Perspective on the integration of substance user needs assessment and treatment planning

In the 1970s and 1980s, several techniques for assessing the needs for substance user treatment were developed. Generally these techniques relied upon the data developed from large-scale data-gathering systems, originally designed to assess the capacity of the substance user treatment system nationwide. The need assessment techniques generally require making estimates of the prevalence of substance use disorders in the population and then applying them to the national utilitization experience. As first attempts often do, these approaches tended to simplify complex problems and tended to rely too heavily on the only available data. The result was that they tended to reify current practice rather than to define best practice. In the 1990s, new challenges face those attempting to assess needs for substance user services. As a result of the last decade's emphasis on cost containment, new concepts have challenged traditional views of needs assessment. This paper will discuss those new concepts and their impact on the needs assessment endeavor. In particular, the impact of the concept of medical necessity will be examined.