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Top Manager Effects on Buprenorphine Adoption in Outpatient Substance Abuse Treatment Programs

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Abstract

To examine the influence of top managers’ characteristics on the adoption of buprenorphine for opioid dependence among U.S. outpatient substance abuse treatment units, this investigation analyzed a cross-sectional national study of 547 such units in the 2004–2005 wave of the Drug Abuse Treatment System Survey. Administrators reported their demographics, training, and treatment orientation, as well as features of the unit and its pattern of use of buprenorphine. Nationally, 15.8% of programs offered any buprenorphine services. Greater adoption of buprenorphine correlated with directors’ younger age, longer tenure, male gender, and weaker endorsement of abstinence as the most important treatment goal. Availability of naltrexone and medical services also correlated positively with buprenorphine adoption. The authors conclude that leaders’ characteristics are related to the adoption of innovative practices in addiction treatment programs. Future work should examine whether leadership development for community addiction programs might speed up the diffusion of buprenorphine and other innovative, evidence-based practices.

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References

  1. Kakko J, Gronbladh L, Svanborg KD, et al. A stepped care strategy using buprenorphine and methadone versus conventional methadone maintenance in heroin dependence: a randomized controlled trial. American Journal of Psychiatry. 2007;164(5):797–803. doi:10.1176/appi.ajp.164.5.797.

    Article  PubMed  Google Scholar 

  2. Kleber HD. Pharmacologic treatments for opioid dependence: detoxification and maintenance options. Dialogues in Clinical Neuroscience. 2007;9(4):455–470.

    PubMed  Google Scholar 

  3. Stein MD, Friedmann PD. Optimizing opioid detoxification: rearranging deck chairs on the Titanic. Journal of Addictive Diseases. 2007;26(2):1–2.

    Article  PubMed  Google Scholar 

  4. Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database of Systematic Reviews. 2002;(4):CD002209.

  5. Heinrich CJ, Lynn Jr LE. Improving the organization, management, and outcomes of substance abuse treatment programs. American Journal of Drug and Alcohol Abuse. 2002;28(4):601–622. doi:10.1081/ADA-120015871.

    Article  PubMed  Google Scholar 

  6. Roman PM, Johnson JA. Adoption and implementation of new technologies in substance abuse treatment. Journal of Substance Abuse Treatment. 2002;22(4):211–218. doi:10.1016/S0740-5472(02)00241-6.

    Article  PubMed  Google Scholar 

  7. Simpson DD. A conceptual framework for transferring research to practice. Journal of Substance Abuse Treatment. 2002;22(4):171–182. doi:10.1016/S0740-5472(02)00231-3.

    Article  PubMed  Google Scholar 

  8. Knudsen HK, Ducharme LJ, Roman PM. Early adoption of buprenorphine in substance abuse treatment centers: data from the private and public sectors. Journal of Substance Abuse Treatment. 2006;30(4):363–373. doi:10.1016/j.jsat.2006.03.013.

    Article  PubMed  Google Scholar 

  9. D’Aunno T. The role of organization and management in substance abuse treatment: review and roadmap. Journal of Substance Abuse Treatment. 2006;31(3):221–233. doi:10.1016/j.jsat.2006.06.016.

    Article  PubMed  Google Scholar 

  10. Ducharme LJ, Knudsen HK, Roman PM, et al. Innovation adoption in substance abuse treatment: exposure, trialability, and the Clinical Trials Network. Journal of Substance Abuse Treatment. 2007;32(4):321–329. doi:10.1016/j.jsat.2006.05.021.

    Article  PubMed  Google Scholar 

  11. Knudsen HK, Ducharme LJ, Roman PM. The adoption of medications in substance abuse treatment: associations with organizational characteristics and technology clusters. Drug and Alcohol Dependence. 2007;87(2–3):164–174. doi:10.1016/j.drugalcdep.2006.08.013.

    Article  PubMed  Google Scholar 

  12. Ducharme LJ, Knudsen HK, Roman PM. Trends in the adoption of medications for alcohol dependence. Journal of Clinical Psychopharmacology. 2006;26(Suppl 1):S13–S19. doi:10.1097/01.jcp.0000246209.18777.14.

    Article  PubMed  Google Scholar 

  13. Bradley EH, Schlesinger M, Webster TR, et al. Translating research into clinical practice: making change happen. Journal of the American Geriatric Society. 2004;52(11):1875–1882. doi:10.1111/j.1532-5415.2004.52510.x.

    Article  Google Scholar 

  14. Bradley EH, Webster TR, Baker D, et al. After adoption: sustaining the innovation. A case study of disseminating the hospital elder life program. Journal of the American Geriatric Society. 2005;53(9):1455–1461. doi:10.1111/j.1532-5415.2005.53451.x.

