In one sense that director would be right, since society clearly rations health care in the field of drug dependence on a different basis than rationing occurs in other health care areas. Payment is available only for inexpensive treatments, while the research evidence for efficacy of other treatments is disregarded. Such rationing leads to waiting lists as the agency must cut treatment slots and serve fewer people. Decreasing the length of treatment and increasing counselor caseloads also blocks the utilization of new treatments of proven efficacy.


Considerable resources flow into drug abuse research but it often takes years before research findings change drug abuse treatment. In a review of outcome studies addiction treatment was shown to be about as successful as treatment of other chronic disorders such as hypertension, diabetes, and asthma. Indeed, less than 50 percent of patients with insulin-dependent diabetes, and less than 30 percent of patients with hypertension or asthma, comply with their medication regimens, with consequently sizable rates of reoccurrence or worsening of condition. These rates are comparable to success rates for treatment of persons with addictive disorders, (O'Brien and McLellan, 1996). Treatment is the most effective way to cut drug use and drug abuse treatment is clearly cost-effective from a societal perspective (Caulkins et al., 1997; Gerstein et al., 1994; SAMHSA, 1997). Despite this evidence, less than 20 percent of those who need treatment are receiving it and there are many barriers to implementing better treatment and providing better access.

With the knowledge explosion taking place in understanding the biology of the brain and the mechanisms of addiction, it is difficult for the best informed and best intentioned treatment provider, researcher, or state substance abuse director to keep abreast of the science. As new treatment questions and new research answers flow out of the new scientific understanding, new policy questions arise. It is important to enhance the exchange of information and knowledge among the research, treatment, and policy areas in order to bring the benefits of treatment research to the drug treatment consumer and to society.

In summary, there are many gaps in communication among treatment, research, and policy, the three key segments of the drug abuse treatment community. These gaps are caused (or exacerbated) by a set of critical barriers to better communication and coordination. Other barriers include lack of advocacy efforts, and lack of training opportunities (and requirements) in substance abuse treatment and research for all health-related professions. In addition, many CBOs lack organizational resources to implement new treatment findings while they are struggling with the complexi-

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