ALCOHOL TREATMENT AND HEALTH-CARE SYSTEM REFORM

After reviewing the empirical literature, we suggest that advances in the assessment and treatment of alcohol problems have the following im portant implications for health care system reform: (1) alcohol use di sorders and problems associated with alcohol use are prevalent and are complicated by various comorbid conditions, and they result in large costs to the health care system and to society; (2) alcohol treatment generally results in reduced drinking and more efficient use of health care resources; (3) specific treatments have demonstrated effectivene ss; (4) screening and assessment instruments with excellent sensitivit y to the heterogeneity of alcohol problems have been developed; (5) ev idence that specific treatments have differential effectiveness with d ifferent patient groups is accumulating; and (6) good evidence: exists for the effectiveness of brief interventions, particularly with less severe and chronic alcohol problems. These findings suggest that alcoh ol treatment services in a reformed health care system should include (1) universal coverage for alcohol treatment, including full benefits for outpatient care; (2) a rational system of assessment and triage fo r treatment, including an increased emphasis on screening and brief in terventions in primary medical care settings; (3) a full range of trea tment services that vary in intensity; and (4) addictions treatment pr ovider incentives and contingencies to provide treatments of proven ef fectiveness. When fully implemented, an efficient approach to the trea tment of alcohol-related problems will result in one of the largest po ols of cost savings in a reformed American health care system.