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Index A Abstinence as central goal of drug treatment, 8, 129 full, partial, and nonrecovery, 126-127 goals of chemical dependency programs, 170-171 individual drug history, 62 Accreditation, Medicaid and drug treatment programs, 26 Acquired immune deficiency syndrome (AIDS) Anti-Drug Abuse Act of 1988, 55 epidemic and national drug policy, 4 goals of drug treatment, 11, 105 health costs of drug problem, 104 Medicaid coverage, 271-272 methadone programs, 14 transmission by injection, 68 n.2 Addiction Severity Index, 110 Admissions, residential treatment committee recommendations on optimal private coverage provisions, 31 elimination of waiting lists, 232 utilization management and review, 28, 251 Adolescents additional policy questions, 37-38 age of drug use onset, 68, 69 aggregate need for drug treatment, 7 estimating extent of need for drug treatment, SO patterns of drug consumption, 05 research recommendations, 21, 19~199 Adults aggregate need for drug treatment, 7-8 arrests for drug crimes, 114 committee findings and recommendations, 37 estimating extent of need for drug treatment, SO patterns of drug consumption, 4 treatment research statistics, 20-21 Aftercare, chemical dependency programs, 171 Age aggregate need for drug treatment, 7 individual drug history, 6~69 patterns of drug consumption, ~5 treatment research statistics, 2~21 Aid to Families with Dependent Children (AFDC), 198, 268 Alabama, state drug coverage mandates, 292 321 Alcohol and alcoholism Addiction Severity Index, 110 chemical dependency programs, 16, 275 cost-effectiveness of treatment, 28~285 employee assistance programs, 121, 288 employers and private coverage decisions, 282-283 extension of treatment capacity to drug treatment, 218 partial legality, 62 pregnant women, 85 private insurance coverage, 278 recovery and relapse compared to heroin, 73 state mandates regarding treatment coverage, 289 n.5 therapeutic communities, 162 trends in provider characteristics, 208-209 Alcohol, Drug Abuse, and Mental Health Administration (ADAM HA) block grant administration, 241 emergency appropriation for F Y 1990, 216 health services research programs, 195 strategic planning for drug treatment, 235 trends in federal funding, 214 Alcoholics Anonymous chemical dependency programs, 16, 53, 170, 171, 190 drug treatment programs, 135 Amantadine, 175 Ambivalence, client incentives and motivation, 224 spectrum of recovery, 12~130 Anslinger, Harry, 48- Anti-Drug Abuse Act of 1986 call for independent study of substance abuse treatment coverage, 1, 33 emphasis on enforcement and interdiction, 55 federal support of research, 192 federal support of treatment, 104, 202 n.1, 216, 244 TASC programs, 116 Anti-Drug Abuse Act of 1988 federal policy and treatment, 55, 216, 245 federal support of research, 192 ARC programs, 116 waiting list reduction, 232 Arkansas, state drug coverage mandates, 292

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322 Arrests, law enforcement and drug crimes, 114 Attitudes full, partial, and nonrecovery, 128 normative, 62, 64 Attrition, client, 126 B Barbiturates, detoxification, 174 n.21 Benefits (see Cost/benefit analysis, Insurance) Bennett, William, 55 Block grants federal role in 1980s, 241-245 management and federal funding, 246 reduction in federal funding, 202 n.1 research on women, 198 sources of treatment dollars, 212 Blue Cross/Blue Shield, 278, 284 Boot camps, effectiveness of correctional treatment programs, 17,183-184 Brain effects of opiates, 138-139 effects of psychoactive drugs, 64 Bromocriptine, 175 Budget (see Financing) Buprenorphine, 175 Bureau of Narcotics and Dangerous Drugs, 51 C California Civil Addict Program, 18~183 Medicaid and AIDS, 271-272 Medicaid and drug treatment, 267-268 methadone maintenance programs, 144, 146, 151-152 CareUnit system, 173 Certification performance and public support, 29, 2S2 Chemical Abuse/Addiction Treatment Outcome Registry (CATOR), 123, 173 Chemical dependency programs average daily charges, 290 291 n.7 description of modality, 170-172 effectiveness of, 16, 172-173 private coverage and effectiveness data, 275 research on treatment effectiveness, 20, 186, 285 research recommendations, 197 rise of modern treatment, 53 state-mandated coverage, 290 INDEX summary of committee findings, 190 variations in electiveness, 173-174 Child care, mothers and drug treatment, 198, 234 Children (see also