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.
- 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
- Recovery and Relapse
- ESTIMATING THE EXTENT OF THE NEED FOR TREATMENT
- Household Survey Data
- Criminal Justice Populations
- The Homeless Population
- Pregnant Women
- Summary
- QUANTIFYING THE CONSEQUENCES
- CONCLUSION
- 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
- CONCLUSION
- 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
- Conclusions
- 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
- Methadone Maintenance
- Therapeutic Communities
- Outpatient Nonmethadone Programs
- Chemical Dependency Programs
- Detoxification
- 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
- CONCLUSION
- 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
- Utilization Management
- THE SPECIAL CASE OF VETERANS' COVERAGE
- CONCLUSIONS
- APPENDIX 7A BASELINE AND STRATEGY OPTION CALCULATIONS
- Baseline Comparison Values
- Core Strategy Option
- Annual Recurring Costs
- Eliminate Waiting Lists
- 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
- Annual Recurring Costs
- Eliminate Waiting List
- Restore Funding per Client to 1976–1979 Level
- Staff Training
- Program/Client Performance Monitoring System
- Aggressive Outreach to Expectant Mothers
- Treat 56,250 Expectant Mothers
- Children of Mothers in Residential Programs
- Comprehensive Probation Emphasis on Treatment
- Comprehensive Prison Treatment
- One-time Capacity Expansion/Improvements
- Residential Capacity Expansion
- Repair Existing Residential Facilities
- Repair Existing Outpatient Facilities
- Train Additional Staff
- Intermediate Strategy Option
- Annual Recurring Costs
- Eliminate Waiting List
- Restore Funding per Client to 1976–1979 Level
- Staff Training
- Program/Client Performance Monitoring System
- Aggressive Outreach to Expectant Mothers
- Treat 37,500 Expectant Mothers
- Children of Mothers in Residential Programs
- Modest Probation/Parole Induction
- Modest Prison Treatment
- One-time Capacity Expansion/Improvements
- Residential Capacity Expansion
- Repair Existing Residential Facilities
- Repair Existing Outpatient Facilities
- Train Additional Staff
- 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
- CONCLUSIONS
- Extent, Costs, and Trends of Coverage
- Mandating Drug Treatment Coverage
- Optimal Coverage Provisions
- Coda
- References
- Biographical Sketches of Committee Members and Staff
- Index
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