1980s and concerned a method for providing employment-related training for ex-drug abusers (Hall et al., 1988; Sorensen et al., 1988). This random assignment study found that dissemination methods employing personal contacts (site visits and conferences) produced significantly more adoptions than did printed materials alone. There were also adopter site differences: residential programs were more likely to adopt the employment workshop than were outpatient programs.

Published case studies include a description of the implementation of NIDA's cocaine prevention program (Forman and Lachter, 1989). NIDA also sponsored a project to educate injection drug users about HIV risk reduction outside of drug abuse treatment clinics (Brown, 1995). Their dissemination model included extensive training and technical assistance with a newsletter publicizing the positive outcomes, and annual meetings of program administrators and practitioners. Another case study examined the difficulties of disseminating an alcohol withdrawal protocol and a pharmacotherapy technique (Naranjo and Bremmer, 1996). A case study of an international project called Effective Care in Pregnancy and Childbirth reviews and illustrates the principles involved in ''retailing research" to bridge the barriers across the cultures of researchers and practitioners (Lomas, 1993). Technology transfer in drug abuse treatment appears to be a fruitful field for further work.

Policy Barriers

In the environment described above, it is easy for society to ration drug treatment, or reject certain forms of treatment. The usual argument advanced for funding drug abuse treatment is not that addiction is a treatable chronic disease, but that drug abuse treatment is cheaper than prison and cheaper than treating AIDS. Drug-dependence treatment is relatively cheap, although not readily available. Residential treatment programs provide intake evaluations, group and individual counseling, recreational therapies, urine monitoring, transportation to supervised work, regular reports to licensing and referring agencies, housing, and all meals at a daily cost less than the bill for sleeping overnight at a mid-price hotel and considerably less than the costs of staying in jail (Kaskutas, 1998). As shown in Figure 2.1, all federal spending on drug treatment has increased less than inflation in recent years.

Prejudice against addicts can also lead to policies that prevent the use of improved treatment approaches. Research has shown that prolonged maintenance treatment with methadone and other opioid agonists like LAAM (levo-alpha-acetylmethadol) and buprenorphine reduces mortality and morbidity among drug abusers and reduces crime in the community (see Appendix F). However, methadone maintenance treatment is banned in many



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