U.S. Department of Health

& Human Services 

National Institutes of Health 

National Institute on Alcohol Abuse 

and Alcoholism 

Number 69 July 2006 

HEALTH SERVICES

RESEARCH

Health services research is the study of how health care is 

organized, managed, financed, and delivered. This Alcohol Alert 

focuses on the issues of access, quality of care, and cost— 

important aspects of alcohol health services research. In an 

ideal world, treatment for alcoholism and alcohol abuse 

would be based solely on solid scientific evidence. It would 

be cost-effective, would target the most appropriate care to 

each patient, and would result in real, measurable outcomes— 

such as reduced rates of alcoholism, fewer incidents of drinking 

and driving, and the best possible use of limited resources. 

In reality, though, there often is a disconnect between 

what is found in research and what is used in real-world 

treatment settings. Financial constraints, staffing issues, even 

a simple lack of understanding of what’s working—all can 

interfere with putting what is learned in the lab into clinical 

practice (1). Add to this the fact that millions of men and 

women have achieved stable recovery using treatments that 

are not based on empirical research, and the distance between 

research and practice becomes even greater. 

This Alert examines the challenges researchers 

and clinicians face when translating scientific findings into 

practice. It describes how research is helping to inform treatment of special populations such as adolescents, women, and 

racial/ethnic minorities and the costs and benefits involved 

in providing treatment. 

Quality of Care: 

What’s Working? 

Knowing what is working in the research field is only the 

first step to bridging the research–treatment gap. Research 

also plays an important role in helping to identify obstacles 

that clinicians face when using medications, such as naltrexone, 

and specialized treatment, such as motivational interviewing, 

in clinical practice. 

Pharmacotherapy—Perhaps one of the greatest disconnects 

between research and practice involves the use of medications 

to treat alcohol-related disorders. For example, clinical trials 

suggest that naltrexone helps reduce the frequency of drinking 

and the severity of relapse among alcohol-dependent patients (2). 

Although there are occasional reports of no effects (3), largescale analyses of clinical trials have continued to support an 

improvement in treatment outcomes with the use of this 

medication (4,5). 

Training materials on the use of medications in alcoholism 

treatment also are available. A Center for Substance Abuse 

Treatment (CSAT) Treatment Improvement Protocol was 

developed to provide detailed clinical guidance on how to 

use naltrexone in alcoholism treatment (2), and the National 

Institute on Alcohol Abuse and Alcoholism (NIAAA) published 

as part of its COMBINE Monograph Series the Medical 

Management Treatment Manual, which details the rationale 

and use of both naltrexone and acamprosate (6). 

Despite the availability of training materials for professionals 

and consistent reports of significant reductions in alcohol 

use, medications such as naltrexone are not commonly prescribed. Members of the American Academy of Addiction 

Psychiatry and the American Society of Addiction Medicine 

prescribed naltrexone to only about 1 in 7 (13 percent) of 

their patients (7,8). A survey of counselors and physicians 

specializing in addiction medicine (9) found that few counselors (5 percent) recommended naltrexone to most of their 

patients, and more than half (54 percent) never suggested 

that patients try it. A higher percentage of physicians prescribed 

naltrexone for patients. Eight of 10 physicians (80 percent) 

reported current or prior use of naltrexone with patients, 

but only 11 percent prescribed it “often,” and only 4 percent 

prescribed it for “almost all patients” with alcoholism or alcohol 

abuse problems. 
If naltrexone is effective, why isn’t it used? Organizational 

support was the strongest predictor of whether counselors 

recommended naltrexone. Patient access to insurance benefits 

also influenced the use of medications. Counselors treating 

patients who had Medicaid coverage were more likely to 

promote the use of naltrexone, which was on the Medicaid 

formulary in the study States (9). Counselors whose patients 

paid for their own treatment or whose treatment was funded 

through State and Federal funds were less likely to recommend 

naltrexone to patients. Among physicians, those involved 

in research and those in organizations that promoted naltrexone use were more likely to prescribe the medication. 

Physicians in recovery themselves were the least likely to 

prescribe naltrexone (9). 

Behavioral Therapies—Motivational therapy—that is, 

a treatment designed to increase a patient’s motivation to 

change his or her drinking behavior—is another approach 

which is well supported by the literature but not commonly 

practiced in the field. Motivational interviewing was found 

to be effective in controlled clinical trials (10,11). Tests conducted in a broad range of community-based alcohol and 

other drug (AOD) abuse treatment settings suggest that this 

approach can be easily implemented. Despite these encouraging 

research findings, however, implementing motivational 

interviewing in practice settings has proven to be a challenge. 

