An increasing number of empirically valid, efficacious behavioral and pharmacological therapies are available for the treatment of alcohol and drug use disorders (McCarty, McConnell, & Schmidt, 2010). However, numerous research studies indicate that some staff in addiction treatment organizations have negative attitudes toward science-based treatment and experience a range of barriers in implementing science-based addiction treatment. Prior studies have found that educational levels of treatment staff, working in a treatment unit affiliated with a research institution, and working in a unit with higher levels of organizational capacity are associated with positive staff attitudes about evidence-based addiction treatment practices (EBPs). This study explored whether these factors were also associated with addiction treatment staff experience of level of barriers when implementing a new EBP.
Methods
A mixed methods study funded by the Robert Wood Johnson Substance Abuse Policy Research Program examined EBP implementation in a national sample of 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). Interview data from phone interviews and web-surveys conducted 2009-2010 with 296 program directors and 510 staff involved in the implementation of EBPs were analyzed using linear regression methods. The regression models tested (for both director and clinical staff) the statistical relationship between level of education, working in an organization affiliated with a research institution, organizational capacity and level of barriers experienced when implementing a new EBP, controlling for treatment unit characteristics, staff characteristics and type of EBP. Organizational capacity measures were Texas Christian University's Organizational Readiness for Change scales (Lehman et al., 2002) The dependent variable was a 10-point “barrier scale”: respondents described how much barriers interfered with their project's ability to implement the EBP by selecting a number on a 10-point scale.
Results
For both the staff and director samples, neither level of education nor organizational research affiliation were associated with level of barriers experienced implementing a new EBP. Instead, staff perceptions of the overall capacity of their organizations to adapt to change, including communication, cohesion, sense of organizational mission, training, and staffing, all are associated with their experience of level of barriers in implementing an EBP. Program directors, who reported higher levels of stress within their organizations also reported high levels of barriers to EBP implementation.
Conclusions and Implications
The multivariate models indicated that for program directors level of stress within the organizations was a key factor associated with experiencing barriers to EBP implementation. For staff, overall organizational capacity was significantly associated with reporting higher ratings of barriers in EBP implementation. Organizational capacity to change is critical to the implementation of EBPs and should be part of the planning process when programs consider adding evidence-based treatments (CSAT, 2007). Our study suggests that, if federal funders of community addiction programs want to see greater implementation of EBPs, they must account for the organizational capacity of the treatment organization.
