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 01 Practice Research Collaboration

·        New York Practice Research Collaborative. (poster)  Frank McCorry, Ph.D., Susan Brandau, Cheryl Backus, and Robert Gallati, M.A.  (Frankmccorry@oasas.state.ny.us)

The New York State Practice Research Collaborative [PRC] is a state endorsed, provider-driven consortium of research and provider organizations committed to (1) improving clinical outcomes in alcohol and substance abuse treatment and prevention programs through the use of evidence-based practices, (2) improving the conduct of research through practitioner involvement; and (3) influencing policy as it effects research and practice at the local, state and national levels. The PRC is comprised of state policy-makers from the Office of Alcoholism and Substance Abuse Services, Department of Health, Office of Mental Health and representatives from the Alcoholism and Substance Abuse Providers of New York State, community-based alcoholism and substance abuse treatment and prevention providers, academic institutions, research organizations, the Northeastern States Addiction Technology Transfer Center, the Institute for Professional Development in the Addictions, and consumers.  The PRC sponsors seven regional Practice Research Networks [PRNs] consisting of providers and researchers. The PRNs are represented on the PRC to ensure the articulation and incorporation of regional issues into the statewide practice research agenda. 

02 Clinical Practice and Treatment Models

·        Chemical Dependence and Family Intervention. (presentation)  Roberta M. DeCarlo (Robertadecarlo@oasas.state.ny.us)

 The research literature and the majority of chemical dependence treatment communities support and recommend a family approach as an integral part of the overall treatment.  Clinicians and researchers who recognize the importance of treating individuals in context have challenged the practice of treating individuals from a pathological-trait framework.  Findings of several research articles indicate the importance of not only involving family members of chemically dependent individuals in the treatment process, but also providing therapy to the family system rather than just the individual user.

·        Adolescent Treatment Models: Evaluation of an Exemplary Adolescent Substance Abuse Treatment Program in New York City. (poster)  Patricia Perry, Ph.D. (Patriciaperry@oasas.state.ny.us)

Dynamic Youth, Inc., in partnership with NYS-OASAS, is participating in the Center for Substance Abuse Treatment’s initiative to evaluate exemplary adolescent treatment programs.  As part of this initiative, quantitative and qualitative data will be collected to (1) evaluate the effectiveness of the program, (2) conduct a cost analysis, and (3) generate a treatment manual so the program can be replicated in other settings.  This poster will show the multiple methods which are planned to evaluate Dynamic Youth and will list the other adolescent treatment programs that are participating in the initiative across the country.

03 Intervention and Outreach

·        Study of Barriers to Referring the At-Risk, Street Outreach Population to Substance Abuse Treatment. (poster)  Phil Appel, Ph.D., Aletha Ellison, B.S., and Lee Jansky, B.S.  (Philappel@oasas.state.ny.us)

The purpose of this study is to identify the barriers that intravenous drug users (IDUs) contacted by OASAS –funded, street outreach programs face in getting referred and admitted to drug abuse treatment, and to get suggestions for reducing the barriers.  Working together with street outreach workers, project staff will conduct field interviews with IDUs about the obstacles they face. Selection criteria include being 18 or older, having injected an illicit drug in the past week, and not having been in treatment within the past 30 days. Issues to be explored include motivations for treatment, lack of basic documents, insurance, ignorance of treatment, aversion to available treatment offerings, among others. Obstacles and suggestions for their remediation will also be obtained from street outreach workers, supervisors, and program directors; program directors, and intake and counseling staff of treatment programs in the major modalities; managers and policy makers in agencies whose operations affect treatment referrals of IDUs, e.g., OASAS, the AIDS Institute, the NYS and NYC Departments of Health, NYC’s Human Resources Administration, the Police Department, among others. Policies, procedures, and practices of the various agencies and systems will be explored as possible sources of obstacles to treatment referral as well as obstacles originating with IDUs themselves. The results should help identify and reduce barriers to AOD treatment enrollment, particularly for those drug abusers at high risk of contracting or transmitting HIV.

EVALUATION TOPICS

04 Treatment Outcome

·        Change in Behaviors of Clients Remaining in Treatment at Least Six Months: OASAS Evaluation Systems. (Presentation)  Alan Kott, M.A. (Alankott@oasas.state.ny.us)

A discussion of the findings of several reports that examine the behavioral status of clients that remain in AOD treatment programs for at least six months.  Admission and discharge information from the OASAS Client Data System is used as the primary source of data along with survey data obtained from the providers on specific clients.  Findings reveal large and statistically significant decreases in negative client behaviors.

