Alcoholism: Services Research in the Era of Managed Care Organization Access Economics Outcome

474 Pages·2001·4.132 MB·English

by  Thomas D’Aunno (auth.)

RECENT DEVELOPMENTS IN
ALCOHOLISM
VOLUME15
SERVICES RESEARCH IN THE ERA OF MANAGED CARE
RECENT
DEVELOPMENTS IN
Edited by
MARC GALANTER
New York University School of Medicine
New York, New York
Associate Editors
HENRI BEGLEITER, RICHARD DEITRICH,
DONALD GALLANT, EDWARD GOTTHEIL,
ALFONSO PAREDES, MARCUS ROTHSCHILD,
and DAVID VAN THIEL
Assistant Editor
DEEANNA CALABRESE
An Official Publication of the American Society of Addiction Medicine
and the Research Society on Alcoholism.
This series was founded by the National Council on Alcoholism.
ALCOHOLISM
VOLUME 15
SERVICES RESEARCH IN
THE ERA OF MANAGED
CARE
Organization
Access
Economics
Outcome
KLUWER ACADEMIC PUBLISHERS
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Print ISBN: 0-306-46441-1
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Editorial Board
Chair: ChairEmeritusandFounder:
James D. Beard, Ph.D. Charles S. Lieber, M.D.
Dharam P. Agarwal, Ph.D. Howard J. Edenberg, Ph.D. Robert O. Messing, M.D.
Genevieve M. Ames, Ph.D. C.J. Peter Eriksson, Ph.D. Esteban Mezey, M.D.
Raymond F. Anton, M.D. Rueben A. Gonzales, Ph.D. Michael F. Miles, M.D., Ph.D.
Enrique Baraona, M.D. Charles R. Goodlett, Ph.D. Roger Nordmann, M.D., Ph.D.
Stefan Borg, M.D., Ph.D. Donna Gruol, Ph.D. Edward P. Riley, Ph.D.
L. Judson Chandler, Ph.D. Jan B. Hoek, Ph.D. Marcia Russell, Ph.D.
Robert T. Cook, M.D., Ph.D. Paula L. Hoffman, Ph.D. Robert F. Saltz, Ph.D.
John Crabbe, Ph.D. Harold D. Holder, Ph.D. John B. Saunders, Ph.D.
Nancy Day, Ph.D. Hiromasa Ishii, M.D. Steven Schenker, M.D.
Phillipe A.J. De Witte, Ph.D. Harold Kalant, M.D., Ph.D. Edith V. Sullivan, Ph.D.
Ivan Diamond, M.D., Ph.D. Barbara J. Mason, Ph.D. Muriel Vogel-Sprott, Ph.D.
Bruce D. Dudek, Ph.D. Gary S. Wand, M.D.
Research Society on Alcoholism American Society of Addiction Medicine
President: President:
Yedy Israel, Ph.D. Marc Galanter, M.D.
VicePresident: President-elect:
Stephanie S. O’Malley, Ph.D. Andrea G. Barthwell, M.D.
Secretary: Secretary:
Robert O. Messing, M.D. Michael M. Miller, M.D.
Treasurer: Treasurer:
Kathleen A. Grant, Ph.D. Elizabeth F. Howell, M.D.
ImmediatePastPresident lmmediate Past President:
Edward P. Riley, Ph.D. G. Douglas Talbott, M.D.
Publications Committee Chair:
Emanuel Rubin, Ph.D
Contributors
Pierre Kébreau Alexandre, Health Services Research Center, University of Miami,
Miami, Florida 33136
Brenda M. Booth, Centers for Mental Health Care Research, Department of Psy-
chiatry, University of Arkansas for Medical Sciences, and HSR&D Center for Men-
tal Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare Sys-
tem, Little Rock, Arkansas 72204
Anne Brisson, Dartmouth Medical School, Hanover, New Hampshire 03755
Sandra A. Brown, VA San Diego Healthcare System, San Diego, California, and
Department of Psychology, University of California, San Diego, La Jolla, California
92093-0109
Michael Calloway, Cecil G. Sheps Center for Health Services Research at the Uni-
versity of North Carolina of Chapel Hill, Chapel Hill, North Carolina 27599-7590
Dale D. Chitwood, Health Services Research Center and Department of Sociology,
University of Miami, Coral Gables, Florida 33124-2208
Elizabeth J. D’Amico, Department of Psychology, University of California, San Di-
ego, La Jolla, California 92093
Thomas D’Aunno, University of Chicago, School of Social Service Administration,
and Pritzker School of Medicine, Department of Health Studies, Chicago, Illinois
60637
Helen Dermatis, New York University School of Medicine, Department of Psychia-
try, Division of Alcoholism and Drug Abuse, New York, New York 10016
Susan Egelko, New York University School of Medicine, Department of Psychiatry,
Division of Alcoholism and Drug Abuse, New York, New York 10016
William Fals-Stewart, Research Institute on Addictions, University at Buffalo, The
State University of New York, Buffalo, New York 14203-1016
vii
viii Contributors
JohnW. Finney, Program Evaluation and Resource Center, and HSR&D Center for
Health Care Evaluation, VA Palo Alto Health Care System, Palo Alto, California
94025
Michael F. Fleming, Department of Family Medicine, University of Wisconsin,
Madison, Wisconsin 53715
John Fortney, Centers for Mental Health Care Research, Department of Psychiatry,
University of Arkansas for Medical Sciences, and HSR&D Center for Mental
Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare Sys-
tem, Little Rock, Arkansas 72204
Michael T. French, Department of Epidemiology and Public Health, and Depart-
ment of Economics, and Health Services Research Center, University of Miami,
Miami, Florida 33136
Bruce Fried, School of Public Health at the University of North Carolina of Chapel
Hill, Chapel Hill, North Carolina 27599-7590
Richard K. Fuller, Division of Clinical and Prevention Research, National Institute
on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Mary-
land 20892
Marc Galanter, New York University School of Medicine, Department of Psychia-
try, Division of Alcoholism and Drug Abuse, New York, New York 10016
David R. Gastfriend, Department of Psychiatry, Harvard Medical School, Boston,
Massachusetts 02114
AllanW. Graham, Kaiser Permanente, Chemical Dependency Treatment Services,
Denver, Colorado 80304
Dominic Hodgkin, Schneider Institute for Health Policy, Heller Graduate School,
Brandeis University, Waltham, Massachusetts 02454-9110
Constance M. Horgan, Schneider Institute for Health Policy, Heller Graduate School,
Brandeis University, Waltham, Massachusetts 02454-9110
Robert B. Huebner, Division of Clinical and Prevention Research, National Insti-
tute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda,
Maryland 20892
Keith Humphreys, Program Evaluation and Resource Center, and HSR&D Center
for Health Care Evaluation, VA Palo Alto Health Care System, Palo Alto, California
94025
Contributors ix
DanielS.Keller,Late of Mount Sinai Medical School, New York, New York 10029
Margaret T. Lee, Schneider Institute for Health Policy, Heller Graduate School,
Brandeis University, Waltham, Massachusetts 02454-9110
Helen J. Levine, Schneider Institute for Health Policy, Heller Graduate School,
Brandeis University, Waltham, Massachusetts 02454-9110
Dennis McCarty, Oregon Health Sciences University, Portland, Oregon 97201
Clyde B. McCoy, Health Services Research Center and Department of Epidemiol-
ogy and Public Health, University of Miami, Miami, Florida 33136
James R. McKay, Department of Psychiatry, University of Pennsylvania, Philadel-
phia, Pennsylvania 19104
Elizabeth Levy Merrick, Schneider Institute for Health Policy, Heller Graduate
