Journal of Substance Abuse Treatment RSS feed: Current Issue. The Journal of Substance Abuse Treatment (JSAT) features original research, systematic reviews and reports on meta-analyses and, with editorial approval, special articles on the assessment and treatment of substance use and addictive disorders, including alcohol, illicit and prescription drugs, and nicotine. JSAT values high quality empirical research that is relevant for translation by treatment practitioners from all disciplines and across any setting where persons with substance use problems are encountered. The editors emphasize that JSAT articles should address assessment techniques and treatment approaches that have clear relevance for routine practice. Accordingly, the scope of JSAT includes health services research, including the design, organization, delivery mechanisms and workforce characteristics of treatments in routine settings. It is the policy of JSAT that treatment research for individuals with substance use disorders meet the same scientific evaluative standards as treatments for those with any other health-related condition or illness. Thus, research articles submitted for publication in JSAT are expected to achieve the same empirical standards of reliability, validity, and empiricism. Theoretical models, clinical experience, and case vignettes are recognized as important supplements to, but not as substitutes for, research-based evidence. It is recognized that research-based evidence may take many forms, such as randomized controlled trials; case-controlled field evaluations; or time series evaluations. In early stages of research development, qualitative study or small trials may be appropriate and necessary first steps. Regardless of the specific type of study, authors of research articles should aim to: (1) use one or more reasonable comparison or control conditions in the design and analysis of collected data, (2) use data collection methods and measures that have been previously validated in the subject population, and (3) analyze data (qualitative or quantitative) with the use of appropriate statistical methods. Authors must insure that the research as reported was conducted ethically, and that all protections to human subject participants were afforded. This insurance must be verified by the appropriate institutional review board or committee for the protection of human subjects. In addition, the editors of JSAT will not consider articles that use pejorative and stereotypical expressions when discussing individuals who suffer from substance use disorders. In drawing conclusions, authors are expected to use a parsimonious, cautious and conservative approach in the interpretation of findings. Hyperbole and overgeneralization beyond the data are considered irresponsible. http://www.journalofsubstanceabusetreatment.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Journal of Substance Abuse Treatment0740-5472422March 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.journalofsubstanceabusetreatment.com/article/PIIS0740547211002650/abstract?rss=yesEditorial Board10.1016/S0740-5472(11)00265-0Journal of Substance Abuse Treatment 42, 2 (2012)2012-03-01Journal of Substance Abuse Treatment2012-03-01422S0740-5472(11)X0009-0IFCIFChttp://www.journalofsubstanceabusetreatment.com/article/PIIS0740547211002686/abstract?rss=yesTable of Contents10.1016/S0740-5472(11)00268-6Journal of Substance Abuse Treatment 42, 2 (2012)2012-03-01Journal of Substance Abuse Treatment2012-03-01422S0740-5472(11)X0009-0iiiiiihttp://www.journalofsubstanceabusetreatment.com/article/PIIS0740547211002327/abstract?rss=yesAbstract: Substance abuse treatment programs represent complex human activity systems in which multiple actors, including clients, counselors, and managers, are nested. Furthermore, treatment programs are nested within the broader environmental context of resource allocation and regulatory enforcement. This special issue of the Journal of Substance Abuse Treatment presents 12 empirical papers that address organizational dynamics within specialty treatment programs. In this introduction to the special issue, the guest editors describe a conceptual framework of organizational dynamics, offer an overview of the articles within this issue, and discuss future prospects for research.Introduction to the special issue on organizational dynamics within substance abuse treatment: A complex human activity systemPatrick M. Flynn, Danica K. Knight, Mark D. Godley, Hannah K. Knudsen10.1016/j.jsat.2011.10.029Journal of Substance Abuse Treatment 42, 2 (2012)2011-12-09Journal of Substance Abuse Treatment2011-12-09422S0740-5472(11)X0009-0Special Issue: Organizational Dynamics Within Substance Abuse