TABLE C-1 Estimated Clients in Specialty Substance Abuse Treatment by Institutional Setting, 1994

Institutional Setting

24-Hour Care

Outpatient

Total

Percent

Free-standing outpatient

1,460

501,853

503,313

53.3

Community mental health center

4,178

136,420

140,598

14.9

General hospital (includes VA)

13,937

81,830

95,767

10.1

Specialized hospitals

8,714

14,045

22,759

2.4

Halfway house/recovery home

18,912

5,416

24,328

2.6

Other residential facilities

47,214

23,140

70,354

7.5

Correctional facilities

18,369

19,960

38,329

4.1

Other/unknown types

7,855

40,320

48,175

5.1

All types

120,639

822,984

943,623

100.0

 

SOURCE: SAMHSA (1996).

needs. Corporations have started programs to address employee's drug abuse. But in comparison, there are many more community-based programs that have arisen in response to the drug treatment needs of people with specific area or residential race, ethnic, and social class bound identities.

In the mission of community-based drug treatment, people come to abuse drugs not simply as individuals, but as members of some constellation of social identities. How they became addicted, what sustains them in their addiction, and the major source of motivation for "recovery" lies in their relationships and changing relationships with communities of people having similar social identities. The assumption of people who start programs within a community framework is that their specific social community is the best agent to address the cultural content of the abuser's drug abuse problem, treatment and recovery (Joe et al., 1977; Peyrot, 1982). For example, firefighters who became addicted to drugs as firefighters and who are going to remain firefighters are best treated by those most familiar with firefighting and who have respect among firefighters. Chinese-American heroin abusers are best treated by people who share the same social identity, are from the same regional and provincial culture, and who have the same generational immigrant experience—time- and place-bound. The same is true for business executives, and celebrities who go to discrete "retreat" programs, for New York Puerto Ricans ("NewYorRicans") and for African Americans from the South, who are culturally distinct from African Americans from southern Louisiana and the Caribbean. People and organizations emerge in varied communities to address drug abuse within their commu-



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