models, even if direct payment to consumers were permitted by federal policy controlling the use of block grant money.
Those who define and implement policies have a third perspective and report yet another set of problems. They do not find the research literature easily accessible. They point to the oversupply of information at all levels, too little of which supports the cost-effectiveness of the programs they fund and administer. For information to be effective, they argue, it must respond directly and easily to the needs of increasingly time-pressed individuals and organizations. Providing information on complex and difficult technical issues poses special challenges for all involved (IOM, 1997b). Frustrated by the time lag and the flood of printed material, policymakers tend to rely on familiar sources to select and summarize the information relevant to them as the issues emerge (Young, 1997).
Policymakers and treatment providers both faulted researchers for having no concept of real time. One provider who participated in a multisite study comparing treatment modalities said that some programs were dead when the positive findings were reported five years after the study ended. However, the value of having the right information at the right time was illustrated by the workshop participant who reported that a timely cost effectiveness study resulted in the 600 substance abuse treatment programs in Ohio receiving a 30 percent funding increase for the biennium (Ohio Department of Alcohol and Drug Addiction Services, 1996). A state agency director expressed the need for faster research turnaround this way:
Much research now being published was conceived several years or a decade ago, when a much different system was in place—when today's problems were just beginning. Research funding should support more exploratory, quasi-experimental, clinically relevant studies. Secondary analyses and meta analyses of state agency data might reveal useful information. (Appendix J)
The consumer perspective is often overlooked. There is no popular literature pushing new research findings to consumers, as there is for other chronic disease conditions. Consumers generally have fewer options in selecting drug treatment programs than in other areas of medical care. When choice is available it is difficult to obtain information to make an informed decision and the individual may also find that the treatment of choice is not provided or not covered by their insurance. Few treatment consumers are effective advocates, and former consumers are busy building lives. Individuals needing treatment may want more treatment capacity to reduce waiting lists, more convenient locations and hours for treatment, better integration of drug abuse treatments with other needed medical and social services, counselors with more training, better detoxification facilities, more research into the causes and treatments of drug abuse disorders, and help in reducing