Adolescents, Pregnant Women) age of drug use onset, 68 external costs of drug abuse, 229, 233-234 patterns of drug consumption, 4 women and therapeutic communities, 198 Civil Addict Program (CAP), 146, 18~183 Civil rights concern for drug-dependent individuals, 108 economic status of clients, 127 Class chemical dependency program clients, criminal and medical views of drug addiction, 48 employee assistance programs, 121 opium addiction and medical idea, 46, 47 Client-Oriented Data Acquisition Process (CODAP), 164, 240 Clients, drug treatment chemical dependency programs and therapeutic communities compared, 172 individual goals, 12~130 parties involved in treatment, 107 public and private tiers, 205-206 trends in numbers and provider characteristics, 206 210 Clinical trials, research on major modalities of drug treatment, 18 n.2 detoxification, 175-176 methadone maintenance, 142-145,149 therapeutic communities, 158-160 Cocaine detoxification, 175, 176 drug sequencing, 69 emergency room and medical examiner cases, 77 employee assistance programs, 122 federal policy emphasis on enforcement, 55 history of use, 66-67 improvement of public coverage, 233 methadone programs, 14 need for expansion of public tier, 219 normative attitudes, 62 patterns of drug consumption, 5 patterns of drug treatment motivation, 111 n.2 positive tests among arresters, 100

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INDEX pregnant women, 85 research recommendations, 20,197-198 state prison inmates, 82, 83 therapeutic communities, 14, 154, 162 urinalysis, 99 Collective bargaining, employer-sponsored health insurance, 273 Colorado, Medicaid funding of drug treatment, 271 Community-based treatment Alcoholics Anonymous methods, 135 n.2 criminal justice system referrals, 10, 120 goals of drug treatment, 108 origins of, 50-52, 133 Community Mental Health Centers Act, 52 Consumer price index (CPI), 210 n.2 Contracts, direct program financing of public tier, 25 Copayments, treatment needs and cost concerns, 299 n.2 Cornerstone program, effectiveness of correctional treatment programs, 178, 180 Correctional treatment programs effectiveness, 176-178, 18~185 summary of committee findings, 191 trends in client numbers, 207 Cost/benefit analysis effectiveness of drug treatment programs, 18 methadone treatment, 151-152,188 outpatient nonmethadone programs, 170, 189 190 therapeutic communities, 165-166, 189 Costs balancing concerns with treatment needs, 22~230 baseline comparison values, 256-257 committee recommendations for private coverage, 296 comprehensive strategy option, 260-262 core strategy option, 238, 257-260 estimation for drug problems, 10~104 external costs and logic of mandating private insurance coverage of drug treatment, 276 external costs and public intervention, 222-225 goals of drug treatment, 129 intermediate strategy option, 263-265 management and health care issues, 275 offsets and private coverage of drug treatment, 282-283 private and public tiers, 218 323 private coverage and drug treatment, 293-294 private coverage and health benefits, 283-288 quantification of societal, 8~90 state mandates and private coverage, 291 utilization management, 28, 251 Counseling and counselors improvement of public coverage, 232-233 methadone maintenance, 141-142 private versus public tied, 204 Courts, criminal justice prison overcrowding and referrals to treatment, 120 referrals to private programs, 112 referrals to treatment, 114, 116-117 Courtwright, David, 34 Crime electiveness of Stay'n Out program, 178 estimating costs of drug problems, 102, 103 methadone clients, 13,143, 153 outpatient nonmethadone programs, 170 reduction as goal of drug treatment, 11, 108, 129 societal costs of drug abuse, 89 type and probable need for treatment, 100 therapeutic communities, 162, 166 Criminal idea classic era of narcotics control, 409 drug policy, 3, 47~8, 55, 57, 218 evolution of governmental roles, 53-56 external costs and public intervention, 223 Criminal justice system (see also Law enforcement, Parole, Probation) Addiction Severity Index, 110 additional policy questions, 38 agencies as parties in drug treatment, 108 comprehensive strategy option, 238 239 estimating extent of need for treatment, 81 84, 88 estimating need for treatment among arresters, 9~102 federal drug policy, 215 goals of drug treatment, 10-11, 106, 113-114, 116-120, 131 health services research, 196 implications of involvement in admissions to drug programs, 11~113 inducing more clients to accept treatment, 235 reasons for seeking treatment, 112

