Access to Health Care in America (1993) / Chapter Skim
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Appendix B: Developing Indicators of Access to Care: Waiting Lists for Drug Abuse Treatment
Appendix B: Developing Indicators of Access to Care: Waiting Lists for Drug Abuse Treatment
Pages 181-198
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From page 181... ...
These waiting lists are generally seen as a measure of unmet demand for drug abuse treatment. For instance, the expansion of drug abuse treatment to the point where waiting lists need not occur was one of the primary recommendations of the Presidential Commission on the Human Immunodeficiency Virus Epidemic (hereafter the Presidential Commission; 1988~.
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From page 182... ...
This paper examines the empirical literature and expert opinions on waiting lists for drug abuse treatment and critiques the concept of waiting lists as a measure of unmet demand for treatment. Data from the early 1970s, when waiting lists for drug abuse treatment were also used as a measure of unmet treatment demand (U.S.
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From page 183... ...
Although both the Presidential Commission on the Human Immunodeficiency Virus Epidemic and the National Commission on AIDS held hearings on waiting lists for drug abuse treatment, and the testimony at these hearings provided a good range of expert opinions on the subject, these hearings also illustrate the relative lack of scientific data on the subject. This paper draws, as well, on the past personal experience of one of its authors (D.
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From page 184... ...
THE NUMBER OF PERSONS ON WAITING LISTS The National Association of State Alcohol and Drug Abuse Directors (NASADAD) conducts occasional surveys of its members regarding waiting lists for drug abuse treatment.
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From page 185... ...
Great variation in utilization rates was seen, however, "THERE ARE NO REAL WAITING LISTS FOR TREATMENT" Even though both the NASADAD and the DSRS studies showed large numbers of persons on waiting lists for drug abuse treatment in the United States, some experts argue that these waiting lists do not represent unmet demand for treatment per se. Prominent among these is Dr.
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From page 186... ...
There are approximately 35,000 long-term drug abuse treatment positions in New York City, with a turnover of probably 20,000 persons per year.6 Thus, diligent referral work can often locate an open position in a treatment program. Sometimes this slot will be found at a program that has openings and no current waiting list.
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From page 187... ...
WAITING LISTS UNDERESTIMATE UNMET DEMAND The preceding section presented the arguments surrounding the notion that current waiting lists overestimate the unmet demand for drug abuse treatment. Yet there are also those who argue that current waiting lists substantially underestimate the unmet demand for treatment.
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From page 188... ...
At that time, the Beth Israel methadone maintenance program had an unduplicated waiting list of approximately 500 persons who had applied but were not currently receiving methadone maintenance treatment. Funds were obtained to add an additional 500 treatment positions to the more than 8,000 treatment positions then in the program.
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From page 189... ...
Nevertheless, if large-scale sources of employment develop in their communities, many discouraged workers apply for the positions. Similarly, the opening of new drug treatment positions may lead many persons with drug abuse problems to apply for treatment even though they were not previously on waiting lists.
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From page 190... ...
Estimating the increased costs of operating a drug abuse treatment system in which the programs operated at no more than 95 percent of capacity is beyond the scope of this paper, but it is worthwhile to note that Kleber's formulation could provide a useful empirical standard for assessing unmet demand for treatment independent of the actual number of persons on waiting lists. Standardized definitions of the capacities of drug abuse treatment programs and of who is enrolled in a treatment programs are less than ideal, but clearly they are much easier to formulate than a standardized definition of who is on a waiting list.
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From page 191... ...
If being on a waiting list indeed serves to screen out applicants who are not sufficiently motivated to enter and remain in a treatment program, then the waiting list would be serving a positive function by maximizing the effectiveness of scarce drug abuse treatment resources. Consideration of this motivational screening argument leads us to the small number of empirical studies of the behavior of drug users while on waiting lists and the effect on subsequent treatment experience of being on a waiting list.
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From page 192... ...
directly examined the relationship between time on a waiting list and later retention in treatment for 130 drug users referred to the Substance Abuse Project at Crawley Hospital, West Sussex, England. The researchers were not testing the motivational screening hypothesis but rather its opposite that quick entry into treatment would increase motivation and lead to higher retention rates.
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From page 193... ...
Grenier (1985) conducted a study that used waiting list controls to assess the effectiveness of an adolescent drug abuse treatment program.
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From page 194... ...
After one month in the waiting list control condition for this study, subjects were then transferred into the interim clinic experimental condition. Eventual enrollment in regular methadone treatment was compared for the group that was immediately assigned to experimental treatment versus the group that remained on a waiting list for an additional month.
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From page 195... ...
The unsolved problems of the same individual being on different waiting lists, and of individuals wanting to transfer, in themselves preclude using these estimates as measures of actual unmet demand. Nevertheless, the number of programs that have waiting lists and the number of persons on those lists demonstrate that the present drug abuse treatment system is not effectively meeting the demand for treatment in this country.
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From page 196... ...
Larger sample sizes are also necessary to allow examination of the possible differential effects of being on a waiting list, considering such variables as age, gender, ethnicity, and history of drug use. FINAL COMMENT In preparing this paper, we have examined opinions and research on waiting lists for drug abuse treatment in the United States.
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From page 197... ...
1989. The functioning of individuals on a drug abuse treatment waiting list.
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From page 198... ...
1973. A mortality study of waiting list patients at the Boston City Hospital methadone maintenance clinic.
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