treatment reimbursement in his state was less than the value of one set of vouchers. And certainly there is the public perception that people should not be paid for staying drug free.

Service Delivery Approaches

Drug abuse providers treat persons who are physically, emotionally, socially, and economically unstable. Standard treatments may target only one facet of their need. Service delivery methods, which involve bundling drug abuse treatment with other services that address the multiple disabilities of addicted individuals, have been shown to promote recovery and prevent relapse. Service delivery approaches include, for example, case management, rapid admission, programs geared to the special requirements of treating women with children, as well as so-called ''wraparound services" such as medical care, job training, and social services. Providers who spoke with the committee saw the decline of such services in their communities as a significant barrier to successful treatment. Research based on data from NIDA's Drug Abuse Treatment Outcome Study (DATOS) reports a widening gap over the last decade between the need for services that go beyond basic drug abuse treatment and the supply of such services (Etheridge et al., 1995). An exception to this disheartening decline of supportive services is the DATOS finding that methadone programs are treating more medical problems than in the past. This report also mentions that methadone dosage levels have improved from earlier years (Leshner, 1997). Others have reported the need for and the contribution of supportive services to treatment outcomes (Ball and Ross, 1991; McLellan et al., 1994; Widman et al., 1997).

Adolescents with a drug abuse problem are another special needs population and one that is still growing overall despite the decline at younger ages (Johnston et al., 1997). When there is co-occurring mental illness or physical handicaps in this population the need for integrated services becomes even more important. Yet few are able to receive treatment from a single source. And if they do find treatment they may be subject to conflicting directions of mental health and substance abuse clinicians. Left to the mercies of these disparate systems, many such young people fall through the cracks (National Health Policy Forum, 1998).

Other special needs in consumers of drug abuse services also have motivated a services delivery approach to treatment. For example, drug abusers are at high risk of contracting the human immunodeficiency virus (HIV), and those with HIV have significant medical needs that cannot be managed in many treatment programs (e.g., HIV treatment, tuberculosis monitoring and diagnosis, and treatment of sexually transmitted diseases) (Selwyn, 1996). Many community-based treatment organizations (CBOs)



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