care and family medicine settings. Difficulties in developing linkages between primary care and the ancillary services used in addiction treatments may pose barriers to the adoption of new treatment technologies. Specialty treatment settings may also be limited in their ability or interest in adopting new pharmacotherapies due to philosophical resistance and lack of training and/or resources.

This appendix applies a framework from health services research on technology diffusion to identify elements that may be important in understanding the adoption of treatment technologies in the substance abuse field. Literature on the adoption of substance abuse treatment technologies is reviewed, and particular challenges and opportunities are outlined—including the organization, financing, and delivery of specialty addiction treatments that may inhibit rapid adoption. Implications for primary care and other treatment settings are discussed relative to the availability of new pharmacology-based interventions. Finally, strategies for making these medications available and encouraging their appropriate use are examined.

ADOPTION OF INNOVATIONS IN MEDICAL CARE

Classical diffusion theory suggests the nature of the technology, the organizational structures and associated financial influences in which the technology is disseminated, characteristics of the providers and patients, and the communication methods (by whom and through what channels) affect the rate and direction of the adoption pattern (Banta and Luce, 1993; Office of Technology Assessment, 1994; Rogers, 1995). Figure D-1 shows a conceptual model of the factors contributing to technology adoption, described below.

Technology Attributes

Adoption depends in part on the attributes of the innovation and how practitioners perceive them (Meyer and Goes, 1988; Rogers, 1995). Characteristics affecting an innovation’s adoption include the relative advantages over existing technologies, whether in economic, clinical, or social terms; compatibility with values, experiences, and needs of potential users; complexity or simplicity of use; “trialability,” or the potential to try on a limited basis without significant risk; and the extent to which results are observable (Rogers, 1995). After a new technology is introduced, uncertainty often remains regarding its use. Emerging technologies are commonly used in ways other than initially intended (Gelijns and Rosenberg, 1994). Modification of the technology occurs after initial adoption (Greer, 1988),



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