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Among various issues for increasing the effectiveness of the drug abuse treatment system are matching clients with treatment programs and improving program accountability. From a practical perspective, no tool is currently available to assist agencies make better matches, and in many communities the number of alternatives (i.e., truly different program content and philosophy) is limited. Moreover, there is no conclusive scientific evidence to support any particular matching strategy. And it is unclear whether the policy goal should be to improve the probability of positive individual outcomes or to reduce aggregate drug use. Research is needed to inform the practical and theoretical issues. Although improved accountability is clearly needed, previous approaches have not been successful. New proposals for outcome monitoring are worth pursuing, although providers' responses could defeat the purpose of reforms. Finally, there is a need for studies that will help set reasonable performance standards.
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