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Chapter 7--Is treatment available?
Pages 163-182

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From page 163... ... Determining whether services are Appropriate is a matter of no small complexity; a judgment of appropriateness indicates that a match has been made between the specific needs of the "client" whether an individual, a group, or a community-and the services and resources available and utilized (Gunnersen and Feldman, 1978; NIAAA, 1980; Brown University Center for Alcohol Studies, 1985; Gilbert and Cervantes, 1988; McAullife et al., 1988; New York Division of Alcoholism and Alcohol Abuse, 1989~. Data on accessibility to treatment for alcohol problems are even sparser than those for availability; additional studies of accessibility are needed before a more comprehensive review can be undertaken. Read the entire page →
From page 164... ... Interest remains, however, in determining the relationship of the level of need to the treatment available, although a great deal of this effort may be driven as much by the need for a methodology to conduct certificate of need reviews (i.e., reviews required if inpatient services are to be expanded) as by the need to plan and allocate treatment funds (Brown University Center for Alcohol Studies, 1985; New York Division of Alcoholism and Alcohol Abuse, 1988~. Read the entire page →
From page 165... ... Given the absence of recent studies on which to base judgments about the differential availability of treatment, the committee decided to use whatever published data were available to look at the distribution of alcohol problems treatment resources across the country. There are a number of problems in conducting such a national analysis because there are no consensually accepted methods for determining either the prevalence of alcohol problems or for projecting the appropriate level of treatment resources that will be required (Wilson and Hartsock, 1981; Brown University Center for Alcohol Studies, 1985; Institute for Health and Aging, 1986~. Read the entire page →
From page 166... ... A replication of the or~g~ucl AEDS resew of the methods ire use by the states for both reeds estimation and determining resource availability is indicated and would be useful for future planning and resource allocation if the states could agree on a common methodology. Despite the important gaps noted above, there are nonetheless several data sources that can provide a rough first comparison of available treatment resources and the prevalence of alcohol problems which can be used as a preliminary answer to the question: "Is treatment for alcohol problems equally available throughout the United States? Read the entire page →
From page 167... ... The first, the National Drug and Alcoholism Treatment Utilization Survey (NDATUS) , is designed to be a census of all known facilities and programs that provide a distinct organized program of alcohol and drug abuse services. Read the entire page →
From page 168... ... Since 1979, the major survey, now known as the National Drug and Alcoholism Treatment Unit Survey (NDATUS) , has been conducted jointly with the National Institute on Drug Abuse; consequently, the NDATUS surveys two kinds of units that offer services to persons with alcohol problems: (1) Read the entire page →
From page 169... ... Inpatient/residential Medical detoxification939 6,391 10,353 62 Social detoxification390 4,015 6,154 65 Rehabilitation/recove~y2,185 37,501 50,615 74 CustodiaVdomicilia~y2,168 2,688 3,822 70 Total5,682 50,595 70,944 71 Outpatient/nonresidential3,701 287,333 345,393 83 Total inpatient and5,627 337,928 416,337 81 outpatient SOURCE: Based on data from the 1987 National Drug and Alcoholism Treatment Utilization Survey (NIDA/NIAAA, 1989) unit (i.e., the maximum number of individuals who could be enrolled as active clients given the unit's staffing, funding, and physical facility at the time of the census) Read the entire page →
From page 170... ... The national rate for budgeted treatment capacity for outpatient care was 1.41 persons per thousand. The national treatment capacity rates for the four types of care identified as only taking place in an inpatient setting were as follows: 0.04 for medical detoxification, 0.03 for social detoxification, 0.21 for rehabilitation, and 0.02 for domiciliary care. Read the entire page →
From page 171... ... Recovery Domiciliary Total Alabama 0.016 0.004 0.172 0.025 0.217 0.195 0.412 Alaska 0.054 0.002 0.481 0.064 0.601 0.029 3.860 Arizona 0.033 0.083 0.277 0.032 1.425 1.023 1.448 Arkansas 0.041 0.007 0.177 0.022 0.247 0.445 0.692 California 0.022 0.027 0.337 0.003 0.389 2.302 2.691 Colorado 0.018 0.089 0.166 0.027 0.300 3.338 3.638 Connecticut 0.055 0.018 0.220 0.010 0.302 0.881 1.183 Delaware 0.049 0.027 0.171 0.000 0.246 2.116 2.362 Dist. of Columbia 0.102 0.000 0.489 0.146 0.738 1.260 1.998 Florida 0.056 0.047 0.198 0.034 0.335 0.739 1.074 Georgia 0.055 0.001 0.109 0.010 0.175 0.896 1.071 Hawaii 0.002 0.014 0.260 0.000 0.275 0.514 0.789 Idaho 0.065 0.031 0.232 0.008 0.336 1.347 1.682 Illinois 0.018 0.033 0.111 0.017 0.178 0.929 1.108 Indiana 0.019 0.014 0.105 0.014 0.153 1.107 1.260 Iowa 0.026 0.011 0.283 0.029 0.348 1.216 1.565 Kansas 0.021 0.029 0.205 0.009 0.264 1.082 1.346 Kentucky 0.015 0.015 0.117 0.016 0.163 1.375 1.538 Louisiana 0.008 0.004 0.119 0.002 0.133 0.940 1.074 Maine 0.072 0.000 0.190 0.024 0.286 2.852 3.138 Maryland 0.031 0.002 0.167 0.047 0.306 2.315 2.621 Massachusetts 0.136 0.002 0.287 0.005 0.429 1.985 2.415 Michigan 0.030 0.002 0.144 0.000 0.176 1.702 1.878 Minnesota 0.039 0.017 0.430 0.020 0.506 3.390 0.896 Mississippi 0.042 0.035 0.198 0.017 0.291 1.706 1.997 Missouri 0.030 0.027 0.202 0.007 0.266 0.802 1.069 Montana 0.012 0.016 0.385 0.000 0.414 1.509 1.923 Nebraska 0.011 0.044 0.269 0.012 0.336 2.810 3.147 Nevada 0.010 0.057 0.266 0.000 0.333 0.586 0.919 New Hampshire 0.141 0.038 0.371 0.013 0.563 1.423 1.986 New Jersey 0.063 0.007 0.246 0.048 0.364 1.190 1.986 New Mexico 0.031 0.056 0.347 0.000 0.434 2.324 1.554 New York 0.052 0.101 0.143 0.008 0.303 1.882 2.758 North Carolina 0.020 0.039 0.124 0.008 0.190 0.851 2.185 North Dakota 0.107 0.000 0.336 0.000 0.570 2.862 1.141 Ohio 0.029 0.004 0.158 0.019 0.215 1.220 3.433 Oklahoma 0.008 0.014 0.153 0.001 0.176 0.834 1.010 Oregon 0.035 0.037 0.302 0.035 0.410 2.661 3.071 Pennsylvania 0.123 0.006 0.288 0.004 0.421 1.500 1.921 Puerto Rico 0.002 0.013 0.071 0.006 0.092 1.285 1.377 Rhode Island 0.081 0.020 0.364 0.012 0.478 2.996 3.473 South Carolina 0.023 0.033 0.099 0.002 0.157 3.164 3.320 South Dakota 0.040 0.068 0.306 0.095 0.510 2.144 2.654 Tennessee 0.012 0.008 0.143 0.003 0.166 0.569 0.735 Texas 0.055 0.008 0.178 0.007 0.248 0.300 0.548 Utah 0.026 0.014 0.227 0.062 0.329 2.186 2.514 Vermont 0.000 0.018 0.144 0.029 0.192 2.082 2.274 Virginia 0.041 0.011 0.151 0.017 0.220 1.185 1.405 Washington 0.059 0.006 0.197 0.006 0.268 2.365 2.632 West Virginia 0.007 0.000 0.086 0.000 0.094 0.205 0.344 TABLE 7-2 continues Read the entire page →
From page 172... ... Five states had no units reporting social detoxification beds. As shown in Table 7-2, the rate for total budgeted treatment capacity ranges from a low of 0.34 beds per 1,000 persons in West Virginia to a high of 3.86 for Alaska. Read the entire page →
From page 173... ... There is wide variation among the states in the per capita expenditure reported for treatment for all types of care. The total per capita expenditures range from highs of $23.54 reported for Rhode Island and $22.70 for North Dakota to lows of $2.36 and $1.33 reported for Oklahoma and Puerto Rico, respectively. Read the entire page →
From page 174... ... Regardless of the determinants of the variation-, the important finding in. the committee's analysis of the 1987 NDATUS irlforrnation is the extreme variation among the states in the per capita expenditure offends for the treatment of Alcohol problems, affording that suggests that there is extremes differentu~l availability of treatment resources across the country. Read the entire page →
