Methadone Treatment in Narcotic Addiction: Chapter 12

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The question of which City agency would operate the new detoxification program was the focus of considerable debate. The Addiction Services Agency, responsible for funding and monitoring most drug-free programs in the City, sought control by arguing that since the NYC ADP would involve referrals to and from long-term programs, optimal coordination could be achieved by unifying the administrative authority.

Health Services Administrator Gordon Chase, on the other hand, felt that the Program would be implemented most rapidly under the direction of the H.S.A., and pointed to the experience of the New York City Methadone Maintenance Treatment Program (NYC MMTP), which had opened fourteen facilities in four months. Furthermore, it was argued that since detoxification is primarily a medical procedure, the Program should be organizationally located in the Department of Health, an agency of the Health Services Administration. In the end, it was decided to follow the same course which had been chosen for the City's Methadone Maintenance Treatment Program. The A.S.A. would provide the funds, and the H.S.A. would be responsible for the operation of the Program.

Fearing considerable pressure to combine organizationally the NYC ADP and the NYC MMTP, I was one of the few H.S.A. officials who did not share Chase's enthusiasm for the new Program. Although funding would be provided for hiring NYC ADP Central Office staff, I was apprehensive that extensive demands upon the limited Methadone Maintenance Program personnel would nevertheless be made. Of greater importance, I was concerned that if the administration of the two programs were combined, the objectives of each might be compromised. Clinically, the NYC MMTP had already experienced tension among patients as well as staff members when the two modalities were juxtaposed geographically (a NYC MMTP clinic had been established in Delafield Hospital, and shared cramped basement quarters with an independent ambulatory detoxification program); the potential clearly existed for similar friction at the central level. I also felt that to be optimally effective, both the maintenance and detoxification programs should remain distinct entities, a difficult task if both were operated under the aegis of the same office.

Nevertheless, Chase was anxious to unify the administration of the two programs, and within several months I was persuaded to accept the added responsibility for directing the operation of the New York City Ambulatory Detoxification Program. Fortunately, the negative consequences which I had feared did not materialize. Within the Central Office, a clear delineation of functions was maintained between the two staffs, and only the Deputy Director and I had responsibilities covering both programs. Clinically, there was virtually no contact between the staffs except at occasional joint training sessions.

In retrospect, the major shortcoming of the organizational unification was that the more visible Maintenance Program overshadowed the NYC ADP for the next several years. The attention of the public, as well as of professionals in the field of addiction, centered on the NYC MMTP, while the New York City Ambulatory Detoxification Program, one of the most ambitious and successful drug treatment programs in the country, was generally overlooked.