Substance Abuse Treatment Organizations as Mediators of Social Policy: Slowing the Adoption of a Congressionally Approved Medication |
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Authors: | Stanley S Wallack Cindy Parks Thomas Timothy C Martin Jon Chilingerian Sharon Reif |
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Institution: | (1) Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035 Waltham, MA 02454, USA |
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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. |
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