Program and client characteristics as predictors of the availability of social support services in community-based substance abuse treatment programs.

Recent emphases on increasing accountability, using less intensive settings, and implementing evidence-based services helped to focus the research community on the structure, processes, and outcomes of services delivered to substance abuse clients. Considerably less attention has been given to understanding how to structure services to enhance engagement and retention leading to treatment continuity. This study examined structural characteristics of community-based treatment facilities in relationship to the availability of supportive services within a sample of 1,332 substance abuse treatment programs surveyed through the Alcohol and Drug Services Study in 1996 and 1997. Structural and client characteristics are important predictors of added supportive services. Furthermore, a program with a broader and established set of core services is more likely to have expanded supportive services. These findings have implications for public health professionals, both in terms of ensuring sustainable service programming for these chronic clients and in identifying services to adopt or discard to meet a population with multiple needs.

Expanding the role of health services research as a tool to reduce the public health burden of alcohol use disorders.

The public and private cost of "heavy alcohol use" is estimated to be more than 187 billion in lost productivity, health care and criminal justice expenditures, and other costs. This does not include the emotional and psychological costs to family, friends, and the community. Investments by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have led to a number of important advances in pharmacological and behavioral treatments for alcohol disorders. Yet, there continues to be a significant gap between research findings and progress in community-based care. Additionally, limited capacity, a lack of acknowledged standards, and a separation between the specialty substance use treatment sector and general medical practice contribute to this gap. As part of its ongoing efforts to encourage translation from clinical research to practice, NIAAA undertook a review of its alcohol related health services research program for the purpose of creating a vision for the next 10 yr that is sensitive to the changing needs of both the clinical and research communities. Central to the development of a new research agenda is a reconceptualization of alcohol use and misuse along a continuum that takes into account quantity and frequency of use as well as the consequences from "heavy use" and misuse of alcohol. This public health approach recommends a number of high priority areas to expand and improve the system of care for "heavy alcohol users" who may be at-risk or who may have developed an alcohol use disorder. These recommendations include research on dissemination and implementation of evidence-based practices, and improving access and utilization to care for individuals who are "heavy users." The paper concludes by outlining some of the steps taken by NIAAA to further the continuing development of alcohol health services research.

Patient and program factors in obtaining supportive services in DATOS.

This study examined patient and program factors that influenced the receipt of scheduled supportive services in the Drug Abuse Treatment Outcome Studies (DATOS). Patients (N = 2,932) in 21 long-term residential (LTR) programs, 27 outpatient methadone treatment (OMT), and 25 outpatient drug-free programs were interviewed at admission and at 3 months during treatment. A hierarchical regression analysis was used to examine the relationship between patient-level and program-level factors associated with receiving supportive services in seven categories (medical, psychological, family, legal, educational, vocational, and financial). LTR patients received more services on average than outpatients (especially OMT), but patients overall received few services in the first 3 months of treatment. The patient-level likelihood of receiving services was related to being female and to having higher problem severity at intake. At the program level, outpatient clientele with higher problem severity received more services if they entered a program whose other enrolled patients were less troubled on average.