National Treatment Center Study Research Articles

Impact of research network participation on the adoption of buprenorphine for substance abuse treatment

There is a growing body of research supporting the use of buprenorphine and other medication assisted treatments (MATs) for the rapidly accelerating opioid epidemic in the United States. Despite numerous advantages of buprenorphine (accessible in primary care, no daily dosing required, minimal stigma), implementation has been slow. As the field progresses, there is a need to understand the impact of participation in practitioner–scientist research networks on acceptance and uptake of buprenorphine. This paper examines the impact of research network participation on counselor attitudes toward buprenorphine addressing both counselor-level characteristics and program-level variables using hierarchical linear modeling (HLM) to account for nesting of counselors within treatment programs. Using data from the National Treatment Center Study, this project compares privately funded treatment programs (N=345) versus programs affiliated with the National Institute on Drug Abuse Clinical Trials Network (CTN) (N=198). Models included 922 counselors in 172 CTN programs and 1203 counselors in 251 private programs. Results of two-level HLM logistic (Bernoulli) models revealed that counselors with higher levels of education, larger caseloads, more buprenorphine-specific training, and less preference for 12-step treatment models were more likely to perceive buprenorphine as acceptable and effective. Furthermore, buprenorphine was 50% more likely to be perceived as effective among counselors working in CTN-affiliated programs as compared to private programs. This study suggests that research network affiliation positively impacts counselors' acceptance and perceptions of buprenorphine. Thus, research network participation can be utilized as a means to promote positive attitudes toward the implementation of innovations including medication assisted treatment.

Management Systems, Patient Quality Improvement, Resource Availability, and Substance Abuse Treatment Quality

To examine the relationships among general management systems, patient-focused quality management/continuous process improvement (TQM/CPI) processes, resource availability, and multiple dimensions of substance use disorder (SUD) treatment. Data are from a nationally representative sample of 221 SUD treatment centers through the National Treatment Center Study (NTCS). The design was a cross-sectional field study using latent variable structural equation models. The key variables are management practices, TQM/continuous quality improvement (CQI) practices, resource availability, and treatment center performance. Interviews and questionnaires provided data from treatment center administrative directors and clinical directors in 2007-2008. Patient-focused TQM/CQI practices fully mediated the relationship between internal management practices and performance. The effects of TQM/CQI on performance are significantly larger for treatment centers with higher levels of staff per patient. Internal management practices may create a setting that supports implementation of specific patient-focused practices and protocols inherent to TQM/CQI processes. However, the positive effects of internal management practices on treatment center performance occur through use of specific patient-focused TQM/CPI practices and have more impact when greater amounts of supporting resources are present.

A multi-level analysis of counselor attitudes toward the use of buprenorphine in substance abuse treatment

Despite evidence that buprenorphine is effective and safe and offers greater access as compared with methadone, implementation for treatment of opiate dependence continues to be weak. Research indicates that legal and regulatory factors, state policies, and organizational and provider variables affect adoption of buprenorphine. This study uses hierarchical linear modeling to examine National Treatment Center Study data to identify counselor characteristics (attitudes, training, and beliefs) and organizational factors (accreditation, caseload, access to buprenorphine, and other evidence-based practices) that influence implementation of buprenorphine for treatment of opiate dependence. Analyses showed that provider training about buprenorphine, higher prevalence of opiate-dependent clients, and less treatment program emphasis on a 12-step model predicted greater counselor acceptance and perceived effectiveness of buprenorphine. Results also indicate that program use of buprenorphine for any treatment purpose (detoxification, maintenance, and/or pain management) and time (calendar year in data collection) was associated with increased diffusion of knowledge about buprenorphine among counselors and with more favorable counselor attitudes toward buprenorphine.

Substance Abuse Treatment for Older Adults in Private Centers

ABSTRACT By 2020, an estimated 4.4 million older adults will require substance abuse treatment compared to 1.7 million in 2000–01. This study examined the availability of special services for older adults, adoption of recommended treatment approaches, and organizational characteristics of centers that offer special services. Data were collected via face-to-face interviews with administrators and/or clinical directors from a nationally representative sample of 346 private treatment centers participating in the 2006–07 National Treatment Center Study. Results indicated that only 18% provided special services for older adults; age-specific recommendations were generally adopted; more older adult-specialty centers offered prescription drug addiction treatment, primary medical care, and housing assistance. The proportion of patients with Medicare payment predicted availability of special services. As more older adults will seek help with a myriad of substance use disorders (SUDs) over the next decade, treatment centers need to get ready for a plethora of challenges as well as unique opportunities for growth.

