The literature on treating substance abusehas dealt basically with four important questions:(a) Is treatment effective? (b) Are allprograms equally effective? (c) Why do programs differ in their effectiveness? (d) Which treatments are more cost-effective? This paper reviews the substance abuse treatment literature around these four questions and discusses methodological issues that hinder the interpretation and generalization of results to date. The answer to the first questionis a sounding “yes,” treatment is effectivebut not all programs are equally effective.Researchers have moved beyond the“black box” literature that concentrated onpatient and program characteristics as explanations for differences in effectiveness and search for the “active” ingredients of treatment.These include, for example, the treatmentphilosophy of the program’s directorand staff attitudes towards patients. Cost-effectiveness studies are less common, and their conclusions are mixed. In general, it is probably safe to say that for the majority of patients, outpatient or shorter programs are more cost-effective.
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