Efforts to assure quality treatment for addiction
have proven highly fallible, with many barriers
standing in the way of adequate performance
and outcome measurement, including limited
consensus regarding core quality standards and
measures, inadequately developed measures and
improvement mechanisms, and inadequate
infrastructure and technical capacity.^243
Further, the way in which addiction treatment is
evaluated differs considerably from the
evaluation of the effectiveness of treatment for
other health conditions like diabetes,
hypertension and asthma. Specifically,
evaluations of the effectiveness of treatment of
chronic diseases typically are conducted while
the patient continues to receive treatment, since
the treatment is considered critical to managing
the disease. In the case of chronic addiction,
however, evaluations of treatment effectiveness
usually are conducted after the treatment has
been withdrawn.^244 In other words, we use an
acute care model to evaluate treatments for a
chronic condition.
Furthermore, because treatment facilities in
some states cannot be licensed to provide both
mental health and addiction treatment services,
the mental health and addiction treatment
systems are divided further. Given the large
number of patients who suffer from co-occurring
addiction and psychiatric disorders, the inability
to treat both conditions concurrently within the
same program is a significant barrier to
providing quality care; it reduces the diagnosis
and treatment of co-occurring conditions,
impedes coordination of care, and increases the
number of transfers which disrupts treatment.^245
Lack of Consensus Regarding the Main Goals
of Treatment. The primary goals of medical
care are the prevention, diagnosis and treatment
of illness, injury and disease, and the consequent
relief of pain and suffering.^246 The picture is not
as clear in addiction treatment: there is little
agreement among addiction treatment providers
about what the goals of treatment are or should
be and whether successful treatment is defined
by abstinence, a reduction in clinical symptoms
or a reduction in negative health and social
consequences.^247 Goals are not defined as
improving health and function or disease
stabilization as they are with other health
conditions. Such inconsistency in goals makes
measuring and assessing the effectiveness of
treatment very difficult.CASA Columbia’s survey of members of key
treatment provider associations* found that the
majority (78.5 percent) “strongly agree” that
improvements in functioning (e.g., employment,
education, parenting, family stability, crime and
recidivism, health, happiness, citizenship) is an
important goal of addiction treatment; about half
(52.5 percent) “strongly agree” that complete
abstinence is an important goal; 44.0 percent
“strongly agree” that remission of clinical
symptoms is an important goal; and 43.8 percent
“strongly agree” that reduced substance use is an
important goal. Nearly half (45.1 percent) of
respondents “strongly agree” that the patient
should be allowed to set the goal that is right for
him or her.^248Respondents to CASA Columbia’s survey of
treatment program directors and staff providers
in New York State were more uniform in their
support of complete abstinence as the main
treatment goal for someone with addiction
involving nicotine, alcohol or other drugs.^249
(Table 10.2)* See Appendix F.