Assessment and Treatment of Co-occurring Eating Disorders in Publicly Funded Addiction Treatment Programs

Publicly funded addiction treatment programs were surveyed to increase understanding of treatment options for persons with co-occurring eating and substance use disorders. Data were collected between 2002 and 2004 from face-to-face interviews with program directors of a nationally representative sample of 351 addiction treatment programs. Half of the programs screen patients for eating disorders; 29% admit all persons with eating disorders, and 48% admit persons with eating disorders of low severity. Few programs attempt to treat eating disorders. Programs that admit and treat patients with eating disorders are more likely to emphasize a medical-psychiatric model of addiction, use psychiatric medications, admit patients with other psychiatric disorders, and have a lower caseload of African-American patients. Generally, patients with co-occurring eating and substance use disorders do not appear to receive structured assessment or treatment for eating disorders in addiction treatment programs. These results highlight the need for education of addiction treatment professionals in assessment of eating disorders.

Longitudinal Research That Can Inform Dynamic Models for the Treatment of Addiction as a Disease

Longitudinal Research That Can Inform Dynamic Models for the Treatment of Addiction as a Disease

A categorical typology of naltrexone-adopting private substance abuse treatment centers

This study used a diffusion of innovations theoretical framework [Rogers, E. M. 2003. Diffusion of innovations. 5th edition. New York: The Free Press] to identify organizational-level predictors of a categorical typology of substance abuse treatment centers based on naltrexone adoption. Data from the National Treatment Center Study ( N = 158) were used to examine the impact of socioeconomic status, organizational personality, and communication behavior on adopter categorization (i.e., innovators, early adopters, early majority, late majority, or laggards). Results from the ordered logistic regression model indicate that organizations that did not have onsite 12-step meetings and were familiar with treatment innovations were more likely to be in a more innovative category. Organizations that learned about innovations from professional development seminars and informal conversations with external treatment providers were more likely to be in a less innovative category. Identifying and targeting the early and late majority categories of adopting organizations for better training and community linkages could help reduce the research-to-practice gap.

Organizational-level predictors of adoption across time: naltrexone in private substance-use disorders treatment centers.

Prominent on the nation's research agenda on substance-use disorders treatment is the dissemination of effective pharmacotherapies. Thus, the purpose of this article is to use a "diffusion of innovations" theoretical framework to examine the organizationallevel predictors of the adoption of a pharmacotherapy, naltrexone (Revia), in private substance use-disorders treatment centers (N = 165). Data for these analyses were derived from the National Treatment Center Study, which contains four waves of data collected between 1994 and 2003. An event history model examined the impact of culture, leadership characteristics, internal structure, and external characteristics on the likelihood of adopting naltrexone between 1994 and 2003. The results suggest that organizations embracing a 12-step model and those employing more experienced administrators were significantly less likely to adopt naltrexone. Moreover, treatment centers that used prescription drugs, possessed an employee handbook, were accredited, and operated on a for-profit basis were significantly more likely to adopt naltrexone over time. Structural characteristics do affect the innovation adoption behaviors of private substanceuse disorders treatment centers. Organizational-level "research to practice" implications to further the adoption of innovative evidence-based treatments are discussed.

Why Are Recovering Substance Abuse Counselors Paid Less?

ABSTRACT The goal of this study is to determine why recovering substance abuse counselors are paid less, on average and controlling for other factors, than nonrecovering substance abuse counselors. The data come from the 2002-2003 wave of the National Treatment Center Study and consist of 1,487 full-time counselors from nationally representative samples of public and private substance abuse treatment programs in the United States. We use ordinary least squares regression models to estimate the differential impacts of numerous personal and program characteristics on the self-reported annual salaries of recovering and nonrecovering counselors. We found that differential returns to a college degree explain the vast majority of the difference in pay by counselor recovery status. Compared to nonrecovering counselors, recovering counselors receive, on average and controlling for other factors, $2,580 less per year for a college degree. Several possible explanations for this result are discussed, including the possibility that recovering counselors are willing to accept lower pay as a reflection of their “calling” to this work.

