropping out of treatment, and increased arrests for drug and property crimes. The good new is that the initiative has saved taxpayers millions of dollars, several promising new programs have the potential to improve Proposition 36's results, and violent crime arrests have decreased more in California than nationally since the proposition's implementation.

Califonia's experience has much to teach us as we plan for the changes in NY State that will result from Rockefeller reform. We don't want to repeat their mistakes s w anticipate a much greater referral to treatment of arrested non-violent drug users. We will need a well-funded system that has the re-training to handle this somewhat new population. Without the knee-jerk reaction to send patients who continue to use substances in treatment back to prison, we will need a system that has a greater appreciation of the complex challenges these patients bring and face and the sophistication and time often required to help many problem users begin to make positive change in their use of substances.

This system must be committed to sophisticated psychological, substance use and medical evaluation and treatment that considers substance use in the context of the whole person in their context. Effective treatment is attractive and relevant to patients (or else why should they stay in treatment?) It is highly individualized and has as essential ingredients motivational enhancement, offering patients goal choice, understanding that continued use, slips and relapses are part of the change process and not evidence of failure and that people must begin the treatment process with treatment that truely starts where they are to maximize therapeutic alliance and retention in treatment. It is too long that the system has held patients accountable for "treatment failure" and not sufficiently looked at how limitations of funding, sophistication and creativity set up patients and clinicians to fail seeming to justify incarceration.

I welcome any feedback and discussion around these critically important issues.

Andrew Tatarsky, PhD

*****************************************************************************
Public release date: 14-Oct-2008
Contact: Mark Wheeler
mwheeler@mednet.ucla.edu
310-794-2265
University of California - Los Angeles

UCLA issues new report on Prop. 36

Treatment alternative for drug offenders has had mixed success

The effectiveness of Proposition 36, a ballot measure approved by California voters in 2000 that offers treatment instead of incarceration for nonviolent drug offenders is being undermined by inadequate funding, participants dropping out of treatment, and increased arrests for drug and property crimes.

The good news, however, is that the initiative has saved taxpayers millions of dollars, several promising new programs have the potential to improve Proposition 36's results, and violent crime arrests have decreased more in California than nationally since the proposition's implementation.

These are some of the key findings from UCLA's latest report on Proposition 36, also known as the Substance Abuse and Crime Prevention Act (SACPA) of 2000. The measure, which went into effect in July 2001, allows nonviolent adult drug offenders to receive substance-abuse treatment with supervision as an alternative to incarceration or supervision without treatment. The law also calls for an independent evaluation of the program, which is being conducted by UCLA's Integrated Substance Abuse Programs at the Semel Institute for Neuroscience and Human Behavior.

According to the report, under Proposition 36, more than 30,000 drug offenders enter treatment each year and about half of them are being treated for the first time. Most receive outpatient care, which is less expensive than residential treatment but is also less effective for heavy drug users. Although the number of available residential treatment beds has increased since the measure's enactment, the increases have not been able to meet the rising need. Stakeholders interviewed in focus groups indicated that this was due to limited funding and infrastructure.

The report also found that drug and property crime arrests were higher among Proposition 36 participants than among a comparison group of pre-Proposition 36 drug offenders, the latter having spent more days in custody and fewer days "on the street" during which they could get arrested. However, despite early concerns by critics of SACPA that the law would result in an increase in violent crime, the rate of violent crime dropped more in California (12 percent between 2001 and 2005) than nationally (9 percent over the same period).

While the Proposition 36 group was more likely to be rearrested, the measure has been a much less expensive alternative to jail or prison time. By reducing incarceration, Proposition 36 has helped save taxpayers about $2 for every $1 invested in the program. To improve Proposition 36's implementation, the report calls for greater use of narcotics-treatment programs, employment assistance and residential treatment, as well as graduated sanctions, ranging from more drug-test requirements to short jail stays, for those participants who fail to comply with the program's provisions.

