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OCR for page 321
Index
A
Abstinence
as central goal of drug treatment, 8, 129
full, partial, and nonrecovery, 126-127
goals of chemical dependency programs,
170-171
individual drug history, 62
Accreditation, Medicaid and drug
treatment programs, 26
Acquired immune deficiency syndrome
(AIDS)
Anti-Drug Abuse Act of 1988, 55
epidemic and national drug policy, 4
goals of drug treatment, 11, 105
health costs of drug problem, 104
Medicaid coverage, 271-272
methadone programs, 14
transmission by injection, 68 n.2
Addiction Severity Index, 110
Admissions, residential treatment
committee recommendations on optimal
private coverage provisions, 31
elimination of waiting lists, 232
utilization management and review, 28,
251
Adolescents
additional policy questions, 37-38
age of drug use onset, 68, 69
aggregate need for drug treatment, 7
estimating extent of need for drug
treatment, SO
patterns of drug consumption, 05
research recommendations, 21, 19~199
Adults
aggregate need for drug treatment, 7-8
arrests for drug crimes, 114
committee findings and
recommendations, 37
estimating extent of need for drug
treatment, SO
patterns of drug consumption, 4
treatment research statistics, 20-21
Aftercare, chemical dependency programs,
171
Age
aggregate need for drug treatment, 7
individual drug history, 6~69
patterns of drug consumption, ~5
treatment research statistics, 2~21
Aid to Families with Dependent Children
(AFDC), 198, 268
Alabama, state drug coverage mandates,
292
321
Alcohol and alcoholism
Addiction Severity Index, 110
chemical dependency programs, 16, 275
cost-effectiveness of treatment, 28~285
employee assistance programs, 121, 288
employers and private coverage
decisions, 282-283
extension of treatment capacity to drug
treatment, 218
partial legality, 62
pregnant women, 85
private insurance coverage, 278
recovery and relapse compared to
heroin, 73
state mandates regarding treatment
coverage, 289 n.5
therapeutic communities, 162
trends in provider characteristics,
208-209
Alcohol, Drug Abuse, and Mental Health
Administration (ADAM HA)
block grant administration, 241
emergency appropriation for F Y 1990,
216
health services research programs, 195
strategic planning for drug treatment,
235
trends in federal funding, 214
Alcoholics Anonymous
chemical dependency programs, 16, 53,
170, 171, 190
drug treatment programs, 135
Amantadine, 175
Ambivalence, client
incentives and motivation, 224
spectrum of recovery, 12~130
Anslinger, Harry, 48-
Anti-Drug Abuse Act of 1986
call for independent study of substance
abuse treatment coverage, 1, 33
emphasis on enforcement and
interdiction, 55
federal support of research, 192
federal support of treatment, 104, 202
n.1, 216, 244
TASC programs, 116
Anti-Drug Abuse Act of 1988
federal policy and treatment, 55, 216,
245
federal support of research, 192
ARC programs, 116
waiting list reduction, 232
Arkansas, state drug coverage mandates,
292
OCR for page 322
322
Arrests, law enforcement and drug crimes,
114
Attitudes
full, partial, and nonrecovery, 128
normative, 62, 64
Attrition, client, 126
B
Barbiturates, detoxification, 174 n.21
Benefits (see Cost/benefit analysis,
Insurance)
Bennett, William, 55
Block grants
federal role in 1980s, 241-245
management and federal funding, 246
reduction in federal funding, 202 n.1
research on women, 198
sources of treatment dollars, 212
Blue Cross/Blue Shield, 278, 284
Boot camps, effectiveness of correctional
treatment programs, 17,183-184
Brain
effects of opiates, 138-139
effects of psychoactive drugs, 64
Bromocriptine, 175
Budget (see Financing)
Buprenorphine, 175
Bureau of Narcotics and Dangerous
Drugs, 51
C
California
Civil Addict Program, 18~183
Medicaid and AIDS, 271-272
Medicaid and drug treatment, 267-268
methadone maintenance programs, 144,
146, 151-152
CareUnit system, 173
Certification
performance and public support, 29, 2S2
Chemical Abuse/Addiction Treatment
Outcome Registry (CATOR), 123,
173
Chemical dependency programs
average daily charges, 290 291 n.7
description of modality, 170-172
effectiveness of, 16, 172-173
private coverage and effectiveness data,
275
research on treatment effectiveness, 20,
186, 285
research recommendations, 197
rise of modern treatment, 53
state-mandated coverage, 290
INDEX
summary of committee findings, 190
variations in electiveness, 173-174
Child care, mothers and drug treatment,
198, 234
Children (see also Adolescents, Pregnant
Women)
age of drug use onset, 68
external costs of drug abuse, 229,
233-234
patterns of drug consumption, 4
women and therapeutic communities,
198
Civil Addict Program (CAP), 146, 18~183
Civil rights
concern for drug-dependent individuals,
108
economic status of clients, 127
Class
chemical dependency program clients,
criminal and medical views of drug
addiction, 48
employee assistance programs, 121
opium addiction and medical idea, 46, 47
Client-Oriented Data Acquisition Process
(CODAP), 164, 240
Clients, drug treatment
chemical dependency programs and
therapeutic communities compared,
172
individual goals, 12~130
parties involved in treatment, 107
public and private tiers, 205-206
trends in numbers and provider
characteristics, 206 210
Clinical trials, research on major
modalities of drug treatment, 18 n.2
detoxification, 175-176
methadone maintenance, 142-145,149
therapeutic communities, 158-160
Cocaine
detoxification, 175, 176
drug sequencing, 69
emergency room and medical examiner
cases, 77
employee assistance programs, 122
federal policy emphasis on enforcement,
55
history of use, 66-67
improvement of public coverage, 233
methadone programs, 14
need for expansion of public tier, 219
normative attitudes, 62
patterns of drug consumption, 5
patterns of drug treatment motivation,
111 n.2
positive tests among arresters, 100
OCR for page 323
INDEX
pregnant women, 85
research recommendations, 20,197-198
state prison inmates, 82, 83
therapeutic communities, 14, 154, 162
urinalysis, 99
Collective bargaining, employer-sponsored
health insurance, 273
Colorado, Medicaid funding of drug
treatment, 271
Community-based treatment
Alcoholics Anonymous methods, 135 n.2
criminal justice system referrals, 10, 120
goals of drug treatment, 108
origins of, 50-52, 133
Community Mental Health Centers Act,
52
Consumer price index (CPI), 210 n.2
Contracts, direct program financing of
public tier, 25
Copayments, treatment needs and cost
concerns, 299 n.2
Cornerstone program, effectiveness of
correctional treatment programs,
178, 180
Correctional treatment programs
effectiveness, 176-178, 18~185
summary of committee findings, 191
trends in client numbers, 207
Cost/benefit analysis
effectiveness of drug treatment
programs, 18
methadone treatment, 151-152,188
outpatient nonmethadone programs, 170,
189 190
therapeutic communities, 165-166, 189
Costs
balancing concerns with treatment needs,
22~230
baseline comparison values, 256-257
committee recommendations for private
coverage, 296
comprehensive strategy option, 260-262
core strategy option, 238, 257-260
estimation for drug problems, 10~104
external costs and logic of mandating
private insurance coverage of drug
treatment, 276
external costs and public intervention,
222-225
goals of drug treatment, 129
intermediate strategy option, 263-265
management and health care issues, 275
offsets and private coverage of drug
treatment, 282-283
private and public tiers, 218
323
private coverage and drug treatment,
293-294
private coverage and health benefits,
283-288
quantification of societal, 8~90
state mandates and private coverage, 291
utilization management, 28, 251
Counseling and counselors
improvement of public coverage, 232-233
methadone maintenance, 141-142
private versus public tied, 204
Courts, criminal justice
prison overcrowding and referrals to
treatment, 120
referrals to private programs, 112
referrals to treatment, 114, 116-117
Courtwright, David, 34
Crime
electiveness of Stay'n Out program, 178
estimating costs of drug problems, 102,
103
methadone clients, 13,143, 153
outpatient nonmethadone programs, 170
reduction as goal of drug treatment, 11,
108, 129
societal costs of drug abuse, 89
type and probable need for treatment,
100
therapeutic communities, 162, 166
Criminal idea
classic era of narcotics control, 409
drug policy, 3, 47~8, 55, 57, 218
evolution of governmental roles, 53-56
external costs and public intervention,
223
Criminal justice system (see also Law
enforcement, Parole, Probation)
Addiction Severity Index, 110
additional policy questions, 38
agencies as parties in drug treatment,
108
comprehensive strategy option, 238 239
estimating extent of need for treatment,
81 84, 88
estimating need for treatment among
arresters, 9~102
federal drug policy, 215
goals of drug treatment, 10-11, 106,
113-114, 116-120, 131
health services research, 196
implications of involvement in admissions
