Hannah K. Knudsen

Modeling the use of innovations in private treatment organizations: The role of absorptive capacity

Few studies have identified the organizational characteristics that are associated with the transfer of research-based treatment techniques into practice. One potentially fruitful concept is absorptive capacity, referring to an organizations ability to seek and utilize information, which may be positively associated with the use of innovative treatment techniques. This paper examines the associations between an additive measure of innovation use and three measures of absorptive capacity: environmental scanning, collection of satisfaction data, and the level of workforce professionalism. Data from a nationally representative sample of 322 privately funded substance abuse treatment centers indicate that treatment organizations use a greater number of innovations when they engage in more environmental scanning, survey referral sources, and third party payers for satisfaction, and have a more professional workforce. These results indicate the importance of absorptive capacity in predicting organizational innovativeness.

Adoption and implementation of medications in addiction treatment programs.

Objectives:Little is known about the extent to which medications are being implemented as routine care in addiction treatment programs. This research describes medication adoption and implementation within the privately funded treatment sector. Methods:Face-to-face interviews were conducted with 345 administrators of a nationally representative sample of privately funded substance treatment organizations in the United States. Results:Rates of adoption of addiction treatment medications in private sector programs were lower than the adoption of psychiatric medications. Even when analyses were restricted to programs with access to physicians, adoption of each addiction treatment medication had occurred in less than 50% of programs. Within adopting programs, implementation was highly variable. Although approximately 70% of patients with cooccurring psychiatric diagnoses received psychiatric medications, rates of implementation of medication-assisted treatment for opioid dependence and alcohol use disorders were just 34.4% and 24.0%, respectively. Conclusions:Although previous research has documented higher rates of medication adoption in privately funded treatment programs, this study revealed that both adoption and implementation of pharmacotherapies to treat addiction remains modest. Future research should examine the different types of barriers to implementation, such as physician decision making, patient preferences, and system-level barriers stemming from financing and public policy.

Using Medication-Assisted Treatment for Substance Use Disorders: Evidence of Barriers and Facilitators of Implementation

The use of medications to treat substance use disorders (SUDs) has emerged as a potentially central part of the treatment armamentarium. In this paper we present data from several recent US national surveys showing that despite the clinical promise of these medications, there has been limited adoption of pharmacotherapies in the treatment of SUDs. The data reveal variable patterns of use of disulfiram, buprenorphine, tablet naltrexone, acamprosate and injectable naltrexone. After examining the environmental and institutional context for the adoption of pharmacotherapies, the specific organizational facilitators and barriers of medication adoption are considered. The paper concludes with a discussion of the minimal clinical and administrative guidance available to enhance adoption, the lack of client and consumer knowledge of medications that puts a brake on their adoption and availability, and the difficulties that must be surmounted in bringing new medications to market.

Turnover intention and emotional exhaustion "at the top": Adapting the job demands-resources model to leaders of addiction treatment organizations

Compared with the large literature on subordinate employees, there are few studies of emotional exhaustion and turnover intention for organizational leaders. There is little research that has extended the job demands-resources (JD-R) model of emotional exhaustion to leaders. In this study, the authors adapted the JD-R framework to analyze data collected from a sample of 410 leaders of addiction treatment organizations. The authors considered whether two job demands (performance demands and centralization) and two job resources (innovation in decision making and long-range strategic planning) were associated with emotional exhaustion and turnover intention. The authors also examined whether emotional exhaustion fully or partially mediated the associations between the job-related measures and turnover intention. The results supported the partially mediated model. Both job demands were positively associated with emotional exhaustion, and the association for long-range strategic planning was negative. Emotional exhaustion was positively associated with turnover intention. Centralization and innovation in decision making were also directly associated with turnover intention. Future research should continue to examine this theoretical framework among leaders of other types of organizations using more refined measures of demands and resources.

Medication-assisted treatment in criminal justice agencies affiliated with the criminal justice-drug abuse treatment studies (CJ-DATS): availability, barriers, and intentions.

Medication-assisted treatment (MAT) is underutilized in the treatment of drug-dependent, criminal justice populations. This study surveyed criminal justice agencies affiliated with the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) to assess use of MAT and factors influencing use of MAT. A convenience sample (N = 50) of criminal justice agency respondents (e.g., jails, prisons, parole/probation, and drug courts) completed a survey on MAT practices and attitudes. Pregnant women and individuals experiencing withdrawal were most likely to receive MAT for opiate dependence in jail or prison, whereas those reentering the community from jail or prison were the least likely to receive MAT. Factors influencing use of MAT included criminal justice preferences for drug-free treatment, limited knowledge of the benefits of MAT, security concerns, regulations prohibiting use of MAT for certain agencies, and lack of qualified medical staff. Differences across agency type in the factors influencing use and perceptions of MAT were also examined. MAT use is largely limited to detoxification and maintenance of pregnant women in criminal justice settings. Use of MAT during the community reentry period is minimal. Addressing inadequate knowledge and negative attitudes about MAT may increase its adoption, but better linkages to community pharmacotherapy during the reentry period might overcome other issues, including security, liability, staffing, and regulatory concerns. The CJ-DATS collaborative MAT implementation study to address inadequate knowledge, attitudes, and linkage will be described.

