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This study examined expressed and received violence among men and women in substance abuse treatment. Rates of past-year partner violence (PV) did not differ by gender, although men reported markedly higher rates of nonpartner violence (NPV). Compared with PV, NPV was associated with more demographic and background factors (e.g., childhood aggression and conduct problems, family history of violence). The most consistent correlates of violence across relationship types were age, minority status, drug-related consequences, psychiatric distress, and frequency of childhood aggression. Only a few gender-specific correlates were identified; most notably, witnessing father-to-mother violence was related to received PV only for women. Identification of correlates of expressed and received violence in partner and nonpartner relationships is essential for the assessment and treatment of individuals in substance abuse treatment settings.

This article examines the variables associated with the presence of smoking cessation interventions in drug abuse treatment units, as well as staff attitudes toward the integration of smoking cessation services as a component of care. Surveys were administered to 106 organizations, 348 treatment clinics, and 3,786 employees in agencies that participated in the National Drug Abuse Treatment Clinical Trials Network. Organizational factors, attributes of the treatment setting, and staff attitudes toward smoking cessation treatment were assessed. Use of smoking cessation interventions was associated with the number of additional services offered at clinics, residential detoxification services, and attitudes of the staff toward smoking cessation treatment. Staff attitudes toward integrating smoking cessation services in drug treatment were influenced by the number of pregnant women admitted, the number of ancillary services provided, the attitudes of staff toward evidence-based practices, and whether smoking cessation treatment was offered as a component of care.

Program administrators and staff in treatment programs participating in the National Drug Abuse Treatment Clinical Trials Network (CTN) completed surveys to characterize participating programs and practitioners. A two-level random effects regression model assessed the influence of Organizational Readiness for Change (ORC) and organizational attributes on opinions toward the use of four evidence-based practices (manualized treatments, medication, integrated mental health services, and motivational incentives) and practices with less empirical support (confrontation and noncompliance discharge). The ORC Scales suggested greater support for evidence-based practices in programs where staff perceived more program need for improvement, better Internet access, higher levels of peer influence, more opportunities for professional growth, a stronger sense of organizational mission and more organizational stress. Support for confrontation and noncompliance discharge, in contrast, was strong when staff saw less opportunity for professional growth, weaker peer influence, less Internet access, and perceived less organizational stress. The analysis provides evidence of the ORC's utility in assessing agency strengths and needs during the implementation of evidence-based practices. IntroductionThe Institute of Medicine's Crossing the Quality Chasm series recommended increased use of treatments with empirical evidence of efficacy and effectiveness for health care (Institute of Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Corresponding NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptMedicine, 2000;Institute of Medicine, 2001) and for the treatment of alcohol, drug, and mental health disorders (Institute of Medicine, 2006). There is, however, a significant lag between science-based treatment innovations and the widespread adoption of those strategies in health care (Balas & Boren, 2000;Institute of Medicine, 2001). A comprehensive review of implementation research identified six core components that must be present to initiate and sustain the use of proven programs in new locations and environments: 1) select staff who can implement the program, 2) train staff, 3) require ongoing coaching, 4) use supervision and fidelity assessments to provide performance feedback to staff, 5) evaluate overall program functioning, and 6) facilitate implementation and sustainability with administrative supports (Fixsen et al., 2005). Many programs neglect one or more core implementation components and struggle to develop the skills required to effectively ...

The relatively traditional beliefs of support staff could inhibit the introduction of evidence-based practices. Programs initiating changes in therapeutic approaches may benefit from including all employees in change efforts.

Attitudes, perceived social norms and intentions were assessed for 376 counselors and 1083 clients from outpatient, methadone and residential drug treatment programs regarding four medications used to treat opiate dependence: methadone, buprenorphine, clonidine, and ibogaine. Attitudes, social norms and intentions to use varied by treatment modality. Methadone clients and counselors had more positive attitudes toward the use of methadone, while their counterparts in residential and outpatient settings had neutral or negative assessments. Across modalities, attitudes, perceived social norms, and intentions toward the use of buprenorphine were relatively neutral. Assessments of clonidine and ibogaine were negative for clients and counselors in all settings. Social normative influences were dominant across settings and medications in determining counselor and client intentions to use medications, suggesting that perceptions about beliefs of peers may play a critical role in use of medications to treat opiate dependence. INTRODUCTIONInvestments in the development of pharmacotherapies for the treatment of alcohol and drug dependence have begun to yield medications that enhance treatment effectiveness (Garbutt, West, Carey, Lohr, & Crews, 1999; Litten,1999;O'Brien, 1997;Swift, 1999). Underutilization of these innovative phamacotherapies, however, is a concern and points to the need for advancements in adoption and implementation strategies (Institute of Medicine, 1998). Speculation about resistance to the use of medications suggests that some patients and therapists believe that the use of medication to treat addiction is inconsistent with the experience of recovery (Institute of Medicine, 1995;Institute of Medicine, 1997). Unfortunately, there is Corresponding Author: Traci Rieckmann, Ph.D., OHSU Dept. PHPM, 3181 SW Sam Jackson Park Rd. CB 669, Portland, OR 97239, rieckman@ohsu.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. little empirical data on the attitudes and beliefs of clients and counselors toward using medication as part of a therapeutic plan for the treatment of drug dependence. NIH Public Access Attitudes Toward the Use of Medications for Opiate DependenceInvestigations conducted in the early 1970's found ambivalent attitudes and beliefs about the use of methadone in treating opiate dependence (Brown, 1975). More contemporary investigations used a measure of "abstinence orientation" (beliefs that methadone use should be time-limited) and assessed the opinions of staff in methadone programs in Australia (Caplehorn, Irwig, Saunders, 1996a;Caplehorn, Irw...

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