Index

A

Academic programs and research, 3, 12, 15, 20

attitudes toward, 79

collaborative research with CBOs, 12-13, 76, 79, 87, 96, 98-99, 102 -103, 140, 141, 144

information linkages with CBOs, 12-13, 20, 35, 68, 111-112, 119,135, 137

preventive interventions, 102-103

primary care services, 35

state funding, 8

see also Medical education;

Professional education

Acupuncture, 37-38, 150, 175, 195, 244

ADAMHA Reorganization Act of 1992, 95-96

Addiction Severity Index, 103, 155-156, 172

Administrators and managers, 211, 248

associations of, opinions, 65, 95-97

CBOs, 5, 10, 27-29, 35, 41-42, 47-51, 59-60, 64, 66, 68, 76, 77,90, 93, 94, 99, 100, 112, 117, 123, 135, 187, 189, 190, 232, 247, 249

state agency, 31, 35

see also Case management;

Management information systems

Adolescents, 34, 74, 87, 148, 194, 238, 239-240

Advocacy groups, 11-13, 31, 46-47, 51, 118-120 passim, 198, 227

Internet sites, 227-228

African Americans, 139, 140, 143, 159, 160, 193, 194, 214, 249

Aftercare, see Followup treatment

Age factors, 152, 153, 193, 194, 209

see also Adolescents;

Children

Agency for Health Care Policy Research, 10, 14, 63-64, 226

Agricultural Extension Service, 69

AHCPR, see Agency for Health Care Policy Research

AIDS, see Human immunodeficiency virus

Alcohol abuse, 27-28, 49, 50, 61, 73, 95

adolescents, 239

Alcohol and Drug Services Survey, 192, 193, 194

cocaine abuse and, 38-39

Community Reinforcement Approach, 169

driving while under the influence,19, 239

naltrexrone, 33, 167



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Index A Academic programs and research, 3, 12, 15, 20 attitudes toward, 79 collaborative research with CBOs, 12-13, 76, 79, 87, 96, 98-99, 102 -103, 140, 141, 144 information linkages with CBOs, 12-13, 20, 35, 68, 111-112, 119,135, 137 preventive interventions, 102-103 primary care services, 35 state funding, 8 see also Medical education; Professional education Acupuncture, 37-38, 150, 175, 195, 244 ADAMHA Reorganization Act of 1992, 95-96 Addiction Severity Index, 103, 155-156, 172 Administrators and managers, 211, 248 associations of, opinions, 65, 95-97 CBOs, 5, 10, 27-29, 35, 41-42, 47-51, 59-60, 64, 66, 68, 76, 77,90, 93, 94, 99, 100, 112, 117, 123, 135, 187, 189, 190, 232, 247, 249 state agency, 31, 35 see also Case management; Management information systems Adolescents, 34, 74, 87, 148, 194, 238, 239-240 Advocacy groups, 11-13, 31, 46-47, 51, 118-120 passim, 198, 227 Internet sites, 227-228 African Americans, 139, 140, 143, 159, 160, 193, 194, 214, 249 Aftercare, see Followup treatment Age factors, 152, 153, 193, 194, 209 see also Adolescents; Children Agency for Health Care Policy Research, 10, 14, 63-64, 226 Agricultural Extension Service, 69 AHCPR, see Agency for Health Care Policy Research AIDS, see Human immunodeficiency virus Alcohol abuse, 27-28, 49, 50, 61, 73, 95 adolescents, 239 Alcohol and Drug Services Survey, 192, 193, 194 cocaine abuse and, 38-39 Community Reinforcement Approach, 169 driving while under the influence,19, 239 naltrexrone, 33, 167

