Treating Drug Problems -- Copyright -- Preface -- Contents -- Contents of Volume 2 -- Summary -- QUESTIONS THE REPORT ANSWERS AND THOSE IT LEAVES UNRESOLVED (CHAPTER 1) -- IDEAS GOVERNING DRUG TREATMENT POLICY (CHAPTER 2) -- DRUG PROBLEMS AND THE NEED FOR DRUG TREATMENT (CHAPTER 3) -- Patterns of Drug Consumption -- Dependence -- Recovery and Relapse -- Determining the Need for Treatment -- Estimating the Aggregate Need for Treatment -- THE GOALS OF DRUG TREATMENT (CHAPTER 4) -- Motivations for Treatment -- Treatment and Criminal Justice -- EFFECTIVENESS OF TREATMENT (CHAPTER 5) -- Methadone Maintenance -- Therapeutic Communities -- Outpatient Nonmethadone Programs -- Chemical Dependency Programs -- Detoxification -- Variations in Effectiveness of Programs within Modalities -- Treatment in Prisons -- Costs and Benefits of Treatment -- Comparison of Data on Effectiveness and Expenditures for the Major Treatment Modalities -- Needs and Priorities for Research on Treatment Services and Methods -- THE TWO-TIERED STRUCTURE OF THE TREATMENT SYSTEM (CHAPTER 6) -- PUBLIC FINANCING OF DRUG TREATMENT (CHAPTER 7) -- The Goals and Priorities of Public Coverage -- Federal and State Roles -- Mechanism for Providing Public Support -- Utilization Management -- PRIVATE COVERAGE OF DRUG TREATMENT (CHAPTER 8) -- Extent, Costs, and Trends of Coverage -- Mandating Drug Treatment Coverage -- Optimal Coverage Provisions -- CODA -- 1 Introduction -- THE LOGIC OF THE REPORT -- ADDITIONAL POLICY QUESTIONS -- Treating Adolescents and Women with Children -- The Criminal Justice System -- The Socioeconomic Environment -- 2 Ideas Governing Drug Policy -- THE CHARACTER OF GOVERNING IDEAS -- THE SPECTRUM OF IDEAS ABOUT DRUGS -- Libertarian Ideas -- Medical and Criminal Ideas -- The Classic Era of Narcotics Control -- THE RISE OF MODERN TREATMENT.

Methadone Maintenance, Therapeutic Communities, and Outpatient Nonmethadone Programs -- Chemical Dependency Treatment -- The Medical/Criminal Idea of Treatment and the Evolution of Governmental Roles -- CONCLUSION -- 3 The Need for Treatment -- THE INDIVIDUAL DRUG HISTORY: A MODEL AND OVERVIEW -- Abstinence, Drug Types, and Normative Attitudes -- Learning and Drug Experience -- Environmental Variations -- Age of Onset Drug Sequencing -- Diagnosing Dependence and Abuse -- Recovery and Relapse -- ESTIMATING THE EXTENT OF THE NEED FOR TREATMENT -- Household Survey Data -- Criminal Justice Populations -- The Homeless Population -- Pregnant Women -- Summary -- QUANTIFYING THE CONSEQUENCES -- CONCLUSION -- APPENDIX 3A-ESTIMATING THE NEED FOR TREATMENT IN THE HOUSEHOLD POPULATION -- APPENDIX 3B-ESTIMATING THE NEED FOR TREATMENT AMONG ARRESTEES -- APPENDIX 3C-ESTIMATING THE COSTS OF DRUG PROBLEMS -- Drug-related Crime-Victim Losses -- Crime Control Resources -- Employee Productivity Losses -- Health Costs -- 4 Defining the Goals of Treatment -- DIVERSE INTERESTS -- REASONS FOR SEEKING TREATMENT -- CRIMINAL JUSTICE AGENCIES AND TREATMENT -- Court Referral to Treatment -- Prison and Parole Referral to Treatment -- Preliminary Conclusions about "Mandatory Treatment" -- EMPLOYERS AND TREATMENT -- Employee Assistance Programs -- Drug Screening Programs -- How Employers View Drug Treatment -- AMBIVALENCE AND THE SPECTRUM OF RECOVERY -- Full, Partial, and Nonrecovery from Drug Problems -- Setting Realistic Goals -- CONCLUSION -- 5 The Effectiveness of Treatment -- METHADONE MAINTENANCE -- What Is Methadone Maintenance? -- Goals -- Substitution -- Clinical Behavioral Strategy -- How Well Does Methadone Work? -- Why Do the Results of Methadone Treatment Vary? -- Costs and Benefits of Methadone Treatment -- Conclusions -- THERAPEUTIC COMMUNITIES.