From page 175... ... Expenditureb CirrhosisC (gallons) d Texas 0.17 3.68 8.61 2.63 Utah 0.10 5.43 8.71 1.58 Vermont 0.16 4.49 10.84 3.18 Virginia 0.10 6.02 8.65 2.53 Washington 0.16 5.44 9.81 2.66 West Virginia 0.13 2.84 8.48 1.64 Wisconsin 0.18 6.84 7.54 3.16 Wyoming 0.24 4.60 10.37 2.64 National total 0.13 6.99 10.58 2.58 aSOURCE: Committee analysis of data from the 1986 AHA Annual Surveyor of Hospitals (American Hospital Association, 1987~. Read the entire page →
From page 176... ... Relationship Between Treatment Availability and the Prevalence of Alcohol Problems To assess whether there was any relationship between the distribution of treatment resources and the prevalence of alcohol problems within the various states, the committee computed Pearson product moment correlations between the treatment capacity rates and two commonly used indirect indexes of the prevalence of alcohol problems that require treatment: apparent per capita consumption of beverage alcohol (Williams et al., 1986; Steffens et al., 1988) and age-adjusted death rates for chronic liver disease and cirrhosis (Colliver and Malin, 1986) Read the entire page →
From page 177... ... For the 50 states and the District of Columbia, the correlation between apparent per capita consumption and the NDATUS rate of budgeted capacity for treatment is .02, which suggests that there is no relationship between this index and the availability of specialist treatment for alcohol problems. The correlation between the cirrhosis mortality rate and the NDATUS total per capita budgeted treatment capacity is .04, again suggesting that there is no association between treatment resources and the level of alcohol problems. Read the entire page →
From page 178... ... Through review of the scant literature and committee analysis of the most relevant data available from the NDATUS and AHA surveys of providers, the committee found that specialist treatment is not equally distributed throughout the country. There is wide variability between jurisdictions in total available treatment capacity. Read the entire page →
From page 179... ... Having such data collected in such a standardized manner across jurisdictions would make surveys like NDATUS and SADAP more useful and would allow researchers to carry out the needed in-depth studies of availability and accessibility within and across states using comparable data on the persons assigned to various treatments. It is clear that there is sufficient variation in treatment resources across the states to conclude that equal availability to specialist treatment for alcohol problems does not exist in this country. Read the entire page →
From page 180... ... Prepared for the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse, Washington, D.C.: National Association of State Alcohol and Drug Abuse Directors, Inc. Colliver, J Read the entire page →
From page 181... ... S Senate Committee on Governmental Affairs hearing regarding an overview of federal activities on alcohol abuse and alcoholism, National Association of State Alcohol and Drug Abuse Directors, Washington, D.C., May 25. Read the entire page →
From page 182... ... 1987a. 1987 National Drug and Alcoholism Treatment Unit Survey: NDATUS Instruction Manual for States and Reporting Units. Read the entire page →

From page 163...

... Determining whether services are Appropriate is a matter of no small complexity; a judgment of appropriateness indicates that a match has been made between the specific needs of the "client" whether an individual, a group, or a community-and the services and resources available and utilized (Gunnersen and Feldman, 1978; NIAAA, 1980; Brown University Center for Alcohol Studies, 1985; Gilbert and Cervantes, 1988; McAullife et al., 1988; New York Division of Alcoholism and Alcohol Abuse, 1989~. Data on accessibility to treatment for alcohol problems are even sparser than those for availability; additional studies of accessibility are needed before a more comprehensive review can be undertaken.

Chapter 7--Is treatment available? Pages 163-182

Chapter 7--Is treatment available?
Pages 163-182