Definitions and measures of program/organizational factors and research findings
D’Aunno, Sutton and Price (1991) describe differing environmental and organizational “forces” that formally and informally influence substance abuse treatment and patient outcomes. They explain that as a result of technological uncertainty (about treatment approaches), complex and conflicting beliefs exist within the mental health and substance abuse treatment sectors that influence program organization, staffing, treatment goals and practices, financial sources and licensing, and client composition. In light of these different and sometimes conflicting perspectives and approaches, it is not surprising that our analysis of variance shows that approximately 50 percent of the variation in substance abuse treatment program outcomes (that is, drug use in the post-treatment period) is at the program (or service delivery unit) level. The importance of investigating variation in outcomes between programs or service delivery units was also affirmed in the findings of other substance abuse treatment studies, which showed considerable heterogeneity in treatment processes, philosophies, staffing, and other characteristics of programs even within treatment modalities (e.g., methadone maintenance, outpatient nonmethadone, therapeutic-residential, correctional programs, etc.) (Gerstein and Harwood, 1990).
Gerstein and Harwood (1990) maintain that the most extensive and scientifically reliable evidence on substance abuse treatment effectiveness comes from studies of methadone maintenance programs (in which methadone, a legally prescribed drug, is administered for the purpose of ending dependence on illegal drugs, particularly heroin.) Based on their review of clinical studies, they found that the effectiveness of methadone programs varied considerably, and that the methadone dosage level (recommended 60-120mg/d) was one of the most important clinical factors affecting patient outcomes. They also criticized the inattention of researchers to