Abstract
<title>Abstract</title> <p> <bold>Introduction</bold> : Evidence-based treatments for substance use disorders (SUDs) are widely available, yet many facilities struggle to adopt and implement them at scale. Little is known about how facility leaders decide to adopt treatment innovations or what motivates and impedes those decisions. In this study, we explored motivations, decision-making processes, and barriers to innovation adoption among addiction treatment executives. <bold>Methods:</bold> We conducted an exploratory sequential mixed-methods study with 12 executives and clinical directors of addiction treatment centers in New England. Semi-structured qualitative interviews were analyzed using codebook thematic analysis. Findings informed a follow-up quantitative survey administered to the same participants and analyzed descriptively. <bold>Results:</bold> Treatment facility leaders held generally positive attitudes toward innovation and often follow a relatively deliberate adoption process. Improving patient outcomes and retention was the most salient motivation across both qualitative and quantitative data, but many described patient referrals, financial sustainability, and staff wellbeing as related rather than competing priorities. Innovation ideas most often originated from clinical staff, peer networks, and conferences. Peer-reviewed journals were among the lowest-rated discovery sources. Regarding barriers to adopting treatment innovations, roughly a third of participants rated trialability as an important factor in adoption decisions, and piloting before full implementation was common but not universal. On surveys, the need to add staff, workflow compatibility, and mission alignment were the highest-rated inner setting barriers, while staff training needs were among the least important. <bold>Conclusions:</bold> These findings suggest that barriers to adoption arise less from facility leaders’ attitudes and more from organizational and operational constraints. Interventions that align with existing workflows can be tested on a small scale. Leveraging clinical and professional networks for dissemination may be more likely to achieve widespread implementation. </p>