dr. clark, we were talking about, john was talking about complicating factors in terms of health challenges that may present at the time of intake for some special population individuals. can you address, continue to address that? well, one of the things that we at samhsa are stressing is that every person who has a mental health issue or substance use issue needs to also get a good physical health assessment. one of the things we know about the misuse of alcohol or drugs is that it does have an effect on the organic integrity of the body. so you may get liver disease, you may get gastritis, you may get heart disease, you're at greater risks for various infections like hepatitis c or hiv. and we want to make sure that anybody who is on the course of recovery has as much information as possible. there was one quote i read recently and a guy says, "i spent all this time using alcohol and drugs and shooting up, etc., etc., so i finally get into treatment only to discover that i have hepatitis c."

dr. clark, why should we be concerned about ethnic and racial differences within the addiction and recovery field, as well as other differences? well, one of the things that we want to make sure is that people who have substance use problems are able to recover and that materials that we use can assist them in that process. and so, you know, there are differences associated with cultural values and beliefs, starting from how one physiologically responds to a particular substance misuse to how certain substances are used in a cultural context. so if we're going to facilitate recovery, we need to understand the language, the beliefs, the social context associated with those substances. and that will help us facilitate that person's recovery by showing that we understand the life experiences that they have associated with their use of substances. and i gather that includes prevalence as well. well, yes, but from a clinical point of view, i mean people look at the epidemiologic data and there are d

and dr. 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 pro

among his numerous professional activities, dr. clark serves as a faculty member of the university of miami school of business administration. recently launched the m.b.a. program in the health sector management and policy. a very important program for us. his academic degrees include an m.b.a. and management and finance from the university of miami school of business administration. our second panelist is michael tuffin. he is an accomplished strategist with extensive experience in public policy, healthcare and national politics. as executive vice president of american health insurance plans whose members provide health care, long-term care and dental and disability benefits to more than 200 million americans, he leads a hip's public affairs strategy which includes communications, advertising, media relations, new media, and grassroots mobilization. he has worked on a wide range of political campaigns on the legislative staff and both the u.s. senate and the house of representatives. i would say that his focus has been on economic and f

among his numerous professional activities, dr. clark serves as a faculty member of the university of miami school of business administration. recently launched the m.b.a. program in the health sector management and policy. a very important program for us. his academic degrees include an m.b.a. and management and finance from the university of miami school of business administration. our second panelist is michael tuffin. he is an accomplished strategist with extensive experience in public policy, healthcare and national politics. as executive vice president of american health insurance plans whose members provide health care, long-term care and dental and disability benefits to more than 200 million americans, he leads a hip's public affairs strategy which includes communications, advertising, media relations, new media, and grassroots mobilization. he has worked on a wide range of political campaigns on the legislative staff and both the u.s. senate and the house of representatives. i would say that his focus has been on economic and f

dr. h. westley clark, director, center for substance abuse treatment, substance abuse and mental health services administration, u.s. department of health and human services, rockville, maryland. marco e. jacome, chief executive officer, healthcare alternative systems incorporated, chicago, illinois. john de miranda, president and ceo, stepping stone, san diego, california.