Better integration of substance-abuse and mental health services for the mentally ill homeless population and more restrictive management for offenders with many prior convictions are also recommended in the report. While additional funding would likely be needed to implement some of these recommendations — and the use of jail sanctions would require a change in the law, since Proposition 36 forbids it — other recommendations could be implemented now and at low cost.

One such low-cost recommendation was demonstrated in a recent pilot project. Currently, about 15 percent of those convicted in California who agree to Proposition 36's provisions never show up to be assessed. But according to a Los Angeles County study, treatment programs that adopted a set of "process improvement" practices borrowed from the business world showed a dramatic 80 percent reduction in the number of assessment no-shows.

"It is particularly exciting to find a tool like this in the current environment of budget cuts," said Darren Urada, the principal investigator on UCLA's Proposition 36 evaluations. "Funding for Proposition 36 has been insufficient and shrinking over the years, and this has eroded stakeholders' ability to adequately treat and monitor offenders. Furthermore, the unpredictability in funding from year to year has undermined long-term planning efforts."

Proposition 36 funding was cut further last month when Gov. Arnold Schwarzenegger vetoed 10 percent of the program's funding in response to the state's fiscal problems. Funding for the voter-mandated evaluation of the measure, which includes research on ways toimprove the program, has also been suspended.

UCLA's evaluation reports may be of particular interest to voters this year, given that a closely related measure, Proposition 5 (the Nonviolent Offender Rehabilitation Act), will be on November's ballot. If passed, this proposition would integrate Proposition 36 into a tiered system of treatment and supervision for nonviolent drug offenders. According to the official summary provided by California's attorney general, the new initiative would allocate $460 million annually to improve and expand treatment programs for those convicted of drug and other offenses; limit court authority to incarcerate offenders who commit certain drug crimes, break drug-treatment rules or violate parole; substantially shorten parole for certain drug offenses; divide California Department of Corrections and Rehabilitation authority between two state secretaries; and create a 19-member board to direct parole and rehabilitation policy.

###

UCLA's reports on Proposition 36 are available at www.uclaisap.org/prop36/html/reports.html.

The UCLA Integrated Substance Abuse Program, part of the Semel Institute for Neuroscience and Human Behavior, is an interdisciplinary research and education institute that serves to advance the knowledge base on drug problems and to improve the delivery of drug-abuse treatment services through an array of projects. The Semel Institute is devoted to the understanding of complex human behavior, including the genetic, biological, behavioral and sociocultural underpinnings of normal behavior, and the causes and consequences of neuropsychiatric disorders.

Press Release: Open Letter to President-Elect Obama Regarding the Selection of the Administrator of Substance Abuse and Mental Health Services Adminis

Dear Colleagues:

The letter regarding the importance of professional leadership of SAMHSA is now off to Presdent Obama. You can still sign on if you haven't and view the list of signatories at www.andrewtatarsky.com/samhsaletter/.

Please disseminate the press release that is copied below and attached to any press you think may be interested in covering this story.

Thank you for your continuing support of this very important issue.

Andrew Tatarsky, PhD
www.andrewtatarsky.com
212-633-8157

*****************************************************************

For Immediate Release:
March 23, 2009

Contact: Andrew Tatarsky, PhD (212) 633-8157

Dozens of prominent substance use and mental health treatment and research professionals urge President Obama to break with recent administrations and appoint a professional with expertise in the science of substance use, mental health and public health to direct the Substance Abuse and Mental Health Services Administration (SAMHSA). They urge the President to appoint a leader to SAMSHA who supports evidence-based and theoretically sound treatments and will make decisions based on science rather than ideology and politics.

To fix SAMHSA’s chronic dysfunction, strong scientific and professional credentials are seen as key to insure that the agency’s $3.3 billion budget is best spent to effectively address the treatment and prevention of mental illness and addiction. The past two decades have seen dramatic scientific advances in understanding mental illness and addiction which have led to the development of effective treatments and prevention programs. Unfortunately, these treatments are not reaching the vast majority of the public who need them. It is noted that the United States spends about $120 billion on behavioral health care but a government review of SAMHSA, the agency responsible for overseeing this area of healthcare, rated the agency’s programs as largely ineffective and that much more could be accomplished with this money. Only 1 out of every 4 of these dollars is spent on evidence-based care with the rest going toward treatments and programs of questionable value. Many politicians including Congressman and Senators who sit on relevant oversight committees have never heard of SAMSHA, despite the fact that SAMSHA is on the same organizational level in the Public Health Service as CDC and FDA.

