In 1929 Congress recognized that drug addiction was primarily a medical and social problem and that treatment of addiction by incarceration was illogical (NIH, 1995). The Lexington, Kentucky, and Forth Worth, Texas "narcotic farms" were set up by Congress to confine and treat persons addicted to habit-forming drugs. After congressional recognition of drug abuse as a social and medical problem, alcohol rather than drug treatment and support programs were started all across the country by community-based social service programs and by ex-alcoholics through organizations such as Alcoholics Anonymous (Bill W, 1967). The alcohol drug problem was much more pervasive until the 1960s. Then the epidemic of heroin use sparked a second community response. The "narcotic farms" and a few drug treatment programs expanded rapidly as an adjunct to community social services, and with government financial support (Musto, 1973). The expansion of alcohol and drug treatment into community settings was very much in keeping with popular institution building social movements. Local schools, health clinics, community policing, and cooperative grocery stores (Cox, 1994) are a few examples of an ongoing movement in American life (Anner, 1996; Fisher, 1994; Hoffman, 1989; McCarthy and Zalder, 1973). The establishment of needle exchange programs is an example a recent movement among community-based AIDS activists (Bowser, 1993).

Local agencies that provided housing, children, and food services in residential neighborhoods started drug treatment programs. Churches with social missions started drug treatment programs. People who were themselves in recovery, started programs. All of these programs have come out of specific racial, social class, ideological, and residential social identities and places. Despite the fact that drug abuse is a chronic relapsing disease, the movement has had visible successes. There are many people who are now clean and sober due to these programs. What is particularly important for our purpose is that their successes have come without a scientific basis. With government funding and regulation of drug treatment, the distinct histories and missions of community-based drug treatment has been obscured. At the same time the Department of Veterans Affairs, county hospitals, university medical centers, and now health maintenance organizations have also rapidly expanded their own drug treatment programs. These are "institutionally based" treatment efforts. The following table gives a sense of the scope of each type of treatment base. In the SAMHSA (1996) survey, "community-based" programs are called "free-standing outpatient" programs.

Table C-1 shows that "community-based" or free-standing programs treat 53 percent of all drug abusers seeking recovery. Clearly, university based treatment programs exist to advance research and knowledge about drug abuse. The hospital programs are responding to local public health