Objective: The study examined the connection between the staff work environment and staff members' beliefs about treatment, the quality of the treatment environment, patients' involvement in treatment and self-help activities, and patients' improvement during treatment. Method: Patient care staff (N = 329) in 15 substance abuse treatment programs reported on the characteristics of their work environment and on their beliefs and treatment orientations about substance abuse. Patients in these programs (N = 3,228) reported on the treatment environment, their participation in treatment and self-help activities, and their treatment goals, confidence in achieving these goals, and coping skills at intake to and discharge from treatment. Results: Staff in supportive and goal-directed work environments were more likely to espouse disease model beliefs and a 12-step orientation toward substance abuse treatment. These work environments were associated with more supportive and goal-directed treatment environments. Patients in these treatment environments participated in more substance abuse, educational and social, and family treatment services, were more involved in self-help groups (as indicated by attending more meetings, reading 12-step materials, and having a sponsor and friends in such groups), were more satisfied with the program, improved more during treatment (as indicated by abstinence goals and confidence in maintaining abstinence, less depression, and more substance abuse and general coping skills), and were more likely to participate in outpatient mental health care after discharge. Conclusions: More goal-directed work environments are associated with more goal-directed treatment environments and patients' engagement in treatment and improvement. The staff work environment is an important component of the substance abuse treatment system.
