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Cooper K, Chatters R, Kaltenthaler E, Wong R. Psychological and psychosocial interventions for cannabis cessation in adults: a systematic review short report. Health Technol Assess 2016. [PMID: 26202542 DOI: 10.3310/hta19560] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cannabis is the most commonly used illicit drug worldwide. Cannabis dependence is a recognised psychiatric diagnosis, often diagnosed via the Diagnostic and Statistical Manual of Mental Disorders criteria and the International Classification of Diseases, 10th Revision. Cannabis use is associated with an increased risk of medical and psychological problems. This systematic review evaluates the use of a wide variety of psychological and psychosocial interventions, such as motivational interviewing (MI), cognitive-behavioural therapy (CBT) and contingency management. OBJECTIVE To systematically review the clinical effectiveness of psychological and psychosocial interventions for cannabis cessation in adults who use cannabis regularly. DATA SOURCES Studies were identified via searches of 11 databases [MEDLINE, EMBASE, Cochrane Controlled Trials Register, Health Technology Assessment (HTA) database, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, NHS Economic Evaluation Database, PsycINFO, Web of Science Conference Proceedings Citation Index, ClinicalTrials.gov and metaRegister of Current Controlled Trials] from inception to February 2014, searching of existing reviews and reference tracking. METHODS Randomised controlled trials (RCTs) assessing psychological or psychosocial interventions in a community setting were eligible. Risk of bias was assessed using adapted Cochrane criteria and narrative synthesis was undertaken. Outcomes included change in cannabis use, severity of cannabis dependence, motivation to change and intervention adherence. RESULTS The review included 33 RCTs conducted in various countries (mostly the USA and Australia). General population studies: 26 studies assessed the general population of cannabis users. Across six studies, CBT (4-14 sessions) significantly improved outcomes (cannabis use, severity of dependence, cannabis problems) compared with wait list post treatment, maintained at 9 months in the one study with later follow-up. Studies of briefer MI or motivational enhancement therapy (MET) (one or two sessions) gave mixed results, with some improvements over wait list, while some comparisons were not significant. Four studies comparing CBT (6-14 sessions) with MI/MET (1-4 sessions) also gave mixed results: longer courses of CBT provided some improvements over MI. In one small study, supportive-expressive dynamic psychotherapy (16 sessions) gave significant improvements over one-session MI. Courses of other types of therapy (social support group, case management) gave similar improvements to CBT based on limited data. Limited data indicated that telephone- or internet-based interventions might be effective. Contingency management (vouchers for abstinence) gave promising results in the short term; however, at later follow-ups, vouchers in combination with CBT gave better results than vouchers or CBT alone. Psychiatric population studies: seven studies assessed psychiatric populations (schizophrenia, psychosis, bipolar disorder or major depression). CBT appeared to have little effect over treatment as usual (TAU) based on four small studies with design limitations (both groups received TAU and patients were referred). Other studies reported no significant difference between types of 10-session therapy. LIMITATIONS Included studies were heterogeneous, covering a wide range of interventions, comparators, populations and outcomes. The majority were considered at high risk of bias. Effect sizes were reported in different formats across studies and outcomes. CONCLUSIONS Based on the available evidence, courses of CBT and (to a lesser extent) one or two sessions of MI improved outcomes in a self-selected population of cannabis users. There was some evidence that contingency management enhanced long-term outcomes in combination with CBT. Results of CBT for cannabis cessation in psychiatric populations were less promising, but may have been affected by provision of TAU in both groups and the referred populations. Future research should focus on the number of CBT/MI sessions required and potential clinical effectiveness and cost-effectiveness of shorter interventions. CBT plus contingency management and mutual aid therapies warrant further study. Studies should consider potential effects of recruitment methods and include inactive control groups and long-term follow-up. TAU arms in psychiatric population studies should aim not to confound the study intervention. STUDY REGISTRATION This study is registered as PROSPERO CRD42014008952. FUNDING The National Institute for Health Research HTA programme.
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Affiliation(s)
- Katy Cooper
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robin Chatters
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Eva Kaltenthaler
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ruth Wong
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Novins DK, Croy CD, Moore LA, Rieckmann T. Use of evidence-based treatments in substance abuse treatment programs serving American Indian and Alaska Native communities. Drug Alcohol Depend 2016; 161:214-21. [PMID: 26898185 PMCID: PMC4817996 DOI: 10.1016/j.drugalcdep.2016.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/31/2016] [Accepted: 02/03/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research and health surveillance activities continue to document the substantial disparities in the impacts of substance abuse on the health of American Indian and Alaska Native (AI/AN) people. While Evidence-Based Treatments (EBTs) hold substantial promise for improving treatment for AI/ANs with substance use problems (as they do for non-AI/ANs), anecdotal reports suggest that their use is limited. In this study, we examine the awareness of, attitudes toward, and use of EBTs in substance abuse treatment programs serving AI/AN communities. METHODS Data are drawn from the first national survey of tribal substance abuse treatment programs. Clinicians or clinical administrators from 192 programs completed the survey. Participants were queried about their awareness of, attitudes toward, and use of 9 psychosocial and 3 medication EBTs. RESULTS Cognitive Behavioral Therapy (82.2%), Motivational Interviewing (68.6%), and Relapse Prevention Therapy (66.8%) were the most commonly implemented psychosocial EBTs; medications for psychiatric comorbidity was the most commonly implemented medication treatment (43.2%). Greater EBT knowledge and use were associated with both program (e.g., funding) and staff (e.g., educational attainment) characteristics. Only two of the commonly implemented psychosocial EBTs (Motivational Interviewing and Relapse Prevention Therapy) were endorsed as culturally appropriate by a majority of programs that had implemented them (55.9% and 58.1%, respectively). CONCLUSIONS EBT knowledge and use is higher in substance abuse treatment programs serving AI/AN communities than has been previously estimated. However, many users of these EBTs continue to have concerns about their cultural appropriateness, which likely limits their further dissemination.
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Affiliation(s)
- Douglas K Novins
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, United States.
| | - Calvin D Croy
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, United States
| | - Laurie A Moore
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, United States
| | - Traci Rieckmann
- Department of Public Health and Preventive Medicine, Oregon Health and Sciences University, United States
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D’Ippolito M, Lundgren L, Amodeo M, Beltrame C, Lim L, Chassler D. Addiction Treatment Staff Perceptions of Training as a Facilitator or Barrier to Implementing Evidence-Based Practices: A National Qualitative Research Study. Subst Abus 2015; 36:42-50. [DOI: 10.1080/08897077.2013.849646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Belur V, Dennis ML, Ives ML, Vincent R, Muck R. Feasibility and impact of implementing motivational enhancement therapy–cognitive behavioral therapy as a substance use treatment intervention in school-based settings. ACTA ACUST UNITED AC 2014; 7:88-104. [DOI: 10.1080/1754730x.2014.888223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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McGarvey EL, Leon-Verdin M, Bloomfield K, Wood S, Winters E, Smith J. Effectiveness of A-CRA/ACC in treating adolescents with cannabis-use disorders. Community Ment Health J 2014; 50:150-7. [PMID: 23229053 DOI: 10.1007/s10597-012-9566-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 10/29/2012] [Indexed: 11/24/2022]
Abstract
An evidence-based treatment for adolescent cannabis users, Adolescent Community Reinforcement Approach with Assertive Continuing Care, was implemented in a rural county and small city in the USA. A total of 147 adolescents, ages 12-18, were enrolled and assessed at baseline and three time points: 3, 6, and 12 months using the Global Appraisal of Individual Needs and related measures. Program effectiveness was confirmed. The treatment was equally effective for youth from the city versus the county. More than two-thirds (68.7%) of the adolescents reported quitting use of cannabis by 12 months. The days of cannabis use in the last 90 days decreased significantly from the first follow-up, controlling for age (p value < .01), and shows consistent decline until the end of the treatment. In addition to reduction in substance use, the average number of days missing school and expelled from school decreased significantly from baseline to the end of the treatment.
