NIDA Research Provides Data to Document and Improve the Effectiveness of Drug Abuse Health Services

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NIDA Director, Alan I. Leshner

As part of its mission to treat and prevent drug abuse and addiction, NIDA has supported the development of numerous research-based drug abuse treatment protocols and drug abuse prevention models. In keeping with standard scientific methodology, these programs have been tested in tightly controlled practice settings with carefully selected populations.

Once these programs are tested the critical question becomes: Will the promising treatment outcomes produced in a controlled research environment hold in widely varying real-life treatment settings and for a wide range of patients? Likewise, will the prevention model that worked on a small scale continue to work in communities that may vary in any number of factors from size and ethnic composition to geography and the nature of their school systems?

Will the promising treatment outcomes produced in a controlled research environment hold in widely varying real-life treatment settings and for a wide range of patients?

To answer these questions, NIDA supports an extensive and growing portfolio of health services research. That portfolio is designed to give drug abuse treatment and prevention service providers the scientific data and research-based methodologies they need to gauge and enhance how well their programs will work for real-life patients in real-life settings. NIDA's health services research also encompasses economic analyses that provide answers to questions such as: Does this drug abuse program provide effective services that are accessible to patients at a reasonable cost? How does this program compare to similar programs in terms of its cost-effectiveness and accessibility? Does this program not only reduce drug abuse and addiction, but also reduce costs to society from drug-related crimes and health expenditures?

While much remains to be done, NIDA-funded scientists have built a solid foundation of science-based information that can be used to document and improve the effectiveness of drug abuse health services. Much of the Institute's research in this area is conducted at its health services research centers, which investigate the Nation's pressing drug abuse health services issues.

For example, investigators at the Center for Managed Care and Drug Abuse at Brandeis University in Waltham, Massachusetts, and Harvard University in Cambridge, Massachusetts, are assessing the impact of managed care on drug abuse treatment availability, content, duration, and utilization. They also are studying how managed care affects the organization and financing of drug abuse treatment facilities. At the Community-Based Health Services Research Center on Chronic Drug Users at the University of Miami in Florida, researchers are using the Dade County, Florida, health services system as a case study to find ways to improve drug abuse patients' access to both primary medical care and drug abuse treatment. The investigators are exploring how the Dade County system identifies, assesses, and serves chronic drug users, and, in particular, whether health care access and effectiveness vary by ethnicity or gender.

The Institute has supported three nationwide studies to assess the effectiveness of drug abuse treatment using numerous measures of treatment outcomes. All three studies have shown that drug abuse treatment patients in the four most common types of treatment programs - outpatient methadone, outpatient nonmethadone, long-term residential, and short-term inpatient - dramatically reduce their drug use following treatment, reduce drug-related criminal activities, and improve their physical and mental health. (For results of the most recent study - the Drug Abuse Treatment Outcome Study - see NIDA NOTES, September/October 1997.)

These studies and other NIDA-funded research highlight the value of providing patients with services in addition to drug abuse treatment. A recent study at the Treatment Research Institute in Philadelphia has found that providing drug abuse patients with services based on their needs in three areas - employment, family relations, and psychiatric problems - can boost the effectiveness of treatment (see "Matching Drug Abuse Treatment Services to Patient Needs Boosts Outcome Effectiveness").

NIDA-funded studies on the economics of treatment and prevention services are comparing the costs of drug abuse services with measures that can be quantified in dollar amounts, such as reduced costs of crime and avoided costs for medical consequences of drug use. Other such studies compare the costs of drug abuse services with measures that cannot be quantified in dollar amounts, such as how long a patient remains abstinent or a patient's degree of social functioning. These studies consistently show that resources spent on drug abuse services result in substantial savings to society. For example, results from the Midwestern Prevention Project - a comprehensive, NIDA-funded prevention study that was conducted in Kansas City, Kansas; Kansas City, Missouri; and Indianapolis, Indiana - indicated that every dollar spent on prevention programs saved $68 per affected family in health and social costs.

To help treatment providers improve treatment outcomes and reduce costs, NIDA is developing a manual to guide them in conducting economic analyses on their own programs. The new manual - titled Measuring and Improving Cost, Cost-Effectiveness, and Cost-Benefit for Substance Abuse Treatment Programs - will provide managers with step-by-step procedures for analyzing the costs of their services and for producing economic analyses. These analyses will provide valuable insights into how providers can serve their patients more efficiently. In the future, the economic data generated by treatment providers throughout the country may be pooled by researchers to produce further large-scale economic studies of drug abuse treatment, which, in turn, will give policymakers and insurance companies more science-based information to help them make decisions related to financing drug abuse treatment. In the coming months, the manual will be available both in print and on NIDA's home page on the World Wide Web. The Web site will also enable treatment providers to communicate with each other about the manual and their findings.

An economic analysis of the Midwestern Prevention Project indicated that every dollar spent on prevention programs saved $68 per affected family in health and social costs.

To keep pace with rapid advances in health services research, NIDA regularly evaluates its health services research agenda by drawing on resources both in the drug abuse field and in the health services research field at large. In December 1997 the Institute began hosting a series of meetings intended to help define an agenda for health services research. These meetings culminated in a research symposium at the annual conference of the Association for Health Services Research in June (see "Researchers at NIDA Symposium Discuss New Directions for Health Services Research"). We will use the information and ideas gleaned from these meetings in the coming months as we develop plans for advancing our research to improve health services for drug abusers.

We must press forward in our search to find ways to provide quality treatment to all drug abuse patients at reasonable costs. Likewise, we must continue to work to insure that promising drug abuse prevention research findings translate to real reductions in drug use among our Nation's children.