Inadequate Performance and Outcome
Measurement. Government and private funders
and insurance companies increasingly are
pressing addiction treatment programs to
demonstrate the effectiveness of their programs
and services.^250 However, most programs do not
measure performance or treatment outcomes or
have reliable evaluation data to demonstrate the
efficacy of their services.^251 There is no
national, unified body that sets standards for
addiction treatment.^252
CASA Columbia’s survey of treatment program
directors in New York State found that, when
asked about the three main ways that their
program evaluates how well it is doing, the most
common response offered was “program
completion rates” (68.7 percent); the next most
common response was “random client
feedback/testimonials” (54.2 percent). Neither
of these measures adequately reflects treatment
quality or effectiveness. Long-term follow up of
patients is not typical, as only 34.9 percent of
program directors reported following patients for
more than six months after treatment exit to
assess how well their patients were faring.^253
Further complicating the measurement of
outcomes is the failure to understand that
addiction in many cases is a chronic disease that
requires management over time.Most addiction treatment programs lack
resources to develop and implement effective
measurement systems.^255 Integrating addiction
treatment into mainstream health care, however,
would permit the performance and outcome
measures and standards that have been well
established for the treatment of other health
conditions to be applied to addiction treatment
as well.Inadequate Insurance Coverage .................................................................................
In spite of recent expansions in coverage for
intervention and addiction treatment through
health care parity laws and the Affordable Care
Act, insurance coverage for addiction and
related services remains severely limited
compared with coverage for other health
conditions.* 256 This lack of insurance coverage
for effective--and cost-effective--intervention
and addiction treatment services provides a
further barrier to increasing the attention of
health care professionals to this disease. The
end result is that millions of Americans are
denied treatment, health care costs continue to
rise as do social consequences and costs, and
taxpayers foot the bill.^257* See Chapter VIII.Table 10.2
New York State Addiction Treatment
Providers’ Opinions of the Main Goal of
Treatment, by SubstanceProgram
Directors
Staff
Providers
Tobacco
Complete abstinence 49.4 48.2
Reduced use 10.8 21.3
Fewer negative consequences 4.8 11.3
Goal set by patient 41.0 41.1
Other goal 3.6 6.4
Alcohol
Complete abstinence 61.4 70.2
Reduced use 3.6 9.2
Fewer negative consequences 10.8 9.2
Goal set by patient 25.3 22.0
Other goal 2.4 3.5
Other Drugs
Complete abstinence 66.3 65.2
Reduced use 8.4 9.2
Fewer negative consequences 13.3 9.9
Goal set by patient 30.1 26.2
Other goal 3.6 5.7
Source: CASA Columbia Survey of New York State
Addiction Treatment Providers, 2009.
The effectiveness of addiction treatment is
evaluated based on perverted measures of
success...you’d never judge the benefits of an
antihypertensive medication AFTER the
medication had been stopped.^254--Michael M. Miller, MD
Past President
American Society of Addiction Medicine