Bridging the Gap Between Practice and Research Forging Partnerships with Community-Based Drug and Alcohol Treatment (1998) / Chapter Skim
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Appendix I: Opportunities for Collaboration
Appendix I: Opportunities for Collaboration
Pages 235-245
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Table I-1 identifies some of the major gaps between what is known from treatment research and what is actually practiced in the outpatient drug abuse treatment system. It suggests questions that could be addressed with more services research and collaboration with treatment providers.
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. Increasing Prevalence of individualized treatment planning unknown Current treatment goals are abstinence, physical health, relationship improvement, not "responsible use" Expert opinion identifies acceptance of responsibility, relapse prevention, denial reduction as core mechanisms of effective treatment Current practice involves individual and group therapy and addiction education High-dose methadone treatment is effective but many programs restrict dosage levels and client participation in treatment planning Supportive legal, family, job, and medical services are important for effective treatment Less than half of treatment settings .
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outpatient drug-free programs Hospital and mental health settings utilize more professionals in treatment Public programs provided better access than private-for-profit programs Private-for-profit programs may achieve lower cost by reducing individual treatment intensity SOURCE: Price RH.
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Managed care organizations, however, often promote case management as an essential tool. While investigations of case management for drug abuse treatment demonstrate that case managed clients receive more services, evidence that outcomes improve has emerged less clearly (Orwin et al., 1993)
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Most data on adolescent treatment focuses on description of services, anecdotal reports, or uncontrolled studies (Tarter, 1990~. Data on outreach, early intervention, treatment outcome, and cost efficacy for adolescent substance
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American Indian and Alaska Native Mental HealtI7 Research 1(3)
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They include the following: the role of the community in motivating drug abusers to seek treatment, organizing groups of addicts to seek treatment concurrently, and in providing family/household support for the addict in treatment (Westermeyer and Bourne, 19781;
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Although these investigators have demonstrated the effectiveness, and even the cost efficacy of these methods, they have not been widely applied. This is probably due to the complexity of the approach, the need for community and treatment resources to cooperate, the requirement for an overarching plan with "reinforcement" of the respective positive as well as negative consequences.
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These include: . outpatient clinics (Lowe and Alston, 1973~; · seeking community cohorts of addicts to enter treatment concurrently or at least within months of one another (Westermeyer and Bourne, 1978~; schools (Red Horse, 1982~; community programs for mentally retarded persons (Westermeyer et al., 1988~; and · building a community consensus about modal or acceptable use versus unacceptable use (Beauvais, 1992~.
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A few studies have shown the feasibility of studying addiction treatment in religious settings (Westermeyer, 19801. In one quasi-experimental comparison of a religion-based program versus a medically based program for opiate addicts in Asia, the religion-based program had a higher mortality during opiate withdrawal; but follow-up failed to show differences between abstinence rates between the two therapies (Westermeyer and Bourne, 19781.
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1976. "Brainwashing" as a therapeutic technique in contemporary Canadian Indian spirit dancing: A case in theory building.
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