Naltrexone in private substance abuse treatment centers
Oser, Carrie Beth
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Prominent on the nation’s research agenda on drug abuse treatment is the development of effective behavioral and pharmacological treatment approaches. Likewise, there is concern about transferring this knowledge to practitioners to foster adoption within the service delivery system. This study addresses a facet of this mission using a diffusion of innovations theoretical framework outlined by Rogers (2003) to explore two objectives regarding the adoption of an innovative substance abuse treatment – naltrexone. First, using data from the National Treatment Center Study, a discrete time event history model examined the impact of culture, leadership characteristics, internal organizational structure, and external characteristics on the likelihood of adopting naltrexone across four points in time. Results suggested that organization’s embracing a 12-step model and those employing more experienced administrators were significantly less likely to adopt naltrexone. Moreover, treatment centers that utilized prescription drugs, possessed an employee handbook, were accredited, and operated on a forprofit basis were significantly more likely to adopt naltrexone over time. Second, a categorical typology of treatment centers that had adopted naltrexone was created based on Rogers’ (2003) adopter methodology. This typology includes the five adopter categories of innovators, early adopters, early majority, late majority, and laggards. I plotted the cumulative number of treatment centers adopting naltrexone over time, which resulted in a S-shaped curve, as well as diagramed the frequency distribution of the number of mean adopters per year, which approached a bell-shaped curve. Socioeconomic status, organizational personality, and communication behavior were used in an ordered logistic regression model to predict adopter categorization. The multivariate analysis revealed that organization’s hosting 12-step meetings on site were significantly less likely to be in a more innovative category, whereas facilities that were already familiar with innovative treatment techniques were significantly more likely to be in a more innovative category. Additionally, treatment centers that learned about innovations from participation in professional development seminars and from informal conversations with treatment providers employed at other centers were significantly more likely to be in a less innovative category. Organizational-level implications for community treatment providers to further the adoption of evidenced-based treatments such as naltrexone are discussed.