Academic journal article Journal of Health and Human Services Administration

Adopting Evidence-Based Medically Assisted Treatments in Substance Abuse Treatment Organizations: Roles of Leadership Socialization and Funding Streams

Academic journal article Journal of Health and Human Services Administration

Adopting Evidence-Based Medically Assisted Treatments in Substance Abuse Treatment Organizations: Roles of Leadership Socialization and Funding Streams

Article excerpt

INTRODUCTION

The treatment of substance use disorders (SUDs) has grown rapidly since the 1970s, now comprising a significant component of the U.S. health care industry with a gross expenditure on SUD treatment in 2006 estimated at over $20 billion (Mark, Levit, Vandivort-Warren, Coffey & Buck. 2007; Kimberly & McLellan, 2006). Together with the entire health care industry (Timmermans & Kolker, 2004), the sector dealing with the treatment of SUDs is under substantial pressure to adopt evidence-based practices. Among the innovative evidence based practices that can enhance outcomes of individuals' struggles with abuse of psychoactive substances is the use of several different pharmaceuticals or medication-assisted treatments (MAT). Yet, there are organizational leadership and ideological barriers to the incorporation of MAT in SUD treatment.

In this paper, we examine the effects of SUD treatment center directors' background and center funding sources on the organizational utilization of MAT in a nationally representative US sample of substance abuse treatment centers. We attempt to understand variation in the adoption of MAT across treatment centers in a treatment environment that has long been centered upon the value of behavioral interventions, abstinence, and particularly, 12-step approaches. We utilize the lens of formal educational socialization that influences professional identity (Hekman, Steensma, Bigley & Hereford, 2009), social capital (Lin, 2001), and resource dependence (Pfeffer & Salancik, 1978) to understand the extent to which they explain why some treatment centers adopt MAT while others do not. We focus on the relationship between the professional studies of treatment centers' executive directors, in terms of socialization dimensions, linking it to their organization's MAT adoption. We also examine the relationship between resource dependence through mixes of public and private benefit funding (Young, 2007) and MAT adoption.

Before presenting our hypotheses and reporting the results of our analyses, we describe the historical context of SUD treatment in which we outline "medicalized," rather than punitive and social tolerance responses to SUD; describe what might be considered a treatment paradigm of abstinence achieved through 12-step programs and behavioral therapies; and, compare SUD and general medical treatment, setting the stage for understanding the context for organizational adoption of MAT as an institutionally contested innovation.

SUBSTANCE ABUSE TREATMENT

Medicalization of SUD

During the 20th century, sociologists highlighted the medicalization of formerly deviant activity within American culture (Roman, 1980; Conrad & Schneider, 1980; Conrad & Leiter, 2004). Medicalization is one of three alternative societal reactions to problematic use of alcohol or other drugs. The second is generalized social tolerance and the absorption of the consequences of these behaviors into social functioning. This reaction prevailed throughout human history until the early 19th century. The third alternative is negative sanctions and punishment, found in modest degree in reactions to the disruptive and non-productive consequences associated with public drunkenness over recorded history. Beginning in the 19th century, these negative sanctions attracted major investment of social resources.

Drinking emerged as a social problem in the U.S. in the 1820s, and punishment first to excessive use and then to all use became the prime reaction (Clark, 1976). The U.S. eventually legislated nationwide prohibition, and this social attitude spilled over to other drug use that became prominent in the late 19th and early 20th centuries and persists today. Incomplete and ambivalent medicalization of illegal drug use is currently represented by sustained punitive attitudes and practices coupled with official policies advocating medicalization and treatment. …

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