Organizational Factors Associated with the Use of Evidenced-Based Practices in Outpatient Substance Abuse Treatment Progams

Background and Purpose: Since the 1999 publication of The Principles of Drug Abuse Treatment by the National Institute on Drug Abuse treatment providers have become aware of the need for implementing interventions with a strong evidence base. Researchers who have examined the factors that lead to the adoption of innovative treatment technologies have focused almost exclusively on the attitudes and behaviors of clinicians regarding innovative practices. Few studies have identified organizational characteristics that are associated with the adoption and use of treatment innovations in substance abuse practice.  In this study we examine the role of absorptive capacity as a predictor of treatment innovation in outpatient substance abuse treatment programs. Absorptive capacity is defined as the ability of an organization to access and effectively use information and is operationalized in this study with four indicators: (1) required continuing education for staff; (2) regular case review by a quality review committee; (3) periodic utilization review; and (4) the use of client satisfaction surveys. This research examines the relationship between measures of absorptive capacity and the utilization of evidence based practices in outpatient substance abuse treatment programs.

Methods: This study is a secondary analysis of the 2010 National Survey of Substance Abuse Treatment Services (N-SSATS) sponsored by the Substance Abuse and Mental Health Services Administration. The N-SATTS is an annual census of all known drug and alcohol abuse treatment facilities in the United States. In 2010 a total of 13,339 programs participated in the survey. This represents a response rate of 94%. For the purpose of the current study we selected only those programs that identified as providing outpatient services (n = 7,768).The specific hypothesis is controlling for size and ownership, organizations that have a greater degree of absorptive capacity will utilize a greater number of evidence based practices. The utilization of evidence based practices are the responses to the extent to which programs report using the following six manualized interventions:  motivational interviewing, the matrix model, community reinforcement, cognitive-behavioral therapy, rational emotive behavioral therapy, and relapse prevention. Programs that reported using the intervention “often” or “always” were scored 1 and all other responses were scored 0. Absorptive capacity is measured by four items: continuing education for staff, case reviews, utilization review and the use of client satisfaction surveys. The control variable ownership was a dummy variable (1= private not-for-profit; 0 = others). Size was the actual number of clients who received services in March of 2010. The hypothesis was tested by logistic regression analysis.

Results: Five of the six regression models were statistically significant at the .05 level. Findings showed that small, private not- for-profit programs that required continuing education of staff, that had periodic utilization reviews and who conducted client satisfaction surveys reported utilizing a greater number of evidenced based practices.

Conclusions: The findings support the thesis that organizational factors are strong correlates of service delivery in substance abuse treatment programs. It is important for social work researchers and practitioners to recognize the importance of organizational dynamics and their effects on practice.