A study of the evolution, effectiveness, and financing of public and private drug treatment systems / Committee for the Substance Abuse Coverage Study, Division of Health Care Services, Institute of Medicine ; Dean R. Gerstein and Henrick J. Harwood, editors.

Format:

Book

Contributor:

Gerstein, Dean R.

Harwood, Henrick J.

Series:

Treating drug problems ; v.1

Language:

English

Subjects (All):

Drug abuse--Treatment--Economic aspects--United States.

Drug abuse.

Drug abuse--Treatment--Government policy--United States.

Drug abuse--Treatment--United States.

Health insurance--United States.

Health insurance.

Physical Description:

xx, 332 p. : ill.

Edition:

1st ed.

Place of Publication:

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

Language Note:

English

Summary:

The large federal role in the drug treatment system was substantially reduced in the early 1980s, undercutting its ability to help communities respond to new challenges such as the crack-cocaine epidemic and the growing violence in drug markets. How can drug treatment dollars be spent most equitably with the highest likelihood of beneficial results? With this basic question as its focus, Treating Drug Problems, Volume 1 provides specific recommendations on how to organize and fund the drug treatment system. Detailed attention is given to both public and private sources and their programs. The book presents the latest data and analysis on these topics and more: How specific approaches to drug treatment fit into drug policy, including the different perspectives of the medical and criminal-justice communities. What is known about drug consumption behavior and what treatment approaches have proven most cost-beneficial. What areas need further research--including specifications for increased study of treatment effectiveness and drug use by adolescents and young women.

Contents:

Treating Drug Problems

Copyright

Preface

Contents

Contents of Volume 2

Summary

QUESTIONS THE REPORT ANSWERS AND THOSE IT LEAVES UNRESOLVED (CHAPTER 1)

IDEAS GOVERNING DRUG TREATMENT POLICY (CHAPTER 2)

DRUG PROBLEMS AND THE NEED FOR DRUG TREATMENT (CHAPTER 3)

Patterns of Drug Consumption

Dependence

Recovery and Relapse

Determining the Need for Treatment

Estimating the Aggregate Need for Treatment

THE GOALS OF DRUG TREATMENT (CHAPTER 4)

Motivations for Treatment

Treatment and Criminal Justice

EFFECTIVENESS OF TREATMENT (CHAPTER 5)

Methadone Maintenance

Therapeutic Communities

Outpatient Nonmethadone Programs

Chemical Dependency Programs

Detoxification

Variations in Effectiveness of Programs within Modalities

Treatment in Prisons

Costs and Benefits of Treatment

Comparison of Data on Effectiveness and Expenditures for the Major Treatment Modalities

Needs and Priorities for Research on Treatment Services and Methods

THE TWO-TIERED STRUCTURE OF THE TREATMENT SYSTEM (CHAPTER 6)

PUBLIC FINANCING OF DRUG TREATMENT (CHAPTER 7)

The Goals and Priorities of Public Coverage

Federal and State Roles

Mechanism for Providing Public Support

Utilization Management

PRIVATE COVERAGE OF DRUG TREATMENT (CHAPTER 8)

Extent, Costs, and Trends of Coverage

Mandating Drug Treatment Coverage

Optimal Coverage Provisions

CODA

1 Introduction

THE LOGIC OF THE REPORT

ADDITIONAL POLICY QUESTIONS

Treating Adolescents and Women with Children

The Criminal Justice System

The Socioeconomic Environment

2 Ideas Governing Drug Policy

THE CHARACTER OF GOVERNING IDEAS

THE SPECTRUM OF IDEAS ABOUT DRUGS

Libertarian Ideas

Medical and Criminal Ideas

The Classic Era of Narcotics Control

THE RISE OF MODERN TREATMENT.

Methadone Maintenance, Therapeutic Communities, and Outpatient Nonmethadone Programs

Chemical Dependency Treatment

The Medical/Criminal Idea of Treatment and the Evolution of Governmental Roles

CONCLUSION

3 The Need for Treatment

THE INDIVIDUAL DRUG HISTORY: A MODEL AND OVERVIEW

Abstinence, Drug Types, and Normative Attitudes

Learning and Drug Experience

Environmental Variations

Age of Onset Drug Sequencing

Diagnosing Dependence and Abuse

ESTIMATING THE EXTENT OF THE NEED FOR TREATMENT

Household Survey Data

Criminal Justice Populations

The Homeless Population

Pregnant Women

QUANTIFYING THE CONSEQUENCES

APPENDIX 3A-ESTIMATING THE NEED FOR TREATMENT IN THE HOUSEHOLD POPULATION

APPENDIX 3B-ESTIMATING THE NEED FOR TREATMENT AMONG ARRESTEES

APPENDIX 3C-ESTIMATING THE COSTS OF DRUG PROBLEMS

Drug-related Crime-Victim Losses

Crime Control Resources

Employee Productivity Losses

Health Costs

4 Defining the Goals of Treatment

DIVERSE INTERESTS

REASONS FOR SEEKING TREATMENT

CRIMINAL JUSTICE AGENCIES AND TREATMENT

Court Referral to Treatment

Prison and Parole Referral to Treatment

Preliminary Conclusions about "Mandatory Treatment

EMPLOYERS AND TREATMENT

Employee Assistance Programs

Drug Screening Programs

How Employers View Drug Treatment

AMBIVALENCE AND THE SPECTRUM OF RECOVERY

Full, Partial, and Nonrecovery from Drug Problems

Setting Realistic Goals

5 The Effectiveness of Treatment

METHADONE MAINTENANCE

What Is Methadone Maintenance?