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Affiliation(s)
- Elizabeth L McGarvey
- Department of Public Health Sciences, School of Medicine, University of Virginia, P.O. Box 800717, Charlottesville, VA, 22908, USA,
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Novins DK, Green AE, Legha RK, Aarons GA. Dissemination and implementation of evidence-based practices for child and adolescent mental health: a systematic review. J Am Acad Child Adolesc Psychiatry 2013; 52:1009-1025.e18. [PMID: 24074468 PMCID: PMC3922894 DOI: 10.1016/j.jaac.2013.07.012] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/05/2013] [Accepted: 07/24/2013] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Although there has been a dramatic increase in the number of evidence-based practices (EBPs) to improve child and adolescent mental health, the poor uptake of these EBPs has led to investigations of factors related to their successful dissemination and implementation. The purpose of this systematic review was to identify key findings from empirical studies examining the dissemination and implementation of EBPs for child and adolescent mental health. METHOD Of 14,247 citations initially identified, 73 articles drawn from 44 studies met inclusion criteria. The articles were classified by implementation phase (exploration, preparation, implementation, and sustainment) and specific implementation factors examined. These factors were divided into outer (i.e., system level) and inner (i.e., organizational level) contexts. RESULTS Few studies used true experimental designs; most were observational. Of the many inner context factors that were examined in these studies (e.g., provider characteristics, organizational resources, leadership), fidelity monitoring and supervision had the strongest empirical evidence. Albeit the focus of fewer studies, implementation interventions focused on improving organizational climate and culture were associated with better intervention sustainment as well as child and adolescent outcomes. Outer contextual factors such as training and use of specific technologies to support intervention use were also important in facilitating the implementation process. CONCLUSIONS The further development and testing of dissemination and implementation strategies is needed to more efficiently move EBPs into usual care.
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McCaffrey DF, Griffin BA, Almirall D, Slaughter ME, Ramchand R, Burgette LF. A tutorial on propensity score estimation for multiple treatments using generalized boosted models. Stat Med 2013; 32:3388-414. [PMID: 23508673 DOI: 10.1002/sim.5753] [Citation(s) in RCA: 760] [Impact Index Per Article: 69.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 01/17/2013] [Indexed: 11/10/2022]
Abstract
The use of propensity scores to control for pretreatment imbalances on observed variables in non-randomized or observational studies examining the causal effects of treatments or interventions has become widespread over the past decade. For settings with two conditions of interest such as a treatment and a control, inverse probability of treatment weighted estimation with propensity scores estimated via boosted models has been shown in simulation studies to yield causal effect estimates with desirable properties. There are tools (e.g., the twang package in R) and guidance for implementing this method with two treatments. However, there is not such guidance for analyses of three or more treatments. The goals of this paper are twofold: (1) to provide step-by-step guidance for researchers who want to implement propensity score weighting for multiple treatments and (2) to propose the use of generalized boosted models (GBM) for estimation of the necessary propensity score weights. We define the causal quantities that may be of interest to studies of multiple treatments and derive weighted estimators of those quantities. We present a detailed plan for using GBM to estimate propensity scores and using those scores to estimate weights and causal effects. We also provide tools for assessing balance and overlap of pretreatment variables among treatment groups in the context of multiple treatments. A case study examining the effects of three treatment programs for adolescent substance abuse demonstrates the methods.
