treatment processes and alternative service arrangements for the management of these programs and treatment practices such as methadone dosage levels.
Using the ODATS data, D’Aunno and Vaughn (1992) studied factors related to variation in methadone treatment practices in 172 outpatient methadone treatment programs. The data were collected from unit directors and clinical supervisors and included program-level information about client characteristics, treatment staff, some environmental factors, and organizational (unit) structure. The structural/management variables used in the regression analysis were unit ownership (private for-profit or non-profit and public), location (hospital-based, mental health center-based, or free-standing facilities), and financial status (measured by profit margins in the last fiscal year.) D’Aunno and Vaughn examined the relationship of these variables to average methadone dosage levels and length of treatment (among others) and found mixed results. For example, public units had a longer average length of time in treatment (positively related to outcomes) but lower average dosage levels (i.e., less than 60 mg/d and negatively related to outcomes). Free-standing units similarly had a longer average time in treatment but lower dosage levels and limits, which is contrary to general results (from this and other studies) showing a positive correlation between time in treatment and methadone dosage levels. No other information was generated about the relationship between ownership and location to other program characteristics and treatment practices. Not surprisingly, they urged further study to understand why these programs continue to implement what are known clinically to be ineffective treatment practices (i.e., dosages below effective levels).
In a follow-up study, D’Aunno, Folz-Murphy and Lin (1999) studied the extent to which key methadone treatment practices — dosage levels, treatment duration, and patient influence in dose decisions — changed from 1988 to 1995 and which treatment practices were related to