|
Items in cart [4] |
Questions? Call 888-624-8373 |
| Copyright © 2009. National Academy of Sciences. All rights reserved. Terms of Use and Privacy Statement |
Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 611
INDEX
OCR for page 612
OCR for page 613
INDEX
Abstinence
A
Alcoholics Anonymous and, 108,
363, 527
as treatment goal, 78-79, 228, 295
as treatment outcome measure, 527-528
Accreditation standards, 125, 313, 413, 426
Acetaldehyde, 75
Activity groups, 83
Acute intervention, 63, 65, 66, 472
"Acute phase services," 61, 62
Addiction Research Foundation
(Ontario), 56, 243, 265
Core-Shell Treatment Program, 285, 331, 338
and treatment goals, 295-296
Addiction Severity Index (ASI), 251, 256, 339
Adolescent Assessment Project, 362
Adolescents. See College students; Youth
Adult children of alcoholics, 390, 391-393
Adult Children of Alcoholics, 556
Advertising, by treatment providers, 432
Affective disorders. See Depression
AFL-CIO, 112
Aftercare, 60, 61, 62, 66, 67-68. See also
Maintenance; Relapse prevention
for mentally ill, 333
research on, 530-531
for special populations, 347
Age
and alcohol consumption, 371
legal alcohol purchase, 383, 388
and liver disease, 176
and prevalence of alcohol problems, 153-154,
357
in special populations, 345, 347, 349
and treatment facilities, 283, 359, 361, 370
Aid to Families with Dependent Children, 194
Al-Anon, 105, 108, 113-114, 391, 556, 562, 570,
571
Alateen, 108, 391, 556, 562, 570, 571
Alberta Alcoholism and Drug Abuse Commission,
338
Alcohol, 20
craving, pharmacological reduction of, 77-78
exposure to, 217
legal purchase age, 383, 388
metabolism of, 53, 368
oxidation of, 75
tolerance, 29
Alcohol, Drug Abuse, and Mental Health
Administration (ADAMHA), 439
administration of block grants, 186, 190, 411,
414, 419
and diagnosis-related groups, 421
Office of Substance Abuse Prevention
(OSAP), 131-132, 350
project grants, 188, 192, 198
recommended actions, 179, 442, 443
and research, 498
613
Alcohol, Drug Abuse, and Mental Health
Amendments (1986), 1
Alcohol, drug abuse and mental health services
block grant. See Block grant
Alcohol abuse, 31
Alcohol Casualty Index, 165
Alcohol Clinical Index (ACI), 219, 255
Alcohol consumption, 30-31, 215, 217, 227, 228
adolescents, 359
American Indians, 366
drinking history, 253, 254, 255, 256, 259, 269
as index of alcohol problems, 176, 229, 295
and injuries, 230
and pregnancy, 230
race and, 369-370
self-reports, 262
and treatment outcome, 321
Alcohol crisis center, 49
Alcohol dependence, 28-30, 31, 217, 386
in adolescents, 359, 361
diagnosis-related group, 420
and matching, 283
treatment, 118, 203
Alcohol Dependence Scale (ADS), 219, 255
Alcohol and drug abuse treatment and
rehabilitation (ADTR) block grant, 191,
192, 198
Alcohol Epidemiologic Data System (AEDS), 165-
166, 443
Alcoholics, recovering, as counselors, 57, 58, 60,
125
Alcoholics Anonymous (AA), 7, 98, 113-114, 132
and abstinence, 108, 363, 527
coerced referral to, 594-595
continuity of care, 19
in correctional institutions, 100
employee assistance programs and, 105
formation of, 14, 15, 27-28
halfway houses, 406
individual assessment and, 245
international programs, 555-556, 558, 562, 567
meetings, 108-109, 527
membership, 109
principles of, 55, 57, 58, 60, 85, 331, 347, 391
psychotherapies and, 82
as relapse prevention, 68, 158-159
studies of, 520-521, 537
as treatment, 52, 56, 110-111
women in, 357
Alcoholics Anonymous (the "Big Book"), 108
"Alcohol idiosyncratic intoxication," 216
Alcoholism, 26-28, 31, 108. See also Alcohol
problems
disease concept of, 32-33
Alcoholism, Alcohol Abuse and Related Problems:
Opportunities for Research (IOM), 2
Alcohol problems. See also Assessment,
pretreatment; Brief intervention;
Specialized treatment; Treatment
assessment of, 243-245
attitudes about, 485
community agency responses to, 211-213
costs of, 202-204, 326, 465, 487
course, 34, 317
OCR for page 614
614
defining, 6-7, 25-26, 44
diagnosis-related groups, 420-421
discrimination against persons with, 413, 423,
426, 428
disease model of, 385, 408, 559
etiology, 35-36, 43-44, 51, 52, 78
heterogeneity of, 15, 31-33, 163, 400, 486
implications for assessment, 249
implications for treatment, 36-37
identification, 218-220
international studies, 552-555, 576
manifestations of, 242
Medicaid and, 421
as moral failure, 14
presentation, 33
prevalence of, 153-154, 215, 229, 364, 478
and treatment availability, 176-178
as a primary disorder, 44, 59, 184, 408
severity of, and matching, 281, 283, 460
stigma of, 48, 357, 409, 428, 432
in treatment
deterioration with, 155-156, 159
improvement without, 152-155, 159, 221
Alcohol problems perspective, 25-26, 30, 37-38,
478
Alcohol and Public Policy: Beyond the Shadow of
Prohibition (NAS), 2
"Alcohol-related disabilities," 29, 31
Alcohol Safety Action Program (ASAP), 381, 382,
492, 588
Alcohol-sensitizing drugs, 75
Alcohol use disorder, 27
Alcohol Use Disorders Identification Test
(AUDIT), 219, 254, 255
Alcohol Use Inventory, 250, 256, 599
Aldehyde dehydrogenase, 75, 368-369
Ambulatory Pediatric Association, 131
American Hospital Association (AMA)
Classification of Health Care
Institutions, 72
surveys of hospitals, 103, 124, 167, 175-176,
406
on treatment financing, 412-413
American Indians, 369, 372
federal programs for, 119, 410
Minnesota programs for, 115, 116, 117, 417
as special population, 344, 346, 347, 348, 349-
350, 351, 352, 365-368
American Journal of Psychiatry, 2
American Medical Association, 131
American Medical Society on Alcoholism and
Other Drug Dependencies, 125
American Psychiatric Association, 27, 125, 583
AMETHYST study, 224, 228
Amitrytyline, 76
Antabuse. See Disulfiram
Antianxiety drugs, 74, 77
Antidepressant drugs, 76-77
Antidipsotropics, 512-514
Anti-Drug Abuse Act (1988), 131, 191, 442, 490,
498
Antipoverty Act, 345
Antisocial personality disorder, 258, 385-386
Anxiety, 78, 99-100, 283, 386
INDEX
Arizona, 193
ASI. See Addiction Severity Index
Asian Americans, 345, 349, 351, 368-369, 372
Assessment, pretreatment, 8, 65, 334, 336, 337,
338, 339
administration of, 261-266
of adolescents, 362, 363
community role in, 228, 329
content of, 255-261, 599-600
cost of, 250, 461
financial bias in, 264-266
ideological bias in, 263, 266
insurance coverage for, 468
managed care and, 437, 476
and matching, 486
medical and psychiatric status, 245-246
methods of obtaining information, 266-269
multidimensional, 251-255
necessity of, 157, 242-243
and outcome, 320
purposes of, 243-249, 270
sequential, 249-251
of special populations, 402
Assessment, treatment program, 288
Association for Medical Education and Research
in Substance Abuse (AMERSA), 125, 130,
131
"Attack" therapy, 247-248
AUDIT. See Alcohol Use Disorders Identification
Test
Australia
alcohol problems in, 554-555
treatment in, 556, 569-570, 572-573
Aversion therapies, 78, 103, 517-518, 531
B
Baltimore, 229
Behavioral self-control training, 80-81, 521-522
Behavioral treatment modalities, 52, 73, 78-81, 431
Benzodiazopines, 74, 77, 555
Beta blockers, 77
Betty Ford Center, 103
Bibliotherapy, 226
Binge drinking, 252
Biofeedback training, 79, 524
Biological factors, 52
Biological markers, 262-263, 322-323, 359
Biopsychosocial model, 35, 51, 52-53, 58
Birch and Davis Associates, Inc., 129-130
