Comprehensive drug and alcohol treatment programming: a bold new approach.

We have witnessed, in the latter half of the 20th century, significant revisions in the manner in which medical, psychiatric, and forensic services are delivered. Specifically, it appears that a wide range of treatment services are moving from modes of intervention that are dominated by primary institutional arrangements towards decentralized, community-based models of care. Missouri's CSTAR program represents a similar shift in alcohol and drug treatment. The CSTAR program provides an array of intensive community services that replaces hospital and residential services. In addition, community-based case management services promote social as well as medically based interventions. Parallels between the CSTAR model and the development of Community Support Services in psychiatric care are offered.