that treat drug abuse are not equipped to manage on-going primary care for these complex needs. This has motivated some programs to integrate primary care services with drug abuse services for these special populations, typically in university-based settings, but the effectiveness of integrated services requires systematic evaluation. Similarly, drug abusing women and their children require a composite of services to effect positive outcomes (Rahdert, 1996) (see Box 2.1). In the California comprehensive model of care for drug-addicted women, the relationship between services offered and outcome is currently being evaluated (Brindis et al., 1997).

Evaluations of the effectiveness of service delivery methods have identified important variables in determining outcome, including patient factors at treatment, duration and intensity of treatment, and service delivery methods and their determinants (McLellan et al., 1996). Outcome studies of a wide variety of programs and service delivery methods demonstrate, when keeping patient characteristics, treatment intensity, and duration constant, some programs have much more success than others. In another study of subjects receiving methadone only, standard methadone treatment, and enhanced methadone services, the enhanced treatment group demonstrated the greatest improvement in the areas of personal adjustment and public health and safety risk (McLellan et al., 1993).

However, reviews of multimodal service delivery across a variety of settings indicate that many modalities had not been sufficiently evaluated (Floyd et al., 1996). Properly designed research is needed to assess the extent to which improvement in outcome can be expected using various increments of treatment intensity. This requires systematic variation in treatment dose as a key element in determining outcomes. In order to determine the most cost-effective mix of treatment and service delivery methods, much more well-designed health services research must be conducted in this area.

According to a state agency chief and research director who were interviewed by a committee member, state planners would like research in community programs to address such issues as:

  • How brief can brief contacts be and still be effective?
  • How much do interventions cost (including assessment, training, consultation, and administrative costs, cost efficacy and cost offsets)?
  • Where should treatment be provided? Examples: medical center, home, workplace, telephone contacts? (See Appendix J)

Treatment Approaches That Are Understudied in Research

Just as research findings have been underutilized in the treatment community, there are treatment approaches that have been understudied by the research community. In committee roundtables providers said they needed

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