J. Aaron Johnson

Adoption and implementation of new technologies in substance abuse treatment.

In addition to clinical outcomes, understanding the adoption and implementation of new treatment interventions is essential. This analysis was designed to assess the predictive utility of organization-level features in understanding the adoption and implementation of new technologies in substance abuse treatment. Naltrexone, which was found to be in current use in 44.1% of a national sample of 400 private substance abuse treatment centers, was selected as an appropriate sample technology for study. Adoption of naltrexone is significantly related to both the treatment centers age and its administrative leadership. Naltrexone adoption is also significantly associated with the percentage of the centers caseload covered by managed care programs and by the percentage of relapsers represented in the caseload. The analysis was less successful in predicting naltrexone implementation for either primary alcohol dependence or primary opiate addiction.

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.

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.

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.

Applying Team-Based Learning in Primary Care Residency Programs to Increase Patient Alcohol Screenings and Brief Interventions

Purpose Educational research demonstrates little evidence of long-term retention from traditional lectures in residency programs. Team-based learning (TBL), an alternative, active learning technique, incites competition and generates discussion. This report presents data evaluating the ability of TBL to reinforce and enhance concepts taught during initial training in a National Institutes of Health–funded alcohol screening and brief intervention (SBI) program conducted in eight residency programs from 2005 to 2007 under the auspices of Mercer University School of Medicine. Method After initial training of three hours, the authors conducted three TBL booster sessions of one and a quarter hours, spaced four months apart at each site. They assessed feasibility through the amount of preparation time for faculty and staff, residents’ evaluations of their training, self-reported use of SBI, residents’ performance on individual quizzes compared with group quizzes, booster session evaluations, and levels of confidence in conducting SBI. Results After initial training and three TBL reinforcement sessions, 42 residents (63%) reported that they performed SBI and that their levels of confidence in performing interventions in their current and future practices was moderately high. Participants preferred TBL formats over lectures. Group performance was superior to individual performance on initial assessments. When invited to select a model for conducting SBI in current and future practices, all residents opted for procedures that included clinician involvement. Faculty found TBL to be efficient but labor-intensive for training large groups. Conclusions TBL was well received by residents and helped maintain a newly learned clinical skill. Future research should compare TBL to other learning methods.

Organizational Predictors of Pharmacological Innovation Adoption: The Case of Disulfiram

The research-to-practice gap in substance abuse treatment, particularly with regard to pharmacological innovations, necessitates the consideration of organizational characteristics that facilitate the adoption of innovations. Using data from a nationally representative sample of 394 privately funded substance abuse treatment centers, this study examines variation in the adoption of disulfiram in terms of organizational structure, workforce professionalism, and treatment philosophy. Logistic regression results indicated that hospital-based centers were significantly more likely to use disulfiram than freestanding treatment programs. In addition, the percentage of counselors with masters degrees and the percentage of certified/licensed counselors were positively associated with the likelihood of disulfiram utilization. Treatment centers that emphasized confrontational group therapy and spirituality were less likely to use disulfiram, while the adoption of disulfiram was more likely in centers that emphasized a medical model of addiction.

Predicting closure of private substance abuse treatment facilities

Researchers in organizational ecology have long been interested in identifying the factors associated with organizations closing their doors. Though the predictors of closure have been examined across many different types of organizations, private substance abuse treatment centers, often characterized as unstable and having high closure rates, have not been subject to empirical study. Data for this study were derived from a nationally representative longitudinal study of 450 private substance abuse treatment centers. Contrary to most previous research, center age was not a significant predictor of closure. Significant predictors included center capacity, being a freestanding facility, the percentage of clients covered by Medicaid, and the ratio of patients to full-time equivalents.

Modified therapeutic communities and adherence to traditional elements.

Abstract Traditional therapeutic communities (TCs) are characterized by confrontational group therapy, treatment phases, a tenure-based resident hierarchy, and long-term residential care. Many TCs have modified the structure and intensity of the traditional model, tailored services for specific client populations, and hired more professionally trained staff. This study examines the extent to which modified TCs are able to retain the underlying core technology of the TC. Using data from a nationally representative sample of 380 self-identified TCs, six traditional TC elements are identified. Results from a structural equation model indicate that offering services for specific populations and professionalization of staff has limited impact on the six TC elements. Modifications to structure and intensity of TC programming evidenced the strongest effect. Specifically, outpatient-only TCs showed significantly lower adherence to five of the six elements. Short-term residential programs showed a similar negative trend. Findings suggest selected modifications are possible without significantly impacting the TC models core technology.

Rural and Urban Similarities and Differences in Private Substance Abuse Treatment Centers

Abstract Although previous research has considered the unique treatment needs of rural residents, little research has investigated the potential differences in the availability of treatment services in rural and urban areas. Using three waves of longitudinal data from a nationally representative sample of privately-funded substance abuse treatment centers, this research compared rural and urban treatment centers with regard to the availability of clinical levels of care, the offering of specialty treatment tracks, the adoption of treatment innovations, and the average costs of care. Results indicate that rural and urban centers were similar in their increasing provision of inpatient psychiatric levels of care and their decreasing offering of more intensive levels of chemical dependency services between 1995 and 2001. Rural and urban centers were increasingly likely to offer specialty treatment tracks for women, adolescents, clients with HIV/AIDS, and relapsing clients over time, but rural centers were less likely to offer a treatment track tai lored to substance-abusing women. The use of treatment innovations was similar at rural and urban treatment centers with the exception of lesser use of acupuncture at rural centers. Rural and urban centers did not differ in their average charges for treatment services.

Screening for At-Risk Alcohol Use and Drug Use in an Emergency Department: Integration of Screening Questions Into Electronic Triage Forms Achieves High Screening Rates

STUDY OBJECTIVE Previous studies have shown that brief interventions for at-risk alcohol and drug use are significantly more likely to occur if patients are screened with a standardized, validated instrument, but high screening rates have traditionally been difficult to attain. Use of very brief screens can enable brief intervention specialists to focus their efforts on assessing and assisting patients most likely to need a brief intervention or more intensive treatment. This study describes the results of integrating brief substance abuse screens into an urban emergency departments (EDs) triage process. METHODS As part of a comprehensive initiative to increase alcohol and drug screening, brief intervention, and referral to treatment (SBIRT), 3 single-item screening questions were programmed into the electronic triage tool used in the ED to detect tobacco use, at-risk alcohol use, illicit drug use, or prescription drug misuse. Project staff conducted training sessions with nurses to ensure the questions were asked properly and ED supervisors provided ongoing performance feedback. Names of patients with positive responses to the alcohol or drug questions automatically populated a list forwarded to health education specialists, who provided assessments, brief interventions, and referrals. RESULTS Screening was conducted with 145,394 of 151,597 eligible patients, a 96% screening rate. Electronic reports revealed an 89% screening rate 30 days postimplementation and gradually increasing and stabilizing at approximately 97%. The overall percentage of patients screening positive for alcohol or drug use was similar to that of other ED-based studies (22%) but varied substantially by patient demographics. CONCLUSION High rates of screening can be achieved if properly integrated into a clinical settings existing patient care processes with well-planned information technology support.