title: Substance abuse treatment organizations as mediators of social policy: slowing the adoption of a congressionally approved medication.
abstract: Most substance abuse treatment occurs in outpatient treatment centers, necessitating an understanding of what motivates organizations to adopt new treatment modalities. Tichy's framework of organizations as being comprised of three intertwined internal systems (technical, cultural, and political) was used to explain treatment organizations' slow adoption of buprenorphine, a new medication for opiate dependence. Primary data were collected from substance abuse treatment organizations in four of the ten metropolitan areas with the largest number of heroin users. Only about one fifth offered buprenorphine. All three internal systems were important determinants of buprenorphine adoption in our multivariate model. However, the cultural system, measured by attitude toward medications, was a necessary condition for adoption. Health policies designed to encourage adoption of evidence-based performance measures typically focus on the technical system of organizations. These findings suggest that such policies would be more effective if they incorporate an understanding of all three internal systems.
authors.affiliation: Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454, USA. wallack@brandeis.edu
authors.forename: Stanley S
authors.initials: SS
authors.lastname: Wallack
authors.forename: Cindy Parks
authors.initials: CP
authors.lastname: Thomas
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Martin
authors.forename: Jon
authors.initials: J
authors.lastname: Chilingerian
authors.forename: Sharon
authors.initials: S
authors.lastname: Reif
mesh_terms: D002047:Buprenorphine / Q000627:therapeutic use*; D003153:Community Health Services / Q000458:organization & administration; D004059:Diffusion of Innovation; D004363:Drug Utilization; D019317:Evidence-Based Medicine / Q000458:organization & administration; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017146:Models, Organizational; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000534:rehabilitation; D015279:Organizational Culture; D011057:Politics; D011640:Public Policy; D012044:Regression Analysis; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration*
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine