DoubleTree Hotel
Rockville, Maryland
September 28 & 29, 1995

Frank M. Tims, Ph.D.
Chief, Services Research Branch
Division of Clinical and Services Research

Summary

Meeting Goals:

• Determine the credible scientific findings supporting drug abuse treatment as both effective and cost-effective.
  

• Produce 10 or more speaking points supporting the effectiveness and cost-effectiveness of drug abuse treatment. The speaking points were to contain:
• Easily comprehensible statements about drug abuse treatment
• A graphic depiction of each statement
• Specific citations

Meeting Process:

The agenda focused on identifying, refining, and conceptualizing science-based research findings. The meeting addressed these issues through presentations on the California civil commitment study, preliminary findings from the Drug Abuse Treatment Outcome Study (DATOS), and participant discussion.

Content:

Drug abuse researchers present concurred with the following statements:

• Substance abuse treatment can be evaluated; evaluation is an accepted procedure with recognized methods and standards.
• Drug abuse treatment outcomes compare favorably to other chronic relapsing diseases such as hypertension and diabetes, but drug abuse treatment frequently is held to a higher standard than other medical treatments.
• Cost-effectiveness of drug abuse treatment compares favorably to interdiction and other law enforcement efforts.
• Science-based research outcomes need to be presented in a comprehensible manner to practitioners, providers, policy makers, and the lay public.

Participant recommendations for the drug treatment research community included:

• Treatment effectiveness cannot be defined as a response to a single episode of care, but is the cumulative effect of several cycles or episodes of treatment.
• Rigorous research standards need to be maintained (including randomized trials) to determine treatment outcomes scientifically.

Data from the California civil commitment study on external coercion through the criminal justice system raised the following issues:

• More than half of all arrestees test positive for one or more drugs of abuse; many admit to drug dependence; and many actually request treatment.
• Data on coercive treatment counter the myth of internal motivation being essential at treatment initiation.
• Monitoring with consequences appears to support a favorable treatment outcome.
• Aftercare is an essential component of long-term effectiveness.
• Linking mainstream treatment with the criminal justice system is an ultimate goal.

After the preliminary DATOS results were presented, the following points were raised:

• External pressures may drive addicts into treatment and promote compliance; however, long-term, stable effects are unlikely in the absence of internal motivational mechanisms.
• Research in therapeutic communities indicates that coerced treatment is most effective for individuals with high internal motivation.
• Social support offered by an addict’s family/friends and a drug-free living environment contribute to recovery and to relapse prevention.
• Social policy tradeoffs occur when assessing treatment outcomes research. Intensive treatment offers greater advantage to the individual, but lower-intensity treatment provided to many may have greater benefit to society overall.

Conclusion:

• The impact of drug abuse treatment on such areas as crime, health care, child care, employment, collateral costs, and averted future costs needs to be identified and quantified.
• Competent, effective, intensive, rigorous drug treatment needs to be defined and minimum standards inferred in references to drug abuse treatment.
• A focus on the increasing role of managed care in drug abuse treatment is encouraged, considering the increasing marginalization of addiction treatment to the fringes of the medical establishment.
• Areas to emphasize include health, employment, crime, and family welfare, with economic benefit subsuming all areas.
• Data that document the size of drug abuse treatment outcome effects need to accompany the speaking points.

Products and Follow-up:

A book of speaking points will be developed containing:

• Brief, understandable statements describing science-based drug abuse treatment research findings.
• A graphic representation for each speaking point.
• Specific citations.

Examples of speaking points included:

• Drug abuse treatment:
• Reduces drug use
• Reduces crime
• Reduces long-term health care costs
• Reduces HIV transmission
• Averts future costs
• Drug abuse treatment has a positive effect on:
• Health (physical and mental)
• Employment
• Families