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INDEX

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INDEX Abstinence A Alcoholics Anonymous and, 108, 363, 527 as treatment goal, 78-79, 228, 295 as treatment outcome measure, 527-528 Accreditation standards, 125, 313, 413, 426 Acetaldehyde, 75 Activity groups, 83 Acute intervention, 63, 65, 66, 472 "Acute phase services," 61, 62 Addiction Research Foundation (Ontario), 56, 243, 265 Core-Shell Treatment Program, 285, 331, 338 and treatment goals, 295-296 Addiction Severity Index (ASI), 251, 256, 339 Adolescent Assessment Project, 362 Adolescents. See College students; Youth Adult children of alcoholics, 390, 391-393 Adult Children of Alcoholics, 556 Advertising, by treatment providers, 432 Affective disorders. See Depression AFL-CIO, 112 Aftercare, 60, 61, 62, 66, 67-68. See also Maintenance; Relapse prevention for mentally ill, 333 research on, 530-531 for special populations, 347 Age and alcohol consumption, 371 legal alcohol purchase, 383, 388 and liver disease, 176 and prevalence of alcohol problems, 153-154, 357 in special populations, 345, 347, 349 and treatment facilities, 283, 359, 361, 370 Aid to Families with Dependent Children, 194 Al-Anon, 105, 108, 113-114, 391, 556, 562, 570, 571 Alateen, 108, 391, 556, 562, 570, 571 Alberta Alcoholism and Drug Abuse Commission, 338 Alcohol, 20 craving, pharmacological reduction of, 77-78 exposure to, 217 legal purchase age, 383, 388 metabolism of, 53, 368 oxidation of, 75 tolerance, 29 Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA), 439 administration of block grants, 186, 190, 411, 414, 419 and diagnosis-related groups, 421 Office of Substance Abuse Prevention (OSAP), 131-132, 350 project grants, 188, 192, 198 recommended actions, 179, 442, 443 and research, 498 613 Alcohol, Drug Abuse, and Mental Health Amendments (1986), 1 Alcohol, drug abuse and mental health services block grant. See Block grant Alcohol abuse, 31 Alcohol Casualty Index, 165 Alcohol Clinical Index (ACI), 219, 255 Alcohol consumption, 30-31, 215, 217, 227, 228 adolescents, 359 American Indians, 366 drinking history, 253, 254, 255, 256, 259, 269 as index of alcohol problems, 176, 229, 295 and injuries, 230 and pregnancy, 230 race and, 369-370 self-reports, 262 and treatment outcome, 321 Alcohol crisis center, 49 Alcohol dependence, 28-30, 31, 217, 386 in adolescents, 359, 361 diagnosis-related group, 420 and matching, 283 treatment, 118, 203 Alcohol Dependence Scale (ADS), 219, 255 Alcohol and drug abuse treatment and rehabilitation (ADTR) block grant, 191, 192, 198 Alcohol Epidemiologic Data System (AEDS), 165- 166, 443 Alcoholics, recovering, as counselors, 57, 58, 60, 125 Alcoholics Anonymous (AA), 7, 98, 113-114, 132 and abstinence, 108, 363, 527 coerced referral to, 594-595 continuity of care, 19 in correctional institutions, 100 employee assistance programs and, 105 formation of, 14, 15, 27-28 halfway houses, 406 individual assessment and, 245 international programs, 555-556, 558, 562, 567 meetings, 108-109, 527 membership, 109 principles of, 55, 57, 58, 60, 85, 331, 347, 391 psychotherapies and, 82 as relapse prevention, 68, 158-159 studies of, 520-521, 537 as treatment, 52, 56, 110-111 women in, 357 Alcoholics Anonymous (the "Big Book"), 108 "Alcohol idiosyncratic intoxication," 216 Alcoholism, 26-28, 31, 108. See also Alcohol problems disease concept of, 32-33 Alcoholism, Alcohol Abuse and Related Problems: Opportunities for Research (IOM), 2 Alcohol problems. See also Assessment, pretreatment; Brief intervention; Specialized treatment; Treatment assessment of, 243-245 attitudes about, 485 community agency responses to, 211-213 costs of, 202-204, 326, 465, 487 course, 34, 317

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614 defining, 6-7, 25-26, 44 diagnosis-related groups, 420-421 discrimination against persons with, 413, 423, 426, 428 disease model of, 385, 408, 559 etiology, 35-36, 43-44, 51, 52, 78 heterogeneity of, 15, 31-33, 163, 400, 486 implications for assessment, 249 implications for treatment, 36-37 identification, 218-220 international studies, 552-555, 576 manifestations of, 242 Medicaid and, 421 as moral failure, 14 presentation, 33 prevalence of, 153-154, 215, 229, 364, 478 and treatment availability, 176-178 as a primary disorder, 44, 59, 184, 408 severity of, and matching, 281, 283, 460 stigma of, 48, 357, 409, 428, 432 in treatment deterioration with, 155-156, 159 improvement without, 152-155, 159, 221 Alcohol problems perspective, 25-26, 30, 37-38, 478 Alcohol and Public Policy: Beyond the Shadow of Prohibition (NAS), 2 "Alcohol-related disabilities," 29, 31 Alcohol Safety Action Program (ASAP), 381, 382, 492, 588 Alcohol-sensitizing drugs, 75 Alcohol use disorder, 27 Alcohol Use Disorders Identification Test (AUDIT), 219, 254, 255 Alcohol Use Inventory, 250, 256, 599 Aldehyde dehydrogenase, 75, 368-369 Ambulatory Pediatric Association, 131 American Hospital Association (AMA) Classification of Health Care Institutions, 72 surveys of hospitals, 103, 124, 167, 175-176, 406 on treatment financing, 412-413 American Indians, 369, 372 federal programs for, 119, 410 Minnesota programs for, 115, 116, 117, 417 as special population, 344, 346, 347, 348, 349- 350, 351, 352, 365-368 American Journal of Psychiatry, 2 American Medical Association, 131 American Medical Society on Alcoholism and Other Drug Dependencies, 125 American Psychiatric Association, 27, 125, 583 AMETHYST study, 224, 228 Amitrytyline, 76 Antabuse. See Disulfiram Antianxiety drugs, 74, 77 Antidepressant drugs, 76-77 Antidipsotropics, 512-514 Anti-Drug Abuse Act (1988), 131, 191, 442, 490, 498 Antipoverty Act, 345 Antisocial personality disorder, 258, 385-386 Anxiety, 78, 99-100, 283, 386 INDEX Arizona, 193 ASI. See Addiction Severity Index Asian Americans, 345, 349, 351, 368-369, 372 Assessment, pretreatment, 8, 65, 334, 336, 337, 338, 339 administration of, 261-266 of adolescents, 362, 363 community role in, 228, 329 content of, 255-261, 599-600 cost of, 250, 461 financial bias in, 264-266 ideological bias in, 263, 266 insurance coverage for, 468 managed care and, 437, 476 and matching, 486 medical and psychiatric status, 245-246 methods of obtaining information, 266-269 multidimensional, 251-255 necessity of, 157, 242-243 and outcome, 320 purposes of, 243-249, 270 sequential, 249-251 of special populations, 402 Assessment, treatment program, 288 Association for Medical Education and Research in Substance Abuse (AMERSA), 125, 130, 131 "Attack" therapy, 247-248 AUDIT. See Alcohol Use Disorders Identification Test Australia alcohol problems in, 554-555 treatment in, 556, 569-570, 572-573 Aversion therapies, 78, 103, 517-518, 531 B Baltimore, 229 Behavioral self-control training, 80-81, 521-522 Behavioral treatment modalities, 52, 73, 78-81, 431 Benzodiazopines, 74, 77, 555 Beta blockers, 77 Betty Ford Center, 103 Bibliotherapy, 226 Binge drinking, 252 Biofeedback training, 79, 524 Biological factors, 52 Biological markers, 262-263, 322-323, 359 Biopsychosocial model, 35, 51, 52-53, 58 Birch and Davis Associates, Inc., 129-130 Blacks, 371, 372 Minnesota programs for, 116, 117 as special population, 106, 345, 346, 347, 348, 349, 351, 352, 369-370, 399 United Kingdom programs for, 570 Block grant (alcohol, drug abuse, and mental health semices), 382, 387, 411, 414, 419, 482, 498 and data collection, 168, 370, 442 distribution of, 440 restrictions on, 190-191, 414 special population targeting, 344, 350