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324 D Data and data systems federal role in 1980s, 244, 245 health services research, 197-198 performance standards, 247 private coverage and sources, 274 utilization management, 2~29, 252 Daytop Village early success stories, 157 therapeutic community approach to treatment, 51 Deaths, heroin recovery and relapse, 74 Dederich, Charles, 51 Defense, Department of (DoD), 266 n.5 Demography populations of different modalities, 134 therapeutic community population, 154 treatment research statistics, 20-21 Demonstration grants, health services research, 190197 Depression, emotional, 112 Depression, Great, 49 Desipramine hydrochloride, 175 Deterrance prisons and criminological thought, 49 Detoxification cross-dependence, 13~139 effectiveness, 16, 174-176 indications for hospital-based inpatient, 28, 251-252 recovery and relapse, 6 summary of committee findings, 19~191 Diagnosis, individual need for drug treatment, 7, 69-72 Dia~osiw and Statistical Manual of Mental Disorders (DSM-III-R), 70, 71, 76 Dole, Vincent, 5(}51 Drug abuse and dependence complexity of problem and estimation of need for treatment, 9~92 diagnostic critiera, 69-72 diagnosis and detoxification, 174 n.20 individual drug history, 59-75 quantification of societal costs, 88 90 Drug Abuse Forecasting (DUF) system, 99, 100, 101, 196 Drug Abuse Reporting Program (DARP) evaluation of effectiveness of OPNMs, 168, 170 research on effectiveness of drug treatment, 12, 134, 196 study of effectiveness of therapeutic communities, 16~163, 165-166 Drug Abuse Treatment Outcome Study (DATOS), 12, 134, 196 INDEX Drug Abuse Warning Network (DAWN) cocaine consumption, 67 data systems and research, 196 Drug consumption estimation of need for treatment, 9~91 goals of drug treatment, 129 individual drug history, 60-61 level of use and criminality, 119 methadone dosage levels, 150 patterns and need for drug treatment, 4-5, 59 use, abuse, and dependence stages, 61-62 "Drug czar," 55 Drug dependence (see Drug abuse and dependence) Drug-Free Workplace Act of 1988, 123 Drug history, individual age of onset and drug sequencing, 6~69 learning and drug experience, 64~6 model and overview of individual, 59-62 social environment, 66 67 Drug screening programs availability to workers, 121 n.4 employers and goals of treatment, 123, 124 Drug sequencing, individual drug history, 6~69 Drug testing, employee libertarian ideas, 45 private treatment programs and goals of drug treatment, 108~109 Drug trade crime control resources, 102103 homicide, 102 Drug treatment (see also Chemical dependency programs, Correctional treatment programs, Detoxification, Methadone maintenance, Private tier, Public tier, Therapeutic communities) balancing needs and cost concerns, 22~230 changing nature of drug problems, 29B~299 determining individual need, 7, 69-72 diverse interests and goals, 106 109 effectiveness, 11-21, 32, 132-199 employers and goals, 12~125 erosion of after 1976, 215-216 estimating extent of need for, 7~, 76~6, 88 estimating need for among arresters, 9~102 estimating need for in criminal justice populations, 76~0

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INDEX estimating need for in homeless population, 84 estimating need for in household population, 77~0, 9~94, 96 99 evaluation of effectiveness and untreated recovery rate, 75-76 goals, ~11, 13~131 growth of national system, 20~216 health insurance cost outlays, 283-284 improvement as priority of public coverage, 23~233 modeling future treatment needs and erects, 265-266 coverall tendencies of effectiveness, 13~135 as principle of public intervention, 227-228 reasons for seeking, 109 113 recommendations for research on services and methods, 192-199 research on effectiveness, 133-134 rise of modern, 49-56 role of in federal anti-drug abuse strategy, 214-215 state Medicaid coverage for specific services, 271 two-tiered system, 21-22 DuPont, Robert, 55 EEconomics (see also Indigency; Poverty) client assets and motivation for recovery, 127 quantification of societal costs, 88-90 Education chemical dependency programs, 171, 172 goals of drug treatment, 129 Effectiveness (see Drug treatment) Elderly, concern about abuse and dependence, 68 Emergency rooms, estimating extent of need for treatment, 76-77 Employee assistance programs (EAPs) defining goals of