Anthony Thomas McLellan

Drug abuse treatment programs need to know the cost of the services they provide. Indeed, continued public and private funding is now being linked to cost and performance measures, and programs can use financial data to improve organizational efficiency. However, one of the dangers of promoting cost studies at treatment programs is that most program staff are not technically prepared to perform a cost analysis and little user-friendly information is available to offer assistance. ...

OBJECTIVE: To provide detailed methodological guidelines for using the Drug Abuse Treatment Cost Analysis Program (DATCAP) and Addiction Severity Index (ASI) in a benefit-cost analysis of addiction treatment.

DATA SOURCES/STUDY SETTING: A representative benefit-cost analysis of three outpatient programs was conducted to demonstrate the feasibility and value of the methodological guidelines.

STUDY DESIGN: Procedures are outlined for using resource use and cost data collected with the ...

BACKGROUND: Monitoring the quality and availability of alcohol and other drug (AOD) services must be a central tenet of any health-related performance measurement system. The Washington Circle Group (WCG), which was convened by the Center for Substance Abuse Treatment Office of Managed Care in March 1998, has developed a core set of performance measures for AOD services for public- and private-sector health plans. It is also collaborating with a broad range of stakeholders to ensure ...

The costs of addiction treatment services are an important determinant of the cost-effectiveness of a program, and therefore, of relevance to addiction treatment providers, insurance companies and, patients. Several methods have been developed to estimate the costs of substance abuse treatment services. One such method is the drug abuse treatment cost analysis program (DATCAP), which collects resource use and cost data from the treatment program perspective and has been used in numerous ...

OBJECTIVE: OxyContin and other pharmaceutical opioids have been given special attention in the media, who frequently describe problematic users of the drug as previously drug-naive individuals who become addicted following legitimate prescriptions for medical reasons. The purpose of this study was to characterize the nature and origins of pharmaceutical opioid addiction among patients presenting at substance abuse treatment programs.

METHOD: The authors evaluated the prevalence and ...

The effects of drug dependence on social systems has helped shape the generally held view that drug dependence is primarily a social problem, not a health problem. In turn, medical approaches to prevention and treatment are lacking. We examined evidence that drug (including alcohol) dependence is a chronic medical illness. A literature review compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and ...

OBJECTIVE: To examine whether the addition of counseling, medical care, and psychosocial services improves the efficacy of methadone hydrochloride therapy in the rehabilitation of opiate-dependent patients.

DESIGN: Random assignment to one of three treatment groups for a 6-month clinical trial: (1) minimum methadone services (MMS)--methadone alone (a minimum of 60 mg/d) with no other services; (2) standard methadone services (SMS)--same dose of methadone plus counseling; or (3) enhanced ...

We performed a double-blind, placebo-controlled, randomized 12-week trial of desipramine hydrochloride treatment of cocaine dependence among methadone-maintained patients. Fifty-nine patients completed the 12-week medication trial (36 received desipramine and 23 received placebo), and 94% were recontacted 1, 3, and 6 months after treatment. There were significantly more dropouts in the desipramine than in the placebo group. Baseline to 12-week comparisons of Addiction Severity Index ...

AIMS: To describe the derivation of recent status scores (RSSs) for version 6 of the Addiction Severity Index (ASI-6).

DESIGN: 118 ASI-6 recent status items were subjected to nonparametric item response theory (NIRT) analyses followed by confirmatory factor analysis (CFA). Generalizability and concurrent validity of the derived scores were determined.

SETTING AND PARTICIPANTS: A total of 607 recent admissions to variety of substance abuse treatment programs constituted the derivation ...

Objective: This study examined aspects of reliability, validity and utility of Addiction Severity Index (ASI) data as administered to clients with severe and persistent mental illness (SMI) and concurrent substance abuse disorders enrolled in a publicly-funded community mental health center. Methods: A total of 62 clients with SMI volunteered to participate in an interobserver and test-retest reliability study of the ASI. Spearman-Brown and Pearson correlation coefficients were ...

We compared the effectiveness, safety, and costs of outpatient (n = 87) and inpatient (n = 77) detoxification from alcohol in a randomized, prospective trial involving 164 male veterans of low socioeconomic status. The outpatients were evaluated medically and psychiatrically and then were prescribed decreasing doses of oxazepam on the basis of daily clinic visits. The inpatient program combined comprehensive psychiatric and medical evaluation, detoxification with oxazepam, and the ...

OBJECTIVE: To evaluate the effectiveness of US state physician health programmes in treating physicians with substance use disorders.

DESIGN: Five year, longitudinal, cohort study.

SETTING: Purposive sample of 16 state physician health programmes in the United States.

PARTICIPANTS: 904 physicians consecutively admitted to one of the 16 programmes from September 1995 to September 2001.

MAIN OUTCOME MEASURES: Completion of the programme, continued alcohol and drug misuse (regular urine ...

There is national concern regarding the problems of alcohol and drug abuse and the adequacy and quality of the national addiction treatment system, particularly for adolescents. This article reviews the published literature evaluating the ability of health, education, and specialty treatment systems to identify and treat affected adolescents and adults. A separate section reviews the status of the national treatment system for adults through findings from a nationally representative ...

INTRODUCTION: Physicians with substance use disorders receive care that is qualitatively different from and reputedly more effective than that offered to the general population, yet there has been no national study of this distinctive approach. To learn more about the national system of Physician Health Programs (PHPs) that manage the care of addicted physicians, we surveyed all 49 state PHP medical directors (86% responded) to characterize their treatment, support, and monitoring ...

The Addiction Severity Index (ASI) is an instrument widely used to assess the treatment problems of substance users. Its psychometric properties have been tested and found satisfactory for many types of substance abusers entering treatment. However, there are many other subgroups of substance users not in formal treatment, such as homeless substance users. While the ASI has been used with this subgroup, its psychometric properties remain questionable. This study examined the reliability ...