Treatment Programs
under the Chemical Dependency Regulations
By Joyce A. Moses, CSW, Deputy, Director,
Office of Chemical Dependency Community
Liaison, Division of Mental Hygiene, NYC
Department of Health and Mental Hygiene
In 1992 a bill was passed that amended the Mental Hygiene Law to create the
New York State Office of Alcoholism and Substance Abuse Services (OASAS) by
merging two formerly separate agencies. The Chemical Dependence Regulations
were created and offered an opportunity for OASAS to address other issues; this
included the development of one Medicaid reimbursement rate for each Medicaid
eligible treatment services category. This addressed a problem where for many
years clients in both systems abused more than one drug simultaneously. Below
is a brief description of the treatment service system as described in the Chemical
Dependence Regulations.
Chemical Dependence Crisis Services
The three services in this category exist in distinct units or in one unit in
combination. Crisis services are usually considered as entry points in treatment
provided on a short-term basis. Upon completion, clients are expected to accept
a referral to the next level of care. The maximum length of stay is 15 days.
Medically managed detox services provide inpatient support and medical care
to patients who are acutely ill from alcohol related and/or substance related
addictions or dependence. The average length of stay is up to 5 days.
Medically supervised withdrawal services offer medical supervision for persons
at risk of experiencing or currently undergoing moderate withdrawal symptoms
and situational crisis, as well as persons experiencing non-acute physical or
psychiatric complications associated with their chemical dependence.
Medically monitored withdrawal services are provided to persons intoxicated
by alcohol and/or other substances and suffering from mild withdrawal complications,
coupled with situational crisis. The length of stay is from 3 to 14 days.
Chemical Dependence Inpatient Rehabilitation Service
This is a short term, intensive, medically supervised treatment program which
promotes and maintains abstinence from alcohol and other drugs; improves functioning
and development of coping skills to enable safe treatment and develops a plan
for recovery, self sufficiency and an improved quality of life. The length of
stay is 25 days.
Chemical Dependence Outpatient Treatment Services
Outpatient Treatment Services offer Clinic programs that provide the core services
in the treatment network. Services provided include diagnostic evaluation and
assessment, educational and relapse prevention, case management, individual
and group counseling for abusers and their families. Treatment planning is aimed
at achieving abstinence, maintaining recovery, attaining self-sufficiency, and
improving quality of life. The length of stay is from 6 to 12 months.
Medically supervised outpatient treatment programs are provided for individuals
who are on methadone or for those being detoxified from methadone. The length
of stay is 6 to 9 months.
Chemotherapy Substance Abuse Programs
Specific treatment procedures exist in the methadone maintenance outpatient
treatment programs; the programs are open at least 6 days per week. The length
of stay is up to 5 years. In methadone maintenance programs, treatment is provided
to people with a long-term addiction to heroin or other narcotics. Each program
provides directly or by referral a comprehensive range of rehabilitative services.
Chemical Dependence Residential Services
Eligible clients include individuals maintained on methadone or other prescribed
medications for psychiatric impairment. There are three (3) levels of service
available in residential services: intensive residential rehabilitation, community
residential services and supportive living services.
Intensive residential rehabilitation services are residences that require 24
hour, seven day per week treatment in a structured environment. Clients’
ability to live independently in recovery is contingent upon substantial social
habilitation or rehabilitation. The length of stay is from 12 to 18 months.
Community residential services (Halfway Houses) provide supervised services
to persons making the transition to abstinent living. This drug and alcohol
free environment provides support for individuals who have already completed
a course of treatment but are not yet ready for independent living. The length
of stay is 9 to 12 months.
Supportive living services are for individuals who require a long-term supportive
environment following care in another type of residential setting. This is a
transitional service to promote independent living in a supervised setting.
Residential Chemical Dependency Programs for Youth
Programs can be developed under this regulation to address an existing gap in
the alcoholism and substance abuse service system for youth, ages 12–18
years, on a short or long-term basis. Structured residential services are provided,
including rehabilitative ones. Academic, physical and vocational education,
including remedial help, are provided as required by law.
Summary
Implementation of the new Chemical Dependence Regulations gives providers a
broader range of options in creating a more responsive, inclusive and cost effective
treatment system. Adults, youth and families should be considered in planning
treatment for alcoholism and other drugs. Methadone is a recognized treatment
option. Since the multiple needs of people with addictions are recognized, Buprenorphine
is included as an additional treatment alternative for opiate addiction. The
regulations also better address alcoholism among patients in methadone treatment.
More information on the Chemical Dependence Regulations is available on the
OASAS Website at www.oasas.state.ny.us.r