Journal of Drug Issues

Johnson, J. Aaron; Ducharme, Lori J.; Knudsen, Hannah K.; Roman, Paul M.

doi: 10.1177/002204260503500301pmid: N/A

Compton, Wilson M.

doi: 10.1177/002204260503500302pmid: N/A

Applying a public health perspective to drug abuse research has far-reaching implications. First, the health of the entire community is of concern, not just the individual patient. Because of the social impact of drug abuse, these problems become the responsibility of all citizens to address. Second, the perspective requires treating drug abuse as a health issue, not as a criminal justice, moral, or social issue. Third, as in other branches of medicine, applying this perspective to drug abuse research will encourage development of the most effective ways to enhance drug abuse prevention and treatment interventions through cross-disciplinary approaches. The public health approach requires studies that (1) determine need for intervention; (2) provide clues about etiology; (3) determine effective approaches, systems, and financing strategies; and (4) measure the impact of interventions and services on the health of a population. Overall, attending to the public health implications of research will help to assure the maximum impact of scientific findings.

Grella, Christine E.; Hser, Yih-Ing; Teruya, Cheryl; Evans, Elizabeth

doi: 10.1177/002204260503500303pmid: N/A

This paper reports on the perspectives of substance abuse treatment providers and administrators who participated in a collaborative project to implement a statewide outcome monitoring system, the California Treatment Outcome Project (CalTOP). Program providers and county administrators were invited to discuss their perceptions regarding the relationship of research to treatment practice following completion of the project. Themes identified from this research-practice meeting were augmented by observations from program site visits and focus groups conducted with project participants during start-up. Participants articulated a range of actual and potential applications for using outcome data to improve treatment practice and to inform policy development, stressed several ways in which they could build upon the data-collection infrastructure developed for the project, and identified potential areas for continued program and staff development based on outcome findings. Future steps include identifying the organizational and workforce characteristics related to a program's readiness to incorporate research-based practices.

Heinrich, Carolyn J.; Fournier, Elizabeth

doi: 10.1177/002204260503500304pmid: N/A

The call for practice improvement in substance abuse treatment is motivated by the ultimate goal of achieving consistently positive post-treatment outcomes. A central hypothesis of the empirical investigation in this study is that consumer-level outcomes are affected either directly or indirectly through clinical practice, by factors originating at the policy and organizational level. Four broad categories of policy and program administration (funding, service technology and delivery, organizational structure, and leadership) that facilitate or hinder the implementation of practice improvements are investigated. Models hypothesizing that the effects of policy and program administration will vary according to the treatment goals and corresponding measurement of outcomes are tested. Using newly available data that link program- and consumer-level measures, the empirical analysis shows statistically significant direct effects of program and policy factors on outcomes as well as effects of these variables on treatment practices that have significant implications for treatment outcomes.

Sindelar, Jody L.; Olmstead, Todd A.

doi: 10.1177/002204260503500305pmid: 24062595

The number and type of services offered at substance abuse treatment (SAT) facilities are important aspects of the quality of care. Managed care (MC) is a growing presence in SAT and has been shown to affect the provision of treatment. We expand on earlier work and examine the impact of managed care on the number and type of services offered by methadone maintenance (MM) and drug-free (DF) outpatient treatment facilities. We use the econometric technique of instrumental variables to address the issue of endogeneity of MC and service offerings, thereby allowing a causal interpretation of results. Using data from the 2000 National Survey of Substance Abuse Treatment Services, we find that MC significantly increases the total number of services offered in MM outpatient facilities by four, yet decreases the number by two in DF outpatient facilities. We also show how the impact on specific services differs by modality and provide explanations for our findings.