to drug programs, 11~113
inducing more clients to accept
treatment, 235
reasons for seeking treatment, 112
OCR for page 324
324
D
Data and data systems
federal role in 1980s, 244, 245
health services research, 197-198
performance standards, 247
private coverage and sources, 274
utilization management, 2~29, 252
Daytop Village
early success stories, 157
therapeutic community approach to
treatment, 51
Deaths, heroin recovery and relapse, 74
Dederich, Charles, 51
Defense, Department of (DoD), 266 n.5
Demography
populations of different modalities, 134
therapeutic community population, 154
treatment research statistics, 20-21
Demonstration grants, health services
research, 190197
Depression, emotional, 112
Depression, Great, 49
Desipramine hydrochloride, 175
Deterrance
prisons and criminological thought, 49
Detoxification
cross-dependence, 13~139
effectiveness, 16, 174-176
indications for hospital-based inpatient,
28, 251-252
recovery and relapse, 6
summary of committee findings, 19~191
Diagnosis, individual need for drug
treatment, 7, 69-72
Dia~osiw and Statistical Manual of Mental
Disorders (DSM-III-R), 70, 71, 76
Dole, Vincent, 5(}51
Drug abuse and dependence
complexity of problem and estimation of
need for treatment, 9~92
diagnostic critiera, 69-72
diagnosis and detoxification, 174 n.20
individual drug history, 59-75
quantification of societal costs, 88 90
Drug Abuse Forecasting (DUF) system,
99, 100, 101, 196
Drug Abuse Reporting Program (DARP)
evaluation of effectiveness of OPNMs,
168, 170
research on effectiveness of drug
treatment, 12, 134, 196
study of effectiveness of therapeutic
communities, 16~163, 165-166
Drug Abuse Treatment Outcome Study
(DATOS), 12, 134, 196
INDEX
Drug Abuse Warning Network (DAWN)
cocaine consumption, 67
data systems and research, 196
Drug consumption
estimation of need for treatment, 9~91
goals of drug treatment, 129
individual drug history, 60-61
level of use and criminality, 119
methadone dosage levels, 150
patterns and need for drug treatment,
4-5, 59
use, abuse, and dependence stages,
61-62
"Drug czar," 55
Drug dependence (see Drug abuse and
dependence)
Drug-Free Workplace Act of 1988, 123
Drug history, individual
age of onset and drug sequencing, 6~69
learning and drug experience, 64~6
model and overview of individual, 59-62
social environment, 66 67
Drug screening programs
availability to workers, 121 n.4
employers and goals of treatment, 123,
124
Drug sequencing, individual drug history,
6~69
Drug testing, employee
libertarian ideas, 45
private treatment programs and goals of
drug treatment, 108~109
Drug trade
crime control resources, 102103
homicide, 102
Drug treatment (see also Chemical
dependency programs, Correctional
treatment programs, Detoxification,
Methadone maintenance, Private
tier, Public tier, Therapeutic
communities)
balancing needs and cost concerns,
22~230
changing nature of drug problems,
29B~299
determining individual need, 7, 69-72
diverse interests and goals, 106 109
effectiveness, 11-21, 32, 132-199
employers and goals, 12~125
erosion of after 1976, 215-216
estimating extent of need for, 7~,
76~6, 88
estimating need for among arresters,
9~102
estimating need for in criminal justice
populations, 76~0
OCR for page 325
INDEX
estimating need for in homeless
population, 84
estimating need for in household
population, 77~0, 9~94, 96 99
evaluation of effectiveness and untreated
recovery rate, 75-76
goals, ~11, 13~131
growth of national system, 20~216
health insurance cost outlays, 283-284
improvement as priority of public
coverage, 23~233
modeling future treatment needs and
erects, 265-266
coverall tendencies of effectiveness,
13~135
as principle of public intervention,
227-228
reasons for seeking, 109 113
recommendations for research on
services and methods, 192-199
research on effectiveness, 133-134
rise of modern, 49-56
role of in federal anti-drug abuse
strategy, 214-215
state Medicaid coverage for specific
services, 271
two-tiered system, 21-22
DuPont, Robert, 55
EEconomics (see also Indigency; Poverty)
client assets and motivation for recovery,
127
quantification of societal costs, 88-90
Education
chemical dependency programs, 171, 172
goals of drug treatment, 129
Effectiveness (see Drug treatment)
Elderly, concern about abuse and
dependence, 68
Emergency rooms, estimating extent of
need for treatment, 76-77
Employee assistance programs (EAPs)
defining goals of treatment, 121-123
employee drug testing, 124
