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NYU and its affiliates provide a rich array of addiction services through programs at Bellevue Hospital Center, the VA New York Harbor Healthcare System and the community-based treatment programs of the NY Node of the NIDA Clinical Trials Network. Private practice services are also available. Our Clinical Core, under the direction of Dr. Stephen Ross, coordinates the clinical activities of the Center of Excellence on Addiction with the goal of maximizing shared information and creating efficiencies, and coordinating clinical, research and training activities.
Bellevue Hospital Center: Bellevue originated in 1736 as part of New York City’s “Public House of Correction, Workhouse and Poorhouse.” It is the oldest continuously operating hospital in the United States. A special unit for alcoholics, one of the earliest addiction treatment units in the world, was created in 1892, six years prior to the 1898 opening of a unit for housing the insane. Bellevue’s name is widely thought to be synonymous with the hospital’s psychiatric and addictions services because of the leading role they have played in the institution’s development and in academic psychiatry nationally. Clinical instruction was started at Bellevue Hospital in 1847, and in 1861 Bellevue Hospital Medical College was founded when a college building was erected on the hospital grounds. The medical school became an integral part of New York University in 1898. Much of NYU’s medical student and resident training is carried out in Bellevue Hospital Center.
The Division of Alcoholism and Drug Abuse was established in 1987 by Marc Galanter. The Division is home to large clinical, training and research programs which have expanded over the past two decades and have contributed substantially to NYU’s national and international reputation as a center for addictions training. Currently, Stephen Ross oversees the Division’s network of clinical programs which are coordinated with research and training programs. These programs include: The Dual Diagnosis Training Unit, a 27-bed unit that was developed specifically for the acute care and rehabilitation of patients with co-occurring disorders with admission criteria based on dangerous behavior to self or others, this unit serves as a principal site for training of fellows in addiction psychiatry and treats approximately 350 patients annually; The Inpatient Detoxification Training Unit, a 20-bed unit that provides short-term detoxification for 1,400 patients annually, and serves as another training site for addiction fellows; it is staffed jointly by Psychiatry and Medicine; The Chemical Dependency Outpatient Unit supports 10,000 visits annually, beginning treatment with an intensive period of engagement into ambulatory care followed by outpatient group therapy and counseling. The program maintains close ties to facilities in the community and to the Bellevue Hospital Shelter for the homeless; it has developed special treatment programs for homeless alcoholics and for buprenorphine treatment for opioid addiction, each subject to evaluation research; The Recovery Program is an ambulatory treatment service adapted from the therapeutic community model for singly and dually diagnosed patients; it supports about 5,000 visits annually for a severely comorbid cohort of patients with psychotic spectrum illness and substance abuse; The Methadone Maintenance Treatment Program provides intensive medical and psychiatric treatment, as well as ongoing drug counseling, for 350 patients, making close to 50,000 visits annually; it includes a special therapeutic and counseling program, Children of Substance Abusers; The Modified Therapeutic Community Residential Program (The Greenhouse) is a halfway house for the dually-diagnosed; it was developed specifically for homeless men as an alternative to long-term hospitalization or residence in shelters and welfare hotels; it includes an intensive therapeutic program based on self-help modalities and directed at reintegration into community living; The Substance Abuse Referral Program (SARP) was established to provide evaluation, consultation, and liaison for substance-abusing patients in the Bellevue catchment area, and throughout the Hospital Center; it links the Hospital Center with addiction treatment units and provides a mechanism to best match patients with appropriate levels of care. Developing Programs include (a) a naloxone overdose prevention initiative to target opiate overdose fatalities within Bellevue’s catchment area; (b) an adolescent substance abuse program in collaboration with the Department of Child and Adolescent Psychiatry; and (c) an addiction mobile crisis outreach van to liaise with the community and engage and treat vulnerable populations, providing services including HIV and hepatitis C testing, anti-retroviral therapy, hepatitis vaccinations, and naloxone overdose kit training and distribution, buprenorphine induction and referral for treatment.
Additional addictions services are provided via the medical primary care programs at Bellevue under Marc Gourevitch’s direction. The primary care programs at Bellevue serve approximately 20,000 unique patients making 60,000 annual visits. The primary care programs have served as a laboratory to study (a) implementation of buprenorphine treatment for heroin dependence with seed funding from the NYC DOHMH; (b) use of buprenorphine in combination with behavioral counseling for prescription opiate dependence (Oxycontin, Vicodin, etc.) funded through the NIDA Clinical Trials Network; (c) the feasibility and acceptability of extended release naltrexone (XR-NTX, Vivitrol) to treat alcohol dependence supported by Alkermes, Inc.; and (d) feasibility and acceptability of extended release naltrexone as an opiate relapse prevention strategy for parolees and probationers supported by the Dana Foundation and NIDA. Unique to all of these is the implementation in a medical primary care setting with the opportunity to expand treatment to populations that may never get to specialized addictions programs, to provide treatment earlier in the course of disease, and to destigmatize treatment.
NYHHS Veterans Affairs Hospital: VA New York Harbor Healthcare System: The VA has been a leader and a generous supporter of innovative addictions programs for decades. Historically the focus was on alcoholism, initially around medical complications, particularly hepatotoxicity and neurological complications. The Vietnam conflict and its sequelae shifted attention to heroin, cocaine and marijuana misuse, and advances in neuroscience shifted attention from medical complications toward addiction as a behavioral disorder. Associated with the major VA healthcare reforms and reorganization under Kenneth Kizer in 1995, VA addictions services shifted from largely inpatient and residential programs to primarily outpatient services and integration and coordination with the primary care model. Since 1987 Paul Casadonte has directed the addictions programs locally and since 1990 he has played a key role in developing LAAM (a long acting methadone congener permitting every 2nd or 3rd day, rather than daily, administration), buprenorphine and the buprenorphine/naloxone combination, an implantable six-month duration buprenorphine rod, and extended release naltrexone. Most of the LAAM and buprenorphine studies were run as joint NIDA/VA Cooperative Studies partnerships. As a consequence, the VA NYHHS clinical programs have been ideal laboratories for implementation demonstration programs. The Manhattan Campus methadone program has been reorganized as an “opiate treatment program” and has probably treated more patients with LAAM than any other program in the world. More recently new patients are routinely offered buprenorphine as an alternative to methadone, and close to a third of the 200 patients are now on buprenorphine. Anticipating SBIRT, the VA has also been exceptionally generous, and perhaps visionary, in “embedding” addictions (and mental health) experts in medical primary care settings and in settings to treat post-traumatic stress disorder. Both campuses (Manhattan and Brooklyn) have opiate treatment programs (formerly methadone programs) serving between 100 and 200 patients making approximately 40,000 visits annually and abstinence-based recovery programs serving over 1,000 unique patients. Additional programs include substance abuse evaluation and referral services, inpatient detoxification for dual-diagnosis patients, outpatient abstinence-oriented treatment for alcohol, cocaine and benzodiazepine misuse, and intensive structured day-treatment for alcohol dependence. All programs have integrated medical and psychiatric treatment on-site and very close collaborations with HIV and hepatitis C programs. Paul Casadonte was the lead author on the first paper examining the psychological impact of screening and testing for HIV amongst patients in a methadone setting. The Manhattan and Brooklyn Campus opiate treatment programs are key sites for a Mary Jeanne Kreek, Rotrosen and Casadonte genetics collaboration.
New York Node of the NIDA Clinical Trials Network – Community Treatment Programs (CTPs): The NY Node of the NIDA Clinical Trials Network (CTN) is a key resource that can serve as a laboratory for research on diffusion of innovation. The CTN mission is to take evidence-based interventions that have been developed in academic settings, translate them into interventions that can be implemented and sustained in real-world treatment settings, test them in diverse settings and diverse populations and then work with other federal, state and local agencies to disseminate those that work. The NY Node of the CTN has been funded since 2000, and is one of NYU’s largest NIH grants. It is a consortium of academic (NYU, The Rockefeller University, NKI, NYAM) and clinical investigators and community-based providers who have a long track record of fruitful collaboration in research, training, and clinical service delivery. Community-based treatment programs (CTPs) represent a wide range of programs and treatment models, and provide services for, and access to, an overall clinical population of more than 13,000 patients with extensive diagnostic, ethnic, and gender diversity. The CTPs have been at the forefront of translational research and have made a number of pioneering achievements including the establishment of the first out-patient narcotic detoxification clinic, the first non-hospital-based methadone program, the first methadone-to-abstinence residential community and the first social work field training in addictions The NY Node closely partners with major public and private stakeholders including the NY State Office of Alcoholism and Substance Abuse Services (OASAS), the Association of Substance Abuse Providers of NY State (ASAP of NYS) and the Northeast Addictions Technology Transfer Center (NeATTC). An important mission is dissemination of research findings to the CTPs and the previously mentioned stakeholders. In addition to Bellevue and the VA NYHHS, NY Node CTPs include the Addictions Research and Treatment Corporation, Gracie Square Hospital, Greenwich House, the Lower Eastside Service Center and Odyssey House. Close to thirty protocols have been completed or are on-going nationally; the NY Node has carried out close to a dozen of these in eight community-based treatment programs in NY City. John Rotrosen is PI of the NY Node of the CTN.