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Rowe C, Rigter H, Henderson C, Gantner A, Mos K, Nielsen P, Phan O. Implementation fidelity of Multidimensional Family Therapy in an international trial. J Subst Abuse Treat 2012; 44:391-9. [PMID: 23085040 DOI: 10.1016/j.jsat.2012.08.225] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 08/21/2012] [Accepted: 08/30/2012] [Indexed: 10/27/2022]
Abstract
Implementation fidelity, a critical aspect of clinical trials research that establishes adequate delivery of the treatment as prescribed in treatment manuals and protocols, is also essential to the successful implementation of effective programs into new practice settings. Although infrequently studied in the drug abuse field, stronger implementation fidelity has been linked to better outcomes in practice but appears to be more difficult to achieve with greater distance from model developers. In the INternational CAnnabis Need for Treatment (INCANT) multi-national randomized clinical trial, investigators tested the effectiveness of Multidimensional Family Therapy (MDFT) in comparison to individual psychotherapy (IP) in Brussels, Berlin, Paris, The Hague, and Geneva with 450 adolescents with a cannabis use disorder and their parents. This study reports on the implementation fidelity of MDFT across these five Western European sites in terms of treatment adherence, dose and program differentiation, and discusses possible implications for international implementation efforts.
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Affiliation(s)
- Cynthia Rowe
- Department of Epidemiology and Public Health, Center for Treatment Research on Adolescent Drug Abuse, University of Miami Miller School of Medicine, 1425N.W. 10th Avenue, Miami, FL 33136, USA.
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Riley KJ, Srikanth P, Choi D, McCarty D. Treatment length and outcomes among adolescents: a secondary data analysis. Subst Abuse Treat Prev Policy 2012; 7:35. [PMID: 22898149 PMCID: PMC3626934 DOI: 10.1186/1747-597x-7-35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 08/06/2012] [Indexed: 11/10/2022] Open
Abstract
Background Adaptations to evidence-based substance abuse treatment programs may impact their effectiveness. A qualitative study of MET/CBT-5 implementation in community agencies treating adolescents found that the majority of the agencies made adaptations and that the most frequent adaptation was to provide more than five treatment sessions. Methods Baseline and outcome data from SAMHSA’s Effective Adolescent Treatment demonstration were analyzed to assess associations between length of treatment, client characteristics, and outcomes at three months. Results Adolescents who received more or less than the protocol length of 5 sessions were less likely to be discharged to the community than those who received the 5 session protocol. Those who received more than five sessions were more likely to have higher severity scores at intake but almost 50% of those with more than five sessions had low intake severity scores. Clients who received less than five sessions tended to have lower severity scores than clients who received more than five sessions. Conclusions Length of treatment tended to vary by site rather than severity of substance problems or frequency of use. There was no significant improvement of substance abuse problems or decrease in frequency of use with longer treatment. Implementation of the MET/CBT-5 component of the Cannabis Youth Treatment trial in the EAT project illustrates the difficulty of adherence to an evidence based protocol in the field.
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Affiliation(s)
- Katherine J Riley
- Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, USA.
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Ulaszek WR, Lin HJ, Frisman LK, Sampl S, Godley SH, Steinberg-Gallucci KL, Kamon JL, O'Hagan-Lynch M. Development and Initial Validation of a Client-Rated MET-CBT Adherence Measure. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2012; 6:85-94. [PMID: 22933842 PMCID: PMC3427034 DOI: 10.4137/sart.s9896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Traditional mechanisms for rating adherence or fidelity are labor-intensive. We developed and validated a tool to rate adherence to Motivational Enhancement Therapy—Cognitive Behavioral Treatment (MET-CBT) through anonymous client surveys. The instrument was used to survey clients in 3 methadone programs over 2 waves. Explanatory and Confirmatory Factor Analyses were used to establish construct validity for both MET and CBT. Internal consistency based on Cronbach’s alpha was within adequate range (α > 0.70) for all but 2 of the subscales in one of the samples. Consensus between clients’ ratings (rwg(j) scores) were in the range of 0.6 and higher, indicating a moderate to strong degree of agreement among clients’ ratings of the same counselor. These results suggest that client surveys could be used to measure adherence to MET-CBT for quality monitoring that is more objective than counselor self-report and less resource-intensive than supervisor review of taped sessions. However, additional work is needed to develop this scale.
