inquiry underlying its recommendations, this committee sought to include the widest range of drug and alcohol treatment programs possible and was careful not to exclude from discussions and consideration those programs that defined themselves as community-based. Likewise, the committee was cautious not to exclude, a priori, any significant programs of interest by a determination that they were not "community-based." Thus, the public workshops included representatives from a diverse group of treatment programs, ranging from small programs who would be considered community-based by the most restrictive definition, to large and complex programs sponsored by larger entities, such as the Department of Veterans Affairs, academic medical centers, state court systems, and managed care organizations.

One of the important cultural elements that differentiates among community-based treatment programs is the set of beliefs that each uses to define the knowledge base about how to deliver effective drug treatment. There are at least two main types of programs in this regard. First, there are programs in which treatment models are based largely on the experiential knowledge of staff, especially those in recovery from drug abuse problems. This is the tradition of the "twelve-step" programs, following the model of Alcoholics Anonymous (AA). Such treatment providers have confidence in their knowledge because it has been tested in a most important test—their own recovery. Also in this category are programs that are identified with religious organizations and bring an element of faith to their treatment approach. Since faith is built into the foundation of their treatment approach, their religious beliefs fuel their organizational culture, including, to some extent, their fundamental "knowledge" about the nature of appropriate treatment for drug abuse problems. On the other hand, there is a set of organizations more closely related to the general health care system or to the traditions of the behavioral sciences. Because these treatment programs share much of the culture of medicine and the behavioral sciences, their organizational cultures include more of their scientific beliefs and values about the nature of treatment. Such a perspective suggests that, in programs in this second category, the therapist's knowledge about what is appropriate in treatment is defined by the fruits of scientific medical or behavioral research.⁴