The key reason? Motivational interviewing is complex, 

and delivering this therapy often requires specialized training and practice. Implementation takes time, resources, 

and, most important, support from the team responsible 

for delivering this therapy. Dickinson and colleagues (12) 

found that local programs attempting to implement motivational interviewing encountered obstacles such as the 

practitioners’ resistance to having their clinical sessions 

audiotaped for later supervision and coaching, and problems using the complex rating forms and procedures. 

Improving Access and 

Quality of Care Among 

Special Populations 

Research also is helping to define the barriers that exist 

among special populations of people—such as adolescents, 

women, and ethnic/racial minorities—in accessing care and 

achieving recovery from alcohol abuse and alcoholism. 

Adolescents—An increasing number of studies show that 

treatment is effective for adolescents with alcohol and drugrelated problems (13,14), but there are unique challenges to 

assessing, diagnosing, and treating alcohol problems in young 

people. Adolescents need a treatment approach that is flexible and integrates all the aspects of their life—including 

school, family, work, and peers. Such an integrated approach 

can be difficult in treatment settings, especially in today’s 

managed care treatment environment (15). 

A recent study (16) examined the use of one model— 

the “research-to-practice integration model”—for treating 

adolescents within a managed health care plan. Key findings 

from this study include the following: 

•	 Compared with matched control subjects, adolescents 

entering AOD treatment had higher rates of several 

psychiatric and medical conditions and more legal, 

educational, and family problems. 

•	 Adolescents entering treatment reported high 

levels of AOD use and often fit the criteria for 

abuse and dependence, indicating that these 

patients were waiting until their problems were 

severe before seeking treatment. 

•	 Patients came into treatment in a variety of ways. 

For example, boys were more likely than girls to have 

been referred to treatment from the legal system. 

Only a relatively small proportion were referred 

by one of their health plan’s medical or psychiatric 

providers. 

•	 Girls were significantly more likely than boys to 

have received previous mental health treatment. 

Based on the results of this study, it appears that adolescents seeking AOD treatment often have serious problems 

in other parts of their lives, and that different health care 

professionals (treatment providers, primary care clinicians, 

and psychiatrists) who are likely to come in contact with 

adolescents need to consider this so that they can identify 

and refer patients for treatment before serious problems 

develop. The study also shows that increased integration 

between AOD and psychiatric programs (“one-stop shopping”) could significantly improve treatment outcomes. 

Women—Women historically consume less alcohol than 

men, drink alcohol less frequently, and are less likely to develop 

alcohol-related problems. Yet when women do develop 

alcohol-related problems, they tend to develop them faster 

severe (18). In fact, women develop 

2


(17), and their problems are more 

higher blood alcohol concentrations 

same amount of alcohol, which 

increases their risk of injury and illness 

from conditions such as alcohol-related 

than men, even when drinking the 

liver disease (18). 

Gender differences also exist in 

alcoholism treatment, beginning 

“Research also is helping to define the 

barriers that exist in accessing care 

and achieving recovery from alcohol 

abuse and alcoholism.”	
“Women are less likely than men to 

be diagnosed with an AOD problem 

in health care settings.” 

with diagnosis. Women are less likely than men to be diagnosed with an AOD problem in health care settings (19). 

Primary care physicians may fail to accurately identify 

women with alcohol use disorders because women tend to 

seek treatment for nonspecific health complaints, nervousness, anxiety, or insomnia. 

Once a woman decides to seek treatment, she faces 

different barriers than men do in finding and accessing services. 

Women are more likely to experience economic barriers to 

treatment, to report having trouble finding time to attend 

regular treatment sessions because of family responsibilities, 

and to have problems with transportation (20). 

Women also tend to have a higher prevalence of anxiety 

and depressive disorders and more severe mental health problems (21). These co-occurring problems may make it harder 

for women to find and follow through with treatment (20). 

Given the obstacles women face in seeking treatment, it 

seems to follow that women would be less likely to seek, 

initiate, or complete treatment, and would therefore have 

poorer long-term outcomes. But this is not the case. A recent 

study found that men and women were equally likely to 

complete treatment, but women who completed treatment 

were nine times more likely to be abstinent than women 

who did not complete, whereas men who completed treatment were only three times more likely to be abstinent than 

men who did not complete treatment (22). 

