SUBSTANCE ABUSE: THE NEED FOR SECOND-ORDER CHANGE

Under modern managed care, private and public sector inpatient substance abuse have reduced their services dramatically. Compounding this problem is the finding that various traditional substance abuse treatment programs, including inpatient and outpatient treatment programs, have high rates of recidivism. There is a need to develop and evaluate lower cost, non-medical, community-based care options for individuals recovering from substancerelated disorders. Therapeutic communities, self-help groups, communal recovery homes, harm reduction interventions, and preventive communitybased interventions have features that might impact “processes of change,” particularly those proposed in the transtheoretical model of change (Prochaska, DiClemente, & Norcross, 1992). These more comprehensive community-based interventions might influence a wide range of processes to produce second-order change (Watzlawick, Weakland, & Fisch, 1974). Substance abuse and addiction are among the most pressing health and social issues facing the international community (Leshner, 1998). In the United States, *The authors appreciate the financial support from the National Institute on Alcohol Abuse and Alcoholism (AA12218) and the National Institute on Drug Abuse (DA13231).