| The organizational effectiveness of methadone maintenance treatment (MMT) was evaluated by analyzing levels of compliance and involvement with treatment programs for clients at three types of MMT clinics in the San Francisco Bay Area. Secondary analysis was used on data collected from the National Institute on Drug Abuse funded project, Injection Drug Users, Methadone Maintenance Treatment, and AIDS, with Marsha Rosenbaum as principle investigator. The analysis rested on Rosenbaum's theoretical model of clinics types differentiated by the clinic's style of control over clients (A Matter of Style: Variation Among Methadone Clinics in the Control of Clients, 1985). With a focus on the interaction between individuals and their institutional environments, the analysis compared three types of clinics: reformist, medical-model and libertarian. Reformist clinics exercised the most control over their clients and libertarians the least. Both qualitative interviews and quantitative survey data were collected from 233 respondents for a total of five interviews each over a period of three years. It was hypothesized that clinics exercising the greatest control would be the least effective at maximizing compliance and involvement. The methodology included content analysis of the qualitative interviews and cross-sectional, dynamic and pooled regression analysis of the quantitative data. Compliance with clinic rules was measured by levels of drug use and involvement with clinic program was measured by turnover rates and continuous treatment. Those clinics that achieved a balance of control by allowing clients to make choices in their treatment plans, recognizing the changing nature of drug use itself, and maximizing the quality of life for their clients were also the clinics with highest levels of compliance and involvement with program style. Therefore, these clinics were the most effective in achieving organizational goals. |
