Article

Innovation Adoption in Substance Abuse Treatment: Exposure, Trialability, and the Clinical Trials Network

Institute for Behavioral Research, University of Georgia, Athens, GA 30602-2401, USA.
Journal of Substance Abuse Treatment (Impact Factor: 3.14). 07/2007; 32(4):321-9. DOI: 10.1016/j.jsat.2006.05.021
Source: PubMed

ABSTRACT

Researchers and policymakers are increasingly focusing on factors that facilitate or impede the diffusion of evidence-based treatment techniques into routine clinical practice. One potentially fruitful avenue of research is the influence of involvement in research networks as a predictor of organizational innovation. The Clinical Trials Network (CTN) is examining a number of behavioral and pharmacological treatment techniques in controlled multisite studies. Using data from participating CTN treatment programs and large samples of programs outside the CTN, these analyses examine the influence of exposure to clinical trials on the subsequent adoption of buprenorphine and voucher-based motivational incentives. The analyses show that, controlling for a variety of organizational characteristics, direct exposure to buprenorphine clinical trials in the CTN significantly increased the odds of subsequent adoption. By contrast, the adoption of motivational incentives was entirely explained by organizational characteristics. The findings suggest that adoption of treatment innovations is a function of exposure, organizational resources, nature of innovations, and stage of the diffusion process.

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    • "One consequence of this organizational distance is that most SAT agencies are underresourced, have few slack resources to invest in technological improvements, rely on paraprofessional rather than professional staff to provide treatment, and commonly focus on helping clients initiate the twelve steps to the exclusion of pharmacotherapy and other evidence-based practices (D'Aunno 2006). At the other end of the spectrum, a minority of SAT programs are fiscally, technologically, and strategically sophisticated; affiliated with mainstream health care institutions and investigators (Ducharme et al. 2007); striving to implement quality improvement processes and evidence-based practices (Hoffman et al. 2011; Quanbeck et al. 2011); and likely positioning themselves in anticipation of health reform. Conceptual Approach We argue that a critical first step toward the integration of substance abuse treatment with primary care and other mainstream health care providers is the formal inclusion of SAT organizations in ACOs (Buck 2011). "
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    • "Larger addiction treatment centers were reported by some to be more likely to implement QI (Knudsen, Ducharme, & Roman, 2007; Knudsen, & Roman, 2004), while an analysis of programs participating in a national research network found a negative relationship between size and QI (Ducharme, Knudsen, Roman, & Johnson, 2007). Corporate structure (forprofit versus not-for-profit) also has inconsistent relationships with the use of QI (Ducharme et al., 2007; Knudsen et al., 2007; Knudsen & Roman, 2004). Roman and colleagues observed a strong need for leadership on implementation to counteract the tendency of clinics to discontinue evidence-based practices after adopting them (Roman et al., 2010). "
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    • "This difficulty is especially visible within the U.S. substance abuse treatment system. For example, Ducharme and colleagues found that exposure to training and positive feedback from peer organizations regarding CM did not persuade clinics to use incentives such as motivational vouchers (Ducharme et al. 2007). Instead, clinical structural factors such as revenue sources, accreditation, and type of clinical programming had a more pronounced negative influence on the use of CM. "

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