Blacks, 371, 372
Minnesota programs for, 116, 117
as special population, 106, 345, 346, 347, 348,
349, 351, 352, 369-370, 399
United Kingdom programs for, 570
Block grant (alcohol, drug abuse, and mental
health semices), 382, 387, 411, 414, 419,
482, 498
and data collection, 168, 370, 442
distribution of, 440
restrictions on, 190-191, 414
special population targeting, 344, 350
OCR for page 615
INDEX
state administration of, 190-192, 197-198, 201,
415-419, 464, 490
Bloustein, Edward, 388-389
Blue Cross/Blue Shield Association, 61, 184, 200,
201, 413, 424, 426, 431, 433
Board and lodging programs, 116
Breathalyzer testing, 262, 322-323
Brief intervention, 16, 18, 37, 47, 249
community agency role, 211, 212, 213, 217,
220-221, 230-231, 334
cost-effectiveness of, 459, 460, 461
effectiveness of, 148, 468
efficacy of, 221-225, 226
goal of, 228
payment for, 473-474
research on, 531
in student assistance programs, 101, 390, 391
target of, 226-227
therapist role in, 532
varieties of, 225-226
Brief therapy, 225-226, 235
British General Practitioner study, 223-224
Brookfield Clinics, 284, 289, 336, 337
Brunel, Sir M. I., 335
Bulgaria, treatment in, 563, 573
Buspirone, 77
C
CAGE questionnaire, 219, 229, 255
Calcium carbide, 75
Calcium carbimide, 159, 514
Califano, Joseph, 408
California
Alcoholics Anonymous membership, 109
alcohol treatment authority, 416-417, 464
DWI treatment legislation, 590, 593-594
involuntary commitments in, 581, 582, 586
private health insurance funding in, 195
social model of recovery, 51, 52, 57-58, 85,
123, 417
social services recipients, 231
Canada, 75, 109
Cancer, 253, 369
Cannon, Walter B., 152
Capitation, 432, 476
Cardiovascular Disease Databank (Duke
University), 145
Cardiovascular disease prevention, 227
Career Teacher Program, 130
Carrier Foundation, 527
Case managers. See also Managed care
and continuity assurance, 480
and cost containment, 330, 331, 436, 467
Catchment areas, 410
Categorical grants, 190, 406, 409-411, 412, 414,
438-439
American Indian programs, 119
drinking driver programs, 382
CATOR. See Chemical Abuse/Addictions
Treatment Outcome Registry
Caucasians. See Whites
615
Causes and Consequences of Alcohol Problems: An
Agenda for Research (IOM), 2, 32
CHAMPUS. See Civilian Health and Medical
Program of the Uniformed Services
CHAMP-VA, 192
Chemical Abuse/Addictions Treatment Outcome
Registry (CATOR), 146, 201, 248, 303,
323, 325, 356, 362-363
services of, 316, 336, 337
Chemical aversion therapy, 78, 79, 517-518, 531
Child care facilities, 348, 357, 358
Children, Medicaid coverage for, 194
Children of alcoholics, 390, 391-393
Children of Alcoholics Foundation, 391, 392
Chippewa Indians, 367
Chronic Health Index, 165
"Chronic phase activities," 61
Churches, 501
Churchill, Winston S., 15
Cirrhosis. See Liver disease and cirrhosis
CIRT (community intensive residential treatment),
418
Citalopram, 514-515
Citizens League, 265
Civil commitment, 580-586
Civilian Health and Medical Program of the
Uniformed Services (CHAMPUS), 61,
186, 192, 194-195, 205, 420
Cleveland Admission Discharge and Transfer
Cntena, 288-289, 295, 303-312, 337, 436,
472
Client fees. See Patients: payments by
Clinical Institute of Ontario, 285
Withdrawal Assessment for Alcohol, 74-75
Codependency, 392-393
Cognitive-behavioral relapse prevention strategies,
80
Cognitive functioning, 258, 280, 320, 520
College students, 351, 388-391
Colorado
Alcohol and Drug Abuse Division, 71
involuntary commitments in, 582
Commission on Accreditation of Rehabilitation
Facilities (CARF), 61, 426
Committee recommendations, 5, 486-488
assessment, 253, 269-270
community role, 211, 218, 235-236
Congress, 488-490
continuity of care, 331, 333
data collection, 124, 205-206
employers and insurers, 493-495
funding studies, 441-444, 461-462
insurance coverage, 468, 469, 473, 474, 475,
480, 481
mandated insurance coverage, 475
matching, 296
NIAAA, 497-500
outcome determination, 326
research, 490, 499
special populations, 10, 358, 399-404
state policies, 491-492
treatment availability studies, 166, 167, 169,
178-179
OCR for page 616
616
treatment providers, 99, 102, 132-133, 495-
497
treatment systems approach, 18, 20, 329, 330,
340
uniform coverage rule, 480, 489
Community agencies. See also Brief intervention
and drinking drivers, 381
effects and costs of, 234-235
funding, 71, 191
international programs, 574-575
personnel, 233-234
referral to specialized treatment, 211, 212,
217, 220, 228, 329, 334
role in treatment, 6, 8, 18-19, 211-213, 214,
216, 329, 330, 334, 336, 338-339, 340
settings for, 228-233
treatment facilities, 99-101, 132, 410, 440
Community general hospitals, 424
Community health centers, 128
Community mental health centers, 128, 410
Community Mental Health Centers Act, 408, 410
Community organizations, 500-501
Community reinforcement approach, 80, 158, 524
525
Community Response to Alcohol-Related Problems
(WHO), 550
CompCare Corporation, 432, 526
Compensatory model of etiology and treatment,
55, 56
Comprehensive Alcohol Abuse and Alcoholism
Prevention, Treatment, and Rehabilitation
Act (Hughes Act) (1970), 14, 15, 346,
407, 408-409, 415
Computerization
of data bases, 248
in obtaining assessment information, 266, 267,
268-269
"Conceptual level," 280, 283
Confrontational psychotherapy, 280, 519
Connecticut
demand-based planning, 166
DWI treatment legislation, 590, 591
involuntary commitment law, 581
social model treatment study, 423
Connecticut, University of, 338, 499
Connecticut General Corporation, 495
Contingency management, 80
Continuing care, 68
Continuity of care, 9, 18, 19, 329, 330-333
and brief intervention, 226
case managers and, 476, 480
community role in, 228
insurance coverage for, 468
as part of treatment system, 46, 334, 336, 338,
339
Continuum of care, 44
under categorical grants, 410
defining, 47-51, 85-86
and homeless persons, 387
insurance coverage for, 430, 480
Minnesota, 112-113
state agencies and, 437~38
INDEX
Contra Costa County, Calif., 214
Cooperative Commission on the Study of
Alcoholism, 25, 407, 438, 485, 486, 494,
497
Coping skills, 52, 403
Core-Shell Treatment System Project, 285, 286,
290, 331, 336, 338
Correctional institutions, 100
Corroboration of outcome, 323
Costa Rica, treatment in, 563-564, 568, 570, 571,
574
Cost containment, 285, 431-432, 439-440, 444
health maintenance organizations, 433
managed care and, 331, 435-436
Medicare and, 420
preferred providers, 435
Cost-effectiveness, 11, 466, 467
analysis, 455, 459-461
insurance industry and, 426
limitations on treatment, 49
matching and, 461
social model treatment and, 469
treatment setting and, 529
Cost offset, 11, 424, 455, 478
brief interventions and, 468
studies of, 455-459
Costs
of alcohol problems, 202-204, 326, 465
assessment and matching, 250, 461
community interventions, 234-235
day treatment, 105
insurance coverage, 411-412
level of services and, 443
of recommended changes, 5-6
treatment, and insurance industry, 424-425
treatment, mandated insurance and, 430
Council of State and Territorial Alcoholism
Authorities, 409
Counseling, 46, 76
Counselors, 7, 125-131, 234. See also Therapists
certification of, 125, 497
mandated insurance coverage and, 427
recovering alcoholics as, 57, 58, 60, 125
research on, 532-533