Are specialized women-only programs needed? In one 

study, women who lived with their children in a residential 

program remained in treatment significantly longer (average 

of 300 days) than did women whose children were placed with 

caretakers (average of 102 days) (23). Thus, providing services 

such as child care may help to keep women in treatment (20). 

Ethnic and Minority Groups—According to national surveys, alcohol consumption and alcohol-related problems 

among White Americans have declined since the mid-1980s 

(24). At the same time, however, alcohol consumption and 

alcohol-related problems have remained stable or even 

increased among Blacks and Hispanics. Studies also show 

that, for any given level of alcohol consumption, ethnic 

minority populations experience more negative health and 

social consequences of drinking (e.g., unemployment, poor 

education outcomes, and alcohol-related legal problems) 

than Whites (25). 

Most of the studies of treatment effectiveness have compared 

Whites with the largest minority groups, primarily Blacks and 

Hispanics. Although some studies reported poorer treatment 

outcomes for minority patients, most found no significant 

differences in treatment effectiveness across groups (26). 

In many studies, minority patients 

enter treatment with more characteristics that predict lower rates of 

success (e.g., lower income, less education, more extensive family histories 

of alcoholism, more co-occurring 

drug abuse, and poorer physical 

health) compared with Whites (27). 

But even with poorer odds of success at the beginning of 

treatment, minority patients often appear to be as successful as 

Whites when followed for a year or more after treatment. 

Although research on alcoholism treatment with these 

groups is very limited, some studies have suggested ethnic 

differences that may be relevant for treatment planning. 

Kaskutas and colleagues (28) found that a higher proportion of Blacks in treatment (76 percent) report having 

had some previous treatment compared with Whites (65 

percent). Blacks are almost twice as likely as Whites to have 

gone to Alcoholics Anonymous (AA) meetings as a part of 

their treatment. Arroyo and colleagues (29) found that 

although Hispanics attended more formal alcoholism therapy 

sessions and fewer AA meetings than Whites, both groups 

had similar treatment outcomes. The authors speculate that 

Hispanics may make greater use of their existing social support system and thus may not need AA as a support system, 

or their treatment preferences simply may reflect a belief 

that AA is not as effective as formal treatment programs. 

The NIAAA Project MATCH study showed that Native 

American patients experienced better outcomes from motivational enhancement therapy than from cognitive-behavioral 

therapy or 12-step facilitation (such as AA) (30). 

Mandated Treatment—Many people enter alcoholism 

treatment through the legal system (31), a large proportion 

of them for driving under the influence (DUI) (32). Research 

on mandated treatment for DUI offenders consistently shows 

that treatment has a modest effect on reducing drinking– 

driving and alcohol-impaired crashes among offenders who 

were mandated to attend and who actually received the 

intervention (33,34). 

Research has not specifically examined the cost-effectiveness 

of mandated treatment for drinking and driving. However, 

considering that alcohol was a factor in 41 percent of U.S. 

traffic deaths in 2002 (35), and that in 1998 the U.S. economic 

costs related to alcohol use problems was $185 billion (36), 

the design of cost-effective treatment is imperative. Developing 

cost-effective alcoholism intervention and treatment for 

mandated populations could mean a decrease in alcoholrelated problems nationwide. 

Treatment efforts aimed at DUI offenders also need to 

consider the changing characteristics of the DUI offender 

population. For example, stricter laws, such as zero-tolerance 

laws for underage drinkers (which set the legal blood alcohol limit for drivers younger than age 21 at 0.00 or 0.02 

percent) have led to a 19-percent reduction in drinking–driving 

and a 20-percent reduction in fatal crashes among young 

drivers (37,38). Still, many young people continue to drink 

3

and drive. With zero-tolerance laws, drinking–driving youth 

who might otherwise have avoided criminal sanctions can 

be mandated to receive treatment. 

TANF Welfare Recipients—The 1996 welfare reform law, 

which replaced the cash entitlement with an emphasis on 

employment, has important implications for the organization of alcoholism treatment services. Studies have estimated 

that 6 to 10 percent of Temporary Assistance to Needy 

Families (TANF) recipients were dependent on either alcohol 

or other drugs (39,40). Women with AOD use disorders 

experience substantially more barriers to employment and 

are less likely to become employed and more likely to be 

sanctioned and lose welfare benefits than women without 

substance abuse problems (41). 

Identifying people with AOD use disorders is the first 

step to improving their employment outcomes, but this can 

be difficult. Most people are reluctant to disclose having an 

AOD use problem because of the stigma involved (42), and 

TANF recipients may be especially reluctant because of 

added concerns about losing their welfare benefits. A number 

of welfare systems attempt to screen for AOD use problems 

using generic screening methods, such as CAGE–AID, a 

nine-item measure designed to screen for AOD problems, 

but these methods identified far fewer TANF recipients with 

AOD use problems than did a specialized screening method (43). 

Specialized screening was designed to augment generic 

screening methods, providing more intensive interview-type 

questioning by trained staff. In one study, such specialized 

screening resulted in a higher rate of referral to treatment 

than found in surrounding counties that used a generic 

screening method (10.3 percent vs. 4.4 percent). 

Costs of Treatment 

Staying abreast of the latest research and understanding the 

needs of special populations can help improve health care 

access and quality. But another part of the health services 

research equation—economics—also must be considered. 

Increases in health care costs in recent years have pressured 

providers, insurers, and policymakers to monitor the costs, 

cost-effectiveness, and cost–benefit of all health care services, including alcohol-related treatment. 

The costs of alcohol abuse and alcoholism are staggering. 

In 1998 the social costs of alcohol abuse and dependence 

were estimated to be $185 billion (36). Although alcoholabusing drinkers and their families pay some of these costs 

(e.g., the medical and legal costs), the nonabusing population also bears costs, such as those related to alcohol-related 

motor vehicle crashes, crime, and increased health care 

expenses. Because of these enormous societal costs, alcohol 

abuse and alcoholism are major concerns for policymakers 

and researchers. But without solid information regarding 

the economic implications of alcohol-related services, 

health insurance companies, managed care organizations, 

and policymakers may be reluctant to fund these services. 

In recent years, especially with the advent of managed 

care, there has been a greater emphasis on cost containment, 

leading researchers to focus on the evaluation of treatment 

service costs. To investigate the role of these economic 

analyses, NIAAA’s National Advisory Council formed a 

Subcommittee on Health Services Research. In its report to 

the Advisory Council, the Subcommittee noted that studies 

of the cost and cost-effectiveness of alcoholism treatments 

are essential to ensure that people with alcohol-related 

problems receive appropriate care and recommended that 

future research compare the costs of alcoholism treatment 

programs with their outcomes and benefits (44). 

In addition to looking at costs and benefits, Gold and 

colleagues (45) recommend that analysts adopt a broad 

societal perspective. Fleming and colleagues (46) used this 

approach in their cost–benefit analysis of Project Trial for 

Early Alcohol Treatment (TrEAT), in which physicians in 

primary care clinics administered brief interventions to problem drinkers in a randomized controlled trial. The TrEAT 

intervention resulted in economic benefits in the form of 

reduced hospital and emergency department use, fewer 

criminal and legal events, and fewer motor vehicle incidents 

(crashes, violations, and related arrests). 

The total cost benefit of Project TrEAT was estimated 

to be $423,519, which included $195,448 in emergency 

department and hospital use savings, and $228,071 in avoided 

costs of crime and motor vehicle crashes. This works out to 

be about $1,151 in savings per person. On the other hand, 

the total cost for the intervention was estimated to be 

$80,210, or about $205 per person, leading the researchers 

to conclude that the benefits of the intervention far outweigh its cost (47). 

Conclusion 

Health services research is providing valuable information 

for people involved in treating alcoholism and its related 

problems. In recent years studies have shown that medications can have an important 

role in treating addiction. 

Research also has helped to 

identify barriers to treatment 

for special populations, such as 

adolescents, women, ethnic/ 

racial groups, people mandated 

to receive treatment, and people 

receiving welfare. Health services research is critical for the 

4


“Studies of the cost and cost-effectiveness 

of alcoholism treatments are essential to 

ensure that people with alcohol-related 

problems receive appropiate care.” 
AOD treatment field, as well as for health insurance companies, managed care organizations, and policymakers who 

require solid information regarding the economic implications of alcohol-related services to fund these services. 

