A study of the evolution, effectiveness, and financing of public and private drug treatment systems

A study of the evolution, effectiveness, and financing of public and private drug treatment systems

Bibliographic Details
Other Authors: Gerstein, Dean R. (-), Harwood, Henrick J.
Format: eBook
Language:Inglés
Published: Washington, D.C. : National Academy Press 1990.
Edition:1st ed
Series:Treating drug problems ; v.1
Subjects:
Drug abuse > Treatment > Economic aspects > United States.
Drug abuse > Treatment > Government policy > United States.
Drug abuse > Treatment > United States.
Health insurance > United States.
See on Biblioteca Universitat Ramon Llull:https://discovery.url.edu/permalink/34CSUC_URL/1im36ta/alma991009820248306719
Table of 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
  • 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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