SERVICES FOR SUBSTANCE-ABUSERS IN A CHANGING HEALTH-CARE SYSTEM

Many managed care plans may need to modify their coverage to address s ubstance abusers' multidimensional physical, mental, and social proble ms. Such adjustments are particularly important for public sector clie nts whose addiction-related problems are typically more severe than th ose of private sector patients. Data from a sample of 161 medical emer gency, primary care, mental health, and substance abuse treatment prog rams in Dade County, Florida, reveal highly varied perceptions of mana ged care. They illustrate that the relevance of provider organization ownership, type of services, and populations served for behavioral man aged care analysis. Further implications are the need to provide ''wra p-around'' or enabling services and to coordinate care for substance a busers to avoid displacement of responsibility for critical aspects of their care onto overwhelmed ''safety net'' agencies.