Table 2.
Research studies focused on adoption of EBTs.
| Author(s)/Year | Article Title | Sample | Study Aim(s) | Key Finding(s) |
|---|---|---|---|---|
| Fals-Stewart & Birchler (2001)b | A national survey of the use of couples therapy in substance abuse treatment | Program administrators from 398 substance abuse treatment programs | Examined the extent to which Behavioral Couples Therapy (BCT) has been adopted in practice | * None of the 398 individuals interviewed reported that their agencies used BCT. * 3% reported even being aware of BCT and its use with married or cohabitating substance- abusing patients. * 71% reported not being willing to use BCT after reviewing a primer on BCT. |
| Roman & Johnson (2002)a | Adoption and implementation of new technologies in substance abuse treatment | 400 private substance abuse treatment centers | Examined the extent to which naltrexone was adopted, as well as examined organizational correlates of naltrexone adoption | * 44% of centers reported using naltrexone. * Adoption of naltrexone was significantly related to center’s age, administrative leadership, percentage of center caseload that were covered by managed care or had relapsed after some formal treatment. |
| Knudsen, Johnson, Roman, & Oser (2003)c | Rural and urban similarities and differences in private substance abuse treatment centers | 303 private substance abuse treatment centers | Compared rural and urban treatment centers with regard to the adoption of treatment innovations and other services | * 46% of Rural and 49% of Urban Centers reported adoption of Naltrexone. * 37% of Rural and 48% of Urban Centers reported adoption of Motivational Enhancement Therapy. * 55% of Rural and 48% of Urban Centers reported adoption of Community Reinforcement Approach. * Overall, rural and urban centers did not significantly differ with regard to their adoption of evidence-based treatments, with the exception of urban centers being more likely to adopt acupuncture. |
| Mark, Kranzler, Poole et al.. (2003)a | Barriers to the use of medications to treat alcoholism | 11 physicians and 11 patients | Assessed reasons for why naltrexone has not been prescribed more widely | * 64% of physicians prescribed naltrexone to fewer than 50% of their alcoholic patients. * Barriers to greater use of naltrexone included: lack of awareness, lack of evidence of efficacy in practice, side effects, time for patient management, reluctance to take medications, medication addiction concerns, AA philosophy, and cost. |
| Mark, Kranzler, & Song (2003)a | Understanding US addiction physicians’ low rate of naltrexone prescription | 1,388 addiction physicians | Examined factors associated with physicians use of naltrexone | * 63% of physicians reported having prescribed naltrexone to at least some of their patients. * On average, physicians prescribed naltrexone to 13% of their patients. * Physicians with greater exposure to information about naltrexone were most likely to prescribe it. |
| Petrakis, Leslie, & Rosenheck (2003)a | Use of naltrexone in the treatment of alcoholism nationally in the Department of Veteran Affairs | 194,001 veterans with an alcohol use disorder | Examined the proportion of VA patients with a diagnosis of alcoholism were prescribed naltrexone | * Less than two percent of patients were prescribed naltrexone. * Several factors were associated with significantly higher odds of receiving naltrexone (e.g., being younger in age; Caucasian, and having major depression diagnosis). |
| Rosenberg & Phillips (2003)a | Acceptability and availability of harm- reduction interventions fro drug abuse in American substance abuse treatment agencies | 222 substance abuse agencies | Assessed the acceptability, availability, and reasons for nonavailability of several interventions | * 20% reported naltrexone as being currently available at their agencies. * 74% of agencies rated naltrexone as somewhat or completely acceptable. * Among agencies not offering naltrexone, the two most frequently listed reasons were lack of resources (i.e., money, staff) and inconsistency with agency philosophy. |
| Thomas, Wallack, Lee, McCarty, & Swift (2003)a | Research to practice: adoption of naltrexone in alcoholism treatment | 1,251 clinicians (135 physicians and 1116 nonphysicians) | Examined the extent to which naltrexone was adopted, including barriers to its adoption | * 45% of physicians reported prescribing or recommending naltrexone occasionally compared to 23% of nonphysicians. * Being affiliated with a treatment program that promoted its use was significantly associated with clinician’s adoption. * Top barriers to naltrexone adoption were financing and inadequent knowledge about naltrexone. |
| Knudsen & Roman (2004)c | Modeling the use of innovations in private organizations: The role of absorptive capacity | 322 privately funded treatment centers | Examined the relationships between several organizational mesures and the extent to which different innovations were used. | * On average, centers used only about 5 of the 15 innovations assessed. * Centers that reported greater use of innovations were significantly more likely to engage in more environmental scanning, be larger in size, have a higer percentage of counselors with master’s degreees, be a for- profit center, be hospital-based and collect satisfaction data from referrals. |
