Transporting Evidence-Based Substance Abuse Treatment

The significant gap between science and service has been widely acknowledged in the field of substance abuse treatment (e.g., Brown, 2000; Carroll & Rounsaville, 2003; Compton et al., 2005). For example, the Institute of Medicine (1998) concluded that only a small proportion of substance abusers receive treatment; and of those who do, the quality of care is highly variable and they are not likely to receive an evidence-based treatment (ebt). Similarly, McLellan and colleagues (McLellan, Carise, & Kleber, 2003) concluded from their survey that the nation’s substance abuse treatment infrastructure will not be capable of adequately supporting efforts to bring most evidence-based treatments into the field. Likewise, Morgenstern and colleagues (Morgenstern, Morgan, McCrady, Keller, & Carroll, 2001) suggested that the science-service gap might be wider in the addiction field than for any other behavioral or emotional problem. The purpose of this paper, therefore, is to examine possible barriers to the transport of evidence-based substance abuse treatment for adolescents to community settings and to propose solutions to those barriers. These barriers pertain to several levels, including the nature of the intervention, characteristics of practitioners, and aspects of the broader systems in which the practitioners work. Nature of the Intervention Validation of effective substance abuse services for adolescents. As described by NIDA (1999) and Waldron and Turner (2008), several treatments of adolescent substance abuse have reasonably strong empirical support (e.g., multisystemic therapy [MST], contingency management [CM], and multidimensional family therapy). Complexity of ebts. Most of the evidence-based treatments are relatively complex, which serves as a barrier to adoption and implementation. For example, MST requires an extensive site assessment process, considerable funding, commitment to an intensive and ongoing quality assurance system, and, often, modification of organizational practices. CM, on the other hand, is less complex, can be tried on a limited basis, and has highly observable results – qualities that should enhance the potential for diffusion (Rogers, 1995). Characteristics of Practitioners Attitudes of substance abuse treatment providers. There has been speculation that substance abuse practitioners hold negative attitudes toward evidence-based treatments, and that such attitudes impede their adoption of evidence-based treatments. Our recent research, however, clearly shows that community-based practitioners are very interested in learning about evidence-based treatments of adolescent substance abuse (Henggeler et al., 2007) and have generally favorable attitudes about such services (Henggeler et al., 2008). Clinical skill deficits. Anecdotal evidence suggests that many practitioners have fundamental clinical skill deficits that impede their ability to engage clients in treatment – thereby limiting their capacity to implement ebts. Similarly, anecdotal evidence also suggests that supervisors often lack the skills needed to guide their therapists in the implementation of ebts. System-Level Barriers