THE EFFECTS OF CONFLICTING TREATMENT APPROACHES ON THE OPERATIONS AND PROCEDURES OF TWO TYPES OF METHADONE TREATMENT PROGRAMS: A STUDY IN INSTITUTIONAL ANALYSIS (ORGANIZATIONAL THEORY, DETOXIFICATION, DRUG ABUSE)
Governmental mandates for the detoxification of methadone clients resulted in the emergence of a methadone detoxification treatment modality, which was adopted by several programs with a therapeutic community orientation. The use of methadone, however, contradicts the drug-free orientation of therapeutic community treatment. Assumptions derived from organizational theory as well as the findings of previous research suggested that such contradictory mandates would result in the emergence of contradictions in the operations of these programs. Thus, it was expected that the adoption of methadone treatment by "therapeutic communities"would result in organizational strain (i.e., dissonance among staff regarding treatment approaches). It was expected that such organizational strain would neutralize organizational control over clients, thus resulting in a lowered rate of client retention. It was finally expected that the organizational strain resulting from the combination of methadone and therapeutic community treatment would be reflected in adaptive changes in organizational structure. Methadone programs with a therapeutic community orientation were compared with methadone programs that did not feature such an orientation through an analysis of interviews collected through a survey of staff employed in a sample of programs in New York City. Data on client characteristics (i.e., age, sex, ethnicity, and time in treatment) were also analysed.^ Findings indicated that staff in methadone programs with a therapeutic community orientation were no more likely to experience organizational strain than were staff in methadone programs without such an orientation, and changes in organizational structure were as likely to occur in the latter group as in the former. However, methadone programs with a therapeutic community orientation did experience a lower rate of client retention. Moreover, the retention rates of methadone programs with a therapeutic community orientation declined over time while the rates of the other methadone programs did not. The findings suggested that the programs interpreted contradictory mandates in such a way so that potentially conflicting treatment procedures were incorporated into the programs' underlying treatment orientation. It is suggested that the findings are relevant to three areas of study: (1) studies of organizations; (2) studies of program implementation and evaluation; and (3) studies of the effectiveness of methadone treatment programs. ^
RAINONE, GREGORY ANTHONY, "THE EFFECTS OF CONFLICTING TREATMENT APPROACHES ON THE OPERATIONS AND PROCEDURES OF TWO TYPES OF METHADONE TREATMENT PROGRAMS: A STUDY IN INSTITUTIONAL ANALYSIS (ORGANIZATIONAL THEORY, DETOXIFICATION, DRUG ABUSE)" (1985). ETD Collection for Fordham University. AAI8521413.