nity (DHHS, 1989; Smith et al., 1971). What makes these programs "community-based" are their history, mission, focus on location, social identity around neighborhood, service to people in the neighborhood, and accountability to local residents and institutions. Whether one agrees or not with the centrality of community in treatment, community is central to their mission and treatment efforts.

An example of the most successful model of community-based drug treatment are Alcohol and Narcotics Anonymous Twelve Step programs. They began as community-based treatment, and continue as such. The legal and formal organizational structure of Twelve Step programs is only part of what makes them "community-based." What is more important to their identity and what they do is their world view that values locality, their method for the social support of recovery, and their social identity as part of the twelve step recovery movement (Stephens, 1991). The same is true for drug treatment programs started by churches, Afrocentric organizations, woman's recovery groups, labor unions, and university-based treatment programs with missions to advance teaching and research. They define themselves by their mission and location, social identity and place.

Program accountability comes closest to capturing the essence of social identity in the definition of community-based. Accountability tells us what interests, mission, and social setting the program serves. Drug treatment programs accountable to health maintenance organizations (HMOs) serve HMO clients and the profit or not-for-profit (time and function) mission of the HMO. Drug treatment programs accountable to university hospitals also serve teaching and research missions (time and function). Drug treatment programs accountable to local citizens (place) with a particular residential allegiance (identity) exist primarily to serve people in the local area. In other words, there are university-based, health department-based, hospital-based, HMO-based, and community-based drug treatment programs. If we investigate all bases of accountability, there are, undoubtedly, additional ones. It is likely that each of these types of drug treatment outposts have both common and unique informational needs, interests, and priorities based on their differing identities and accountabilities.

As we have already seen; however, the community-based programs are the most numerous, and the most diverse. They are also as a group furthest from science and the use of science. The core of our committee's expressed mission is to address the problems of these community-based programs in utilizing science. But the definition what is "community-based" is not without relevance to their openness to using research in the future.


One of the reasons why community-based drug treatment is unrecog-

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement