Research on the diffusion of evidence-based treatments within substance abuse treatment: A systematic review

Chestnut Health Systems, 448 Wylie Dr., Normal, IL 61761, USA.
Journal of substance abuse treatment (Impact Factor: 2.9). 12/2008; 36(4):376-99. DOI: 10.1016/j.jsat.2008.08.004
Source: PubMed


This article provides a comprehensive review of research studies that have examined the diffusion of evidence-based treatments (EBTs) within the field of substance abuse treatment. Sixty-five research studies were identified and were grouped into one of three major classifications: attitudes toward EBTs, adoption of EBTs, and implementation of EBTs. This review suggests significant progress has been made with regard to the advancement of the fields' knowledge about attitudes toward and the extent to which specific EBTs have been adopted in practice, as well as with regard to the identification of organizational factors related to EBT adoption. In an effort to advance the substance abuse treatment field toward evidence-based diffusion practices, recommendations are made for greater use of methodologically rigorous experimental or quasi-experimental designs, psychometrically sound instruments, and integration of quantitative and qualitative data collection.

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Available from: Bryan R Garner, Jul 28, 2014
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    • "In contrast, use of medications in other psychiatric illnesses is common (Pincus et al., 1998; Wu, Wang, Katz, & Farley, 2013). Potential reasons for underutilization of addiction medications include patient and clinician-related barriers, such as doubts about treatment effectiveness by both clinicians and patients, clinicians' lack of knowledge or comfort in delivering the treatment, differing philosophies about the role of addiction medications in assisting addiction recovery, stigma, and patients' reluctance to take them (Friedmann & Schwartz, 2012; Garner, 2009; Roman, Abrahama, & Knudsen, 2011). Systems-related barriers for underutilization may include separate and uncoordinated systems of medical and addiction care, limitations in access to care, lack of institutional support, and inadequate administrative and personnel infrastructures (McLellan & Meyers, 2004; Samet, Friedmann, & Saitz, 2001; Walley et al., 2008). "
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    ABSTRACT: People with addictive disorders commonly do not receive efficacious medications. Chronic care management (CCM) is designed to facilitate delivery of effective therapies. Using data from the CCM group in a trial testing its effectiveness for addiction (N=282), we examined factors associated with the prescription of addiction medications. Among participants with alcohol dependence, 17% (95% CI 12.0-22.1%) were prescribed alcohol dependence medications. Among those with drug dependence, 9% (95% CI 5.5-12.6%) were prescribed drug dependence medications. Among those with opioids as a substance of choice, 15% (95% CI 9.3-20.9%) were prescribed opioid agonist therapy. In contrast, psychiatric medications were prescribed to 64% (95% CI 58.2-69.4%). Absence of co-morbid drug dependence was associated with prescription of alcohol dependence medications. Lower alcohol addiction severity and recent opioid use were associated with prescription of drug dependence medications. Better understanding of infrequent prescription of addiction medications, despite a supportive clinical setting, might inform optimal approaches to delivering addiction medications. Copyright © 2014 Elsevier Inc. All rights reserved.
    Journal of Substance Abuse Treatment 12/2014; 52. DOI:10.1016/j.jsat.2014.11.008 · 3.14 Impact Factor
    • "As EBTs are translated into clinical practice, adherence monitoring allows for verification that the EBT has been effectively implemented (Miller, Zweben, & Johnson, 2005). As noted by Garner (2009) " one of the most significant barriers to implementation research may be the lack of objective criteria for what determines when an EBT implementation has or has not occurred in practice " (p. 394). "
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    ABSTRACT: This study investigated the correspondence among four groups of raters on adherence to STAGE-12, a manualized 12-step facilitation (TSF) group and individual treatment targeting stimulant abuse. The four rater groups included the study therapists, supervisors, study-related ("TSF expert") raters, and non-project related ("external") raters. Results indicated that external raters rated most critically mean adherence - the mean of all the adherence items - and global performance. External raters also demonstrated the highest degree of reliability with the designated expert. Therapists rated their own adherence lower, on average, than did supervisors and TSF expert raters, but therapist ratings also had the poorest reliability. Findings highlight the challenges in developing practical, but effective methods of fidelity monitoring for evidence based practice in clinical settings. Recommendations based on study findings are provided.
    Journal of Substance Abuse Treatment 09/2014; 47(3). DOI:10.1016/j.jsat.2014.05.008 · 3.14 Impact Factor
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    • "Simpson, Joe, & Rowan-Szal, 2007) or provide comprehensive reviews of such studies (see Franklin & Hopson, 2007; Garner, 2008; and Manuel, Hagedorn, & Finney, 2011). A third group of articles reports on staff and administrator attitudes about EBP implementation. "
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    ABSTRACT: Background: Research studies have identified addiction treatment staff who have higher levels of education as having more positive attitudes about evidence-based treatment practices, science-based training, and the usefulness of evidence-based practices. This study examined associations between addiction treatment staff level of education and their perceptions of 3 measures of organizational change: organizational stress, training resources and staffing resources in their treatment unit. Methods: The sample included 588 clinical staff from community-based substance abuse treatment organizations who received Substance Abuse and Mental Health Services Administration (SAMHSA) funding (2003-2008) to implement evidence-based practices (EBPs). Bivariate analysis and regression modeling methods examined the relationship between staff education level (no high school education, high school education, some college, associate's degree, bachelor's degree, master's degree, doctoral degree, and other type of degree such as medical assistant, registered nurse [RN], or postdoctoral) and attitudes about organizational climate (stress), training resources, and staffing resources while controlling for staff and treatment unit characteristics. Results: Multivariable models identified staff with lower levels of education as having significantly more positive attitudes about their unit's organizational capacity. These results contradict findings that addiction treatment staff with higher levels of education work in units with greater levels of organizational readiness for change. Conclusion: It cannot be inferred that higher levels of education among treatment staff is necessarily associated with high levels of organizational readiness for change.
    Substance Abuse 03/2014; 35(1):3-6. DOI:10.1080/08897077.2013.792313 · 1.62 Impact Factor
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