How Do These Research Results Translate into Recommendations that Can Be Useful for Treatment Providers?—Although the conclusions from reviews of the recent treatment research literature are important and gratifying, they are not adequate to inform important clinical questions regarding the delivery of substance abuse treatment services. Simply knowing that those who stay in treatment longer have better outcomes does not help when the funding and duration of treatment in ''real world" settings is regularly reduced (McLellan et al., 1996a). Further, research demonstrating that highly specialized and resource-intensive treatments "work" with highly selected samples of patients may not be helpful to "real world" treatment providers who have no prospects of accessing those treatments and whose caseloads contain very few of the patients on whom the specialized treatment was tested. This is particularly true at the level of the "community-based" public sector treatment programs that have been forced to operate under limited budgets with little access to sophisticated services. How can research in the treatment setting inform these providers? How can these providers use information from research studies to upgrade or expand their treatment efforts—within the practical constraints of budget and personnel available?
Parameters of the Literature Review—In response to these questions, we have reviewed the existing treatment outcome literature to summarize the available knowledge regarding the important patient and treatment factors that have been shown to influence the outcomes of addiction rehabilitation treatments. We felt this was an important first step in recognizing and recommending proven, practical, and cost-effective treatment strategies that can be implemented by community behavioral treatment programs. In this regard, we have elected not to review literature on detoxification methods in order to better focus on standard rehabilitation treatments for drug and alcohol dependence—typically following detoxification. Our review does not include the adolescent drug abuse treatment literature since it is still a developing field and there is a paucity of pertinent outcome studies in this area. In addition, we elected not to include a review of the smoking cessation literature as there have been excellent recent reviews of this entire field (see Fiore et al., 1996).
From a methodological perspective, we included only those clinical trials, treatment matching, or health services studies where the patients were alcohol or drug dependent by contemporary criteria (e.g., DSM); where the treatment provided was a conventional form of rehabilitation (any setting or modality); and where there were measures of either treatment processes or patient change during the course of treatment as well as posttreatment measures of outcome as defined later in the chapter. We have elected to include methadone maintenance (as well as its long acting form,