A. Thomas McLellan, Ph.D.

SUMMARY: This presentation argues that there is a disconnect between the realistic limits of the effects of addiction treatments and the traditional methods used to evaluate those effects, producing a significant underestimation of the potential effectiveness of addiction treatments and restricting the clinical and policy relevance of the existing research data on addiction treatment. To illustrate, Dr. Thomas McLellan presents three sets of findings from prior addiction treatment studies: 1) Few outcome differences exist between more intensive inpatient or residential forms of treatment and less intensive outpatient treatments; 2) Little outcome enhancement created from efforts to “match” patients to treatments; and 3) Lack of robust findings occurred in medication trials. These perplexing findings are explained by the explicit acute care assumption that some finite amount, duration, or intensity of services will sustain symptom remission and enhance functional status 6–12 months following the cessation of the intervention. McLellan argues that these expectations are not consistent with a chronic care approach and may have limited the development of more appropriate approaches. The presentation concludes with an illustration of a more appropriate treatment and evaluation model.