Reducing the harmful effects of drug and alcohol addictions and related disorders by improving the quality of care available for the estimated 22.2 million Americans age 12 and older who need treatment.

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ACH YEAR, addiction or misuse of alcohol and other drugs in the United States costs over $275 billion and causes approximately 120,000 deaths. According to the Substance Abuse and Mental Health Services Administration, just over 8 percent of the estimated 22.2 million Americans age 12 and older who need treatment for substance use disorders actually receive treatment. While effective treatments for addictions exist, they are not readily accessible or routinely used. According to a broad-based study that appeared in the New England Journal of Medicine, only 11 percent of recommended care is provided for those with alcohol dependence. Recommended treatment for substance use addictions requires detoxification and medical stabilization, rehabilitation, continued monitoring and aftercare.

The Foundation’s investments in treatment of substance use in 2004 were focused on increasing the number of providers using evidence-based, proven practices. The RWJF national program Paths to Recovery® increased the number of care providers adopting quality improvement practices, thus improving patients’ ability to access and stay in appropriate treatment. A sister program, Resources for Recovery, continued encouraging states to expand treatment capacity within existing financial constraints, and contributed to the establishment of the Alabama Commission for the Prevention and Treatment of Substance Abuse. Examples of the work of Reclaiming Futures®, an RWJF initiative that promotes integrated systems of care to treat youth suffering from addictions, were presented on the Emmy Award-winning program “Choose or Lose: 20 Million Loud” on MTV. The program sought to broaden public understanding of addiction as a public health issue.

Improving the quality of treatment is of national importance and is often best addressed through productive collaborations. To that end, RWJF and the National Quality Forum, the Washington Circle Group and the Carter Center will develop indices that reflect appropriate timing of treatment, optimal medications, clinical therapies and systems supports.

The Foundation also convened leading addiction treatment stakeholders, researchers and innovators to gain insight for future program investments. In one such effort, the Center for Health Care Strategies and the Legal Action Center brought together state purchasing and licensing authorities to determine the most effective leverage points for improving treatment quality. The Foundation supported the White House Office of National Drug Control Policy’s Leadership Conference on Medical Education in Substance Abuse, a forum in which leaders in medical education, research and patient care developed plans to ensure that medical school curricula include courses on treating addictions using evidenced-based approaches. To complement these efforts to improve treatment quality, RWJF hosted an inaugural “Treatment Visioning” meeting of addiction specialists, people in recovery from addictions, communications experts, engineers and others to map future frameworks for addiction care.

In 2005 RWJF’s programming in addiction prevention and treatment will be directed toward: (1) supporting provider-based demonstration projects that can overcome barriers to providing quality treatment, (2) encouraging purchasers and payers to use performance and quality as a basis for reimbursement and to assist licensing and accrediting bodies in adopting quality standards for treatment programs, and (3) engaging consumers to advocate for better quality treatment for addictions.