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NIH heroin addiction treatment guidelines, 209 outcome monitoring, 153-160 passim, 167, 168, 169 pregnant women, 36 Alcohol and Drug Research Study, 37 Alcohol and Drug Services Survey, 187-197 Alcoholics Anonymous, 24, 27-29, 85, 138, 140, 160, 162-164, 169, 175 Aliviane, 77 American Cancer Society, 46 American Heart Association, 46 American Lung Association, 46 American Medical Association, 62, 200 American Psychiatric Association, 61 American Society of Addiction Medicine, 61, 100, 161 Amphetamines, see Methamphetamines Antabuse (disulfiram), 167, 169, 242 Antidepressants, 170 Anxiolytic buspirone, 170 Arapaho House Comprehensive Substance Abuse Treatment Center, 73-75, 78, 79, 82 Arizona, 20 ASI, see Addiction Severity Index Asians/Pacific Islanders, 139, 194, 244 Assessment methodology, see Evaluation methodology; Quality control Attitudes, vi AA members, 27-29 abuser motivation, 33, 50, 80, 156-157, 162, 163, 175, 235, 241-242, 247 contingency management, 34 methadone maintenance, 32, 49-50 researchers, 77, 98 research subjects, 98, 99 self-esteem, 80 stigma, 9, 11, 16, 17, 25, 32, 46-48, 49-50, 116, 153, 205, 210, 213 treatment facilities placement, local residents, 38, 46, 47, 49-50 trust building, xv, 3, 5, 56, 57, 66-70, 74, 98, 112 B Barbiturates, 194 Behavioral interventions, 2, 6, 7, 18, 19, 20, 24, 59, 67, 74, 86, 150, 164-165, 170-171 NIH heroin addiction treatment guidelines, 202, 208, 209 see also Contingency management; Counseling and counselors; Group therapy Benzodiazepines, 194 Biopsychological factors, vii,6, 16, 17, 80 methamphetamine abuse, 229 opiate addiction, 200-201, 203-204, 212 outcome analysis, 152 recovering addicts, 149 see also Drugs to treat abusers; Genetic factors; Medical interventions; Mental illness; Withdrawal Black persons, see African Americans Block grants, 7, 17, 27, 42-43, 65, 114, 197 methadone, 31 Buprenorphine, 49, 151, 166, 207, 209 C California, 20, 22, 35, 36 Cancer treatment, 11, 46, 68-69, 96, 100-102, 107 cost-effectiveness, 5, 101, 112 see also Community Clinical Oncology Program Case management, 34, 74, 97, 173, 238, 248, 250 CASPAR, 102 CBOs, see Community-based drug treatment organizations CCOP, see Community Clinical Oncology Program Center for Mental Health Services, 95 Center for Substance Abuse Prevention, 94-95 Center for Substance Abuse Treatment, v, vii, 9, 17-18, 116, 124, 231 collaborative research support, 10, 13-15, 18, 74, 94, 100, 117-118, 120 definitional issues, 23 technology transfer, 58, 59-60, 115, 120, 136 treatment protocols, list of approved, 233-234 Center on Alcohol, Substance Abuse, and Addiction, 20, 96, 98-99, 108 Certification, see Licensing and certification Chestnut Health Systems and Interventions, 99, 107

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Children, 32, 34, 35, 36, 65, 153-154 Alcohol and Drug Services Survey, 194, 195 school-based preventive interventions, 73-74, 97, 102-103, 240 see also Adolescents Chinese Americans, 139 Clinical protocols, 6, 49, 96, 100, 161 CSAT, list of approved, 233-234 Clinical trials, 32, 37, 38, 62, 68, 79, 86, 90, 100-101, 106, 148 , 152, 174 CME, see Continuing medical education Cocaine, 20, 22, 30, 33, 40(n.1), 49 adolescents, 239 alcohol abuse and, 38-39 Alcohol and Drug Services Survey, 193, 194 NIH heroin addiction treatment guidelines, 206, 209 outcome monitoring, 153, 155, 159, 160-161, 163, 164, 167-168, 171 prison treatments, 249 treatment guidelines, 61 Colleges and universities, see Academic programs and research Colorado, 73-74 Community-based drug treatment organizations, 2, 5, 6, 17, 18, 42-43 academic researchers, collaboration, 12-13, 76, 79, 87, 96, 98-99, 102-103, 140, 141, 144 academic researchers, information linkages, 12-13, 20, 35, 68, 111 -112, 119, 135, 137 administrators and managers, 5, 10, 27-29, 35, 41-42, 47-51, 59-60, 64, 66, 68, 76, 77, 90, 93, 94, 99, 100, 112, 117, 123, 135, 187, 189, 190, 232, 247, 249 Agricultural Extension Service as model, 69 Alcohol and Drug Services Survey, 187-197 cancer treatment as model, 5-6, 11, 46, 68-69, 96, 100-102, 107-108, 112-113, 118 counselors in recovery, 24, 27, 41, 44, 45, 75 cultural factors, 20, 24, 98, 131 definitional issues, 2-3, 23-25, 135-141 employment issues, staff, 12-13, 15, 41, 43-46, 59, 76-68, 113 training, 12-13, 15, 41, 43-46, 59, 76-68, 113 historical perspectives, 21-23, 138, 141-143 models, 5-6, 58-70, 83, 85, 101-102, 107-108, 112-113 multimodal treatments, 35 research contributions of, 73-88, 96, 111-114 research recommendations, 7, 12-13 site visit vignettes, 27, 28, 29, 31, 74, 89-90 small providers, 27,29, 41, 59, 60, 84, 85, 141, 190, 191 structural factors, 40-42, 51-52, 59-60 training of staff, 12-13, 15, 41, 43-46, 59, 76-68, 113 understudied approaches, 35-40 underutilized research, 32-34, 116-117, 135-136, 147-176 woman-centered, 36 Community Clinical Oncology Program (NCI), 5-6, 68-69, 96, 100-102, 107-108, 112-113 infrastructure, 5, 101-102, 106, 112-113 Community-level factors, other, 87, 101 adolescent outreach, 240 definitional issues, 136-137 education and training, 43-44 treatment facilities placement, attitudes, 38, 46, 47, 49-50 Community Reinforcement Approach, 169-170, 240-242 Connecticut, 22, 141 Consensus conferences, 63-64, 117, 199 Consumer participation, 2, 4, 6, 10, 31-32, 84, 113, 118-119, 120, 214 cost factors, 5, 11-12, 119 cultural factors, 24(n.4) foreign language speakers, 20, 99 HIV treatment, 11, 105, 108 professional licensing, 8, 44, 115 standards, 8, 12, 119 training, 13, 113 see also Advocacy groups; Public education; Stakeholders