Guydish, Joseph; Manser, Sarah Turcotte; Jessup, Martha; Tajima, Barbara; Sears, Clare; Montini, Theresa

doi: 10.1177/002204260503500306pmid: 20890376

The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) is intended to test promising drug abuse treatment models in multisite clinical trials and to support adoption of new interventions into clinical practice. Using qualitative research methods we asked the following question: how might the technology of multisite clinical trials be modified to better support adoption of tested interventions? A total of 42 participants, representing eight organizational levels ranging from clinic staff to clinical trial leaders, were interviewed about their role in the clinical trial, its interactions with clinics, and intervention adoption. Among eight clinics participating in the clinical trial, we found adoption of the tested intervention in one clinic only. Analysis of interview data revealed four conceptual themes likely to affect adoption and may be informative in future multisite clinical trials. Planning for adoption in the early stages of protocol development will better serve the aim of integrating new interventions into practice.

Arfken, Cynthia L.; Agius, Elizabeth; Dickson, Marcus W.; Anderson, Heidi L.; Hegedus, Andrea M.

doi: 10.1177/002204260503500307pmid: N/A

Clinicians' beliefs and awareness of treatment techniques may influence what innovations are perceived as needed and adoption of them. Clinicians at research-affiliated programs, however, may differ from clinicians at programs without research affiliation. We surveyed 162 clinicians at 15 substance abuse treatment programs (five research-affiliated programs and 10 matched nonresearch-affiliated programs) on addiction treatment belief items and awareness of Clinical Trials Network treatment innovations currently being tested. The research-affiliated clinicians had a higher percentage of clinicians with advanced degrees. In bivariate analyses, three differences in beliefs and four differences in awareness by research affiliation were found. Most of these differences disappeared during multivariate analyses. The results suggest that beliefs and awareness toward addiction treatment of research-affiliated clinicians, when controlling for demographic and professional characteristics, may be similar to those of other clinicians. This similarity should help in wider dissemination for those innovations found acceptable to clinicians at research-affiliated programs.

Knudsen, Hannah K.; Roman, Paul M.; Ducharme, Lori J.; Johnson, J. Aaron

doi: 10.1177/002204260503500308pmid: N/A

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 master's 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.

North, Carol S.; Pollio, David E.; Perron, Brian; Eyrich, Karin M.; Spitznagel, Edward L.

doi: 10.1177/002204260503500309pmid: N/A

This study aims to advance understanding of service provision to the homeless population through investigation of the effects of organizational characteristics. A longitudinal study of homelessness obtained structured psychiatric interview data from 400 participants and these individuals' service use and organizational data from 23 organizations over the next 12 months. Substance abuse service use was associated with organizational funding diversity, professionalism, and focus of services on substance abuse service provision. Other mental health service use was associated with small organizational size, professionalism, and simplicity of organizational funding diversity. Shelter service use was associated with complexity of services and small organizational size and inversely related to professionalism of staff. Results suggest relevance of organizational characteristics to understanding service access and use, controlling for individual need factors. Only by examining interactions among individual and organizational characteristics across sectors of care can the complexity of service provision to this multifaceted population be approached.

Magruder, Kathryn M.; Sonne, Susan C.; Brady, Kathleen T.; Quello, Susan; Martin, Renée Hebert

doi: 10.1177/002204260503500310pmid: N/A

Substance abuse treatment organizations are universally faced with the problem of co-occurring psychiatric disorders among the clients they serve. A first step is assessment of such comorbid conditions; however, the time constraints in front-line substance abuse treatment organizations make extensive clinical assessments almost impossible. The development and validation of a brief screening tool for psychiatric disorders in individuals with substance use disorders (SUDs) could have enormous implications for clinical practice. We assessed the performance characteristics of the Psychiatric Diagnostic Screening Questionnaire (PDSQ) and the Conners' Adult ADHD Rating Scale (CAARS) against the Structured Clinical Interview for DSM-IV (SCID-IV) in 120 patients admitted to SUD treatment. Patients were randomly assigned to receive either the SCID or PDSQ. In general, the PDSQ and CAARS performed well. There were no statistically significant performance differences by order of administration, gender, or drug use in past month. For the GAD subscale, Caucasian patients had higher levels of agreement than non-Caucasian patients.