Broadening the Base of Treatment for Alcohol Problems (1990) / Chapter Skim
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Chapter 21--Leadership
Chapter 21--Leadership
Pages 485-504
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From page 485... ...
A review of some of the commission's conclusions and recommendations can be helpful in illustrating the progress that has been made in recent years. As noted in its report, the state of affairs when the commission began its work in 1967 was problematic: Public attitudes and feelings about drinking and about alcohol abuse have significantly influenced the way services for alcoholics have developed.
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From page 486... ...
With the knowledge this comprehensive assessment provides, explicit guidelines can subsequently be used to match individuals seeking treatment with what is likely to be the most effective treatment for them. To employ matching a broad range of well-speciffed treatment interventions must be made available if appropriate treatment is to be offered to all who seek it.
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From page 487... ...
Prototype examples are available in some jurisdictions in the public sector (e.g., Minnesota's consolidated fund, Ontario's independent assessment and referral centers) and in some organizations in the private sector (e.g., utilization management companies, employee assistance programs)
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From page 488... ...
In recent years, Congress has shown an increasing willingness to share this role with the states through the development of the block grant mechanism to fund categorical services for the uninsured and indigent. It is also sharing the role with the employers who are the major purchasers of private health insurance by its unwillingness to pass legislation mandating a specific benefit for the treatment of alcohol problems.
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From page 489... ...
Medicare and Medicaid have narrow provider eligibility criteria that exclude providers who offer social model alternatives; they continue to support only a medical model of hospital-based detoxification and rehabilitation whereas the majority of states, using block grant funds, support a mixed medical and social model that also includes maintenance and extended care in nontraditional, nonhospital settings. While different oversight committees are involved for the different federal treatment programs, all could use similar or identical guidelines to review the current manner in which pretreatment assessment, referral and matching to treatment, treatment itself, and outcome monitoring are carried out.
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From page 490... ...
Medicare is not participating in the system. Conversely, the alcohol, drug abuse, and mental health block grant and many of the state alcoholism authorities exclude hospital-level service from their funded options because of cost.
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From page 491... ...
Whether such funding is part of the categorical program administered under the state alcoholism authority or supplied by Medicaid, the following questions are relevant: Do the standards and policies indude a provision for comprehensive pretreatment assessment? Do the standards and policies require outcome monitoring and performance contracting?
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From page 492... ...
Using the network of drinking-driver programs as test sites, some of the newer brief intervention strategies along with comprehensive pretreatment assessment and continuity assurance could be introduced and evaluated following a process outlined below. State-administered and state-regulated drinking-driver programs already have in place a prototype version of the comprehensive assessment process discussed in Chapter 10, as well as a network of probation specialists responsible to the court for reports on offenders, progress and outcome.
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From page 493... ...
The Leadership Opportunity for Employers and Private Insurers Insurers and employers are major purchasers of health care in general and of treatment for alcohol problems in particular. Similarly to the federal and state governments that also purchase these services, employers and insurers are seeking answers to questions about the effectiveness of treatment services to aid in cost containment and benefit design.
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From page 494... ...
Are those medical model and social model venders that provide the most cost-effective treatment part of the continuum and eligible to participate in the plan? Are the participating venders capable of providing the alternative treatments (e.g., brief interventions, ambulatory detoxification, day care)
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From page 495... ...
Employers and insurers can also provide leadership by requiring the implementation of the committee's recommendations in any managed care arrangement which they develop or with which they contract, be it an HMO or a preferred provider network The HMO or preferred provider network should include an organized system for the treatment of alcohol problems that includes screening and the opportunity for brief intervention in the generalist system before referral to the specialist system (see Chapter 9~. The managed care specialist system should include pretreatment assessment)
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From page 496... ...
Each community could work toward implementing the comprehensive spectrum of intervention responses that constitutes the vision of this committee_including the opportunity for brief intervention in the generalist system before referral to the specialist system, as well as pretreatment assessment, matching, continuity assurance, and outcome monitoring in the specialist system. The Leadership Opportunity for the Professions and Training Programs One of the focuses of the Cooperative Commission's recommendations in the late 1960s was development of enhanced services for problem drinkers within existing health, welfare, and community mental health agencies as well as on the development of a separate network of specialized services (Plaut, 1967~.
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From page 497... ...
Ihe Leadership Opportunity for the National Institute on Alcohol Abuse and Alcoholism That there needed to be strong federal leadership, and discrete federal and state administrative entities working in close partnership, was the theme of several of the Cooperative Commission's recommendations (Plaut, 1967~. NIAAA and the state alcoholism authorities were subsequently established, and the goal of a strong federal presence was achieved for many years.
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From page 498... ...
These allocations are relatively small amounts, considering the need for research on treatment effectiveness outlined here and in the 1989 IOM report, Pr~venfion and Treatment of Alcohol Problems: Research Opportunities. Yet recently, there have also been some heartening changes: the creation of the Treatment Research Branch within NIAAA's new Division of Clinical and Prevention Research; the reestablishment of a specific services demonstration authority for NLAAA in the Anti-Drug Act of 1988 (P.L 100~90, Sec.
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From page 499... ...
A recommendation more directly tied to the implementation of its vision is the committee's suggestion that NIAAA be given the additional resources to fund clinical research consortia in several communities around the country to test the feasibility of implementing its proposed comprehensive system. Such a plan would involve the development of sites designed to undertake cooperative studies of the effectiveness of specific treatment approaches with specific target groups when assessment and outcome monitoring, including detailed cost data, are in place.
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From page 500... ...
The criteria for association should include an agreement to participate fully in the pretreatment assessment of individual patients and the posttreatment monitoring of outcome and, whenever possible, in clinical trials of specific treatments. The number of treatment programs involved in any one consortium is not as critical as having a range of treatments that represent the entire continuum of care.
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From page 501... ...
This divergence comes from the unique perspective these groups bring to community needs and interests and as such represent a substantial force for change in both the public and private sectors. It is the committee's hope that these groups can adopt the broad perspective on alcohol problems presented in Chapter 1 and work with the relevant government agencies, treatment providers, third-party payers, and professional associations to develop a full response in both the generalist and specialist sectors to persons at each level of the spectrum.
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From page 502... ...
Presented at the U.S. House of Representatives, Subcommittee on Commerce, Consumer Protection and Competitiveness hearing regarding insurance coverage of drug and alcohol abuse treatment.
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From page 503... ...
Special Committee on Alcohol and Drug Abuse Policy.
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