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Consumer scorecards, 11, 61-63, 118 Contingency management, 30-31, 33-34, 43, 169-170, 175 Continuing care, see Followup treatment Continuing medical education, 8, 12, 15, 48 guidelines, 62-64 Cost and cost-effectiveness factors, vi, 1, 18, 31, 35, 49, 93, 95, 247, 248 adolescents, treatment, 239-240 cancer treatment as model, 5, 101, 112 consumer participation, 5, 11-12, 119 drug addiction, national losses, 144, 147, 206, 212-213 drugs to treat abusers, 28, 33 employer treatment programs, 147 innovation, 60(n.2) institutional care, 25 literature review parameters, 148 NIDA/NIAAA efforts, 9, 116 NIH heroin addiction treatment guidelines, 206, 209, 212-213 outreach, 239-240, 243 research design, 81, 101 research/practice links, 4, 76-77, 111-112 treatment/patient matching, multiple problems, 173 see also Funding Counseling and counselors, 20, 37, 41, 44, 86, 231 abusers as counselors, 24, 27, 41, 44, 45, 75, 138; see also Group therapy mentors, 45, 48, 111, 244 NIH heroin addiction treatment guidelines, 203 outcome monitoring, 164-165, 170-172, 175 theoretical basis, 80 therapy vs, 164-165, 170-171, 175 training, 84 see also Marital status and therapy; Peer support Crime and criminal justice system, vi, 2, 3, 20, 43, 96, 143, 144 adolescents, 239 Alcohol and Drug Services Survey, 191, 192 Department of Justice, 213 driving while under the influence, 19 heroin addiction and, 200, 206, 209 historical perspectives, 22 naltrexone use by probationers, 167 outcome monitoring, 152, 160, 165, 171, 176, 209 outreach, 239, 243 see also Prisons and jails CSAT, see Center for Substance Abuse Treatment Cultural factors addiction, 80, 139, 214 community-based treatment, 20, 24, 98, 131 organizational, vii, 5, 27-29, 60, 85-86, 108, 112, 136 religious factors, 24, 85-86, 138, 140, 244 research collaboration, vii, 24, 77, 96 see also Social factors; specific groups D Databases, 5, 87, 95, 189-190 TEDIS, 232 Data collection, 4, 21, 81, 82, 87, 93, 96, 99, 100, 101 adolescents, 239-240 Alcohol and Drug Services Survey, 187-188 homeless persons, 103-104 see also Management information systems; Research methodology Demographic factors, 142-143 Alcohol and Drug Services Survey, 193, 194 clinical factors and, 16 NIH heroin addiction treatment guidelines, 205-206 outcome analysis, 152-152 types of research, 81 see also Age factors; Children; Employment factors; Gender factors; Homeless persons; Minority groups; Rural areas; Socioeconomic status; Urban areas Department of Health and Human Services, see specific agencies Department of Justice, 213 Department of Veterans Affairs, 3, 67, 138, 160, 166

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Detoxification methods and centers, 22, 31, 73-74, 148-176 Alcohol and Drug Services Survey, 192, 193, 195 see also Drugs to treat abusers Diagnosis, see Identification of abusers Diagnostic and Statistical Manual of Mental Disorders, 100, 148 Directors, see Administrators and managers Diseases, other than alcohol/substance abuse, 41, 46, 59, 147, 152 , 204 outcome analysis, 63-64 see also Mental illness; specific diseases District of Columbia, 20-21 Disulfiram, see Antabuse Doctors, see Physicians Driving while under the influence, 19, 239 Drug Abuse Treatment Outcome Study, 34 Drug Outcome Monitoring System, 99-100 Drugs of abuse, specific, see specific drugs Drugs to treat abusers, 41, 49, 67, 80, 117, 149, 150, 166-168, 175 , 202, 208, 214 underutilized, 32-33 see also Antabuse; Buprenorphine; Methadone; Naltrexone DSM-IV, see Diagnostic and Statistical Manual of Mental Disorders Duration of treatment, 35, 147, 149, 150, 151, 154, 181, 161-162, 166, 207, 209, 248 E EAP, see Employee assistance programs Economic factors, 16, 19-20, 51-52, 112 health services research, 94 knowledge development, 9 see Cost and cost-effectiveness factors; Socioeconomic status Educational attainment, 152, 153 Education and training, 2, 12-13, 15, 43-45, 47, 56, 97, 99, 111, 119-120 addicts, 175, 195 costs, 35 counselors, 44, 113 families, 13 Internet sites, 228 organizational learning, 6, 76, 79, 111-112, 113 school-based preventive interventions, 73-74, 97, 102-103, 240 see also Medical education; Professional education; Public education; Technology transfer Employee assistance programs, 18 Employment factors, 47, 49, 139, 142 Alcohol and Drug Services Survey, 187, 192, 195 drug rehabilitation organizations, 59, 95, 237, 238 CBO staff, 12-13, 15, 41, 43-46, 59, 76-68, 113 job training/finding, 34, 80, 95, 169, 172, 195 labor unions, 140, 143 outcome monitoring, 157-158, 160, 165, 169, 171, 172, 173 self-insured employers, 11-12, 119 unemployment, 20, 47, 143, 152, 158, 165, 207 Etiology, 1, 16, 31, 150 NIH heroin addiction treatment guidelines, 202-204 Evaluation methodology, 9, 39, 77, 117 guidelines, 61-62, 236 scorecards, 11, 61-63, 118 state policy on service delivery, 9 see also Cost and cost-effectiveness factors; Grant review processes; Outcome monitoring Evidence-based treatments, 10-11, 14, 17, 56, 59-60, 63-64, 118 F Faith, see Religious factors Families, 8, 11, 84, 119, 152 adolescents, 240 Alcohol and Drug Services Survey, 192, 195 NIH heroin addiction treatment guidelines, 203 outcome monitoring, 158-159, 160, 167, 168, 173, 175, 176 training, 13 see also Parents Federal government, vii, 2, 22, 29-30, 114, 117 Internet sites, 226-227, 232 see also Legislation; Regulatory issues; specific departments and agencies

