tient programs that serve men might also develop services for alcoholand drug-dependent women with young children. When organizations become more complex they develop systems to control and coordinate the growing number of pieces of their business. Among the most important new capacities they develop is specialized management for dealing with institutional actors like regulators, payers, and training institutions (Shortell and Kaluzny, 1983).

In recent years, some CBOs have expanded through mergers with larger organizations and acquisitions of smaller community-based providers (see Appendix E, Table E-2). These growing entities face financial and management challenges as they absorb and integrate other programs, each of which may have its own culture and community. The information and financial systems often are inadequate, and capital and human resources to fix the problems are lacking. Nevertheless, this emerging group of Stage III community providers are the most likely to be able to absorb research findings and to participate as full partners in the development of new clinical knowledge. However, they may also need special support from regulatory agencies, payers, and even research organizations to realize this potential. For example, Stage III CBOs are likely to be very sensitive to payers' demands for measurable improvements in treatment outcomes. To respond, they may need help in providing staff training and implementing information systems that monitor outcomes. In fact, they may need the same information systems to track their operations that researchers need to follow their clinical interventions. However, without special incentives and support, services will always take precedence over research in clinical settings where management teams are likely to be fully stretched responding to the challenges of growth and change.

Another important dimension that mediates a CBO's willingness and ability to engage in research activities is the cultural model defining their "knowledge" about how to treat drug abuse. There are at least two main types of treatment programs in this regard (see Table 4.1). The first group includes programs whose treatment models are based largely on the experiential knowledge of a staff largely comprising people in recovery from drug abuse problems. An example of this would be the drug abuse treatment program built in the tradition of the twelve step programs following the model of AA. The therapists at these programs have come to "know" what it takes to treat the disorder by living with it and they have confidence in their knowledge because it has been tested in what is to them the most important test—their own recovery.

Included in this first group of programs are some which are identified with religious organizations. These programs bring an element of faith into their treatment approach. Since faith is built into the foundation of their treatment approach, their religious beliefs fuel their organizational culture,