References 

(1) McCarty, D.; Edmundson, E.; and Hartnett, T. Charting a path between research and 

practice in alcoholism treatment. Alcohol Research & Health 29(1):5–10, 2006. PMID: 

16767847. (2) O’Malley, S.S. Naltrexone and Alcoholism Treatment: Treatment Improvement 

Protocol (TIP) Series 28. DHHS Pub. No. SMA–98–3206. Rockville, MD: Substance 

Abuse and Mental Health Services Administration, Center for Substance Abuse 

Treatment, 1998. (3) Krystal, J.H.; Cramer, J.A.; Krol, W.F.; et al. Naltrexone in the treatment of alcohol dependence. New England Journal of Medicine 345:1734–1739, 2001. 

PMID: 11742047. (4) Kranzler, H.R., and Van Kirk, J. Efficacy of naltrexone and acamprosate for alcoholism treatment: A meta-analysis. Alcoholism: Clinical and Experimental 

Research 25:1335–1341, 2001. PMID: 11584154. (5) Streeton, C., and Whelan, G. 

Naltrexone, a relapse prevention maintenance treatment of alcohol dependence: A metaanalysis of randomized controlled trials. Alcohol and Alcoholism 36:544–552, 2001. PMID: 

11704620. (6) Pettinati, H.M.; Weiss, R.D.; Miller, W.R.; et al. COMBINE Monograph 

Series, Volume 2. Medical Management Treatment Manual: A Clinical Research Guide for 

Medically Trained Clinicians Providing Pharmacotherapy as Part of the Treatment for 

Alcohol Dependence. DHHS Publication No. (NIH)04–5289. Bethesda, MD: NIAAA, 2004. 

(7) Mark, T.L.; Kranzler, H.R.; Poole, V.H.; et al. Barriers to the use of medications to treat 

alcoholism. American Journal on Addictions 12:281–294, 2003. PMID: 14504021 (8) 

Mark, T.L.; Kranzler, H.R.; Song, X.; et al. Physicians’ opinions about medications to treat 

alcoholism. Addiction 98:617–626, 2003. PMID: 12751979. (9) Thomas, C.P.; Wallack, 

S.S.; Lee, S.; et al. Research to practice: Adoption of naltrexone in alcoholism treatment. 

Journal of Substance Abuse Treatment 24:1–11, 2003. PMID: 12646325. (10) Carroll, 

K.M.; Libby, B.; Sheehan, J.; and Hyland, N. Motivational interviewing to enhance treatment initiation in substance abusers: An effectiveness study. American Journal on 

Addictions 10:335–339, 2001. PMID: 11783748. (11) Miller, W.R., and Rollnick, S. 

Motivational Interviewing: Preparing People for Change. 2d ed. New York: Guilford Press, 

2002. (12) Dickinson, D.M.; Edmundson, E.H.; and Tomlin, K. Strategies to support clinicians’ use of motivational interviewing. Journal of Teaching in the Addictions, in press. (13) 

Deas, D., and Thomas, S.E. An overview of controlled studies of adolescent substance 

abuse treatment. American Journal on Addictions 10:178–189, 2001. PMID: 11444159. 

(14) Jainchill, N. Substance dependency treatment for adolescents: Practice and 

research. Substance Use & Misuse 35:2031–2060, 2000. PMID: 11138716. (15) Sterling, 

S., and Weisner, C. Translating research findings into practice: Example of treatment services for adolescents in managed care. Alcohol Research & Health 29(1):11–18, 2006. 

PMID: 16767848. (16) Sterling, S.; Kohn, C.S.; Lu, Y.; and Weisner, C. Pathways to chemical dependency for adolescents in an HMO. Journal of Psychoactive Drugs 36:439–453, 

2004. PMID: 15751482. (17) Randall, C.L.; Roberts, J.S.; Del Boca, F.K.; et al. 

Telescoping of landmark events associated with drinking: A gender comparison. Journal 

of Studies on Alcohol 60:252–260, 1999. PMID: 10091964. (18) Bradley, K.A.; Badrinath, 

S.; Bush, K.; et al. Medical risks for women who drink alcohol. Journal of General Internal 

Medicine 13:627–639, 1998. PMID: 9754520. (19) Brienza, R.S., and Stein, M.D. Alcohol 

use disorders in primary care: Do gender-specific differences exist? Journal of General 

Internal Medicine 17:387–397, 2002. PMID: 12047738. (20) Brady,T.M., and Ashley, O.S., 

eds. Women in Substance Abuse Treatment: Results From the Alcohol and Drug Services 