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Fluoxetine, 170 Followup treatment, 34, 87, 101, 150, 163, 195, 235, 236 see also Relapse and relapse prevention Food and Drug Administration, 33, 152, 166, 167, 211, 212 Foreign language speakers, 20, 99 For-profit organizations, 137, 138, 140, 188, 189, 191, 196, 237 see also Health insurance; Health maintenance organizations Foundations, 18-19, 46, 141 Funding, vi, 7-8, 12, 14, 17, 21, 42, 49, 77, 97, 98-99, 113-115, 120, 141, 196 advocacy, 46 CBO site visit vignettes, 27-29, 31, 73-74, 89-90 clinical involvement, 247 historical perspectives, 22, 23, 25, 27 homeless persons, treatment, 104 ineffective treatments, 10 managed care reimbursement, 27 prevention programs, 102 small research projects, 7, 76, 84, 114 top-down, 64-66 see also Block grants; Grant review processes; Incentives, financial G Gay Men's Health Crisis, 46-47 Gender factors, 7, 114, 152, 153, 194 see also Men; Women Genetic factors, 150, 202, 203, 205, 212 Global Appraisal of Individual Needs, 99-100 Government, see Federal government; Local government; State government Grant review processes, 7, 28, 106-107 Group therapy, 22, 164, 175, 195 see also Peer support H Halfway houses, 22, 27-28 Harrison Act, 199 Health insurance, 42, 196, 214 consumer participation, 11-12 Mathematica study, vi Mental Health Parity Act, vi self-insured employers, 11-12, 119 see also Medicaid; Medicare Health maintenance organizations, 19, 101, 135-136, 140, 141, 143 Health Plan Employer Data and Information Set, 63 Hepatitis, 25, 204, 206, 209 Heredity, see Genetic factors Here's Looking at You, 102 Heroin, 22, 30, 138, 139, 167 adolescents, 239 Alcohol and Drug Services Survey, 193, 194 crime and, 200, 206, 209 NIH treatment guidelines, 198-225 outcome monitoring, 153, 158 see also Methadone Hispanic persons, 20, 77, 194, 214 Historical perspectives, 1, 21-23, 25, 27, 73, 94, 136, 138, 141-143, 199-200 collaborative research, 90-95 community-based defined, 137, 138, 140 demonstration initiatives, 102 funding, 22, 23, 25, 27 hospitals, 21-22, 25 methamphetamine abuse, 230 technology transfer, 48-49, 57, 58 HIV, see Human immunodeficiency virus HMOs, see Health maintenance organizations Homeless persons, 74, 102, 103-105, 108, 237 Hospitals, 97, 100, 135, 137-141 passim, 143, 237 Alcohol and Drug Services Survey, 188, 193 historical perspectives, 21-22, 25 outcome monitoring, 150, 159-161, 169 Human immunodeficiency virus, 7, 25, 34-35, 42, 49, 65, 114, 118, 142 advocacy groups, 46 Alcohol and Drug Services Survey, 195 consumer participation in treatment, 11, 105, 108 demonstration projects, 105, 108 NIH heroin addiction treatment guidelines, 200, 201, 204, 209 outreach, 105, 114

