Broadening the base of treatment for alcohol problems report of a study by a committee of the Institute of Medicine, Division of Mental Health and Behavioral Medicine
| Autor principal: | |
|---|---|
| Autores Corporativos: | , |
| Formato: | Libro electrónico |
| Idioma: | Inglés |
| Publicado: |
Washington, D.C. :
National Academy Press
1990.
|
| Edición: | 1st ed |
| Colección: | Publication (National Research Council (U.S.)) ;
no. 4038. |
| Materias: | |
| Ver en Biblioteca Universitat Ramon Llull: | https://discovery.url.edu/permalink/34CSUC_URL/1im36ta/alma991009820338206719 |
Tabla de Contenidos:
- 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.
