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Assessing State Regulation of Outpatient Substance Abuse Treatment Programs in the U.S. along a Quality Continuum

Chriqui JF, Eidson SK, McBride DC, Scott W, Capoccia V, Chaloupka FJ.

Aims: To assess the extent to which state outpatient substance abuse treatment program policies incorporate quality elements that may be related to program and client outcomes.
Design: A cross-sectional study of statutes and regulations effective as of February 1, 2004 in the 50 states and the District of Columbia in the US
Methods: A framework for assessing the continuum of state outpatient substance abuse treatment program regulation was developed from the quality and performance measure indicator literature and applied to state policies. The continuum captures structural and process measures of quality related to program capacity and accountability and performance measures related to recognizing treatment need, treatment provision, and maintaining treatment effects (relapse prevention, aftercare, support groups).
Findings: Every state has some type of outpatient substance abuse treatment program policy; one state has yet to promulgate implementation regulations and two states' policies are entirely voluntary. Overall, state policies are significantly more likely to include (t=5.001, p<.0001) quality indicators most directly related to program capacity and accountability over performance measures more directly related to client outcomes. State policies are significantly more likely to include specific treatment components (e.g., counseling, testing, education) then they are to include provisions recognizing treatment need (t=4.46, p<.001) or maintaining treatment effects (t=5.48, p<.001).
Conclusion: This study provides a critical first step in categorizing the state outpatient substance abuse treatment policies along a quality and performance measure continuum. With this foundation, it will be possible to examine the relationship between state policies and treatment program practices.

Research Paper (PDF - 1.03MB)