What Is a Therapeutic Community? -- How Well Do Therapeutic Communities Work? -- The Character of Nonexperimental Evaluations -- Other Significant Follow-up Studies -- Why Do the Results of Therapeutic Communities Vary? -- Costs and Benefits of Therapeutic Community Treatment -- Conclusions -- OUTPATIENT NONMETHADONE TREATMENT -- What is Outpatient Nonmethadone Treatment? -- How Well Does Outpatient Nonmethadone Treatment Work? -- Why Do the Results of Outpatient Nonmethadone Treatment Vary? -- Benefits and Costs of Outpatient Nonmethadone Treatment -- CHEMICAL DEPENDENCY TREATMENT -- What Is Chemical Dependency Treatment? -- How Well Does Chemical Dependency Treatment Work? -- Why Do the Results of Chemical Dependency Treatment Vary? -- Benefits and Costs of Chemical Dependency Treatment -- DETOXIFICATION -- CORRECTIONAL TREATMENT PROGRAMS -- Stay'n Out and Cornerstone -- The California Civil Addict Program -- Boot Camps -- Conclusions about Prison Treatment -- SUMMARY AND CONCLUSIONS ABOUT TREATMENT EFFECTIVENESS -- Methadone Maintenance -- Therapeutic Communities -- Outpatient Nonmethadone Programs -- Chemical Dependency Programs -- Detoxification -- Correctional Treatment -- RECOMMENDATIONS FOR RESEARCH ON TREATMENT SERVICES AND METHODS -- Rebuilding the Research Base -- Major Research Questions -- Services Research -- Chemical Dependency -- Cocaine Treatment -- Women, Children, and Adolescents -- 6 Two Tiers: Public and Private Supply -- THE TWO TIERS: AN OVERVIEW -- Financing Differences -- Client Differences -- Capacity Differences -- THE GROWTH OF THE NATIONAL TREATMENT SYSTEM -- Trends in Client Numbers and Provider Characteristics -- Trends in the Funding Base -- Sources of Treatment Dollars -- Trends in Federal Funding -- CONCLUSION -- 7 Public Coverage -- THE PRINCIPLES OF PUBLIC INTERVENTION -- External Costs -- Income Constraints.

Positive Response to Treatment -- Balancing Treatment Needs and Cost Concerns -- FROM PRINCIPLES TO PRIORITIES -- Eliminate Waiting Lists -- Improve Treatment -- Reach More Young Mothers -- Induce More Criminal Justice Clients to Accept Treatment -- THREE STRATEGY OPTIONS -- The Core Strategy Option -- Comprehensive and Intermediate Strategy Options -- PUBLIC INTERVENTION IN THE 1990S -- Federal and State Roles in the 1970s -- The 1980s: Block Grants -- The 1990s: Appropriate Shifts in Federal and State Roles -- Transitional Steps toward the Year 2000 -- Utilization Management -- THE SPECIAL CASE OF VETERANS' COVERAGE -- CONCLUSIONS -- APPENDIX 7A BASELINE AND STRATEGY OPTION CALCULATIONS -- Baseline Comparison Values -- Core Strategy Option -- Annual Recurring Costs -- Eliminate Waiting Lists -- Restore Funding per Client to 1976-1979 level -- Staff Training -- Program/Client Performance Monitoring System -- Active Outreach to Expectant Mothers -- Treat 18,750 Expectant Mothers -- Children of Mothers in Residential Programs -- One-time Capacity Expansion/Improvements -- Residential Capacity Expansion -- Repair Existing Residential Facilities -- Repair Existing Outpatient Facilities -- Train Additional Staff -- Comprehensive Strategy Option -- Annual Recurring Costs -- Eliminate Waiting List -- Restore Funding per Client to 1976-1979 Level -- Staff Training -- Program/Client Performance Monitoring System -- Aggressive Outreach to Expectant Mothers -- Treat 56,250 Expectant Mothers -- Children of Mothers in Residential Programs -- Comprehensive Probation Emphasis on Treatment -- Comprehensive Prison Treatment -- One-time Capacity Expansion/Improvements -- Residential Capacity Expansion -- Repair Existing Residential Facilities -- Repair Existing Outpatient Facilities -- Train Additional Staff -- Intermediate Strategy Option -- Annual Recurring Costs.

Eliminate Waiting List -- Restore Funding per Client to 1976-1979 Level -- Staff Training -- Program/Client Performance Monitoring System -- Aggressive Outreach to Expectant Mothers -- Treat 37,500 Expectant Mothers -- Children of Mothers in Residential Programs -- Modest Probation/Parole Induction -- Modest Prison Treatment -- One-time Capacity Expansion/Improvements -- Residential Capacity Expansion -- Repair Existing Residential Facilities -- Repair Existing Outpatient Facilities -- Train Additional Staff -- APPENDIX 7B MODELING FUTURE TREATMENT NEEDS AND EFFECTS -- APPENDIX 7C MEDICAID -- Coverage Policy Determination under Medicaid -- Eligibility -- Coverage Provisions -- The Current and Future Status of Medicaid Coverage -- 8 Private Coverage -- THE LOGIC OF PRIVATE COVERAGE -- THE EXTENT OF PRIVATE INSURANCE COVERAGE -- Employees of Private Companies -- State and Local Government Employees -- Federal Employees -- Employers and Coverage Decisions -- TRENDS AFFECTING PRIVATE COVERAGE: COST CONTAINMENT OF HEALTH BENEFITS -- PRIVATE INSURANCE AND STATE MANDATES -- Access to Coverage -- Adequacy of Coverage -- Cost Containment -- The Value of Additional Mandates -- CONCLUSIONS -- Extent, Costs, and Trends of Coverage -- Mandating Drug Treatment Coverage -- Optimal Coverage Provisions -- Coda -- References -- Biographical Sketches of Committee Members and Staff -- Index.