current regulations governing method of treatment programs are otps are under the ages of hhs, samhsa, csat. and in this regard, these regulations have been in effect since 2001 through an accreditation mechanism. and ultimately every one of the license and approved treatment programs has to go through one of the accreditation surveys in order to continue operations. and in this sense they follow fairly stringent guidelines, not only at the federal level but at the state level also. in this area of medication and medicine you have federal regulations and you have state regulations in place, and sometimes the state regulations can be even more stringent than in the federal regulations. and dr. clark, let's talk a little bit about those federal regulations. you are the director of the center for substance abuse treatment which has the oversight function for methadone and some of the other medication-assisted therapies. specifically, what does the federal ggovernment do in the oversight process? well we certify opiod treatment programs with regard to methadone used primarily. we also register

i recall that a few years back, i would say around four or five years ago at csat we did do the right dose, for the 65 and over. we had two; we had the 50 to 65 because we thought that they would not identify with a picture of an older adult. and then we did the 65 and over, and we worked with fda. and in one particular thing that you said, dr. krantz, was the use and the mixing of it with alcohol, which is absolutely tragic. right. and i think brings us back to it's extremely important to educate the patient, to educate the physicians, and to educate the patients regarding the use of the medication, and i think with prescription drug medication, like dr. condon was saying also, is that, as people age, the normal physiological changes that occur with aging, the drug itself, because there's a volume distribution, the drug itself has more impact on the body. so that needs to be taken into consideration also as far as education. i think one of the things that we also want to establish here is that prescription drugs, if taken properly, are beneficial. i think-but that really leads to the

clark, i know that in csat, for example, a lot of special population clients go to mainstream programs, to nonspecialized programs. what kind of success are we seeing with that? well, the issue of cultural competence is really the important discussion point here. we do find that programs that are run by american indians, alaska natives, for american indians, alaska natives or programs that target hispanics, run by hispanics, tend to produce better outcomes than programs that are not sensitive to those issues. so we use sort of a bias force paradigm. there are programs that are not run by the specific population group, but have modules that are targeted to the unique needs of that group. so they do not as well as the programs that are run by the specific population group, but they do better than programs that are general. so when we look at the outcomes of, say, a woman in a male program or a general program that doesn't have any gender specific programming, she doesn't do as well as the program that is targeted to, for women, run for women or a program that has gender-specific issues.

this program came from a federal grant that we receive, from csat and aaft. and what is done is assertive adolescent family treatment. each individual is unique. each individual needs a variety of services to help them on the road to recovery from the chronic relapsing disease of alcoholism and drug abuse and the chronic nature of mental illness. in addition, there are many other people affected by these illnesses who are in need of ongoing services as well. i've been doing this for 14 years and i finally found something that i can see the change, which is having the youth come in, having the families come in, putting them together and finding the things that they really value. i think that's the most important thing of our program. and also the environment that we sit in. when they come in, they feel accepted, they feel we're very warm, we speak spanish, we're bilingual because most of our clients are, you know, bilingual, so i think that they feel, they feel at home. awsome to see you today, before we begin our session, you know, can i offer you a snack or

this program came from a federal grant that we receive, from csat and aaft. and what is done is assertive adolescent family treatment. each individual is unique. each individual needs a variety of services to help them on the road to recovery from the chronic relapsing disease of alcoholism and drug abuse and the chronic nature of mental illness. in addition, there are many other people affected by these illnesses who are in need of ongoing services as well. i've been doing this for 14 years and i finally found something that i can see the change, which is having the youth come in, having the families come in,