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Amodeo M, Lundgren L, Cohen A, Rose D, Chassler D, Beltrame C, D'Ippolito M. Barriers to implementing evidence-based practices in addiction treatment programs: comparing staff reports on Motivational Interviewing, Adolescent Community Reinforcement Approach, Assertive Community Treatment, and Cognitive-behavioral Therapy. EVALUATION AND PROGRAM PLANNING 2011; 34:382-9. [PMID: 21420171 DOI: 10.1016/j.evalprogplan.2011.02.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE This qualitative study explored barriers to implementing evidence-based practices (EBPs) in community-based addiction treatment organizations (CBOs) by comparing staff descriptions of barriers for four EBPs: Motivational Interviewing (MI), Adolescent Community Reinforcement Approach (A-CRA), Assertive Community Treatment (ACT), and Cognitive-behavioral Therapy (CBT). METHODS The CBOs received CSAT/SAMHSA funding from 2003 to 2008 to deliver services using EBPs. Phone interview responses from 172 CBO staff directly involved in EBP implementation were analyzed using content analysis, a method for making inferences and developing themes from the systematic review of participant narratives (Berelson, 1952). RESULTS Staff described different types of barriers to implementing each EBP. For MI, the majority of barriers involved staff resistance or organizational setting. For A-CRA, the majority of barriers involved specific characteristics of the EBP or client resistance. For CBT, the majority of barriers were associated with client resistance, and for ACT, the majority of barriers were associated with resources. DISCUSSION EBP designers, policy makers who support EBP dissemination and funders should include explicit strategies to address such barriers. Addiction programs proposing to use specific EBPs must consider whether their programs have the organizational capacity and community capacity to meet the demands of the EBP selected.
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Affiliation(s)
- M Amodeo
- Center for Addictions Research and Services, Boston University, School of Social Work, 264 Bay State Road, Boston, MA 02215, United States.
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Manuel JK, Hagedorn HJ, Finney JW. Implementing evidence-based psychosocial treatment in specialty substance use disorder care. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2011; 25:225-37. [PMID: 21668085 DOI: 10.1037/a0022398] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Implementing evidence-based psychosocial or behavioral treatments for clients with substance use disorders (SUDs) presents significant challenges. In this article, we first identify the treatments for which there is some consensus that sufficient empirical support exists to designate them as "evidence-based," and then briefly consider the nature of that evidence. Following that, we review data from a Substance Abuse and Mental Health Services Administration survey on the extent to which these evidence-based treatments (EBTs) are used in SUD treatment in the United States. The main focus of the article is a review of 21 studies attempting to implement EBTs from which we glean information on factors associated with more and less successful implementation. We conclude that more conceptually driven, organizationally focused (not just individual-provider-focused) approaches to implementation are needed and that, at least with some providers in some organizational contexts, it may be more effective to implement evidence-based practices or processes (EBPs) rather than EBTs.
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Affiliation(s)
- Jennifer K Manuel
- Health Services Research & Development (HSR&D) Center for Health Care Evaluation, VA Palo Alto Health Care System, CA, USA.
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Ramchand R, Griffin BA, Suttorp M, Harris KM, Morral A. Using a cross-study design to assess the efficacy of motivational enhancement therapy-cognitive behavioral therapy 5 (MET/CBT5) in treating adolescents with cannabis-related disorders. J Stud Alcohol Drugs 2011; 72:380-9. [PMID: 21513674 DOI: 10.15288/jsad.2011.72.380] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate how adolescents with marijuana problems who received a research-based treatment (five sessions of motivational enhancement therapy plus cognitive behavioral therapy [MET/CBT5]) in an experimental setting would have fared had they received exemplary community-based outpatient treatment. METHOD Twelve-month outcomes representing six domains (substance use problems, substance use frequency, emotional problems, illegal activities, recovery, and institutionalization) were assessed for youth who received MET/CBT5 in the Cannabis Youth Treatment study and youth who received outpatient treatment from one of three community-based programs selected for evidence of efficacy. Groups were matched on pretreatment characteristics using a propensity score weighting strategy. RESULTS Youth who received MET/CBT5 exhibited greater reductions in substance use frequency, substance use problems, and illegal behaviors 12 months after treatment entry than had they entered the community based outpatient programs. Results showed no evidence that youth who received MET/CBT5 would have fared better with respect to emotional problems, the likelihood of being institutionalized, or achieving a "recovery" status at 12 months had they received community-based treatments. CONCLUSIONS The community-based treatments used in this study have not been assessed relative to "treatment as usual" but were selected as "exemplary" models of adolescent treatment. There is no evidence in this study that these exemplary programs yielded superior 12-month outcomes for the treatment of adolescents with marijuana problems; youth receiving MET/CBT5 experienced greater reductions in substance use and illegal activities. Thus, MET/CBT5 may be a promising treatment for community-based providers to adopt to treat these clients.