    Article  Google Scholar 

  15. Chagantim R, Sambharya S. Strategic orientation and characteristics of upper management. Strategic Management Journal. 1987;8:393–401. doi:10.1002/smj.4250080409.

    Article  Google Scholar 

  16. Miller D, Kets De Vries M, Toulouse J. Top executive’s locus of control and its relation to strategy making, structure and environment. Academy of Management Journal. 1982;25:237–253. doi:10.2307/255988.

    Article  Google Scholar 

  17. Hambrick DC, Mason PA. Upper echelons: the organization as a reflection of its top managers. Academy of Management Review. 1984;9:193–206. doi:10.2307/258434.

    Article  Google Scholar 

  18. Carroll G. Dynamics of publisher succession in newspaper organizations. Administrative Science Quarterly. 1984;59:93–113. doi:10.2307/2393082.

    Article  Google Scholar 

  19. Levinthal DA. Organizational adaptation, environmental selections and random walks. In: Singh JV, ed. Organizational Evolutions: New Directions. Newbury Park, CA: Sage; 1990:201–223.

    Google Scholar 

  20. Miller D, Droge C. The relative determinants of structures in small firms. Administrative Science Quarterly. 1986;31:539–560. doi:10.2307/2392963.

    Article  Google Scholar 

  21. Haveman H. Ghosts of managers past: managerial succession and organization mortality. Academy of Management Journal. 1993;36:864–881. doi:10.2307/256762.

    Article  Google Scholar 

  22. Mintzberg H. The Structuring of Organizations: A Synthesis of the Research. Englewood Cliffs, NJ: Prentice Hall; 1979.

    Google Scholar 

  23. Preisendoerfer P, Voss T. Organizational mortality of small firms: the effects of entrepreneurial age and human capital. Organizational Studies. 1990;11:107–129. doi:10.1177/017084069001100109.

    Article  Google Scholar 

  24. Kanter RM. Men and Women of the Corporation. New York: Basic Books; 1977.

    Google Scholar 

  25. Young GJ, Charns MP, Shortell SM. Top manager and network effects on the adoption of innovative management practices: a study of TQM in a public hospital system. Strategic Management Journal. 2001;22:935–951. doi:10.1002/smj.194.

    Article  Google Scholar 

  26. Bradley EH, Webster TR, Baker D, et al. Translating research into practice: speeding the adoption of innovative health care programs. Commonwealth Fund Issue Brief. 2004;724:1–12.

    Google Scholar 

  27. Bandura A. Personal and collective efficacy in human adaptation and change. In: Adair JG, Belanger D, Dion KL, eds. Advances in Psychological Science: Social, Personal and Cultural Aspects. Montreal: Psychology Press; 1996.

    Google Scholar 

  28. Wells R, Lemak CH, D’Aunno TA. Insights from a national survey into why substance abuse treatment units add prevention and outreach services. Substance Abuse Treatment, Prevention and Policy. 2006;1(1):21. doi:10.1186/1747-597X-1-21.

    Article  Google Scholar 

  29. Kraatz MA, Moore JH. Executive migration and institutional change. Academy of Management Journal. 2002;45:120–145. doi:10.2307/3069288.

    Article  Google Scholar 

  30. Kimberly JR, Evanisko MJ. Organizational innovation: the influence of individual, organizational and contextual factors on hospital adoption of technological and administrative innovations. Academy of Management Journal. 1981;24(4):689–713. doi:10.2307/256170.

    Article  CAS  PubMed  Google Scholar 

  31. Meyer AD, Goes JB. Organizational assimilation of innovations: a multilevel contextual analysis. Academy of Management Journal. 1988;31(4):897–923. doi:10.2307/256344.

    Article  Google Scholar 

  32. Arndt M, Bigelow B. The adoption of corporate restructuring by hospitals. Hospital and Health Services Administration. 1995;40(3):332–347.

    CAS  Google Scholar 

  33. Grimm CM, Smith KG. Management and organizational change: a note on the railroad industry. Strategic Management Journal. 1991;12:557–562. doi:10.1002/smj.4250120708.

    Article  Google Scholar 

  34. Boeker W. Strategic change: the influence of managerial characteristics and organizational growth. Academy of Management Journal. 1997;40:152–170. doi:10.2307/257024.

    Article  Google Scholar 

  35. D’Aunno T, Pollack HA. Changes in methadone treatment practices: results from a national panel study, 1988–2000. Journal of the American Medical Assocation. 2002;288(7):850–856. doi:10.1001/jama.288.7.850.

    Article  Google Scholar 

  36. Kerwin ME, Walker-Smith K, Kirby KC. Comparative analysis of state requirements for the training of substance abuse and mental health counselors. Journal of Substance Abuse Treatment. 2006;30(3):173–181. doi:10.1016/j.jsat.2005.11.004.

    Article  PubMed  Google Scholar 

  37. Carlson R, Karlsson K. Age, cohorts and the generation of generations. American Sociological Review. 1970;35:710–718. doi:10.2307/2093946.

    Article  Google Scholar 

  38. Damanpour F, Schneider M. Phases of the adoption of innovation in organizations: effects of environment, organization and top managers. British Journal of Management. 2006;17:215–236. doi:10.1111/j.1467-8551.2006.00498.x.

    Article  Google Scholar 

  39. Berger J, Zelditch M, eds. Status, Rewards, and Influence. How Expectations Organize Behavior. Washington, DC: Jossey-Bass; 1985.

  40. Moore KA, Peters RH, Hills HA, et al. Characteristics of opinion leaders in substance abuse treatment agencies. American Journal of Drug and Alcohol Abuse. 2004;30(1):187–203. doi:10.1081/ADA-120029873.

    Article  PubMed  Google Scholar 

  41. Goldman S, Kahnweiler WM. A collaborator profile for executives of nonprofit organizations. Nonprofit Management and Leadership. 2000;10(4):435–450. doi:10.1002/nml.10406.

    Article  Google Scholar 

  42. Friedmann PD, Lemon SC, Durkin EM, et al. Trends in comprehensive service availability in outpatient drug abuse treatment. Journal of Substance Abuse Treatment. 2003;24(1):81–88. doi:10.1016/S0740-5472(02)00323-9.

    Article  PubMed  Google Scholar 

  43. Damanpour F. Organizational innovation: a meta-analysis of effects of determinants and moderators. Academy of Management Journal. 1991;34:555–590. doi:10.2307/256406.

    Article  Google Scholar 

  44. Fiol CM. Squeezing harder doesn’t always work: continuing the search for consistency in innovation research. Academy of Management Review. 1996;21(4):1012–1021.

    Google Scholar 

  45. Friedmann PD, Alexander JA, D’Aunno TA. Organizational correlates of access to primary care and mental health services in drug abuse treatment units. Journal of Substance Abuse Treatment. 1999;16(1):71–80. doi:10.1016/S0740-5472(98)00018-X.

    Article  CAS  PubMed  Google Scholar 

  46. Fitzgerald L, Ferlie E, Wood M, Hawkins C. Interlocking interactions, the diffusion of innovations in health care. Human Relations. 2002;55:1429–1449. doi:10.1177/001872602128782213.

    Article  Google Scholar 

  47. McCaughrin WC, Price RH. Effective outpatient drug treatment organizations: program features and selection effects. International Journal of the Addictions. 1992;27:1335–1358.

    CAS  PubMed  Google Scholar 

  48. D’Aunno TA. Linking substance abuse treatment and primary health care. In: Egertson JA, Fox DM, Leshner AI, eds. Treating Drug Abusers Effectively. Malden, MA: Blackwell Publishers; 1997:311–351.

    Google Scholar 

  49. Thompson J. Organizations in Action. New York: McGraw-Hill; 1967.

    Google Scholar 

  50. Wells R, Lemak CH, D’Aunno TA. Organizational survival in the outpatient substance abuse treatment sector, 1988–2000. Medical Care Research and Review. 2005;62(6):697–719. doi:10.1177/1077558705281062.

    Article  PubMed  Google Scholar 

  51. Moch MK, Morse EV. Size, centralization and organizational adoption of innovations. American Sociological Review. 1977;42:716–725. doi:10.2307/2094861.

    Article  Google Scholar 

  52. D’Aunno T, Vaughn TE, McElroy P. An institutional analysis of HIV prevention efforts by the nation’s outpatient drug abuse treatment units. Journal of Health and Social Behavior. 1999;40(2):175–192. doi:10.2307/2676372.

    Article  PubMed  Google Scholar 

  53. Pollack HA, D’Aunno T, Lamar B. Outpatient substance abuse treatment and HIV prevention: an update. Journal of Substance Abuse Treatment. 2006;30(1):39–47. doi:10.1016/j.jsat.2005.09.002.

    Article  PubMed  Google Scholar 

  54. D’Aunno T, Vaughn TE. An organizational analysis of service patterns in outpatient drug abuse treatment units. Journal of Substance Abuse. 1995;7(1):27–42. doi:10.1016/0899-3289(95)90304-6.

    Article  PubMed  Google Scholar 

  55. Knudsen HK, Ducharme LJ, Roman PM, et al. Buprenorphine diffusion: the attitudes of substance abuse treatment counselors. Journal of Substance Abuse Treatment. 2005;29(2):95–106. doi:10.1016/j.jsat.2005.05.002.

