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