Paul M. Roman

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.

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.

Spirits and demons at work : alcohol and other drugs on the job

The National Council on Alcoholism estimates that alcoholism costs employers some

Effects of marital and co-worker relationships on negative affect: Testing the central role of marriage

10 billion a year in lost productivity. The figure can be taken with a grain of salt (or snifter of brandy) but nobody, least of all employers, questions the size of the problem. Drunkenness on the job contributes just a small part. Accidents, long lunch hours, absenteeism, irritability, sloppy work\p=m-\allfrequently have a common origin: fondness for the sauce. Perhaps employers have always known this, but only recently have any tried to correct the situation. Sci-

Adoption and implementation of medications in addiction treatment programs.

Abstract Many authors have noted the importance of the marital relationship for regulating mood. Marriage is asserted to be a primary source of both social support and interpersonal stress. In the current investigation, an index of salient social support irrespective of source and an index of salient interpersonal stress irrespective of source were found to be related to level of negative affective symptoms. As predicted, the marital relationship was found to be the most frequently named source of support, but co-workers were named equally often as a source of interpersonal stress. Marital satisfaction was found to be the most consequential interpersonal variable for predicting level of negative affect.

Subclinical depression and performance at work

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 relationship between subclinical depression and the fulfillment of important work roles is the focus of this study. The analysis controls for social processes (i.e., interpersonal stress) that may precede the development of depressive symptomatology and potential depressive distortion associated with selfreport of symptoms and performance. Using interview data collected from 265 community-dwelling adults, multiple regression analyses indicated that depressive symptomatology was significantly related to externally rated performance at work. This relationship was independent of other important social influences of interpersonal stress attributed to coworkers, spouses and others, and job stress related to dissatisfying work. Subclinical depression thus appeared related to decrements in job performance. Further, this effect was not entirely due to other social influences not measured in previous studies or to the problem of depressive mood affecting the direction of self-report measures.

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

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.

Social acceptance of psychiatric illness and psychiatric treatment

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.

The sick role, labelling theory, and the deviant drinker.

SummarySuccessful re-integration of former psychiatric patients into the community rests upon social acceptance of such persons. A set of empirical studies is widely interpreted as supporting a high degree of indigenous community rejection of the mentally ill. An examination of the conceptual structure underlying these studies indicates bias in favor of a rejection interpretation; the same data can be interpreted as reflecting a high degree of indigenous acceptance. Analysis of new evidence on social acceptance of the mentally ill within a community dominated by the presence of a state mental hospital indicates that social acceptance of the mentally ill is positively related to exposure to psychiatric processing systems. When differences in measurement within the research design are considered, it appears that exposure to inpatient treatment systems may also lead to greater community optimism about the effectiveness of such systems. The analyses support an incremental pattern of community acceptance of psychiatric patients with the accumulation of exposure over time.