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INDEX state administration of, 190-192, 197-198, 201, 415-419, 464, 490 Bloustein, Edward, 388-389 Blue Cross/Blue Shield Association, 61, 184, 200, 201, 413, 424, 426, 431, 433 Board and lodging programs, 116 Breathalyzer testing, 262, 322-323 Brief intervention, 16, 18, 37, 47, 249 community agency role, 211, 212, 213, 217, 220-221, 230-231, 334 cost-effectiveness of, 459, 460, 461 effectiveness of, 148, 468 efficacy of, 221-225, 226 goal of, 228 payment for, 473-474 research on, 531 in student assistance programs, 101, 390, 391 target of, 226-227 therapist role in, 532 varieties of, 225-226 Brief therapy, 225-226, 235 British General Practitioner study, 223-224 Brookfield Clinics, 284, 289, 336, 337 Brunel, Sir M. I., 335 Bulgaria, treatment in, 563, 573 Buspirone, 77 C CAGE questionnaire, 219, 229, 255 Calcium carbide, 75 Calcium carbimide, 159, 514 Califano, Joseph, 408 California Alcoholics Anonymous membership, 109 alcohol treatment authority, 416-417, 464 DWI treatment legislation, 590, 593-594 involuntary commitments in, 581, 582, 586 private health insurance funding in, 195 social model of recovery, 51, 52, 57-58, 85, 123, 417 social services recipients, 231 Canada, 75, 109 Cancer, 253, 369 Cannon, Walter B., 152 Capitation, 432, 476 Cardiovascular Disease Databank (Duke University), 145 Cardiovascular disease prevention, 227 Career Teacher Program, 130 Carrier Foundation, 527 Case managers. See also Managed care and continuity assurance, 480 and cost containment, 330, 331, 436, 467 Catchment areas, 410 Categorical grants, 190, 406, 409-411, 412, 414, 438-439 American Indian programs, 119 drinking driver programs, 382 CATOR. See Chemical Abuse/Addictions Treatment Outcome Registry Caucasians. See Whites 615 Causes and Consequences of Alcohol Problems: An Agenda for Research (IOM), 2, 32 CHAMPUS. See Civilian Health and Medical Program of the Uniformed Services CHAMP-VA, 192 Chemical Abuse/Addictions Treatment Outcome Registry (CATOR), 146, 201, 248, 303, 323, 325, 356, 362-363 services of, 316, 336, 337 Chemical aversion therapy, 78, 79, 517-518, 531 Child care facilities, 348, 357, 358 Children, Medicaid coverage for, 194 Children of alcoholics, 390, 391-393 Children of Alcoholics Foundation, 391, 392 Chippewa Indians, 367 Chronic Health Index, 165 "Chronic phase activities," 61 Churches, 501 Churchill, Winston S., 15 Cirrhosis. See Liver disease and cirrhosis CIRT (community intensive residential treatment), 418 Citalopram, 514-515 Citizens League, 265 Civil commitment, 580-586 Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), 61, 186, 192, 194-195, 205, 420 Cleveland Admission Discharge and Transfer Cntena, 288-289, 295, 303-312, 337, 436, 472 Client fees. See Patients: payments by Clinical Institute of Ontario, 285 Withdrawal Assessment for Alcohol, 74-75 Codependency, 392-393 Cognitive-behavioral relapse prevention strategies, 80 Cognitive functioning, 258, 280, 320, 520 College students, 351, 388-391 Colorado Alcohol and Drug Abuse Division, 71 involuntary commitments in, 582 Commission on Accreditation of Rehabilitation Facilities (CARF), 61, 426 Committee recommendations, 5, 486-488 assessment, 253, 269-270 community role, 211, 218, 235-236 Congress, 488-490 continuity of care, 331, 333 data collection, 124, 205-206 employers and insurers, 493-495 funding studies, 441-444, 461-462 insurance coverage, 468, 469, 473, 474, 475, 480, 481 mandated insurance coverage, 475 matching, 296 NIAAA, 497-500 outcome determination, 326 research, 490, 499 special populations, 10, 358, 399-404 state policies, 491-492 treatment availability studies, 166, 167, 169, 178-179

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616 treatment providers, 99, 102, 132-133, 495- 497 treatment systems approach, 18, 20, 329, 330, 340 uniform coverage rule, 480, 489 Community agencies. See also Brief intervention and drinking drivers, 381 effects and costs of, 234-235 funding, 71, 191 international programs, 574-575 personnel, 233-234 referral to specialized treatment, 211, 212, 217, 220, 228, 329, 334 role in treatment, 6, 8, 18-19, 211-213, 214, 216, 329, 330, 334, 336, 338-339, 340 settings for, 228-233 treatment facilities, 99-101, 132, 410, 440 Community general hospitals, 424 Community health centers, 128 Community mental health centers, 128, 410 Community Mental Health Centers Act, 408, 410 Community organizations, 500-501 Community reinforcement approach, 80, 158, 524 525 Community Response to Alcohol-Related Problems (WHO), 550 CompCare Corporation, 432, 526 Compensatory model of etiology and treatment, 55, 56 Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act (Hughes Act) (1970), 14, 15, 346, 407, 408-409, 415 Computerization of data bases, 248 in obtaining assessment information, 266, 267, 268-269 "Conceptual level," 280, 283 Confrontational psychotherapy, 280, 519 Connecticut demand-based planning, 166 DWI treatment legislation, 590, 591 involuntary commitment law, 581 social model treatment study, 423 Connecticut, University of, 338, 499 Connecticut General Corporation, 495 Contingency management, 80 Continuing care, 68 Continuity of care, 9, 18, 19, 329, 330-333 and brief intervention, 226 case managers and, 476, 480 community role in, 228 insurance coverage for, 468 as part of treatment system, 46, 334, 336, 338, 339 Continuum of care, 44 under categorical grants, 410 defining, 47-51, 85-86 and homeless persons, 387 insurance coverage for, 430, 480 Minnesota, 112-113 state agencies and, 437~38 INDEX Contra Costa County, Calif., 214 Cooperative Commission on the Study of Alcoholism, 25, 407, 438, 485, 486, 494, 497 Coping skills, 52, 403 Core-Shell Treatment System Project, 285, 286, 290, 331, 336, 338 Correctional institutions, 100 Corroboration of outcome, 323 Costa Rica, treatment in, 563-564, 568, 570, 571, 574 Cost containment, 285, 431-432, 439-440, 444 health maintenance organizations, 433 managed care and, 331, 435-436 Medicare and, 420 preferred providers, 435 Cost-effectiveness, 11, 466, 467 analysis, 455, 459-461 insurance industry and, 426 limitations on treatment, 49 matching and, 461 social model treatment and, 469 treatment setting and, 529 Cost offset, 11, 424, 455, 478 brief interventions and, 468 studies of, 455-459 Costs of alcohol problems, 202-204, 326, 465 assessment and matching, 250, 461 community interventions, 234-235 day treatment, 105 insurance coverage, 411-412 level of services and, 443 of recommended changes, 5-6 treatment, and insurance industry, 424-425 treatment, mandated insurance and, 430 Council of State and Territorial Alcoholism Authorities, 409 Counseling, 46, 76 Counselors, 7, 125-131, 234. See also Therapists certification of, 125, 497 mandated insurance coverage and, 427 recovering alcoholics as, 57, 58, 60, 125 research on, 532-533 for special populations, 348 Course, heterogeneity of, 34 Court decisions, 345, 408. See also Criminal justice system Covert sensitization, 79, 518, 531 Criminal justice system, 346 coerced referrals to treatment, 371, 382-383, 579, 586-591, 593, 598 and drinking drivers, 232, 381, 382-383 and homeless persons, 387 personnel, 234 and public inebriates, 408 Crisis management, 62 Cuban Americans, 370 Cue exposure therapy, 81 Custodial care, 406

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INDEX D Data bases. See also National Drug and Alcoholism Treatment Unit Survey; State Alcohol and Drug Abuse Profile assessment information, 248-249 computerization of, 248 on funding and costs of treatment, 441-444 outcome information, 316 on special populations, 350-351 Data-driven treatment selection, 293-294 Day treatment, 104, 123, 133. See also Intermediate care cost-effectiveness of, 460 mandated insurance and, 430 Delirium tremens, 74 Demographic variables, 256-257, 281, 282, 345 Denoix, P. F., 253 Depression and alcohol problems, 385-386 and matching, 282 treatment for, 76, 358, 516, 519 women and, 357 Detoxification, 49, 59, 61, 64, 65, 313, 511-512, 555 costs of, 204 health maintenance organizations and, 434 insurance coverage for, 71, 464, 468 managed care and, 436 Minnesota programs, 114-115 NDATUS classification, 122-123, 169 Oregon programs, 418-419 pharmacotherapies, 73, 74, 515-516 placement criteria, 472 prospective payment system and, 421 setting for, 72 social model and, 52, 56 treatment capacity, 170-172 Detoxification centers, 48, 387, 408 Diagnosis, 303. See also Assessment, pretreatment and matching, 281, 282 psychiatric 251, 358 Diagnosis-related groups (DRG), 61, 204, 420 421 Diagnostic Interview Schedule (DIS), 229, 251, 255, 256 Diagnostic programs, 105 Diagnostic and Statistical Manual of the Amencan Psychiatric Association (DSM-III-R), 27, 29-30, 244, 255 Directory of Chemical Dependency Programs (Minnesota), 116 DIS. See Diagnostic Interview Schedule Discharge and transfer criteria, 309-310 Discrimination against persons with alcohol problems, 413, 426, 428 and treatment utilization, 371 Disease, alcoholism as, 51, 385, 408, 559 Disease Concept of Alcoholism (Jellinek), 27-28 Disease and illness, 20, 152 District of Columbia, 415 617 Disulfiram (Antabuse), 14, 51, 52, 58, 75-76, 589 matching and, 282 outcome information, 333 studies of, 512-514 Disulfiram-ethanol reaction (DER), 75, 76 Domiciliary care, 63, 66, 122, 169, 170 Donwood Institute (Toronto), 331 Dopamine, 77 Doxepin, 76 Drinking drivers, 232, 381-385, 399 coerced treatment, 156, 534-535, 588-589, 590, 593-594, 595, 596, 599 in Mexico, 553 programs for, 47, 111, 114, 492-493, 522 as special population, 345, 346, 348, 349 youth, 388, 389 "Drink-related disabilities," 29 Drinkwatchers groups, 108, 558-559, 567 Drug problems, 3, 102, 257, 348, 587 in Alcoholics Anonymous membership, 109 treatment programs, 118, 198 Drug therapy. See Pharmacotherapies DSM-III. See Diagnostic and Statistical Manual of the American Psychiatric Association "Dual-diagnosis" patients, 385-386, 387, 516 Duke University Medical Center, 145 DWI. See Drinking drivers E Early intervention, 45-46, 213, 592-593 See also Brief intervention Economic Opportunity Amendments (1968 and 1969), 410 Edinburgh study, 222, 233 Educational programs, 46, 82, 291 for college students, 390, 391 for drinking drivers, 382, 383, 384, 520 Educational settings for intervention, 231-232 Edwards, Griffith, 33 Edwards, Justin, 14 Edwards and Orford study, 221 Effect-altering medications, 512, 514-515 Effectiveness and Costs of Alcoholism Treatment (OTA), 1 Elderly Medicare and, 419 as special population, 345, 348, 349, 350, 351, 352, 364-365 Electrical aversion therapy, 78 Emergency treatment, 65, 66. See also Detoxification health maintenance organizations, 434 hospital, 229, 406, 481 for poor, 481 Uniform Act guidelines, 48, 49 Employee assistance programs (RAP), 68, 111 112, 114, 232, 363, 411 coerced referrals to treatment, 579, 591-592, 593, 594, 596, 597, 598 cost offset and, 456 federal employees, 350

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618 insurance companies and, 424, 494-495 managed care providers, 436 personnel, 234 studies of, 535 Employees insurance cost sharing, 431 as special population, 346 Employers and health maintenance organizations, 433 and insurance coverage, 422, 424-425, 431, 488 and mandated insurance, 428, 476 recommended actions, 493-495 self-insurance, 185-186, 200, 427, 431, 475 Employment, Retirement, and Income Security Act (ERISA) (1974), 186, 427 England alcohol problems in, 553-554 special populations, 570-571 treatment in, 557-559, 575 Enlightenment model of etiology and treatment, 55 Epidemiologic Catchment Area (ECA) study, 34, 154, 229, 231, 257 PRISM See Employment, Retirement, and Income Security Act Etiology heterogeneity of, 35-36 models of, 43-44, 55-56, 78 Europe, pharmacotherapy in, 75 Evaluation, 63, 65 Expert committees, 287, 296, 473 Extended care (stabilization), 65, 66-67, 68, 70 costs of, 204 facilities in Minnesota, 116 group psychotherapy in, 82 F "Faders," 322 Families, children of alcoholics and, 391, 392 Family history, 258 Family Services of America, 495 Family therapy, 49-50, 52, 83-84, 356 Farm workers, 346, 349 Federal employees, 349-350, 411 Federal Employees Health Benefits Program (FEHBP), 186, 192, 350, 419, 422-423 Fetal alcohol effects, 230 Fetal alcohol syndrome, 230, 366 Fifth Special Report to Congress on Alcohol and Health (USDHHS), 32, 348 Filipino Americans, 368 Fillmore, Kaye M., 4 Financial case management, 331 First Special Report to the U.S. Confpess on Alcohol and Health (USDHEW), 279, 346 Fluoxetine, 515 Fluvoxamine, 515 Folk medicine, 348 Follow-up, 46, 62, 66, 68. See also Continuity of care INDEX interviews, 19, 323 and outcome reporting, 314 treatment, 48 Formula grants, 408-409, 415, 438-439 France, treatment in, 47 Fraternity houses, 389 Funding, 10-12. See also Block grant; Cost- effectiveness; States brief therapy, 235 categories of, 183-187, 204-206 continuum of care and, 47 current environment, 439-441 data collection, 442 expenditure levels, 202-204 federal, 408-411, 414, 419-423 FEHBP, 422 health care, 201-202, 431 health insurance, 125, 411-414 international, 572-573 national policy development, 407-408 outcome determination, 325-326 personnel training, 125 poor and uninsured treatment, 480-483 research, 441-444, 498-499 special population programs, 119, 401 specialty programs, 188-197 private-sector, 200-201 public-sector, 197-200 state and local role, 415-419 and treatment capacity, 173-175 treatment facilities, 115, 116 G Gamma aminobutyric acid (GABA), 77 Gamma glutamyl transferase (GGT), 221-222, 224 Gays, 345, 351, 570 Gender, 345, 347, 349, 553. See also Women General Health Questionnaire (GHQ), 251, 256 General Motors Corporation, 495 Genetic factors, 35, 51, 53, 368-369 GGT. See Gamma glutamyl transferase GHQ. See General Health Questionnaire Gibbons, Henty, 581 Gordis, Enoch, 1 Greater Cleveland Hospital Association, 303 Group Health Association of America, Inc., 433, 434 Group psychotherapy, 82 for children of alcoholics, 391-392 confrontational, 280 for married couples, 83 for special populations, 356 Guide to Clinical Preventive Services (U.S. Preventive Services Task Force), 231 H Halfway houses, 52, 70, 98, 101, 107, 406 insurers and, 133 in Minnesota, 115-116

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IDEA personnel, 127 Handicapped persons, 349 Harwood, Henriek, 4 Hazelden Foundation, 58, 59, 85, 128, 132, 526 Health care costs, 424, 428 alcohol problems treatment and, 183-184 cost containment, 431 funding of, 201-202, 407 Health Care Financing Administration (HCFA), 186, 200-201, 419, 423, 462 and diagnosis-related groups, 421 Health care sector, 98, 99-100, 335 cost offset and, 11, 456 and homeless persons, 387 treatment settings, 229-231 Health insurance, 71. See also Private health insurance; Public health insurance; Self- insurance; Uninsured persons availability of, 423 for brief therapy, 235 and cost-effectiveness, 461 and cost offset, 456, 458 coverage appropriateness, 466-467 coverage of minorities, 372 exclusion of alcohol-related disorders, 409 funding of, 125, 185-186, 406-407 model benefit packages, 428, 429-430, 439, 475, 476 insurers and, 426 NLAAA and, 61, 411-412, 423-424 national, 412 optimal conventional coverage, 467-474 reimbursement limits, 476 and treatment quality, 315 Health maintenance, 200, 201 Health Maintenance Organizations (HMO), 431, 493, 495 cost offset and, 456 coverage of, 425, 432-435 mandated insurance and, 427 research on 434-435 Health Services Funding Regulations and Guidelines, 413 Hippocrates, 159-160 Hispanic Americans, 370-371, 372 Minnesota programs, 117 as special population, 345, 346, 347, 348, 349, 351, 352 Holder, Harold D., 4 Homeless persons, 43, 358, 401 extent of alcohol problems, 231 programs for, 116, 387-388 as special population, 349, 350 United Kingdom programs, 570-571 Homeostasis, 152 Homicide, 366 vehicular, 381 Hospitals admission practices, 409 cost containment, 420-421 cost offset and, 456 mental health programs, 406 prevalence of alcohol problems in patients, 33, 229 619 Hospital treatment. See also Inpatient treatment for adolescents, 359 availability of, 175-176 block grant restrictions on, 190-191, 414 costs of, 196, 202, 203, 407, 440, 465 of couples, 83 insurance coverage of, 424, 469, 470 insurers' preference for, 205, 440-441 Medicare coverage, 193 in Minnesota, 115 personnel, 126 state reimbursement of, 417, 418 types of settings, 103 Hughes, Harold, 14, 108, 408 Hughes Act. See Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act Humana Hospitals, 432 Human services, 98, 100-101 Huss, Magnus, 26 Hypertension, 36 ICD. See International Classification of Diseases Identification, 61, 211, 218-220, 249 Illinois Alcoholics Anonymous membership, 109 involuntary commitments in, 582 social model treatment study, 423 Illness, 20, 152 Imipramine, 76 Incentive grants, 410 Income, and alcohol consumption, 370. See also Low-ineome and poor persons Indiana, 415 resource allocation model, 165 Indian Health Board (Minnesota), 113-114 Individual assessment, 245-246, 251, 319. See also Assessment, pretreatment and treatment planning, 247-248 Individual dynamic psychotherapy, 81-82 Individual practice associations (IPA), 432, 434 Inoculation, 285 Inpatient treatment, 48, 69-70, 72-73, 103, 122. See also Halfway houses; Hospital treatment; Residential treatment eost-effeetiveness of, 460 effectiveness of, 147 insurance coverage of, 428, 430, 469-470, 474- 475 model benefit plan, 429 insurance industry and, 425-426 length of stay, 412 managed care and, 435 matching and, 295, 307-309, 311, 473-474 medical model and, 55 Medicare coverage of, 420 mental health hospitals, 406 in Minnesota model, 59, 60 and relapse prevention, 67-68 social model and, 56 for special populations, 347

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620 state agencies and, 437 treatment capacity, 172 utilization of, 169 Inquiry into the Effects of Ardent Spirits upon the Human Body and Mind, (Rush), 14 Institute of Health and Aging, 166, 167 Institute of Medicine (IOM), 2-3, 32, 35, 498 Committee to Identify Research Opportunities for the Prevention and Treatment of Alcohol-Related Problems, 147 homelessness report, 387 on research, 318 Insurance. See Health insurance; Private health insurance; Public health insurance Intelligence assessment, 258 Interagency Committee on Alcohol Abuse and Alcoholism, 419 Intermediate care, 48, 70, 72, 73, 104-107. See also Day treatment costs of, 204 expansion of, 133 insurance coverage of, 429 length of stay, 412 International Classification of Diseases (ICD), 29, 255 Intervention, 44-46 categories of, 63, 113 spectrum of, 211, 212, 218 Inventory of Drinking Situations, 260 "Involuntary outpatient civil commitment," 585. See also Treatment: coerced Iowa, 204 Irish immigrants, 345 J Jails, 406, 410 Japanese Americans, 368 Jellinek, E. M., 14, 27-28, 32 Jellinek classification, 283 Jenner, Edward, 285 Johns Hopkins Hospital, 33, 229 Johns Hopkins Medical School, 33, 233 Johnson, Lyndon B., 408 Johnson, Vernon, 59 Johnson Foundation, 85 Johnson Institute, 58, 59 Joint Commission on the Accreditation of Health Care Organizations (JCAHO), 413, 426, 427 Joint Commission on the Accreditation of Hospitals (JCAH), 61, 413-414, 426, 428 Joint Commission on Mental Illness and Health, 407 Joint Federal and State Agency Meeting-on Alcohol and Drug Data Collection, 392 INDEX K Kaiser Foundation Health Plans, 432, 433 Kaiser-Portland health plan, 458 Keller's law, 36, 245 Kemper Insurance Companies, 424 Kenya alcohol problems in, 552 treatment in, 555-556, 568, 572, 573-574 Kidney disease, 419 L Laboratory examinations, 218-219, 255 Language barriers, 348, 370 Learning disabilities, 363 Legal Action Center, 429 Length of stay in model benefit plan, 412 and outcome, 529 prospective payment and, 420, 421 Levels of care. See also Treatment: setting of in Cleveland criteria, 289, 295, 303, 472-473 in international programs, 564-567 managed care and, 436, 437 matching to, 439, 443-444, 470 Life events, 258-260, 357, 364 Lincoln, Abraham, 2 Lithium, 77, 282, 516 Liver disease and cirrhosis and blacks, 369 as index of alcohol problems, 176 mortality, 14, 176-177, 366, 552, 554 treatment costs, 203 and women, 357 Local governments allocation of block grants to, 190-191 responsibility for treatment, 406, 477 treatment funding by, 186, 191, 196-197, 198, 416 Longitudinal studies, 318 Low-income and poor persons, 349 mandated insurance and, 429 treatment financing, 415, 480-483 federal formula grants, 345, 410 Medicaid, 421, 481 state and local, 440, 481 and utilization, 456-457 LSD (lysergic acid diethylamide), 282 Lutheran General Hospital (Park Ridge, Ill.), 59 M MacAndrew Scale, 219 Maine, 166 Maintenance, 62, 63, 66, 68-69 insurance coverage, 468 phalll~acotherapy, 75-77 Makah Indians, 367 Malmo study, 221-222, 233 Malpractice suits, 433

