3 years following treatment (French et al., 1991; Gerstein et al., 1994; Holder and Blose, 1992).
Although the conclusions from this line of research are important and gratifying, they are not adequate to inform important clinical, economic, or health and social policy questions regarding the delivery of substance abuse treatment services. Knowledge that some of these treatments can work and that better outcomes are associated with longer treatment does not help to determine (1) which of the multiple elements in these multicomponent treatments are causally related to the favorable outcomes (i.e., the so-called active ingredients of treatment), (2) how long or at what level of intensity these ingredients should be delivered, or (3) the point at which the additional provision of these ingredients is no longer associated with increased benefits.
If the field of substance abuse treatment research is to help guide and inform the search for better, faster, less expensive treatments, it will be necessary to develop better, faster, less expensive means of evaluating the specific effects of substance abuse treatments. To respond to this need, the treatment field has begun to look for markers of or proxies for true outcomes that can be easily measured during the course of treatment (ideally as part of a management information system) and that have been associated with favorable outcomes following treatment. These early indicators of subsequent favorable outcomes have been called “quality indicators.”
Until now, these indicators have typically been developed by groups of clinicians and administrators who have simply selected indicators that have a clear, “face-valid” or intuitive link with longer-term outcomes. This common sense approach has had great appeal because the results have been measures that can be collected, analyzed, and reported rapidly and inexpensively, with the results being clear to patients, clinicians, and administrators alike.
Furthermore, because these indicators could be measured for individual patients and during the early course of an individual's treatment, they have the potential for use as early warning signs to correct inappropriate treatments. Because of their potential clinical and administrative value, systems of quality indicators have already been widely adopted by treatment providers, and there is a widespread effort to build the reporting of these measures into existing clinical or management information systems.
The existing and proposed quality indicators for the substance abuse field (e.g., American Managed Behavioral Healthcare Association and the National Committee for Quality Assurance) have been useful in identifying obvious problems in the conduct of treatment, in bringing the consumer perspective into the treatment setting, and in stimulating the treatment field toward greater self-