For many decades the health and mental health fields have tested promising treatments through the use of randomized clinical trials and have disseminated those treatments that showed the most consistently positive outcomes. In contrast, in the addiction treatment field, scientifically based treatments or evidence-based practices (EBPs) are relatively new phenomena. However, treatments with empirical evidence of efficacy and effectiveness are increasingly being recommended for the treatment of alcohol and drug disorders (Institute of Medicine, 2006) and government funders and addiction researchers increasingly emphasize the need for addiction treatment programs in community-based organizations (CBOs). This research effort explored implementation of EBPs in 100 community-based addiction treatment organizations nationwide. The purpose of this exploratory study is to describe 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(Lundgren et al., 2011).
Methods
A mixed methods study funded by the Robert Wood Johnson Substance Abuse Policy Research Program examined EBP implementation in a national sample of 330 community based addiction treatment organizations funded by the Substance Abuse Mental Health Services Administration to implement EBPs (Lundgren et al., 2011; Amodeo et al., in press). Semi-structured data from phone-interviews with 100 addiction treatment program directors were analyzed using grounded theory methods (Glaser & Strauss, 1967; Wiseman, 1987). Program directors were interviewed between 2009-2010 and the study had a 93% response rate.
Results
Overall, program directors were highly positive about the EBPs they implemented (95%). However, more than half reported modifying the EBP implemented. The most often cited reason for modification was the need to change the EBP in response to client needs. The large majority of the sample identified that modifications of EBPs improved the intervention and helped the organization better serve clients. Common modifications included adding or deleting intervention sessions, with some organizations conducting ongoing modifications of the specific EBP throughout the entirety of the project time period.
Conclusions and Implications
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. Without standards that define appropriate modifications or set guidelines for responsible decision-making relative to modifications, addiction treatment staff are often unclear about which changes to an EBP qualify as acceptable and which ones may even negatively affect client outcomes. Five recommendations for how to best to approach modifications of EBPs are described.
