Organizational Correlates of Medication-Assisted Treatment in Substance Abuse Treatment Facilities: Examining How Institutional Forces Shape Treatment

Methadone and buprenorphine/naloxone are the two recommended pharmacotherapies for the treatment of opioid dependence, having been demonstrated to be effective in numerous clinical trials. While methadone has been an approved treatment for opioid dependence for that past 50 years, buprenorphine/naloxone is a newer substance that was only approved for use in 2002. This mixed-methods study utilizes a comprehensive conceptual framework of neoinstitutional theory and institutional logics to explore possible factors that might predict adoption of medication-assisted treatment. First, in-depth qualitative interviews with managerial level staff at substance abuse treatment centers were conducted. The interviews were semi-structured and explored perceptions of treatment philosophy, the merging of substance abuse and mental health, managed care, services, funding, licensing and accreditation and personal and professional networks. Next, logistic regression models were used to explore possible predictors of medication-assisted treatment. The National Treatment Center Study (NTCS), a nationally representative survey of private substance abuse treatment facilities conducted between 2002-2004, was used in this study, allowing for the exploration of early adoption of buprenorphine/naloxone. Findings from the qualitative interviews suggested that the two medications are viewed differently and should therefore be explored separately. Findings from the logistic analysis of the NTCS supported this distinction. The proportion of clients with a primary diagnosis of opiate dependence or abuse was the only factor positively associated with both the early adoption of buprenorphine/naloxone and methadone provision. The program\u27s proportion of managed care funding was the only other significant predictor for early adoption of buprenorphine/naloxone. Accreditation by JACHO, proportion of clients who are women and past organizational participation in research, all positively predicted methadone provision, while the proportion of counselors with a master\u27s degree or higher negatively predicted it. The results indicate that coercive and normative institutional forces, as well as the institutional logics operating on organizations and the organizational networks they are embedded in, impact service provision and adoption of innovation. To promote adoption of pharmacotherapies into treatment, attention must be paid to the unique barriers and opportunities facing the adoption of each medication

Binge Drinking Among Young Adults in Israel: Application of the Theory of Planned Behavior

Binge drinking is common among young people, and is an area of concern in many countries worldwide. Israel has seen a steady increase in binge drinking behaviors in recent years among youth and young adults. Using the Theory of Planned Behavior (TPB) as a guiding theoretical framework, this study examines whether attitudes, subjective norms, perceived behavioral control and intention to engage in binge drinking are correlated with individual participation in binge drinking among young adults aged 18–35 in Israel. Participants (n = 213) completed a cross-sectional survey that included measures of the TPB and binge drinking. Correlations between the TPB variables were conducted and multiple and logistic regression models were calculated to predict binge drinking intention and behavior. Findings show that 38% of the sample reported engaging in binge drinking activities in the past 30 days, and that TPB variables significantly predicted both intent to engage in binge drinking and the behavior itself (explaining 68 and 45% of the variance, respectively). These findings enable us to better understand some of the motivations young people may have for engaging in binge drinking. Results and implications for future education and prevention efforts, research and policy are therefore discussed within a social context

Long-term residential substance abuse treatment for women: lessons learned from Israel

Maayan Schori1, Yaffa Sapir2, Eli Lawental31School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA; 2Central School for the Training of Social Welfare Workers, Ministry of Social Affairs and Social Services, Tel Aviv, Israel; 3Department of Social Work, Tel-Hai College, Upper Galilee, IsraelBackground: Policymakers and treatment providers must consider the role of gender when designing effective treatment programs for female substance abusers. This study had two aims. First, to examine female substance abusers' perceptions regarding factors that contribute to their retention (and therefore positive treatment outcomes) in a women-only therapeutic community in Northern Israel. Second, to explore pretreatment internal and external factors including demographic, personal and environmental factors, factors associated with substance use and with the treatment process, and networks of support that contribute to retention and abstinence.Methods: The study was a conducted using a mixed methods approach. Semi-structured qualitative interviews examining perceptions towards treatment were conducted in five focus groups (n = 5 per group; total n = 25). Intake assessments and a battery of questionnaires examining pretreatment internal and external factors related to treatment retention and abstinence were collected from 42 women who were treated in the program during the 2 year study period. Twenty-three women who completed the 12 month program were compared to the 19 women who did not, using chi-square for categorical variables and t-tests for continuous variables. Nineteen of the 23 women who completed the questionnaires also completed a post-treatment follow-up questionnaire.Results: A content analysis of the interviews revealed five central themes: factors associated with treatment entry; impact of treatment in a women-only setting; significant aspects of treatment; difficulties with the setting; prospects for the future. Analysis of the questionnaires revealed that compared to non-completers, completers had fewer psychiatric symptoms, higher levels of introverted behavior in stressful situations, a better sense of coherence, and less ability to share emotions. No significant differences were found with regard to demographic and substance use factors. All 19 women who completed treatment and the follow-up questionnaire remained abstinent from illicit drugs for 18 months following the end of treatment.Conclusion: Results indicate that women see the women-only treatment setting as extremely significant. Also, there is a profile of psychiatric co-morbidity, extrapunitiveness, and fewer personal resources that predict a risk for attrition. Thus, women at risk for attrition may be identified early and treatment staff can utilize the results to assist clients in achieving their treatment goals. Results can inform policymakers in making decisions regarding the allocation of resources, by pointing to the importance of long-term women-only residential treatment in increasing positive treatment outcomes.Keywords: gender, drug abuse, therapeutic community, mixed methods, program evaluatio

Serious Mental Illness among Young Adult Women who use Drugs in the Club Scene: Co-occurring Biopsychosocial Factors

Young women who regularly attend nightclubs are at risk for numerous health and social consequences, including mental distress, sexual and physical victimization and substance dependence. This paper uses a biopsychosocial framework to examine co-occurring mental health problems, victimization, substance dependence, sexual risk and physical pain among a sample of young women who use drugs (N = 222) in Miami’s club scene. The majority of women were under 24 years old, Hispanic, and identified as heterosexual. Almost all the women reported past 90-day use of alcohol, ecstasy/MDMA, marijuana, cocaine and prescription opioids and benzodiazepines; 32% of women reported being in a monogamous relationship while 41.9% reported having three or more sexual partners in the past 90 days; 65.3% met DSM-IV criteria for substance dependence; 60.4% met DSM-IV criteria for serious mental illness (SMI) and 59.9% were victimized as minors. Women who had SMI had higher odds of substance dependence, concurrent physical pain, three or more sexual partners in the past 90 days, childhood victimization and severe abuse-related trauma. The high levels of interconnected mental health, victimization, trauma, physical pain, substance dependence and sexual risk factors observed are underreported in the literature, as young women club scene participants appear to be more similar to other marginalized drug-involved populations than previously considered. While further research is needed, it appears these young women are in great need of outreach for primary health, mental health, HIV prevention, increased social support and substance abuse treatment services