Broadening the Base of Treatment for Alcohol Problems (1990) / Chapter Skim
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Introduction and Summary
Introduction and Summary
Pages 1-12
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critically review available research knowledge and experience in the United States and other countries regarding alternative approaches and mechanisms (including statutory and voluntary mechanisms) for the provision of alcoholism and alcohol abuse treatment and rehabilitative services; (b)
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The financial aspects of treatment proved a common interest in the substance abuse coverage study and this study; nevertheless, the interest of the former focused on drugs other than alcohol and on mechanisms of insurance coverage, whereas the treatment study committee concerned itself with more general aspects of the financing of treatment
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The role of staff was technical and supportive; the content of the report is the responsibility of the committee. In addition, a project officer from NIAAA subserved important liaison functions and provided invaluable information throughout but did not participate in executive sessions of the committee when recommendations were formulated.
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Each task force developed a written report, on which much of the material in the final report is based. Some of the task forces, such as the Task Force on Assessment and Treatment Assignment, developed literally volumes of original written resource materials, some of which are cited as references at appropriate places in the report text.
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Many other federal, state, and local governmental agencies are significantly involved in the support of treatment efforts for alcohol problems, and it is hoped the report will also be useful to these organizations. Another very important audience for the report is what those who are in it often refer to as The field" those indispensable persons and organizations whose work focuses on the understanding and treatment of alcohol problems.
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The role of community agencies in treatment would include the identification of individuals with alcohol problems, the provision of brief interventions to a portion of those identified, and the referral of others to specialized treatment. Specialized treatment would emphasize comprehensive pretreatment assessment, the matching of particular individuals to specific treatment interventions, and the regular determination of the outcome of treatment.
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There is no one uniformly effective treatment approach for all persons with alcohol problems. Providing appropriate specific treatments, however, can substantially improve outcome.
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There is a need for a comprehensive effort to identify persons having few but significant alcohol problems and to deal with them effectively and efficiently outside of the context of specialized treatment and within the community itself. Fortunately, suitable methods of identification and readily learned brief intervention techniques with good evidence of efficacy are now available.
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The committee recommends that four or five model comprehensive treatment systems be implemented as demonstration projects in the immediate future, with provision for full, objective evaluation of all aspects of their functioning and of their treatment outcomes. Special Populations in Treatment Overview am Deft rat ons Special population groups are defined in legislation, research, and practice not only in terms of their unique biological and sociocultural characteristics but also in terms of extant concerns regarding access to services.
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The same lack of evidence favoring the application of specific treatment approaches for populations defined by structural characteristics holds for those special populations defined by functional characteristics. Conclusions and Recommendations Regarding Special Populations The committee recommends a dual approach to the issue of culturally relevant treatment for special populations.
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Inconsistencies in financing policy remain; funding varies considerably among jurisdictions and between the public and private treatment efforts within jurisdictions. In the light of current concerns over rapidly rising health care costs, the major question now being raised is whether current financing and reimbursement policies promote access to the most cost-effective treatments.
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Guiding the Ongoing Effort Although it is tempting to charge a single designated leader individual, a federal agency, an advocacy group, a profession, Congress-with ongoing stewardship of the treatment of alcohol problems, realistically the base of leadership must be broad. The committee believes that, to ensure progress, community and voluntary organizations, government agencies, treatment providers, professional organizations, employers, insurance companies, consumers of treatment services, and other interested parties will need to evaluate its recommendations and take appropriate and concerted action.
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