for special populations, 348
Course, heterogeneity of, 34
Court decisions, 345, 408. See also Criminal justice
system
Covert sensitization, 79, 518, 531
Criminal justice system, 346
coerced referrals to treatment, 371, 382-383,
579, 586-591, 593, 598
and drinking drivers, 232, 381, 382-383
and homeless persons, 387
personnel, 234
and public inebriates, 408
Crisis management, 62
Cuban Americans, 370
Cue exposure therapy, 81
Custodial care, 406
OCR for page 617
INDEX
D
Data bases. See also National Drug and
Alcoholism Treatment Unit Survey; State
Alcohol and Drug Abuse Profile
assessment information, 248-249
computerization of, 248
on funding and costs of treatment, 441-444
outcome information, 316
on special populations, 350-351
Data-driven treatment selection, 293-294
Day treatment, 104, 123, 133. See also
Intermediate care
cost-effectiveness of, 460
mandated insurance and, 430
Delirium tremens, 74
Demographic variables, 256-257, 281, 282, 345
Denoix, P. F., 253
Depression
and alcohol problems, 385-386
and matching, 282
treatment for, 76, 358, 516, 519
women and, 357
Detoxification, 49, 59, 61, 64, 65, 313, 511-512,
555
costs of, 204
health maintenance organizations and, 434
insurance coverage for, 71, 464, 468
managed care and, 436
Minnesota programs, 114-115
NDATUS classification, 122-123, 169
Oregon programs, 418-419
pharmacotherapies, 73, 74, 515-516
placement criteria, 472
prospective payment system and, 421
setting for, 72
social model and, 52, 56
treatment capacity, 170-172
Detoxification centers, 48, 387, 408
Diagnosis, 303. See also Assessment,
pretreatment
and matching, 281, 282
psychiatric 251, 358
Diagnosis-related groups (DRG), 61, 204, 420
421
Diagnostic Interview Schedule (DIS), 229, 251,
255, 256
Diagnostic programs, 105
Diagnostic and Statistical Manual of the Amencan
Psychiatric Association (DSM-III-R), 27,
29-30, 244, 255
Directory of Chemical Dependency Programs
(Minnesota), 116
DIS. See Diagnostic Interview Schedule
Discharge and transfer criteria, 309-310
Discrimination
against persons with alcohol problems, 413,
426, 428
and treatment utilization, 371
Disease, alcoholism as, 51, 385, 408, 559
Disease Concept of Alcoholism (Jellinek), 27-28
Disease and illness, 20, 152
District of Columbia, 415
617
Disulfiram (Antabuse), 14, 51, 52, 58, 75-76, 589
matching and, 282
outcome information, 333
studies of, 512-514
Disulfiram-ethanol reaction (DER), 75, 76
Domiciliary care, 63, 66, 122, 169, 170
Donwood Institute (Toronto), 331
Dopamine, 77
Doxepin, 76
Drinking drivers, 232, 381-385, 399
coerced treatment, 156, 534-535, 588-589,
590, 593-594, 595, 596, 599
in Mexico, 553
programs for, 47, 111, 114, 492-493, 522
as special population, 345, 346, 348, 349
youth, 388, 389
"Drink-related disabilities," 29
Drinkwatchers groups, 108, 558-559, 567
Drug problems, 3, 102, 257, 348, 587
in Alcoholics Anonymous membership, 109
treatment programs, 118, 198
Drug therapy. See Pharmacotherapies
DSM-III. See Diagnostic and Statistical Manual of
the American Psychiatric Association
"Dual-diagnosis" patients, 385-386, 387, 516
Duke University Medical Center, 145
DWI. See Drinking drivers
E
Early intervention, 45-46, 213, 592-593 See also
Brief intervention
Economic Opportunity Amendments (1968 and
1969), 410
Edinburgh study, 222, 233
Educational programs, 46, 82, 291
for college students, 390, 391
for drinking drivers, 382, 383, 384, 520
Educational settings for intervention, 231-232
Edwards, Griffith, 33
Edwards, Justin, 14
Edwards and Orford study, 221
Effect-altering medications, 512, 514-515
Effectiveness and Costs of Alcoholism Treatment
(OTA), 1
Elderly
Medicare and, 419
as special population, 345, 348, 349, 350, 351,
352, 364-365
Electrical aversion therapy, 78
Emergency treatment, 65, 66. See also
Detoxification
health maintenance organizations, 434
hospital, 229, 406, 481
for poor, 481
Uniform Act guidelines, 48, 49
Employee assistance programs (RAP), 68, 111
112, 114, 232, 363, 411
coerced referrals to treatment, 579, 591-592,
593, 594, 596, 597, 598
cost offset and, 456
federal employees, 350
OCR for page 618
618
insurance companies and, 424, 494-495
managed care providers, 436
personnel, 234
studies of, 535
Employees
insurance cost sharing, 431
as special population, 346
Employers
and health maintenance organizations, 433
and insurance coverage, 422, 424-425, 431,
488
and mandated insurance, 428, 476
recommended actions, 493-495
self-insurance, 185-186, 200, 427, 431, 475
Employment, Retirement, and Income Security
Act (ERISA) (1974), 186, 427
England
alcohol problems in, 553-554
special populations, 570-571
treatment in, 557-559, 575
Enlightenment model of etiology and treatment,
55
Epidemiologic Catchment Area (ECA) study, 34,
154, 229, 231, 257
PRISM See Employment, Retirement, and Income
Security Act
Etiology
heterogeneity of, 35-36
models of, 43-44, 55-56, 78
Europe, pharmacotherapy in, 75
Evaluation, 63, 65
Expert committees, 287, 296, 473
Extended care (stabilization), 65, 66-67, 68, 70
costs of, 204
facilities in Minnesota, 116
group psychotherapy in, 82
F
"Faders," 322
Families, children of alcoholics and, 391, 392
Family history, 258
Family Services of America, 495
Family therapy, 49-50, 52, 83-84, 356
Farm workers, 346, 349
Federal employees, 349-350, 411
Federal Employees Health Benefits Program
(FEHBP), 186, 192, 350, 419, 422-423
Fetal alcohol effects, 230
Fetal alcohol syndrome, 230, 366
Fifth Special Report to Congress on Alcohol and
Health (USDHHS), 32, 348
Filipino Americans, 368
Fillmore, Kaye M., 4
Financial case management, 331
First Special Report to the U.S. Confpess on Alcohol
and Health (USDHEW), 279, 346
Fluoxetine, 515
Fluvoxamine, 515
Folk medicine, 348
Follow-up, 46, 62, 66, 68. See also Continuity of
care
INDEX
interviews, 19, 323
and outcome reporting, 314
treatment, 48
Formula grants, 408-409, 415, 438-439
France, treatment in, 47
Fraternity houses, 389
Funding, 10-12. See also Block grant; Cost-
effectiveness; States
brief therapy, 235
categories of, 183-187, 204-206
continuum of care and, 47
current environment, 439-441
data collection, 442
expenditure levels, 202-204
federal, 408-411, 414, 419-423
FEHBP, 422
health care, 201-202, 431
health insurance, 125, 411-414
international, 572-573
national policy development, 407-408
outcome determination, 325-326
personnel training, 125
poor and uninsured treatment, 480-483
research, 441-444, 498-499
special population programs, 119, 401
specialty programs, 188-197
private-sector, 200-201
public-sector, 197-200
state and local role, 415-419
and treatment capacity, 173-175
treatment facilities, 115, 116
G
Gamma aminobutyric acid (GABA), 77
Gamma glutamyl transferase (GGT), 221-222, 224
Gays, 345, 351, 570
Gender, 345, 347, 349, 553. See also Women
General Health Questionnaire (GHQ), 251, 256
General Motors Corporation, 495
Genetic factors, 35, 51, 53, 368-369
GGT. See Gamma glutamyl transferase
GHQ. See General Health Questionnaire
Gibbons, Henty, 581
Gordis, Enoch, 1
Greater Cleveland Hospital Association, 303
Group Health Association of America, Inc., 433,
434
Group psychotherapy, 82
for children of alcoholics, 391-392
confrontational, 280
for married couples, 83
for special populations, 356
Guide to Clinical Preventive Services (U.S.
