Table 1. Preparing to Implement Addiction Counselor-Led Group CBT.

Domain	Challenges	Solutions
Organizational	• Staff skepticism of ESTs	• Obtain consistent, visible support from program administration for EST
Context	• Staff concern about altering usual treatment	implementation.
	approaches	• Highlight benefits to organization, staff, and clients in communications
	• Implementation of a new treatment in an	about EST implementation.
	overburdened system	• Ensure release time and work support for counselors to be trained.
		•Collaboratively develop administrative procedures that are minimally disruptive to competing staff demands
CBT Counselor	• Low counselor buy-in to EST due to concerns	• Select counselors with high interest in learning about CBT and
Selection	about:	depression.
	◦ Required time commitment	• Link learning CBT to enhancement of professional development.
	◦ Unfamiliar nature of the intervention
Initial Counselor	• Counselors may be overwhelmed by amount of	• Provide in-person training balancing didactic material and interactive
Training	material to be learned.	exercises.
		• Frame training as building on pre-existing counselor competencies.
		• Focus on counselor ability to understand and explain basic CBT model.
	• Counselors may have philosophical differences	• Acknowledge differences in treatment approaches, but highlight
	about what constitutes an effective treatment	compatibility between CBT and counselors' existing treatment
	approach.	philosophy.
		• Use CBT skills to address counselor concerns.