One major reason for SAMSHA’s obscurity and dysfunction has been the failure to appoint a person with significant scientific and professional expertise to lead the agency. Past administrators have been drawn from the ranks of state government with experience in community action, but without recognized high level scientific mental health, addiction, and public health expertise. These professionals say that it is essential to have the highest caliber professional leading the agency in the fight to improve the lives of all those who struggle with mental health problems and the consequences of substance abuse and to assure that government money works for the benefit of all Americans. They call on the Obama transition team to appoint a professional with a national reputation of excellence as a scientist and innovator in implementing science-based and theoretically sound mental health, addiction and public health programs in communities.

To view the letter and view the list of signatories, go to: www.andrewtatarsky.com/samhsaletter/

For further information or to arrange interviews with Andrew Tatarsky, the organizer of this campaign, or any of the other signatories call 212-633-8157 or email atatarsky@aol.com.

Dare to Act - New Website from the Hungarian Civil Liberties Union

Dear All,

As many of you know, on March 11-12 a High Level Segment of the Commission on Narcotic Drugs will review the implementation of targets adopted by the UNGASS in 1998. HCLU launched a new campaign to raise awareness on the unintended consequences of the international drug control system and mobilize people to ask for change.

Please have a look at our brand new campaign site and make sure you send this link to as many people as possible: http://daretoact.net/

We also launched a new YouTube group profile where people can upload their own messages to the governmental delegates - this intro video explains why and how:



Best wishes,

Peter Sarosi
Drug Policy Program Director
Hungarian Civil Liberties Union
Tel.: +36 1 279 2236
www.drugreporter.net

Upcoming Trainings on Integrative Harm Reduction Psychotherapy for Problem Substance Use

Dear Colleague:

I copy below information about two training opportunites coming up in the near future on Integrative Harm Reduction Psychotherapy. Next Thursday, March 26th, I will be giving a free introductory talk on my work at the Washington Square Institute down in the Village. The following Friday afternoon, April 3rd, I will be offering a three hour workshop at the et Ellis Institute on 65th Street in which we will have more time to explore the theory and techniqe of my approach with an emphasis on how you can integrate it into your therapy practice. I would welcome case material and clinical challenges that you have come up against to bring to the discussion.

I hope to see you!

Best,
Andrew Tatarsky, PhD

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Free introductory talk on Integrative Harm Reduction Psychotherapy (IRP)

Thursday March 26, 2009 @8:30-10pm
Scientific Meeting

Washington Square Institute
41-51 East 11th Street
New York, NY 10003
212-477-2600

Free to Public

RSVP: registrar@wsi.org , 212-477-2600

Effective Psychotherapy for Drug and Alcohol Users: Theory and Technique of Integrative Harm Reduction Psychotherapy

The treatment of patients with drug and alcohol problems has been dominated by an anti-psychological disease model which promotes the view that such patients cannot benefit from psychodynamic psychotherapy and instead require authoritarian treatment. Experienced and well-intentioned psychotherapists have been influenced by this view and avoid treating this population of 35 million in the USA.

I will introduce Integrative Harm Reduction Psychotherapy (IHRP) as an alternative approach to effective treatment of substance using patients. IHRD is based on a multifaceted view of problem substance use as reflecting the interplay of biology, personal and interpersonal dynamics and social context. IHRD integrates a relational psychoanalytic approach with active skills building to support positive changes in substance use and related issues.

