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: Lawbeat

Assignment Desk: Rehab reform, state by state

By Mark Obbie

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The New York Times series "The Evidence Gap" turns its gaze toward a quasi-legal topic today: drug-rehab programs mandated and paid for with public money. The series is rooted in science, "exploring medical treatments used despite scant proof that they work and are examining steps toward medicine based on evidence." Benedict Carey's installment today states at the outset that the billions in tax dollars spent on drug and alcohol treatment -- a number expected to grow with changes in federal law -- form a big question mark:

. . . [V]ery few rehabilitation programs have the evidence to show that they are effective. The resort-and-spa private clinics generally do not allow outside researchers to verify their published success rates. The publicly supported programs spend their scarce resources on patient care, not costly studies.And the field has no standard guidelines. Each program has its own philosophy; so, for that matter, do individual counselors. No one knows which approach is best for which patient, because these programs rarely if ever track clients closely after they graduate. Even Alcoholics Anonymous, the best known of all the substance-abuse programs, does not publish data on its participants’ success rate.

The story interestingly looks at the efforts by a handful of states -- it cites Delaware, North Carolina, and Oregon, focusing on the latter -- require more accountability through evidence-based methods of tracking and reporting. A curious legal or government reporter could read the story as a road map to a useful regional story that questions the requirements under state law; whether a debate over these methods is taking place, or ought to; and the role of the courts in mandating treatment (a factor that Carey's piece doesn't touch on).

Full post as published by Lawbeat on December 23, 2008 (boomark / email).