New Approaches in the Treatment of Substance Abuse
Inciardi, James A, Saum, Christine A, Journal of Drug Issues
When community-based substance abuse treatment services were introduced in the United States in the 1960s, they were somewhat limited in scope, grossly under funded, and under supported. Few were served by the available treatment programs and many of the existing treatment modalities were found to be ineffective in the long term reduction of drug use. Over the past 30 years, however, many innovative strategies in substance abuse treatment have been developed to ameliorate these problems. New strategies have been designed to serve disparate populations of drug users by matching programs and services to clients with a multitude of special needs. As a result, there are many more options available to drug users who seek help for their addictions. Further, a substantial amount of evidence has accrued on the effectiveness of these innovative treatment programs indicating that drug and alcohol use, drug-related criminal activity, and poor social functioning improve during treatment and remain at more favorable levels after treatment (Ball and Ross 1991; Simpson and Sells 1990).
The difficulty for treatment programs is, however, formulating effective drugabuse reduction strategies for the diverse populations that require treatment. The challenge for providers is to determine what type of treatment works for what types of people. Indeed, various treatment issues such as modality, counseling techniques, and available resources interact with characteristics of the patient like motivation for treatment, suitability for treatment, and medical and psychological problems (De Leon and Jainchill 1986; McLellan et al. 1993). Client demographics and external environmental events also serve as important influences on treatment entry, retention, and outcome. Over the past 10 years substantial evidence has accrued on the effectiveness of substance abuse treatment, much of which has focused on the incorporation of individual treatment needs into specific treatment modalities.
Nonetheless, political agendas continue to restrict positive steps and the allocation of money toward prevention and treatment efforts. However, the message that treatment works and that treatment is cost effective is becoming increasingly accepted by policy makers. In addition, the problems of HIV and AIDS continue to direct funding efforts on the reduction of high risk behaviors of drug users. The Clinton Administration announced as part of a five-point plan in its anti-drug campaign an initiative to strengthen efforts at prevention and treatment. Of the $15.1 billion dollars allotted for federal drug spending, about one-third is planned for treatment and prevention.
The National Institute on Drug Abuse (NIDA) has developed a program of research demonstration projects to improve drug-abuse treatment effectiveness and to expand treatment capacity nationwide. NIDA instituted the Applied Evaluation Research (AER) portfolio in an effort to systematically integrate science and practice in the improvement of drug-abuse treatment. Many projects were funded under these initiatives including 12 of the projects included in this special issue. Two projects incorporated here are not part of the AER portfolio but are nonetheless innovative and worthy of inclusion.
All of the projects contributing to this issue focus on applied community-based drug-abuse treatment research problems. As discussed above, those who seek treatment for drug abuse have diverse problems and needs that must be addressed while in treatment in order to ensure success. Thus, all of the projects presented here vary as to their focus; some deal with methadone maintenance clients, some with criminal justice populations, and others with mentally ill patients. Some of the projects function to modify existing treatment modalities, whereas others have developed new therapies and methods of service organization and delivery. Each of these undertakings makes substantial contributions to our knowledge of the drugabuse treatment process and outcomes. …