I will discuss clinical challenges and limitations of traditional treatment and the clinical rationale for harm reduction as an alternative paradigm for helping substance users. I will define the harm reduction model, give a little history and discuss its application to psychotherapy. I will discuss the theoretical basis for IHRP including a biopsychosocial process view of addiction, the multiple meanings of substance use as points of engagement and the stages of motivational change model and will explore how to use these ideas to create a collaborative, negotiated therapeutic alliance. Fina lly, I will present an overview of IHRD’s 7 therapeutic tasks with emphasis on therapeutic process and technique.

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Integrating Harm Reduction Psychotherap y Into Your Practice

HALF-DAY WORKSHOP emphasizing theory and technique at The Albert Ellis Institute

Friday, April 3, 2009, 1:30-4:30pm

The Albert Ellis Institute
45 East 65th Street
New York, NY
(212) 535-0822

The Workshop will:

Explore the main tenets of the clinical philosophy of Integrative Harm Reduction Psychotherapy

Identify the three main theoretical bases of this approach: a biopsychosocial process model of problem substance use, the multiple meanings model and the stages of motivational change

Discuss the three domains of IHRP: the therapeutic alliance sets the stage for the therapeutic process, active skills building for assessment, goal-setting and working toward positive change and exploration of the multiple personal and social meanings of substance use

Describe the seven key therapeutic tasks, including managing the therapeutic alliance, therapeutic relationship as healing agent, facilitating capacities for change, assessment as treatment, embracing ambivalence, goal setting, and working toward positive change

TUITION

Regular Registration: $50.00

F/T grad students (with proof of status) $40.00

Call to register: (212) 535-0822

Bio:

Dr. Andrew Tatarsky has specialized in the field of substance use treatment for almost 30 years as psychotherapist, supervisor, program director, trainer and author. He holds a doctorate in clinical psychology from the City University of New York and is a candidate in20New York University’s Post-doctoral program. He is Co-Director of Harm Reduction Psychotherapy and Training Associates; founding board member, Division on Addictions of NYSPA, Chairman of the board of Moderation Management and founding board member, Association for Harm Reduction Therapy. His book, Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems, now in paperback, has been published in the United States and Poland. Dr. Tatarsky is in private practice in New York City and trains nationally and internationally.

Obama's Odd Drug Control Plan: Appoint Qualified People

20.03.2009
The New Republic
Harold Pollack

Harold Pollack is a public health policy researcher at the University of Chicago's School of Social Service Administration, where he is faculty chair of the Center for Health Administration Studies. He is a regular contributor to The Treatment.

I'm not a fan of the Office of National Drug Control Policy (ONDCP), the "Drug Czar's" office. I wish the office would moderate its near-exclusive focus on illicit drugs to pay greater attention to alcohol, tobacco, and prescription drugs. Of course ONDCP should place greater emphasis on treatment, harm reduction interventions for street users, and measures to reduce the large-scale incarceration of so many drug users and drug sellers.

Ironically, these ideological matters mask a larger problem: ONDCP has done a bad job at what it is trying to do. The office's self-marginalization under Bush-43's John Walters exemplified the dysfunction, but the problem is deeper than any one person or administration.

Some excellent people have worked at ONDCP and have done some good. (I will do them the courtesy of not naming them, given the broadside I am now delivering.) By and large, however, ONDCP has been an obvious hindrance in efforts to form and communicate effective policies, even in areas that fit the office's narrow policy agenda.

If a congressional aide or a reporter needed a sensible take on (say) the effectiveness of Mexican drug interdiction or the operational challenges of retaining street drug users in treatment, ONDCP would not make the first round of calls--unless, that is, one were seeking the predictable red meat from an extreme use-reduction perspective. It is almost impossible to imagine an academic making that call.

There is something fundamentally amiss here. This is not (wholly) a question of partisan politics, though the capture of ONDCP by cultural conservatives is an aggravating factor. Maybe things would have turned out differently had William Bennett enjoyed less success in making needle exchange and other matters a profitable front in the culture wars. We'll never know. Somehow, drug policy brings out the worst in American politics.

