Skip to main content

Organizational Correlates of Service Availability in Outpatient Substance Abuse Treatment Programs

Abstract

In pursuit of quality care for drug abuse treatment programs, researchers continue to monitor program characteristics related to service provision. The current study examines 115 outpatient drug-free programs in four U.S. regions and documents typical methods of offering an array of services and the relationship between program characteristics and services offered onsite and by referral. Core services (e.g., comprehensive assessments) are offered primarily onsite, whereas delivery methods of wraparound services are mixed with transitional services offered generally onsite and medical services traditionally offered offsite. Accredited programs offered more core services onsite, while those providing case management offered more core and wraparound services onsite. Programs with a higher proportion of dually diagnosed clients offered more core services onsite and fewer wraparound services by referral. Programs with a higher concentration of criminal justice-referred clients offered fewer core services onsite. These findings suggest ways of improving access to services.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    National Institute on Drug Abuse. Principles of drug addiction treatment: A research-based guide. Bethesda, MD: National Institutes of Health, 1999.

    Google Scholar 

  2. 2.

    Institute of Medicine. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press, 2001.

    Google Scholar 

  3. 3.

    McLellan AT. Have we evaluated addiction treatment correctly? Implications from a chronic care perspective. Addiction 2002; 97(3):249–252.

    PubMed  Article  Google Scholar 

  4. 4.

    McLellan AT, Hagan TA, Levine M, et al. Supplemental social services improve outcomes in public addiction treatment. Addiction 1998; 93(10):1489–1499.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    McLellan AT, Hagan TA, Levine M, et al. Does clinical case management improve outpatient addiction treatment. Drug and Alcohol Dependence 1999; 55(1,2):91–103.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Pringle JL, Edmondston LA, Holland CL, et al. The role of wrap around services in retention and outcome in substance abuse treatment: Findings from the Wrap Around Services Impact Study. Addictive Disorders & Their Treatment 2002; 1(4):109–118.

    Article  Google Scholar 

  7. 7.

    Ducharme LJ, Mello HL, Roman PM, et al. Service delivery in substance abuse treatment: Reexamining "Comprehensive Care". Journal of Behavioral Health Services & Research 2007; 34(2):121–136.

    Article  Google Scholar 

  8. 8.

    Alexander JA, Nahra TA, Lemak CH, et al. Tailored treatment in the outpatient substance abuse treatment sector: 1995-2005. Journal of Substance Abuse Treatment 2008; 34:282–292.

    PubMed  Article  Google Scholar 

  9. 9.

    Thompson J. Organizations in action. New York: McGraw-Hill, 1967.

    Google Scholar 

  10. 10.

    Friedmann PD, Lemon SC, Stein MD, et al. Linkage to medical services in the Drug Abuse Treatment Outcome Study. Medical Care 2001; 39(3):284–295.

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Substance Abuse and Mental Health Services Administration. The DASIS Report: Facilities offering outpatient care. Rockville, MD: Author, 2007.

    Google Scholar 

  12. 12.

    D'Aunno TA, Vaughn TE. An organizational analysis of service patterns in outpatient drug abuse treatment units. Journal of Substance Abuse 1995; 7(1):27–42.

    PubMed  Article  Google Scholar 

  13. 13.

    Etheridge RM, Craddock SG, Dunteman GH, et al. Treatment services in two national studies of community-based drug abuse treatment programs. Journal of Substance Abuse Treatment 1995; 7(1):9–26.

    Article  CAS  Google Scholar 

  14. 14.

    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.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Hoffman JA, Caudill BD, Koman JJ, et al. Comparative cocaine abuse treatment strategies: Enhancing client retention and treatment exposure. Journal of Addictive Diseases 1994; 13(4):115–128.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    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, 1997, pp. 311–351.

    Google Scholar 

  17. 17.

    Polinsky M, Hser Y, Anglin M, et al. Drug-user treatment programs in a large metropolitan area. Substance Use & Misuse 1998; 33:1735–1761.

    Article  CAS  Google Scholar 

  18. 18.

    Durkin EM. An organizational analysis of psychosocial and medical services in outpatient drug abuse treatment programs. Social Service Review 2002; 76:406–429.

    Article  Google Scholar 

  19. 19.

    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.

    PubMed  Article  Google Scholar 

  20. 20.

    Friedmann P, Saitz R, Samet JH, et al. Management of adults recovering from alcohol or other drug problems: Relapse prevention in primary care. Journal of the American Medical Association 1998; 279:1227–1231.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    McLellan AT, Grissom GR, Brill P, et al. Private substance abuse treatments: Are some programs more effective than others? Journal of Substance Abuse Treatment 1993; 10(3):243–254.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Price RH, Burke AC, D'Aunno TA, et al. Outpatient drug abuse treatment services, 1988: Results of a national survey. In Pickens RW, Leukefeld CG, Schuster CR (eds). Improving drug abuse treatment (NIDA Research Monograph 106, DHHS Publication No. 91-1754). Rockville, MD: National Institute on Drug Abuse, 1991, pp. 63–92.

    Google Scholar 

  23. 23.