| Ducharme, Knudsen, & Roman (2006)a | Trends in the adoption of medications for alcohol dependence | 1 sample of 252 private-sector programs and one sample of 766 substance abuse treatment centers 403 privately-funded and 363 publically funded) | Examined the prevalence and correlates of the adoption of of disulfiram, naltrexone, and acamprosate | * The proportion of programs using pharmacotherapies for alcohol dependence has significantly declined between 1995 (49%) and 2004 (42%). * Adoption of naltrexone was significantly higher among programs with a higher percentage of revenues from insurance, who offered integrated care for patients with co-occuring psychiatric disorders, and had physicians on staff. |
| Fuller, Rieckmann, McCarty, Smith, & Levine (2005)a | Adoption of naltrexone to treat alcohol dependence | Outpatient clinics who participated in at least one of three surveys (n for 1997 = 281; n for 1999 = 235; n for 2001 = 246) | Assessed organizational correlates of naltrexone adoption | * Adoption of naltrexone increased over the five-year period (14% in 1997; 17% in 1999; and 25% in 2001). * Data from the most recent 2001 survey indicated that adoption of naltrexone was significantly higher among programs funded by managed care, that were larger in size, and had more educated staff. *Programs that provided only substance abuse treatment services were less likely to have adopted use of naltrexone. |
| Knudsen, Roman, Ducharme, & Johnson (2005)a | Organizational predictors of pharmacological innovation adoption: The case of disulfiram | 394 privately funded substance abuse treatment centers | Examined organizational structure, workforce professionalism, and treatment philosophy as predictors of disulfiram adoption | * 49% of centers reported using disulfiram. * Hospital-based centers were significantly more likely to use disulfiram relative to freestanding centers. * Percentage of counselor’s with master’s degrees and the percentage of certified counselors were also significantly associated with use of disulfiram. |
| Peters et al. (2005)b | Use of opinion leaders and intensive training to implement evidence-based co- occuring disorders treatment in the community | 73 substance abuse treatment counselors (43 in experimental group and 28 in comparision group) | Examined the effectiveness of intensive counselor training sessions and use of peer opinion leaders to monitor and supervise implementation of a manualized treatment approach | * Counselor’s in the experimental group were significantly more likely to report having adopted the treatment manual relative to the comparision group (48% vs 19%). * There were no statistically significant differences between the experimental and comparison group regarding counselor’s attitude or knowledge. |
| Rich et al. (2005)a | Attitudes and practices regarding the use of methadone in US state and federal prisons | 40 medical directors | Assessed attitudes and practices regarding use of methadone both state and federal prisons within the US | * 48% used methadone. * 8% refered opiate-dependent inmates to methadone upon release. * 30% believed methadone maintenance benefits opiate- dependent inmates. |
| Trafton, Humphreys, Kivlahan, & Willenbring (2005)a | Barriers to implementation of an evidence-based practice: The example of methadone maintenance | 174 substance abuse treatment programs | Examined the extent to which attitudes toward MMT guidelines differed by whether or not a program offered MMT | * 75% of programs did not offer MMT. * Programs which offered MMT were more likely than those that did not offer MMT to be associated with an academic medical center, have greater levels of staffing, have more research experience, and have more confidence in clinical research. |
| Ducharme, Knudsen, & Roman (2006)c | Evidence-based treatment for opiate- dependent clients: Availability, variation, and organizational correlates | 763 substance abuse treatment programs | Examined differenes in the availability of several different evidence-based treatments between programs with and without methadone maintenance services | * A significantly higher percentage of opiate-focused programs offered naltrexone (33%) compared to non-opiate focused programs (10%). * A significantly higher percentage of opiate-focused programs offered buprenorphine (17%) compared to non-opiate focused programs (8%). * A significantly higher percentage of opiate-focused programs offered contingency management (31%) compared to non-opiate focused programs (23%). |
| Knudsen, Ducharme, Roman, & Link (2006)a | Early adoption of buprenorphine in substance abuse treatment centers: Data from the private and public sectors | 576 substance abuse treatment centers (299 privately-funded and 277 publically funded) | Examined organizational correlates of buprenorphine adoption at two timepoints (baseline and 12-month later). | * 6% of centers reported use of buprenorphine at baseline and 14% reported use at the 12- month follow-up. * Private centers were significantly more likely to report buprenorphine adoption. * Several organizational characteristics were found to be significantly associated with buprenorphine adoption including: being accredited, availablility of detoxification and physician services, and current use of naltrexone. |
| Koch, Arfken, & Schuster (2006)a | Characteristics of U.S. substance abuse treatment facilities adopting buprenorphine in its initial stage of availability | 13,060 substance abuse treatment facilities | Examined extent to which buprenorphine was offered in substance abuse facilities in the U.S., as well as correlates of adoption | * Overall 5.5% of facilities reported adoption of buprenorphine. * Prevalence of buprenorphine adoption was higher in opioid treatment programs (11%) relative to non-opioid treatment programs (5%). * Currently offering naltrexone and medically supervised withdrawal were significantly associated with buprenorphine adoption. |
| Bartholomew, Joe, Rowan-Szal, & Simpson (2007)b | Counselor assessments of training and adoption barriers | 211 counselors who attended a state- sponsored training conference on dual- diagnosis or therapeutic alliance | Examined relationships between workshop evaluations and 6- month post workshop follow-up assessments regarding adoption and barriers to adoption | * Training relevance and training engagement were significant predictors of adoption of training materials. * Lack of time and already using similar materials were reported as being among the top barriers to adoption of training materials. |
| Ducharme, Knudsen, Roman, & Johnson (2007)c | Innovation adoption in substance aubse treatment: Exposure, trialability, and the Clinical Trials Network | 1,006 substance abuse treatment centers (766 outside CTN network and 240 within CTN network) | Examined the extent to which adoption of buprenorphine and vocher-based motivational incentives were associated with exposure and trialability | * Centers within the CTN network were significantly more likely to report adoption of buprenorphine relative to those outside the CTN network (20% vs. 11%). * There was not a significant difference in adoption of motivational incentives between centers within or outside the CTN network (34% vs 31%). * Organizational characteristics associated with buprenorphine adoption included availability of physicans and offering detoxification services. * Organizational characteristics associated with significantly lower odds of adoption of motivational incentives were: being accredited, offering outpatient services only, being for-profit. |
| Friedman, Taxman, & Henderson (2007)b | Evidence-based treatment practices for drug-involved adults in the criminal justice system | 384 criminal justice and community-based substance abuse treatment facilities for treatment of adult offenders | Estimated the extent and organizational correlates of evidence-based practices in substance abuse treatment programs for drug-involved adult offenders | * 65% of facilities provide 3 or fewer of the 13 possible EBTs. * Only 35% of the overall sample indicated the use of a treatment manual or specific evidence-based treatment orientation. * Organizational correlates significantly associated with reporting the use more EBTs included being community- based, having formal or informal working relationships with other non-criminal justice programs, have non-punishment attitudes, being accredited, and larger in size. |
| Knudsen, Ducharme, & Roman (2007)a | Racial and Ethnic Disparities in SSRI availability in substance abuse treatment | 665 substance abuse treatment centers (339 privately-funded and 326 publically funded) | Examined the availability of selective serotonin reuptake inhibitors (SSRIs), as well as its association with racial and ethnic composition of center’s caseloads | * 48% of centers reported using SSRIs. * Based upon the final model, use of SSRIs was significantly lower in centers with a higher proportion of hispanic clients, among centers in the Northeast region, who did not have a physician on staff, and were smaller in size. |
| Knudsen, Ducharme, & Roman (2007)a | The adoption of medications in substance abuse treatment: Associations with organizational characteristics and technology clusters | 766 substance abuse treatment centers (403 privately-funded and 363 publically funded) | Examined extent to which agonist medications have been adopted, as well as the extent to which certain organizational characteristics were associated with adoption | * Rates of adoption were 49% for SSRIs, 24% for disulfiram, 21% for naltrexone, and 18% for agonist medications. * Results indicated that adoption significantly varied across several center types (e.g., government owned, public non- profit, private non-profit, and for-profit). |
| Knudsen, Ducharme, & Roman (2007)a | The use of antidepressant medications in substance abuse treatment: The public- private distinction, organizational compatability, and the environment | 766 substance abuse treatment centers 403 privately-funded and 363 publically funded) | Examined extent to which selective serotonin reuptake inhibitors (SSRIs) have been adopted, as well as the extent to which certain organizational and environmental characteristics were associated with adoption | *Overall, SSRIs were reported as being adopted by 50% of sample. * Based upon the final model, top predictors of SSRI adoption included being a for-profit center, a center with physicians on staff, and a center with a higher percentage of drug-court referrals. |
| Joe, Broome, Simpson, & Rowan- Szal (2007)b | Counselor perceptions of organizational factors and innovations training experience | 1,047 counselors from 345 treatment programs | Identified classes of counselors and examined relationship with these classes with job engagement, as represented by prior training exposure, use and satisfaction | * Latent profile analysis identified three classes of counselors based staff attributes and perceptions of organizational climate (i.e., Isolated, Integrated, and Exceptional). * Isolated counselors reported significantly lower program- wide adoption of prior workshop ideas or techniques. |
| Simpson, Joe, & Rowan-Szal (2007)b | Linking the elements of change: Program and client responses to innovation | Varying sample of staff and clients from 59 substance abuse treatment units | Examined longitudinal interrelationships among program-level measures of needs and functioning, workshop training, innovation adoption, client functioning, and follow-up changes in training needs collected at six separate time points during a two-year period | * Adoption of workshop training materials was significantly associated with lower perceived barriers to training assessed 12- months prior to training, as well as higher perceptions of organizational climate (e.g., Mission, Openness to Change) assessed 4-months prior to training. * Significantly higher ratings of counselor rapport and treatment satisfaction were given by clients at programs with higher ratings of workshop training adoption. |
| Henggeler et al., (2008) b | Statewide adoption and initial implementation of contingency management for substance-abusing adolescents | 432 substance abuse and mental health practitioners | Examined the extent of contingency management adoption and fidelity of implementation, as well a predictors of each | * Overall, 30% of the sample reported adoption of contingency management at least one client. * Among therapists who treated at least one substance-abusing client 58% reported adoption of contingency management procedures. * Therapist factors significantly associated with reported adoption of contingency management included: higher education, more years of experience, being in the mental health sector, attitude to adopt if required, and holding more positive attitudes that treatment manuals facilitate positive outcomes. * Implementation measured via therapist-reported adherence to cognitive-behavioral techniques and monitoring techniques was significantly higher in cases where contingency management was used than in cases where it was not used. |
| Henderson, Taxman, & Young (2008)b | A Rasch model analysis of evidence- based treatment used in the criminal justice system | 748 correctional administrators and treatment directors from juvenile and adult correctional agencies | Examined the extent to which programs report adoption of different EBTs, which EBTs are more likely to be adopted, and what are some organizational correlates of adoption | * Approximately 60% reported use of a standardized substance abuse assessment tool. * Approximately 15% of the sample indicated the use of a treatment manual or specific evidence-based treatment orientation. * The reported use of certain practices clustered together (e.g., drug testing with systems integration; standardized risk assessment with use of a treatment manual or specific evidence-based treatment orientation). * Network connectedness was the strongest organizational correlate of EBT adoption. |
| Oser & Roman (2008)a | A categorical typology of naltrexone -adopting private substance abuse treatment centers | 158 private substance abuse treatment centers | Cateorgized treatment centers according to when they adopted naltrexone and examined organizational-level predictors of adopter categorization | * Organizations which did not hold on-site 12 step meetings and were familiar with other treatment innovations (e.g., disulfiram, buprenorphine) were significantly more likely to be in a more innovative category. |
| Squires, Gumbley, & Storti (2008)b | Training substance abuse treatment organizations to adopt evidence-based practices: The Addiction Technology Transfer Center of New England science to service labratory | 54 community-based substance abuse treatment agencies | Assessed the impact of using an organizational change strategy to increase organization’s and their employee’s skills needed to adopt evidence-based practices | * 63% of agencies completed the training. * Of the agencies who completed the training, 96% successfully adopted and implemented contingency management. * Agencies that had more turnover of their assigned technology transfer specialist were more likely to dropout of the training. |
| Oser & Roman (in press)a | Organizational-level predictors of adoption across time: Naltrexone in private addiction treatment centers | 165 private addiction treatment centers | Examined organizational predictors of naltrexone adoption | * 71% of centers reported the adoption of naltrexone. * Several organizational factors were significantly associated with adoption of naltrexone including: being accredited, being for-profit, having an employee handbook using prescription drugs, and not being based on 12-step model. |
Note: Sub-classification are indicated by superscripts
a
pharmacological EBTs only;
b
psychosocial EBTs only; both pharmacological and psychosocial EBTs.