US State policies influence drug treatment programmes

State policies have a significant impact on the services performed by substance abuse treatment programmes, and could play a key role in efforts to expand the use of research-based "comprehensive" treatment approaches, reports a study in the June issue of the Journal of Substance Abuse Treatment (JSAT).

"The states are uniquely positioned to institute specific policy proscriptions emanating from scientific research in the substance abuse treatment arena, indicating that a comprehensive approach[is] associated with positive treatment outcomes and reduced recidivism," according to the researchers, led by Jamie F. Chriqui, Ph.D., M.H.S., of University of Illinois at Chicago.

Dr. Chriqui and colleagues gathered data on state policy requirements regarding outpatient substance abuse treatment programmes. They focused on state-authorised programmes, which make up the vast majority of drug and alcohol abuse programmes in the United States. The study included data on more than 9,000 drug treatment programmes nationwide.

Nearly all of the programmes were in a state with policies requiring some type of assessment for substance abuse treatment programmes. However, most were in states that did not mandate the use of comprehensive diagnostic criteria, such as those published by the American Society for Addiction Medicine.

Most programmes were in states requiring some type of group and individual counselling or therapy, but not family counselling or therapy. Studies have found that family counselling is an important part of successful substance abuse treatment. Few programmes were in states requiring specific types of medical tests. For example, only six per cent of programmes were required to perform drug or alcohol testing/screening. Most programmes were not in states requiring testing for diseases related to substance abuse, such as hepatitis and sexually transmitted diseases, including HIV. Less than 30 % of programmes were in states requiring relapse-prevention services. Just over 40 % were required to provide aftercare counseling services.

When the researchers looked at what services the programmes actually provided, there was a closer correspondence to research recommendations. Almost all programmes performed diagnostic assessment and group and individual therapy, although rates of family counselling were lower. Nearly all programmes performed urine screening for drugs and alcohol, but most did not test for substance-abuse related diseases. Most programmes did provide relapse-prevention and aftercare services.

When other factors were taken into account, programmes in states requiring more comprehensive services were more likely to offer those services. "The resultsindicate that state policy requirements governing outpatient substance abuse treatment may have significant public health implications," the researchers write.

The researchers concluded: "It is crucial for health services researchers to work with policy makers to incorporate best treatment practices into state policy and regulations".

Jamie F. Chriqui Ph.D, et al.(2008) State policies matter: The case of outpatient drug treatment programme practices', Journal of Substance Abuse Treatment
35 (1): 13-21

Article published on 11/07/2008