Treatment109115http://www.journalofsubstanceabusetreatment.com/article/PIIS0740547211002108/abstract?rss=yesAbstract: The Institute of Medicine noted that effective substance abuse treatment (SAT) programs integrate individual therapeutic approaches with transitional/ancillary services. In addition, research suggests that type of ownership impacts SAT services offered and that Medicaid plays a key role in SAT access. Data from the National Survey of Substance Abuse Treatment Services for the years 2000 and 2002–2006 were used to examine relationships among SAT program Medicaid acceptance, program ownership, and transitional/ancillary service accessibility. Multivariate logistic regression models controlling for state- and program-level contextual factors were used to analyze the data. Nonprofit SAT programs were significantly more likely to offer transitional/ancillary services than for-profit programs. However, programs that accepted Medicaid, regardless of ownership, were significantly more likely to offer most transitional/ancillary services. The data suggest that Medicaid may play a significant role in offering key transitional/ancillary services related to successful treatment outcome, regardless of program ownership type.Drug treatment program ownership, Medicaid acceptance, and service provisionDuane C. McBride, Jamie F. Chriqui, Yvonne M. Terry-McElrath, Mesfin S. Mulatu10.1016/j.jsat.2011.10.007Journal of Substance Abuse Treatment 42, 2 (2012)2011-12-07Journal of Substance Abuse Treatment2011-12-07422S0740-5472(11)X0009-0Special Issue: Organizational Dynamics Within Substance Abuse Treatment116124http://www.journalofsubstanceabusetreatment.com/article/PIIS0740547211002169/abstract?rss=yesAbstract: This study investigates how average costs for an episode of care in outpatient drug-free (ODF) treatment relate to clinical intensity (length of stay and weekly counseling hours) and program structure (e.g., size, staffing), controlling for prices paid and selected clientele measures. Based on cost assessments from a naturalistic sample of 67 programs located across the United States (using the Treatment Cost Analysis Tool), robust regression techniques showed that programs having 10% longer treatment stays had episode costs 7% higher; those having 10% more weekly counseling hours per client had 4% higher episode costs. Other important factors included wages, amount of counselors' time conducting sessions, and serving more clients referred from the criminal justice system. The study provides valuable information on treatment program features that relate to costs. Most importantly, cost differences associated with longer stays or more intensive counseling protocols appear modest and may be justified by improved client outcomes.Treatment program operations and costsKirk M. Broome, Danica K. Knight, George W. Joe, Patrick M. Flynn10.1016/j.jsat.2011.10.013Journal of Substance Abuse Treatment 42, 2 (2012)2011-12-07Journal of Substance Abuse Treatment2011-12-07422S0740-5472(11)X0009-0Special Issue: Organizational Dynamics Within Substance Abuse Treatment125133http://www.journalofsubstanceabusetreatment.com/article/PIIS0740547211002182/abstract?rss=yesAbstract: High staff turnover has been described as a problem for the substance use disorder treatment field. This assertion is based primarily on the assumption that staff turnover adversely impacts treatment delivery and effectiveness. This assumption, however, has not been empirically tested. In this study, we computed annualized rates of turnover for treatment staff (N = 249) participating in an evidence-based practice implementation initiative and examined the association between organizational-level rates of staff turnover and client-level outcomes. Annualized rates of staff turnover were 31% for clinicians and 19% for clinical supervisors. In addition, multilevel analyses did not reveal the expected relationship between staff turnover and poorer client-level outcomes. Rather, organizational-level rates of staff turnover were found to have a significant positive association with two measures of treatment effectiveness: less involvement in illegal activity and lower social risk. Possible explanations for these findings are discussed.Treatment staff turnover in organizations implementing evidence-based practices: Turnover rates and their association with client outcomesBryan R. Garner, Brooke D. Hunter, Kathryn C. Modisette, Pamela C. Ihnes, Susan H. Godley10.1016/j.jsat.2011.10.015Journal of Substance Abuse Treatment 42, 2 (2012)2011-12-07Journal of Substance Abuse Treatment2011-12-07422S0740-5472(11)X0009-0Special Issue: Organizational Dynamics Within Substance Abuse Treatment134142http://www.journalofsubstanceabusetreatment.com/article/PIIS0740547211002121/abstract?rss=yesAbstract: The purpose of this study was to examine the impact of staff turnover on perceptions of organizational demands and support among staff who remained employed in substance abuse treatment programs. The sample consisted of 353 clinical staff from 63 outpatient agencies. Two scales from the Survey of Organizational Functioning measured work environment demands (stress and inadequate staffing), and 3 measured supportive work relationships (communication, cohesion, and peer collaboration). Results from a series of multilevel models documented that counselors working in programs that had previously experienced high staff turnover perceived higher demands and lower support within their organization, even after controlling for other potentially burdensome factors such as budget, census, and individual measures of workload. Two individual-level variables, caseload and tenure, were important determinants of work environment demands but were not related to supportive work relationships. Findings suggest that staff turnover increases workplace demands, decreases perceptions of support, and underscores the need to reduce stress and minimize subsequent turnover among clinical staff.Organizational consequences of staff turnover in outpatient substance abuse treatment programsDanica K. Knight, Jennifer E. Becan, Patrick M. Flynn10.1016/j.jsat.2011.10.009Journal of Substance Abuse Treatment 42, 2 (2012)2011-12-07Journal of Substance Abuse Treatment2011-12-07422S0740-5472(11)X0009-0Special Issue: Organizational Dynamics Within Substance Abuse Treatment143150http://www.journalofsubstanceabusetreatment.com/article/PIIS074054721100211X/abstract?rss=yesAbstract: Using data from a nationwide study, we annually track a cohort of 598 substance use disorder counselors over a four-wave period to (a) document the cumulative rates of voluntary turnover and (b) examine how counselor perceptions of the organizational environment (procedural justice, distributive justice, perceived organizational support, and job satisfaction) and clinical supervisor leadership effectiveness (relationship quality, in-role performance, extra-role performance) predict voluntary turnover over time. Survey data were collected from counselors in Year 1, and actual turnover data were collected from organizational records in Years 2, 3, and 4. Findings reveal that 25% of the original counselors turned over by Year 2, 39% by Year 3, and 47% by Year 4. Counselors with more favorable perceptions of the organizational environment are between 13.8% and 22.8% less likely to turn over than those with less favorable perceptions. None of the leadership effectiveness variables are significant.The relationship between perceptions of organizational functioning and voluntary counselor turnover: a four-wave longitudinal studyLillian T. Eby, Tanja C. Rothrauff-Laschober10.1016/j.jsat.2011.10.008Journal of Substance Abuse Treatment 42, 2 (2012)2011-11-24Journal of Substance Abuse Treatment2011-11-24422S0740-5472(11)X0009-0Special Issue: Organizational Dynamics Within Substance Abuse Treatment151158http://www.journalofsubstanceabusetreatment.com/article/PIIS0740547211002224/abstract?rss=yesAbstract: Although evidence suggests that turnover rates are higher in high-stress/high-needs work environments, it is unclear whether agencies' attempts at improving practices influence individuals' decisions to stay at or leave a job. The purpose of this study was to examine whether program needs and change orientation influence individual decisions to quit. A sample of 206 counselors from 25 outpatient substance abuse treatment programs completed the Survey of Organizational Functioning, rating the organization on program needs, leadership, and change. They also rated themselves on stress, burnout, and job satisfaction. Multilevel modeling indicated a significant interaction between program needs and change orientation, even after controlling for stress, burnout, job satisfaction, tenure, and selected program characteristics. When perceptions of program needs were high, counselors were more likely to stay if they felt that the organization was making progress toward change. These findings suggest that an orientation toward change can counteract negative effects of perceived need within the workplace.Program needs and change orientation: Implications for counselor turnoverDanica K. Knight, Brittany Landrum, Jennifer E. Becan, Patrick M. Flynn10.1016/j.jsat.2011.10.019Journal of Substance Abuse Treatment 42, 2 (2012)2011-12-07Journal of Substance Abuse Treatment2011-12-07422S0740-5472(11)X0009-0Special Issue: Organizational Dynamics Within Substance Abuse Treatment159168http://www.journalofsubstanceabusetreatment.com/article/PIIS0740547211002212/abstract?rss=yesAbstract: The exposure to new clinical interventions through formalized training and the utilization of strategies learned through training are two critical components of the program change process. This study considers the combined influence of actual program fiscal resources and counselors' perceptions of workplace resources on two mechanisms of training: exposure and utilization. Data were collected from 323 counselors nested within 59 programs located in nine states. Multilevel analysis revealed that training exposure and training utilization represent two distinct constructs that are important at different stages in the Program Change Model. Training exposure is associated primarily with physical and financial resources, whereas utilization is associated with professional community and job burnout. These results suggest that financial resources are important in initial exposure to new interventions but that successful utilization of new techniques depends in part on the degree of burnout and collaboration experienced by counselors.Resources and training in outpatient substance abuse treatment facilitiesWayne E.K. Lehman, Jennifer E. Becan, George W. Joe, Danica K. Knight, Patrick M. Flynn10.1016/j.jsat.2011.10.018Journal of Substance Abuse Treatment 42, 2 (2012)2011-12-07Journal of Substance Abuse Treatment2011-12-07422S0740-5472(11)X0009-0Special Issue: Organizational Dynamics Within Substance Abuse Treatment169178http://www.journalofsubstanceabusetreatment.com/article/PIIS0740547211002170/abstract?rss=yesAbstract: One of the unique contributions of this study is a glimpse into the process by which counselors decide to try new innovations in their clinical work. Data were collected from 421 counseling staff from 71 outpatient treatment programs in 4 U.S. regions. Using hierarchical linear modeling, results reveal that the propensity to adopt workshop-based interventions is facilitated by two important mechanisms: (a) an innovative organization with creative leadership and (b) change-oriented staff attributes (i.e., seeking professional growth, efficacy, adaptability, and influence on others). Innovative leaders and a climate receptive to change also bolster the development of these change-oriented attributes. One implication of these findings is the cascading effect of leaders' support of innovative thinking and action resulting in employees strengthening their own adaptive skills and carrying this innovative thinking into individual adoption.Innovation adoption as facilitated by a change-oriented workplaceJennifer E. Becan, Danica K. Knight, Patrick M. Flynn10.1016/j.jsat.2011.10.014Journal of Substance Abuse Treatment 42, 2 (2012)2011-12-07Journal of Substance Abuse Treatment2011-12-07422S0740-5472(11)X0009-0Special Issue: Organizational Dynamics Within Substance Abuse Treatment179190http://www.journalofsubstanceabusetreatment.com/article/PIIS0740547211002194/abstract?rss=yesAbstract: Within the context of an initiative to implement evidence-based practices (EBPs) for adolescents with substance use disorders, this study examined the extent to which staff factors measured at an initial EBP training workshop were predictive of EBP competence and turnover status of staff (N = 121) measured 6, 9, and 12 months posttraining. By the final assessment point, 52.3% of staff transitioned to the employed/EBP-competent category, 26.6% transitioned to the not employed/not EBP-competent category, 4.6% transitioned to the not employed/EBP-competent category, and 16.5% had not transitioned out of the initial category. Multilevel multinomial regression analysis identified several measures that were significant predictors of staff transitions to the not employed/not EBP-competent category (e.g., program needs, job satisfaction, burnout) and transitions to the employed/EBP-competent category (e.g., months in position, pressures for change, influence). Findings have implications for the development and testing of strategies to train and retain staff to deliver EBPs in practice settings.Training and retaining staff to competently deliver an evidence-based practice: The role of staff attributes and perceptions of organizational functioningBryan R. Garner, Brooke D. Hunter, Susan H. Godley, Mark D. Godley10.1016/j.jsat.2011.10.016Journal of Substance Abuse Treatment 42, 2 (2012)2011-11-23Journal of Substance Abuse Treatment2011-11-23422S0740-5472(11)X0009-0Special Issue: Organizational Dynamics Within Substance Abuse Treatment191200http://www.journalofsubstanceabusetreatment.com/article/PIIS0740547211002200/abstract?rss=yesAbstract: The purpose of this study was to evaluate the impact of an assessment training and certification program on the quality