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INDEX Managed care, 336, 337, 431, 469 cost containment, 331, 435-437, 475-476 insurance coverage of, 461 psychiatric, 436 Mann, Marty, 28, 34 Marital status, and matching, 282, 283, 357 Marital therapy, 83, 292, 522-523 Maryland, 229 Massachusetts, 580, 582, 584 MAST. See Miehigan Alcoholism Screening Test Matching, 9, 44, 242, 279-280, 329, 333, 334, 336, 337, 439, 440-441, 468 assessment and, 247-248 brief intervention and, 221 Cleveland criteria, 303-312 and continuity assurance, 480 cost of, 461 and cost-effectiveness, 461, 478 and drinking drivers, 381-382 examples of programs, 285-287 guidelines, specification of, 289-294, 337, 338, 339, 486 psychiatric diagnosis, 386 and special populations, 400-401, 402 specification of treatment, 287-289 studies of, 280-284, 498 and treatment controversies, 294-296 treatment philosophy and, 54-56 Maudslay, H., 335 Medicaid, 186, 205, 412-413, 417, 419, 490 categorization of alcohol problems, 184, 194, 421 coverage of, 193-194, 200, 201, 202, 421-422, 440, 481-483 restrictions on funds, 192 coverage criteria, 414, 464-465, 489 and medical model treatment, 415, 476-477 Medieal disorders, 358 "Mediealization of deviance," 579 Medieal (disease) model of treatment, 51, 55, 416, 441 detoxification, 122, 123 insurance industry and, 425, 469 Medicaid and, 415, 476-477 Medieal Research Council (United Kingdom), 223 Medicare, 186, 205, 435-436 categorization of alcohol problems, 184, 194, 421 coverage of, 192-193, 194, 200, 201-202, 203, 419-421 coverage criteria, 414, 476-477, 489 financing of, 187 prospective payment system, 61, 420 Medication. See Pharmaeotherapies Mental illness. See also "Dual diagnosis" patients alcoholism as, 408 continuity of care for, 331, 333 and homelessness, 387 insurance coverage, 422 state programs, 406 and substance abuse, 385 treatment, 407 621 Mental Retardation Facilities and Community Mental Health Centers Construction Act (1963), 407 Met ran id azole , 75 Mexican Americans, 163, 348, 349, 370, 371, 399, 590 Mexico alcohol problems in, 552-553 treatment in, 559-560, 568 Michigan, 284, 338, 423, 437-438 Miehigan Alcoholism Screening Test (MAST), 219, 229, 256, 268, 382 Miehigan State University, 438 Mikado (Gilbert and Sullivan), 279 Military personnel, 349 Minnesota, 491 Alcoholics Anonymous membership, 109 assessment and matching in, 265-266, 284, 336, 337 Chemieal Dependency Program Dh ision, 106, 417, 437, 464, 470-472, 490 Civil Service Commission, 128 commitment laws, 584 Consolidated Chemieal Dependency Treatment Fund, 470, 473, 477, 481, 489 490 Department of Public Safety, 114 health maintenance organizations in, 434 treatment services in, 112-117, 204, 316, 325 Minnesota Model of Chemieal Dependence Intervention and Treatment, 67, 385, 526 programs based on, 104, 132, 347, 415416, 418, 428, 559 treatment strategy, 46-47, 58-60, 85 Minnesota Multiphasie Personality Inventory (MMPI), 219 Missouri, 166 Model Cities Act, 345 Model State Law on Civil Commitment of the Mentally Ill, 583-584 Modifying variables, 217 Monitoring the Future Project, 359 Monoamine oxidase inhibitors, 77 Montana, 415 Moral hazard, 432 Moral model of etiology and treatment, 55 Mortality alcohol-related, 366, 381 liver cirrhosis, 14, 176-177, 366, 552, 554 liver disease, as index of alcohol problems, 176-177 Mortimer-Filkins Interview, 382 Mothers Against Drunk Driving, 383 Motivation, 533-534, 599 Motor vehicle deaths, 366, 381 Multidimensional assessment, 251-255, 269 Multivitamins, 74 Mutual help groups, 57, 304-305, 520-521 N Narcotic Addict Rehabilitation Act (1966), 586

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622 Narcotics Anonymous, 113-114, 527 NASADAD. See National Association of State Alcohol and Drug Abuse Directors National Academy of Sciences, 1, 2 National Alcoholism and Drug Abuse Program Inventory (NDAPI), 120, 124, 168 National Alcoholism Program Information System (NAPIS), 197, 370 National Association of Addiction Treatment Programs (NAATP), 200-201, 204 National Association of Alcoholism and Drug Abuse Counselors, 125, 127, 128 National Association for Children of Alcoholics, 391 National Association of Insurance Commissioners, 427 National Association of State Alcohol and Drug Abuse Directors (NASADAD), 167, 197, 198, 199, 200, 392, 409, 442 National Cancer Institute, 254 National Center for Health Services Research, 462 National Center for Health Statistics, 167, 441- 442 National Center for the Prevention and Control of Alcoholism, 345, 408 National Clearinghouse for Alcohol and Drug Abuse Information, 350-351 National Collaborative Matching Project, 336, 338, 339, 340 National Commission on Credentialing of Alcoholism and Drug Abuse Counseling, 129 National Conference of Commissioners on Uniform State Laws, 410-411, 588 National Council on Alcoholism (NCA), 28, 112, 389, 408, 411, 426, 429-430, 496 National Drug and Alcoholism Treatment Unit Survey (NDATUS), 119-124, 133, 469 codependency data, 392 criminal justice referrals data, 589-590 employee assistance programs data, 592 funding data, 188, 195, 196, 197, 199, 204, 205-206, 415, 439, 442 insurance expenditures data, 429 personnel data, 125-126, 131 special populations data, 351-352 treatment availability data, 167, 168-175, 178, 179 treatment setting data, 70-71, 104, 428 utilization data, 165 National health insurance, 412 National Highway Traffic Safety Administration, 345, 381 National Hospital Discharge Survey, 441-442 National Institute on Alcohol Abuse and Alcoholism (NIAAA), 14, 108, 407-408, 413, 414, 462 Alcohol Epidemiologic Data System (AEDS), 165-166, 443 alcohol problems indexes, 176 and American Indians, 366, 367 categorical grants, 119, 190, 409-411 and diagnosis-related groups, 421 and drinking drivers, 381, 382 INDEX and employee assistance programs, 112, 494, 591 funding sources studies, 188, 204, 444 health care costs studies, 183 and health maintenance organizations, 434 435 and homeless persons, 388 and mandated insurance, 426 matching study, 285 model health insurance benefit packages, 411 412, 423-424, 426 personnel training funding, 125, 130, 131, 233 and private health insurance, 61, 426 recommended actions, 497-500 and social model treatment, 56, 423 and special populations, 345-346, 349 State Manpower Development Program, 125 treatment facility surveys, 119-120, 121, 168 Treatment Research Branch, 338, 490, 498 499 and treatment setting, 70, 71 and youth drinking, 389 National Institute on Drug Abuse (NIDA), 119 120, 130, 131, 190, 233, 414 National Institute of Mental Health (NIMH), 167, 190, 414, 485 Division on Alcohol Abuse and Alcoholism, 408 National Medical Care Expenditures Survey, 441 National Nursing Home Survey, 441-442 National Survey of Worksite Health Promotion Activities, 592 Native Alaskans, 345, 346, 349, 352, 365, 369, 410 Native Hawaiians, 349, 368 Navajo Indians, 367 NDAPI. See National Alcoholism and Drug Abuse Program Inventory NDATUS. See National Drug and Alcoholism Treatment Unit Survey Nebraska, 166 New England Journal of Medicine, 318 New Jersey, 423, 430, 437 New York State alcohol crisis centers, 49 Alcoholics Anonymous membership, 109 Division of Alcoholism and Alcohol Abuse, 100 involuntary commitments in, 582, 586, 590 Medicaid coverage in, 194 social model treatment study, 423 New York Times, 388 New Zealand referral study, 223, 233 North American Association of Alcoholism Programs, 408, 485 North American Congress on Alcohol and Drug Problems, 58, 62, 72 Northern Addictions Centre (Alberta), 336, 338, 339 Northern Ohio Chemical Dependency Treatment Directors Association, 303 NoIway, treatment in, 556-557, 568-569, 571, 574 575 Nurses, 126, 233-234