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Affiliation(s)
- Rajeev Ramchand
- RAND Corporation, 1200 South Hayes Street, Arlington, Virginia 22202-5050, USA.
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Modifications of evidence-based practices in community-based addiction treatment organizations: a qualitative research study. Addict Behav 2011; 36:630-635. [PMID: 21310541 DOI: 10.1016/j.addbeh.2011.01.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 12/17/2010] [Accepted: 01/05/2011] [Indexed: 11/20/2022]
Abstract
This qualitative research effort explored implementation of evidence-based practices (EBPs) in 100 community-based addiction treatment organizations (CBOs) nationwide. The study describes CBO program director attitudes on: (1) satisfaction with EBPs they were mandated to implement; (2) the extent to which their organization modified the EBPs; (3) reasons for modifications; and, (4) the standards they used for modifications. Findings indicate that program directors were highly positive both about EBPs implemented and the modifications made to those EBPs. A broad range of modifications were identified; most common were adding or deleting intervention sessions in efforts to serve the needs of a specific client population. Given the addiction treatment field's lack of standards for modifying EBPs, it is not surprising that little consistency occurred in modification efforts. As government funders of addiction treatments require that CBOs implement EBPs, standards need to be created for modifying and adapting the EBPs while maintaining their fidelity.
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Godley SH, Garner BR, Passetti LL, Funk RR, Dennis ML, Godley MD. Adolescent outpatient treatment and continuing care: main findings from a randomized clinical trial. Drug Alcohol Depend 2010; 110:44-54. [PMID: 20219293 PMCID: PMC2885472 DOI: 10.1016/j.drugalcdep.2010.02.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 01/29/2010] [Accepted: 02/01/2010] [Indexed: 10/19/2022]
Abstract
This study evaluated the effectiveness and cost-effectiveness of two types of outpatient treatment with and without Assertive Continuing Care (ACC) for 320 adolescents with substance use disorders. Study participants were randomly assigned to one of four conditions: (a) Chestnut's Bloomington Outpatient Treatment (CBOP) without ACC; (b) CBOP with ACC; (c) Motivational Enhancement Therapy/Cognitive Behavior Therapy-7 session model (MET/CBT7) without ACC; and (d) MET/CBT7 with ACC. All study conditions attained high rates of participant engagement and retention. Follow-up interviews were completed with over 90% of the adolescents at three, six, nine, and 12 months after treatment admission. There was a significant time by condition effect over 12 months, with CBOP having a slight advantage for average percentage of days abstinent. Unlike previous findings that ACC provided incremental effectiveness following residential treatment, there were no statistically significant findings with regard to the incremental effectiveness of ACC following outpatient treatment. Analysis of the costs of each intervention combined with its outcomes revealed that the most cost-effective condition was MET/CBT7 without ACC.
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Garner BR. Research on the diffusion of evidence-based treatments within substance abuse treatment: a systematic review. J Subst Abuse Treat 2008; 36:376-99. [PMID: 19008068 DOI: 10.1016/j.jsat.2008.08.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 08/12/2008] [Accepted: 08/23/2008] [Indexed: 10/21/2022]
Abstract
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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Affiliation(s)
- Bryan R Garner
- Chestnut Health Systems, 448 Wylie Dr., Normal, IL 61761, USA.
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