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I Idaho, 30 Identification of abusers, 36, 235 DSM-IV, 10, 148 NIH heroin addiction treatment guidelines, 204 saliva testing, 204 urine testing, 33, 49, 151, 160, 164, 166, 187, 204 see also Outreach; Referral Ideology, see Political and ideological factors Illinois, 22, 96, 99-100, 141 Incentives, behavioral, see Behavioral interventions Incentives, financial, 56, 115, 120, 127 CBOs, 8, 14, 112, 115 top-down models, 64-66 Information dissemination, 4, 6, 9-11, 18, 19, 21, 45, 49, 58, 76, 84, 95, 116-117, 124, 131, 247 academic/CBO collaboration, 12-13, 20, 35, 68, 111-112, 119, 135, 137 bidirectional, general, 2, 3, 18, 23, 36, 58-59, 66-67, 121, 123, 135-137, 144, 186-197 CBO administrators, 42, 84 definitional issues, 58 guidelines, 62-64 lag time, 19, 29, 31, 250 NIDA role, 12-15, 28, 48-49, 58, 116-118, 119-120, 136 policymakers, 7-8, 9-11, 19, 31-32, 113 see also Education and training; Management information systems; Technology transfer Informed consent, 78, 99 Infrastructure, 19, 56, 69, 106 CCOP strategy, 5, 101-102, 106, 112-113 DHHS support, 65 NIDA support, 6, 14 state support, 97 Inhalants, 239 Innovation, 60, 61, 62 Inpatient treatment Alcohol and Drug Services Study, 188-193 passim block grants and, 42-43 heroin addiction, NIH treatment statement, 208 outcome monitoring, 149, 150-155 passim, 158, 159-163, 170, 172 see also Residential treatment Institute of Medicine, v, viii-ix, 1, 4, 17-18, 23, 48, 95, 106 study objectives, 123-124 technology transfer, 57-58, 62-63 Institutional review boards, 78 Insurance, see Health insurance Internet resources, 226-232 Iowa Consortium for Substance Abuse Research and Evaluation, 95-98, 107 J Jails, see Prisons and jails Joint Commission on Accreditation of Healthcare Organizations, 20, 100 K Kentucky, 22 Knowledge development, see headings beginning ''Research" Knowledge dissemination/transfer, see Information dissemination; Technology transfer L LAAM, 49, 149, 151, 166, 201, 209, 212 Language, see Foreign language speakers Law, see Crime and criminal justice system; Informed consent; Regulatory issues Legislation federal ADAMHA Reorganization Act of 1992, 95-96 Harrison Act, 199 Mental Health Parity Act, vi Narcotic Addict Rehabilitation Act, 22 women's services, 36 state driving while under the influence, 19, 239

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Length of treatment, see Duration of treatment Levo-alpha-acetylmethadol/levomethadyl acetate, see LAAM Licensing and certification, professional, 8, 44, 115, 165, 175 Local factors, see Community-based drug treatment organizations; Community-level factors, other Local government, 17, 42, 43, 114 M Managed care organizations, general, 2, 3, 7, 11, 12, 17, 18, 24, 27, 29, 63, 64, 65-66, 90, 95, 101, 186, 235-236, 248 see also Community-based drug treatment organizations; Health maintenance organizations Management information systems, 8, 100, 101, 111, 113, 115, 127 Alcohol and Drug Services Survey, 188-189 TEDIS, 232 training in, 77 see also Databases Managers, see Administrators and managers Marijuana, 22, 193, 194, 206, 239 Marital status and therapy, 153, 168, 169 Massachusetts, 22 Mass media, 10, 240, 248 Mathematica study, vi Medicaid, 42, 94, 96, 176, 197 Medical education, 12-13, 47-48, 62-63, 210-211, 213 continuing medical education, 8, 12, 15, 48, 62-64 Medical interventions, 24, 31, 56, 94-94, 112, 173 acupuncture, 37-38, 150, 175, 195, 244 Alcohol and Drug Services Survey, 188 Medicaid, 42, 94, 96, 176, 197 Medicare, 94, 197 NIH heroin addiction treatment guidelines, 204, 206 primary care, 35, 36, 101 women, 34, 154 see also Biopsychological factors; Detoxification methods and centers; Hospitals; Saliva testing; Urine testing Medicare, 94, 197 Men, 85, 192 Mental Health Parity Act, vi Mental Health Services Administration, see Center for Substance Abuse Treatment Mental illness, other than alcohol/drug abuse, 16-17, 25, 38-39, 68, 84, 203, 238, 249-250 adolescents, 239 outcome monitoring, 154-155, 157, 160, 170, 171, 172, 173, 175, 176 suicide, 168, 239 see also Biopsychological factors; Psychiatric treatment Mentors, 45, 48, 111, 244 Methadone, 22, 30-31, 32-33, 34, 35, 47, 49-50, 58, 62, 80, 149 Alcohol and Drug Services Survey, 188, 192 LAAM, 49, 149, 151, 166 NIH treatment guidelines, 201-214 passim nonmethadone treatments vs, 37, 208, 209 outcome monitoring, 151, 154, 155, 158, 164-166, 170-172 withdrawal from, 166, 204, 208 Methamphetamines, 194, 229-230 Methodology, see Research methodology Minority groups, 7, 47, 91, 101, 114, 139, 142, 152, 153, 194, 214 , 237, 238 adolescents, 239 see also specific groups Mississippi, 30, 141 "Money with strings," see Incentives, financial Motivation, see Attitudes; Behavioral interventions; Contingency management Multi-problem addicts, 16-17, 25, 34, 38-39, 46, 168-174, 212, 239 , 250 Multiple substance abusers, 27, 38, 158, 174, 209 Multiple treatment modalities, 17, 30, 31, 34-35, 103, 168-174, 175 Myths of addiction, see Stigma

