Drug Abuse:

Research Shows Treatment Is Effective, but Benefits May Be Overstated

HEHS-98-72: Published: Mar 27, 1998. Publicly Released: Apr 27, 1998.

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Bernice Steinhardt
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Pursuant to a congressional request, GAO reported on: (1) the level of federal support for drug abuse treatment activities; (2) the treatment approaches and settings most commonly used and what is known about an alternative approach--faith-based treatment; (3) research issues affecting drug abuse treatment evaluations; and (4) research findings on the effectiveness of drug treatment overall as well as what is known about the effectiveness of treatment for heroin, cocaine, and adolescent drug addiction. GAO did not comprehensively analyze the extensive literature on drug treatment research methodologies and study results, independently evaluate the effectiveness of drug treatment programs, or verify the results reported in the studies it reviewed.

GAO noted that: (1) billions of dollars are spent annually to support treatment for drug abuse and related research; (2) in 1998, 20 percent of the federal drug control budget, $3.2 billion, supported drug abuse treatment; (3) to meet the requirements of the Government Performance and Results Act, agencies are beginning to set goals and performance measures to monitor and assess the effectiveness of federally funded drug treatment efforts; (4) treatment services and research aim to reduce the number of current drug abusers; (5) experts recognize that not all drug users require treatment because some do not progress to the stage of abuse or dependence; (6) those who do need treatment can receive services in a variety of settings and via two major approaches: pharmacology and behavioral therapy, with many programs combining elements of both; (7) other treatment approaches, such as faith-based strategies, are sometimes used but have not been sufficiently evaluated to determine their effectiveness; (8) measuring the effectiveness of drug abuse treatment is a complex undertaking; (9) the most comprehensive studies have used an observational or quasiexperimental design, assessing effectiveness by measuring drug use before and after treatment; (10) few studies have used the most rigorous approach--random assignment to treatment and control groups--to isolate the particular effects of treatment on drug abuse; (11) in most studies, the conclusions researchers can draw are limited by factors such as reliance on self-reported data and the time frame planned for client followup; (12) furthermore, comparisons of study results are complicated by differences in how outcomes are defined and measured and differences in program operations and client factors; (13) a number of large, multisite, longitudinal studies provide evidence that drug abuse treatment is beneficial, but reliance on self-reported data may overstate effectiveness; (14) substantial numbers of clients report reductions on drug use and criminal activity following treatment; (15) research on treatment effectiveness relies heavily on client records of drug use; (16) when examining recent drug use, objective tests, such as urinalysis, consistently identify more drug users than self-reports do; (17) the research evidence to support the relative effectiveness of specific treatment approaches or settings for particular groups of drug abusers is more varied; (18) methadone maintenance has been shown to be the most effective approach to treating heroin abusers; and (19) research on the best treatment approach or setting for other groups of drug abusers is less definitive.

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