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Charles O'Brien, vice chairman of the Psychiatry Department, is no stranger to the White House. As a leader in the field of substance abuse, he participated in President Nixon's "War on Drugs," served as an advisor to Gerald Ford's cabinet and has visited the White House to meet with President Bush. On September 12th, however, the tables turned, and Bush came to visit him. O'Brien described the president's visit as an "amazing experience." He said that Bush visited the Treatment Research Program "to show his support for demand-reduction," so that fewer people will want to try drugs in the first place. Although much of Bush's visit was out in the open, with reporters and cameras watching, he spent considerable time meeting privately with doctors and patients. The president visited a methadone clinic at the Treatment Research Center for a first-hand look at dispensing medication, urine testing and patient therapy. Bush then met privately with a patient who did not want to be seen in public -- especially with photographers around. "Bush showed a great deal of concern and asked good questions," O'Brien said. O'Brien and Clinical Psychiatry Professor George Woody then experienced the thrill of being invited to ride with Bush in his limousine to the main building of the VA Hospital. Once at the VA Hospital, Bush spoke at a public briefing, praising the faculty for their work. The briefing featured posters which presented research data on the Addiction Severity Index, which the VA/Penn center developed, as well as their findings regarding treatment with methadone and Naltrexone. According to O'Brien, the president seemed very much at ease as he passed by the University. "When we were in the limo, he talked about how he remembered when he was on the Yale baseball team and Yale would come to Philadelphia to play Penn," he said. O'Brien said he was impressed with Bush. "He comes across as being a very intelligent person who is genuinely concerned with the problems of substance abuse," O'Brien said. "He showed sensitivity in worrying about patients who were on medication for addiction." The Treatment Research Center features programs ranging from pre-clinical work with animals to actual treatment of patients. Currently, 25 research programs are comparing the effects of various medications in treatment of patients. "We're trying virtually every form of treatment which has a chance of success," O'Brien said. The Treatment Research Center measures the success of treatment on the basis of the Addiction Severity Index. The index considers medical, family and occupational dimensions to give doctors a better idea of the patient's progress. The index is used all over the world and has been translated into seven languages. O'Brien said that two thirds of the cocaine addicts at the center have shown improvement. "The recovery rate is better than I expected," he said. According to O'Brien, intravenous drug users are the fastest growing segment of people who are turning up HIV positive, as other at risk groups are changing their lifestyles. In the past 18 months, 36 percent of IV drug users not undergoing treatment tested HIV positive. However, the center's AIDS research has found that HIV is not increasing significantly for IV drug abusers who are in treatment. "We need more money for research and treatment," O'Brien said. Other work at the center involves testing Naltrexone, a narcotic antagonist which blocks opiate receptors. A study involving probationers convicted for drug activities compared the re-incarceration rate for those who received the drug with those who only received counseling. Researchers discovered that people given Naltrexone had half the re-incarceration rate of the control group. O'Brien also said researchers have also found that Naltrexone causes a significant improvement in the relapse rate for patients undergoing treatment for alcohol abuse. This new finding has been replicated at Yale University. However, according to O'Brien, "use of the relatively new drug requires more sophistication."

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