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David H. Mulligan
Consensus Panel Chair
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
Rockwall II, 5600 Fishers Lane
Rockville, MD 20857
DHHS Publication No. (SMA) 95-3047
Printed 1995
This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. All material appearing in this volume except quoted passages from copyrighted sources is in the public domain and may be reproduced or copied without permission from the Center for Substance Abuse Treatment (CSAT) or the authors. Citation of the source is appreciated.
This publication was written under contract number ADM 270-92-0006 from the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration (SAMHSA). Duiona R. Baker, M.P.H., and David L. Griffith, M.Ed., M.S., R.N., served as the CSAT Government project officers.
The opinions expressed herein are the views of the consensus panel members and do not reflect the official position of CSAT or any other part of the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT or DHHS for these opinions or for particular instruments of software that may be described in this document is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized patient care and treatment decisions.
Substance abusers -- be they dependent on alcohol or drugs or both -- are so stigmatized in our society that those of us who work in the substance abuse field have grown accustomed to doing our important and valuable work in relative isolation from others. In recent years, however, our patients and employees have been ravaged by a very public disease, tuberculosis (TB). To meet the threat that TB poses to both our patients and employees, many alcohol and other drug (AOD) treatment programs have entered collaborative relationships with appropriate State, local, and private agencies. Born less of legal than of practical and ethical obligations, those efforts comport with the AOD field's tradition of compassion, respect, responsibility, and commitment to health. In light of that tradition -- and given that most substance abuse treatment programs have but the most limited budgets -- we believe that it would be in everyone's interest if more AOD programs were to collaborate with both the public and private sectors in the effort to prevent the transmission of TB in the AOD setting.
It was in the spirit of collaboration that the Center for Substance Abuse Treatment (CSAT) convened a consensus panel of AOD providers, public health officials, and others in New York City during the week of May 16-20, 1994. That panel produced this document, one in a series of Treatment Improvement Protocols (TIPs) that CSAT has funded over the past few years. Intended for AOD administrators, AOD staff, public health officials, corrections officials, and State substance abuse officials, this TIP summarizes the latest advice and recommended protocols for dealing with the threat of TB in the AOD setting. We believe that the recommendations and advice in this document can help smooth the way for further and improved collaboration between the AOD field and others in preventing not only TB but other communicable diseases in the treatment setting.
In closing, I should like to thank the members of the Federal resource panel and the consensus panel for giving so much of their valuable time to this project. I should also like to thank the many field reviewers who took time to give detailed suggestions for improving this document. Finally, I should like to thank Felix Lopez, Esquire, of the Legal Action Center of New York City, Inc., for his editorial assistance and for endeavoring to revise this document in accordance with the suggestions of both the consensus panel members and the field reviewers.
David H. Mulligan
Commissioner
Massachusetts Department of Public Health
CSAT Treatment Improvement Protocols (TIPs) are prepared by the Quality Assurance and Evaluation Branch to facilitate the transfer of state-of-the-art protocols and guidelines for the treatment of alcohol and other drug (AOD) abuse from acknowledged clinical, research, and administrative experts to the Nation's AOD abuse treatment resources.
The dissemination of a TIP is the last step in a process that begins with the recommendation of an AOD abuse problem area for consideration by a panel of experts. These include clinicians, researchers, and program managers, as well as professionals in such related fields as social services or criminal justice.
Once a topic has been selected, CSAT creates a Federal resource panel, with members from pertinent Federal agencies and national organizations, to review the state of the art in treatment and program management in the area selected. Recommendations from this Federal panel are then transmitted to the members of a second group, which consists of non-Federal experts who are intimately familiar with the topic. This group, known as a non-Federal consensus panel, meets in Washington for 5 days, makes recommendations, defines protocols, and arrives at agreement on protocols. Its members represent AOD abuse treatment programs, hospitals, community health centers, counseling programs, criminal justice and child welfare agencies, and private practitioners. A Chair for the panel is charged with the responsibility of ensuring that the resulting protocol reflects true group consensus.
The next step is a review of the proposed guidelines and protocol by a third group whose members serve as expert field reviewers. Once their recommendations and responses have been reviewed, the Chair approves the document for publication. The result is a TIP reflecting the actual state of the art of AOD abuse treatment in public and private programs recognized for their provision of high quality and innovative AOD abuse treatment.
This TIP on guidelines to assist AOD treatment providers in dealing with legal and ethical issues posed by the tuberculosis epidemic is the 18th published by CSAT since a treatment improvement initiative began. The reader may be interested in the sixth TIP in the series, Screening for Infectious Disease Among Substance Abusers, which also deals with tuberculosis, particularly in chapters 6, 7, and 8. This TIP represents another step by CSAT toward its goal of bringing national leadership to bear in the effort to improve AOD abuse treatment.
Other TIPS may be ordered by contacting the National Clearinghouse for Alcohol and Drug Information (NCADI), (800) 729-6686 or (301) 468-2600; TDD (for hearing impaired), (800) 487-4889.
David H. Mulligan
Consensus Panel Chair
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
Rockwall II, 5600 Fishers Lane
Rockville, MD 20857
DHHS Publication No. (SMA) 95-3047
Printed 1995
This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. All material appearing in this volume except quoted passages from copyrighted sources is in the public domain and may be reproduced or copied without permission from the Center for Substance Abuse Treatment (CSAT) or the authors. Citation of the source is appreciated.