managed care system, 287-288
Employee Retirement Income Security
Act (ERISA), 289-290
Employers
drug screening programs, 123
extent and nature of insurance coverage
for drug treatment, 273, 282-283
federal government and drug treatment
coverage, 281-282
goals of drug treatment, 120125, 131
325
parties involved in drug treatment, 108
private companies and drug treatment
coverage, 278-279
reasons for seeking treatment, 112
state and local government and drug
treatment coverage, 279-280
Employment
Addiction Severity Index, 110
aggregate need for drug treatment, 8
oost/benefit ratio of methadone
maintenance, 153
cost/benefit ratio of outpatient
nonmethadone programs, 170
goals of drug treatment, 10, 129
therapeutic communities and treatment
retention, 162
F
Facilities, improvement of public coverage,
233
Families
Addiction Severity Index, 110
chemical dependency programs, 171
criminal view of drug problem, 47~8
goals of drug treatment, 129
parties involved in drug treatment, 107,
108 n.1
reasons for seeking treatment, 112
therapeutic communities, 156
Federal Employee Benefits Health Plan,
281
Financing
amounts needed to meet priority
objectives, 255
differences between private and public
tiers, 202-204
private coverage, 29-32, 273-300
public care, 21-29, 22~272
sources of treatment dollars, 211-214
trends in federal funding, 214-216
trends in funding base, 21~211
Flupenthixol decanoate, 175
Food and Drug Administration
Dole-Nyswander model of methadone
maintenance, 51
LOAM, 139 n.6
Function impairments, recovery process, 6
G
Gatekeepers
employee assistance program staff, 288
utilization management, 27, 28, 250
Gaudenzia House, 166
OCR for page 326
326
Goals
criminal justice agencies, 113-114,
116-120
detoxification, 176
diverse interests, 10~109
drug treatment, 8-11, 130-131
employers, 120-125
full, partial, and nonreeovery from drug
problems, 126-128
methadone maintenance, 137
operational for programs, 105
and priorities of public coverage, 22-24
reasons for seeking treatment, 109-113
setting realistic, 12~130
Government, federal
crime control resources, 102-103
employees and drug treatment coverage,
281-282
financing of public tier, 21, 24-25
libertarian ideology, 41 15
Medicaid and matching dollars, 267
national drug policy, 3 -
role in the 1990s, 240-241, 245-248, 256
support for drug research, 192
trends in funding, 214-216
Government, local
crime control resources, 103
employees and drug treatment coverage,
279-280
sources of treatment dollars, 211-212,
213-214
Government, state (see also States, and
individual states)
crime control resources, 103
employees and drug treatment coverage,
279-280
financing of public tier, 21, 2~25,
211-212, 213-214
responsibility for public tier in 1980s,
244, 256
role in the 1990s, 24~241, 245-248
Grants (see also Block grants;
Demonstration grants)
direct program financing of public tier,
25
matching and maintenance-of-effort
requirements, 26, 249
Great Britain, methadone maintenance,
137
"Great Society," 3
H
Harrison Act of 1914, 48
Hazelden Foundation, 53, 173
INDEX
Health (see also Public health)
Addiction Severity Index, 110
estimating costs of drug problems, 104
methadone clients, 13
Health Maintenance Organizations
(HMOs), 281-282, 290 n.6
Health services
cost offsets, 283
research and treatment systems, 19-20
research recommendations, 195-197
Heart infections, transmission by injection,
68 n.2
Hepatitis, transmission by injection, 68 n.2
Heroin
detoxification and relapse, 13~139, 176
Dole-Nyswander research on methadone
maintenance, 50-51
effects compared to methadone, 140
emergency room and medical examiner
cases, 77
literature on dependence and recovery,
73-74
literature on patterns of drug treatment
motivation, 111 n.2
Nixon administration "War on Drugs,"
53-54
research and problem of noncompliance,
157-158 n.14
state prison inmates, 82-83
therapeutic communities, 14, 154, 162
Homeless, estimating extent of need for
treatment, 8~85, 88
Homicide, drug trafficking, 102
Hong Kong, study of methadone
maintenance, 144 n.8
Hospitals
chemical dependency programs, 16,190
committee recommendations on optimal
private coverage provisions, 3~31
cost control and utilization management,
28
drug detoxification, 16, 175, 19~191
optimal private coverage provisions,
294-295
prescription of methadone, 141
trends in drug treatment client numbed,
207-208
utilization management and public tier,
251-252
Household population, estimating extent
of need for treatment, 77-80, 92-94,
9~99
Human immunodeficiency virus (HIV) (see
also Acquired immune deficiency
syndrome)
methadone programs, 14
OCR for page 327
INDEX
I
Ideas
character of governing, 41-42
drug treatment policy, 2 - , 56
rise of modern drug treatment, 49-56
spectrum of about drugs, 42-49
Illinois Drug Abuse Program, 52
Incapacitation, prisons and criminological
thought, 49
Incentives
external costs and public intervention,
224
private providers and efficiency, 285-286
staff performance, 233
Income
constraints and public support of
treatment, 225-227
employee productivity losses, 103-104
estimating extent of need for drug
treatment, 80
as index of external costs, 229
private tier and insurance coverage, 277
sensitivity of drug abusers to price of
treatment, 276
Indigency, committee estimates of and
public coverage, 23, 227, 254-255
Infants (see Pregnant women)
Injection, transmission of disease, 68 n.2
Insurance, health (see also Financing,
Medicaid, Private coverage, Public
coverage)
employer-sponsored and unions, 273
and income constraints, 225 227
mandates, 30, 275-276, 288 293, 294
Intemational Statistical Classification of
Diseases, Injunes, and Causes of
Death (ICD-10), 70, 71
J
Jaffe, Jerome, 52
Jails, compared to prisons, 82 n.5
Job applicants, drug screening programs,
123
Johnson Institute, 53
Journal of the Arnencan Medical
Association, 50
Justice Assistance Act of 1984, 116
L
Law enforcement (see also Crime,
Criminal justice system)
additional policy questions, 38
arrests for drug crimes, 114
327
crime control resources, 102-103
societal costs of drug abuse, 89
Learning
drug consumption behavior, 69
individual drug history, 6~66
Legalization, illicit drugs, 265
Legislation (see also specific acts:
Anti-Drug Abuse, Drug-Free
Workplace, Employee Retirement
Income Security, Harrison, Justice
Assistance, Narcotic Addiction
Rehabilitation, Omnibus Budget
Reconciliation)
early anti-drug, 45
federal and Medicaid, 248, 271
federal anti-drug and expansion of
public tier, 22
state-mandated private coverage, 30,
275-276, 2~293, 294
Levo-alpha-acetylmethadyl (LAAM), 139
n.6, 158 n.14
Libertarian ideas
drug policy, 3, 11 46, 56, 57
influence on nation's collective thinking,
223
M
Managed care
employee assistance program personnel,
288
health insurance and cost containment,
286-287
Marijuana
drug sequencing, 69
emergency room reports, 77
employee assistance programs, 122
normative attitutes, 62
patterns of drug consumption, 5
positive tests among arresters, 100
state prison inmates, 82, 83
urinalysis, 99 100
Marketing, chemical dependency
programs, 20, 197
Maryland, state-mandated drug treatment
coverage, 290
Medicaid
federal contribution, 212
federal legislation and drug treatment
needs, 248 250
public tier funding of treatment services,
26-27, 256, 265-272
transitional steps toward the year 2000,
249
Medical idea
classic era of narcotics control, 48
OCR for page 328
328
drug policy, 3, 46-47, 48, 56, 57
evolution of governmental roles, 53-56
influence on nation's collective thinking,
223
private treatment programs and goals of
drug treatment, 108
Medical price index (MPI), 210 n.2
Medicare
nursing home care and Medicaid, 268
population served and treatment needs,
266
public coverage and income constraints,
225-227
Men
aggregate need for drug treatment, 7
estimating extent of need for drug
treatment, 80
married and reasons for seeking
treatment, 112
treatment research statistics, 2~21
Meperidine, 136 n.3
Methadone
compared to naltrexone and LAAM, 158
n.14
effects compared to heroin, 140
opiate detoxification, 174
types of narcotic analgesics, 136 n.3
Methadone maintenance
characteristics of long-tel~ clients, 160
Civil Addict Program supervision,
182-183
clinical behavioral strategy, 14~142
compared to outpatient nonmethadone
programs, 15, 168, 169, 170
compared to therapeutic communities,
166
cost/benefit ratio, 18, 151-152
criminal justice system and reasons for
seeking treatment, 112
description of modality, 136-137
electiveness, 12-14, 14~144, 146,
152-154
excess capacity, 206
expansion of private tier, 218
goals of treatment, 137
incentives to continue treatment,
22~225
need for expansion of public tier, 219
negative beliefs among public and policy
makers, 136 n.4
prevalence of repeat admissions, 111
research on expenditures and
effectiveness, 18, 19
research on treatment effectiveness,
185-186
rise in modern treatment, 50-51, 133