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Naltrexone, 28, 33, 80, 166-168, 201, 207-208 alcohol abuse treatment, 33, 167 Narcotic Addict Rehabilitation Act, 22 Narcotics Anonymous, 140, 162-164, 175 National Acupuncture Detoxification Association, 37 National Advisory Council on Alcohol Abuse and Alcoholism, 95 National AIDS Demonstration Research, 105 National Alliance for the Mentally Ill, 47 National Alliance of Methadone Advocates, 47 National Association of Alcohol and Drug Abuse Counselors, 20 National Association of State Alcohol and Drug Abuse Directors, 65 National Cancer Institute see also Community Clinical Oncology Program National Committee on Quality Assurance see also Health Plan Employer Data and Information Set National Institute of Mental Health, 94 National Institute on Alcohol Abuse and Alcoholism, 7, 9, 10, 13-15, 74, 94, 95, 100, 102, 104, 108, 116, 117 Project MATCH, 155, 159, 162, 170, 173 National Institute on Drug Abuse, v, vii, 7, 74, 94, 114, 124 AIDS, 105, 142 acupuncture, 37-38 definitional issues, 23 grant review, 106 information development/dissemination, 9, 10, 12-15, 28, 48-49, 58 , 116-118, 119-120, 136 methamphetamine abuse, 229-230 NIH heroin addiction treatment guidelines, 213 prevention demonstrations, 102-103, 108 service delivery approaches, 34, 116 technology transfer, 12-13, 48-49, 58, 119-120, 136 understudied approaches, 37 Web site, 58 National Institutes of Health, v, 15, 101, 106, 107 heroin treatment guidelines, 198-225 methadone maintenance, 32-33 Native Americans, 3, 20, 73-74, 98-99, 194 Navajo Nation, 20, 96, 98-99, 108 New Hampshire, 30 New Jersey, 22 New Mexico, 20, 131 New York, 22 NIDA, see National Institute on Drug Abuse Non-residential treatment, see Outpatient treatment Non-traditional interventions, 87, 244 acupuncture, 37-38, 150, 175, 195, 244 relaxation therapy, 175 North Dakota, 30 Not-for-profit organizations, 74, 137, 237 abusers, recovering, 22 Alcohol and Drugs Services Study, 188, 189, 191, 196, 197 foundations, 18-19, 46, 141 HMOs, 140 market forces and, 59 Treatment Episode Data Set, 232 O Office for Treatment Improvement, 94 Office of National Drug Control Policy, 22, 94, 213 methadone maintenance, 32 Ohio, 31 Opiates, 22, 32-33, 49-50, 194 biopsychological factors, 200-201, 203-204, 212 dependence defined, 204 outcome monitoring, 153, 154, 155, 158 relapse and relapse prevention, 200, 202, 205, 208, 212 treatment guidelines, 61, 198-225 withdrawal from, 151, 166, 207-208, 244 see Buprenorphine; Heroin; LAAM; Methadone; Naltrexone Organizational factors, general, 4-5, 9, 40-42, 56, 94, 116, 237 ADAMHA reorganization, 94-95 Alcohol and Drug Services Survey, 188-190

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change models, 59-60, 66-69, 82-86, 87 cultural, vii, 5, 27-29, 60, 85-86, 108, 112, 136 funding, 196-197 institutional review boards, 78 learning, 6, 76, 79, 111-112, 113 see also Administrators and managers; For-profit organizations; Infrastructure; Not-for-profit organizations Orlaam ™, see LAAM Outcome monitoring, 10-12, 14, 17, 25, 39, 41, 49, 61-64, 93, 95, 96, 99-100, 118 alcohol abusers, 153-160 passim, 167, 168, 169 cocaine users, 153, 155, 159, 160-161, 163, 164, 167-168, 171 consumer participation, 11 crime and criminal justice system, 152, 160, 165, 171, 176, 209 definitional issues, 149, 174-175, 176 employment variables, 157-158, 160, 165, 169, 171, 172, 173 family factors, 158-159, 160, 167, 168, 173, 175, 176 goals, controversy, 38 heroin abusers, 153, 158 homeless persons, 103-104 hospitals, 150, 159-161, 169 inpatient treatments, 149, 150-155 passim, 158, 159-163, 170, 172 relapse, 154, 157, 158, 159, 163, 164, 170, 171, 172, 195 residential treatment, 150, 155, 159-160, 172 self-reporting, 152, 160 social factors, 158-159, 160, 172 socioeconomic status, 142-143, 152, 203, 239, 243 top-down incentives, 65 variables, 35, 152-176 see also Evidence-based treatments Outpatient treatment, 22, 37, 49, 137, 138, 149, 243 Alcohol and Drug Services Survey, 188, 192, 193 outcome monitoring, 150, 159-161, 171, 172 see also Counseling and counselors Outreach, 7, 42, 87, 242-243 adolescents, 87, 239-240 Community Reinforcement Approach, 169-170, 240-242 cost factors, 239-240, 243 crime and criminal justice system, 239, 243 HIV-infected persons, 105, 114 P Parents, 8, 65, 153, 203 see also Children; Families Patient Outcome Research Teams, 63-64 Peer support, 22, 24, 27, 41, 44, 45, 75, 138, 164, 243, 244 Alcoholics Anonymous, 24, 27-29, 85, 138, 140, 160, 162-164, 169, 175 Narcotics Anonymous, 140, 162-164, 175 Synanon, 22 see also Group therapy Performance Partnership Grants, 65 Pharmacotherapy, see Drugs to treat abusers Physicians, 48, 62, 101, 210 see also Medical education Physicians in Residence program, 48 Policy and policymakers, general, vi, 1-8 passim, 14, 18, 29, 40, 49-51, 56, 90-91, 96, 97, 113, 114-115, 127, 247-248 historical perspectives, 21-23 knowledge development/dissemination, 7-8, 9-11, 19, 31-32, 113 report at hand, panelists, 126 war on drugs, 22 see also Funding; Legislation Political and ideological factors, vi, 16, 19-20, 51-52, 94 see also Cultural factors; Religious factors Practice-based research networks, 6, 12, 57, 69, 79, 119 see also Community Clinical Oncology Program Practice guidelines, 61-64, 75, 248 heroin addiction treatment, NIH guidelines, 198-225 see Clinical protocols

