ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1991.tb02614.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1991.tb02615.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract.This article should be considered not in isolation but in a context of private health provision in general, and examined from an international standpoint. In the UK there has been a growth of private health care and as pan of this growth, it is likely that patients with problems of alcohol and drug misuse will choose private facilities, which now increasingly exist. Patterns of treatment in any country are based on historical traditions. Thus in the UK the principle NHS response has been to provide specialised alcoholism treatment units, which increasingly provide out‐patient and day facilities, as well as in‐patients. Although there has been criticism of these units, they remain the principle approach. In West Germany in‐patient treatment has been the norm. In other countries in Northern Europe emphasis has been on out‐patient treatment with a strong social bias. More important, however, is that clearly patients with alcohol or drug problems, once they recognise such problems, wish to attend a treatment facility where they feel they will receive expert treatment. Their experience with non‐specialized agencies is often said to be negative and it is not surprising if they turn towards such specialized units, in the same way as patients with other medical conditions all seek specialist expertise. Patients are hardly likely to have analyzed research studies on effectiveness of treatment and it is questionable whether many studies alleging failure of treatment take into account poor compliance. Both on historical, traditional and common sense lines it is, therefore, likely that people will pursue private treatment, despite what so called ex

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1991.tb02616.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract.The author is in basic disagreement with Dr Curson's editorial. Based on many years experience with in‐patient programs in the USA, in both the public and private sectors, the author considers in‐patient chemical dependency treatment which fits the general discription of the Minnesota Model a valuable component of the continuum of addiction treatment servi

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1991.tb02617.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract.Dr Curson understandably casts doubt on the cost effectiveness of many popular private residential treatments for substance misuse disorders. This re‐appraisal of the role of the private sector could provide an opportunity for treatments investment in early detection and simple intervention strategies, which could be marketed widely throughout the health care syste

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1991.tb02618.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract.Curson's analysis of the growth of private for profit treatment of substance abuse is seen as exaggerated. The main growth in the 1980s was over 50% in the voluntary charitable sector. His criticism of lay' counsellors ignores the responsibility of health care professionals, to train and supervise them. Curson's criticism of the effectiveness of treatment in general indicates he is not well informed and his reference to Minnesota Model outcome research and the philosophy of the mutual help movement of AA is misleading.

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1991.tb02619.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract.In the USA, treatment for alcohol and drug problems is provided in both the public and private sectors. But because there is no universal health insurance scheme, access to treatment is severely limited.This unfortunate situation may be a consequence of an historically influential moral perspective on poverty and illness. An alternative perspective is urged.

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1991.tb02620.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract.The Minnesota Model approach used by private units during the past decade has come in for criticism because of various negative aspects. On the other hand it obviously also has many positive features. There are many similarities between the Minnesota approach and that of the NHS from the 1960s onwards, based largely on the 1952 Warlingham Park Hospital model. It should be possible to provide both NHS and private units which cut out the criticized aspects of the Minnesota Model whilst retaining its positive features. Community (outpatient) facilities should play a prominent part in all such units.

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1991.tb02621.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract.David Curson has spent many years working full time in the private sector, and his analysis of this area of addiction treatment is welcome. Private addiction treatment differs from Health Service treatment in that it seems to favour the Minnesota Model more frequently. There is no absence of reliable outcome studies on the effectiveness of the Minnesota Method, but some form of accreditation of treatment techniques in the private sector seems inevitable.

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1991.tb02622.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract.When invited to write this editorial it was suggested that I “stir up questions, challenge complacencies, and fly kites”. The responses suggest that I have achieved what I was asked to do. Dr Hore Interprets my editorial as an attack on in‐patient treatment. This was never my intention. Some patients certainly need to be hospitalized. Some do not. If Dr Hore blames the patient for treatment failure, who gets the credit for success and when will patients be asked to comment on the “value of their treatment”; on discharge, after 1 year, after 10 years, or after 20 years? Both the Ditzlers and Dr Bloom take exception to my terminology, my criticisms of lay counsellors, and my concerns about research methodology and claimed ‘success rates’. The term ‘brainwashing’ appears in Cook's review of the Minnesota Model (p. 744). Some years ago the National Council on Alcoholism had a strict qualifying rule for those ‘in recovery’ who applied for training as voluntary counsellors: they must have achieved 2 years of sorbriety before embarking on a 2 year period of closely supervised training. Dr Blume's experience in New York is similar to mine, and the Ditzlers and Dr Blume clearly share my views about professional standards. Alas, I remain to be convinced that such strict entry criteria, intensive training, and careful supervision are being applied in the private addiction units. No moral arguments are sufficient to excuse unsubstantiated claims that a particular treatment model is superior when it results in attracting patients who pay for it. I am not “engaged in a joyful anticipation of the demise of the private treatment system in Great Britain”. I wish it to flourish–but honestly and on a firmer scientific footing. When referring to studies of outcome Professor Edwards observes that “within that longitudinal perspective, it is absurdly medico‐centric to suppose that ‘treatment efficacy’ is the single important question. Treatment is more accurately conceived as being at best a timely nudge or whisper on a long life course”. The questions posed by my article are how big a nudge, how often, from whom

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1991.tb02623.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY