Biomedical subjects

Paul M Roman

Publications and source records attributed to Paul M Roman.

At least 19 recordsLinked to original sources

PubMed2007

Racial and ethnic disparities in SSRI availability in substance abuse treatment.

OBJECTIVE: The high rate of co-occurrence of psychiatric and substance use disorders suggests that specialty substance abuse treatment facilities may be an important site for the delivery of psychotropic medications. However, the literature suggests there may be associations between the percentage of racial and ethnic minority clients and the availability of selective serotonin reuptake inhibitors (SSRIs) in these facilities. METHODS: Survey data from the National Treatment Center Study, comprising nationally representative samples of 326 publicly funded and 339 privately funded substance abuse treatment centers, were used to measure the availability of SSRI medications from 2002 to 2004. Independent variables included the percentages of African-American and Hispanic clients, center type, organizational affiliation, region, size, accreditation status, presence of an integrated care program, and physician availability. RESULTS: SSRIs were available in 48% of the centers. Logistic regression analysis indicated that greater minority representation in centers' caseloads was negatively associated with the availability of SSRIs. The association between the percentage of African-American clients and SSRI availability was fully mediated by the addition of factors related to treatment inputs, such as the presence of a physician on staff or contract and the presence of an integrated care program. With organizational and treatment characteristics factored out, there was a negative association between the percentage of Hispanic clients and the availability of SSRIs. CONCLUSIONS: Although SSRIs were available in nearly half of these substance abuse treatment settings, racial and ethnic disparities exist in the availability of these medications.

Black or African American↗

PubMed2006

The adoption of medications in substance abuse treatment: associations with organizational characteristics and technology clusters.

Despite growing interest in closing the "research to practice gap", there are few data on the availability of medications in American substance abuse treatment settings. Recent research suggests that organizational characteristics may be associated with medication availability. It is unclear if the availability of medications can be conceptualized in terms of "technology clusters", where the availability of a medication is positively associated with the likelihood that other medications are also offered. Using data from 403 privately funded and 363 publicly funded specialty substance abuse treatment centers in the US, this research models the availability of agonist medications, naltrexone, disulfiram, and SSRIs. Bivariate logistic regression models indicated considerable variation in adoption across publicly funded non-profit, government-owned, privately funded non-profit, and for-profit treatment centers. Some of these differences were attenuated by organizational characteristics, such as accreditation, the presence of staff physicians, and the availability of detoxification services. There was some evidence that naltrexone, disulfiram, and SSRIs represent a group of less intensely regulated medications that is distinct from more intensely regulated medications. These types of medications were associated with somewhat different correlates. Future research should continue to investigate the similarities and differences in the predictors of medication availability across national contexts.

Community Mental Health Centers↗

PubMed2006

Patterns of organization and management in private and public substance abuse treatment programs.

As an organizational field, substance abuse treatment clearly includes a remarkable range of organizations. Yet only in the past two decades has there been research interest in the organizational context in which treatment is delivered. The goal of this article is to promote the concept of organizational field by summarizing findings from an ongoing research program and by examining the organizational structure, service delivery, and patterns of innovation adoption in two large samples of substance abuse treatment programs in the United States. Among highlighted findings, there are notable differences between the public and private sectors in structural and staffing characteristics, as well as in the characteristics of clients receiving substance abuse treatment. With regard to the use of evidence-based practices, our findings suggest that pharmacotherapies are more likely to be adopted in private centers, whereas notably effective voucher approaches are more common in public centers. Future research directions are discussed.

Counseling↗

PubMed2006

Counselor emotional exhaustion and turnover intention in therapeutic communities.

Counselor turnover is a significant problem facing substance abuse treatment agencies. Understanding the role of organizational culture in predicting burnout and turnover intention may yield important information on how to address turnover in treatment organizations. Using data collected from 817 counselors employed in a national sample of 253 therapeutic communities (TCs), structural equation modeling was used to estimate the associations between emotional exhaustion, turnover intention, and three measures of organizational culture: centralized decision making, distributive justice, and procedural justice. The model controlled for counselor demographics, credentials, and earnings. Counselors' emotional exhaustion scores were higher in TCs with greater centralized decision making (p < .01) but lower in TCs where greater distributive justice (p < .05) and procedural justice (p < .001) were reported. Likewise, turnover intention was positively associated with centralized decision making (p < .05) and inversely associated with the workplace justice measures (p < .001). These data suggest that management practices in TCs and perhaps in other types of substance abuse treatment facilities likely play a substantial role in counselors' well-being and in their decisions to leave their jobs. Because these practices are not structural features of organizations, they may be targeted for intervention and change.

Adult↗

PubMed2006

Availability of integrated care for co-occurring substance abuse and psychiatric conditions.

The co-occurrence of psychiatric conditions and substance abuse presents significant challenges for behavioral healthcare providers. The need for integrated care has received substantial recent attention from clinical, research, and funding entities. However, the availability of integrated care has been low, carrying potential adverse implications for quality of care and treatment outcomes. This article describes the prevalence and key correlates of the availability of integrated care for co-occurring conditions within public and private-sector addiction treatment programs. Several organizational attributes, caseload characteristics, and service provision patterns were associated with the availability of integrated care.

Adult↗

PubMed2006

Early adoption of buprenorphine in substance abuse treatment centers: data from the private and public sectors.

The recent approval of buprenorphine for the treatment of opiate dependence offers an opportunity to analyze innovation adoption in community-based treatment. Using data collected from national samples of 299 privately funded and 277 publicly funded treatment centers, this research examines buprenorphine adoption using baseline data collected between 2002 and 2004 as well as follow-up data collected 12 months later. Private centers were significantly more likely than public centers to report current use of buprenorphine. The baseline data indicated that early adoption was positively associated with center accreditation, physician services, availability of detoxification services, current use of naltrexone, and the percentage of opiate-dependent clients. Multivariate analyses of follow-up data suggest that adoption was greater in accredited centers, for-profit facilities, organizations offering detoxification services, and naltrexone-using centers. Future research should continue to monitor the extent to which buprenorphine is adopted in these settings.

Buprenorphine↗

PubMed2006

Evidence-based treatment for opiate-dependent clients: availability, variation, and organizational correlates.

The majority of opiate-dependent clients entering substance abuse treatment are referred to "drug-free" (non-methadone) modalities. Given the known challenges of treating these clients in drug-free settings relative to the documented effectiveness of methadone maintenance, these analyses investigate the availability of various clinical and wraparound services for this population among a US sample of addiction treatment programs with and without methadone maintenance services (N = 763). Face-to-face interviews conducted in 2002-2003 gathered data on the number of opiate-dependent clients treated; organizational characteristics, including size, ownership, accreditation, and staffing; treatment practices, including methadone availability, use of other pharmacotherapies, and levels of care; and services offered, including vouchers, transportation, and other wraparound services. Facilities treating proportionately more opiate-dependent clients were significantly more likely to offer a variety of evidence-based services, regardless of methadone availability. Implications for referral linkages and quality of care are discussed.

Counseling↗

PubMed2006

Trends in the adoption of medications for alcohol dependence.

Increasing attention is being paid to the development and dissemination of effective pharmacotherapies for the treatment of alcohol and other drug dependence. However, numerous structural and philosophical barriers impede the widespread adoption of these treatment approaches in everyday clinical practice. Research is needed to understand and overcome this gap. Drawing upon data collected from 2 large samples of substance abuse treatment providers at multiple time points, this article examines the prevalence and correlates of the adoption of the currently available pharmacotherapies for alcohol dependence: disulfiram, oral naltrexone, and acamprosate. These data suggest that the proportion of treatment programs using pharmacotherapies for alcohol dependence has been declining over time. In addition, the proportion of patients to whom these medications are prescribed is notably low. The adoption of disulfiram and naltrexone is significantly more likely in programs that are accredited, employ at least 1 physician, offer integrated care for patients with co-occurring psychiatric conditions, derive proportionately more revenue from commercial insurance payers, and have fewer linkages with the criminal justice system. Preliminary data suggest that the early adoption of acamprosate is following a similar pattern. Recommendations for addressing challenges to the diffusion of pharmacotherapies for alcohol dependence are presented.

Acamprosate↗

PubMed2005

Buprenorphine diffusion: the attitudes of substance abuse treatment counselors.

