SUBSTANCE USER TREATMENT PROGRAM QUALITY: SELECTED TOPICS

Abstract

This panel explores the “state of the art” in conceptualization and research pertinent to program quality in substance user treatment. First, seven critical questions for program quality are identified and discussed. Second, a recent national evaluation of treatment examines the implications of long-term patient outcomes for treatment quality. Third, a large number of clinical trials of behavioral and pharmacological treatments for cocaine dependence were conducted during the 1990s; this research is synthesized and interpreted. Fourth, progress is reported in improving the quality of treatment through standardized criteria for patient placement matching.

Truth seems to come with its final word; and the final word gives birth to its next.

Rabindranath Tagore, Stray Birds

• Substance dependency treatment
• Program quality
• Treatment outcomes
• Cocaine dependency treatment
• Patient placement matching
• Evidence-based treatment

RESUMEN

Este trabajo exploró el presente conocimiento sobre la conceptualización y la investigación pertinentes a la calidad de programas de tratamiento para los utilizadores de drogas. Primero, siete preguntas críticas para la calidad de programas se identifican y se discuten. En segundo lugar, una evaluación nacional reciente del tratamiento examina las implicaciones de los resultados de pacientes a largo plazo para la calidad del tratamiento. Tercero, una gran cantidad de ensayos clínicos de los tratamientos del comportamiento y farmacológicos para la dependencia de la cocaína fueron conducidos durante los años 90; se sintetiza y se interpreta esta investigación. Cuarto, el progreso está señalado en mejorar la calidad del tratamiento con los criterios estandardizados para la colocación de pacientes.

RÉSUMÉ

Ce panel explore les connaissances actuelles sur la conceptualisation et la recherche concernant la qualité des programmes de traitement de la toxicomanie. D'abord, sept questions cruciales pour la qualité des programmes sont identifiées et discutées. En second lieu, une récente évaluation de traitement nationale examine des implications des résultats à long terme des patients pour la qualité du traitement. Troisièmement, un grand nombre d’épreuves cliniques de traitements comportementaux et pharmacologiques pour la dépendance de cocaïne ont été conduits pendant les années 90; cette recherche est synthétisée et interprétée. Quatrièmement, le progrès est documente dans l'amélioration de la qualité du traitement par l'utilisation de critères normalisés pour le placement des patients.

Additional information

Notes on contributors

Stephen Magura

Stephen Magura, Ph.D., C.S.W., is Deputy Executive Director at National Development and Research Institutes, Inc. He has designed and directed clinical trials, treatment outcome studies, health services research, social epidemiology studies, HIV prevention research and policy analysis, as related to drug dependency. He has published over 100 articles and authored/edited several books and special journal issues on outcome evaluation and clinical trials, including Experimental Therapeutics in Addiction Medicine.

Sam Schildhaus

Sam Schildhaus, Ph.D., who served as Principal Investigator of the Services Research Outcomes Study, is a Senior Research Scientist at the University of Chicago's National Opinion Research Center (NORC). Prior to joining NORC, he served as Senior Policy Analyst at the Executive Office of the President's Office of National Drug Control Policy. He has conducted health services research for over 20 years; his doctorate is in Political Science from the Maxwell School at Syracuse University.

Andrew Rosenblum

Andrew Rosenblum, Ph.D., is Director, Institute for Treatment and Services Research at National Development and Research Institutes, Inc. His current treatment research work includes evaluation of intensive case management services for homeless drug users, a multi-site study of cognitive-behavior therapy for cocaine-using methadone patients, and the implementation and testing of an organization treatment linkage model for street-based sex workers.

David Gastfriend

David R. Gastfriend, M.D., directs Addiction Services at Massachusetts General Hospital and is Associate Professor of Psychiatry at Harvard Medical School. He initiated the first multi-site study to validate and refine the ASAM Patient Placement Criteria. He is a Researcher-in-Residence for the National Institute on Alcohol Abuse and Alcoholism. He founded the Fellowship in Addiction Psychiatry at the MGH and Spaulding Rehabilitation Hospital. He teaches and provides outpatient substance user clinical care at the MGH.