practical, relevant research results that they could implement with the resources available to them. Some representatives of community-based drug treatment programs expressed the belief that researchers were not knowledgeable about community-based treatments. They suggested providers should be involved in research from the beginning to help formulate research questions that were important to them, rather than just serving as a research site for investigating researchers' ideas. As the paper by McLellan and McKay points out there is a strong need to identify clinical and policy issues that should be the focus of future research to fill the gaps between what is known and what needs to be known (see Appendix D). The committee found little evidence of research that systematically examines the distribution of treatment research across different kinds of modalities of drug abuse treatment.

The National Institute on Drug Abuse recognizes that very few researchers are studying therapeutic communities, and the research that has been done tends to focus on assessing their overall effectiveness rather than investigating how they work, why, or for whom (Chasnoff et al., 1996). Consequently, NIDA has given a prominent role in its new treatment initiative to increasing research with therapeutic communities (Leshner, 1997).

The treatment modality most commonly available is the outpatient modality. Outpatient programs offer counseling to drug abusers or their families. The term "outpatient" encompasses a variety of treatment programs that may have little in common, except that they do not offer a place to live (Sorensen and Bernal, 1987). The 1990 NIDA-sponsored Alcohol and Drug Research Study found that outpatient "drug-free" treatment accounted for approximately half of the total treatment, and were offered in 71 percent of all facilities (Batten et al., 1993). Preliminary data from a SAMHSA study carried out by the same researchers in 1997 showed that outpatient nonmethadone treatment accounted for more than 60 percent of total treatment in a national sample of drug and alcohol treatment facilities (see Appendix E).

Other nontraditional treatment programs may be more widespread than research evidence would indicate. For example, acupuncture treatment of addiction is commonplace in the growing drug court movement. The National Acupuncture Detoxification Association points out that acupuncture is used in over 200 programs across the United States. There have been many studies of its potential usefulness but until now these studies have generally provided equivocal results because of design, sample size, and other factors. A review of 22 controlled clinical trials of acupuncture for addiction treatment concluded that the strength of positive findings varied inversely with the methodological rigor of the study (Ter Riet et al., 1990). Widespread support for acupuncture has persisted despite these review findings. An NIH consensus development panel reviewed this issue



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