Best Treatment for Long-Term Substance Abuse? Same as for Any Chronic Disease

Comprehensive service system for chronic substance abusers

Between 1993 and 1995, staff at the Center for Addictive Behaviors in Salem, Mass., carried out a planning phase of a project to develop and test a model of coordinated substance abuse treatment services for chronic substance abusers.

Center staff designed the project to develop new mechanisms for the organization and reimbursement of publicly financed treatment services at a cost that stabilizes or reduces expenditures associated with episodic care.

The planning phase included:

  • A literature and best practices review.
  • A six-month pilot mini-demonstration.
  • Development of a full-scale demonstration proposal.

Key Results

  • The literature review revealed parallels in treatment and case management between chronic substance abusers and people with other chronic conditions.

  • A full-scale proposal was developed to test three suggested shifts in focus for the treatment of chronic substance abusers in managed care environments:

    • From discharging to retaining the client in care.
    • From episodic care to continuous care individualized to client needs.
    • From unit-of-service-driven reimbursement to case-based prepayment rates.

The methodology and implementation strategy for the case-based reimbursement rate concept proved problematic.

Since the implementation of a case-based reimbursement rate was the focus of the original support of this project and the proposal did not show decisively how it would be implemented, the Robert Wood Johnson Foundation (RWJF) turned down the full-scale renewal proposal.