Preventive Services Task Force), 231
H
Halfway houses, 52, 70, 98, 101, 107, 406
insurers and, 133
in Minnesota, 115-116
OCR for page 619
IDEA
personnel, 127
Handicapped persons, 349
Harwood, Henriek, 4
Hazelden Foundation, 58, 59, 85, 128, 132, 526
Health care costs, 424, 428
alcohol problems treatment and, 183-184
cost containment, 431
funding of, 201-202, 407
Health Care Financing Administration (HCFA),
186, 200-201, 419, 423, 462
and diagnosis-related groups, 421
Health care sector, 98, 99-100, 335
cost offset and, 11, 456
and homeless persons, 387
treatment settings, 229-231
Health insurance, 71. See also Private health
insurance; Public health insurance; Self-
insurance; Uninsured persons
availability of, 423
for brief therapy, 235
and cost-effectiveness, 461
and cost offset, 456, 458
coverage appropriateness, 466-467
coverage of minorities, 372
exclusion of alcohol-related disorders, 409
funding of, 125, 185-186, 406-407
model benefit packages, 428, 429-430, 439,
475, 476
insurers and, 426
NLAAA and, 61, 411-412, 423-424
national, 412
optimal conventional coverage, 467-474
reimbursement limits, 476
and treatment quality, 315
Health maintenance, 200, 201
Health Maintenance Organizations (HMO), 431,
493, 495
cost offset and, 456
coverage of, 425, 432-435
mandated insurance and, 427
research on 434-435
Health Services Funding Regulations and
Guidelines, 413
Hippocrates, 159-160
Hispanic Americans, 370-371, 372
Minnesota programs, 117
as special population, 345, 346, 347, 348, 349,
351, 352
Holder, Harold D., 4
Homeless persons, 43, 358, 401
extent of alcohol problems, 231
programs for, 116, 387-388
as special population, 349, 350
United Kingdom programs, 570-571
Homeostasis, 152
Homicide, 366
vehicular, 381
Hospitals
admission practices, 409
cost containment, 420-421
cost offset and, 456
mental health programs, 406
prevalence of alcohol problems in patients, 33,
229
619
Hospital treatment. See also Inpatient treatment
for adolescents, 359
availability of, 175-176
block grant restrictions on, 190-191, 414
costs of, 196, 202, 203, 407, 440, 465
of couples, 83
insurance coverage of, 424, 469, 470
insurers' preference for, 205, 440-441
Medicare coverage, 193
in Minnesota, 115
personnel, 126
state reimbursement of, 417, 418
types of settings, 103
Hughes, Harold, 14, 108, 408
Hughes Act. See Comprehensive Alcohol Abuse
and Alcoholism Prevention, Treatment,
and Rehabilitation Act
Humana Hospitals, 432
Human services, 98, 100-101
Huss, Magnus, 26
Hypertension, 36
ICD. See International Classification of Diseases
Identification, 61, 211, 218-220, 249
Illinois
Alcoholics Anonymous membership, 109
involuntary commitments in, 582
social model treatment study, 423
Illness, 20, 152
Imipramine, 76
Incentive grants, 410
Income, and alcohol consumption, 370. See also
Low-ineome and poor persons
Indiana, 415
resource allocation model, 165
Indian Health Board (Minnesota), 113-114
Individual assessment, 245-246, 251, 319. See also
Assessment, pretreatment and treatment
planning, 247-248
Individual dynamic psychotherapy, 81-82
Individual practice associations (IPA), 432, 434
Inoculation, 285
Inpatient treatment, 48, 69-70, 72-73, 103, 122. See
also Halfway houses; Hospital treatment;
Residential treatment
eost-effeetiveness of, 460
effectiveness of, 147
insurance coverage of, 428, 430, 469-470, 474-
475
model benefit plan, 429
insurance industry and, 425-426
length of stay, 412
managed care and, 435
matching and, 295, 307-309, 311, 473-474
medical model and, 55
Medicare coverage of, 420
mental health hospitals, 406
in Minnesota model, 59, 60
and relapse prevention, 67-68
social model and, 56
for special populations, 347
OCR for page 620
620
state agencies and, 437
treatment capacity, 172
utilization of, 169
Inquiry into the Effects of Ardent Spirits upon the
Human Body and Mind, (Rush), 14
Institute of Health and Aging, 166, 167
Institute of Medicine (IOM), 2-3, 32, 35, 498
Committee to Identify Research Opportunities
for the Prevention and Treatment of
Alcohol-Related Problems, 147
homelessness report, 387
on research, 318
Insurance. See Health insurance; Private health
insurance; Public health insurance
Intelligence assessment, 258
Interagency Committee on Alcohol Abuse and
Alcoholism, 419
Intermediate care, 48, 70, 72, 73, 104-107. See also
Day treatment
costs of, 204
expansion of, 133
insurance coverage of, 429
length of stay, 412
International Classification of Diseases (ICD), 29,
255
Intervention, 44-46
categories of, 63, 113
spectrum of, 211, 212, 218
Inventory of Drinking Situations, 260
"Involuntary outpatient civil commitment," 585.
See also Treatment: coerced
Iowa, 204
Irish immigrants, 345
J
Jails, 406, 410
Japanese Americans, 368
Jellinek, E. M., 14, 27-28, 32
Jellinek classification, 283
Jenner, Edward, 285
Johns Hopkins Hospital, 33, 229
Johns Hopkins Medical School, 33, 233
Johnson, Lyndon B., 408
Johnson, Vernon, 59
Johnson Foundation, 85
Johnson Institute, 58, 59
Joint Commission on the Accreditation of Health
Care Organizations (JCAHO), 413, 426,
427
Joint Commission on the Accreditation of
Hospitals (JCAH), 61, 413-414, 426, 428
Joint Commission on Mental Illness and Health,
407
Joint Federal and State Agency Meeting-on
Alcohol and Drug Data Collection, 392
INDEX
K
Kaiser Foundation Health Plans, 432, 433
Kaiser-Portland health plan, 458
Keller's law, 36, 245
Kemper Insurance Companies, 424
Kenya
alcohol problems in, 552
treatment in, 555-556, 568, 572, 573-574
Kidney disease, 419
L
Laboratory examinations, 218-219, 255
Language barriers, 348, 370
Learning disabilities, 363
Legal Action Center, 429
Length of stay
in model benefit plan, 412
and outcome, 529
prospective payment and, 420, 421
Levels of care. See also Treatment: setting of
in Cleveland criteria, 289, 295, 303, 472-473
in international programs, 564-567
managed care and, 436, 437
matching to, 439, 443-444, 470
Life events, 258-260, 357, 364
Lincoln, Abraham, 2
Lithium, 77, 282, 516
Liver disease and cirrhosis
and blacks, 369
as index of alcohol problems, 176
mortality, 14, 176-177, 366, 552, 554
treatment costs, 203
and women, 357
Local governments
allocation of block grants to, 190-191
responsibility for treatment, 406, 477
treatment funding by, 186, 191, 196-197, 198,
416
Longitudinal studies, 318
Low-income and poor persons, 349
mandated insurance and, 429
treatment financing, 415, 480-483
federal formula grants, 345, 410
Medicaid, 421, 481
state and local, 440, 481
and utilization, 456-457
LSD (lysergic acid diethylamide), 282
Lutheran General Hospital (Park Ridge, Ill.), 59
M
MacAndrew Scale, 219
Maine, 166
Maintenance, 62, 63, 66, 68-69
insurance coverage, 468
phalll~acotherapy, 75-77
Makah Indians, 367
Malmo study, 221-222, 233
Malpractice suits, 433
OCR for page 621
INDEX
Managed care, 336, 337, 431, 469
cost containment, 331, 435-437, 475-476
insurance coverage of, 461
psychiatric, 436
Mann, Marty, 28, 34
Marital status, and matching, 282, 283, 357
Marital therapy, 83, 292, 522-523
Maryland, 229
Massachusetts, 580, 582, 584
MAST. See Miehigan Alcoholism Screening Test
Matching, 9, 44, 242, 279-280, 329, 333, 334, 336,
337, 439, 440-441, 468
assessment and, 247-248
brief intervention and, 221
Cleveland criteria, 303-312
and continuity assurance, 480
cost of, 461
and cost-effectiveness, 461, 478
and drinking drivers, 381-382
examples of programs, 285-287
guidelines, specification of, 289-294, 337, 338,
339, 486
psychiatric diagnosis, 386
and special populations, 400-401, 402
specification of treatment, 287-289
studies of, 280-284, 498
and treatment controversies, 294-296
treatment philosophy and, 54-56
Maudslay, H., 335
Medicaid, 186, 205, 412-413, 417, 419, 490
categorization of alcohol problems, 184, 194,