Service delivery in substance abuse treatment: reexamining "comprehensive" care.

Substance abuse treatment clients present with an array of service needs in various life domains. Ideal models of addiction treatment incorporate provision or linkages to services to meet clients’ multiple needs; in turn, these wraparound and supportive services are associated with improvements in client retention and treatment outcomes. Using data from large samples of specialty addiction treatment providers in the public and private sectors, this article examines the extent and organizational correlates of the comprehensiveness of service delivery. Multivariate models indicate that private sector treatment facilities offer more “core” medical and treatment services, whereas public sector programs offer more wraparound and supportive services. However, both sectors fall short of the ideal model of service comprehensiveness in terms of absolute number of services offered. These findings raise concerns regarding the quality and availability of needed services for treatment of addiction.

Trends in the adoption of medications for alcohol dependence

Increasing attention is being paid to the development and dissemination of effective pharmacotherapies for the treatment of alcohol and other drug dependence. However, numerous structural and philosophical barriers impede the widespread adoption of these treatment approaches in everyday clinical practice. Research is needed to understand and overcome this gap. Drawing upon data collected from 2 large samples of substance abuse treatment providers at multiple time points, this article examines the prevalence and correlates of the adoption of the currently available pharmacotherapies for alcohol dependence: disulfiram, oral naltrexone, and acamprosate. These data suggest that the proportion of treatment programs using pharmacotherapies for alcohol dependence has been declining over time. In addition, the proportion of patients to whom these medications are prescribed is notably low. The adoption of disulfiram and naltrexone is significantly more likely in programs that are accredited, employ at least 1 physician, offer integrated care for patients with co-occurring psychiatric conditions, derive proportionately more revenue from commercial insurance payers, and have fewer linkages with the criminal justice system. Preliminary data suggest that the early adoption of acamprosate is following a similar pattern. Recommendations for addressing challenges to the diffusion of pharmacotherapies for alcohol dependence are presented.

Downsizing Survival: The Experience of Work and Organizational Commitment

Although downsizing has become a common feature of American workplaces, the existing literature has focused on the effects of how downsizing is conducted, rather than considering how downsizing affects the experience of work for downsizing survivors. Using data from the 1997 National Employee Survey and structural modeling techniques, this study compares downsizing survivors and workers unaffected by downsizing on a variety of sociodemographic indicators, job characteristics, and organizational environment measures in order to explain the lower levels of organizational commitment among survivors. The model in which downsizing survival was directly and indirectly associated with commitment was generally supported. Survivors reported less commitment than unaffected workers. In addition, downsizing survival was positively associated with job-related stress and negatively associated with perceived organizational support, which translated into survivors’ lower levels of commitment. This research suggests that organizations that downsize should consider ways to redesign work processes so as to reduce job-related stress and should engage in organizational practices that demonstrate organizational support for surviving employees.

Structural and cultural barriers to the adoption of smoking cessation services in addiction treatment organizations.

ABSTRACT Few studies have examined associations between the availability of smoking cessation services in addiction treatment organizations and specific cultural, staffing, and resource barriers. Telephone interviews were conducted with administrators of 897 addiction treatment organizations in the United States. These data revealed that few programs had adopted the full bundle of five recommended tobacco-related intake procedures, and that less than half of programs offered any smoking cessation services. Barriers to adoption of the intake bundle and availability of services included organizational culture and low levels of staff skills. Adoption of cessation services was associated with center type, location in a hospital setting, levels of care, and organizational size. Although a substantial proportion of organizations offer smoking cessation services, expansion of these services and greater adoption of tobacco-related intake procedures are needed to address the needs of nicotine-dependent individuals in addiction treatment.

Buprenorphine adoption in the National Drug Abuse Treatment Clinical Trials Network

The National Drug Abuse Treatment Clinical Trials Network (CTN), a collaborative federal research initiative that brings together universities and community-based treatment programs (CTPs), has conducted multiple clinical trials of buprenorphine for opioid dependence. Part of the CTNs mission is to promote the adoption of evidence-based treatment technologies. Drawing on a data collected during face-to-face interviews with administrators from a panel of 206 CTPs, this research examines the adoption of buprenorphine over a 2-year period. These data indicated that the adoption of buprenorphine doubled between the baseline and 24-month follow-up interviews. Involvement in a buprenorphine protocol continued to be a strong predictor of adoption at the 2-year follow-up, although adoption of buprenorphine tripled among those CTPs without buprenorphine-specific protocol experience. For-profit CTPs and those offering inpatient detoxification services were more likely to adopt buprenorphine over time. A small percentage of programs discontinued using buprenorphine. These findings point to the dynamic nature of service delivery in community-based addiction treatment and the continued need for longitudinal studies of organizational change.