Goals

Substitution

Clinical Behavioral Strategy

How Well Does Methadone Work?

Why Do the Results of Methadone Treatment Vary?

Costs and Benefits of Methadone Treatment

Conclusions

THERAPEUTIC COMMUNITIES.

What Is a Therapeutic Community?

How Well Do Therapeutic Communities Work?

The Character of Nonexperimental Evaluations

Other Significant Follow-up Studies

Why Do the Results of Therapeutic Communities Vary?

Costs and Benefits of Therapeutic Community Treatment

OUTPATIENT NONMETHADONE TREATMENT

What is Outpatient Nonmethadone Treatment?

How Well Does Outpatient Nonmethadone Treatment Work?

Why Do the Results of Outpatient Nonmethadone Treatment Vary?

Benefits and Costs of Outpatient Nonmethadone Treatment

CHEMICAL DEPENDENCY TREATMENT

What Is Chemical Dependency Treatment?

How Well Does Chemical Dependency Treatment Work?

Why Do the Results of Chemical Dependency Treatment Vary?

Benefits and Costs of Chemical Dependency Treatment

DETOXIFICATION

CORRECTIONAL TREATMENT PROGRAMS

Stay'n Out and Cornerstone

The California Civil Addict Program

Boot Camps

Conclusions about Prison Treatment

SUMMARY AND CONCLUSIONS ABOUT TREATMENT EFFECTIVENESS

Correctional Treatment

RECOMMENDATIONS FOR RESEARCH ON TREATMENT SERVICES AND METHODS

Rebuilding the Research Base

Major Research Questions

Services Research

Chemical Dependency

Cocaine Treatment

Women, Children, and Adolescents

6 Two Tiers: Public and Private Supply

THE TWO TIERS: AN OVERVIEW

Financing Differences

Client Differences

Capacity Differences

THE GROWTH OF THE NATIONAL TREATMENT SYSTEM

Trends in Client Numbers and Provider Characteristics

Trends in the Funding Base

Sources of Treatment Dollars

Trends in Federal Funding

7 Public Coverage

THE PRINCIPLES OF PUBLIC INTERVENTION

External Costs

Income Constraints.

Positive Response to Treatment

Balancing Treatment Needs and Cost Concerns

FROM PRINCIPLES TO PRIORITIES

Eliminate Waiting Lists

Improve Treatment

Reach More Young Mothers

Induce More Criminal Justice Clients to Accept Treatment

THREE STRATEGY OPTIONS

The Core Strategy Option

Comprehensive and Intermediate Strategy Options

PUBLIC INTERVENTION IN THE 1990S

Federal and State Roles in the 1970s

The 1980s: Block Grants

The 1990s: Appropriate Shifts in Federal and State Roles

Transitional Steps toward the Year 2000

THE SPECIAL CASE OF VETERANS' COVERAGE

CONCLUSIONS

APPENDIX 7A BASELINE AND STRATEGY OPTION CALCULATIONS

Baseline Comparison Values

Core Strategy Option

Annual Recurring Costs

Restore Funding per Client to 1976-1979 level

Staff Training

Program/Client Performance Monitoring System

Active Outreach to Expectant Mothers

Treat 18,750 Expectant Mothers

Children of Mothers in Residential Programs

One-time Capacity Expansion/Improvements

Residential Capacity Expansion

Repair Existing Residential Facilities

Repair Existing Outpatient Facilities

Train Additional Staff

Comprehensive Strategy Option

Eliminate Waiting List

Restore Funding per Client to 1976-1979 Level

Aggressive Outreach to Expectant Mothers

Treat 56,250 Expectant Mothers

Comprehensive Probation Emphasis on Treatment

Comprehensive Prison Treatment

Intermediate Strategy Option

Annual Recurring Costs.

Eliminate Waiting List

Treat 37,500 Expectant Mothers

Modest Probation/Parole Induction

Modest Prison Treatment

APPENDIX 7B MODELING FUTURE TREATMENT NEEDS AND EFFECTS

APPENDIX 7C MEDICAID

Coverage Policy Determination under Medicaid

Eligibility

Coverage Provisions

The Current and Future Status of Medicaid Coverage

8 Private Coverage

THE LOGIC OF PRIVATE COVERAGE

THE EXTENT OF PRIVATE INSURANCE COVERAGE

Employees of Private Companies

State and Local Government Employees

Federal Employees

Employers and Coverage Decisions

TRENDS AFFECTING PRIVATE COVERAGE: COST CONTAINMENT OF HEALTH BENEFITS

PRIVATE INSURANCE AND STATE MANDATES

Access to Coverage

Adequacy of Coverage

Cost Containment

The Value of Additional Mandates

Coda

References

Biographical Sketches of Committee Members and Staff

Index.

Notes:

"This study was supported by the National Institute on Drug Abuse, U.S. Department of Health and Human Services, under Contract No. 283-99-0009 (SA)/9D/--T.p. verso.

Includes bibliographical references and index.

ISBN:

1-280-21230-6

9786610212309

0-309-55570-1

0-585-02544-4

OCLC:

923267715