In October 2002, the Food and Drug Administration approved buprenorphine for use in the treatment of opioid dependence. Successful diffusion, adoption, and implementation of this medication within the treatment field depend in part on substance abuse counselors. Using questionnaire data obtained from 2,298 counselors in community-based treatment programs in the private and public sectors between June 2002 and July 2004, we explored the diffusion of this new treatment technique. Analyses indicate that a substantial proportion of the clinical workforce is unaware of the effectiveness of buprenorphine in the treatment of opiate addiction. Several variables predicted counselors' attitudes toward buprenorphine. Predictors included receipt of buprenorphine-specific training, educational attainment, years of experience, and 12-step orientation. Implications for the diffusion of this and other emerging treatment techniques are discussed.

Attitude↗

PubMed2005

What are the correlates of substance abuse treatment counselor salaries?

This article identifies and measures the key correlates of substance abuse treatment (SAT) counselor salaries. The data come from the 2002-2003 wave of the National Treatment Center Study that consists of approximately 1,500 full-time counselors from nationally representative samples of public and private SAT facilities. We used interval regression models to estimate the relationship between annual salary and numerous counselor and organizational characteristics. We found that counselor characteristics associated with annual salary include education, tenure in the SAT field, licensure, race, recovery status, and administrative responsibilities above and beyond duties as a full-time counselor. Organizational characteristics associated with counselor salary include accreditation status, hospital ownership, and the population density of the county where the facility is located. Taken together, these factors explain approximately 50% of the total variation in SAT counselor salaries.

Counseling↗

PubMed2005

A changed America? The effects of September 11th on depressive symptoms and alcohol consumption.

In the weeks following the terrorist attacks of September 11, 2001, social commentators argued that America had profoundly "changed." In light of these arguments and the literature on disasters, we examine the immediate and longer-term mental health consequences of September 11th using a national sample of full-time American workers. We model the effects of temporal proximity to the attacks on depressive symptoms and alcohol consumption, while controlling for demographic characteristics. Our data revealed a significant increase in the number of depressive symptoms reported during the 4 weeks after the attacks. In the subsequent weeks, levels of depressive symptoms returned to pre-September 11th levels. Contrary to expectations, there was some indication of decreased alcohol consumption after September 11th, although these effects were modest. These analyses provide little support for popular assertions that September 11th resulted in lasting and measurable impacts on Americans' well-being.

Adult↗

PubMed2004

Modeling the use of innovations in private treatment organizations: the role of absorptive capacity.

Few studies have identified the organizational characteristics that are associated with the transfer of research-based treatment techniques into practice. One potentially fruitful concept is absorptive capacity, referring to an organization's ability to seek and utilize information, which may be positively associated with the use of innovative treatment techniques. This paper examines the associations between an additive measure of innovation use and three measures of absorptive capacity: environmental scanning, collection of satisfaction data, and the level of workforce professionalism. Data from a nationally representative sample of 322 privately funded substance abuse treatment centers indicate that treatment organizations use a greater number of innovations when they engage in more environmental scanning, survey referral sources, and third party payers for satisfaction, and have a more professional workforce. These results indicate the importance of absorptive capacity in predicting organizational innovativeness.

Attitude of Health Personnel↗

PubMed2004

The availability of psychiatric programs in private substance abuse treatment centers, 1995 to 2001.

OBJECTIVE: The high rate of co-occurrence of substance abuse and mental disorders renders the availability of psychiatric programs, or integrated service delivery, a vital quality-of-care issue for substance abuse clients. This article describes the availability of psychiatric programs and integrated care for clients with severe mental illness in the private substance abuse treatment sector and examines these patterns of service delivery by profit status and hospital status. METHOD: S: Survey data from the National Treatment Center Study, which is based on a nationally representative sample of privately funded substance abuse treatment centers, were used to identify the proportion of centers that offered psychiatric programs in 1995-1996, 1997-1998, and 2000-2001. Centers reported whether they treated clients with severe mental illness on-site or referred them to external providers. Repeated-measures general linear models were used to test for significant changes over time and to assess mean differences in service availability by profit status and hospital status. RESULTS: About 59 percent of private centers offered a psychiatric program, and this proportion did not significantly change over time. The proportion of centers that referred clients with severe mental illness to external providers increased significantly from 57 percent to 67 percent. For-profit centers and hospital-based centers were significantly more likely to offer psychiatric programs and were less likely to refer severe cases to other providers. CONCLUSION: S: Although the importance of integrated care for clients with dual diagnoses is widely accepted, data from the private substance abuse treatment sector suggest that this pattern of service delivery is becoming less available.