421
coverage of, 193-194, 200, 201, 202, 421-422,
440, 481-483
restrictions on funds, 192
coverage criteria, 414, 464-465, 489
and medical model treatment, 415, 476-477
Medieal disorders, 358
"Mediealization of deviance," 579
Medieal (disease) model of treatment, 51, 55, 416,
441
detoxification, 122, 123
insurance industry and, 425, 469
Medicaid and, 415, 476-477
Medieal Research Council (United Kingdom), 223
Medicare, 186, 205, 435-436
categorization of alcohol problems, 184, 194,
421
coverage of, 192-193, 194, 200, 201-202, 203,
419-421
coverage criteria, 414, 476-477, 489
financing of, 187
prospective payment system, 61, 420
Medication. See Pharmaeotherapies
Mental illness. See also "Dual diagnosis" patients
alcoholism as, 408
continuity of care for, 331, 333
and homelessness, 387
insurance coverage, 422
state programs, 406
and substance abuse, 385
treatment, 407
621
Mental Retardation Facilities and Community
Mental Health Centers Construction Act
(1963), 407
Met ran id azole , 75
Mexican Americans, 163, 348, 349, 370, 371, 399,
590
Mexico
alcohol problems in, 552-553
treatment in, 559-560, 568
Michigan, 284, 338, 423, 437-438
Miehigan Alcoholism Screening Test (MAST), 219,
229, 256, 268, 382
Miehigan State University, 438
Mikado (Gilbert and Sullivan), 279
Military personnel, 349
Minnesota, 491
Alcoholics Anonymous membership, 109
assessment and matching in, 265-266, 284,
336, 337
Chemieal Dependency Program Dh ision, 106,
417, 437, 464, 470-472, 490
Civil Service Commission, 128
commitment laws, 584
Consolidated Chemieal Dependency
Treatment Fund, 470, 473, 477, 481, 489
490
Department of Public Safety, 114
health maintenance organizations in, 434
treatment services in, 112-117, 204, 316, 325
Minnesota Model of Chemieal Dependence
Intervention and Treatment, 67, 385, 526
programs based on, 104, 132, 347, 415416,
418, 428, 559
treatment strategy, 46-47, 58-60, 85
Minnesota Multiphasie Personality Inventory
(MMPI), 219
Missouri, 166
Model Cities Act, 345
Model State Law on Civil Commitment of the
Mentally Ill, 583-584
Modifying variables, 217
Monitoring the Future Project, 359
Monoamine oxidase inhibitors, 77
Montana, 415
Moral hazard, 432
Moral model of etiology and treatment, 55
Mortality
alcohol-related, 366, 381
liver cirrhosis, 14, 176-177, 366, 552, 554
liver disease, as index of alcohol problems,
176-177
Mortimer-Filkins Interview, 382
Mothers Against Drunk Driving, 383
Motivation, 533-534, 599
Motor vehicle deaths, 366, 381
Multidimensional assessment, 251-255, 269
Multivitamins, 74
Mutual help groups, 57, 304-305, 520-521
N
Narcotic Addict Rehabilitation Act (1966), 586
OCR for page 622
622
Narcotics Anonymous, 113-114, 527
NASADAD. See National Association of State
Alcohol and Drug Abuse Directors
National Academy of Sciences, 1, 2
National Alcoholism and Drug Abuse Program
Inventory (NDAPI), 120, 124, 168
National Alcoholism Program Information System
(NAPIS), 197, 370
National Association of Addiction Treatment
Programs (NAATP), 200-201, 204
National Association of Alcoholism and Drug
Abuse Counselors, 125, 127, 128
National Association for Children of Alcoholics,
391
National Association of Insurance Commissioners,
427
National Association of State Alcohol and Drug
Abuse Directors (NASADAD), 167, 197,
198, 199, 200, 392, 409, 442
National Cancer Institute, 254
National Center for Health Services Research, 462
National Center for Health Statistics, 167, 441-
442
National Center for the Prevention and Control of
Alcoholism, 345, 408
National Clearinghouse for Alcohol and Drug
Abuse Information, 350-351
National Collaborative Matching Project, 336, 338,
339, 340
National Commission on Credentialing of
Alcoholism and Drug Abuse Counseling,
129
National Conference of Commissioners on
Uniform State Laws, 410-411, 588
National Council on Alcoholism (NCA), 28, 112,
389, 408, 411, 426, 429-430, 496
National Drug and Alcoholism Treatment Unit
Survey (NDATUS), 119-124, 133, 469
codependency data, 392
criminal justice referrals data, 589-590
employee assistance programs data, 592
funding data, 188, 195, 196, 197, 199, 204,
205-206, 415, 439, 442
insurance expenditures data, 429
personnel data, 125-126, 131
special populations data, 351-352
treatment availability data, 167, 168-175, 178,
179
treatment setting data, 70-71, 104, 428
utilization data, 165
National health insurance, 412
National Highway Traffic Safety Administration,
345, 381
National Hospital Discharge Survey, 441-442
National Institute on Alcohol Abuse and
Alcoholism (NIAAA), 14, 108, 407-408,
413, 414, 462
Alcohol Epidemiologic Data System (AEDS),
165-166, 443
alcohol problems indexes, 176
and American Indians, 366, 367
categorical grants, 119, 190, 409-411
and diagnosis-related groups, 421
and drinking drivers, 381, 382
INDEX
and employee assistance programs, 112, 494,
591
funding sources studies, 188, 204, 444
health care costs studies, 183
and health maintenance organizations, 434
435
and homeless persons, 388
and mandated insurance, 426
matching study, 285
model health insurance benefit packages, 411
412, 423-424, 426
personnel training funding, 125, 130, 131, 233
and private health insurance, 61, 426
recommended actions, 497-500
and social model treatment, 56, 423
and special populations, 345-346, 349
State Manpower Development Program, 125
treatment facility surveys, 119-120, 121, 168
Treatment Research Branch, 338, 490, 498
499
and treatment setting, 70, 71
and youth drinking, 389
National Institute on Drug Abuse (NIDA), 119
120, 130, 131, 190, 233, 414
National Institute of Mental Health (NIMH), 167,
190, 414, 485
Division on Alcohol Abuse and Alcoholism,
408
National Medical Care Expenditures Survey, 441
National Nursing Home Survey, 441-442
National Survey of Worksite Health Promotion
Activities, 592
Native Alaskans, 345, 346, 349, 352, 365, 369, 410
Native Hawaiians, 349, 368
Navajo Indians, 367
NDAPI. See National Alcoholism and Drug Abuse
Program Inventory
NDATUS. See National Drug and Alcoholism
Treatment Unit Survey Nebraska, 166
New England Journal of Medicine, 318
New Jersey, 423, 430, 437
New York State
alcohol crisis centers, 49
Alcoholics Anonymous membership, 109
Division of Alcoholism and Alcohol Abuse,
100
involuntary commitments in, 582, 586, 590
Medicaid coverage in, 194
social model treatment study, 423
New York Times, 388
New Zealand referral study, 223, 233
North American Association of Alcoholism
Programs, 408, 485
North American Congress on Alcohol and Drug
Problems, 58, 62, 72
Northern Addictions Centre (Alberta), 336, 338,
339
Northern Ohio Chemical Dependency Treatment
Directors Association, 303
NoIway, treatment in, 556-557, 568-569, 571, 574
575
Nurses, 126, 233-234
OCR for page 623
INDEX
o
Obstetrics, 230
Occupational groups, 381
Occupational intervention. See Employee
assistance programs
Office of Economic Opportunity, 345, 367, 410
Office of Human Services, 186, 419
Office of Personnel Management, 186, 419,
422
Office of Technology Assessment, 1, 422
pharmacotherapy in, 75
Preventive Services Task Force, 231
Public Health Service, 131
treatment programs of, 117-119
Oklahoma
mental health information system, 315-316
outcome monitoring, 322, 325, 335-336
social model treatment study, 423
Omnibus Budget Reconciliation Act (1981), 190,
191, 414
Ontario, 243
assessment and referral system, 284, 336, 337
Oregon, 491
alcohol and drug program, 416, 417-419, 437
program licensing in, 71
"Organic mental problems," 420, 421
Orthopedics, 230
Osler, Sir William, 33
Outcome monitoring, 9, 146, 242, 313-316, 329,
334, 335, 336, 339, 358
and case management, 476
CATOR, 337
content of, 320-321
feedback of information, 19, 329, 333-334,
336, 486