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INDEX o Obstetrics, 230 Occupational groups, 381 Occupational intervention. See Employee assistance programs Office of Economic Opportunity, 345, 367, 410 Office of Human Services, 186, 419 Office of Personnel Management, 186, 419, 422 Office of Technology Assessment, 1, 422 pharmacotherapy in, 75 Preventive Services Task Force, 231 Public Health Service, 131 treatment programs of, 117-119 Oklahoma mental health information system, 315-316 outcome monitoring, 322, 325, 335-336 social model treatment study, 423 Omnibus Budget Reconciliation Act (1981), 190, 191, 414 Ontario, 243 assessment and referral system, 284, 336, 337 Oregon, 491 alcohol and drug program, 416, 417-419, 437 program licensing in, 71 "Organic mental problems," 420, 421 Orthopedics, 230 Osler, Sir William, 33 Outcome monitoring, 9, 146, 242, 313-316, 329, 334, 335, 336, 339, 358 and case management, 476 CATOR, 337 content of, 320-321 feedback of information, 19, 329, 333-334, 336, 486 funding of, 325-326 limitation on, 317-319 and placement criteria, 473 process of, 321-323 responsibility for, 323-325, 419 setting of, 322-323 specification, 319-320 youth treatment, 362-363 Outcomes biased perceptions of, 263, 314 in coerced populations, 596-601 continuum of, 148 corroboration of, 323 cost-containment and, 444 and special populations, 351, 367 studies of, 147, 296, 384, 571 Outpatient (nonresidential) treatment, 48, 69, 70, 72, 73, 101-102, 104, 122, 123, 406 assessment and, 247, 470, 471 in California, 416-417 cost-effectiveness of, 460 costs of, 117 effectiveness of, 147 extended care, 67 in France, 47 funding sources, 196-197 insurance benefits for, 429 623 length of stay, 412 managed care and, 436 mandated insurance and, 430 matching and, 295, 305-307, 311-312 Medicaid coverage of, 422 model benefit plans and, 429, 439 in Oregon, 418 treatment capacity, 172 utilization of, 169 Oxford English Dictionary, 13, 18 p Pacific Islanders, 368-369 Pare, Ambroise, 152, 159 Parkinson's disease, 32-33 Parkside Medical Services, 59 "Pathological intoxication," 216 Patients. See also Matching and matching, 281-284 payments by (client fees), 185, 188, 192, 200, 201, 205, 407 psychiatric deinstitutionalization of, 473 "dual-diagnosis," 385-386 selection of treatment by, 291 Pennsylvania, 63, 167 Pennsylvania, University of, 337 Penn-VA project, 336, 337-38, 339 Personal (individual) assessment, 251, 256-261. See also Assessment, pretreatment Personality factors, 258, 281, 283 Personality Research Form, 258 Personnel (staff). See also Counselors accreditation of, 413 community agencies, 233-234 costs, 203 nondegreed counselors, 125, 417 physicians, 125, 126, 127, 128 and special populations, 403-404 training programs, 496-497 NIAAA funding, 125, 130, 131, 233 Pharmacotherapies, 51, 52, 73-78 criticism of, 385 in detoxification, 56 matching and, 282 studies of, 512-517 Philadelphia Diagnostic Center, 388 Physical disabilities, 349 Physician Data Query, 254 Physicians, 125, 126, 127, 128 in community role, 233 general practitioners, 230 primary care, 99-100 training of, 130 Physiological (biological) perspective on treatment, 51, 53 Police, 565 Poor. See Low-income and poor persons Poverty grant program, 410 Preferred providers, 200, 434, 435, 495 Pregnancy, 350

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624 Presentation, heterogeneity of, 33 Presidential Commission on Drunk Driving, 383 President's Commission on Law Enforcement, 408 President's Commission on Mental Health, 586 President's Commission for the Study of Ethical Problems in Medicine and Biomedical Behavioral Research, 477 Prevention services, 4, 190, 198. See also Primary prevention; Secondary prevention Prevention and Trea~nent of Alcohol Problems: Research Opportunities (IOM), 498 "Preventive paradox," 215 Primary care, 60, 65, 66-67, 68, 99-100, 566 insurers and, 428 Primary care workers, 312 Primary prevention, 44, 45 international programs, 552 targets of, 212-213 for youth, 363, 391 Princeton University, 388 Private health insurance and cost containment, 431-432 costs of, 61 and hospital treatment, 440 mandated, 426-430, 440, 474-475, 476, 488 and model benefit plans, 411, 412-413 recommended actions, 493-495 treatment funding, 8, 184, 195-196, 198, 200, 205, 407, 423-426, 429, 439, 464 unavailability of, 183, 423 Private sector and outcome, 316 psychiatric hospitals, 406 specialty programs funding, 200-201 Problem assessment, 250-251, 252, 255-256, 259, 269. See also Assessment, pretreatment Problem drinkers, 31, 381, 382, 384. See also Alcohol problems Problem-oriented treatment selection, 291-292 "Program design" barriers, 164 Program entry, 61-62 Progression, of problems, 34, 217, 317 Prohibition, 14, 32 Project grants and contracts, 409-410 Prompt intervention. See Brief intervention Propranalol, 77 Prospective payment system, 61, 420, 421 Psychiatric diagnosis, 251, 358 and matching, 281, 282 Psychiatric hospitalization, involuntary, 580 Psychiatric managed care, 436 Psychiatric patients deinstitutionalization of, 473 "dual-diagnosis," 385-386 Psychoactive substance use disorders, 29, 244 Psychodynamic treatment modalities, 78, 81-84 Psychological perspective on treatment, 51, 52, 53 Psychological treatment modalities, 73, 78 Psychologists, 126, 127 in community role, 234 Psychosis, 366 Psychosocial treatment, 431. See also Social model of recovery Psychotherapy, 52, 386 INDEX ineffectiveness of, 385 matching and, 282 studies of, 518-519 Psychotropic medications, 76-77, 512, 515-517. See also Pharmacotherapies Public health insurance, 412-413, 464. See also Medicaid; Medicare cost offset and, 456-457 and hospital treatment, 440 mandated private coverage and, 429 and model benefit plans, 411 reliance of minorities on, 372 treatment funding, 186, 187, 196, 197-200, 201, 205, 476-477 Public inebriates, 231, 406, 593 commitment of, 588 detoxification programs, 49, 103, 408 homeless persons, 387 social model approach and, 56 as special population, 345, 346, 348, 349-350, 352 support services for, 43 Public intoxication, decriminalization of, 43, 56, 114, 410, 473 Puerto Rican Americans, 370 Puget Sound Health Cooperative, 433 Q Quality of treatment, 146, 313, 413 Quarte~way houses, 70 R Race. See also Blacks in special populations, 345, 349, 351 and treatment outcome, 369 and underutilization, 372 Ramsey Clinic, 303 RAND Corporation, 253, 458 Randomized controlled trials (RCT), 9, 143-146, 153, 334 limitations of, 9, 144-145, 149, 293, 318-319 of treatment effectiveness, 149, 457-458, 528, 538 Reagan administration, 120 Recommended actions. See Committee recommendations Recovery Attitude and Treatment Evaluator, 437 Recovery homes, 133 Referral to specialized treatment coerced, 579, 580, 586-593 treatment outcome for, 596-601 community agency role, 16, 211, 212, 217, 220, 228, 329, 334 and utilization, 434-435 Regional Youth Substance Abuse Project (Bridgeport), 336, 338, 339 Regression to the mean, 457 Rehabilitation, 59, 61, 62, 65, 66-67, 103 costs of, 115, 204 group psychotherapy in, 82