Health Facilities, Proprietary↗

PubMed2003

Retaining counseling staff at substance abuse treatment centers: effects of management practices.

The turbulence created by the emergence of managed care has increased the importance of staff retention for substance abuse treatment centers. This study examines the relationships between management practices, organizational commitment, and turnover intention among substance abuse treatment counselors. Counselors from 345 randomly selected privately funded treatment centers were surveyed about management practices, organizational commitment, and turnover intention. Structural equation model estimates indicate significant associations between these variables. The effects of performance-based rewards and support for creativity, two measures of management practices, on turnover intention are mediated by organizational commitment. Job autonomy has a direct effect on turnover intention. Treatment center administrators may improve staff retention by systematic attention to these factors shown to enhance organizational commitment and reduce counselors' intentions to quit. Such steps may include increasing counselor autonomy, providing rewards for strong job performance, and establishing a work environment that supports creativity and innovation.

Counseling↗

PubMed2003

Problem drinking patterns among African Americans: the impacts of reports of discrimination, perceptions of prejudice, and "risky" coping strategies.

This research builds on a series of recent studies that have reported independent effects of personal experiences of racial discrimination on poor mental health outcomes. We suggest that for one mental health outcome, problem drinking, discrimination experiences have an impact not only via abridged socioeconomic attainment and the frustrations associated with institutionally limited opportunity structures, but also by directly increasing the likelihood of problem drinking. Moreover, we argue that personal experiences with discrimination help to foster a set of beliefs about the utility of drinking as a means of reducing stress that in the alcohol literature is referred to as "escapist" drinking. Escapist drinking is proposed as an intervening mechanism that is associated with a higher probability of alcohol-related mental health problems. Using data from the 1999-2000 National Survey of Black Workers, we find that, independent of socioeconomic attainment, personal reports of discriminatory experiences have direct influences on problem drinking. Consistent with our hypotheses, we also find that the effects of personal reports of discrimination are at least partially mediated by the endorsement of beliefs that drinking provides an effective coping mechanism. We conclude that racial impacts on mental health outcomes reflect more than the "simple" effects of constrained socioeconomic attainment.

Adaptation, Psychological↗

PubMed2002

Predicting closure of private substance abuse treatment facilities.

Researchers in organizational ecology have long been interested in identifying the factors associated with organizations closing their doors. Though the predictors of closure have been examined across many different types of organizations, private substance abuse treatment centers, often characterized as unstable and having high closure rates, have not been subject to empirical study. Data for this study were derived from a nationally representative longitudinal study of 450 private substance abuse treatment centers. Contrary to most previous research, center age was not a significant predictor of closure. Significant predictors included center capacity, being a freestanding facility, the percentage of clients covered by Medicaid, and the ratio of patients to full-time equivalents.

Forecasting↗

PubMed2002

Adoption and implementation of new technologies in substance abuse treatment.

In addition to clinical outcomes, understanding the adoption and implementation of new treatment interventions is essential. This analysis was designed to assess the predictive utility of organization-level features in understanding the adoption and implementation of new technologies in substance abuse treatment. Naltrexone, which was found to be in current use in 44.1% of a national sample of 400 private substance abuse treatment centers, was selected as an appropriate sample technology for study. Adoption of naltrexone is significantly related to both the treatment center's age and its administrative leadership. Naltrexone adoption is also significantly associated with the percentage of the center's caseload covered by managed care programs and by the percentage of relapsers represented in the caseload. The analysis was less successful in predicting naltrexone implementation for either primary alcohol dependence or primary opiate addiction.

Humans↗

PubMed2002

The workplace and alcohol problem prevention.

Workplace programs to prevent and reduce alcohol-related problems among employees have considerable potential. For example, because employees spend a lot of time at work, coworkers and supervisors may have the opportunity to notice a developing alcohol problem. In addition, employers can use their influence to motivate employees to get help for an alcohol problem. Many employers offer employee assistance programs (EAPs) as well as educational programs to reduce employees' alcohol problems. However, several risk factors for alcohol problems exist in the workplace domain. Further research is needed to develop strategies to reduce these risk factors.

Alcohol Drinking↗