funding of, 325-326
limitation on, 317-319
and placement criteria, 473
process of, 321-323
responsibility for, 323-325, 419
setting of, 322-323
specification, 319-320
youth treatment, 362-363
Outcomes
biased perceptions of, 263, 314
in coerced populations, 596-601
continuum of, 148
corroboration of, 323
cost-containment and, 444
and special populations, 351, 367
studies of, 147, 296, 384, 571
Outpatient (nonresidential) treatment, 48, 69, 70,
72, 73, 101-102, 104, 122, 123, 406
assessment and, 247, 470, 471
in California, 416-417
cost-effectiveness of, 460
costs of, 117
effectiveness of, 147
extended care, 67
in France, 47
funding sources, 196-197
insurance benefits for, 429
623
length of stay, 412
managed care and, 436
mandated insurance and, 430
matching and, 295, 305-307, 311-312
Medicaid coverage of, 422
model benefit plans and, 429, 439
in Oregon, 418
treatment capacity, 172
utilization of, 169
Oxford English Dictionary, 13, 18
p
Pacific Islanders, 368-369
Pare, Ambroise, 152, 159
Parkinson's disease, 32-33
Parkside Medical Services, 59
"Pathological intoxication," 216
Patients. See also Matching
and matching, 281-284
payments by (client fees), 185, 188, 192, 200,
201, 205, 407
psychiatric
deinstitutionalization of, 473
"dual-diagnosis," 385-386
selection of treatment by, 291
Pennsylvania, 63, 167
Pennsylvania, University of, 337
Penn-VA project, 336, 337-38, 339
Personal (individual) assessment, 251, 256-261. See
also Assessment, pretreatment
Personality factors, 258, 281, 283
Personality Research Form, 258
Personnel (staff). See also Counselors
accreditation of, 413
community agencies, 233-234
costs, 203
nondegreed counselors, 125, 417
physicians, 125, 126, 127, 128
and special populations, 403-404
training programs, 496-497
NIAAA funding, 125, 130, 131, 233
Pharmacotherapies, 51, 52, 73-78
criticism of, 385
in detoxification, 56
matching and, 282
studies of, 512-517
Philadelphia Diagnostic Center, 388
Physical disabilities, 349
Physician Data Query, 254
Physicians, 125, 126, 127, 128
in community role, 233
general practitioners, 230
primary care, 99-100
training of, 130
Physiological (biological) perspective on treatment,
51, 53
Police, 565
Poor. See Low-income and poor persons
Poverty grant program, 410
Preferred providers, 200, 434, 435, 495
Pregnancy, 350
OCR for page 624
624
Presentation, heterogeneity of, 33
Presidential Commission on Drunk Driving, 383
President's Commission on Law Enforcement, 408
President's Commission on Mental Health, 586
President's Commission for the Study of Ethical
Problems in Medicine and Biomedical
Behavioral Research, 477
Prevention services, 4, 190, 198. See also Primary
prevention; Secondary prevention
Prevention and Trea~nent of Alcohol Problems:
Research Opportunities (IOM), 498
"Preventive paradox," 215
Primary care, 60, 65, 66-67, 68, 99-100, 566
insurers and, 428
Primary care workers, 312
Primary prevention, 44, 45
international programs, 552
targets of, 212-213
for youth, 363, 391
Princeton University, 388
Private health insurance
and cost containment, 431-432
costs of, 61
and hospital treatment, 440
mandated, 426-430, 440, 474-475, 476, 488
and model benefit plans, 411, 412-413
recommended actions, 493-495
treatment funding, 8, 184, 195-196, 198, 200,
205, 407, 423-426, 429, 439, 464
unavailability of, 183, 423
Private sector
and outcome, 316
psychiatric hospitals, 406
specialty programs funding, 200-201
Problem assessment, 250-251, 252, 255-256, 259,
269. See also Assessment, pretreatment
Problem drinkers, 31, 381, 382, 384. See also
Alcohol problems
Problem-oriented treatment selection, 291-292
"Program design" barriers, 164
Program entry, 61-62
Progression, of problems, 34, 217, 317
Prohibition, 14, 32
Project grants and contracts, 409-410
Prompt intervention. See Brief intervention
Propranalol, 77
Prospective payment system, 61, 420, 421
Psychiatric diagnosis, 251, 358
and matching, 281, 282
Psychiatric hospitalization, involuntary, 580
Psychiatric managed care, 436
Psychiatric patients
deinstitutionalization of, 473
"dual-diagnosis," 385-386
Psychoactive substance use disorders, 29, 244
Psychodynamic treatment modalities, 78, 81-84
Psychological perspective on treatment, 51, 52, 53
Psychological treatment modalities, 73, 78
Psychologists, 126, 127
in community role, 234
Psychosis, 366
Psychosocial treatment, 431. See also Social model
of recovery
Psychotherapy, 52, 386
INDEX
ineffectiveness of, 385
matching and, 282
studies of, 518-519
Psychotropic medications, 76-77, 512, 515-517. See
also Pharmacotherapies
Public health insurance, 412-413, 464. See also
Medicaid; Medicare
cost offset and, 456-457
and hospital treatment, 440
mandated private coverage and, 429
and model benefit plans, 411
reliance of minorities on, 372
treatment funding, 186, 187, 196, 197-200,
201, 205, 476-477
Public inebriates, 231, 406, 593
commitment of, 588
detoxification programs, 49, 103, 408
homeless persons, 387
social model approach and, 56
as special population, 345, 346, 348, 349-350,
352
support services for, 43
Public intoxication, decriminalization of, 43, 56,
114, 410, 473
Puerto Rican Americans, 370
Puget Sound Health Cooperative, 433
Q
Quality of treatment, 146, 313, 413
Quarte~way houses, 70
R
Race. See also Blacks
in special populations, 345, 349, 351
and treatment outcome, 369
and underutilization, 372
Ramsey Clinic, 303
RAND Corporation, 253, 458
Randomized controlled trials (RCT), 9, 143-146,
153, 334
limitations of, 9, 144-145, 149, 293, 318-319
of treatment effectiveness, 149, 457-458, 528,
538
Reagan administration, 120
Recommended actions. See Committee
recommendations
Recovery Attitude and Treatment Evaluator, 437
Recovery homes, 133
Referral to specialized treatment
coerced, 579, 580, 586-593
treatment outcome for, 596-601
community agency role, 16, 211, 212, 217,
220, 228, 329, 334
and utilization, 434-435
Regional Youth Substance Abuse Project
(Bridgeport), 336, 338, 339
Regression to the mean, 457
Rehabilitation, 59, 61, 62, 65, 66-67, 103
costs of, 115, 204
group psychotherapy in, 82
OCR for page 625
INDEX
insurance coverage of, 71, 422, 424, 464, 468
insurers and, 431
managed care and, 436
NDATUS classification, 122, 123, 169
Oregon programs, 418-419
pharmacotherapy in, 75-77
placement criteria, 472-473
prospective payment system and, 421
social model of, 52
treatment capacity, 170
Reich questionnaire, 219
Reimbursement limits, 476. See also Health
insurance
Relapse
extended care and, 67~8
in stages of change model, 53
Relapse prevention, 61, 66, 68, 333, 512
disulfiram in, 76
research on, 525-526, 530-531
strategies, 80-81, 158-159
Relman, Arnold, 313
Remission rates, 34
Research, 144, 314-315
ADAMHA and, 498
adolescent alcohol problems, 359
aftercare, 530-531
on Alcoholics Anonymous, 520-521, 537
alcohol problems, international studies, 552
555, 576
brief interventions, 531
committee recommendations, 490, 499
cost-effectiveness, 461-462
cost offset, 455-459
counselors, 532-533
disulffram, 512-514
employee assistance programs, 535
funding, 188, 204, 441-444, 498-499
health care costs, 183-184
health maintenance organizations, 434-435
IOM on, 318
longitudinal studies, 318
matching, 280-284, 498
NIAAA, 183, 188, 204, 444, 490
pharmacotherapies, 512-517
psychotherapies, 518-519
relapse prevention, 525-526, 530-531
special populations treatment, 347-353, 401
402
theory in, 401
treatment, international studies, 555-564, 573
577
treatment availability, 166, 167, 169, 178-179
treatment effectiveness, 422423, 511, 526
528, 529
treatment efficacy, 531-532
treatment outcome, 147, 296, 384, 571
Research-driven treatment selection, 293
Research Triangle Institute, 465
Residential treatment, 70, 72, 73, 103, 169, 406.