of data collected from clients entering substance abuse treatment. Data were obtained from 15,858 adult and adolescent clients entering 122 treatment sites across the United States using the Global Appraisal of Individual Needs–Initial (GAIN-I). GAIN Administration and Fidelity Index (GAFI) scores were predicted from interviewer certification status, interviewer experience, and their interactions. We controlled for client characteristics expected to lengthen or otherwise complicate interviews. Initial bivariate analyses revealed effects for certification status and experience. A significant interaction between certification and experience indicates interviewers attaining certification and having more experience far outperformed certified interviewers with low experience. Although some client characteristics negatively impacted fidelity, interviewer certification and experience remained salient predictors of fidelity in the multivariate model. The results are discussed with regard to the importance of ongoing monitoring of interviewer skill.Impact of a training and certification program on the quality of interviewer-collected self-report assessment dataJanet C. Titus, Douglas C. Smith, Michael L. Dennis, Melissa Ives, Laine Twanow, Michelle K. White10.1016/j.jsat.2011.10.017Journal of Substance Abuse Treatment 42, 2 (2012)2011-12-05Journal of Substance Abuse Treatment2011-12-05422S0740-5472(11)X0009-0Special Issue: Organizational Dynamics Within Substance Abuse Treatment201212http://www.journalofsubstanceabusetreatment.com/article/PIIS0740547211002157/abstract?rss=yesAbstract: Adoption of contingency management (CM) by the addiction treatment community is limited to date despite much evidence for its efficacy. This study examined systemic and idiographic staff predictors of CM adoption attitudes via archival data collected from treatment organizations affiliated with the National Drug Abuse Treatment Clinical Trials Network. Multilevel modeling analyses evaluated potential predictors from organizational, treatment unit, and workforce surveys. Among these were individual and shared perceptions of staff concerning aspects of their clinic culture and climate. Modeling analyses identified three systemic predictors (clinic provision of opiate agonist services, national accreditation, and lesser shared perception of workplace stress) and five idiographic predictors (staff with a graduate degree, longer service tenure, managerial position, e-communication facility, and openness to change in clinical procedures). Findings are discussed as they relate to extant literature on CM attitudes and established implementation science constructs, and their practical implications are discussed.A multilevel approach to predicting community addiction treatment attitudes about contingency managementBryan Hartzler, Dennis M. Donovan, Carrie J. Tillotson, Solange Mongoue-Tchokote, Suzanne R. Doyle, Dennis McCarty10.1016/j.jsat.2011.10.012Journal of Substance Abuse Treatment 42, 2 (2012)2011-12-05Journal of Substance Abuse Treatment2011-12-05422S0740-5472(11)X0009-0Special Issue: Organizational Dynamics Within Substance Abuse Treatment213221http://www.journalofsubstanceabusetreatment.com/article/PIIS0740547211002145/abstract?rss=yesAbstract: This article explores the impact of organizational attributes on client engagement within substance abuse treatment. Previous research has identified organizational features, including small size, accreditation, and workplace practices, that impact client engagement (K. M. Broome, P. M. Flynn, D. K. Knight, & D. D. Simpson, 2007). This study sought to explore how aspects of the work environment impact client engagement. The sample included 89 programs located in 9 states across the United States. Work environment measures included counselor perceptions of stress, burnout, and work satisfaction at each program, whereas engagement measures included client ratings of participation, counseling rapport, and treatment satisfaction. Using multiple regression, tests of moderation and mediation revealed that staff stress negatively predicted client participation in treatment. Burnout was related to stress but was not related to participation. Two additional organizational measures—workload and influence—moderated the positive relationship between staff stress and burnout. Implications for drug treatment programs are discussed.The impact of organizational stress and burnout on client engagementBrittany Landrum, Danica K. Knight, Patrick M. Flynn10.1016/j.jsat.2011.10.011Journal of Substance Abuse Treatment 42, 2 (2012)2011-12-07Journal of Substance Abuse Treatment2011-12-07422S0740-5472(11)X0009-0Special Issue: Organizational Dynamics Within Substance Abuse Treatment222230