Publications (15)20.25 Total impact
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Article: Facilitating Factors in Implementing Four Evidence-Based Practices: Reports from Addiction Treatment Staff.
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ABSTRACT: In this Robert Wood Johnson Foundation-funded study (2009-2011), treatment staff (n = 178) from 330 federally funded U.S. addiction treatment programs provided data through semistructured telephone interviews about factors that facilitated their implementation of four evidence-based practices (EBPs). Such studies can assist the addiction field in improving EBP implementation and ultimately, client care. Research questions: What factors were identified as facilitating implementation of the four EBPs? And, Do facilitating factors vary by EBP? Coders classified facilitating factors (n = 518) using a six-category schema. Results showed that although facilitating factors varied by EBP, organization-related factors dominated. Study implications and limitations are described.Substance Use & Misuse 06/2013; · 1.10 Impact Factor -
Article: Association between immigrant status and history of compulsory treatment in a national sample of individuals assessed for drug use disorders through the Swedish public welfare system.
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ABSTRACT: In-person interview data from 13,903 individuals assessed for a drug use disorder in the Swedish welfare system from 2002-2008, were analyzed using logistic regression methods. Second generation immigrants with non-Scandinavian parents were 41% more likely to report a history of compulsory treatment compared to those born in Sweden to Swedish parents after controlling for age, gender, education, mental health treatment homeless status history, and criminal justice history. Implications include the need to study acculturation, stigma, and discrimination-related factors as well as to promote culturally competent outreach to immigrant populations.Substance Use & Misuse 11/2011; 47(1):67-77. · 1.10 Impact Factor -
Article: Barriers to implementation of evidence-based addiction treatment: a national study.
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ABSTRACT: Prior studies have identified that working in an addiction treatment unit with higher levels of organizational capacity is a factor associated with positive staff attitudes about evidence-based addiction treatment practices (EBPs). The study presented here explored whether staff perceptions about the organizational capacity of their treatment unit are also associated with staff experience of barriers to implementing EBPs. Multivariate regression methods examined the relationship between the clinical staff (n = 510) and director (n = 296) perceptions of organizational capacity (Texas Christian University Organizational Readiness for Change [TCU ORC]-staff and TCU ORC-director) and level of barriers experienced when implementing a new EBP controlling for a range of treatment unit characteristics, staff characteristics, and type of EBP implemented. For both samples, reporting higher levels of stress in their organizations was significantly associated with reporting higher levels of barriers when implementing a new EBP. For clinical staff only, experiencing lower levels of program needs in their organization, working in a program that had been in existence for a shorter period, and implementing motivational interviewing techniques compared with other EBPs were all factors significantly associated with experiencing lower levels of barriers with EBP implementation.Journal of substance abuse treatment 10/2011; 42(3):231-8. · 2.90 Impact Factor -
Article: Attitudes toward evidence-based pharmacological treatments among community-based addiction treatment programs targeting vulnerable patient groups.
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ABSTRACT: A national sample of addiction treatment Program Directors (N = 296) were assessed regarding their attitudes about pharmacological treatment for addiction disorders. Multivariable analyses indicate that directors who worked in organizations affiliated with research institutions and who had more professional experience had significantly more positive attitudes about a range of pharmacological therapies. Also, directors in organizations serving higher percentage homeless clients and clients with severe and persistent mental illness had more negative attitudes toward use of buprenorphine. Community-based organizations providing addiction treatment to specific vulnerable client groups exhibit more negative attitudes about pharmacological evidence-based practices and may underutilize those practices.Journal of Addictive Diseases 10/2011; 30(4):323-33. · 1.46 Impact Factor -
Article: Addiction treatment provider attitudes on staff capacity and evidence-based clinical training: results from a national study.
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ABSTRACT: This national study of addiction-treatment organizations' implementation of evidence-based practices examines: (1) organizational/leadership factors associated with director (n = 212) attitudes regarding staff resistance to organizational change, and (2) organizational/staff factors associated with staff (n = 312) attitudes regarding evidence-based clinical training. Linear regression analyses, controlling for type of treatment unit, leadership/staff characteristics and organizational readiness to change, identified that directors who perceived their organization needed more guidance and had less staff cohesion and autonomy rated staff resistance to organizational change significantly higher. Staff with higher levels of education and greater agreement that their organization supported change had greater preference for evidence-based trainings. Federal addiction treatment policy should both promote education and training of treatment staff and organizational development of treatment CBOs.American Journal on Addictions 03/2011; 20(3):271-84. · 1.74 Impact Factor -
Article: Community-based addiction treatment staff attitudes about the usefulness of evidence-based addiction treatment and CBO organizational linkages to research institutions.
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ABSTRACT: This national study of community-based addiction-treatment organizations' (CBOs) implementation of evidence-based practices explored CBO Program Directors' (n=296) and clinical staff (n=518) attitudes about the usefulness of science-based addiction treatment. Through multivariable regression modeling, the study identified that identical factors were associated with directors, and staff attitudes about the usefulness of science-based addiction treatment. For both directors and staff working in an organization that was affiliated with a research institution, working in an organization with better internet technology (measured through TCU-ORC scores) and having higher levels of education were all significantly associated with having more positive attitudes regarding science-based addiction treatment. Implications: government policy that promotes the hiring of addiction treatment clinical staff with professional degrees and encourages the development of linkages between addiction treatment researchers and treatment staff may positively impact attitudes and use of evidence-based addiction treatment practices (EBPs) in CBOs.Evaluation and program planning 03/2011; 34(4):356-65. · 0.89 Impact Factor -
Article: Substance use, sexual identity, and health care provider use in men who have sex with men.
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ABSTRACT: This article describes the association between substance use, sexual identity, and seeing a health care provider on a regular basis for 257 men who have sex with men (MSM). Data from in-person interviews were gathered from MSM who resided in Massachusetts between 2003 and 2007. A logistic regression analysis that controlled for demographic characteristics, health insurance status, HIV/AIDS status, drug use, and social support revealed that MSM who identified as heterosexual, compared with those who identified as gay or bisexual, were 60% less likely to access a health care provider on a regular basis. Further, the likelihood of seeing a provider regularly was 54% lower for MSM who had used illegal drugs in the past 30 days and 32% higher for MSM who had more social support. Study limitations and implications are discussed.Substance Use & Misuse 01/2011; 46(4):452-9. · 1.10 Impact Factor -
Article: Modifications of evidence-based practices in community-based addiction treatment organizations: a qualitative research study.
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ABSTRACT: This qualitative research effort explored implementation of evidence-based practices (EBPs) in 100 community-based addiction treatment organizations (CBOs) nationwide. The study describes CBO program director attitudes on: (1) satisfaction with EBPs they were mandated to implement; (2) the extent to which their organization modified the EBPs; (3) reasons for modifications; and, (4) the standards they used for modifications. Findings indicate that program directors were highly positive both about EBPs implemented and the modifications made to those EBPs. A broad range of modifications were identified; most common were adding or deleting intervention sessions in efforts to serve the needs of a specific client population. Given the addiction treatment field's lack of standards for modifying EBPs, it is not surprising that little consistency occurred in modification efforts. As government funders of addiction treatments require that CBOs implement EBPs, standards need to be created for modifying and adapting the EBPs while maintaining their fidelity.Addictive behaviors 01/2011; 36(6):630-5. · 2.25 Impact Factor -
Article: High-frequency users of detoxification: who are they?
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ABSTRACT: Utilizing a longitudinal database (1996-2002) with all intake information from entries to all licensed drug treatment programs in Massachusetts (N = 27,801), this study examined factors associated with multiple detoxification admissions by injection drug users (IDUs). Four logistic regression models were developed. Although our hypothesis was that the highest frequency treatment users (in the 95th percentile) would be those in the detoxification-only group, this was incorrect: the highest frequency detoxification users were those most likely to use detoxification along with methadone maintenance, outpatient counseling, and/or residential treatment. Health insurance was a key factor. Study implications, limitations, and future research directions are noted.Substance Use & Misuse 02/2008; 43(7):839-49. · 1.10 Impact Factor -
Article: Examining drug treatment entry patterns among young injection drug users.
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ABSTRACT: Using a longitudinal state data base, 1996-2002, of all Injection Drug Users (IDU) (n = 37,227) admissions to all state-licensed drug treatment programs, this study examined differences in drug treatment entry patterns between younger IDUs (ages 18-25) compared to middle-age IDUs (ages 26-39) and older IDUs (over 40 years of age). Most of the younger IDUs were male, unemployed, and dependent on heroin. After controlling for factors known to affect type of drug treatment entered, younger IDUs were significantly more likely than their older counterparts to only use detoxification services and not enter additional treatment. Further, younger IDUs were significantly less likely to enter methadone maintenance and significantly more likely to enter residential treatment compared to older IDUs. Development of strategies to promote transition from detoxification to more comprehensive treatments and especially to methadone maintenance treatment is warranted.The American Journal of Drug and Alcohol Abuse 02/2007; 33(2):217-25. · 1.55 Impact Factor -
Article: Use of mental health and substance abuse treatment services by female injection drug users.
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ABSTRACT: This article examines whether female injection drug users (IDUs) who have a history of using mental health services (i.e., one or more psychiatric hospitalizations or counseling) enter types of drug treatment different from those of female IDUs who do not have a history of using mental health services. Data used for this exploration originate from a statewide drug-treatment database covering all women who entered drug treatment in the state of Massachusetts from 1996 to 2001. A total of 7776 women were included in the study. Through the use of logistic regression analysis, the study determined that those female IDUs who had a mental health service history, compared with female IDUs who had no such history, were about two-thirds more likely to enter substance abuse treatment other than detoxification only. Specifically, women with a mental health service history were about 66% more likely to enter substance abuse treatment modalities such as drug-free outpatient counseling, methadone maintenance, and/or long-term residential services rather than detoxification alone. This is a positive result, indicating that female IDUs who have mental health problems and therefore have high needs for effective substance abuse treatment are entering the more intensive and/or longer term modalities likely to lead to better outcomes. Possible factors accounting for this, including the referral process within detoxification centers, the role of community referral agents, and the experience women gain as a consequence of receiving services in more than one service system, are discussed.The American Journal of Drug and Alcohol Abuse 02/2004; 30(1):101-20. · 1.55 Impact Factor -
Article: Deciding to work less in a high-level profession: negotiating strategies and consequences of reduced-hours careers in medicine
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ABSTRACT: Based on forty interviews with physicians who chose to work a reduced-hours career track, this paper explores the perceived consequences of this career track on career progression and satisfaction. Our study suggests that for this population, a reduced-hours career path is a strategy developed primarily on the individual physician's initiative, informally negotiated with the organization, and dependent upon factors such as relationships with supervisors and peers. The physicians believed that the non-standard and informal ways in which these alternative career paths were created lead to a flexible working situation. However, they also acknowledged that reduced-hours careers also resulted in less career mobility. In contrast to other research on the relationship between lack of standardized, formal workplace policies and career stigmatization, these physicians did not describe a relationship between these two factors. Instead, participation in tasks and activities defined as normative to the profession was a key factor affecting career mobility.D_Research in the Sociology of Work 03/2001; 10:263-286. -
Article: African–American injection drug users: association between pre-treatment services and entry into and completion of detoxification
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ABSTRACT: Research suggests that African–American injection drug users, when compared with other ethnic and racial groups of injection drug users, are more likely to have no history of substance abuse treatment. The project evaluated was designed to attract African–American injection drug users to treatment by providing comprehensive pre-treatment services including street outreach, drop-in center services, case management, and motivational counseling. The overall program goal was to facilitate clients’ acceptance of referral to treatment and readiness to utilize treatment. The evaluation described here examines whether, for this African–American population of hard-core drug users, utilization of pre-treatment services improved the intermediary treatment outcomes of entry into and completion of detoxification. Findings showed that high utilization of drop-in center services increased the frequency of entrance into detoxification programs. Entrance into detoxification has been shown to be significantly correlated with (a) entrance into further treatment, (b) reduced HIV/AIDS risk, and (c) successful linkage with health care and social services. Contrary to expectations, high utilization of pre-treatment services was not significantly correlated to increased completion of detoxification.Evaluation and Program Planning. 02/1999; -
Article: Factors associated with emergency room use among injection drug users of African-American, Hispanic and White-European background.
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ABSTRACT: This study examined the relationship between substance abuse treatment use, health services use, HIV status, and emergency room/hospital use for 507 injection drug users (IDUs). Logistic regression models showed that mental health status, severity of drug use and private health insurance were significantly associated with having used emergency room/hospital services in the past six months. History of substance abuse treatment use, positive HIV/AIDS diagnosis, mental health service use, ethnic/racial background, gender, age, education and homelessness were not significant at either the bivariate or the multivariate level. These results point to the need to improve mental health screening and referrals through emergency room medical systems.American Journal on Addictions 14(3):268-80. · 1.74 Impact Factor -
Article: What factors are associated with high-frequency drug treatment use among a racially and ethnically diverse population of injection drug users?
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ABSTRACT: This study explored the frequency of drug treatment utilization by 36,081 injection drug users (IDUs) in Massachusetts, 1996-2002. A number of multiple and logistic regression analyses examined the relationship between demographic characteristics, parental status, level of and type of drug use, history of mental health treatment use, types of drug treatment entered, and the number of times an IDU had entered drug treatment for the seven-year time period. Homelessness, using heroin as the primary drug of choice, and health insurance status were all associated with number of treatments entered. Logistic regression analysis identified that health insurance was a key factor associated with more frequent treatment: those with private health insurance were ten times more likely to be in the 90th percentile (12-107 entries) with respect to number of treatment entries.American Journal on Addictions 15(6):440-9. · 1.74 Impact Factor
Top co-authors
Top Journals
Institutions
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1999–2004
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Boston University
- School of Social Work
Boston, MA, USA
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