Broadening the base of treatment for alcohol problems : report of a study by a committee of the Institute of Medicine, Division of Mental Health and Behavioral Medicine.

Format:

Book

Author/Creator:

Institute of Medicine (U.S.)

Contributor:

Institute of Medicine (U.S.). Committee for the Study of Treatment and Rehabilitation Services for Alcoholism and Alcohol Abuse.

National Institute on Alcohol Abuse and Alcoholism (U.S.)

Series:

Publication (National Research Council (U.S.)) ; no. 4038.

[Publication ; 4038]

Language:

English

Subjects (All):

Alcoholism--Treatment.

Alcoholism.

Alcoholics--Rehabilitation.

Alcoholics.

Physical Description:

1 online resource (639 p.)

Edition:

1st ed.

Place of Publication:

Washington, D.C. : National Academy Press, 1990.

Language Note:

English

Summary:

In this congressionally mandated study, an expert committee of the Institute of Medicine takes a close look at where treatment for people with alcohol problems seems to be headed, and provides its best advice on how to get there. Careful consideration is given to how the creative growth of treatment can best be encouraged while keeping costs within reasonable limits. Particular attention is devoted to the importance of developing therapeutic approaches that are sensitive to the special needs of the many diverse groups represented among those who have developed problems related to their use of "man's oldest friend and oldest enemy." This book is the most comprehensive examination of alcohol treatment to date.

Contents:

Broadening the Base of Treatment for Alcohol Problems

Copyright

Contents

Introduction and Summary

The Study Process

A Summary of the Text

Our Vision

Some Fundamental Questions

Aspects of Treatment

Special Populations in Treatment

Aspects of Financing

Guiding the Ongoing Effort

REFERENCES

1 Our Vision

A Brief History of Treatment

Broadening the Base

Toward Treatment Systems

Advice to the Reader

2 What Is Being Treated?

The Alcohol Problems Perspective

Other Perspectives

Alcoholism

Alcohol Dependence Syndrome

A Terminological "Map"

The Heterogeneity of Alcohol Problems

Heterogeneity of Presentation

Heterogeneity of Course

Heterogeneity of Etiology

Implications of Heterogeneity for Treatment

Summary and Conclusions

3 What Is Treatment?

Refining the Definition of Treatment for Alcohol Problems

Defining the Expanded Continuum of Care

Defining the Elements of Treatment in the Continuum of Care

Treatment Philosophy or Orientation

Treatment Stages

Stage 1: Acute Intervention

Stage 2: Rehabilitation

Stage 3: Maintenance

Treatment Settings

Treatment Modalities

4 Who Provides Treatment?

Describing the System to Treat Persons with Alcohol Problems

Treatment of Alcohol Problems in the Nonspecialist Community Sectors

Treatment in the Specialist Alcohol Problems Sector

A State Perspective on Treatment Providers

A Federal Perspective

A National Perspective

Treatment Personnel

5 Does Treatment Work?

Reframing the Question

Answering the Reframed Question: Methods

The Randomized Controlled Trial

The Role of Quality Assurance

Other Methods

Answering the Reframed Question: Results.

Summary and Conclusions

6 Is Treatment Necessary?

Improvement in Alcohol Problems Without Formal Treatment

Deterioration in Alcohol Problems with Formal Treatment

Coerced Treatment for Alcohol Problems

Implications for Treatment

Treatment Based on Knowledge of Improvement Without Treatment

7 Is Treatment Available?

Distribution of Resources for Alcohol Problems Treatment

The National Drug and Alcoholism Treatment Unit Survey

The Distribution of Treatment Capacity

Expenditure Data

American Hospital Association Annual Survey of Hospitals

Relationship Between Treatment Availability and the Prevalence of Alcohol Problems

8 Who Pays for Treatment?

Who Are the Payers?

Who Pays for Treatment in Specialty Programs?

Sources of Funding in Public-Sector Specialty Programs

Sources of Funding in Private Sector Specialty Programs

Who Pays for Treatment of All Health Care?

What Does Treatment of Alcohol Problems Cost?

9 The Community Role: Identification, Brief Intervention, and Referral

An Orientation to the Community Role in Treatment

A Paradox and Its Implications

Identifying People with Alcohol Problems

Brief Intervention

Efficacy of Brief Interventions

Varieties of Brief Intervention

The Target of Brief Intervention

The Goal of Brief Intervention

Referral

Implementing the Community Role

Settings

Personnel

Effects and Costs

Conclusions and Recommendations

10 Assessment

What Is Assessment?

The Purposes of Assessment for Alcohol Problems

Characterizing the Problem

Characterizing the Individual

Characterizing the Treatment Population

Planning Treatment for the Individual.