·        Methadone Patients Continuously in Treatment for at Least Ten Years. (poster)  Philip W. Appel, Ph.D., Herman Joseph, Ph.D., Bill Nottingham, M.S., Ed Tesiny, M.S., and Alan Kott  (Philappel@oasas.state.ny.us)

Methadone maintenance treatment (MMT) is designed for indefinitely long treatment tenures so evaluations should explore in-treatment outcomes of very long-term patients.  An opportunity to conduct such a study arose in New York State, in 1996. The Office of Alcoholism and Substance Abuse Services (OASAS) implemented a study of patients in treatment continuously for at least 10 years (with no more than a ninety-day interruption) by having counselors provide data for eligible patients on urinalysis positives for illicit drugs, problematic alcohol use, employment status, arrests, days hospitalized (for nondetox services), emergency room admissions, current  methadone dose, among others, for the period of February – July, 1996. Ten-year plus patients comprised nearly 18% of the MMT population in August, 1996. Results for a ten percent stratified random sample of 10-year plus patients (N = 560) were compared to patients with three months to five years of continuous treatment, discharged during the first half of 1996 (N = 7,250). The ten-year patients had a much lower arrest rate and a much lower percentage of them were arrested (p < .0001); fewer 10 year patients were hospitalized (p < .0001) and they had fewer than half the days hospitalized (p < .05) as did comparison group patients. More than twice as many 10-year patients were employed yet more of them were classified as “disabled”, 19.8 versus 11.0 percent. Over 60% of the 10-year patients had no urine positives, and over three-quarters, between zero and two, showing no to low drug abuse. As expected, the 10-year patients did have better outcomes than the comparison group though some of the differences were small, the majority were supported by benefits, and a important segment exhibit serious medical,  social, and illicit drug use (cocaine) problems which need to be addressed.

·        New York TOPPS II. (poster)  Shirley DeStafeno  (Shirleydestafeno@oasas.state.ny.us)

In October 1998, the New York State Office of Alcoholism and Substance Abuse Services (OASAS) received a grant from the Federal Center for Substance Abuse Treatment (CSAT) to conduct the Treatment Outcomes and Performance Pilot Enhancement Study (TOPPS II).  The purpose of the NYS TOPPS II is to study the predictive validity of a set of performance indicators that are currently included in OASAS’s Management Information System (MIS).  If the performance indicators are valid predictors of outcomes assessed at 6 months after discharge, the State will move toward using data currently provided by the MIS to predict outcomes rather than relying on expensive and time-consuming long-term outcomes evaluations.  Secondly, the State will evaluate whether the data collection instrument that is currently mandated statewide, the Client Admission Report (PAS-44), is sufficiently comprehensive and sensitive to support the results or whether an alternative instrument is necessary to increase the predictive power of performance indicators.  The ASI-Lite-CF, a shorter version of the Addiction Severity Index (ASI) with clinical factors, will be pilot-tested as the alternative instrument.  The NYS TOPPS II is being conducted as part of the larger TOPPS II nationwide study of 19 states that includes New York.

The NYS TOPPS II is designed to study a sample of statewide substance abuse treatment clients who receive state-funded treatment services.  The five types of programs included in the study are short-term inpatient, residential drug free, intensive outpatient, standard outpatient, and methadone maintenance.  These programs represent the major program types available in New York, and cover the range of population at risk (excluding crisis centers).  The client sample for TOPPS II will consist of 65 to 75 clients from each of the 25 treatment programs, resulting in a total sample size of approximately 1,875 clients.  All adult clients (age 18 and older) entering treatment at the 25 treatment programs will be asked to participate in the study.  If they agree to participate, they must sign an informed consent form before any data collection begins.  An "intent to treat" design will be employed, in which every client who consents to participate in the outcomes study is included in the follow-up collection effort. 

Trained staff from the treatment providers will gather baseline data with the NYS-OASAS, Client Admission Report (PAS-44).  In addition, the ASI-Lite-CF, which is being pilot tested, will also be used to collect base-line data.  Through the Client Services Reporting Form (CSRF), program staff will obtain detailed information on client services received during treatment.  When a client completes treatment or leaves the program, staff will complete the NYS-OASAS Client Discharge Report (PAS–45).  DeltaMetrics, OASAS’ subcontractor, will collect comprehensive post-treatment follow-up data (i.e., 6 months after discharge) through telephonic administration of the ASI Lite-CF including a Client Satisfaction Survey.

