Alcoholism Services Research in the Era of Managed Care Organization

From the President ofthe Research Society onAlcoholism - On behalf of the Research Society on Alcoholism I welcome the important contri bution that Volume 15 of this excellent series on Recent Developments in Alcoh- ism brings to our field. It is not enou

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ALCOHOLISM VOLUME 15 SERVICES RESEARCH IN THE ERA OF MANAGED CARE

RECENT DEVELOPMENTS IN

Edited by

MARC GALANTER New York University School of Medicine New York, New York

Associate Editors HENRI BEGLEITER, RICHARD DEITRICH, DONALD GALLANT, EDWARD GOTTHEIL, ALFONSO PAREDES, MARCUS ROTHSCHILD, and DAVID VAN THIEL

Assistant Editor

DEEANNA CALABRESE

An Official Publication of the American Society of Addiction Medicine and the Research Society on Alcoholism. This series was founded by the National Council on Alcoholism.

ALCOHOLISM VOLUME 15 SERVICES RESEARCH IN THE ERA OF MANAGED CARE Organization Access Economics Outcome

KLUWER ACADEMIC PUBLISHERS

NEW YORK, BOSTON, DORDRECHT, LONDON, MOSCOW

eBook ISBN: Print ISBN:

0-306-47193-0 0-306-46441-1

©2002 Kluwer Academic Publishers New York, Boston, Dordrecht, London, Moscow Print ©2001 Kluwer Academic / Plenum Publishers New York All rights reserved No part of this eBook may be reproduced or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, without written consent from the Publisher Created in the United States of America Visit Kluwer Online at: and Kluwer's eBookstore at:

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Editorial Board Chair: James D. Beard, Ph.D. Dharam P. Agarwal, Ph.D. Genevieve M. Ames, Ph.D. Raymond F. Anton, M.D. Enrique Baraona, M.D. Stefan Borg, M.D., Ph.D. L. Judson Chandler, Ph.D. Robert T. Cook, M.D., Ph.D. John Crabbe, Ph.D. Nancy Day, Ph.D. Phillipe A.J. De Witte, Ph.D. Ivan Diamond, M.D., Ph.D. Bruce D. Dudek, Ph.D.

Chair Emeritus and Founder: Charles S. Lieber, M.D. Howard J. Edenberg, Ph.D. C.J. Peter Eriksson, Ph.D. Rueben A. Gonzales, Ph.D. Charles R. Goodlett, Ph.D. Donna Gruol, Ph.D. Jan B. Hoek, Ph.D. Paula L. Hoffman, Ph.D. Harold D. Holder, Ph.D. Hiromasa Ishii, M.D. Harold Kalant, M.D., Ph.D. Barbara J. Mason, Ph.D.

Robert O. Messing, M.D. Esteban Mezey, M.D. Michael F. Miles, M.D., Ph.D. Roger Nordmann, M.D., Ph.D. Edward P. Riley, Ph.D. Marcia Russell, Ph.D. Robert F. Saltz, Ph.D. John B. Saunders, Ph.D. Steven Schenker, M.D. Edith V. Sullivan, Ph.D. Muriel Vogel-Sprott, Ph.D. Gary S. Wand, M.D.

Research Society on Alcoholism

American Society of Addiction Medicine

President: Yedy Israel, Ph.D.

President: Marc Galanter, M.D.

VicePresident: Stephanie S. O’Malley, Ph.D.

President-elect: Andrea G. Barthwell, M.D.

Secretary: Robert O. Messing, M.D.

Secretary: Michael M. Miller, M.D.

Treasurer: Kathleen A. Grant, Ph.D.

Treasurer: Elizabeth F. Howell, M.D.

Immediate Past President Edward P. Riley, Ph.D. Publications Committee Chair: Emanuel Rubin, Ph.D

lmmediate Past President: G. Douglas Talbott, M.D.

Contributors Pierre Kébreau Alexandre, Health Services Research Center, University of Miami, Miami, Florida 33136 Brenda M. Booth, Centers for Mental Health Care Research, Department of Psychiatry, University of Arkansas for Medical Sciences, and HSR&D Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System, Little Rock, A