treatment, 121-123 employee drug testing, 124 managed care system, 287-288 Employee Retirement Income Security Act (ERISA), 289-290 Employers drug screening programs, 123 extent and nature of insurance coverage for drug treatment, 273, 282-283 federal government and drug treatment coverage, 281-282 goals of drug treatment, 120125, 131 325 parties involved in drug treatment, 108 private companies and drug treatment coverage, 278-279 reasons for seeking treatment, 112 state and local government and drug treatment coverage, 279-280 Employment Addiction Severity Index, 110 aggregate need for drug treatment, 8 oost/benefit ratio of methadone maintenance, 153 cost/benefit ratio of outpatient nonmethadone programs, 170 goals of drug treatment, 10, 129 therapeutic communities and treatment retention, 162 F Facilities, improvement of public coverage, 233 Families Addiction Severity Index, 110 chemical dependency programs, 171 criminal view of drug problem, 47~8 goals of drug treatment, 129 parties involved in drug treatment, 107, 108 n.1 reasons for seeking treatment, 112 therapeutic communities, 156 Federal Employee Benefits Health Plan, 281 Financing amounts needed to meet priority objectives, 255 differences between private and public tiers, 202-204 private coverage, 29-32, 273-300 public care, 21-29, 22~272 sources of treatment dollars, 211-214 trends in federal funding, 214-216 trends in funding base, 21~211 Flupenthixol decanoate, 175 Food and Drug Administration Dole-Nyswander model of methadone maintenance, 51 LOAM, 139 n.6 Function impairments, recovery process, 6 G Gatekeepers employee assistance program staff, 288 utilization management, 27, 28, 250 Gaudenzia House, 166

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326 Goals criminal justice agencies, 113-114, 116-120 detoxification, 176 diverse interests, 10~109 drug treatment, 8-11, 130-131 employers, 120-125 full, partial, and nonreeovery from drug problems, 126-128 methadone maintenance, 137 operational for programs, 105 and priorities of public coverage, 22-24 reasons for seeking treatment, 109-113 setting realistic, 12~130 Government, federal crime control resources, 102-103 employees and drug treatment coverage, 281-282 financing of public tier, 21, 24-25 libertarian ideology, 41 15 Medicaid and matching dollars, 267 national drug policy, 3 - role in the 1990s, 240-241, 245-248, 256 support for drug research, 192 trends in funding, 214-216 Government, local crime control resources, 103 employees and drug treatment coverage, 279-280 sources of treatment dollars, 211-212, 213-214 Government, state (see also States, and individual states) crime control resources, 103 employees and drug treatment coverage, 279-280 financing of public tier, 21, 2~25, 211-212, 213-214 responsibility for public tier in 1980s, 244, 256 role in the 1990s, 24~241, 245-248 Grants (see also Block grants; Demonstration grants) direct program financing of public tier, 25 matching and maintenance-of-effort requirements, 26, 249 Great Britain, methadone maintenance, 137 "Great Society," 3 H Harrison Act of 1914, 48 Hazelden Foundation, 53, 173 INDEX Health (see also Public health) Addiction Severity Index, 110 estimating costs of drug problems, 104 methadone clients, 13 Health Maintenance Organizations (HMOs), 281-282, 290 n.6 Health services cost offsets, 283 research and treatment systems, 19-20 research recommendations, 195-197 Heart infections, transmission by injection, 68 n.2 Hepatitis, transmission by injection, 68 n.2 Heroin detoxification and relapse, 13~139, 176 Dole-Nyswander research on methadone maintenance, 50-51 effects compared to methadone, 140 emergency room and medical examiner cases, 77 literature on dependence and recovery, 73-74 literature on patterns of drug treatment motivation, 111 n.2 Nixon administration "War on Drugs," 53-54 research and problem of noncompliance, 157-158 n.14 state prison inmates, 82-83 therapeutic communities, 14, 154, 162 Homeless, estimating extent of need for treatment, 8~85, 88 Homicide, drug trafficking, 102 Hong Kong, study of methadone maintenance, 144 n.8 Hospitals chemical dependency programs, 16,190 committee recommendations on optimal private coverage provisions, 3~31 cost control and utilization management, 28 drug detoxification, 16, 175, 19~191 optimal private coverage provisions, 294-295 prescription of methadone, 141 trends in drug treatment client numbed, 207-208 utilization management and public tier, 251-252 Household population, estimating extent of need for treatment, 77-80, 92-94, 9~99 Human immunodeficiency virus (HIV) (see also Acquired immune deficiency syndrome) methadone programs, 14

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INDEX I Ideas character of governing, 41-42 drug treatment policy, 2 - , 56 rise of modern drug treatment, 49-56 spectrum of about drugs, 42-49 Illinois Drug Abuse Program, 52 Incapacitation, prisons and criminological thought, 49 Incentives external costs and public intervention, 224 private providers and efficiency, 285-286 staff performance, 233 Income constraints and public support of treatment, 225-227 employee productivity losses, 103-104 estimating extent of need for drug treatment, 80 as index of external costs, 229 private tier and insurance coverage, 277 sensitivity of drug abusers to price of treatment, 276 Indigency, committee estimates of and public coverage, 23, 227, 254-255 Infants (see Pregnant women) Injection, transmission of disease, 68 n.2 Insurance, health (see also Financing, Medicaid, Private coverage, Public coverage) employer-sponsored and unions, 273 and income constraints, 225 227 mandates, 30, 275-276, 288 293, 294 Intemational Statistical Classification of Diseases, Injunes, and Causes of Death (ICD-10), 70, 71 J Jaffe, Jerome, 52 Jails, compared to prisons, 82 n.5 Job applicants, drug screening programs, 123 Johnson Institute, 53 Journal of the Arnencan Medical Association, 50 Justice Assistance Act of 1984, 116 L Law enforcement (see also Crime, Criminal justice system) additional policy questions, 38 arrests for drug crimes, 114 327 crime control resources, 102-103 societal costs of drug abuse, 89 Learning drug consumption behavior, 69 individual drug history, 6~66 Legalization, illicit drugs, 265 Legislation (see also specific acts: Anti-Drug Abuse, Drug-Free Workplace, Employee Retirement Income Security, Harrison, Justice Assistance, Narcotic Addiction Rehabilitation, Omnibus Budget Reconciliation) early anti-drug, 45 federal and Medicaid, 248, 271 federal anti-drug and expansion of public tier, 22 state-mandated private coverage, 30, 275-276, 2~293, 294 Levo-alpha-acetylmethadyl (LAAM), 139 n.6, 158 n.14 Libertarian ideas drug policy, 3, 11 46, 56, 57 influence on nation's collective thinking, 223 M Managed care employee assistance program personnel, 288 health insurance and cost containment, 286-287 Marijuana drug sequencing, 69 emergency room reports, 77 employee assistance programs, 122 normative attitutes, 62 patterns of drug consumption, 5 positive tests among arresters, 100 state prison inmates, 82, 83 urinalysis, 99 100 Marketing, chemical dependency programs, 20, 197 Maryland, state-mandated drug treatment coverage, 290 Medicaid federal contribution, 212 federal legislation and drug treatment needs, 248 250 public tier funding of treatment services, 26-27, 256, 265-272 transitional steps toward the year 2000, 249 Medical idea classic era of narcotics control, 48

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328 drug policy, 3, 46-47, 48, 56, 57 evolution of governmental roles, 53-56 influence on nation's collective thinking, 223 private treatment programs and goals of drug treatment, 108 Medical price index (MPI), 210 n.2 Medicare nursing home care and Medicaid, 268 population served and treatment needs, 266 public coverage and income constraints, 225-227 Men aggregate need for drug treatment, 7 estimating extent of need for drug treatment, 80 married and reasons for seeking treatment, 112 treatment research statistics, 2~21 Meperidine, 136 n.3 Methadone compared to naltrexone and LAAM, 158 n.14 effects compared to heroin, 140 opiate detoxification, 174 types of narcotic analgesics, 136 n.3 Methadone maintenance characteristics of long-tel~ clients, 160 Civil Addict Program supervision, 182-183 clinical behavioral strategy, 14~142 compared to outpatient nonmethadone programs, 15, 168, 169, 170 compared to therapeutic communities, 166 cost/benefit ratio, 18, 151-152 criminal justice system and reasons for seeking treatment, 112 description of modality, 136-137 electiveness, 12-14, 14~144, 146, 152-154 excess capacity, 206 expansion of private tier, 218 goals of treatment, 137 incentives to continue treatment, 22~225 need for expansion of public tier, 219 negative beliefs among public and policy makers, 136 n.4 prevalence of repeat admissions, 111 research on expenditures