INDEX
significant private demand not subsidized
by private insurance reimbursements,
277
substitution, 138-140
summary of committee finding, 187-188
trends in client numbers, 206 207
variations in effectiveness, 17, 147-150
Modeling, future treatment needs and
effects, 265-266
Mothers (see also Pregnant women)
additional policy questions, 37
priorities of public coverage, 233-234
research recommendations, 21, 198
Motivations, client
ambivalence and spectrum of recovery,
126
full, partial, and nonrecove~y, 126-128
goals of drug treatment, 9-10, 106
reasons for seeking drug treatment,
109 113
N
Naltrexone
compared with methadone, 158 n.14
incentives to continue treatment,
22~225
Narcotic Addiction Rehabilitation Act
(NARA) of 1966, 52
National Academy of Sciences, 3~34
National Association of State Alcohol and
Drug Abuse Directors (NASADAD),
232
National Drug and Alcoholism Treatment
Utilization Survey (NDATUS)
baseline comparison values, 256-257
data on client numbers and provider
characteristics, 206
data on provider insurance receipts, 274
health insurance and cost of drug
treatment, 283-284
public and private tiers, 202, 216-219
women and special services, 198
National Drug Control Strategy
(September 1988), 76, 235-236
National Forum on the Future of Children
and Families, 38
National Household Survey of Drug
Abuse (1988), 92
National Institute of Justice, 77, 99
National Institute on Drug Abuse (NIDA)
evolution of government roles, 5~55
health services research programs, 195
household survey data and estimation of
extent of need for treatment, 76, 77,
77-78
OCR for page 329
INDEX
research on treatment services and
methods, 193-194
research recommended on adolescents,
pregnant women, and mothers, 21,
199
research responsibilities, 19
sponsor of report, 33
transfer of authority from SAODAP, 241
transition of role to research and
educational functions, 241
zoning and "not in my backyard"
problem, 197
New Yorlc
Dole-Nyswander research and
methadone treatment programs, 51
early trials of methadone maintenance,
142-143, 147-148
Medicaid policies, 267, 270, 271
study of heroin recovery and relapse, 74
Nicotine, partial legality, 62
Nixon, Richard, administration and drug
policy, 3, 5~54
Normative attitudes, individual drug
history, 62, 64
Nonh Dakota, state drug coverage
mandates, 292
"Not in my baclyard" (NIMBY) problem,
197
Nursing homes, Medicare and Medicaid,
268
Nyswander, Marie, 50-51
o
Office of Economic Opportunity, 52
Office of National Drug Control Policy
establishment and federal drug policy,
55-56, 245
inconsistencies among federal programs,
27
strategic planning for drug treatment,
235
Office of Personnel Management, 278, 281
Office of Treatment Improvement, 195,
235
Omnibus Budget Reconciliation Act
(OBRA), 241
Opiates (see also Buprenorphine, Heroin,
LOAM, Methadone, Naltrexone)
addiction in nineteenth century, 46
effects on brain, 138 139
pharmacological agents and
detoxification, 174
pharmacological properties of, 139
positive tests among arrestees, 100
urinalysis, 99
329
Opium
early anti-drug legislation, 45
nineteenth-century addiction and medical
idea, 46-47
types of narcotic analgesics, 136 n.3
Oregon, state drug coverage mandates,
293
Outpatient nonmethadone programs
(OPNMs)
cost/benefit ratio, 18,170
cost effectiveness compared to
therapeutic communities, 166
description of modality, 167-168
effectiveness of chug treatment, 15,
168-169
prison treatment programs, 17
private coverage and effectiveness data,
275
research on treatment effectiveness,
18-19, 185-186
rise in modern treatment, 52,133
summary of committee finding, 189-190
trends in client numbers, 206
variations in effectiveness, 169
Oxford House, 135
p
Parole (see also Civil Addict Program,
Criminal justice system)
community-based treatment programs, 10
estimating extent of need for treatment,
84
implications of criminal justice
involvement in admissions to drug
treatment, 113
reasons for seeking treatment, 112
state prison inmates and revocation, 82
n.6
Pennsylvania, Medicaid and drug
treatment, 267, 271
Performance
certification and public support, 29
committee recommendations on optimal
private coverage provsions, 31,
296 297
states and data systems, 247
utilization management, 250
Phillips, Mary Dana, 35
Phoenix House, 161
Pleasure seeking, methadone as effective
analgesic, 140
Polipy, national drug
effect of alternative scenarios on need
for treatment, 265-266
