title: Changes in services and structure in community residential treatment facilities for substance abuse patients.
abstract: OBJECTIVE
  This study examined the extent to which community residential facilities that contract with the Department of Veterans Affairs (VA) to treat substance abuse patients are providing more services and structure to meet the needs of a client population with increasingly severe problems.
  
  
  METHODS
  A nationwide sample of 249 community residential facilities with VA contracts was surveyed in 1995 and again in 1998.
  
  
  RESULTS
  In 1998 facilities were more likely than they were in 1995 to have psychiatrists and psychologists available to patients as well as specialized counseling and psychoeducational, rehabilitation, and medical services. Facilities also provided more social and recreational activities, and more structure was provided by discouraging patients' choice of individual daily living patterns. In 1998 the facilities were more likely to admit dual diagnosis patients, those with substance use disorders and psychiatric disorders. Programs that changed toward accepting dual diagnosis patients had more services and structure than programs that consistently accepted only substance abuse patients.
  
  
  CONCLUSIONS
  Community residential facilities that contract with VA are responding appropriately to an increasingly ill patient population by providing more services and structure.
authors.affiliation: Department of Veteran Affairs, Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA.
authors.forename: C
authors.initials: C
authors.lastname: Timko
authors.forename: M
authors.initials: M
authors.lastname: Lesar
authors.forename: M
authors.initials: M
authors.lastname: Engelbrekt
authors.forename: R H
authors.initials: RH
authors.lastname: Moos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003155:Community Mental Health Centers / Q000639:trends*; D003156:Community Mental Health Services / Q000639:trends*; D003284:Contract Services / Q000639:trends; D005260:Female; D005544:Forecasting; D006301:Health Services Needs and Demand / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000639:trends; D012112:Residential Facilities / Q000639:trends*; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D014481:United States; D014728:Veterans / Q000523:psychology*