This publication was written under contract number ADM 270-92-0006 from the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration (SAMHSA). Duiona R. Baker, M.P.H., and David L. Griffith, M.Ed., M.S., R.N., served as the CSAT Government project officers.
The opinions expressed herein are the views of the consensus panel members and do not reflect the official position of CSAT or any other part of the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT or DHHS for these opinions or for particular instruments of software that may be described in this document is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized patient care and treatment decisions.
Substance abusers -- be they dependent on alcohol or drugs or both -- are so stigmatized in our society that those of us who work in the substance abuse field have grown accustomed to doing our important and valuable work in relative isolation from others. In recent years, however, our patients and employees have been ravaged by a very public disease, tuberculosis (TB). To meet the threat that TB poses to both our patients and employees, many alcohol and other drug (AOD) treatment programs have entered collaborative relationships with appropriate State, local, and private agencies. Born less of legal than of practical and ethical obligations, those efforts comport with the AOD field's tradition of compassion, respect, responsibility, and commitment to health. In light of that tradition -- and given that most substance abuse treatment programs have but the most limited budgets -- we believe that it would be in everyone's interest if more AOD programs were to collaborate with both the public and private sectors in the effort to prevent the transmission of TB in the AOD setting.
It was in the spirit of collaboration that the Center for Substance Abuse Treatment (CSAT) convened a consensus panel of AOD providers, public health officials, and others in New York City during the week of May 16-20, 1994. That panel produced this document, one in a series of Treatment Improvement Protocols (TIPs) that CSAT has funded over the past few years. Intended for AOD administrators, AOD staff, public health officials, corrections officials, and State substance abuse officials, this TIP summarizes the latest advice and recommended protocols for dealing with the threat of TB in the AOD setting. We believe that the recommendations and advice in this document can help smooth the way for further and improved collaboration between the AOD field and others in preventing not only TB but other communicable diseases in the treatment setting.
In closing, I should like to thank the members of the Federal resource panel and the consensus panel for giving so much of their valuable time to this project. I should also like to thank the many field reviewers who took time to give detailed suggestions for improving this document. Finally, I should like to thank Felix Lopez, Esquire, of the Legal Action Center of New York City, Inc., for his editorial assistance and for endeavoring to revise this document in accordance with the suggestions of both the consensus panel members and the field reviewers.
David H. Mulligan
Commissioner
Massachusetts Department of Public Health
CSAT Treatment Improvement Protocols (TIPs) are prepared by the Quality Assurance and Evaluation Branch to facilitate the transfer of state-of-the-art protocols and guidelines for the treatment of alcohol and other drug (AOD) abuse from acknowledged clinical, research, and administrative experts to the Nation's AOD abuse treatment resources.
The dissemination of a TIP is the last step in a process that begins with the recommendation of an AOD abuse problem area for consideration by a panel of experts. These include clinicians, researchers, and program managers, as well as professionals in such related fields as social services or criminal justice.
Once a topic has been selected, CSAT creates a Federal resource panel, with members from pertinent Federal agencies and national organizations, to review the state of the art in treatment and program management in the area selected. Recommendations from this Federal panel are then transmitted to the members of a second group, which consists of non-Federal experts who are intimately familiar with the topic. This group, known as a non-Federal consensus panel, meets in Washington for 5 days, makes recommendations, defines protocols, and arrives at agreement on protocols. Its members represent AOD abuse treatment programs, hospitals, community health centers, counseling programs, criminal justice and child welfare agencies, and private practitioners. A Chair for the panel is charged with the responsibility of ensuring that the resulting protocol reflects true group consensus.
The next step is a review of the proposed guidelines and protocol by a third group whose members serve as expert field reviewers. Once their recommendations and responses have been reviewed, the Chair approves the document for publication. The result is a TIP reflecting the actual state of the art of AOD abuse treatment in public and private programs recognized for their provision of high quality and innovative AOD abuse treatment.
This TIP on guidelines to assist AOD treatment providers in dealing with legal and ethical issues posed by the tuberculosis epidemic is the 18th published by CSAT since a treatment improvement initiative began. The reader may be interested in the sixth TIP in the series, Screening for Infectious Disease Among Substance Abusers, which also deals with tuberculosis, particularly in chapters 6, 7, and 8. This TIP represents another step by CSAT toward its goal of bringing national leadership to bear in the effort to improve AOD abuse treatment.
Other TIPS may be ordered by contacting the National Clearinghouse for Alcohol and Drug Information (NCADI), (800) 729-6686 or (301) 468-2600; TDD (for hearing impaired), (800) 487-4889.
Chapter 2—Summary of Recommendations
Chapter 3—The Facts About Tuberculosis
Chapter 4—AOD Programs and Public Health: Joining Together to Fight the Spread of TB
Chapter 5—Providing TB-Related Services to Patients
Chapter 6—Toward a Safe Workplace
Appendix B—Legal Questions and Answers Regarding TB-Related Discrimination in the AOD Setting
Appendix D—Massachusetts Policy for TB Control in Substance Abuse Treatment Centers
Appendix E—A Massachusetts Pamphlet on HIV and TB
Appendix G—New York State OASAS Administrative Bulletin on TB Control In Drug Treatment Programs
Appendix H—New York City TB/Methadone Registry Match Procedure
Appendix I—New York State Division Of Substance Abuse Services Tuberculosis Update