fundamental questions, 220-221
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330
ideas governing, 2-4, 56-57
questions for additional study, 2, 37-39
rise of modern drug treatment, 49-56
rule of simple ideas, 41-42
spending patterns, 213
spectrum of ideas about drugs, 42-44
Population studies, estimating extent of
need for treatment, 76
Poverty (see also Indigency)
external costs and treatment needs, 229
Preferred provider organizations (PPOs),
286
Pregnant women (see also Children,
Mothers)
comprehensive strategy option, 239
core strategy option, 238
estimating extent of need for treatment,
85-86, 234
Medicaid coverage, 272
research recommendations, 21, 198
Presidential Commission on the Human
Immunodeficiency Virus Epidemic
(1988), 76
Price, sensitivity of drug abusers to cost of
treatment, 276, 277
Prison-hospitals
classic era of narcotics control, 48
rise of modern treatment, 49-50
Prisons
compared to jails, 82 n.5
effectiveness of drug treatment, 17,
176-185, 191
external costs and public intervention,
223
motivations for treatment, 127
overcrowding and criminal justice
referrals to treatment, 10, 120
populations and estimating extent of
need for treatment, 81-84
referrals to treatment, 117-119
Private coverage
committee recommendations, 293-297
cost containment of health benefits,
283-288, 291-292
extent, 277-283
logic of mandating coverage of drug
treatment, 276-277
state mandates, 28~293
Private tier
clients compared to public tier, 205, 206
defined, 201-202
drug treatment coverage, 29-32, 277-283
drug treatment supply system, 216-217,
217-218
excess capacity, 206, 218-219
expansion in 1980s, 215, 218
INDEX
financing, 21-22, 202-203
goals of drug treatment, 10~109
overview, 273-276
ownership of programs, 209
ratio of drug treatment expenditures,
203-204
referrals from criminal justice system,
112
sources of treatment dollars, 21
Probation (see also Criminal justice
system)
community-based treatment programs, 10
estimating extent of need for treatment,
84
implications of criminal justice
involvement in admissions to drug
treatment, 113
outpatient nonmethadone treatment, 167
prisons and criminological thought, 49
reasons for seeking treatment, 112
Productivity
employers and drug treatment, 124, 282
estimating costs of drug problems,
103-104
goals of drug treatment, 106
societal costs of drug abuse, 89
Profit, growth of drug treatment industry
in 1980s, 277
Psychoactive drugs (see also Heroin;
Methadone; Opiates)
effects on brain, 64
federal and state codes, 62
medical and social uses and fundamental
ideas about drugs, 40
outpatient nonmethadone programs, 167
Psychotherapy, clinical rigor, 126
Public health
goals of drug treatment, 11
policy role of treatment, 56-57
societal costs of drug abuse, 89
street sales of methadone, 137 n.5
Public Health Service, 199
Public coverage
adequacy of present means for
managing, 221
committee recommendations, 24~252,
254-256
federal and state roles, 239-248
Medicaid, 248-250, 265-272
principles of coverage, 221-230
priorities, 23~235
strategy options, 235-239, 256-264
veterans, 252-254
Public tier
ambulatory treatment, 209
capacity and need for expansion, 219
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INDEX
clients compared to private tier, 205-206
criminal justice referrals, 112
defined, 201
drug treatment supply system, 216, 217
erosion after 1976, 215-216, 218
excess capacity, 206
financing, 21, 2~27
goals and priorities, 22-24
ratio of drug treatment expenditures,
203-204
selective expansion and resource
intensity, 22
R
Race/ethnicity
criminal and medical views of drug
addiction, 48
libertarian view of drug use, 45
therapeutic community clients, 154 n.12
Reagan, Ronald
administration and drug policy, 55
California and Civil Addict Program, 181
Recidivism
drug consumption and criminality, 119
length of imprisonment and drug
involvement, 118
Recommendations (see Policy, national
drug; Private coverage; Public
coverage; Research, needs and
priorities)
Recovery
ambivalence and spectrum of, 125-130
drug dependence, 6-7
full, partial, and nonrecovery, 126-128
goals of drug treatment, 106, 131
individual drug history, 73-76
Rehabilitation, prisons and criminological
thought, 49
Reimbursers, third-party and drug
treatment, 107
Relapse
detoxification, 16, 138-189
drug dependence, 5-6
individual drug history, 73-76
Remission, term compared to recovery, 73
n.3
Research
animal models, 64
character of nonexperimental
