Beyond Equity in the Delivery of Alcohol and Drug Abuse Treatment Services

Abstract

Equity in service utilization has become an important policy goal of federally-, state-, and locally-funded alcohol and drug treatment programs. A number of conceptual and methodological issues surrounding equity, including its strengths and limitations as a policy goal, are addressed. Among the many issues discussed is the observation that inequity in service utilization carries evaluative connotations in that a service system is likely to be judged as unsatisfactory, inadequate, or inappropriate when the inequity is modest, and as morally reprehensible when the inequity is significant. Violation of the norm of equity is a prescription for institutional reform and political action. On the other hand, policies that would increase the equity in service utilization may be incompatible with the goal of “service on demand” and they may have no consequent effect of increasing service efficacy. Moreover, there are some arrangements in which maintaining or even increasing inequity would be cost-effective. Other methodological, conceptual and policy-related issues are addressed.