New directions in alcohol and drug treatment under managed care

Objective: To examine the potential effects of the introduction and expansi on of managed care on the financing and organization of public and private alcohol and drug abuse treatment systems by reviewing studies on managed ca re and substance abuse. Study Design: Spending on treatment for alcohol and drug abuse, the organiz ation of treatment, treatment workforce composition, provision of services, and their implications for access and treatment outcome were examined by r eview of the treatment literature. Results: Managed care has had major effects on the organization of service delivery, the workforce, and the provision of services. Most of the changes have occurred without the benefit of clinical or policy research. Although managed care has the potential ability to address longstanding problems as sociated with alcohol and drug treatment, it also presents additional barri ers to access and improving treatment outcome. Conclusions: The review suggests that organizational approaches, particular ly the settings in which treatment is placed, will differ in their impact o n ties between treatment agencies and the medical community, and ties with other health and social service agencies. Also of importance is a new empha sis on accountability of treatment through the mechanisms of outcomes monit oring and performance indicators. It remains to be seen whether these innov ations will be meaningfully linked with outcomes research. It is incumbent on researchers and clinicians to explore these issues.