Alcohol treatment and health care system reform.

After reviewing the empirical literature, we suggest that advances in the assessment and treatment of alcohol problems have the following important implications for health care system reform: (1) alcohol use disorders and problems associated with alcohol use are prevalent and are complicated by various comorbid conditions, and they result in large costs to the health care system and to society; (2) alcohol treatment generally results in reduced drinking and more efficient use of health care resources; (3) specific treatments have demonstrated effectiveness; (4) screening and assessment instruments with excellent sensitivity to the heterogeneity of alcohol problems have been developed; (5) evidence that specific treatments have differential effectiveness with different patients groups is accumulating; and (6) good evidence exists for the effectiveness of brief interventions, particularly with less severe and chronic alcohol problems. These findings suggest that alcohol treatment services in a reformed health care system should include (1) universal coverage for alcohol treatment, including full benefits for outpatient care; (2) a rational system of assessment and triage for treatment, including an increased emphasis on screening and brief interventions in primary medical care settings; (3) a full range of treatment services that vary in intensity; and (4) addictions treatment provider incentives and contingencies to provide treatments of proven effectiveness. When fully implemented, an efficient approach to the treatment of alcohol-related problems will result in one of the largest pools of cost savings in a reformed American health care system.