Racial and Ethnic Disparities in SSRI Availability in Substance Abuse Treatment

Racial and Ethnic Disparities in SSRI Availability in Substance Abuse Treatment

Racial and Ethnic Disparities in SSRI Availability in Substance Abuse Treatment

The high rate of co-occurrence of psychiatric and substance use disorders suggests that specialty substance abuse treatment facilities may be an important site for the delivery of psychotropic medications. However, the literature suggests there may be associations between the percentage of racial and ethnic minority clients and the availability of selective serotonin reuptake inhibitors (SSRIs) in these facilities. Survey data from the National Treatment Center Study, comprising nationally representative samples of 326 publicly funded and 339 privately funded substance abuse treatment centers, were used to measure the availability of SSRI medications from 2002 to 2004. Independent variables included the percentages of African-American and Hispanic clients, center type, organizational affiliation, region, size, accreditation status, presence of an integrated care program, and physician availability. SSRIs were available in 48% of the centers. Logistic regression analysis indicated that greater minority representation in centers' caseloads was negatively associated with the availability of SSRIs. The association between the percentage of African-American clients and SSRI availability was fully mediated by the addition of factors related to treatment inputs, such as the presence of a physician on staff or contract and the presence of an integrated care program. With organizational and treatment characteristics factored out, there was a negative association between the percentage of Hispanic clients and the availability of SSRIs. Although SSRIs were available in nearly half of these substance abuse treatment settings, racial and ethnic disparities exist in the availability of these medications.

What are the correlates of substance abuse treatment counselor salaries?

This article identifies and measures the key correlates of substance abuse treatment (SAT) counselor salaries. The data come from the 2002–2003 wave of the National Treatment Center Study that consists of approximately 1,500 full-time counselors from nationally representative samples of public and private SAT facilities. We used interval regression models to estimate the relationship between annual salary and numerous counselor and organizational characteristics. We found that counselor characteristics associated with annual salary include education, tenure in the SAT field, licensure, race, recovery status, and administrative responsibilities above and beyond duties as a full-time counselor. Organizational characteristics associated with counselor salary include accreditation status, hospital ownership, and the population density of the county where the facility is located. Taken together, these factors explain approximately 50% of the total variation in SAT counselor salaries.

Predominantly female caseloads: Identifying organizational correlates in private substance abuse treatment centers

This study used a national sample of private substance abuse treatment centers to identify the organizational attributes characterizing facilities with a predominantly female caseload. Data were drawn from the National Treatment Center Study, a nationally representative study of private-sector alcohol and drug abuse treatment centers (N = 365). Bivariate and multivariate analyses were conducted to explore which organizational characteristics are associated with higher percentages of women in treatment. Private substance abuse treatment facilities were more likely to have a predominantly female caseload if they (1) offered childcare programs, (2) had a higher percentage of families participating in treatment, (3) treated psychiatric disorders, (4) employed a greater percentage of counselors with at least a master's degree, (5) received a higher proportion of referrals from mental health sources and a lower proportion of referrals from workplace-based referral sources, and (6) accepted higher proportions of Medicare and/or Medicaid clients.

The availability of psychiatric programs in private substance abuse treatment centers, 1995 to 2001.

The high rate of co-occurrence of substance abuse and mental disorders renders the availability of psychiatric programs, or integrated service delivery, a vital quality-of-care issue for substance abuse clients. This article describes the availability of psychiatric programs and integrated care for clients with severe mental illness in the private substance abuse treatment sector and examines these patterns of service delivery by profit status and hospital status. S: Survey data from the National Treatment Center Study, which is based on a nationally representative sample of privately funded substance abuse treatment centers, were used to identify the proportion of centers that offered psychiatric programs in 1995-1996, 1997-1998, and 2000-2001. Centers reported whether they treated clients with severe mental illness on-site or referred them to external providers. Repeated-measures general linear models were used to test for significant changes over time and to assess mean differences in service availability by profit status and hospital status. About 59 percent of private centers offered a psychiatric program, and this proportion did not significantly change over time. The proportion of centers that referred clients with severe mental illness to external providers increased significantly from 57 percent to 67 percent. For-profit centers and hospital-based centers were significantly more likely to offer psychiatric programs and were less likely to refer severe cases to other providers. S: Although the importance of integrated care for clients with dual diagnoses is widely accepted, data from the private substance abuse treatment sector suggest that this pattern of service delivery is becoming less available.