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Broadening the Base of Treatment for Alcohol Problems

Broadening the Base of Treatment for Alcohol Problems

  • Publisher: National Academies Press
  • ISBN: 9780309040389
  • eISBN Pdf: 9780309568388
  • Place of publication:  United States
  • Year of digital publication: 1990
  • Month: January
  • Pages: 640
  • DDC: 615
  • Language: English

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.

  • 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
    • REFERENCES
  • 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
    • REFERENCES
  • 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
    • Summary and Conclusions
    • REFERENCES
  • 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
    • Summary and Conclusions
    • REFERENCES
  • 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
    • REFERENCES
  • 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
    • Summary and Conclusions
    • REFERENCES
  • 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
      • Summary and Conclusions
    • REFERENCES
  • 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?
      • Summary and Conclusions
    • REFERENCES
  • 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
    • REFERENCES
  • 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
    • Conclusions and Recommendations
    • REFERENCES
  • 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
      • Conclusions and Recommendations
    • REFERENCES
  • 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
      • A. Brief Description of Treatment Level
      • B. Programmatic Description
      • C. Brief Description of Typical Patient
      • D. Dimensional Admission Criteria
    • LEVEL V: MEDICALLY SUPERVISED INTENSIVE INPATIENT TREATMENT
      • A. Brief Description of Treatment Level
      • B. Programmatic Description
      • C. Brief Description of Typical Patient
      • D. Dimensional Admission Criteria
    • ADULT DISCHARGE & TRANSFER CRITERIA
      • Introduction
      • Exceptions to Transfer Criteria
      • Transfer to a Higher Level of Care
      • Transfer to a Lower Level of Care
      • LEVEL V: MEDICALLY SUPERVISED INTENSIVE INPATIENT TREATMENT
      • LEVEL II: LOW INTENSITY OUTPATIENT TREATMENT
  • 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
    • Conclusions and Recommendations
    • REFERENCES
  • 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
    • Conclusions and Recommendations
    • REFERENCES
  • 14 The Treatment of Special Populations: Overview and Definitions
    • Defining Special Populations: A Historical Perspective
    • The Research Perspective on Special Populations
    • REFERENCES
  • 15 Populations Defined by Structural Characteristics
    • Women
    • Adolescents
    • The Elderly
    • American Indians
    • Asian Americans and Pacific Islanders
    • Blacks
    • Hispanics
    • Summary and Conclusions
    • REFERENCES
  • 16 Populations Defined by Functional Characteristics
    • Drinking Drivers
    • Dual-Diagnosis Psychiatric Patients
    • Homeless Persons: The New Public Inebriates
    • College Students
    • Children of Alcoholics
    • Summary and Conclusions
    • REFERENCES
  • 17 The Treatment of Special Populations: Conclusions and Recommendations
    • REFERENCES
  • 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
      • Conclusions and Recommendations
        • The Current Funding Environment
        • The Need for Better Data on Funding and the Costs of Treatment
    • REFERENCES
  • 19 Cost-Effectiveness
    • Studies of Costs and Cost Offsets
    • Cost-Benefit and Cost-Effectiveness Analysis
    • Matching and Cost-Effectiveness
    • Conclusions and Recommendations
    • REFERENCES
  • 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
    • REFERENCES
  • 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
  • APPENDIXES
    • A Task Forces
      • TASK FORCE ON TREATMENT OUTCOME EVALUATION
      • TASK FORCE ON ASSESSMENT AND TREATMENT ASSIGNMENT
      • TASK FORCE ON SPECIAL POPULATIONS
      • TASK FORCE ON FINANCING
    • B Treatment Modalities: Process and Outcome
      • OUTCOME RESEARCH ON SPECIFIC TREATMENT APPROACHES
        • Pharmacotherapies
          • Antidipsotropics
          • Effect-Altering Medications
          • Psychotropics
        • Aversion Therapies
        • Psychotherapy and Counseling
        • Didactic Approaches
        • Mutual Help Groups
        • Behavioral Self-Control Training
        • Conjoint Therapies
        • Broad-Spectrum Treatment Strategies
        • Relapse Prevention
      • RESEARCH ON TRADITIONAL TREATMENT PROGRAMS
      • RESEARCH ON THE INTENSITY AND DURATION OF TREATMENT
      • RESEARCH ON AFTERCARE
      • TREATMENT PROCESS RESEARCH
        • Mechanisms of Treatment Efficacy
        • Therapist Variables
        • Motivation
        • Compliance
        • Mandated Treatment
      • CONCLUSIONS
        • Does Treatment Work?
        • Specific Conclusions
      • REFERENCES
    • C International Review of Treatment and Rehabilitation Services for Alcoholism and Alcohol Abuse
      • Types of Alcohol Problems Experienced
        • Kenya
        • Mexico
        • England and Wales
        • Australia
        • Union of Soviet Socialist Republics (USSR)
      • Treatment Responses
        • Australia
        • Norway
        • England and Wales
        • Mexico
        • USSR
        • Zimbabwe
        • Bulgaria
        • Costa Rica
        • Summary
      • Levels of Intervention
      • Criteria for Admission to Different Types of Treatment
      • Treatment Services for Special Populations
      • Information Regarding the Outcome of Treatment Services
      • How Are Treatment Services Financed?
        • England and Wales
        • Australia
      • The Future of Alcohol Treatment Services
      • Conclusion
      • REFERENCES
    • D COERCION IN ALCOHOL TREATMENT
      • Types of Coercion
        • Involuntary Treatment: Civil Commitments
        • Diversion from the Criminal Justice System
        • The Prevalence of Criminal Justice Referrals
        • Workplace Referrals
        • The Prevalence of Workplace Referrals
        • Early Intervention Programs
      • The Distribution of Criminal Justice and Employee Assistance Program Referrals: Public Versus Privat Programs
        • Coercion Versus Self-Referral
        • Alcoholics Anonymous and Coercion
      • The Epidemiology Of Individuals In Different Diversion Programs
        • The Criminal Justice-Referred Population
        • The Employee Assistance Program Population
      • Treatment Outcome in Coerced Populations
      • Implications for Alcohol Treatment
      • NOTES
      • REFERENCES
  • INDEX

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