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Substance Abuse Treatment Organizations as Mediators of Social Policy: Slowing the Adoption of a Congressionally Approved Medication

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Abstract

Most substance abuse treatment occurs in outpatient treatment centers, necessitating an understanding of what motivates organizations to adopt new treatment modalities. Tichy’s framework of organizations as being comprised of three intertwined internal systems (technical, cultural, and political) was used to explain treatment organizations’ slow adoption of buprenorphine, a new medication for opiate dependence. Primary data were collected from substance abuse treatment organizations in four of the ten metropolitan areas with the largest number of heroin users. Only about one fifth offered buprenorphine. All three internal systems were important determinants of buprenorphine adoption in our multivariate model. However, the cultural system, measured by attitude toward medications, was a necessary condition for adoption. Health policies designed to encourage adoption of evidence-based performance measures typically focus on the technical system of organizations. These findings suggest that such policies would be more effective if they incorporate an understanding of all three internal systems.

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Acknowledgments

This organizational analysis was one of studies conducted under a grant from NIH, NIDA R01DA014578. The NIDA project officers, Drs. Jerry Flanzer and Richard Denisco, have provided encouragement on understanding the impact of treatment organizations. Of course, we take full responsibility for the conduct of the study and interpretation of the findings. NIDA had no role in the conduct of the study, data collection, management, analysis, and interpretation of the data, or the preparation, review, or approval of the manuscript. A number of our colleagues contributed to the survey design, web-based collection of information, and creation of the analytical files. We wish to thank ElizabethTighe, Ph.D., Brandeis University, as well as Sayeda Haq and Alex Hoyt, Ph.D. candidates. Grant Ritter, Ph.D. provided assistance on the sampling frame, survey instrument, and variable construction. Wendy Colnon provided assistance throughout the study, and Sarita Bhalotra, M.D., Ph.D. made numerous contributions to the study. Finally, we would like to thank Jody Hoffer Gittell, Ph.D. for her substantive comments on an earlier draft. Tim Martin, Ph.D. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analyses.

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Authors and Affiliations

  1. Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA, 02454, USA

    Stanley S. Wallack PhD, Cindy Parks Thomas PhD, Timothy C. Martin PhD, Jon Chilingerian PhD & Sharon Reif PhD

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  1. Stanley S. Wallack PhD
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  2. Cindy Parks Thomas PhD
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Correspondence to Stanley S. Wallack PhD.

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Wallack, S.S., Thomas, C.P., Martin, T.C. et al. Substance Abuse Treatment Organizations as Mediators of Social Policy: Slowing the Adoption of a Congressionally Approved Medication. J Behav Health Serv Res 37, 64–78 (2010). https://doi.org/10.1007/s11414-008-9132-4

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