Academic journal article Social Work Research

Closing the Need-Service Gap: Gender Differences in Matching Services to Client Needs in Comprehensive Substance Abuse Treatment

Academic journal article Social Work Research

Closing the Need-Service Gap: Gender Differences in Matching Services to Client Needs in Comprehensive Substance Abuse Treatment

Article excerpt

Despite the broad recognition in social work that services are more effective when they are tailored to individual client needs, we have only limited evidence of the impact that services matched to client needs have on treatment outcomes. This study examines gender differences in the impact of matched services, access services, and outcome-targeted services on substance abuse treatment outcomes by using data collected from 1992 through 1997 for the National Treatment Improvement Evaluation Study, a prospective, cohort study of substance abuse treatment programs and clients. The analytic sample consists of 3,027 clients (1,105 women and 1,922 men) who reported needed services from 59 treatment facilities. Findings from the study indicate that overall programs have only limited success in targeting services to client needs, but when they do, receipt of substance abuse counseling and matched services predicts both remaining in treatment and reduced posttreatment substance use for both women and men, but especially for women.

KEY WORDS: comprehensive services; gender; need-service matching; substance abuse treatment

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Research indicates that treatment approaches that provide comprehensive services to address the numerous problems that co-occur with substance abuse are most effective in reducing problematic substance use, particularly when services are targeted to meet specific client needs. These findings result from evaluations of comprehensive service programs that provide substance abuse services as well as ancillary health and social services designed to address client-identified needs (Friedmann, Hendrickson, Gerstein, & Zhang, 2004; Smith & Marsh, 2002). Although women enter substance abuse treatment with more co-occurring problems than men, it is unclear whether they benefit disproportionately when services are tailored to their needs. The purpose of this study was to examine the fundamental social work practice principle that treatment is more effective when tailored to meet client-identified needs (Berlin & Marsh, 1993; Rosen, Proctor, & Livne, 1985).

Practitioners, policymakers, and researchers have observed that medical, psychiatric, economic, family, vocational, and legal problems contribute to the development of substance abuse problems and serve as impediments to their reduction. The argument for comprehensive substance abuse services is based on the premise that substance abuse treatment is more effective when health, mental health, parenting, vocational, housing, and legal issues are addressed, along with substance abuse issues (Marsh, Cao, & D'Aunno, 2004; Marsh, D'Aunno, & Smith, 2000; McLellan & McKay, 1998). Furthermore, although the data are not consistent, a number of studies indicate that specifically matching services to clients' diverse medical, psychological, and social needs contributes positively to client retention in treatment, satisfaction, and outcome (Friedmann et al., 2004; Smith & Marsh, 2002). In studies that have not found the matching effect, researchers explained the finding by suggesting that the overall effectiveness of substance abuse treatment may be reduced if limited resources are diverted from primary substance abuse treatment activities to ancillary health and social services (Fiorentine, 1998).

Components of a Comprehensive Service Model

Studies have focused on specific types of comprehensive service strategies that contribute to improved outcomes. Among the service strategies studied are the following three: (1) outcome-targeted services, (2) access services designed to increase linkage to substance abuse services, and (3) matched services--that is, services received by clients that match their descriptions of need. In this article, in which we are concerned with the impact of substance abuse services on the outcome of reduction in substance use, we refer to substance abuse services as "outcome-targeted" services. …

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