BOX 3.1 Attributes Associated With Innovations Likely to Be Implemented

  • Relative Advantage—the degree to which a new idea is perceived as superior to the existing practice that it replaces.
  • Compatibility—the degree to which an innovation is perceived by an individual as similar to previous experience or to beliefs and values.
  • Complexity—the degree to which a new idea is perceived as relatively easy to understand.
  • Trialability—the degree to which an innovation can be divided for experimental use by an individual.
  • Observability—the degree to which a new idea can easily be seen by others.

    SOURCE: Rogers EM. 1995b. Lessons for Guidelines from the Diffusion of Innovations. Joint Commission Journal on Quality Improvement 21(7):324-328.


The development of practice guidelines might help close the gap among the three segments of the drug abuse field, as well as improve clinical outcomes and enhance the credibility of caregivers. Both payers and policymakers have voiced skepticism about the efficacy of treatment for substance use disorders. In part, this skepticism is based on anecdotal experience, along with biases rooted in stigma and a history of perceived abuses of the reimbursement system by some providers. To some extent these same barriers operate at the interface between the substance treatment community and the rest of health care system.

Guidelines are relatively new in this field. The American Society of Addiction Medicine (ASAM) has published placement criteria, and the American Psychiatric Association (APA) has published comprehensive practice guidelines for this patient population (APA, 1996). The psychiatric practice guidelines are based on review and synthesis of the currently available treatment literature, complimented where appropriate by the experience of a group of skilled clinician reviewers. Sequential drafts of the guidelines were reviewed by a national sample of individual clinicians and researchers, as well as numerous professional organizations and governmental agencies in the addictions field.

The psychiatric practice guidelines include principles of treatment applicable to all forms of substance use disorder, as well as sections on the assessment and management of patients with alcohol, cocaine, and opioid related disorders. They provide a framework for choosing among treatment

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