Innovation adoption in substance abuse treatment: Exposure, trialability, and the Clinical Trials Network

Abstract

Researchers and policymakers are increasingly focusing on factors that facilitate or impede the diffusion of evidence-based treatment techniques into routine clinical practice. One potentially fruitful avenue of research is the influence of involvement in research networks as a predictor of organizational innovation. The Clinical Trials Network (CTN) is examining a number of behavioral and pharmacological treatment techniques in controlled multisite studies. Using data from participating CTN treatment programs and large samples of programs outside the CTN, these analyses examine the influence of exposure to clinical trials on the subsequent adoption of buprenorphine and voucher-based motivational incentives. The analyses show that, controlling for a variety of organizational characteristics, direct exposure to buprenorphine clinical trials in the CTN significantly increased the odds of subsequent adoption. By contrast, the adoption of motivational incentives was entirely explained by organizational characteristics. The findings suggest that adoption of treatment innovations is a function of exposure, organizational resources, nature of innovations, and stage of the diffusion process.

Treatment programs in the National Drug Abuse Treatment Clinical Trials Network

“…A comparison of the CTN and a nationally representative sample of drug abuse treatment units controlled for organizational variables and suggested that participation in the buprenorphine clinical trials was associated with increased adoption of buprenorphine (20% versus 11%) (Ducharme, et al, 2007). Participation in the CTN, however, did not enhance adoption of contingency management strategies (34% versus 31%).…”

“…Participation in the CTN, however, did not enhance adoption of contingency management strategies (34% versus 31%). The study also noted that CTN participants were less likely to operate as for-profit corporations (12% versus 18%), less likely to offer detoxification services (19% versus 29%), more likely to treat opiate dependent patients (42% with a primary opiate problem versus 16%), and more likely to report JCAHO or CARF accreditation (66% versus 48%) (Ducharme, et al, 2007). CTN and non-CTN programs did not differ on percent of revenues from public sources (about 50%), physicians on staff or contract (about 70%), and counselors with Master's degrees (45%).…”

“…Participating community treatment programs were selected to enhance the competitive applications and tend to be larger corporations that offer multiple levels of care and have an emphasis on treating drug problems. Nonetheless, the CTN is one of the more ambitious efforts to bridge the practice/research gap and to test the applicability of emerging drug abuse treatments in diverse patient populations using community treatment programs as study sites.A comparison of the CTN and a nationally representative sample of drug abuse treatment units controlled for organizational variables and suggested that participation in the buprenorphine clinical trials was associated with increased adoption of buprenorphine (20% versus 11%) (Ducharme, et al, 2007). Participation in the CTN, however, did not enhance adoption of contingency management strategies (34% versus 31%).…”

The Supply of Physicians Waivered to Prescribe Buprenorphine for Opioid Use Disorders in the United States: A State-Level Analysis

“…Considerable work has examined its diffusion in SUD treatment programs and OTPs (Brigham et al, 2007;Ducharme & Abraham, 2008;Ducharme et al, 2007;Friedmann et al, 2010;Gordon et al, 2007;Knudsen et al, 2006Knudsen et al, , 2009Koch et al, 2006;Kovas et al, 2007;Wallack et al, 2010). Several surveys of physicians have examined the nexus between attitudes and prescribing (Arfken et al, 2010;Kissin et al, 2006;Netherland et al, 2009;Reif et al, 2007;Thomas et al, 2008;WESTAT, 2006).…”

The Transition to Medication Adoption in Publicly Funded Substance Use Disorder Treatment Programs: Organizational Structure, Culture, and Resources

“…Studies on the availability of SUD pharmacotherapies in specialty treatment organizations have often focused on the diffusion of specifi c medications, such as buprenorphine, acamprosate, and naltrexone (Abraham et al, 2010Ducharme et al, 2006Ducharme et al, , 2007Friedmann et al, 2010;Koch et al, 2006;Roman, 2007, 2008;Roman et al, 2011;Savage et al, 2012;Thomas et al, 2003Thomas et al, , 2008. In addition, research has considered the organizational factors associated with the availability of any type of SUD medication Knudsen et al, 2010Knudsen et al, , 2011, in part because the adoption of at least one medication is correlated with offering other pharmacotherapies (Fuller et al, 2005).…”