See also Inpatient treatment
in California, 416
cost-effectiveness of, 460
costs of, 115, 529
effectiveness of, 147
625
funding sources, 196-197
insurance coverage of, 469, 470
insurance industry and, 425
managed care and, 436
mandated insurance coverage, 428
Oregon programs, 418
social model, 407
staffing, 126
in Uniform Act, 48
Resource allocation models, 164-165
Rhode Island State Alcohol/Drug Authority, 430
Risk/benefft analysis, 155
Robert Wood Johnson Foundation, 338
Rogers, Carl, 532
Rogers, Paul, 408
Roger Williams General Hospital (Providence,
R.I.), 100
Royal Edinburgh Hospital, 222
Rush, Benjamin, 14, 153
Russell study of smoking cessation, 224
Rutgers University, 14, 388
S
SAA See State alcoholism authorities
SADAP. See State Alcohol and Drug Abuse
Profile
St. Mary's Hospital (Minneapolis), 59
Salvation Army, 107-108, 116
Sampling, in outcome monitoring, 322
San Diego County, 204
San Diego VA Medical Center, 499
San Francisco, 229-230
"Scatter" beds, 420, 424
Schizophrenia, 36, 282, 386, 516
Schools
prevention programs in, 231-232, 391
student assistance programs, 100-101, 363
364
Scottish immigrants, 345
Screening, 65, 66, 249, 255, 256, 259. See also
Assessment, pretreatment
drinking driver programs, 382
and utilization, 434-435
Secondary prevention, 45-46, 47, 213
at colleges, 391
for drinking drivers, 383
Second Special Report to the U.S. Congress on
Alcohol and Health (USDHEW), 346
Seizures, 74
Selective Severity Assessment Scale, 74
Self-efficacy, 80, 293
Self-esteem, 357, 358, 519
and matching, 280, 283
Self-help
groups, 108-111, 113-114, 304-305, 418, 567
manuals, 226
Self-insurance, 185-186, 200, 427, 431, 475
Self-monitoring, 81
Self-payment. See Patients: payments by
Self-referral, 594
Self-reports, 255, 532
OCR for page 626
626
corroboration of, 323
validity of, 219, 262, 263, 264, 527-528
Self-selection, 457
Sequential assessment, 249-251, 256, 269. See also
Assessment, pretreatment
Serotonin, 77
serotonin uptake inhibitors, 514-515, 516
Severity of Alcohol Dependence Questionnaire,
255
Sexual abuse, 357, 363
Sexually transmitted diseases, 390
Shadel Sanatorium (Seattle), 78
Situational factors, 260, 283
Sixteen Personality Factors Inventory, 258
Sixth Special Report to the U.S. Congress on
Alcohol and Health (USDHHS), 349
"Sleepers," 322
Smither's Foundation, 112
Smokers, 257
Smoking cessation, 216, 224
"Sobering up services," 49
Social assistance agencies, 231
Social class, in special populations, 345
Social-community model of recovery, 51
Social context, 246
Social drinkers, 381-382, 384
Social learning model, 51, 52
Social learning theory, 78, 524
Social model of recovery, 52, 56-58
costs of, 204
detoxification, 74, 103, 122, 123, 169, 170
insurance coverage of, 422, 425, 431, 469
states' adoption of, 415, 416, 417, 440, 441
Social networks, 403
Social Security Act (1965)
payroll taxes, 193
Title XVIII, 192-193
Title XIX, 193
Social Services Amendments (1974), 191
Title XX social services funds, 191, 412-413
Social skills training, 524
Social stability, 282, 460
Social workers, 126, 127, 234
Society of General Internal Medicine, 131
Society of Teachers of Family Medicine, 131
Sociocultural perspective on treatment, 51, 52, 53
Soviet Union (USSR)
alcohol problems in, 555
treatment in, 517, 560-561, 573, 574
Specialized treatment, 6, 18, 19, 37, 218, 220, 438.
