Organizational-Level Predictors of Adoption Across Time: Naltrexone in Private Substance-Use Disorders Treatment Centers * (Report‪)‬

A MAJOR FOCUS WITHIN the substance-use disorders treatment field is on conducting clinical trials in an effort to identify more effective treatment modalities. Despite the development of a number of evidence-based treatment strategies, including pharmacotherapies, substance-use disorders treatment providers (Foreman et al., 2001; McGovern et al., 2004) and community treatment programs have been slow to adopt these new strategies (Backer et al., 1995; Lamb et al., 1998; Read et al., 2001) suggesting that the adoption of innovations is a more complex organizational process. We argue that much of the "gap" that exists between research and practice can be explained by the structural variations of treatment organizations. Therefore, the purpose of this article is to use a "diffusion of innovations" theoretical framework (Rogers, 2003) to examine the organizational predictors of innovation adoption in private substance-use disorders treatment centers using an event history analysis. Specifically, the adoption of naltrexone (Revia) between 1994 and 2003 will be explored. Naltrexone is an opiate antagonist used in the treatment of both opiate and alcohol dependence. The development of naltrexone for the treatment of opiate dependence was approved by the U.S. Food and Drug Administration (FDA) in 1984. Subsequently, naltrexone can be defined as an innovation (Rogers, 2003) since it was approved for the treatment of alcohol dependence a decade later based on two randomized trials (O'Malley et al., 1992; Volpicelli et al., 1992). Theoretical concepts predicting naltrexone adoption