Data analysis will examine the relationship between performance indicators and post-treatment outcomes: (a) across the sample as a whole, (b) within each program type, and (c) within specific subgroups of clients.  The results of the study will assist in the development of an Outcomes Monitoring System (OMS) that allows continual tracking and reporting on the effectiveness of the State’s substance abuse treatment providers.  Revalidation of TOPPS II data will assist with updating and refining the OMS.  In addition, study findings will inform policy and funding decisions addressing resource allocation.

·        Treatment Outcome Study (TOS). (poster)  Edward Tesiny and Joyce Robinson, Ph.D.  (Edwardtesiny@oasas.state.ny.us)

The New York State Office of Alcoholism and Substance Abuse Services (OASAS) is about to implement a Treatment Outcome Study (TOS).  The TOS seeks to assess the ability of OASAS-licensed programs to produce the desired treatment outcomes in the clients that they serve.  The primary goals of the TOS are to (1) examine the relationship between types and intensity of services received and positive client outcome, (2) examine the effectiveness of different types of programs in producing positive outcomes in clients with similar presenting problems, (3) examine the cost-benefit of the New York drug and alcohol treatment system, and (4) determine the effectiveness of individual OASAS-licensed drug and alcohol treatment programs in producing positive client outcomes.

The TOS will utilize a sample of alcohol and substance abuse treatment programs to conduct the evaluation. The sampling methodology requires a 10% sample resulting in the selection of 116 programs.  Within each program, 85 adult clients will be selected to participate on a voluntary basis resulting in a subject pool of approximately 10,000 clients. OASAS randomly sampled programs to participate in the TOS based on program type, size and geographic location.  Participating programs will select the first 85 consecutive adult clients who are admitted into their program and who voluntarily consent to participate in the evaluation. For a client to be included in a program's TOS sample, he/she must have used alcohol or drugs in the past 30 days unless they are referred from the criminal justice system.  Upon a client's admission to the study, direct-care staff will record every service provided to the client, the duration of the service, the date the service was provided, and whether it was provided on-site or not. These data allow OASAS to examine the relationship between the type, frequency and intensity of services received and client change while in treatment and after leaving treatment.

The Addiction Severity Index (ASI) will be used to assess clients' level of functioning in seven areas: medical status, employment status, drug and alcohol use, family history, family and social relationships, legal status, and psychiatric status.  In addition, the client's motivation and readiness for treatment is assessed.  For every three months that the client remains in treatment, the program will administer a shortened version of the ASI.  These data will permit OASAS to examine the progress clients make while in treatment.

Six months following the client's termination from the program, a contractor will contact him/her by telephone and administer a follow-up ASI and collect information concerning his/her current status and activities, and satisfaction with the treatment received.  The contractor will utilize a Computer Assisted Telephone Interviewing (CATI) system to administer this follow-up.

OASAS will issue annual reports that describe the status of the project and the results of the analyses relating to the impact of client services on outcomes and the relative effectiveness of treatment types.  As soon as this and the program-specific data become available, they will be used to direct the provision of technical assistance and to inform OASAS funding and planning decisions.

The focus of this presentation is the TOS On-Line System that will be utilized as a management, monitoring and data entry system by individual TOS programs to monitor their progress while participating in the study.  In addition, the TOS On-Line System will be utilized by OASAS to monitor all participating programs' compliance with study protocol and recruitment progress statewide.

05 Performance Monitoring

·        Integrated Program Monitoring and Evaluation System and Workscope. (poster)  Janet Reilly  (Janetreilly@oasas.state.ny.us)

New York State OASAS evaluates the efficiency and effectiveness of alcoholism and substance abuse treatment services utilizing the Integrated Program Monitoring and Evaluation System and Workscope Objective Attainment System, generally referred to as IPMES/Workscopes.

Integrated Program Monitoring and Evaluation System (IPMES).  IPMES monitors the program performance of  OASAS licensed treatment programs and identifies areas in which programs appear to be operating below expectations.  IPMES utilizes demographics and transactional data to compare similar programs.  An IPMES report is produced for @ 1300 programs on an annual basis.  Agency staff work with providers to interpret the data, identify problem areas and establish action plans to improve performance.  Reports present performance indicators such as retention and completion rates, as well as admission-to-discharge changes in client functioning.  They also provide client profiles that chart characteristics such as age, sex, educational attainment, employment history, and criminal justice involvement.

