Leadership Approaches to Developing an Effective Drug Treatment System

Improving the effectiveness of the substance use disorder (SUD) treatment requires leadership approaches that have an impact on the effectiveness of drug treatment. To promote this positive system change, we define leadership beyond leaders’ characteristics. We consider leadership as a developmental competency among individuals, as well as the relational role of followers and the enabling context of organizational climate which together create a system of influence. Using this developing framework, we discuss how the foundations of certain leadership styles, like transformational leadership can be enacted by program leaders to improve the human and program resources necessary to deliver culturally responsive and evidence-based treatment for some of the most vulnerable groups struggling with SUDs. Building on their transformational and implementation competencies, program leaders can promote organizational climates and program and financial approaches to deliver effective care to some of the most vulnerable populations. We provide a case study to stimulate discussion on how leadership can trickle down to staff to improve care for vulnerable clients

Exploring Gender and Ethnoracial Differences and Trends in Methamphetamine Treatment

Introduction: Given the significant rise in methamphetamine use and related mortality in the United States, it is critical to explore differences in treatment trends with particular attention to women and ethnoracial groups in hard-hit areas like Los Angeles County. Methods: We analyzed a large sample across 4 waves: 2011 (105 programs, 10 895 clients), 2013 (104 programs, 17 865 clients), 2015 (96 programs, 16 584 clients), and 2017 (82 programs, 15 388 clients). We completed a comparative analysis to identify differences across subgroups and a trend analysis of treatment episodes by gender and ethnoracial group to differentiate users of methamphetamine and users of other drugs. Results: Treatment clients using methamphetamine increased over time for each gender and race. There were also significant differences across age groups. Women comprised a greater proportion of treatment episodes involving methamphetamine use (43.3%) compared to all other drugs combined (33.6%). Latinas represented 45.5% of methadone-related admissions. Compared with other drug users, methamphetamine users had a lower successful treatment completion rate and were served by programs with less financial and culturally responsive capacity. Conclusions: Findings highlight a sharp increase in treatment admissions for methamphetamine users of all gender and ethnocultural groups. Women, especially Latinas, saw the most significant increases, with a widening gender gap over time. All subgroups of methamphetamine users had a lower treatment completion rate compared with users of other drugs, and critical differences existed in the programs where they received services.</p

Cultural Competence as a Response to Structural Racism in Latino Substance Use and Access to Care in the United States

Disparities in substance use disorders (SUD) and access to treatment among individuals identified as Latino/Hispanic have become a significant public health issue in the United States. National efforts to identify, understand, and eliminate such disparities have highlighted the role of structural racism in Latino health. In this chapter, we offer a critical review of how Latino substance use and access to care may be impacted by discrimination, acculturation stress, and other mechanisms of structural racism. As structural racism is represented by policies, systems, structures, and norms that deny and/or minimize cultural strengths and disempower culturally diverse groups and their attempts to invest in their wellness, we highlight how cultural competence may reduce the risk of SUD and may enhance access to treatment among Latinos. We conclude by highlighting policies and responsive organizational practices that may improve Latino health

Parental Motivations to Discuss Unhealthy Eating and Marijuana Use with their Children

Objective: Adolescent engagement in health risk behaviors, such as unhealthy eating and marijuana use, remains a significant issue in the United States. Parents are an important component in preventing their children from engaging in behaviors that could harm their health and well-being. Parent motivations to have discussions about these behaviors with their child may be influenced by their parenting dynamics (i.e., attachment styles, parenting styles, and parent-child communication), and other cognitive factors (i.e., perceived risks, prototypes, self-efficacy, coherence, worry, intentions and willingness). Little is known about how these factors might influence parent decisions to discuss unhealthy eating and marijuana use with their children. Methods: In a series of three studies, parent motivations to discuss unhealthy eating and marijuana use with their child was explored. Guided by an adapted Prototype-Willingness Model (PWM), Study 1 tested the associations of parenting dynamics; specific risks and prototypes of unhealthy eating and marijuana use by one’s child; levels of self-efficacy, coherence in understanding behavioral risks, worry, discussion intentions and discussion willingness on parental discussions about unhealthy eating and marijuana use with their child (N = 208); Study 2 tested the relationship of messages framed according to authoritative, authoritarian, and permissive parenting styles on youth’s perceived effectiveness, perceived interpretability, motivations to discuss behavior, and discussion similarity in promoting discussion of unhealthy eating and marijuana use with a parent (N = 393); and Study 3, a longitudinal study with a national sample of parents, tested the effects of unhealthy eating and marijuana use discussion tools on parent discussions with their child about these behaviors one month later (N = 318). Results: In Study 1, the findings supported most of the hypothesized relationships delineated by the adapted PWM, suggesting the potential utility of parenting styles and cognitive factors (e.g., self-efficacy, intentions) in motivating parent discussions with their child about unhealthy eating and marijuana use. In Study 2, the authoritative parenting-framed message on talking with one’s parent about unhealthy eating and marijuana use was perceived by youth as the most effective in motivating discussions about these behaviors compared to the authoritarian and permissive parenting-framed messages. In Study 3, the findings partially supported the moderating effects of parenting styles on some of the relationships between discussion tools and other cognitive (e.g., self-efficacy, intentions) factors. Conclusions: The results of these studies provide new evidence about the relationship of parenting styles and the adapted PWM framework in motivating parental discussions of unhealthy eating and marijuana use with their children. However, there is a need for further investigation on how these newly developed discussion tools can motivate discussion of health risk behaviors with children. Subsequent research should be directed at a larger longitudinal study examining the effects of the authoritatively-framed discussion tools of unhealthy eating and marijuana use in promoting open discussion about these behaviors in families

Understanding the role of financial capacity in the delivery of opioid use disorder treatment

Opioid treatment programs must have adequate financial capacity to sustain operations and deliver a high standard of care for individuals suffering from opioid use disorder. However, there is limited consistency in the health services literature about the concept and relationship of organizational financial capacity and key outcome measures (wait time and retention). In this study, we explored five common measures of financial capacity that can be applied to opioid treatment programs: (a) reserve ratio, (b) equity ratio, (c) markup, (d) revenue growth, and (e) earned revenue. We used these measures to compare financial capacity among 135 opioid treatment programs across four data collection points: 2011 (66 programs), 2013 (77 programs), 2015 (75 programs), and 2017 (69 programs). We examined the relationship between financial capacity and wait time and retention. Findings from the literature review show inconsistencies in the definition and application of concepts associated with financial capacity across business and social service delivery fields. The analysis shows significant differences in components of financial capacity across years. We observed an increase in average earned revenue and markup in 2017 compared to prior years. The interaction between minorities and markup was significantly associated with higher likelihood of waiting (IRR = 1.077, p < .05). Earned revenue (IRR = 0.225, p < .05) was related to shorter wait time in treatment. The interaction between minorities and equity ratio is also significantly associated with retention (IRR = 0.796, p < .05). Our study offers a baseline view of the role of financial capacity in opioid treatment and suggests a framework to determine its effect on client-centered outcomes