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Pregnancy, 36, 49, 65, 153, 195, 207, 239 Preventive interventions, 87, 91, 95, 96, 97, 102-104, 108, 249 academic research, 102-103 school-based, 73-74, 97, 102-103, 240 see also Followup treatment; Identification of abusers; Outreach Prisons and jails, 43, 137 cocaine abusers, 249 cost-effectiveness, 49 historical perspectives, 22, 25 opiate offense incarceration, 200 Professional education, 2, 4, 6, 12-13, 15, 69-70, 76, 97, 107, 119 -120 counselors, 84 guidelines, 62-63, 210-211 Internet sites, 228 licensing/certification, 8, 44, 115, 165, 175 practice-based research networks, 6, 12, 57, 69, 79, 119 see also Academic programs and research; Medical education Program of Assertive Community Treatment, 67-68 Project MATCH, 155, 159, 162, 170, 173 Psychiatric treatment, 16, 25, 61, 150, 152, 154, 170, 172, 203 Psychological factors, see Biopsychological factors Public education, 4, 6, 14, 113, 118 school-based preventive interventions, 73-74, 97, 102-103, 240 see also Mass media Puerto Ricans, 139 Q Quality control, 39, 76, 93, 99 see also Evaluation methodology; Standards R Racial factors, see Minority groups; White persons Referral, 100, 170-174 Alcohol and Drug Services Survey, 191 clinical protocols, 6, 96, 100, 161 self-referral, 191, 192 Regulatory issues, 6, 19, 21, 24, 90-91, 113, 138, 141, 211-212 state barriers, 40 see also Legislation; Standards Relapse and relapse prevention, 16, 30, 33, 34, 58, 100, 236 opiates, NIH statement, 200, 202, 205, 208, 212 outcome monitoring, 154, 157, 158, 159, 163, 164, 170, 171, 172, 195 Relaxation therapy, 175 Religious factors, 24, 85-86, 138, 140, 244 Research, general, vii, 2, 4-11, 14, 56, 111-114, 116 academic/CBO collaboration, 12-13, 76, 79, 87, 96, 98-99, 102-103, 140, 141, 144 agenda building, 21 clinical settings, researchers in, 6, 12, 57, 69, 79, 89-110, 119 cost of practice linkages, 4, 76-77, 111-112 cultural factors, vii, 24, 77, 96 direct CBO contributions to, 73-88 Internet sites, 228 misuse of, 6, 90, 113 models, 111-114, 127, 247 CBOs as researchers, 5-6, 58-70, 83, 85, 123-124, 131 researchers as such, 5-6, 95-105, 123-124 NIH heroin addiction treatment guidelines, 212-214 practice-based research networks, 6, 12, 57, 69, 79, 119 small projects, 7, 76, 84, 114, 148 social factors, vii, 92-93, 94, 158-159 training strategies, 12-13, 15 understudied approaches, 35-40 underutilized, 32-34, 116-117, 135-136, 147-176 see also Academic programs and research; Data collection; Information dissemination; Outcome monitoring; Technology transfer; Theory Research methodology, 80-82, 90, 91-92, 94, 95 Alcohol and Drug Services Study, 187-188 applied social science, 91-92

