comorbid psychiatric disorders in community settings? What is the best way to provide combined addiction and mental health services in the community, especially in a time of dwindling resources?

At a community level, much resources continue to be devoted to patients whose benefit or outcomes from treatment are poor or nil. How can we identify when to reduce services to such patients? How should treatment of chronic, relapsing patients be managed? Should they have special assessments to ascertain whether a treatable condition exists? How much would this cost. Who would do this and where should it be done? What ethical, legal, and socially acceptable alternatives can be brought to bear (e.g., case management, asylum, methods of managing their money, or other resources)?

The research "turn around time" needs to be faster. Much research now being published was conceived several years or a decade ago, when a much different system was in place. Research funding should support more exploratory, quasi-experimental, clinically relevant studies. Secondary analyses and meta-analyses of state agency data might reveal useful trends or information.

Federal "on-site" visits/reviews and technical assistance to states and communities should be expanded. Perhaps these could include researchers who have conducted community-applicable research. Those who have a national or cross-state perspective can tell community, state, and regional people what is being tried and what has been successful in similar settings. Community and state program leaders and planners have found these contacts helpful.

Providing care to addicted persons in rural areas is a growing problem. More drug use now occurs in rural areas; it is no longer "contained" in urban settings. All aspects of care are multiplied: access to care; support over time back in the community; special help for people with special needs (e.g., solo mothers, adolescents, elderly). We need new models of care such as more use of primary care, telemedicine, and mobile treatment teams.