Workscope Objective Attainment System (WOAS).  The Workscope Objective Attainment System applies to @ 750 OASAS-funded treatment programs.  The basis of this system are annual performance targets established by the service providers themselves.  A program's performance is monitored against both numeric and programmatic objectives.  Achievement of numeric objectives is computed from reports submitted to the OASAS client data system, and does not require additional reporting by service providers.  Programmatic objectives reflect unique aspects of a provider's services and require annual progress reports.

POLICY TOPICS

06 Prevention Planning

·        State Incentive Cooperative Agreement Prevention Initiative: R+D for a Comprehensive NYS Planning and Evaluation System. (presentation)  Barry Donovan, Ph.D., M.S.W. Barrydonovan@oasas.state.ny.us

The State Incentive Cooperative Agreement Prevention Initiative is a state inter-agency effort designed to assist 15 counties and local communities in applying data based needs assessment and strategic planning technology.  This process is intended to increase the use of research-based prevention strategies by counties and service providers guided by the OASAS Risk and Protective framework.  The presentation will describe the state, county, community and program level evaluation strategies planned to assess the process, outcomes and impacts of this initiative.  The knowledge and skills developed during the evaluation will be spread to other counties and communities during and after the three year evaluation.  This will be accomplished through the institutionalization and transfer of the OASAS prevention services evaluation technologies developed during the initiative.

·        State Incentive Cooperative Agreement Evaluation Design. (poster)  Barry R. Donovan, Ph.D., M.S.W.  (Barrydonovan@oasas.state.ny.us)

The State Incentive Cooperative Agreement (SICA) Prevention Initiative is a NYS inter-agency effort designed to assist 15 counties or urban communities in applying data based needs assessment and strategic planning technology.  This process is intended to increase the use of research-based prevention strategies by counties and service providers guided by the OASAS Risk and Protective framework.  This poster will present the design for the Cross-state, State, community and program level evaluation strategies planned to evaluate the process, outcomes and community impacts of the SICA initiative.

07 Epidemiology and Need Assessment

·        Who Needs Alcohol/Substance Abuse Treatment And Where Do They Live?: Horizontal Synthetic Estimation. (presentation)  Cheryl A. Backus, James Schmeidler, Ph.D., Robert J. Gallati, M.A., and Kellie Barr Konye, M.A.  (Cherylbackus@oasas.state.ny.us)

The New York alcoholism and substance abuse (ASA) service system is the largest ASA service system in the world.  Statewide planning for ASA treatment need in NYS can be extremely complex.   The state encompasses a wide range of geographically and culturally diverse areas from New York City to extremely rural areas.  Types, levels and consequences of substances used can vary dramatically among these areas. In order to address this complexity in a manner both valid and informative, Office of Alcoholism and Substance Abuse Services (with funding from CSAT Contract # 270-96-0019) conducted a series of need assessment efforts.  The culmination of these efforts resulted in estimates of the number of people in need of ASA treatment for each county in the state.  Horizontal synthetic estimation was used to combine the results of a social area analysis of current, relevant community indicators with 1994  NYS-specific Adult Household Survey data to estimate the number of people in each county that may need ASA treatment services.  Contrary to more traditional synthetic estimation techniques, an assumption when using horizontal synthetic estimation is that the environment affects ASA prevalence rates.  The use of both community indicator and survey data together may also produce less biased estimates than either used alone.  This presentation will go through each step of the process used to obtain these synthetic estimates of need.

·        Methadone Maintenance Treatment System: A Stochastic Model with Population Estimates. (Presentation)  Nelson Toth, Ph.D.  (Nelsontoth@oasas.state.ny.us)

Methadone maintenance is an important treatment modality with a current state wide population of approximately 40,000 individuals in treatment.  Discussed here is a ‘model’ of this treatment system that describes the duration of treatment, and inter-treatment, episodes, as well as how the probability of readmission depends on treatment duration.  Also discussed is a capture-recapture analysis that affords estimation of the size of the ‘methadone-competing’ population.

·        Estimation of Heroin Prevalence in New York State. (presentation)  James Schmeidler and Blanche Frank  (Jamesschmeidler@oasas.state.ny.us)

This study attempted to develop a new method to estimate heroine prevalence. The method combined two approaches: first, the quantitative modeling of treatment data to yield numbers of heroin users who are likely to enter treatment for the first time, heroin users who were formerly in treatment and are likely to enter treatment once again, and those who are currently in treatment. Second, an ethnographic study of 1,035 heroin abusers in 12 communities in New York City and in other parts of New York State to yield the proportions of four types of heroin abusers constituting the whole heroin-abusing population—the three treatment amenable or susceptible types indicated above—and also those who refuse to ever enter treatment.  Together, the numbers yielded by the first approach and the proportions yielded by the second approach could give the total prevalence.

As it turned out, the quantitative modeling of treatment data was able to define categories of heroin users that were somewhat different than the categories defined by the ethnographic study.  Nevertheless, there was enough agreement to produce a number and proportion for heroin users currently in treatment that yields a prevalence estimate of 206,000 heroin abusers in New York State. In addition, the quantitative modeling yielded estimates for: (1) those who r have ever used heroin who will eventually enter treatment for the first time—200,759. (2) Those who are currently in treatment for heroin abuse over a 28-day period (excluding detoxification)—48,761 and, (3) Those formerly in treatment who are expected to return to treatment because of their heroin use—18,697.

·        The New York City Half -Borough Reports: Emergent Trends Citywide between 1991 and 1997 and a Summary of Illicit Drug-Related Events by Area and by Population in New York City. (presentation)  Rozanne Marel  (Rozannemarel@oasas.state.ny.us)

In this latest series of "The New York City Half-Borough Reports", the Bureau of Applied Studies monitored and analyzed trends over time in key indicators of illicit drug-related events that reflect many facets of the substance abuse problem in New York City. Nine reports were generated describing trends at the sub-Borough level and showing, in effect, the differential impact that drug abuse has had on life throughout New York City. In showing that certain areas have suffered far more serious consequences than others, the reports highlight those areas and "neighborhoods" of the City that would appear to be particularly in need of services for problems related to drug abuse.

As a measure of differential impact in problem severity, the latest population estimates for each part of the City were used as crude guides as to what might be expected in terms of the drug-related events described. Thus, the table showing a "Summary of Illicit Drug-Related Events by Area and by Population in New York City" clearly reveals, for each sub-area of the City, the proportion of the total estimated household population it contains in relation to an area's proportionate share of illicit drug-related events.

·        Alcohol and Other Drug Use Among New York State's 5th through 12th Grade Students: The OASAS School Survey, 1998. (presentation)  Rozanne Marel, Ph.D., and Greg Rainone, Ph.D.  (Rozannemarel@oasas.state.ny.us)

OASAS conducted its fifth major survey of alcohol, tobacco and other drug use among a probability sample of 21,000 school students statewide during the spring of 1998.  The findings were projected to the 1.9 million students enrolled in grades five through 12.  Much like past surveys conducted by the agency, this survey included 7th through 12th graders in public and private schools throughout the State.  In addition, the study for the third time included 5th and 6th graders in public and private schools, with a separate questionnaire especially for these grades. The findings of this latest survey indicate that the major substances of use among New York State’s students continue to be alcohol, cigarettes, marijuana, inhalants, and prescription analgesics used nonmedically.  A comparison of findings with those from the last survey conducted in 1994 showed slight declines in the use of alcohol, cigarettes, prescription analgesics and inhalants and slight increases in the use of marijuana, LSD and cocaine. Furthermore, the increases tended to occur among students in the upper grades, especially 11th and 12th graders.  Findings by gender tended to show similar rates of use for girls and boys, while findings by ethnicity generally showed the highest rates among white students, followed by Hispanic students, black students and Asian-American students.  Findings on the use of nonprescription medications indicated that nearly one out of every 10 students had used “over  the  counter” pain  killers on 10 or more days during the past 30 days.

·        Alcohol and Other Drug Use Among College Students in New York State: Findings from a Statewide College Survey. (poster)  Blanche Frank, Ph.D., Rozanne Marel, Ph.D., and Richard Lucey, Jr.  (Blanchefrank@oasas.state.ny.us)

·        The Changing New York City Heroin Scene. (poster)  Blanche Frank, Ph.D., and staff of Bureau of Applied Studies  (Blanchefrank@oasas.state.ny.us)

Substantial changes have taken place in New York City’s heroin scene, especially over the past two decades.  The purity of retail-level heroin is higher than it has ever been, averaging above 60% for much of the 1990s.  The impact of AIDS among injecting drug users coupled with heroin’s high purity have  resulted in a change in the mode of use from injecting to intranasal use.  Also, heroin users have become an aging population.  Nevertheless, a new image of heroin has taken hold in affluent suburban areas outside New York City, attracting young people in their late teens and early twenties.

