can be tied to research findings? Currently, research findings do not seem to influence public policy.

    5.  

    Is there a way that research findings can inform public perceptions and opinions? Currently, public opinion leaders (e.g., mass media, heads of managed health care organizations, elected officials, health professionals, educational system, etc.) hold opinions counter to research findings (e.g., treatment for addiction does not work, treatment is more expensive than "supply reduction").

    6.  

    State planners would like to have research findings that address the following issues facing community programs:

    • How "brief" can brief contacts be and still be effective? One hour, half hour, fifteen minutes, five minutes?
    • How much do interventions cost in terms of assessment, total costs (including training, consultation, administrative costs, cost efficacy, cost offsets) ?
    • Where should treatment be best provided? Medical center? Home? Workplace? What about telephone contacts?

      1.  

      Any research findings, to be utilized at a community level, must be simple to apply (KISS principle). Interventions requiring special interviews (e.g., ASI), or costly psychological evaluation, or special assessments of staff members (e.g., personality types) are not used.

      2.  

      More research should be conducted in community settings. Much research now is conducted in large university or VA medical centers.

      3.  

      Community personnel, programs, and planners need algorithms to help in guiding patients through treatment. Examples include patients who are failing in treatment, special demographic groups, those with associated biomedical or psychosocial problems.

      4.  

      Managed care has become an integral part of health care. How can managed care methods be brought to the service of addicted patients? What are reasonable criteria for the involvement of managed care organizations and personnel in the care of addicted patients?

      5.  

      The distinction between private and public patients is fading fast in the addiction field. Previously "private" programs are taking public patients, as private programs no longer pay for addiction services. In addition, employed addicted persons either cannot get health insurance nowadays or lose private insurance coverage more readily than in the past. How can these "mixed" patients be best managed in the same system? What kind of case manager (or what kind of case management) should apply to either or both systems? How much does such case management cost? Case managers currently seem to add to treatment costs, rather than decrease costs. In addition, the cost efficacy of case management is far from obvious.



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