Alcohol/Substance Abuse Programs At New York State Psychiatric Centers

Develop And Expand...

By
Kathleen Sciacca, M.A.
Executive Director,
Sciacca Comprehensive Service Development
for Mental Illness, Drug Addiction, and Alcoholism (MIDAA)
299 Riverside Drive
New York, N.Y. 10025
(212) 866-5935

An alcohol/substance abuse treatment program in community services began in December

of 1984 with the initiative of one group program and the development of a treatment
model to address the multiple needs of this special client population. The program has
grown steadily and is presently included in six of our Community Service Areas. An
assessment questionnaire has been developed specifically for these clients, and the
majority of treatment staff throughout the community reviewed this questionnaire and have
access to its use.

The development of a Liaison Group of treatment staff throughout the community services
is a major contributing factor to the implementation and success of our community
programs, as is the interest and involvement of many of our professional staff.

In late 1984, faced with a majority of day treatment program clients who had alcohol
and/or drug problems, a N.Y. State Day Treatment Team set out to find a solution. A first
attempt was that of identifying and cultivating the use of outside treatment programs. This
proved to be a discouraging pursuit, and an ineffective one as far as the treatment of our
clients was concerned. As a result, a group for substance users was planned within the Day
Treatment Program. Kathleen Sciacca volunteered and was selected for this new project.
Although Sciacca had treated primary substance abusers for more than seven years before
joining the New York State Office of Mental Health Staff, there was not a clear treatment
model available that was directly applicable to the dually diagnosed client population with
a primary chronic mental illness, and an alcohol or substance abuse problem. Sciacca
developed a treatment model that continually adapted to the needs of this special
population, and that features a "Non-Confrontational" approach. It is presently included in
clinic programs, continuing treatment programs, day treatment programs and, inpatient
programs.

The first group which began in December 1984, proved to be successful in both areas of
client treatment and in programmatic improvements. Clients who attended the group
improved along some of the following criteria:

1. They were better able to discuss their substance use problems more openly with staff
and peers. 2. They gained insight into their substance using behavior.

3. They remained out of the hospital for longer periods of time.

4. They were able to attend outside programming such as A.A., N.A., in addition to
Harlem Valley programs.
5. They remained abstinent from substance abuse.

6. They were able to give and receive support.

7. They gained education and awareness which included pertinent information about
substance abuse.

Different clients improved along different dimensions. Programmatically, the following

improvements took place:

1. Clients were clearly identified by staff as having alcohol/substance abuse problems.

2. Staff were better able to identify the interaction effects between substance use and
psychiatric symptoms and to avert some hospitalizations.

3. There was a substance abuse program readily available when clients were discharged
from inpatient or came from other referral sources. This enabled work on prevention to
begin immediately with clients from inpatient.

4. As the program took hold, staff became more amenable to learning about the etiology
and treatment of substance abuse, and more comfortable with addressing these issues with
their clients.

The results of the treatment model and treatment program proved successful and a formal
approach was taken to develop system-wide substance abuse programming throughout the
multi-site community services. Liaisons for substance abuse programming were appointed
and a Liaison Group was formed under the leadership of Kathleen Sciacca, Director. An
overview of substance abuse treatment programming for community services was drawn
up by Sciacca. It included assessment criteria and treatment objectives, a group treatment
model, and individual treatment strategies. Later, the assessment criteria were separated
out and developed to form a separate instrument. The assessment questionnaire serves as a
treatment guide for use by primary therapists. Staff education and training needs were also
outlined, and in part, included the presentation of some materials by Liaisons to staff at
their respective Service Areas. Liaisons lead substance abuse groups within their Areas.
Many of them have co-leaders who are not Liaisons which has enabled more staff to be
included in treating this special population of clients.

Implementation of the program model in each of the community services is reliant upon
the efforts of Liaisons to structure programs in their Service Areas.

In effect, the goals of the Liaison Group are as follows:

1. To unify and assure staff exposure to educational and training materials, and to
introduce them to new program initiatives.

2. To provide education and training materials to Liaisons, as well as initiatives for

learning at other training programs.

3. To provide a case conference that includes peer support and consultation for Liaisons
who are providing individual and group treatment.

4. To review and learn new program initiatives such as screening tools, assessment tools,
patient progress reviews, and to plan approaches to introduce these program initiatives to
staff in the community.

5. To serve as a forum for invited guest speakers and literature and media reviews for
education and training.

6. To network materials such as video tapes and literature to staff and clients throughout
the community services.

7. To share experiences and resources from all aspects of substance abuse programming.

8. To develop treatment groups in the community that are in keeping with the treatment
model and approach initially developed for this patient population.

The Liaison Group began meeting in November, 1985, and continues to meet once a
month. New initiatives in substance abuse programming continue to develop throughout
the community services. Six Service Areas provide substance abuse treatment some have
more than one group, totalling eleven groups thus far.

Many of the clients who participate in our programming are actively using drugs and/or
alcohol. Liaisons and other group leaders continually grapple with the difficult treatment
issues these clients present. Liaisons also engage in addressing the issues inherent in
introducing this programming and new initiatives into their Service Areas.

The treatment model and program proved replicable and adaptable to numerous program
settings. At the request of many professionals from across other agencies, i.e., N.Y. State,
county, voluntary agencies, and agencies from Connecticut, Ms. Sciacca has formed an
"Inter-Agency Liaison group for the Advancement of treatment of the Mentally Ill
Chemical Abusers (MICA)". This group, which also meets monthly (since May '87), has
been the source of development of a variety of MICA programs in both inpatient and
outpatient settings, and the source of education and training for program leaders,
administrators, and direct care staff in the community who now provide services for MICA
patients.

Ms. Sciacca has recently been appointed Mental Health Program Specialist to the New
York State Office of Mental Health. She will be the Director of the first training site the
State will establish to train professional staff to treat MICA patients. Ms. Sciacca will
develop programs for various New York State facilities, and train the staff from those
facilities to provide treatment and to implement programming.

Sciacca's program has grown to include initiatives for family members of MICA patients,
and a collaborative treatment approach for necessary services that psychiatric facilities do
not provide.

Ms. Sciacca has presented at numerous conferences, and she has conducted workshops, all
day seminars and lectures across the country and in Canada. Her approach has sparked a
great deal of enthusiasm among professionals from all of the disciplines. New
programming, task forces, committees and academic courses have developed as a result of
her work and her consultations.

It is clear that MICA patients are amenable to treatment and that they can improve along a
number of criteria. As more attention is paid to this patient population, more professionals
are gaining interest in providing treatment for them. As is evidenced in Sciacca's work,
and her consultations, entire professional communities can engage in this effort once they
are convinced that they can effect positive results through their treatment efforts and
program initiatives.

Update: 12/17/87

Published: AID Bulletin, Addictive Intervention with the Disabled, Winter, 1987.

COPYRIGHT 1987, K.Sciacca

Copyright 1996 Kathleen Sciacca