and effectiveness, 18, 19 research on treatment effectiveness, 185-186 rise in modern treatment, 50-51, 133 INDEX significant private demand not subsidized by private insurance reimbursements, 277 substitution, 138-140 summary of committee finding, 187-188 trends in client numbers, 206 207 variations in effectiveness, 17, 147-150 Modeling, future treatment needs and effects, 265-266 Mothers (see also Pregnant women) additional policy questions, 37 priorities of public coverage, 233-234 research recommendations, 21, 198 Motivations, client ambivalence and spectrum of recovery, 126 full, partial, and nonrecove~y, 126-128 goals of drug treatment, 9-10, 106 reasons for seeking drug treatment, 109 113 N Naltrexone compared with methadone, 158 n.14 incentives to continue treatment, 22~225 Narcotic Addiction Rehabilitation Act (NARA) of 1966, 52 National Academy of Sciences, 3~34 National Association of State Alcohol and Drug Abuse Directors (NASADAD), 232 National Drug and Alcoholism Treatment Utilization Survey (NDATUS) baseline comparison values, 256-257 data on client numbers and provider characteristics, 206 data on provider insurance receipts, 274 health insurance and cost of drug treatment, 283-284 public and private tiers, 202, 216-219 women and special services, 198 National Drug Control Strategy (September 1988), 76, 235-236 National Forum on the Future of Children and Families, 38 National Household Survey of Drug Abuse (1988), 92 National Institute of Justice, 77, 99 National Institute on Drug Abuse (NIDA) evolution of government roles, 5~55 health services research programs, 195 household survey data and estimation of extent of need for treatment, 76, 77, 77-78

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INDEX research on treatment services and methods, 193-194 research recommended on adolescents, pregnant women, and mothers, 21, 199 research responsibilities, 19 sponsor of report, 33 transfer of authority from SAODAP, 241 transition of role to research and educational functions, 241 zoning and "not in my backyard" problem, 197 New Yorlc Dole-Nyswander research and methadone treatment programs, 51 early trials of methadone maintenance, 142-143, 147-148 Medicaid policies, 267, 270, 271 study of heroin recovery and relapse, 74 Nicotine, partial legality, 62 Nixon, Richard, administration and drug policy, 3, 5~54 Normative attitudes, individual drug history, 62, 64 Nonh Dakota, state drug coverage mandates, 292 "Not in my baclyard" (NIMBY) problem, 197 Nursing homes, Medicare and Medicaid, 268 Nyswander, Marie, 50-51 o Office of Economic Opportunity, 52 Office of National Drug Control Policy establishment and federal drug policy, 55-56, 245 inconsistencies among federal programs, 27 strategic planning for drug treatment, 235 Office of Personnel Management, 278, 281 Office of Treatment Improvement, 195, 235 Omnibus Budget Reconciliation Act (OBRA), 241 Opiates (see also Buprenorphine, Heroin, LOAM, Methadone, Naltrexone) addiction in nineteenth century, 46 effects on brain, 138 139 pharmacological agents and detoxification, 174 pharmacological properties of, 139 positive tests among arrestees, 100 urinalysis, 99 329 Opium early anti-drug legislation, 45 nineteenth-century addiction and medical idea, 46-47 types of narcotic analgesics, 136 n.3 Oregon, state drug coverage mandates, 293 Outpatient nonmethadone programs (OPNMs) cost/benefit ratio, 18,170 cost effectiveness compared to therapeutic communities, 166 description of modality, 167-168 effectiveness of chug treatment, 15, 168-169 prison treatment programs, 17 private coverage and effectiveness data, 275 research on treatment effectiveness, 18-19, 185-186 rise in modern treatment, 52,133 summary of committee finding, 189-190 trends in client numbers, 206 variations in effectiveness, 169 Oxford House, 135 p Parole (see also Civil Addict Program, Criminal justice system) community-based treatment programs, 10 estimating extent of need for treatment, 84 implications of criminal justice involvement in admissions to drug treatment, 113 reasons for seeking treatment, 112 state prison inmates and revocation, 82 n.6 Pennsylvania, Medicaid and drug treatment, 267, 271 Performance certification and public support, 29 committee recommendations on optimal private coverage provsions, 31, 296 297 states and data systems, 247 utilization management, 250 Phillips, Mary Dana, 35 Phoenix House, 161 Pleasure seeking, methadone as effective analgesic, 140 Polipy, national drug effect of alternative scenarios on need for treatment, 265-266 fundamental questions, 220-221

