Does Empirical Evidence Matter? Implications for Practice and Service Providers' Endorsement of Alcohol and Substance Abuse Treatments

Background: The collaborative work of service providers (e.g., social workers, counselors and medical professionals) is essential in substance abuse treatment (SAT).  Multidisciplinary practice, involving social workers, psychologists and medical care providers improve the quality of SAT and client outcomes receiving behavioral and medical interventions.  Research is lacking about how providers from various professional disciplines compare in their endorsement of behavioral and medical evidence-based practices (EBPs). Divergent attitudes toward EBPs may hamper the capacity of multidisciplinary teams to offer research-based services to consumers who will thus receive substandard services. This study thus examines the relative contribution of key provider-level factors (e.g., providers’ prior involvement in scientific research and training needs) toward their endorsement of buprenorphine and Cognitive Behavioral Therapy (CBT).  

Method: Multiple linear regressions were used to analyze cross-sectional survey data from a national sample (n = 571) of providers (social workers, psychologists, counselors, and medical staff) affiliated with the National Drug Abuse Treatment Clinical Trials Network (CTN), a research platform funded by the National Institute on Drug Abuse (NIDA).  The CTN, comprised of approximately 240 SAT programs in the United States was established to bring researchers and providers together to develop and test treatments in community settings. Outcomes: Endorsement of Buprenorphine and endorsement of CBT as effective treatments.  Independent variables: Previous involvement in research, training needs, attitudes, knowledge and organizational-level variables. Multiple imputations were used for missing data.

Results: Sample: 571 providers. Demographics: 61% female, 70% white, 16% African American, 7% Latino, 4% Native-American, 3% Asian/Pacific Islander. Professional disciplines: 30% social workers, 25% medical staff, 23% psychologists, 22% counselors. 120 providers reported previous involvement in research. Favorable attitudes toward EBPs in general were positively associated with endorsement of both CBT and buprenorphine (p<0.001). Providers with previous involvement in research strongly endorsed buprenorphine and CBT (p<0.05). There was a positive association between providers’ need for training to improve rapport with clients and their endorsement of buprenorphine (p<0.01) and a negative association with endorsement of CBT (p<0.001). There was a positive association between providers’ need for training to manage clients’ behaviors and assess clients’ needs and endorsement of CBT (p<0.05).

Conclusions: Results underscore the need for providers from medical and behavioral disciplines to be involved in research and to receive specific types of training to enhance their use of evidence-based practices.  Grounded in the findings from this study, trainings ought to target providers’ attitudes toward EBP, help providers to improve their rapport with clients, as well as develop behavioral management and assessment skills.  Trainings for providers ought to be designed collaboratively with providers to facilitate co-learning between medical and behavioral professionals working in multidisciplinary settings.