School, Brandeis University, Waltham, Massachusetts 02454-9110
Rudolf H. Moos, Program Evaluation and Resource Center, and HSR&D Center for
Health Care Evaluation, VA Palo Alto Health Care System, Palo Alto, California
94025
Joseph Morrissey, Cecil G. Sheps Center for Health Services Research at the Uni-
versity of North Carolina of Chapel Hill, Chapel Hill, North Carolina 27599-7590
TimothyJ. O’Farrell, Harvard Families and Addiction Program, Harvard Medical
School Department of Psychiatry, Veterans Affairs Medical Center, Brockton, Mas-
sachusetts 02301
Paige Crosby Ouimette, Program Evaluation and Resource Center, and HSR&D
Center for Health Care Evaluation, VA Palo Alto Health Care System, Palo Alto,
California 94025
Sharon Reif, Schneider Institute for Health Policy, Heller Graduate School, Brandeis
University, Waltham, Massachusetts 02454-9110
Grant A. Ritter, Schneider Institute for Health Policy, Heller Graduate School,
Brandeis University, Waltham, Massachusetts 02454-9110
M. Christopher Roebuck, Health Services Research Center, University of Miami,
Miami, Florida 33136
Amy Rubin, Department of Psychiatry, Massachusetts General Hospital, Boston,
Massachusetts 02114
x Contributors
Helena J. Salomé, Health Services Research Center and Department of Epidemiol-
ogy and Public Health, University of Miami, Miami, Florida 33136
Laura A. Schmidt, Alcohol Research Group, Public Health Institute, Berkeley, Cali-
fornia 94709
Michael R. Sosin, University of Chicago, School of Social Service Administration,
Chicago, Illinois 60637
Peter J. E. Stan, RAND Corporation, Santa Monica, California 90401
Shelley Steenrod, Reading, Massachusetts 01867
Bradley Stein, Department of Psychiatry and the Behavioral Sciences, University of
Southern California, Los Angeles, California 90033
Roland Sturm, RAND Corporation, Santa Monica, California 90401
Sharon Topping, College of Business Administration at the University of Southern
Mississippi, Hattiesburg, Mississippi 39406
Constance Weisner, Department of Psychiatry, University of California, San Fran-
cisco, San Francisco, California 94143
Weiying Zhang, RAND Corporation, Santa Monica, California 90401
Preface
FromthePresidentoftheResearchSocietyonAlcoholism
On behalf of the Research Society on Alcoholism I welcome the important contri-
bution that Volume 15 of this excellent series on Recent Developments in Alcohol-
ism brings to our field. It is not enough for our scientists to develop effective and
efficient methods to identify and treat alcohol abuse and alcohol dependence; the
availability of these services is often limited and it is certainly nonexistent for the
early problem drinker.
In nineteen outstanding chapters, Volume 15 deals with organizational issues
concerning access to and delivery of substance abuse treatment and the role of
managed care. Several chapters deal with economic issues, cost-benefits, and fi-
nancing of these services. Lastly, five address recent treatment outcome studies.
Thus, this volume will be of great value to both scientists and practitioners. The
Editor and Associate Editors are congratulated for this conceptual and organiza-
tional accomplishment.
Yedy Israel, Ph.D.
President, Research Society on Alcoholism
From the President of the American Society of Addiction Medicine
The rise of managed care has had a major effect in all areas of the health care sys-
tem, and this volume provides a context for understanding this effect. In recent
years, treatment has been compromised in many ways by changes in insurance
coverage. A recent comprehensive evaluation sponsored by ASAM revealed that
the value of substance abuse insurance coverage for corporate employees declined
by 74.5% from 1988 through 1998. This compared with declines during the same
period of only 11.5% in the value of general medical coverage.
Clinician options for providing treatment have suffered, as the shift toward
managed care has come to be associated with a marked reduction in frequency and
duration of inpatient hospitalization, despite the demonstrable need of many pa-
tients who require this level of treatment intensity. Significantly, this decrease has
not been offset by a corresponding increase in outpatient treatment utilization. The
impact of these developments is apparent in another ASAM survey of physicians
specializing in addiction, a majority of whom indicated that managed care had a
xi