Can the national addiction treatment infrastructure support the public's demand for quality care?

As part of a larger study of the national substance abuse treatment system, the authors had an opportunity to interview the directors and key staff from a nationally representative sample of 175 drug and alcohol treatment programs. Results indicated that within the previous 16 months, 15% of facilities had closed or stopped addiction treatment and an additional 29% had been reorganized under a different agency. There was a 53% turnover among directors and a similar rate among counselors within the previous year. Less than half the programs had a full-time physician or nurse, and very few programs had a social worker or psychologist. The predominant form of treatment was abstinence-oriented group counseling. The intake process typically required 2 to 4 hours to collect data required by managed care and city, state, and federal agencies. Very few programs had computers for clinical operations or decision support. These findings are disturbing and call into question the ability of the national treatment system to meet the complex demands of both the patients that enter this system and the agencies that refer to it. (C) 2003 Elsevier Inc. All rights reserved.