evaluations, 156-157
on effectiveness and expenditures for
major treatment modalities, 18-19
on effectiveness of drug treatment, 12,
185-186
331
experimental evaluation of effectiveness
of therapeutic communities, 158-160
needs and priorities for treatment
services and methods, 19-21,
192-199
optimal private coverage provisions, 32
Retention
therapeutic communities, 189
treatment effectiveness, 187-188 n.26
Rice, Dorothy, 89
S
Self-recove~y, relapse, 6-7
Sentences, criminal justice
law enforcement and drug crimes, 114
varying lengths and prison populations,
82 n.6
Shock incarceration (SI), effectiveness of
correctional treatment programs, 17,
183-184
Social change, fundamental ideas about
drugs, 40
Social services
improvement of public coverage, 233
outpatient nonmethadone programs,
167-168
Society
ethical position on income constraints,
225
external costs and private coverage, 276
external costs and public intervention,
223
Socioeconomic environment
additional policy questions, 3~39
drug dependence, 5
individual drug history, 66~7
recovery and relapse, 6, 75
Special Action Office for Drug Abuse
Prevention (SAODAP), 54, 240-241,
250
Staff
chemical dependency programs and
therapeutic communities compared,
172
composition of in 1982 NDATUS, 210
n.1
differential effectiveness of treatment
programs, 24
improvement of public coverage, 233
requirements of public tier programs,
206
variations in treatment effectiveness, 150,
164, 185
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332
States (see also Government, state)
drug problems among prison inmates,
82, 83 n.7
mandates of private coverage of drug
treatment, 30, 275-276, 288-293, 294
medical/criminal ideas and evolution of
governmental roles, 54, 55
use of Medicaid to fund treatment, 267
Statistics, sample size and standard error,
98-99
Stay'n Out, effectiveness of correctional
treatment programs, 177-178, 180
Stereotypes
individual drug history, 60
pleasure user and ethnicity, 45
Supplemental Security Income, 268
Supreme Court, criminal idea and drug
policy formation, 48
Sweden, methadone maintenance, 143-144
Syna non
early success stories, 157
therapeutic community approach to
treatment, 52, 133
T
Technology, libertarian view of drug use,
45
Therapeutic communities
compared to chemical dependency
programs, 171-172
compared to outpatient nonmethadone
programs, 15, 168, 169, 170
cost/benefit ratio, 18, 165-166
description of modality, 154-156
electiveness of drug treatment, 14-15,
156-163, 16~167
origins and development, 133
prison treatment programs, 17, 180
research on expenditures and
effectiveness, 18
research on treatment electiveness,
185-186
rise in modern treatment, 51-52
summary of committee findings, 188-189
variations in effectiveness, 163-165
Tobacco
partial legality, 62
pregnant women, 85
Treatment Alternatives to Street Crime
(TASC), 114, 116-117, 157
Treatment Outcome Prospective Study
(TOPS)
cost/benefit analyses, 152
effectiveness of drug treatment, 12, 35,
1 134, 196
electiveness of OPNMs, 168-169, 170
INDEX
effectiveness of therapeutic communities,
160, 162-163, 166
veterans as clients, 253
TASC referrals, 116
variations in effectiveness of methadone
maintenance programs, 148-149
veterans and drug treatment programs,
253
U
Unemployment
aggregate need for drug treatment, 8
estimating extent of need for drug
treatment, 80
goals of drug treatment, 10
Unions, employer-sponsored health
insurance, 273
Urban neighborhoods, goals of drug
treatment, 108
Urinalysis
clinical rigor, 125-126
estimating need for treatment among
arresters, 99-100
Utilization management
optimal private coverage provisions, 31
public financing of drug treatment, 27-29
public intervention in the 1990s, 25~252
V
Veterans, as special case of public
coverage, 25, 252-254, 256
Veterans Affairs, Department of, 252-254,
266 n.5
Vietnam War, 253
W
Waiting lists
elimination as priority of public
coverage, 232
reduction and core strategy option, 238
Wlllmar State Hospital, 53
Withdrawal, methadone and symptoms of
heroin, 140
Women (see also Mothers; Pregnant
women)
opiate addiction in nineteenth century,
46
reasons for seeking treatment, 112
research recommendations, 198, 199
self-esteem, and treatment, 198
Stay'n Out program, 178
therapeutic communities and graduation
rates, 161 n.17
World War II, decline in drug problem, 49
z
Zoning, drug treatment programs, 197
Representative terms from entire chapter:
private coverage
