. "1 The Quality Chasm in Health Care for Mental and Substance-Use Conditions." Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. Washington, DC: The National Academies Press, 2006.
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Improving the Quality of Health Care for Mental and Substance-Use Conditions
imaging, and animal models of behavior (Gould and Manji, 2004; Sarver et al., 2002; Tecott, 2003).
The past decade also has seen rapid growth in the science of evaluating the costs and effectiveness of health interventions. These approaches increasingly demonstrate that care for many M/SU problems and illnesses can be both effective (i.e., it can work) and cost-effective (i.e., it can represent a good value). Recent studies have used these approaches to evaluate a variety of mental health interventions, ranging from use of a specific medication (clozapine) in populations with schizophrenia (Essock et al., 2000; Rosenheck et al., 1999), to using specific models for treating depression in primary care (Pirraglia et al., 2004), to providing supported housing for homeless persons with mental illness (Rosenheck et al., 2003). These and other mental health interventions have been found to be as or more cost-effective than many treatments currently provided in general medical practice. Consistent with these findings, more than half of adults who received treatment for mental health problems in 2003 reported that their treatment improved their ability to manage daily activities “a great deal” or “a lot” (SAMHSA, 2004a).
A large body of research shows likewise that treatment for alcohol and other drug problems and illnesses is effective. Many people who enter treatment decrease their substance use and have fewer problems (Finney and Moos, 1991; McLellan et al., 2000; Miller et al., 2001). Recent years have seen many scientific advances in understanding the behavioral and social factors that lead to substance use and dependence, in identifying key neuropathways and chemical changes that create the cravings characteristic of alcohol or drug dependence, and in developing mechanisms to block these effects. These advances have resulted in a spectrum of evidence-based pharmacological and psychosocial treatments for individuals who misuse or are dependent on substances—treatments that produce results similar to or better than those obtained with treatments for other chronic illnesses (McLellan et al., 2000). New medications, such as buprenorphine, are effective in significantly reducing opioid use (Johnson et al., 2000). In contrast to the first medication for opiate dependence (methadone), buprenorphine can be prescribed routinely in physicians’ offices. Naltrexone and acamprosate also show efficacy in treating alcohol dependence (Kranzler and Van Kirk, 2001; O’Malley et al., 2003) and may be more acceptable to patients than disulfiram, the first medication approved for treating that condition.6
Nonpharmacological treatments for drug dependence, such as cognitive behavioral therapy and motivational enhancement treatment, have also
Disulfiram produces a very uncomfortable physiological reaction in the individual when alcohol is consumed, and does not reduce craving.