• the adjunctive role of disulfiram in the Community Reinforcement treatment of alcoholism (Azrin et al., 1982);

• the effectiveness of a work program for young drug abusers in the community (Stead et al., 1990);

• the application of these principles to the chronic public inebriate (Willenbring et al., 1990); and

• the utility of the Community Reinforcement treatment in the care of substance abusers and addicts, as well as in rural settings and among ethnic minority groups (Miller et al., 1992).

Although these investigators have demonstrated the effectiveness, and even the cost efficacy of these methods, they have not been widely applied. This is probably due to the complexity of the approach, the need for community and treatment resources to cooperate, the requirement for an overarching plan with ''reinforcement" of the respective positive as well as negative consequences. In order to work effectively, the reinforcements must be consistently and fairly applied over lengthy periods of time. Political support and diverse funding streams add to the further difficulty of establishing and maintaining Community Reinforcement programs.

Azrin NH. 1976. Improvements in the community-reinforcement approach to alcoholism. Behavior Research Therapy 14:339-348.

Azrin NH, Sisson RW, Meyers R, Godley M. 1982. Alcoholism treatment by disulfiram and community reinforcement therapy. Journal of Behavior Therapy and Experimental Psychiatry 13:105-112.

Hunt GM, Azrin NH. 1973. A community-reinforcement approach to alcoholism. Behavior Research Therapy 11:91-104.

Miller WR, Meyers RF, Tonigan JS, Hester RK. 1992. Effectiveness of the Community Reinforcement Approach. Albuquerque, NM: Center on Alcoholism, Substance Abuse, and Addictions.

Stead P, Rozynko V, Berman S. 1990. The SHARP carwash: A community-oriented work program for substance abuse patients. Social Work 35(1):79-80.

Westermeyer J, Bourne P. 1978. Treatment outcome and the role of the community in narcotic addiction. Journal of Nervous Mental Disorders 166:51-58.

Willenbring ML, Whelan JA, Dahlquist JS, O'Neal MW. 1990. Community treatment of the chronic public inebriate: I. Implementation. Alcoholism Treatment Quarterly 7(1):79-98.

Outreach activities can be used for two purposes: to intervene early in the course of addiction and bring substance abusers to treatment before

Front Matter (R1-R22)

Executive Summary (1-15)

1 Introduction (16-26)

2 The Gaps Between Research, Treatment, and Policy (27-55)

3 Approaches to Closing the Gaps (56-72)

4 Benefits and Challenges of Research Collaboration for Community-Based Treatment Providers (73-88)

5 Benefits and Challenges of Community-Based Collaboration for Researchers (89-110)

6 Findings and Recommendations (111-120)

Appendix A: Statment of Task (121-124)

Appendix B: Workshops and Roundtable: Agendas and Participants (125-134)

Appendix C: Commissioned Paper: Drug Treatment Programs and Research: The Challenge of Bidirectionality (135-146)

Appendix D: Commissioned Paper: The Treatment of Addiction: What Can Research Offer Practice? (147-185)

Appendix E: Commissioned Paper: The Substance Abuse Treatment System: What Does It Look Like and Whom Does It Serve? Preliminary Findings from the Alcohol and Drug Services Study (186-197)

Appendix F: National Institute of Health Consensus Development Statement on Effective Medical Treatment of Heroin Addiction (198-225)

Appendix G: Useful Internet Resources -- Examples (226-232)

Appendix H: List of Currently Available CSAT Tretment Improvement Protocols (TIPs) (233-234)

Appendix I: Opportunities for Collaboration (235-245)

Appendix J: Summary of Interviews with Minnesota State Alcoholism-Addiction Leaders (246-250)

Index (251-264)