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330 ideas governing, 2-4, 56-57 questions for additional study, 2, 37-39 rise of modern drug treatment, 49-56 rule of simple ideas, 41-42 spending patterns, 213 spectrum of ideas about drugs, 42-44 Population studies, estimating extent of need for treatment, 76 Poverty (see also Indigency) external costs and treatment needs, 229 Preferred provider organizations (PPOs), 286 Pregnant women (see also Children, Mothers) comprehensive strategy option, 239 core strategy option, 238 estimating extent of need for treatment, 85-86, 234 Medicaid coverage, 272 research recommendations, 21, 198 Presidential Commission on the Human Immunodeficiency Virus Epidemic (1988), 76 Price, sensitivity of drug abusers to cost of treatment, 276, 277 Prison-hospitals classic era of narcotics control, 48 rise of modern treatment, 49-50 Prisons compared to jails, 82 n.5 effectiveness of drug treatment, 17, 176-185, 191 external costs and public intervention, 223 motivations for treatment, 127 overcrowding and criminal justice referrals to treatment, 10, 120 populations and estimating extent of need for treatment, 81-84 referrals to treatment, 117-119 Private coverage committee recommendations, 293-297 cost containment of health benefits, 283-288, 291-292 extent, 277-283 logic of mandating coverage of drug treatment, 276-277 state mandates, 28~293 Private tier clients compared to public tier, 205, 206 defined, 201-202 drug treatment coverage, 29-32, 277-283 drug treatment supply system, 216-217, 217-218 excess capacity, 206, 218-219 expansion in 1980s, 215, 218 INDEX financing, 21-22, 202-203 goals of drug treatment, 10~109 overview, 273-276 ownership of programs, 209 ratio of drug treatment expenditures, 203-204 referrals from criminal justice system, 112 sources of treatment dollars, 21 Probation (see also Criminal justice system) community-based treatment programs, 10 estimating extent of need for treatment, 84 implications of criminal justice involvement in admissions to drug treatment, 113 outpatient nonmethadone treatment, 167 prisons and criminological thought, 49 reasons for seeking treatment, 112 Productivity employers and drug treatment, 124, 282 estimating costs of drug problems, 103-104 goals of drug treatment, 106 societal costs of drug abuse, 89 Profit, growth of drug treatment industry in 1980s, 277 Psychoactive drugs (see also Heroin; Methadone; Opiates) effects on brain, 64 federal and state codes, 62 medical and social uses and fundamental ideas about drugs, 40 outpatient nonmethadone programs, 167 Psychotherapy, clinical rigor, 126 Public health goals of drug treatment, 11 policy role of treatment, 56-57 societal costs of drug abuse, 89 street sales of methadone, 137 n.5 Public Health Service, 199 Public coverage adequacy of present means for managing, 221 committee recommendations, 24~252, 254-256 federal and state roles, 239-248 Medicaid, 248-250, 265-272 principles of coverage, 221-230 priorities, 23~235 strategy options, 235-239, 256-264 veterans, 252-254 Public tier ambulatory treatment, 209 capacity and need for expansion, 219

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INDEX clients compared to private tier, 205-206 criminal justice referrals, 112 defined, 201 drug treatment supply system, 216, 217 erosion after 1976, 215-216, 218 excess capacity, 206 financing, 21, 2~27 goals and priorities, 22-24 ratio of drug treatment expenditures, 203-204 selective expansion and resource intensity, 22 R Race/ethnicity criminal and medical views of drug addiction, 48 libertarian view of drug use, 45 therapeutic community clients, 154 n.12 Reagan, Ronald administration and drug policy, 55 California and Civil Addict Program, 181 Recidivism drug consumption and criminality, 119 length of imprisonment and drug involvement, 118 Recommendations (see Policy, national drug; Private coverage; Public coverage; Research, needs and priorities) Recovery ambivalence and spectrum of, 125-130 drug dependence, 6-7 full, partial, and nonrecovery, 126-128 goals of drug treatment, 106, 131 individual drug history, 73-76 Rehabilitation, prisons and criminological thought, 49 Reimbursers, third-party and drug treatment, 107 Relapse detoxification, 16, 138-189 drug dependence, 5-6 individual drug history, 73-76 Remission, term compared to recovery, 73 n.3 Research animal models, 64 character of nonexperimental evaluations, 156-157 on effectiveness and expenditures for major treatment modalities, 18-19 on effectiveness of drug treatment, 12, 185-186 331 experimental evaluation of effectiveness of therapeutic communities, 158-160 needs and priorities for treatment services and methods, 19-21, 192-199 optimal private coverage provisions, 32 Retention therapeutic communities, 189 treatment effectiveness, 187-188 n.26 Rice, Dorothy, 89 S Self-recove~y, relapse, 6-7 Sentences, criminal justice law enforcement and drug crimes, 114 varying lengths and prison populations, 82 n.6 Shock incarceration (SI), effectiveness of correctional treatment programs, 17, 183-184 Social change, fundamental ideas about drugs, 40 Social services improvement of public coverage, 233 outpatient nonmethadone programs, 167-168 Society ethical position on income constraints, 225 external costs and private coverage, 276 external costs and public intervention, 223 Socioeconomic environment additional policy questions, 3~39 drug dependence, 5 individual drug history, 66~7 recovery and relapse, 6, 75 Special Action Office for Drug Abuse Prevention (SAODAP), 54, 240-241, 250 Staff chemical dependency programs and therapeutic communities compared, 172 composition of in 1982 NDATUS, 210 n.1 differential effectiveness of treatment programs, 24 improvement of public coverage, 233 requirements of public tier programs, 206 variations in treatment effectiveness, 150, 164, 185

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332 States (see also Government, state) drug problems among prison inmates, 82, 83 n.7 mandates of private coverage of drug treatment, 30, 275-276, 288-293, 294 medical/criminal ideas and evolution of governmental roles, 54, 55 use of Medicaid to fund treatment, 267 Statistics, sample size and standard error, 98-99 Stay'n Out, effectiveness of correctional treatment programs, 177-178, 180 Stereotypes individual drug history, 60 pleasure user and ethnicity, 45 Supplemental Security Income, 268 Supreme Court, criminal idea and drug policy formation, 48 Sweden, methadone maintenance, 143-144 Syna non early success stories, 157 therapeutic community approach to treatment, 52, 133 T Technology, libertarian view of drug use, 45 Therapeutic communities compared to chemical dependency programs, 171-172 compared to outpatient nonmethadone programs, 15, 168, 169, 170 cost/benefit ratio, 18, 165-166 description of modality, 154-156 electiveness of drug treatment, 14-15, 156-163, 16~167 origins and development, 133 prison treatment programs, 17, 180 research on expenditures and effectiveness, 18 research on treatment electiveness, 185-186 rise in modern treatment, 51-52 summary of committee findings, 188-189 variations in effectiveness, 163-165 Tobacco partial legality, 62 pregnant women, 85 Treatment Alternatives to Street Crime (TASC), 114, 116-117, 157 Treatment Outcome Prospective Study (TOPS) cost/benefit analyses, 152 effectiveness of drug treatment, 12, 35, 1 134, 196 electiveness of OPNMs, 168-169, 170 INDEX effectiveness of therapeutic communities, 160, 162-163, 166 veterans as clients, 253 TASC referrals, 116 variations in effectiveness of methadone maintenance programs, 148-149 veterans and drug treatment programs, 253 U Unemployment aggregate need for drug treatment, 8 estimating extent of need for drug treatment, 80 goals of drug treatment, 10 Unions, employer-sponsored health insurance, 273 Urban neighborhoods, goals of drug treatment, 108 Urinalysis clinical rigor, 125-126 estimating need for treatment among arresters, 99-100 Utilization management optimal private coverage provisions, 31 public financing of drug treatment, 27-29 public intervention in the 1990s, 25~252 V Veterans, as special case of public coverage, 25, 252-254, 256 Veterans Affairs, Department of, 252-254, 266 n.5 Vietnam War, 253 W Waiting lists elimination as priority of public coverage, 232 reduction and core strategy option, 238 Wlllmar State Hospital, 53 Withdrawal, methadone and symptoms of heroin, 140 Women (see also Mothers; Pregnant women) opiate addiction in nineteenth century, 46 reasons for seeking treatment, 112 research recommendations, 198, 199 self-esteem, and treatment, 198 Stay'n Out program, 178 therapeutic communities and graduation rates, 161 n.17 World War II, decline in drug problem, 49 z Zoning, drug treatment programs, 197