"People told us that treatment works, but that they need access," said Camille T. Barry, R.N., Ph.D., deputy director of the Center for Substance Abuse Treatment (CSAT), reporting on public comments on the center’s forthcoming national substance abuse treatment plan.

"There’s no surprise in what we heard, but we still face a challenge in translating words into action."

Open hearings in five cities around the country helped clarify directions for "Changing the Conversation: A National Plan to Improve Substance Abuse Treatment." Barry said that hundreds of citizens spoke their minds before CSAT panels in Hartford, Chicago, Washington, Tampa, and Portland, Ore. The plan, scheduled for release next May, will set policy in five major areas of substance abuse treatment. CSAT is part of the federal Substance Abuse and Mental Health Services Administration.

"We have to begin by closing the gap between the number of people who want treatment and the slots available," said Barry last month at a conference in Bethesda, Md., sponsored by the CSAT Advisory Council.

Strengthening and improving treatment systems will mean not only increasing capacity, but also working harder to connect research and treatment. Barry said that an earlier Institute of Medicine report had established a framework for how treatment providers can collaborate with researchers.

The panels also heard comments on overcoming stigmatization of drug abusers, an issue not previously addressed, according to Barry. "The panels looked into how language was used in regard to substance abusers among the general public. Perhaps we will need some sort of language audit," she said.

Finally, the panels addressed the needs of the treatment workforce, said Barry. "We want to know not only how many but what types of health care providers we need and how to get them in place."

CSAT Advisory Council members generally approved the progress of the plan’s march to completion, but urged Barry and her team to make certain that segments of both the patient and provider populations weren’t left out of the process.

"We’re hearing from people who are already self-identified as abusers, but we need to ensure the identification of new cases," said John R. Hughes, M.D., a professor in the departments of psychiatry and psychology and family practice at the University of Vermont. "We also have to ensure that patients are getting the most advanced treatments. At present, consumers just don’t know about the quality of their treatment."

Similarly, Martin Y. Iguchi, Ph.D., codirector of drug policy research at the RAND Corporation in Santa Monica, registered his concern about those outside the present system. "What about poor kids in south Los Angeles who want treatment but can’t find it, and then walk away frustrated and distrustful of treatment systems? We want to hear from them," said Iguchi, who suggested that outreach workers might be useful in learning what this patient population needs.

Louis E. Baxter Jr., M.D., medical director of the physicians’ health program of the Medical Society of New Jersey, noted that some health care providers are also addicted and required a targeted intervention.

"Diagnosis and treatment are different for health care providers," said Baxter, "since they have the knowledge and the ability to mask their addiction."

CSAT Director H. Westley Clark, M.D., J.D., M.P.H., praised the accountability inherent in the open process of the plan’s creation. Clark said the 11,300 substance abuse treatment centers in the U.S. needed a national model for substance abuse treatment that was real and substantive.

"Not everything we set forth will happen," said Clark, "but the National Treatment Plan will serve as a living template for CSAT’s future directions in supporting drug and alcohol abuse treatment across the country."