EDITORS' INTRODUCTION: SPECIAL ISSUE ON HEALTH SERVICES RESEARCH IN SUBSTANCE ABUSE

While a significant portion physic abuse research funding is directed toward the disclosure and testing of new pharmaceuticals and psychosocial treatment techniques, health services research has become increasingly important above the past 15 years. Broadly speaking, this stamp of research refers to studies that examine the organization, management, and financing of substance abuse treatment services and the impact that these factors have upon four inter-related issues: treatment access, take away from quality, and outcome. Health services research in substance abuse has become increasingly important given the wide range of changes facing the field including managed care, ever-tightening state rolls demands for greater credentialing of the clinical workforce, FDA approval of fresh medications, and increasing rates of cooccurring psychiatric and physical conditions. These changes have all had an impact upon the way treatment services are delivered. The field has evolv considerably above the past 10 to 15 years. Many treatment programs have been forced to shut up their doors. Others, who were better able to adapt, have diversified and now proffer a wider range of services to a abundant larger client base.

This special issue of the Journal of medicine Issues is devoted to substance abuse health services research. The 11 papers are the fruits of a special annual conversation on this topic. The talk was designed as a forum in which health services researchers, greatest in quantity of whom were funded through the National Institute on medicine Abuse, shared their work and ideas. It has been held annually since 1996 always meeting in a different location with different researchers serving as entertainers Though the number of discourse attendees has increased each year, it remains small and informal, with just above 70 attendees at the 2003 talk Despite being small, this conversation includes many of the country's leading researchers in the field of substance abuse health services.

The 8th annual discourse was held October 22-24, 2003 in Atlanta, and was cosponsored through the Center for Research upon Behavioral Health and Human Services Delivery at the University of Georgia and the Dupree body of Management at the Georgia Institute of Technology, which was the entertainer site for the event. The conversation theme centered on studies of organization and management of substance abuse treatment. More than 100 coauthors were exhibited in the 44 papers, [i]affiche[/i]s and plenary addresses presented during the two-day discourse Sessions focused on organizational form and process, innovation adoption, of recent origin approaches to treatment services and evaluation, patients' access to treatment and healthcare, and predictors of patient outcomes

This special issue of the Journal of medicine Issues contains 11 papers that are broadly representative of each of the conversation sessions. They provide insights into the ever-changing field of addiction treatment, including ongoing efforts to improve program quality, attract and retain patients, and bridge the "research-to-practice gap."

The issue begins with an essay upon applying a public health perspective to physic abuse research by Wilson Compton, director of the Division of Epidemiology, Services and Prevention Research at the National Institute upon Drug Abuse. The next three papers focus upon the implications of externally driven policies and practices upon the structure and quality of clinical practice in physic abuse treatment settings. Grella, Hser Teruya, and Evans examine feedback from programs participating in a statewide results monitoring system, identifying organizational and workforce characteristics associated with treatment programs' readiness to incorporate similar technologies into ongoing practice. Heinrich and Fournier continue this theme by dint of investigating the policy and program factors that affect the implementation of evidence-based practices and their implications for client results Next, Sindelar and Olmstead explore the impact of managed care upon the provision of outpatient substance abuse treatment services, with particular attention to differences in methadone and nonmethadone modalities.

The nearest three papers identify various structural factors related to organizations' adoption of treatment innovations. Guydish et al. address the challenges to innovation adoption, focusing specifically upon barriers to the subsequent adoption of treatment techniques experimented in clinical trials in which the programs themselves participated. Their findings highlight the difficulties inherent in incorporating evidence-based practices into real world treatment settings. Following upon this theme, Arfken, Agius, Dickson, Anderson, and Hegedus share findings related to clinician awareness of treatment techniques, looking specifically at programs' research affiliation as a lock opener predictor. Knudsen, Roman, Ducharme, and Johnson then identify organizational predictors related to program adoption of a specific treatment technology, disulfiram. Together, these papers highlight a number of organizational factors that may facilitate or impede the adoption of evidence-based practices in community treatment settings.