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clinical trials, 32, 37, 38, 62, 68, 79, 86, 90, 100-101, 106, 148 , 152, 174 cost factors, 81, 101 detoxification, literature review, 148-176 evidence-based treatments, 10-11, 14, 17, 56, 59-60, 63-64, 118 homeless persons, 103-104 longitudinal studies, 249 NIH heroin addiction treatment guidelines, 199 quasi-experimental, 86, 249 report at hand, v-vii, 20-21, 123-134 participants, 128-130, 132-134 see also Evaluation methodology Research recommendations, 1, 18, 123-124, 247-250 CSAT role, 10, 13-15, 18, 74, 94, 100, 117-118, 120 implementation of research, vii, 4-7, 111-114, 148 NIDA role, 9, 10, 12-15, 28, 48-49, 58, 116-118, 119-120, 136 small research projects, 7, 76, 84, 114, 148 technology transfer, 12-13, 48-49, 58, 119-120, 136 treatment facilities placement, 38 Residential treatment, 27-28, 80, 86, 137, 138, 141 Alcohol and Drug Services Survey, 188, 189, 192, 193 outcome monitoring, 150, 155, 159-160, 172 see also Detoxification methods and centers; Halfway houses; Hospitals Revia™, see Naltrexone Runaways, 239 Rural areas, 7, 20, 99, 250 S Saliva testing, 204 SAMHSA, see Substance Abuse and Mental Health Services Administration Scorecards, 11, 61-63, 118 Screening, see Identification of abusers Self-help, see Peer support Self-reporting, 152, 160 Severity of addiction, 154, 168, 170, 173-174, 206, 236, 249 Addiction Severity Index, 103, 155-156, 172 duration of abuse, 153 Smoking, 148, 195 Social factors, general, 20, 80, 87, 97, 139, 142-143 community defined, 136-137 outcome monitoring, 158-159, 160, 172 research, vii, 92-93, 94, 158-159 see also Community-level factors; Cultural factors; Socioeconomic status Social support and services, 20, 31, 34, 86, 97, 116-117, 137, 140 , 141 Alcohol and Drug Services Survey, 187-197 Medicaid, 42, 94, 96, 176, 197 Medicare, 94, 197 welfare, 2, 7, 191, 192, 249 see also Children; Families; Group therapy; Parents; Stakeholders Socioeconomic status, 142-143, 152, 203, 239, 243 see also Homeless persons South Dakota, 30 Special Action Office for Drug Abuse Prevention, 22 Stakeholders, general, 3, 9, 19, 20, 57, 70, 93, 100, 116, 151 Standards, 10, 75, 100 clinical, 6, 12, 96, 100, 161, 233-234 consumer participation, 8, 12, 119 data collection, 104 funding and, 141 level of care, 100 practice guidelines, 61-64, 75, 198-225, 248 professional, 44, 62-63, 115 licensing/certification, 8, 44, 115, 165, 175 State government, vii, 2, 8, 14, 114, 115, 118 AIDS, 105 administrators, 31, 35 consumer participation, 12 professional licensing/certification, 8, 44, 115, 165, 175 service delivery monitoring, 9, 116 see also Block grants

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State-level actions, 22-23, 95-86 service delivery approaches, 35 see also District of Columbia; State government; specific states Statistics, 93 access to treatment, 16 addiction and dependency, national figures, 1, 16, 200, 205-206 Alcohol and Drug Services Survey, 187-188 cancer treatment, 68 counselor training, 44 naltrexone treatment, 33 outpatient treatment, 37 see also Databases; Data collection; Management information systems STEP ONE, 89-90 Stigma, 9, 11, 16, 17, 25, 32, 46-48, 49-50, 116, 153, 205, 210, 213 Structural factors, see Infrastructure; Organizational factors Substance Abuse Prevention and Treatment Block Grant, 7, 114 Substance Abuse and Mental Health Services Administration, v, vi, 17-18, 68, 94-95, 106, 138, 187, 232 Suicide, 168, 239 Synanon, 22 T Technical assistance, 31, 42, 49, 58, 77, 104, 250 Technology transfer, 4, 9, 18, 21, 48-49, 116, 117, 123-124 bidirectional, general, 2, 3, 18, 23, 36, 58-59, 66-68, 121, 123, 135-137, 144, 186-197 CSAT role, 58, 59-60, 115, 120, 136 definitional issues, 57-58 lag time, 19, 29, 31, 250 models, 57-59, 60-62, 77 NIDA role, 12-13, 48-49, 58, 119-120, 136 trust-building and, xv, 3, 5, 56, 57, 66-70, 74, 98, 112 see also Medical education Telephone contacts, 248 Television, 10 Texas, 20, 22, 77 Theory, 79, 81, 87, 90, 91-93 counseling, 80 etiology of drug addiction, 1, 16, 31, 150, 202-204 Therapeutic community, see Synanon Time factors community defined, 137 duration of abuse, 153; see also Severity of addiction duration of treatment, 35, 147, 149, 150, 151, 154, 161-162, 166, 181, 207, 209, 248 research/implementation lag, 19, 29, 31, 250 state implementation of federal requirements, 19 Tobacco, 148 Training, see Education and training Transportation services, 49, 195, 247 Treatment Assistance Publication Series, 58-59 Treatment Episode Data Set, 232 Treatment Improvement Exchange, 59 Trust building, xv, 3, 5, 56, 57, 66-70, 74, 98, 112 Tuberculosis, 25, 65, 195 U University-based programs, see Academic programs and research University of Rhode Island Change Assessment, 157 Urban areas, 7, 160 Urine testing, 33, 49, 151, 160, 164, 166, 187, 204 V Vermont, 30 Videotapes, 58 W Washington, D.C., see District of Columbia Washington State, 20 Welfare programs, 2, 7, 249 Alcohol and Drug Services Survey, 191, 192 Medicaid, 42, 94, 96, 176, 197

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West Virginia, 30 WESVAR, 188 White persons, 192, 193, 194 Withdrawal, 149, 155, 202, 203, 204 alcohol, 49 methadone, withdrawal from, 166, 204, 208 opiates, 151, 166, 207-208, 244 see also Detoxification methods and centers; Drugs to treat abusers Women, 34, 36, 140, 153-154, 194, 237, 238 see also Pregnancy Wraparound services, 20, 34