Study (ADSS). DHHS Pub. No. SMA 04–3968, Analytic Series A–26. Rockville, MD: 

Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 

2005. (21) Hesselbrock, M.N., and Hesselbrock, V.M. Gender, alcoholism, and psychiatric 

comorbidity. In: Wilsnack, R.W., and Wilsnack, S.C., eds. Gender and Alcohol: Individual 

and Social Perspectives. New Brunswick, NJ: Center of Alcohol Studies, Rutgers 

University, 1997. pp. 49–71. (22) Green, C.A.; Polen, M.R.; Lynch, F.L.; et al. Gender differences in outcomes in an HMO-based substance abuse treatment program. Journal of 

Addictive Diseases 23:47–70, 2004. PMID: 15132342. (23) Hughes, P.N.; Coletti, S.D.; 

Neri, R.L.; et al. Retaining cocaine-abusing women in a therapeutic community: The effectiveness of a live-in program. American Journal of Public Health 85:1149–1152, 1995. 

PMID: 7625517. (24) Caetano, R., and Clark, C.L. Trends in alcohol consumption among 

Whites, Blacks and Hispanics: 1984 and 1995. Journal of Studies on Alcohol 59:659–668, 

1998. PMID: 9811087. (25) Boyd, M.R.; Phillips, K.; and Dorsey, C.J. Alcohol and other 

drug disorders, comorbidity, and violence: Comparison of rural African American and 

Caucasian women. Archives of Psychiatric Nursing 17:249–258, 2003. PMID: 14685949. 

(26) Brower, K.J.; and Carey, T.L. Racially related health disparities and alcoholism treatment outcomes. Alcoholism: Clinical and Experimental Research 27:1365–1367, 2003. 

PMID: 12966341. (27) Le Fauve, C.E.; Lowman, C.; Litten, R.Z., III; and Mattson, M.E. 

Introduction: National Institute on Alcohol Abuse and Alcoholism Workshop on Treatment 

Research Priorities and Health Disparities. Alcoholism: Clinical and Experimental 

Research 27:1318–1320, 2003. PMID: 12966328. (28) Kaskutas, L.A.; Weisner, C.; Lee, 

M.; and Humphreys, K. Alcoholics Anonymous affiliation at treatment intake among White 

and Black Americans. Journal of Studies on Alcohol 60:810–816, 1999. PMID: 10606493. 

(29) Arroyo, J.A.; Westerberg, V.S.; and Tonigan, J.S. Comparison of treatment utilization 

and outcome for Hispanics and non–Hispanic Whites. Journal of Studies on Alcohol 

59:286–291, 1998. PMID: 9598709. (30) Villanueva, M.; Tonigan, J.S.; and Miller, W.R. A 

retrospective study of client-treatment matching: Differential treatment response of Native 

American alcoholics in Project MATCH [Abstract]. Alcoholism: Clinical and Experimental 

Research 26(Suppl. 5):83A, 2002. (31) Weisner, C.M.; Matzger, H.; Tam, T.; and Schmidt, 

L. Who goes to alcohol and drug treatment? Understanding utilization within the context 

of insurance. Journal of Studies on Alcohol 63:673–682, 2002. PMID: 12529067. (32) 

Weisner, C.M. Coercion in alcohol treatment. In: Institute of Medicine. Broadening the 

Base of Treatment for Alcohol Problems: Report of a Study by a Committee of the Institute 

of Medicine, Division of Mental Health and Behavioral Medicine.Washington, DC: National 

Academy Press, 1990. pp. 579–609. (33) Mann, R.E.; Anglin, L.; Wilkins, K.; et al. 

Rehabilitation for convicted drinking drivers (second offenders): Effects on mortality. 

Journal of Studies on Alcohol 55:372–374, 1994. PMID: 8022186. (34) Wells-Parker, E., 

and Williams, M. Interpreting research for practice: A challenge for evidence-based 

assessment and intervention with DWI offenders. Book reviews of Assessment and 

Treatment of the DWI Offender by A. Cavaiola and C. Wuth. Contemporary Psychology: 

APA Review of Books 49:161–164, 2004. (35) Hingson, R., and Winter, M. Epidemiology 

and consequences of drinking and driving. Alcohol Research & Health 27(1):63–78, 2003. 

PMID: 15301401. (36) Harwood, H. “Updating Estimates of the Economic Costs of 

Alcohol Abuse in the United States: Estimates, Update Methods, and Data.” Report prepared by the Lewin Group for the National Institute on Alcohol Abuse and Alcoholism, 

2000. (37) Wagenaar, A.C.; O’Malley, P.; and LaFond, C. Lowered legal blood alcohol limits for young drivers: Effects on drinking, driving, and driving after drinking behaviors in 30 

states. American Journal of Public Health 91:801–804, 2001. PMID: 11344892. (38) 

Hingson, R.; Heeren, T.; and Winter, M. Lower legal alcohol limits for young drivers. Public 

Health Reports 109:738–744, 1994. PMID: 7800781. (39) Jayakody, R.; Danziger, S.; and 

Pollack, H. Welfare reform, substance use and mental health. Journal of Health Politics, 

Policy and Law 25:623–651, 2000. PMID: 10979515. (40) Schmidt, L.; Weisner, C.; and 

Wiley, J. Substance abuse and the course of welfare dependency. American Journal of 

Public Health 88:1616–1622, 1998. PMID: 9807526. (41) Morgenstern, J., and 

Blanchard, K.A. Welfare reform and substance abuse treatment for welfare recipients. 

Alcohol Research & Health 29(1):63–67, 2006. PMID: 16767856. (42) Metsch, L.R., and 

Pollack, H.A. Welfare reform and substance abuse. Milbank Quarterly 83:65–99, 2005. 

PMID: 15787954. (43) Morgenstern, J.; Riordan, A.; DePhilippis, D.; et al. Specialized 

Screening Approaches Can Substantially Increase the Identification of Substance Abuse 

Problems Among Welfare Recipients. Washington, DC: U.S. Department of Health and 

Human Services, Office of the Assistant Secretary for Planning and Evaluation, 2001. (44) 

Subcommittee on Health Services Research, National Advisory Council on Alcohol 

Abuse and Alcoholism. Improving the Delivery of Alcohol Treatment and Prevention 

Services: A National Plan for Alcohol Health Services Research. Bethesda, MD: National 

Institute on Alcohol Abuse and Alcoholism, 1997. (45) Gold, M.R.; Siegel, J.E.; Russell, 

L.B.; and Weinstein, M.C.; eds. Cost-Effectiveness in Health and Medicine. New York: 

Oxford University Press, 1996. (46) Fleming, M.F.; Mundt, M.P.; French, M.T.; et al. 

Benefit–cost analysis of brief physician advice with problem drinkers in primary care settings. Medical Care 38:7–18, 2000. PMID: 10630716. (47) Mundt, M. Analyzing the costs 

and benefits of brief intervention. Alcohol Research & Health 29(1):34–36, 2006. PMID: 

16767851. 

5

R e s o u r c e s 

Source material for this Alcohol Alert originally appeared in Alcohol 

Research & Health, Volume 29, Number 1, 2006. For more information on

recent advances in alcoholism treatment, see also: 

▲

COMBINE Monograph Series: Volume 1, Combined Behavioral 

Intervention Manual: A Clinical Research Guide for Therapists Treating 

People With Alcohol Abuse and Dependence—Highlights the use of 

Combined Behavioral Intervention, an intensive treatment that 

combines several successful features from previously evaluated 

interventions. 

▲

COMBINE Monograph Series: Volume 2, Medical Management 

Treatment Manual: A Clinical Research Guide for Medically Trained 

Clinicians Providing Pharmacotherapy as Part of the Treatment for Alcohol 

Dependence—Describes the use of medical management and brief counseling 

sessions to enhance medication adherence and abstinence from alcohol. 

▲

For these and other resources, visit NIAAA’s Web site, www.niaaa.nih.gov 

Full text of this publication is available on NIAAA’s World Wide Web site at http://www.niaaa.nih.gov. 

All material contained in the Alcohol Alert is in the public domain and may be used or reproduced 

without permission from NIAAA. Citation of the source is appreciated.


Copies of the Alcohol Alert are available free of charge from the National Institute on Alcohol Abuse and Alcoholism


Publications Distribution Center, P.O. Box 10686, Rockville, MD 20849–0686.


U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES 

NIAAA Publications Distribution Center 

Attn.: Alcohol Alert 

P.O. Box 10686 

Rockville, MD 20849–0686 

Official Business 

Penalty for Private Use $300 

PRSRT STD 

POSTAGE AND FEES PAID 

NIH/NIAAA 

PERMIT NO. G-824