Drug treatment programs scarce and getting scarcer

December 19, 1999

Less than one in four drug abusers receives treatment for addiction, and yet the number of programs dwindles, according to recent research.

"Access has shrunk in the last decade," said lead author Marjorie Gutman, PhD, of the Treatment Research Institute at the University of Pennsylvania School of Medicine. "Capacity falls far short of need and may be shrinking under managed care."

Gutman and co-author Richard Clayton, PhD, of the Lexington-based University of Kentucky Center for Prevention Research, found encouraging evidence of improvements in treatment effectiveness. Overshadowing the good news, however, is a steady reduction of availability and access. They report their results in the November/December issue of the American Journal of Health Promotion.

According to the researchers, state-of-the-art drug treatment programs work best. These programs usually include detoxification; assessment and diagnosis; habilitation and rehabilitation; and aftercare, with or without medication.

"When clients do manage to enter programs, 30 percent to 50 percent stay off drugs for at least a year," said Gutman.

"There is an urgent need for new programs related to marijuana, inhalants, and methamphetamines," said Gutman. "The mentally ill, and people who abuse more than one substance, need new treatment options." However, rather than expanding, treatment options and opportunities are becoming less available.

"Treatment alternatives aren't simply dwindling; they are deteriorating in range, professionalism, and duration of services," said Gutman, citing national and local data. These declines are reflected in programs and services available in many different settings, including, for example, managed care programs that "carve out" mental health and substance abuse programs from physical health services.

The researchers also point out that controversy currently limits two treatment-related programs: needle exchanges and perinatal substance abuse responses. Needle swaps draw fire from criminal justice proponents, despite research consensus that such programs slow the spread of HIV without creating more drug users. Concerns about criminal justice issues have also restricted the availability of programs for pregnant addicts.

School-based prevention programs have gained sophistication, expanding beyond classroom instruction to include parents, media, and community. In comparison with students outside programs, results of up to 44 percent fewer drug users and 66 percent fewer polydrug users have been reported. "However, the widely publicized DARE program, sponsored by police in more than half the nation's school districts, has shown little if any sustained effect," said Gutman.

National and statewide efforts tend to focus on banning drugs, rather than prevention or treatment. One exception, the privately funded "Partnership for a Drug-free America" has tried for 15 years to "denormalize" drug use.

"Unfortunately, it has not been rigorously evaluated to determine its effectiveness," said Gutman. Federal efforts on a much wider scope are under way.
-end-
The American Journal of Health Promotion is a bimonthly peer-reviewed journal dedicated to the field of health promotion. For information about the journal call (248) 682-0707 or visit the journal's website at www.healthpromotionjournal.com .

Posted by the Center for the Advancement of Health < http://www.cfah.org >. For information about the Center, call Petrina Chong, < pchong@cfah.org > (202) 387-2829.

Center for Advancing Health

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