Why do drug treatment organizations use contingent staffing arrangements? An analysis of market and social influences

Contingent staffing arrangements are defined as conditional and transitory work arrangements. In the drug abuse treatment sector, contingent staffing arrangements have the potential to improve treatment if they are used to increase access to needed services. Alternatively, such arrangements could interfere with the development of consistent, long-term client-staff relationships. Unfortunately, little is known about the consequences of or influences on contingent staff arrangements in this sector. The goal of this study is to examine the conditions under which outpatient substance abuse treatment organizations are more likely to use contingent staffing arrangements. Building on previous research on the social organization of health care structures and practices, we develop a conceptual model based in market economics and institutional perspectives to suggest that treatment organizations choose contingent arrangements in response to market conditions and uncertainty, institutional demands, and client needs. Using data from a nationally representative study conducted in 1988, 1990, and 1995, we find limited evidence that drug treatment units use contingent staff in response to market pressures. Labor market and demand uncertainty, however, are systematically associated with greater use of contingent staff. Study results suggest that expectations and norms from the institutional environment, particularly the organizational context of the treatment unit are strong predictors of the use of contingent staff. By considering both market and social influences of contingent staffing, we contribute to a growing body of research on how markets and institutions interact to influence organizational structures and practices in the health care system.     

INTERMINABLE SEX THERAPY: A REPORT ON TEN CASES OF THERAPEUTIC GRIDLOCK

This paper reports on ten cases in which treatment began with conventional sex therapy and was later modified by incorporating techniques of psychodynamic couple therapy. While the modifications initially led to symptom reversal, the reversal of symptoms activated a recycling sequence of relapses and renewed symptom reversals, ultimately terminating in treatment failure. While the ten couples were heterogeneous in many respects, they did form a distinct clinical group. In common, they demonstrated a set of characteristics laced with hate, love and dependency, which interacted to create what the authors have called "therapeutic gridlock" and "interminable" sex therapy.     

The limits of uncertainty: A note

Discussions of decision making by individuals and organizations invariably touch on the issue of uncertainty. Decision theory axiomatizations are based on the assumption that uncertainty cannot be unlimited, but that there must exist a minimal interval of value stability. This note makes explicit that assumption for individual choice. For group and organizational decision making, a proof is presented which deduces a limit to uncertainty from the existence of deliberate social action.     

The search for Jewish identity in Russia∗

A NARROW PERSPECTIVE ON SOVIET DISSENT

DISSENT IN THE USSR. POLITICS, IDEOLOGY, AND PEOPLE, ed. by Rudolf L. Tökés. Baltimore and London, The Johns Hopkins University Press, 1976. xiv, 453 pp. Index. $4.95, £3.50 paperback.

SOVIET JEWISH SCHOOLS

JEWISH SCHOOLS UNDER CZARISM AND COMMUNISM: A STRUGGLE FOR CULTURAL IDENTITY, by Zvi Halevy. New York, Springer, 1976. 239 pp. $14.50.

>THE SOVIET JEWISH EMIGRATION MOVEMENT

COURTS OF TERROR. SOVIET CRIMINAL JUSTICE AND JEWISH EMIGRATION, by Telford Taylor, Alan Dershowitz, George Fletcher, Leon Lipson and Melvin Stein. New York, Alfred A. Knopf, 1976, xi + 187 pp. Illus. Appendices. $6.95.

LE GRAND RETOUR, by Christian Jelen and Léopold Unger. Paris, Albin Michel, 1977, 348 pp. Illus. Bibl.

FROM MOSCOW TO JERUSALEM. THE DRAMATIC STORY OF THE JEWISH LIBERATION MOVEMENT AND ITS IMPACT ON ISRAEL, by Rebecca Rass with the collaboration of Morris Brafman. New York, Shengold, 1976. 256 pp. $8.95

TWO NAZI SATELLITES, SLOVAKIA AND BULGARIA

THE PARISH REPUBLIC: HLINKA'S SLOVAK PEOPLE'S PARTY 1939–1945, by Yeshayahu Jelinek. Columbia University Press, 1976. viii, 206 pp. Bibl. Index. (East European Monographs, No. XIV.) $18.75, £7.20.

BULGARIEN — LAND OHNE ANTISEMITISMUS, by Wolf Oschlies. Erlangen, Ner Tamid Verlag, 1976. 168 pp. Illus. Docs. DM 18.80.

AN UNSATISFACTORY STUDY

THE SOVIET UNION AND BLACK AFRICA, by Christopher Stevens. London, New York, Macmillan, 1976. xii + 236 pp. Appendices. Bibl. Index. £10.00.     

Diagnostic significance of free salivary testosterone measurement using a direct luminescence immunoassay in healthy men and in patients with disorders of androgenic status

The accurate measurement of testosterone remains a challenge. The determination of the blood testosterone concentrations in serum by conventional immunoassays is inaccurate in men and even more so in females and children. A new luminescence enzyme immunoassay (LIA) has been developed and validated. The high analytical (8.7 pmol/L) and functional (17.3 pmol/L) sensitivity allows the quantification of the very low concentration in saliva, as well as in serum, after 1/40 dilution. This study measured salivary testosterone levels and compared the results with the free levels calculated from total testosterone and sex hormone-binding globulin in eugonadal and hypogonadal men. Salivary testosterone concentrations in healthy men in morning hours were 369 pmol/L (mean), range 263–544 pmol/L, which was statistically significantly higher than that in men with androgen deficiency, 215 pmol/L (mean), range 51–249 pmol/L.

Repetitive determination of free testosterone concentrations in saliva (once a week for 5 weeks) showed high stability of results over time, with coefficient of variation 9% (range 5–23%).

In this study we showed that free salivary testosterone levels in morning samples correlated well with calculated free testosterone in blood, both in healthy men (R = 0.754, P = 0.001), and in patients with androgen deficiency (R = 0.889, P = 0.0001), though in cases with very low testosterone, salivary concentrations were systematically higher than calculated free testosterone levels in blood.