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INDEX insurance coverage of, 71, 422, 424, 464, 468 insurers and, 431 managed care and, 436 NDATUS classification, 122, 123, 169 Oregon programs, 418-419 pharmacotherapy in, 75-77 placement criteria, 472-473 prospective payment system and, 421 social model of, 52 treatment capacity, 170 Reich questionnaire, 219 Reimbursement limits, 476. See also Health insurance Relapse extended care and, 67~8 in stages of change model, 53 Relapse prevention, 61, 66, 68, 333, 512 disulfiram in, 76 research on, 525-526, 530-531 strategies, 80-81, 158-159 Relman, Arnold, 313 Remission rates, 34 Research, 144, 314-315 ADAMHA and, 498 adolescent alcohol problems, 359 aftercare, 530-531 on Alcoholics Anonymous, 520-521, 537 alcohol problems, international studies, 552 555, 576 brief interventions, 531 committee recommendations, 490, 499 cost-effectiveness, 461-462 cost offset, 455-459 counselors, 532-533 disulffram, 512-514 employee assistance programs, 535 funding, 188, 204, 441-444, 498-499 health care costs, 183-184 health maintenance organizations, 434-435 IOM on, 318 longitudinal studies, 318 matching, 280-284, 498 NIAAA, 183, 188, 204, 444, 490 pharmacotherapies, 512-517 psychotherapies, 518-519 relapse prevention, 525-526, 530-531 special populations treatment, 347-353, 401 402 theory in, 401 treatment, international studies, 555-564, 573 577 treatment availability, 166, 167, 169, 178-179 treatment effectiveness, 422423, 511, 526 528, 529 treatment efficacy, 531-532 treatment outcome, 147, 296, 384, 571 Research-driven treatment selection, 293 Research Triangle Institute, 465 Residential treatment, 70, 72, 73, 103, 169, 406. See also Inpatient treatment in California, 416 cost-effectiveness of, 460 costs of, 115, 529 effectiveness of, 147 625 funding sources, 196-197 insurance coverage of, 469, 470 insurance industry and, 425 managed care and, 436 mandated insurance coverage, 428 Oregon programs, 418 social model, 407 staffing, 126 in Uniform Act, 48 Resource allocation models, 164-165 Rhode Island State Alcohol/Drug Authority, 430 Risk/benefft analysis, 155 Robert Wood Johnson Foundation, 338 Rogers, Carl, 532 Rogers, Paul, 408 Roger Williams General Hospital (Providence, R.I.), 100 Royal Edinburgh Hospital, 222 Rush, Benjamin, 14, 153 Russell study of smoking cessation, 224 Rutgers University, 14, 388 S SAA See State alcoholism authorities SADAP. See State Alcohol and Drug Abuse Profile St. Mary's Hospital (Minneapolis), 59 Salvation Army, 107-108, 116 Sampling, in outcome monitoring, 322 San Diego County, 204 San Diego VA Medical Center, 499 San Francisco, 229-230 "Scatter" beds, 420, 424 Schizophrenia, 36, 282, 386, 516 Schools prevention programs in, 231-232, 391 student assistance programs, 100-101, 363 364 Scottish immigrants, 345 Screening, 65, 66, 249, 255, 256, 259. See also Assessment, pretreatment drinking driver programs, 382 and utilization, 434-435 Secondary prevention, 45-46, 47, 213 at colleges, 391 for drinking drivers, 383 Second Special Report to the U.S. Congress on Alcohol and Health (USDHEW), 346 Seizures, 74 Selective Severity Assessment Scale, 74 Self-efficacy, 80, 293 Self-esteem, 357, 358, 519 and matching, 280, 283 Self-help groups, 108-111, 113-114, 304-305, 418, 567 manuals, 226 Self-insurance, 185-186, 200, 427, 431, 475 Self-monitoring, 81 Self-payment. See Patients: payments by Self-referral, 594 Self-reports, 255, 532

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626 corroboration of, 323 validity of, 219, 262, 263, 264, 527-528 Self-selection, 457 Sequential assessment, 249-251, 256, 269. See also Assessment, pretreatment Serotonin, 77 serotonin uptake inhibitors, 514-515, 516 Severity of Alcohol Dependence Questionnaire, 255 Sexual abuse, 357, 363 Sexually transmitted diseases, 390 Shadel Sanatorium (Seattle), 78 Situational factors, 260, 283 Sixteen Personality Factors Inventory, 258 Sixth Special Report to the U.S. Congress on Alcohol and Health (USDHHS), 349 "Sleepers," 322 Smither's Foundation, 112 Smokers, 257 Smoking cessation, 216, 224 "Sobering up services," 49 Social assistance agencies, 231 Social class, in special populations, 345 Social-community model of recovery, 51 Social context, 246 Social drinkers, 381-382, 384 Social learning model, 51, 52 Social learning theory, 78, 524 Social model of recovery, 52, 56-58 costs of, 204 detoxification, 74, 103, 122, 123, 169, 170 insurance coverage of, 422, 425, 431, 469 states' adoption of, 415, 416, 417, 440, 441 Social networks, 403 Social Security Act (1965) payroll taxes, 193 Title XVIII, 192-193 Title XIX, 193 Social Services Amendments (1974), 191 Title XX social services funds, 191, 412-413 Social skills training, 524 Social stability, 282, 460 Social workers, 126, 127, 234 Society of General Internal Medicine, 131 Society of Teachers of Family Medicine, 131 Sociocultural perspective on treatment, 51, 52, 53 Soviet Union (USSR) alcohol problems in, 555 treatment in, 517, 560-561, 573, 574 Specialized treatment, 6, 18, 19, 37, 218, 220, 438. See also Treatment availability of, 440 funding for poor and uninsured, 480-483 funding sources, 188-197 processes of, 329, 330, 340 referral to coerced, 579, 580, 596-601 community agency role, 16, 211, 212, 217, 220, 228, 329, 334 and utilization, 434-435 treatment settings, 101-112, 406 Special populations, 9, 344-347, 410 day treatment for, 106 defined by functional characteristics, 381, 393 INDEX defined by structural characteristics, 356, 371- 373 international programs, 569-571 recommendations on, 10, 399-404 research on treatment for, 347-353, 401-402 Specialty mental health care, 98-99, 101 Specification problem and individual, 319 treatment, 319-320 "Spontaneous remission, 152 Stabilization, 63, 65. See also Extended care Stages of change model, 53 State alcohol and drug abuse agencies (SA/DAA), 197-200 State Alcohol and Drug Abuse Profile (SADAP), 167, 201, 392 criminal justice referrals data, 589-590 employee assistance programs data, 592 funding data, 185, 197-200, 415, 416, 440- 441, 442 suggested modifications, 205-206 State alcoholism authorities (SAA), 409, 491 administration of grants, 125, 411, 415-419, 439 and cost containment, 437-438 and data collection, 442, 443 and insurance coverage, 428 licensing procedures, 426 and model benefit plans, 412 Medicaid reimbursement of, 422 and social model treatment, 415, 440, 441 State Alcohol Profile Information System (SAPIS), 197 State hospitals, 99 State mental health authorities, 409 State mental hospitals, 99, 406 States. See also State alcoholism authorities accreditation and regulation, 129, 413-414, 426 administration of block grants, 190-191, 414, 415-419, 464, 488, 498 alcohol consumption, per capita, 176 continuum of care definitions, 50 data collection, 442-443 detoxification centers, 103 drinking driver programs, 382-383 employee assistance programs, 592 and federal formula grants, 408-409 insurance coverage for poor, 481-483 involuntary commitment laws, 581-582 mandated insurance coverage, 427, 429-430, 475 and Medicaid, 193 recommended actions, 491-493 resource allocation models, 164-165 social model treatment, adoption of, 415, 416, 417, 440, 441 and special populations, 349, 350 and treatment availability, 170-173, 178-179 treatment program funding by, 186-187, 196- 197, 406, 476, 477 expenditure levels, 173-175 sources of funds, 189-190, 195, 200, 407, 415, 439

