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

• COMMITTEE FOR THE SUBSTANCE ABUSE COVERAGE STUDY
• Preface
• Contents of Volume 2
• Summary
• 1. Introduction
  • The Logic of the Report
  • Additional Policy Questions
• 2. Ideas Governing Drug Policy
  • The Character of Governing Ideas
  • The Spectrum of Ideas about Drugs
  • The Rise of Modern Treatment
  • Conclusion
• 3. The Need for Treatment
  • The Individual Drug History: A Model and Overview
  • Estimating the Extent of the Need for Treatment
  • 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
• 4. Defining the Goals of Treatment
  • Diverse Interests
  • Reasons for Seeking Treatment
  • Criminal Justice Agencies and Treatment
  • Employers and Treatment
  • Ambivalence and the Spectrum of Recovery
  • Conclusion
• 5. The Effectiveness of Treatment
  • Methadone Maintenance
  • Therapeutic Communities
  • Outpatient Nonmethadone Treatment
  • Chemical Dependency Treatment
  • Detoxification
  • Correctional Treatment Programs
  • Summary and Conclusions about Treatment Effectiveness
  • Recommendations For Research On Treatment Services And Methods
• 6. Two Tiers: Public and Private Supply
  • The Two Tiers: an Overview
  • The Growth of The National Treatment System
  • Conclusion
• 7. Public Coverage
  • The Principles Of Public Intervention
  • From Principles To Priorities
  • Three Strategy Options
  • Public Intervention in the 1990s
  • The Special Case of Veterans' Coverage
  • Conclusions
  • Appendix 7A Baseline And Strategy Option Calculations
  • Appendix 7B Modeling Future Treatment Needs and Effects
  • Appendix 7C Medicaid
• 8. Private Coverage
  • The Logic of Private Coverage
  • The Extent of Private Insurance Coverage
  • Trends Affecting Private Coverage: Cost Containment of Health Benefits
  • Private Insurance and State Mandates
  • Conclusions
• Coda
• References
• Biographical Sketches of Committee Members and Staff

This study was supported by the National Institute on Drug Abuse, U.S. Department of Health and Human Services, under Contract No. 283-88-0009 (SA).

“This study was supported by the National Institute on Drug Abuse, U.S. Department of Health and Human Services, under Contract No. 283-88-0009 (SA)”—T.p. verso.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their competencies and with regard for the appropriate balance.

The report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Samuel O. Thier is president of the Institute of Medicine.