    Rodgers JH, Barnett PG. Two separate tracks? A national multivariate analysis of differences between public and private substance abuse treatment programs. American Journal of Drug and Alcohol Abuse 2000; 26(3):429–442.

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Pfeffer J. The external control of organizations: A resource dependence perspective. New York: Harper & Row, 1978.

    Google Scholar 

  25. 25.

    Williamson O. Transaction-cost economics: The governance of contractual relations. Journal of Law & Economics 1979; 22:233–261.

    Article  Google Scholar 

  26. 26.

    D'Aunno TA, 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; 40:175–192.

    PubMed  Article  Google Scholar 

  27. 27.

    Nohria N, Gulati R. Is slack good or bad for innovation? Academy of Management Journal 1996; 39:1245–1264.

    Article  Google Scholar 

  28. 28.

    Tinney S, Oser CB, Johnson J, et al. Predominantly female caseloads: Identifying organizational correlates in private substance abuse treatment centers. The Journal of Behavioral Health Services & Research 2004; 31:403–417.

    Google Scholar 

  29. 29.

    D'Aunno TA. The role of organization and management in substance abuse treatment: Review and roadmap. Journal of Substance Abuse Treatment 2006; 31:221–233.

    PubMed  Article  Google Scholar 

  30. 30.

    Knight DK, Broome KM, Simpson DD, et al. Program structure and counselor–client contact in outpatient substance abuse treatment. Health Services Research 2008; 43(2):616–634.

    PubMed  Article  Google Scholar 

  31. 31.

    Broome KM, Flynn PM, Knight DK, et al. Program structure, staff perceptions, and client engagement in treatment. Journal of Substance Abuse Treatment 2007; 33(2):149–158.

    PubMed  Article  Google Scholar 

  32. 32.

    U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. National Survey of Substance Abuse Treatment Services (N-SSATS) 2004. Retrieved April 22, 2010 from http://www.dasis.samhsa.gov/qaire/nssats_2004_clean_q.pdf

  33. 33.

    Etheridge RM, Hubbard RL, Anderson J, et al. Treatment structure and program services in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors 1997; 11(4):244–260.

    Article  Google Scholar 

  34. 34.

    Rubin DB. Multiple imputations for nonresponse in surveys. New York: John Wiley & Sons, Inc., 1987.

    Book  Google Scholar 

  35. 35.

    McLellan AT, Arndt IO, Metzger DS, et al. The effects of psychosocial services in substance abuse treatment. Journal of the American Medical Association 1993; 269(15):1953–1959.

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Mojtabai R. Perceived benefits of substance abuse treatments. Psychiatric Services 2003; 54:780.

    PubMed  Article  Google Scholar 

  37. 37.

    Institute of Medicine. Bridging the gap. Washington, DC: National Academy Press, 1999.

    Google Scholar 

  38. 38.

    Friedmann PD, Alexander JA, Jin L, et al. On-site primary care and mental health services in outpatient drug abuse treatment units. Journal of Behavioral Health Services & Research 1999; 26:80–94.

    Article  CAS  Google Scholar 

  39. 39.

    Drake RE, Essock SM, Shaner A, et al. Implementing dual diagnosis services for clients with severe mental illness. Psychiatric Services 2001; 52:469–476.

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Steel L, Rechberger E. Meeting the treatment needs of multiply diagnosed consumers. Journal of Drug Issues 2002; 32:811–823.

    Google Scholar 

  41. 41.

    Watkins KE, Burnam MA, Kung F-Y, et al. A national survey of care for persons with co-occurring mental and substance use disorders. Psychiatric Services 2001; 52(8):1062–1068.

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Horgan CM, Reif S, Ritter GA, et al. Organizational and financial issues in the delivery of substance abuse treatment services. In: Galanter M (ed). Recent developments in alcoholism: Volume 15 Services research in the era of managed care. New York: Kluwer Academic/Plenum Publishers, 2001, pp. 9–29.

    Google Scholar 

  43. 43.

    Knight DK, Edwards JR, Flynn PM. Predictors of change in the provision of services within outpatient substance abuse treatment programs. Journal of Public Health Management and Practice 2010; 16(6):553–563.

    PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the Gulf Coast, Great Lakes, Northwest Frontier, and Southern Coast Addiction Technology Transfer Centers (ATTCs) for their assistance with recruitment and training. We would also like to thank the individual programs (program leadership) who participated in the assessments and training in the TCOM Project.

This work was funded by the National Institute on Drug Abuse (grant R01 DA014468). The interpretations and conclusions, however, do not necessarily represent the position of the NIDA, NIH, or Department of Health and Human Services. More information (including intervention manuals and data collection instruments that can be downloaded without charge) is available on the Internet at http://www.ibr.tcu.edu, and electronic mail can be sent to ibr@tcu.edu.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Jennifer R. Edwards PhD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Edwards, J.R., Knight, D.K. & Flynn, P.M. Organizational Correlates of Service Availability in Outpatient Substance Abuse Treatment Programs. J Behav Health Serv Res 38, 432–443 (2011). https://doi.org/10.1007/s11414-010-9231-x

Download citation

Keywords

  • Substance Abuse Treatment
  • Behavioral Health Service
  • Service Offering
  • Core Service
  • Outpatient Program