I may be sensitive because I spend much of my day researching health policy. However much I disagree with conservatives such as Gail Wilensky and Douglas Holz-Eakin, I cannot doubt their expertise and their good faith. Yeah, there are plenty of health policy hacks out there, but the serious players on all sides are generally expected to be conversant with a large and growing body of evidence and to make some minimum of sense.

For years, Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, has been America's de facto AIDS Czar. Last year, he spent a day on our university campus fielding questions from students and faculty about AIDS research and care. He spoke with evident mastery about virtually every major challenge ranging from the molecular biology of proposed vaccines to the prevention challenges of "treatment complacency" to the politics of needle exchange and Ryan White CARE Act funding, to the cultural, political, and implementation challenges facing PEPFAR in different countries. The contrast over time in expertise, sustained commitment, high-level access, and sheer civility between him and his ONDCP counterparts is damning.

Things are looking up, though. The new Drug Czar, Gil Kerlikowski combines the credibility of a big-city police chief with a solid reputation for pragmatic and decent law enforcement practices. More important are those being brought in to back him up, particularly on clinical and scientific matters beyond the Chief's personal experience.

Sources report that Tom McClellan will be Kerlikowski's deputy director, and second-in-command. McLellan's appointment is part of a weird pattern of hires made by the Obama administration: Appoint people who actually know what they are talking about rather than ideologues or the President's smiling and funny roommate from boarding school.

Moreover, Kerlikowski and his superiors might actually listen to him. McClellan isn't the first drug policy expert to hold that post. William Bennett had at-hand an authentic treatment authority, Columbia's Herb Kleber. As Mark Kleiman tartly notes, Bennett was content to trade on Kleber's reputation without allowing Kleber's expertise to interfere with his culture-warring.
You probably have never heard of McLellan. He doesn't blog or banter on the Daily Show. He is a household name within the worlds of substance abuse treatment and drug policy. He's spent the last few decades tending the vineyard of evidence-based treatment practices. A prolific researcher, he edits the flagship Journal of Substance Abuse Treatment. He directs the University of Pennsylvania's Treatment Research Institute. He was a major development of the Addiction Severity Index, the standard assessment tool for entering treatment clients. He worked with Vietnam veterans returning home facing complex challenges alongside their substance use. Sadly, this work is especially timely.

He was also lead author of one of the most widely-cited articles ever published on substance abuse, which argued that drug dependence is a chronic medical disorder which should be insured, treated, and evaluated in similar fashion to asthma, type-2 diabetes, and hypertension. In its understated way, this remains an important, humane, and pragmatic statement of the challenges facing clinical practice and public policy in this difficult area.

Kerlikowski and McLellan have their work cut out for them. They will operate in a DC environment that breeds bad drug policies and that fails to provide needed resources for programs of proven value. The recent stimulus debate was sadly typical: Substance abuse treatment received kind words in the final legislation. Yet these services received almost no money to offset cutbacks imposed by state governments.

As the presumed point-man on matters of demand reduction, Dr. McLellan faces a particularly daunting challenge. He must challenge politicians to provide greater treatment resources. He must challenge the treatment community itself to provide better, more-accessible, more effective and evidence-based services. So often, treatment falls far short of what we can do. Most Americans with drug or alcohol disorders will never access formal treatment. We need to find better ways to serve them in other ways. Prevention programs raise similarly serious concerns.

Perhaps most important, McLellan and his boss must nurture ONDCP as a serious and capable organization, creating an environment in which good people not only visit, but stay to do good work. A depressing number of Drug Czars and staff quickly move on to greener pastures.
These are hard problems, and one shouldn't expect too much. At least the President has assigned good people to the task.

--Harold Pollack

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Rethinking Drinking

This website and booklet from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) provides evidence-based information and interactive tools about risky drinking patterns, signs of an alcohol problem, and ways to help people cut back or quit drinking.

Click here to visit Rethinking Drinking

Publication Year: 2009

Publisher:
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
5635 Fishers Lane, MSC 9304
Bethesda, md 20892
Phone: 301-443-3885
Website: http://www.niaaa.nih.gov/