See also Treatment
availability of, 440
funding for poor and uninsured, 480-483
funding sources, 188-197
processes of, 329, 330, 340
referral to
coerced, 579, 580, 596-601
community agency role, 16, 211, 212, 217,
220, 228, 329, 334
and utilization, 434-435
treatment settings, 101-112, 406
Special populations, 9, 344-347, 410
day treatment for, 106
defined by functional characteristics, 381, 393
INDEX
defined by structural characteristics, 356, 371-
373
international programs, 569-571
recommendations on, 10, 399-404
research on treatment for, 347-353, 401-402
Specialty mental health care, 98-99, 101
Specification
problem and individual, 319
treatment, 319-320
"Spontaneous remission, 152
Stabilization, 63, 65. See also Extended care
Stages of change model, 53
State alcohol and drug abuse agencies (SA/DAA),
197-200
State Alcohol and Drug Abuse Profile (SADAP),
167, 201, 392
criminal justice referrals data, 589-590
employee assistance programs data, 592
funding data, 185, 197-200, 415, 416, 440-
441, 442
suggested modifications, 205-206
State alcoholism authorities (SAA), 409, 491
administration of grants, 125, 411, 415-419,
439
and cost containment, 437-438
and data collection, 442, 443
and insurance coverage, 428
licensing procedures, 426
and model benefit plans, 412
Medicaid reimbursement of, 422
and social model treatment, 415, 440, 441
State Alcohol Profile Information System (SAPIS),
197
State hospitals, 99
State mental health authorities, 409
State mental hospitals, 99, 406
States. See also State alcoholism authorities
accreditation and regulation, 129, 413-414,
426
administration of block grants, 190-191, 414,
415-419, 464, 488, 498
alcohol consumption, per capita, 176
continuum of care definitions, 50
data collection, 442-443
detoxification centers, 103
drinking driver programs, 382-383
employee assistance programs, 592
and federal formula grants, 408-409
insurance coverage for poor, 481-483
involuntary commitment laws, 581-582
mandated insurance coverage, 427, 429-430,
475
and Medicaid, 193
recommended actions, 491-493
resource allocation models, 164-165
social model treatment, adoption of, 415, 416,
417, 440, 441
and special populations, 349, 350
and treatment availability, 170-173, 178-179
treatment program funding by, 186-187, 196-
197, 406, 476, 477
expenditure levels, 173-175
sources of funds, 189-190, 195, 200, 407, 415,
439
OCR for page 627
INDEX
and treatment settings, 71, 123
Stress management training, 79, 524
Student assistance programs, 100-101, 363-364
Suicide, 362, 366, 553
Supplemental Security Income, 192, 194
Supportive services, 43, 52, 63
"Survival" model, 80
Syphilis, 33
T
Tarlov, Alvin R., 20
Task of Medicate (White), 20
Tax subsidy, private insurance, 474-475
Teachers, 234, 363
Television Bureau of Advertising, 432
Temperance movement, 14
Temposil, 159
Tertiary prevention, 45, 213
Texas, 109
Theory, research and, 401
Theory-driven treatment selection, 293
Therapists. See also Counselors
characteristics of, 148, 532-533, 537
selection of treatment by, 289-291
for special populations, 356
Thiamine, 74
Third-party payers. See Health insurance
Third Special Report to Congress on Alcohol and
Health (USDHEW), 32, 345, 346
Time-line interview, 268
Title XX social services funds, 191, 412-413
Training programs, 496-497
NIAAA funding, 125, 130, 131, 233
for outcome monitoring, 321-322
Treatment. See also Funding; Matching; Outcome
monitoring; Specialized treatment;
Treatment providers; Treatment systems
approach
accessibility of, 163-164, 600
health insurance and, 423
for special populations, 371, 400-401
alcohol problems
deterioration with treatment, 155-156, 159
implications of heterogeneity of, 36-37
improvement without treatment, 152-155,
159, 221
availability of, 8, 163-167, 178-179, 440
cost containment and, 444
mandated insurance and, 429
prevalence of alcohol problems and, 176
178
coerced, 156-157, 159, 382, 534-535, 580-586
compliance with, 534, 597
controversies, 294-296
and cost containment, 431, 444
cost-effectiveness of, 455-456, 457
defining, 42-47, 84-86
effectiveness of, 145, 467, 538
for coerced treatment, 601
for elderly, 364-365
and insurance industry, 413, 424-425
627
for special populations, 401, 402
studies of, 422-423, 511, 526-528, 529
efficacy of, 145, 279, 531-532
etiology and, 35-36
expenditures, 173-175, 188, 198, 202-204, 416,
424, 441, 465
goals of, 62, 257, 295, 313, 320, 512
goals inventory, 290, 291
and health care costs, 183-184
health maintenance organizations, 434
history of, 14-15
insurance coverage of, 422, 474
intensity and duration of, 529
international studies, 555-564, 573-577
modalities of, 73-84
personnel, 124-132, 203, 413
philosophy or orientation of programs and,
51~0, 85-86
progression in, 34, 217
results of, 142-149, 152, 536-537
setting of, 63, 69-73, 101-112, 202, 203
cost offset and, 456, 529
inpatient, 103
intermediate, 104-107
length of stay, 412
outpatient, 104
for special populations, 400-404
specification of, 287-289, 319-320
stages of, 60-69, 72, 103, 105, 202, 204, 402,
437
stigma of, 48
utilization rates, 165, 166, 168-169
for youth, 361-362
Treatment Alternatives to Street Crime, 587
Treatment Outcome Prospective Study, 596, 598
Treatment population
assessment of, 246-247
planning treatment for, 248-249
Treatment providers, 7, 98-99
advertising, 432
bias in assessment, 263-266
community sector, 99-101
federal programs, 117-119
insurance industry and, 425-426
Minnesota programs, 112-117
national surveys of, 119-124
public insurance criteria, 489
recommended actions, 495-496
specialist alcohol problems sector, 101-112
Treatment systems approach, 9, 11, 17-19, 329,
334-340, 487
financing of, 474-480
Triage referral, 61, 220
Tricyclic antidepressants, 76-77
Trotter, Thomas, 31-32
Tumor-node-metastasis system, 253-254
Twelfth Step houses, 406
U
Uncompensated care, 481
OCR for page 628
628
Uniform Alcoholism and Intoxication Treatment
Act, 56
and continuum of care, 48, 49, 85-86, 428
definition of treatment, 43
state adoption of, 387, 410-411, 491, 588
Uninsured persons, 187, 409-410
treatment financing for, 480-483
Union Internationale Centre de la Cancer, 253
Union of Soviet Socialist Republics. See Soviet
Union
United Auto Workers, 112, 495
United Kingdom
alcohol problems in, 553-554
treatment in, 557-559, 569, 570-571, 572, 573,
575
United States
Alcoholics Anonymous membership, 109
Bureau of Labor Statistics, 425, 427, 494
Bureau of Prisons, 118-119, 186, 205
Congress, 1, 3, 5, 120, 166, 413, 422
recommended actions, 488-490
and special populations, 349-350
Department of Defense, 118, 186, 205, 419
Department of Health, Education, and
Welfare, 409
Department of Health and Human Services
462, 167, 175, 197
and continuum of care, 48, 49, 50
data collection, 442
and special populations, 349, 350, 364
and treatment setting, 69
Department of Veterans Affairs, 118, 499
federal policies
continuum of care, 50
funding, 407-408, 477
health maintenance organizations, 433,
434
legal drinking age, 383
recommended actions, 488-490
research funding, 444
special populations, 344, 345-346, 401
federal treatment funding, 14, 186, 187,
192, 198, 199-200, 419-423
block grant, 414, 419
categorical grants, 406-407, 409-411
cost-effectiveness, 462
development of national policy on,
407-408
efforts to shift to insurance, 411-414
formula grants, 408-409
services systems, 340
General Accounting Office, 422
Indian Health Service, 119, 186, 205, 365, 367
United Technologies Employee Assistance
Program, 105
United Way, 338
Utility, outcome information and, 323
Utilization
cost offset and, 456
insurance availability and, 444
mandated insurance and, 429, 430
Utilization management, 284-285, 316, 434
INDEX
V
Vaillant, George, 33, 34
Valium, 385
Vehicular homicide, 381
Verbal aversion therapy, 79
Verbal reports. See Self-reports
Vermont, 427
Veterans, 349
Veterans Administration
and cost containment, 420
funding by, 116, 186, 205
VA hospitals, 115, 118, 204, 337
Voluntary commitment, 585-586
Voluntary organizations, 500-501
Vulnerability factors, 217
W
Wales. See England
Washington, D.C., 415
Washington, University of, 389, 391
Washington State, 584
Washingtonian Movement, 14
Wechsler Adult Intelligence Scales, 258
Weisner, Constance M., 4
Welfare assistance, 231
White, Kerr, 20
Whites (Caucasians), 368, 369-370, 399
Williams, Harrison, 408
Willmar State Hospital, 58, 59, 85, 128, 132
Winter VA Hospital study, 279, 284
Withdrawal, 49, 264, 472
pharmacotherapy, 74-75
treatment, insurers and, 431-432
Withering, William, 285
Women, 399
adolescent, treatment, 362
and alcohol consumption, 224, 230, 369, 389
American Indian, 366
grant targeting to, 190-191, 414
matching and, 283
prevalence of alcohol problems, 154
as special population, 9, 344, 346, 348, 349-
350, 351, 352, 356-358
United Kingdom programs, 570
Women for Sobriety, 108, 113-114
World Health Organization (WHO), 156, 227
AMETHYST study, 224, 228
expert committees, 287
international treatment study, 550, 551, 589
y
Yale School of Alcohol Studies, 14, 28, 112
Yale Plan Clinics, 128, 132
YAVIS syndrome, 321
Youth. See also Children of alcoholics
American Indian, 366
driver training programs, 383
Medicaid coverage, 421-422
OCR for page 629
INDEX
programs for, 115, 338, 358-364
in special populations, 9, 345, 346, 348, 349-
350, 351, 352
United Kingdom programs, 570
Youth Evaluation Service, 338
629
z
Zimbabwe, treatment in, 561-563, 568, 573
Zimelidine, 514-515
OCR for page 630
Representative terms from entire chapter:
insurance coverage
