Contemporary addiction treatment: a review of systems problems for adults and adolescents

There is national concern regarding the problems of alcohol and drug abuse and the adequacy and quality of the national addiction treatment system, particularly for adolescents. This article reviews the published literature evaluating the ability of health, education, and specialty treatment systems to identify and treat affected adolescents and adults. A separate section reviews the status of the national treatment system for adults through findings from a nationally representative survey of 175 specialty treatment programs. The findings are unambiguous and disturbing. Although substance abuse is prevalent in most schools, primary care practices, mental health clinics, and criminal justice agencies, there is insufficient training, organization, or reimbursement to screen, assess, and refer those with dependence or abuse disorders to appropriate services. There are too few programs available to treat those substance-dependent patients who are screened and significant barriers for patients attempting to enter those programs. Finally, the organizational, administrative, and personnel infrastructures of many treatment programs are fragile and unstable, making them unable to implement evidence-based care. These problems are serious in the adult system and even worse in the adolescent system. The article concludes with suggestions for improving systems integration to improve the quantity and quality of available care.