Guiding Treatment for the Population

The Structure of Comprehensive Assessment

Sequential Assessment

Multidimensional Assessment

The Content of Comprehensive Assessment

Content of Screening

Content of the Problem Assessment

Content of Personal Assessment

Desirable Qualities of Assessment Content

The Administration of Assessment

Obtaining Valid Assessment Data: Problems in Providing Information

Obtaining Valid Assessment Data: Problems in Gathering Information

Methods of Obtaining Assessment Information

11 Matching

Studies of Matching in the Treatment of Alcohol Problems

Examples of Matching Programs

Specification of Treatment

Specification of Matching Guidelines

Therapist Selection

Patient Selection

Problem-Oriented Selection

Theory-driven Selection

Research-driven Selection

Data-driven Selection

Some Treatment Controversies as Matching Problems

Appendix: Excerpts From The Cleveland Admission, Discharge and Transfer Criteria

Overview of Adult Admission Criteria

Diagnosis

Levels of Care

Placement Criteria Consideration

Dimensions for Making Placement Decisions

LEVEL I: MUTUAL/SELF-HELP

A. Brief Description of Treatment Level

B. Programmatic Description

C. Brief Description of Typical Patient

D. Dimensional Admission Criteria

LEVEL II: LOW INTENSITY OUTPATIENT TREATMENT

LEVEL V: MEDICALLY SUPERVISED INTENSIVE INPATIENT TREATMENT

D. Dimensional Admission Criteria.

ADULT DISCHARGE &amp

TRANSFER CRITERIA

Introduction

Exceptions to Transfer Criteria

Transfer to a Higher Level of Care

Transfer to a Lower Level of Care

12 Determining Outcome

The Rationale for Outcome Determination

Some Examples of Systematic Outcome Determination

A Major Caveat

Implementing Outcome Monitoring

Setting the Stage for Outcome Monitoring

The Content of Outcome Monitoring

The Process of Outcome Monitoring

The Locus of Responsibility for Outcome Monitoring

The Funding of Outcome Determination

13 Implementing the Vision: Toward Treatment Systems

Assuring Continuity of Care

Feedback of Outcome Information

An Audit of the Systems Approach

Description of the Table

Evaluation of the Systems Approach

14 The Treatment of Special Populations: Overview and Definitions

Defining Special Populations: A Historical Perspective

The Research Perspective on Special Populations

15 Populations Defined by Structural Characteristics

Women

Adolescents

The Elderly

American Indians

Asian Americans and Pacific Islanders

Blacks

Hispanics

16 Populations Defined by Functional Characteristics

Drinking Drivers

Dual-Diagnosis Psychiatric Patients

Homeless Persons: The New Public Inebriates

College Students

Children of Alcoholics

17 The Treatment of Special Populations: Conclusions and Recommendations

18 The Evolution of Financing Policy

Development of a National Policy.

The Establishment of the National Institute on Alcohol Abuse and Alcoholism

Using Federal Grants to Increase Treatment Resources

Efforts to Increase Public and Private Health Insurance

The Current Situation

The Shifting Leadership Role

State and Local Government Activities

Federal Government Activities

Private Health Insurance Activities

Mandated Private Health Insurance

Changes in Health Care Financing Policy: The Recent Emphasis on Cost Containment

Health Maintenance Organizations

Preferred Provider and Managed Care Arrangements

State Agencies

The Current Funding Environment

The Need for Better Data on Funding and the Costs of Treatment

19 Cost-Effectiveness

Studies of Costs and Cost Offsets

Cost-Benefit and Cost-Effectiveness Analysis

Matching and Cost-Effectiveness

20 Paying for the Treatment System

Financing the Current Treatment System

Criteria for Evaluating Coverage Appropriateness

Optimal Conventional Coverage

Paying for the Current Treatment System

Financing the Ideal Treatment System

Financing the Vision: Paying for Specialized Treatment Services for the Poor and the Uninsured

21 Leadership

Our Vision: The Committee's Recommendations

Opportunities for Leadership

The Leadership Opportunity for Congress

The Leadership Opportunity for the States

The Leadership Opportunity for Employers and Private Insurers

The Leadership Opportunity for Treatment Providers

The Leadership Opportunity for the Professions and Training Programs

The Leadership Opportunity for the National Institute on Alcohol Abuse and Alcoholism

The Leadership Opportunity for Voluntary and Community Organizations

The Challenge for the Future

REFERENCES.

Acknowledgments.

Notes:

"Committee for the Study of Treatment and Rehabilitation Services for Alcoholism and Alcohol Abuse"--P. v.

"Contract no. ADM-281-87-003 with the National Institute on Alcohol Abuse and Alcoholism of the Department of Health and Human Services"--T.p. verso.

Includes bibliographical references.

ISBN:

9786610214334

9781280214332

1280214333

9780309568388

0309568382

OCLC:

645436818