The VA has implemented a nationwide evaluation program to monitor process and outcome of care for substance abuse patients. This program focuses on the changing characteristics of VA substance abuse patients and treatment services and involves outcome-based evaluations of major VA substance abuse treatment modalities. Initial findings show that VA substance abuse patients, including patients with concomitant psychiatric disorders, improve substantially from treatment intake to a 1-year follow-up and that community residential facilities are an important part of the continuum of substance abuse care. Moreover, within broad limits, there is a dose-response relationship between the continuity of outpatient mental health care and better 1-year substance use and psychosocial outcomes. These findings are placed into context as part of an evidence-based initiative to improve the quality of VA mental health care.
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References
1.
Regier D, Narrow W, Ray DS, et al.The de facto US mental and addictive disorders service system: epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Arch Gen Psychiatry1993;50:85-94.
2.
Office of Applied Studies. Uniform Facilities Data Set. Rockville, Md: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 1996.
3.
Weisner C, Greenfield T, Room R. Trends in the treatment of alcohol problems in the US general population, 1979 through 1990. Am J Public Health1995;85:55-60.
4.
Piette J, Baisden K, Moos R. Health Services for VA Substance Abuse Patients: Utilization for Fiscal Year 1997. Palo Alto, Calif: Veterans Affairs Health Care System, Program Evaluation and Resource Center and Center for Health Care Evaluation, 1998.
5.
Humphreys K, Hamilton E, Moos R, et al.Policy-relevant program evaluation in a national substance abuse treatment program. J Ment Health Adm1997;24:373-385.
6.
Humphreys K, Dearmin-Huebsch P, Moos R. The Department of Veterans Affairs Substance Abuse Treatment System: Settings, Services, Staffing, and Management Policies. Palo Alto, Calif: Program Evaluation and Resource Center and Center for Health Care Evaluation, Department of Veterans Affairs Health Care System, 1998.
7.
Ouimette PC, Finney JW, Moos R. Twelve step and cognitive behavioral treatment for substance abuse: a comparison of treatment effectiveness. J Consult Clin Psychol1997;65:220-234.
8.
Derogatis L. Brief Symptom Inventory: Administration, Scoring, and Procedures Manual. 3rd ed.Minneapolis, Minn: National Computer Systems, 1993.
9.
Miller WR, Tonigan JS. Assessing drinkers' motivation for change: the Stages of Change and Treatment Readiness Scale (SOCRATES). Psychol Addict Behav1996;10:81-89.
10.
Project MATCH Research Group. Matching alcoholism treatments to client heterogeneity: Project MATCH posttreatment drinking outcomes. J Stud Alcohol1997;58:7-29.
11.
Finney JW, Noyes C, Coutts A, et al.Evaluating substance abuse treatment process models: I. Changes on proximal outcome variables during 12-step and cognitive-behavioral treatment. J Stud Alcohol1998;59:371-380.
12.
McCrady BS. Alcoholics Anonymous and behavior therapy: Can habits be treated as diseases? Can diseases be treated as habits?J Consult Clin Psychol1994;62:1141-1158.
13.
Ito JR, Donovan DM. Predicting drinking outcome: demography, chronicity, coping, and aftercare. Addict Behav1990;15:553-559.
14.
Timko C, Finney J, Moos R, et al.Short-term treatment careers and outcomes of previously untreated alcoholics. J Stud Alcohol1995;56:597-610.
15.
Devine JA, Brody CJ, Wright JD. Evaluating an alcohol and drug treatment program for the homeless: an econometric approach. Eval Prog Plann1997;20:205-215.
16.
Humphreys K, Moos R. Reduced substance abuse related health care costs among voluntary participants in Alcoholics Anonymous. Psychiatr Serv1996;47:709-713.
17.
McKay JR, Alterman AI, McLellan AT, et al.Treatment goals, continuity of care, and outcome in a day hospital substance abuse rehabilitation program. Am J Psychiatry1994;151:254-259.
18.
Ouimette PC, Moos R, Finney J. Influence of outpatient treatment and 12-step involvement on one-year substance abuse treatment outcomes. J Stud Alcohol. 1998;59:513-522.
19.
Moos R. Community Residential Facilities for VA Substance Abuse Patients: An Evaluation of the Contract Program for Veterans with Alcohol and Drug Dependence Disorders. Palo Alto, Calif: Veterans Affairs Health Care System, Program Evaluation and Resource Center and HSR&D Center for Health Care Evaluation, 1998.
20.
Moos R, Pettit E, Gruber V. Longer episodes of community residential care reduce substance abuse patients' readmission rates. J Stud Alcohol1995;56:433-443.
21.
Rosenheck R, Leda C. Effectiveness of treatment elements in a multi-site residential-work therapy program for severe substance abuse. Psychiat Serv1997;48:928-935.
22.
Rosenheck R, Frisman L, Gallup P. Effectiveness and cost of specific treatment elements in a program for homeless mentally ill veterans. Psychiatr Serv1995;46:1131-1139.
23.
Moos, R. Evaluating Treatment Environments: The Quality of Psychiatric and Substance Abuse Programs. New Brunswick, NJ: Transaction, 1997.
24.
Ouimette PC, Ahrens C, Moos R, et al.During treatment changes in substance abuse patients with posttraumatic stress disorder: the influence of specific interventions and program environments. J Subst Abuse Treat. 1998;15:555-564.
25.
Barnett P, Swindle R. Cost-effectiveness of inpatient substance abuse treatment. Health Serv Res1997;32:615-629.
26.
Finney JW, Hahn AC, Moos RH. The effectiveness of inpatient and outpatient treatment for alcohol abuse: the need to focus on mediators and moderators of setting effects. Addiction1996;91: 1773-1796.
27.
Humphreys K, Moos R, Cohen C. Social and community resources and long-term recovery from treated and untreated alcoholism. J Stud Alcohol1997;58:231-238.
28.
Moos R, Finney J, Cronkite R. Alcoholism Treatment: Context, Process, and Outcome. New York: Oxford University Press, 1990.
29.
Finney J, Moos R. Psychological treatment for alcohol use disorders. In: Nathan PE, Gorman JM, eds. Treatments that WorkNew York: Oxford, 1997:156-166.
30.
Moos R, Finney J, Cannon D, et al.Outcome Monitoring for Substance Abuse Patients: I. Patients' Characteristics and Treatment at Baseline. Palo Alto, Calif: Veterans Affairs Health Care System, Program Evaluation and Resource Center and HSR&D Center for Health Care Evaluation, 1998.
