2004). One study found that roughly one in four state prisoners received any treatment for substance-use problems, with a higher percentage (40 percent) receiving such treatment if they reported drug use at the time of their offense. The most common treatment received was self-help group/peer counseling (Mumola, 1999). Similarly, although substance-use treatment or other programs, such as education or self-help, were provided by the majority of jails (73 percent) in 1998, only 20 percent of convicted jail inmates who were actively involved with drugs prior to their admission to jail had participated in substance-use treatment or program subsequent to their incarceration. Treatment (i.e., detoxification units, group/individual counseling, and residential programs) was provided by approximately 43 percent of jail facilities. Nearly two-thirds of jails reported providing access to drug or alcohol education or self-help groups (Wilson, 2000).

How These Adverse Consequences Can Be Mitigated

The delivery of effective treatment for M/SU problems and illnesses could mitigate many of the serious individual and societal consequences discussed above. Findings of observational studies and some controlled trials indicate that effective treatment for depression, for example, can result in improved productivity in the workplace, and this might substantially offset the cost of the treatment (Goetzel et al., 2002; Simon et al., 2001b; Wang et al., 2003). Treatment for this and other M/SU illnesses also might help ameliorate the adverse effects of emotional or behavioral problems and illnesses on children’s educational achievement, as well as reduce the burden on the child welfare and juvenile justice systems. At a minimum, provision of effective treatment ensures that funds spent for treatment will not be wasted.

A CHARGE TO CROSS THE QUALITY CHASM

The high prevalence and adverse consequences of M/SU problems and illnesses, the availability of many efficacious treatments, and the widespread delivery of poor-quality care are increasingly being recognized by consumers, purchasers, care providers, and policy makers. Similar concerns about the safety, ineffectiveness, and poor quality of U.S. health care overall have previously received substantial attention among the health care community, the lay press, and the public at large as a result of two IOM reports—To Err Is Human: Building a Safer Health System (IOM, 2000) and Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001). These reports have played a key role in focusing national attention on problems in the quality of the nation’s health care, while garnering consensus on strategies for achieving significant quality improve-



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