Assessing Drug and Alcohol Treatment Needs of General and Special Populations: Conceptual, Empirical and Inferential Issues

• Date: 01 July 1994
• Author: Robert Florentine
• Published date: 01 July 1994
• DOI: 10.1177/002204269402400306
• Subject Matter: Article

The Journal of Drug Issues 24(3), 445-462 1994

ASSESSING

DRUG

AND

ALCOHOL

TREATMENT

NEEDS

OF

GENERAL

AND

SPECIAL

POPULATIONS:

CONCEPTUAL,

EMPIRICAL

AND

INFERENTIAL

ISSUES

Robert Florentine

"Needs

assessments" have become increasingly important in guiding

resource allocations to publicly funded drug and alcohol treatment

programs. Although technicalprogress in conducting needs assessments in

recent years has occurred. virtually all approaches used to identify

treatment needs

of

general and special populations suffer from conceptual,

empirical, and inferential problems. This article clarifies the more

important problems and offers recommendations about how to improve

needs assessments.

Allocating

resources to publicly funded drug and alcohol treatment programs

based upon some empirical assessment of treatment need has become an

increasingly prominent feature of resource allocation strategies. Needs

assessments of general and special populations are now mandated by many federal

and state funding agencies. An important goal driving the increased use of needs

assessments is the desire to increase the rationality of the resource allocation

process. This goal, unfortunately; may be compromised by a number of

conceptual, inferential, and empirical problems associated with needs assessments.

Some of these problems have been discussed in previously published works

(Kimmel 1990; Center for Substance Abuse Treatment 1992; McBride and McCoy

1985; Hser 1993). The purpose of this article is to extend the inquiry by

addressing a wider range of conceptual, empirical, and inferential problems that

beset treatment needs assessments of general and special populations.

This article is divided into four sections. Conceptual, empirical, and

inferential issues are discussed in the first three sections, followed by conclusions

and recommendations in the final section.

Conceptual Issues

Some of the problems pertaining to needs assessments stem from unwarranted

assumptions about populations, services, and need. Two especially troublesome

assumptions include the possible heterogeneity of special populations. and the

Robert

florentine.

Ph. D.• is a principal investigator at the UCLA Neuropsychiatric Institute. Drug Abuse

Research Center. His research has centered on treatment effectiveness evaluations. substantive and policy-related

issues relating to barriers to treatment utilization. perception of treatment need by drug users. client effects of

"enhanced" treatment. and treatment needs assessments of general and special populations. Send reprtint requests to

Robert Fiorentine, UCLA Neuropsychiatric Institute. Drug Abuse Research Center. 1100 Glendon Avenue. Suite

763. Los Angeles. CA 90024.

©Journal of Drug Issues, Inc. 002-0426/94/03/445-462 $1.00

445

FlORENTINE

difference (and potential confusion) between service adequacy and service equity.

Heterogeneity

within

Special

Populations

Referring to some groups as

special

or

target

populations has entered the

lexicon of alcohol and drug program practitioners and policy makers. Sometimes

these terms are used interchangeably even though they hold somewhat different

meanings. "Special populations" refer to the characteristics of the populations

themselves, and suggests that members of these groups have health care needs that

are different from the general population. "Target populations," on the other hand,

refer to characteristics of the policy, and imply that members of this group are to

be singled out for differential treatment. Of course, the reason that special

populations may be singled out for differential treatment may stem from their

different health care needs. Some typical examples of special or target

populations include women, ethnic populations, the homeless, persons with

disabilities, youth, elderly, AIDS victims, gays, and lesbians (Fiorentine and Attar

1992).

While there are planning advantages in conceptualizing the general population

as composed of different groups or subpopulations, there is likely to be substantial

heterogeneity among members of these populations. One notable example

includes ethnic categories. Ethnic populations are typically aggregated into five

categories, including

white,

African-American,

Hispanic,

Asian/Pacific

Islander,

and

native

American.

Individuals identified as Hispanic, for example, may

include recent immigrants to this county who have a minimal command of

English, as well as fourth-generation Mexican-Americans whose cultural

background is more similar to a fourth-generation white. Similarly, those

identified as "Asian/Pacific Islanders" could trace their heritage to Pakistan and

may have very little in common with individuals from Samoa, yet both are lumped

into the same ethnic category.

If

ethnic populations are heterogeneous, it may be unreasonable to develop

programs and allocate resources based on the five ethnic groupings that are

typically used. Rather than experiencing cultural congruence with program

personnel and treatment services, the individual may feel alienated from the very

programs designed to be congruent with his or her background.

Heterogeneity in ethnic populations also poses problems for program

evaluation and policy recommendations. Existing programs that target a particular

ethnic population may miss their mark for some individuals not because the

programs are unsound or mismanaged, but because of the difficulty in providing

culturally congruent services to such a heterogeneous population.

Service

Adequacy

versus

Service

Equity

Whereas

service

adequacy

refers to the degree to which existing services meet

the total client need for services within a planning area,

service

equity

refers to the

proportional utilization of services by various population groups. Service equity

exists when the various populations in the planning area are no more or less likely

to utilize services.

Contrasting service adequacy with service equity suggests that even though

some target populations may be underserved relative to other populations, it

should not be assumed that nontarget populations are

adequately

served. A

population may be "overserved" relative to other populations, but still be

underserved relative to its need for services.

446 JOURNAL OF DRUG ISSUES