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Paradoxically, assessing treatment and treatment processes has not always been a high priority in the alcohol treatment field (Glaser 1980). Recently, however, interest in treatment assessment has surged among administrators, researchers, and clinicians. This interest has been spurred by several developments. One is a focus on systems analysis and between-program differences, sustained most recently by efforts toward health care reform. In order to describe programs and examine interrelationships among program characteristics and quality of care indices, policymakers, administrators, and researchers have recognized the need for instruments to assess program-level variables.

A second reason for the rising interest in treatment assessment is the increasing recognition of the complex nature of predominantly psychosocial interventions, such as those often employed to treat alcohol use disorders. One example of this complexity is therapist effects in the delivery of treatment (Najavits and Weiss 1994), that is, the way in which the "same" treatment can be delivered quite differently by different therapists. Treatment researchers have recognized the need to not only facilitate the provision of standardized treatment through the use of therapist training, supervision, and treatment manuals (e.g., Kadden et al. 1989), but also to assess the implementation of the com

plex, multifaceted treatments they are studying. In particular, it is seen as important to document that distinctive treatments have been applied in comparative evaluations, especially in studies of patient-treatment matching, and to conduct treatment process analyses to identify "active ingredients of treatment" and "mechanisms of change."

On the clinical side, treatment providers have been seeking instruments with which to assess the quality of treatment provision as well as the progress of their clients during treatment. Their motivation is the same as that among researchers; such instruments are seen as essential elements in the effort to improve clinical care.

This chapter presents a broad, multilevel model of treatment and treatment processes. Then measures of the different domains of treatment variables addressed by the model are reviewed. The predominantly recent interest in the assessment of treatment is reflected in the availability of only a few established measures. Consequently, there is no table of measures in this chapter, and only a few measures (indicated by an asterisk) are included in the master grid. A number of promising instruments are reviewed, however, and additional work needed to develop high-quality measures of treatment and treatment processes is considered.