study of the relationship of counseling and self-help participation to patient outcomes, Etheridge, Craddock, Hubbard and Rounds-Bryant (1999:111) urged more research on the contributions of program-level variables to substance abuse treatment outcomes in order to provide “the kinds of policy- and practice-relevant information necessary to improve the effectiveness and efficiency of substance abuse treatment in this era of increased cost constraints and accountability.”
Substance abuse treatment expenditures totaled about $3.3 billion in 1992, and public financing for substance abuse treatment – including federal block grants, state agency funding, and Medicaid – accounted for approximately 80 percent of these expenditures (Rettig and Yarmolinsky, 1995). In view of these substantial public investments in treatment, the high costs of failure to ameliorate substance abuse problems, and great variability in outcomes between different programs, understanding how to improve program effectiveness is not only a major challenge facing substance abuse treatment researchers but also an important public management question. Over the last two decades, substance abuse treatment researchers have been gradually collecting more data on program-level factors that might influence treatment approaches and patients’ responses to treatments. The analysis of these data to date, however, has focused more on clinical treatment practices (with data aggregated at the program level) than on program administration and management variables that might have implications for treatment practices and patient outcomes.
This paper represents a first step toward bringing a public management perspective to bear on the empirical analysis of substance abuse treatment effectiveness. The theoretical perspective we apply is based on a framework or logic of governance in which client-level outcomes are hypothesized to reflect the influence of factors originating at different levels of organization and process, from the policy level through organizational and managerial levels to