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Treatment Center Culture Influences Adoption Of Naltrexone

Despite the success of pharmacotherapies for alcohol and drug disorders a significant number of treatment providers and programs have been slow to adopt these new medications. This study examined how the structural variations of private treatment centers may affect their adoption of naltrexone (Revia) – an opiate antagonist used in the treatment of both opiate and alcohol dependence.

Researchers analyzed information gathered on 165 private Substance Abuse (SA)treatment centers by the National Treatment Center Study, which currently contains four waves of data collected between 1994 and 2003. Specifically, they looked at the impact of culture, leadership characteristics, internal structure, and external characteristics on the likelihood of naltrexone being adopted as part of the treatment protocols.

Results showed that the majority of the private treatment facilities were based on a 12-Step philosophy (93%) and also held 12-Step meetings on their premises (80%). In a multivariate model those programs employing a 12-Step model were less likely to adopt naltrexone. The researchers noted that AA recommends that members follow their physician’s advice and be medication compliant. Nonetheless, these structural characteristics clearly had an impact on openness to innovative practices. In addition those organizations utilizing a 12-Step model and those employing more experienced administrators were significantly less likely to adopt naltrexone. Conversely, those that used prescription drugs, possessed an employee handbook, were accredited, and operated on a for-profit basis were significantly more likely to adopt naltrexone over time.

(Oser, CB, Roman, PM: Organizational-level predictors of adoption across time: Naltrexone in private substance-use disorders treatment centers. Journal of Studies on Alcohol and Drugs 68:852-861, 2007.)

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