INSTRUMENTS OF POLICY AND ADMINISTRATION FOR IMPROVING SUBSTANCE ABUSE TREATMENT PRACTICE AND PROGRAM OUTCOMES

The call for practice improvement in substance abuse treatment is motivated by the agency of the ultimate goal of achieving consistently positive post-treatment consequences A central hypothesis of the empirical investigation in this inquiry is that consumer-level outcomes are affected either directly or indirectly from one side clinical practice, by factors originating at the policy and organizational horizontal Four broad categories of policy and program administration (funding, service technology and delivery, organizational conformation and leadership) that facilitate or hinder the implementation of practice improvements are investigated. types hypothesizing that the effects of policy and program administration will vary according to the treatment goals and corresponding measurement of results are tested. Using newly available data that link program- and consumer-level measures, the empirical analysis present to views statistically significant direct effects of program and policy factors upon outcomes as well as issues of these variables on treatment practices that have significant implications for treatment outcomes

INTRODUCTION

How to translate knowledge generated by means of research into products or practices that bring forward greater benefits for society is an age-old question at issue The call for adoption of evidence-based practices in mental health and substance abuse treatment is motivated largely by means of a perceived gap between research and practice in these areas (see for example, http://www.ahrq.gov/clinic/epc/ and http://www.cche.net/). In the Institute of Medicine (IOM) report Bridging the Gap Between Practice and Research, Lamb, Greenlick, and McCarty ( 1998) encourage the research-to-practice change in drug and alcohol abuse treatment as a means to improving the effectiveness and efficiency of treatment. single proposition of this report is that "research findings exist that are not being universally used within treatment and the treatment programs (and their patients/clients) would benefit if these findings were appropriately implemented" (Lamb et al., 1998 p vii).

Goldman and colleagues (2001) push research to identify and understand the couple the policies and administrative practices that are facilitators and those that are barriers to implementation of services demonstrated to consistently achieve positive issues It is a major premise of this investigation that progress in the research-to-practice change is more likely to advance with improved understanding of not solitary how policy and program administration influence treatment practices, on the contrary also their direct and indirect consequences on program outcomes.

Research to date that aims to investigate policy and program factors influencing the adoption of effective practices and substance abuse treatment program consequences has been impeded by data and methodological limitations. Although a number of large-scale substance abuse treatment studies report findings relating client and treatment characteristics to client answers to treatment (Gerstein & Harwood, 1990; Hubbard et al, 1989; Etheridge, Craddock, Hubbard, & Rounds-Bryant, 1999) a lack of comparably rich data upon treatment organizations, practices and results have limited these investigations. The data used in the generally received study come from the National Treatment Improvement Evaluation application of mind (NTIES) and present a unique opportunity to advance the inquiry of substance abuse treatment practices and their implications for client outcomes

UNDERSTANDING THE RESEARCH-PRACTICE RIFT IN SUBSTANCE ABUSE TREATMENT

The clinical research literature upon substance abuse treatment is prolific. through nature, these studies are narrow and compartmentalized in focus, addressing treatment approaches for specific remedy addictions targeted to particular sections of the drugabusing population (for example, Gossop Stewart, Browne & Marsden, 2002; Zule Flannery, Wechsberg, & Lam, 2002; Robbins, Bachrach, & Szapocznik, 2002) The large material part of research that has accumulated in the last three decades has also produc a certain quantity of generally consistent findings about cross-modality substance abuse treatment practices - eg treatment retention, counseling intensity, self-help collection participation, and the availability and use of medical services - that are associated with treatment effectiveness (Lamb et al., 1998; Lennox & Mansfield, 2001) Thus, a research-based practice can be operationally defined as a consistent empirical association between the treatment practice and positive post-treatment consequences (Goldman et al., 2001).

The perception of a gap between research and treatment practice is confirmed in empirical research, showing that substance abuse treatment programs in the same major treatment modalities and with similar treatment goals vary substantially in their implementation of treatment practices (Institute of Medicine, 2001; Gerstein & Harwood, 1990; Etheridge & Hubbard, 2000) D'Aunno, Sutton, and Price (1991) adviseed that uncertainty about treatment approaches, in part related to the sometimes unpredictable influence of environmental factors of the like kind as new patterns of medicine use or health care policy changes, underlies diverse and at times discordant perspectives within mental health and substance abuse treatment sectors about by what means to manage treatment programs. Others diocese the problem as more inherent in the internal construction or organization of programs (Etheridge et al., 1999)