Substance abuse represents a significant underlying cause of the health issues faced in the United States, which severely impacts the nation's health care system and economy. Recently enacted parity legislation mandates that benefits for addiction and mental health treatment be provided on an equal footing with those for treatment for physical health. Diversion and abuse of prescription medications is growing in young people, with much of the diversion occurring between family and friends. Addiction has been accepted by mainstream medicine as a brain disease, and is associated with many other medical disorders. Early intervention and treatment for addiction provides extraordinary cost-benefit outcomes. Additional training for addiction professionals will be necessary. Stigmatization of substance abusers continues to exist at the state and federal levels, although research during the past 10 years indicates that patient compliance and relapse rates for substance abusers are not significantly different than those for individuals with other chronic diseases, e.g. diabetes, hypertension, and cardiac issues. While parity for addiction treatment has become policy at the federal level, great challenges lie ahead in funding access, facilities, and training, as well as redirecting societal perceptions and legislated penalties.
"Public funding is substantial but flows through multi-layered fragmented decision-making as each state and territory has substantial autonomy in allocating and controlling expenditure of Federal funding, including Medicaid. These decisions can be both fluid and unpredictable as they are variably impacted by politically-based legislative agendas (DeGrandpre, 2006; Smith et al., 2010), and high turnover in state level leadership. Uncertainty also stems from recent pressure from policy and funding agencies for re-engineering SUD treatment through implementing " evidence-based practices " (EBPs) (Lamb, Greenlick & McCarty, 1998; Miller, Sorensen, Selzer, & Brigham, 2006). "
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] ABSTRACT: The Affordable Care Act calls for integration of substance abuse treatment into medical care via medical homes and continuing specialty care. For this integration to occur in the substance abuse treatment field, substantial sharing and dissemination of information by treatment providers is required. This study explored the determinants of organizational activities directed at disseminating evidence-based practices (EBPs) undertaken by 193 community treatment programs who are members of the National Institute on Drug Abuse (NIDA) Clinical Trials Network. Using factor analysis, the research identified two generic categories reflecting different motivations for dissemination activities and explored both treatment center leadership and organizational characteristics as determinants of these different types of dissemination activities. Organizational characteristics predicting treatment center dissemination activities included size, previous involvement in research protocols, linkages with other providers, and having non-profit status. The treatment center leader's membership in professional organizations was also a significant determinant. Organization variables account for a larger portion of the variance in treatment center dissemination activities. The results suggest that the willingness of treatment providers to help disseminate EBPs within the industry may be heavily influenced through shared network connections with other treatment organizations.
The Journal of Behavioral Health Services & Research 04/2014; 41(4). DOI:10.1007/s11414-014-9405-z · 1.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Internal process improvements embedded within the Network for Improvement of Addiction Treatment (NIATx) program are promising innovations for improving substance use disorder (SUD) treatment performance, such as engagement and retention. To date, few studies have examined the variables that may increase diffusion and implementation of NIATx innovations. This study investigates organizational characteristics associated with SUD treatment center utilization of NIATx process improvements in a sample of 458 treatment programs. Overall, 19% had utilized NIATx process improvements. After statistically controlling environmental factors, five organizational variables were associated with the likelihood that treatment centers used NIATx processes. Organization size, administrative intensity, membership in a provider association, and participation in National Institute on Drug Abuse's Clinical Trials Network were positively associated with the odds of utilizing NIATx processes, while the association for the level of slack resources was negative. The findings suggest that policies and related supportive efforts may be required to facilitate diffusion and implementation of NIATx processes to affect SUD treatment center performance and capacity.
The Journal of Behavioral Health Services & Research 05/2015; DOI:10.1007/s11414-015-9466-7 · 1.37 Impact Factor
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