    Article  PubMed  Google Scholar 

  56. Center for Substance Abuse Treatment. Changing the Conversation: Improving Substance Abuse Treatment: The National Treatment Plan Initiative. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 2000.

    Google Scholar 

  57. Camison-Zornoza C, Boronat-Navarro M, Segarra-Cipres M. A meta-analysis of organizational innovation: moderator effects and internal and market variables. In: Saee J, ed. Contemporary Corporate Strategy. London: Global Perspectives; 2007.

    Google Scholar 

  58. Ostroff C, Atwater LE, Feinberg BJ. Understanding self-other agreement: a look at rater and rates characteristics, context and outcomes. Personnel Psychology. 2004;57:333–375. doi:10.1111/j.1744-6570.2004.tb02494.x.

    Article  Google Scholar 

  59. Weil P, Kimball P. Gender and compensation in health care management. Health Care Management Review. 1996;21(3):19–33.

    CAS  PubMed  Google Scholar 

  60. Foundation of the American College of Healthcare Executives. A Comparison of Career Attainments of Men and Women Healthcare Executives. Findings of a National Survey of Health Care Executives. http://www.ache.org/PUBS/research/gender_study_full_report.pdf. 2006. Accessed 4 November 2008.

  61. Jaskyte K. Transformational leadership, organizational culture and innovativeness in nonprofit organizations. Nonprofit Management & Leadership. 2004;15:153–167. doi:10.1002/nml.59.

    Article  Google Scholar 

  62. Batten HL, Horgan CH, Prottas JM, et al. Drug Services Research Survey. Phase I Final Report: Non-Correctional Facilities. Waltham, MA: Brandeis University Institute for Health Policy; 1993.

    Google Scholar 

  63. Lawrence BS. The black box of organizational demography. Organization Science. 1997;8(1):1–22.

    Article  Google Scholar 

  64. Amass L, Ling W, Freese TE, et al. Bringing buprenorphine–naloxone detoxification to community treatment providers: the NIDA Clinical Trials Network field experience. American Journal of Addiction. 2004;13(Suppl 1):S42–S66. doi:10.1080/10550490490440807.

    Article  Google Scholar 

  65. D’Aunno TA, Sutton RI, Price RH. Isomorphism and external support in conflicting institutional environments: a study of drug abuse treatment units. Academy of Management Journal. 1991;34:636–661. doi:10.2307/256409.

    Article  PubMed  Google Scholar 

  66. D’Aunno TA, Alexander JA, Succi M. The role of institutional and market factors in divergent organizational change. Administrative Science Quarterly. 2000;45(4):679–703. doi:10.2307/2667016.

    Article  Google Scholar 

  67. Hasenfeld Y. Human Service Organizations. Englewood Cliffs, NJ: Prentice Hall; 1983.

    Google Scholar 

  68. Hoge MA, Morris JA, Daniels AS, et al. Report of recommendations: the Annapolis Coalition Conference on Behavioral Health Work Force Competencies. Administration and Policy in Mental Health. 2005;32(5–6):651–663. doi:10.1007/s10488-005-3267-x.

    PubMed  Google Scholar 

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Acknowledgments

Grant R01-DA32727 from the National Institute on Drug Abuse (NIDA) supported this research. Dr. Friedmann directs the Program to Integrate Psychosocial and Health Services, a Targeted Research Enhancement Program (TRP 04-179) supported by the Department of Veterans Affairs Health Services Research & Development Service at the Providence Veterans Affairs Medical Center (Rhode Island). The views expressed in this article are the authors’ and not necessarily those of the National Institute on Drug Abuse or Department of Veterans Affairs.

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Authors and Affiliations

  1. Center on Systems, Outcomes & Quality in Chronic Disease & Rehabilitation (SOQCR), Research Service, Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI, USA

    Peter D. Friedmann MD, MPH

  2. Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA

    Peter D. Friedmann MD, MPH

  3. Center on Systems, Outcomes & Quality in Chronic Disease & Rehabilitation, Research Service, Providence Veterans Affairs Medical Center, Providence, RI, USA

    Lan Jiang MS

  4. Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA

    Jeffrey A. Alexander PhD

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  1. Peter D. Friedmann MD, MPH
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Correspondence to Peter D. Friedmann MD, MPH.

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Friedmann, P.D., Jiang, L. & Alexander, J.A. Top Manager Effects on Buprenorphine Adoption in Outpatient Substance Abuse Treatment Programs. J Behav Health Serv Res 37, 322–337 (2010). https://doi.org/10.1007/s11414-009-9169-z

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