·        Using Community Indicators for County-Level Prevention Needs Assessment. (poster)  Kathy Dixon and Dawne Amsler  (Kathydixon@oasas.state.ny.us)

OASAS has developed an instrument to assess the need for youth alcohol and substance abuse (ASA) prevention services at the county level.  The Prevention Risk Indicators Services Monitoring System (PRISMS) Profiles utilize indicator data to predict negative youth outcomes from known risk factors for alcohol and substance abuse.  These Profiles are based on two Risk Indices, the Community Risk Index (CRI), and the Youth Risk Index (YRI), as well as two Consequences Indices, the Youth Alcohol Consequences Index, and the Youth Drug Consequences Index.  The CRI and YRI were constructed by reducing county-level risk indicators into risk constructs through factor analysis, and then selecting those risk constructs that were correlated with or predicted later alcohol and drug consequences.  The CRI and YRI were validated by regressing the later Alcohol and Drug Consequences Indices on their earlier Risk Indices.  The CRI and YRI are able to account for over one-half of the variance in later youth alcohol and drug consequences, and the predictive ability of the model is increased in both cases by including the current Youth Alcohol and Drug Consequences Indices.  Once the CRI and YRI and Consequences Indices were developed, the Indices scores were mapped.  The maps visually demonstrate that alcohol and drug risk factors and consequences operate independently at the county level.  Rural counties are most likely to experience alcohol risk factors and alcohol consequences.  Drug risk factors and drug consequences are mostly concentrated in urban counties and suburban counties, especially the NYC suburban counties.

·        Gender Issues in Estimating Alcohol and Substance Abuse Treatment Need. (poster)  Cheryl Backus; Nelson Toth, Ph.D.; Robert Gallati; James Schmeidler Ph.D.; Rozanne Marel Ph.D. and Kellie Barr Konye, M.A.  (Cherylbackus@oasas.state.ny.us)  
Click Here to see a power point presentation

Recently, New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) revised the methodology used to determine the number of individuals in need of treatment.  Prevalence estimates were derived from the 1994 NYS Adult Household Survey funded by the Center for Substance Abuse Treatment. Estimates of need for treatment were developed by differentiating individuals by their use category (i.e., frequency, quantity and pattern of use), whether they received a survey-determined DSM-IIIr diagnosis of abuse or dependence, and, for drugs, whether they perceived themselves as addicted and/or experienced a substance-related problem experienced in the past year.

A close scrutiny of these estimates revealed greater gender differences in estimated need for alcohol treatment than would usually be expected.  The ratio of men to women who are in need of alcohol treatment was approximately 4:1.  There also appeared to be a possible gender effect in terms of whether a respondent was diagnosed with alcohol or other drug abuse or dependence.  This observation appeared even when use levels were held constant (i.e., men were more likely to be diagnosed with alcohol abuse or dependence than women overall). While we might expect the opposite trend this was also evident at particularly higher levels of consumption.

Further investigation of these preliminary observations include the following: assessment of possible gender differences for each of the DSM-IIIr criteria in the survey; further analyses of overall gender differences; assessment of DSM-IIIr criteria survey item wording; selection of the number of items per criteria; and selection of criteria.

·        Estimation of Heroin Abusers in New York State from Treatment Data and an Ethnographic Survey. (poster)  James Schmeidler, Ph.D., Blanche Frank, Ph.D., and Nelson Toth, Ph.D.  (Jamesschmeidler@oasas.state.ny.us)

Heroin abusers were classified into four categories of willingness to enter treatment: unwilling to enter treatment, willing to enter treatment but not yet treated, currently in treatment, or formerly in treatment.  Treatment data were used to estimate numbers and rates for those willing to enter treatment.  An ethnographic survey was used to estimate rates of all categories in three ways: respondents, excluding detox from treatment history; respondents, including detox in treatment history; and acquaintances well known to respondents.  These estimation procedures differed in their definitions, so some estimates of rates using different methods were not directly comparable.  The number of heroin addicts was estimated by extrapolating from an estimated 49,327 in treatment including recent detox to 206,000 abusers, based on the 23.9 percent of respondents’ acquaintances in treatment.  

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