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Book Review   |    
Treating Drug Abusers Effectively
Mark C. Radosta, L.I.C.S.W.
Psychiatric Services 1999; doi:
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edited by Joel A. Egerston, Daniel M. Fox, and Alan I. Leshner; Malden, Massachusetts, Blackwell Publishers (with the Milbank Memorial Fund), 1997, 340 pages, $59.95

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In spite of the billions of dollars that have been spent on drug abuse treatment programs in this country since the "war on drugs" was declared in the Reagan-Bush era, the public, who finance about 70 percent of the programs, have been nonplused about their efficacy. And for good reason, according to the impressively qualified contributors whose efforts produced this book. Research evidence, they conclude, clearly shows that drug treatment works. But what is known to work, they point out, is not always what is practiced.

Organized by the National Institute on Drug Abuse and the Milbank Memorial Fund, a private foundation that focuses on health policy issues, this book began as a series of planning meetings that brought together heavily credentialed players from the arenas of drug treatment research and public policy. Their task was to formulate topics for articles "that would describe current, research-based knowledge about what services for treating drug abuse ought to be provided to whom, by whom, in what setting, at what cost."

Among this field of experts, a select group was commissioned to write these articles. They were asked to synthesize the research findings in their area of expertise and apply this knowledge to answer three questions: What treatment programs should policy makers stop financing? What programs should they start to finance? What changes should be made in existing programs? The resulting works were subjected to rigorous peer review and then edited for publication.

The book is divided into three parts. The five chapters in the first section present an expansive but well-integrated overview of research findings that focus on drug treatment methods and processes. The section starts with a discussion of what is expected from drug treatment and offers a model for evaluating it, and it culminates with a description of what constitutes a "best practices" framework for providing it.

Questions about patient readiness and motivation for treatment, retention of patients in treatment, staffing patterns that work, and prediction of outcomes are among those answered by data from an array of studies. Policy implications of such important issues as the need for treatment and barriers to obtaining it are examined in light of changes associated with managed care and state health care reform.

The next section explores aspects of financing drug abuse treatment. State policy makers may be particularly interested in the article on performance-based contracting, illustrated by a model used in Maine. Two other chapters look at ways of forecasting and analyzing the cost of drug treatment. They present concepts that are difficult but necessary to understand before one confronts this economic Gordian knot.

The last section, informative and compelling, takes on three "special issues." It includes a well-argued polemic on the human and economic cost of the drug war and the inequities wrought on the African-American community, a prescription for effective drug services for adolescents, and a case for providing services that meet the health and social needs of substance abuse clients.

This book is targeted at state-level policy makers, according to its editors, but it would appeal to program and clinical directors as well. A separate companion report that distills much of the book's contents, called Treating Drug Abusers Effectively: Researchers Talk With Policy Makers, can be obtained free from the Milbank Memorial Fund's New York office (212-355-8400).

Mr. Radosta is coordinator of dual diagnosis services for the central Massachusetts area of the Massachusetts Department of Mental Health in Worcester.




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