the increased risk of drug problems among children of drug abusers. But, there is little structure for consumer input. The stigma and denial attached to addiction inhibit consumer action and social support.

Despite these handicaps, there is support for treatment and research for problems of drug dependence. Often it is built on the need to defend society from drug abusers, rather than on a need to help "victims" of addiction. Mayors and county officials may lobby their state and federal representatives for help in controlling drug problems with treatment. Judges and district attorneys can also be effective voices for change as they seek treatment resources for the growing drug court movement (Drug Strategies, 1997); but drug abusers rarely lobby for more treatment. Addicted persons are not in a strong position to ask society for help.

The committee identified several examples of research findings that are not generally utilized or are underutilized in various components of the treatment system. They include pharmacotherapy and psychosocial treatments as well as service delivery approaches. The issues are introduced in this chapter to illustrate the consequences of the gaps between research, treatment and policy. They are discussed in greater detail in a paper by McLellan and McKay included as Appendix D.

Medications in the treatment of drug abuse disorders are underutilized in many community-based treatment settings. Methadone maintenance for treatment of opiate addiction provides an example of the difficulty implementing established findings and knowledge in this field. Adequately designed clinical trials have consistently shown that methadone maintenance treatment is effective only when methadone is given in adequate doses (Ball and Ross, 1991; Caplehorn and Bell, 1991). Despite this research finding, past surveys have found many treatment programs that prescribe inadequate methadone doses (Calsyn et al., 1991; D'Aunno and Vaughn, 1992), although this situation may be improving according to recent reports (Leshner, 1997).

The reasons for this low dosage of methadone may still include lack of adequate information concerning the effectiveness of higher doses, despite public statements of support by such authorities as the National Institutes of Health and Office of National Drug Control Policy. Ambivalent attitudes concerning the use of medications in the treatment of drug abuse disorders may also be a contributing factor. However, while this study was under way, an important and historic event took place which may be a hopeful indicator for change. In 1997 the National Institutes of Health convened a Consensus Development Conference on Effective Medical Treatment of Heroin Addiction, the first NIH conference on this topic. After