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INDEX and treatment settings, 71, 123 Stress management training, 79, 524 Student assistance programs, 100-101, 363-364 Suicide, 362, 366, 553 Supplemental Security Income, 192, 194 Supportive services, 43, 52, 63 "Survival" model, 80 Syphilis, 33 T Tarlov, Alvin R., 20 Task of Medicate (White), 20 Tax subsidy, private insurance, 474-475 Teachers, 234, 363 Television Bureau of Advertising, 432 Temperance movement, 14 Temposil, 159 Tertiary prevention, 45, 213 Texas, 109 Theory, research and, 401 Theory-driven treatment selection, 293 Therapists. See also Counselors characteristics of, 148, 532-533, 537 selection of treatment by, 289-291 for special populations, 356 Thiamine, 74 Third-party payers. See Health insurance Third Special Report to Congress on Alcohol and Health (USDHEW), 32, 345, 346 Time-line interview, 268 Title XX social services funds, 191, 412-413 Training programs, 496-497 NIAAA funding, 125, 130, 131, 233 for outcome monitoring, 321-322 Treatment. See also Funding; Matching; Outcome monitoring; Specialized treatment; Treatment providers; Treatment systems approach accessibility of, 163-164, 600 health insurance and, 423 for special populations, 371, 400-401 alcohol problems deterioration with treatment, 155-156, 159 implications of heterogeneity of, 36-37 improvement without treatment, 152-155, 159, 221 availability of, 8, 163-167, 178-179, 440 cost containment and, 444 mandated insurance and, 429 prevalence of alcohol problems and, 176 178 coerced, 156-157, 159, 382, 534-535, 580-586 compliance with, 534, 597 controversies, 294-296 and cost containment, 431, 444 cost-effectiveness of, 455-456, 457 defining, 42-47, 84-86 effectiveness of, 145, 467, 538 for coerced treatment, 601 for elderly, 364-365 and insurance industry, 413, 424-425 627 for special populations, 401, 402 studies of, 422-423, 511, 526-528, 529 efficacy of, 145, 279, 531-532 etiology and, 35-36 expenditures, 173-175, 188, 198, 202-204, 416, 424, 441, 465 goals of, 62, 257, 295, 313, 320, 512 goals inventory, 290, 291 and health care costs, 183-184 health maintenance organizations, 434 history of, 14-15 insurance coverage of, 422, 474 intensity and duration of, 529 international studies, 555-564, 573-577 modalities of, 73-84 personnel, 124-132, 203, 413 philosophy or orientation of programs and, 51~0, 85-86 progression in, 34, 217 results of, 142-149, 152, 536-537 setting of, 63, 69-73, 101-112, 202, 203 cost offset and, 456, 529 inpatient, 103 intermediate, 104-107 length of stay, 412 outpatient, 104 for special populations, 400-404 specification of, 287-289, 319-320 stages of, 60-69, 72, 103, 105, 202, 204, 402, 437 stigma of, 48 utilization rates, 165, 166, 168-169 for youth, 361-362 Treatment Alternatives to Street Crime, 587 Treatment Outcome Prospective Study, 596, 598 Treatment population assessment of, 246-247 planning treatment for, 248-249 Treatment providers, 7, 98-99 advertising, 432 bias in assessment, 263-266 community sector, 99-101 federal programs, 117-119 insurance industry and, 425-426 Minnesota programs, 112-117 national surveys of, 119-124 public insurance criteria, 489 recommended actions, 495-496 specialist alcohol problems sector, 101-112 Treatment systems approach, 9, 11, 17-19, 329, 334-340, 487 financing of, 474-480 Triage referral, 61, 220 Tricyclic antidepressants, 76-77 Trotter, Thomas, 31-32 Tumor-node-metastasis system, 253-254 Twelfth Step houses, 406 U Uncompensated care, 481

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628 Uniform Alcoholism and Intoxication Treatment Act, 56 and continuum of care, 48, 49, 85-86, 428 definition of treatment, 43 state adoption of, 387, 410-411, 491, 588 Uninsured persons, 187, 409-410 treatment financing for, 480-483 Union Internationale Centre de la Cancer, 253 Union of Soviet Socialist Republics. See Soviet Union United Auto Workers, 112, 495 United Kingdom alcohol problems in, 553-554 treatment in, 557-559, 569, 570-571, 572, 573, 575 United States Alcoholics Anonymous membership, 109 Bureau of Labor Statistics, 425, 427, 494 Bureau of Prisons, 118-119, 186, 205 Congress, 1, 3, 5, 120, 166, 413, 422 recommended actions, 488-490 and special populations, 349-350 Department of Defense, 118, 186, 205, 419 Department of Health, Education, and Welfare, 409 Department of Health and Human Services 462, 167, 175, 197 and continuum of care, 48, 49, 50 data collection, 442 and special populations, 349, 350, 364 and treatment setting, 69 Department of Veterans Affairs, 118, 499 federal policies continuum of care, 50 funding, 407-408, 477 health maintenance organizations, 433, 434 legal drinking age, 383 recommended actions, 488-490 research funding, 444 special populations, 344, 345-346, 401 federal treatment funding, 14, 186, 187, 192, 198, 199-200, 419-423 block grant, 414, 419 categorical grants, 406-407, 409-411 cost-effectiveness, 462 development of national policy on, 407-408 efforts to shift to insurance, 411-414 formula grants, 408-409 services systems, 340 General Accounting Office, 422 Indian Health Service, 119, 186, 205, 365, 367 United Technologies Employee Assistance Program, 105 United Way, 338 Utility, outcome information and, 323 Utilization cost offset and, 456 insurance availability and, 444 mandated insurance and, 429, 430 Utilization management, 284-285, 316, 434 INDEX V Vaillant, George, 33, 34 Valium, 385 Vehicular homicide, 381 Verbal aversion therapy, 79 Verbal reports. See Self-reports Vermont, 427 Veterans, 349 Veterans Administration and cost containment, 420 funding by, 116, 186, 205 VA hospitals, 115, 118, 204, 337 Voluntary commitment, 585-586 Voluntary organizations, 500-501 Vulnerability factors, 217 W Wales. See England Washington, D.C., 415 Washington, University of, 389, 391 Washington State, 584 Washingtonian Movement, 14 Wechsler Adult Intelligence Scales, 258 Weisner, Constance M., 4 Welfare assistance, 231 White, Kerr, 20 Whites (Caucasians), 368, 369-370, 399 Williams, Harrison, 408 Willmar State Hospital, 58, 59, 85, 128, 132 Winter VA Hospital study, 279, 284 Withdrawal, 49, 264, 472 pharmacotherapy, 74-75 treatment, insurers and, 431-432 Withering, William, 285 Women, 399 adolescent, treatment, 362 and alcohol consumption, 224, 230, 369, 389 American Indian, 366 grant targeting to, 190-191, 414 matching and, 283 prevalence of alcohol problems, 154 as special population, 9, 344, 346, 348, 349- 350, 351, 352, 356-358 United Kingdom programs, 570 Women for Sobriety, 108, 113-114 World Health Organization (WHO), 156, 227 AMETHYST study, 224, 228 expert committees, 287 international treatment study, 550, 551, 589 y Yale School of Alcohol Studies, 14, 28, 112 Yale Plan Clinics, 128, 132 YAVIS syndrome, 321 Youth. See also Children of alcoholics American Indian, 366 driver training programs, 383 Medicaid coverage, 421-422

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INDEX programs for, 115, 338, 358-364 in special populations, 9, 345, 346, 348, 349- 350, 351, 352 United Kingdom programs, 570 Youth Evaluation Service, 338 629 z Zimbabwe, treatment in, 561-563, 568, 573 Zimelidine, 514-515

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