A new report, containing consensus recommendations for improving the way in which alcohol and drug treatment services are delivered and paid for in the U.S., was released last month by the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (CSAT).

The report, titled "Changing the Conversation: Improving Substance Abuse Treatment—The National Treatment Plan Initiative," is the result of a consensus-building process, said Nelba Chavez, Ph.D., director of the Substance Abuse and Mental Health Services Administration (SAMHSA). "It reflects the very best thinking in the treatment field, including people recovering from alcohol and drug dependence and their families. The recommendations released in this report serve as a blueprint for closing the treatment gap and improving the quality of substance abuse treatment services available."

The Treatment Plan Initiative (TPI) contains five major guidelines, or principles, each of which includes several specific recommendations. First, resources must be used more effectively as an investment for future results. For example, the report calls for broad-based, standardized insurance coverage of substance abuse treatment in parity with all other medical benefits. It also calls for new reimbursement mechanisms, which include both performance measures and outcome standards, and ensures rates sufficient to cover treatment costs with a surplus dedicated to reinvestment.

The second major principle of the TPI calls for there being "No Wrong Door for Treatment."

"When a substance-abusing individual presents for treatment of any condition, at any point in the health care system," said CSAT Director H. Westley Clark, M.D., J.D., M.P.H, "and that individual gives indications of substance abuse, she or he should be guided toward effective, appropriate treatment."

The TPI also urges overall improvements in treatment through "Commitment to Quality," the third major principle. The substance abuse treatment community should be made up of men and women of diverse ethnic groups and cultural backgrounds who are well trained and appropriately credentialed or certified. The TPI also calls for "fair compensation for their professional expertise."

The TPI notes that while the treatment community expresses widespread agreement that substance abuse/dependence is a chronic relapsing disease that is responsive to treatment, the general public does not yet share this view. The TPI strongly recommends that efforts be made to cause a "Change in Attitudes" by educating the general public that recovery from substance abuse is not only possible but that best practice treatments are cost-effective. The plan also makes recommendations for reducing overall stigma and discrimination against people in recovery from substance abuse.

Finally, the TPI notes that to accomplish the recommendations contained in the report, "Partnerships Must be Built." This fifth guiding principle stresses that the most important relationship that must be nurtured is the strong connection between the research community and the treatment community. For the best evidence-based practices to be widely implemented, this relationship is vital, the TPI concludes.

"CSAT sees this report as the beginning of the end of a fragmented system of substance abuse treatment," said Clark. "We will work with the treatment field to apply the guidelines contained in the plan to the organization, delivery, and financing of high-quality treatment services for children, adolescents, and adults with substance abuse problems."

The National Treatment Plan Initiative documents are available on the Web at <www.natxplan.org>.