Early Adoption of Injectable Naltrexone for Alcohol-Use Disorders: Findings in the Private-Treatment Sector

Institute for Behavioral Research, 112 Barrow Hall, University of Georgia, Athens, Georgia 30602-2401, USA.
Journal of studies on alcohol and drugs (Impact Factor: 2.76). 05/2010; 71(3):460-6. DOI: 10.15288/jsad.2010.71.460
Source: PubMed


The U.S. substance-abuse treatment system has been slow to adopt medications for the treatment of alcohol-use disorders (AUDs). The objectives of this study are to (a) determine how the inherent characteristics of injectable naltrexone (i.e., relative advantage, complexity, trialability, observability, compatibility) shape organizational-level decisions to adopt the medication and (b) identify key predictors of adoption and barriers that impede adoption.
This study uses data from a nationally representative sample of 345 privately funded U.S. substance-abuse treatment programs to examine adoption (current use) of injectable naltrexone.
Sixteen percent of private treatment programs are early adopters of injectable naltrexone. Multivariate logistic regression models reveal that organizational size and percentage of patients paying with private insurance are significant predictors of adoption. The most salient predictor of adoption is innovation compatibility, measured by program use of other AUD pharmacotherapies. Barriers to adoption include cost, lack of access to prescribing physicians, and lack of knowledge about the medication. Injectable naltrexone, however, is addressing the patient compliance barrier, demonstrated by 70% of patients receiving at least 2 months of medication.
The adoption of AUD pharmacotherapies remains low, with only half of the sampled programs prescribing any AUD pharmacotherapies. Patterns of early adoption of injectable naltrexone are, however, promising. Results highlight innovation compatibility and relative advantage as explanations of organizational decisions to adopt injectable naltrexone. Future research will move beyond issues of adoption and provide a more detailed examination of the implementation process.

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Available from: Paul Michael Roman, Oct 01, 2015
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    • "Central to this uncertainty are shifting medical and legal ambiguities surrounding the treatment of SUDs. For example, medications that aid the recovery process, recently expanded in variety and effectiveness, potentially conflict with long-standing regimens of treatment based on 12-step principles, advocating combinations of self-help, social support and spirituality (Abraham & Roman, 2010). In addition, a substantial proportion of SUDs patients may be processed through the criminal justice system, and face being imprisoned or re-imprisoned for non-conformity to prescribed treatment (Nolan, 2002; Henderson & Taxman, 2009). "
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    ABSTRACT: To examine the relationships among general management systems, patient-focused quality management/continuous process improvement (TQM/CPI) processes, resource availability, and multiple dimensions of substance use disorder (SUD) treatment. Data are from a nationally representative sample of 221 SUD treatment centers through the National Treatment Center Study (NTCS). The design was a cross-sectional field study using latent variable structural equation models. The key variables are management practices, TQM/continuous quality improvement (CQI) practices, resource availability, and treatment center performance. Interviews and questionnaires provided data from treatment center administrative directors and clinical directors in 2007-2008. Patient-focused TQM/CQI practices fully mediated the relationship between internal management practices and performance. The effects of TQM/CQI on performance are significantly larger for treatment centers with higher levels of staff per patient. Internal management practices may create a setting that supports implementation of specific patient-focused practices and protocols inherent to TQM/CQI processes. However, the positive effects of internal management practices on treatment center performance occur through use of specific patient-focused TQM/CPI practices and have more impact when greater amounts of supporting resources are present.
    Health Services Research 11/2011; 47(3 Pt 1):1068-90. DOI:10.1111/j.1475-6773.2011.01352.x · 2.78 Impact Factor
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    • "Studies have found a positive relationship between size and innovation, presumably because larger organizations have more financial and human resources (Damanpour & Schneider, 2006). In studies of innovation adoption in SUD treatment, treatment center size as measured by the number of full-time equivalents (FTEs) has been positively associated with the adoption of buprenorphine (Knudsen, Ducharme, & Roman, 2006), integrated care for co-occurring disorders (Ducharme, Knudsen, Roman, 2006a), the adoption of injectable naltrexone for the treatment of alcohol use disorders (Abraham & Roman, 2010), and overall adoption of evidence-based practices (Friedmann, Taxman, & Henderson, 2007; Knudsen & Roman, 2004); but not with the adoption of disulfiram (Knudsen, Rpman, Ducharme, & Johnson, 2005). "
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    ABSTRACT: Extended-release naltrexone (XR-NTX; Vivitrol), developed to address poor adherence in addictive disorders, is approved for use in alcohol and opioid-dependence disorders. In alcohol-dependent adults with ≥ 4-day initial abstinence, XR-NTX increased initial and 6-month abstinence. An fMRI study found that XR-NTX attenuated the salience of alcohol visual and olfactory cues in the absence of alcohol, and post hoc analyses demonstrated efficacy even during high cue-exposure holiday periods. Safety and tolerability have generally been good, without adverse hepatic impact or intractable acute pain management. XR-NTX use appears feasible in primary care and public systems, and retrospective claims analyses have found cost savings and decreased intensive service utilization relative to oral agents. In opioid dependence, following detoxification, XR-NTX shows efficacy for maintaining abstinence, improving retention, decreasing craving, and preventing relapse. Trials are also exploring its use for the treatment of stimulant dependence. XR-NTX appears compatible with counseling and self-help attendance. While more research is needed, current findings suggest that a formulation of naltrexone that was sought beginning over three decades ago is fulfilling its promise as an extended-release pharmacotherapeutic.
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