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Revision with unchanged content. Improving federal efforts to implement public health policy requires a better understanding of the impact of institutional and market forces on organi zational change mandated by federal regulations. Previous institutional literature assumed that institutional change driven by federal regulatory agencies is relatively easy to accomplish; however, there is a growing belief that other forces impact the extent to which government agencies are able to influence institutional change. Recently, the opioid dependence treatment field underwent a dramatic shift in regulatory oversight. This shift and the subsequent mandate of new federal regulations represent a punctuated change in the field that offers a unique opportunity to study the influences of institutional and market forces on change within organizations under federal regulation. For the purposes of this study, organizational change focuses on three areas of opioid dependence treatment targeted within the federally mandated regulations for policies and practice changes: (1) take-home medi cations, (2) medication dosage, and (3) quality assurance systems. These areas represent the organizational policies and practices impacted most by the legislative change and new regulations. This book is addressed to professionals in public administration, public health, and substance abuse treatment.