Barriers and Facilitators to Implementing Evidence-Based Practices in Substance Use Treatment

Increased attention has been given to the organizational context of evidence-based practice implementation, however, much less is known about the role of leadership and the process that program leaders use to make decisions to implement EBPs in substance use treatment programs. Because implementation theories do not fully explicate the role of leadership and decision making in EBP adoption, this study draws from relevant behavioral theories to fill these gaps. Using a mixed methods study design, the specific aims were to: (1) Examine the impact of EBP implementation in substance use treatment programs as a function system, organizational, and leadership attributes; and (2) Describe decision-making processes in implementing EBPs and associated barriers and facilitators.

In the first phase, invitations to participate in the survey were distributed to a Qualtrics panel of 8,000 substance use treatment providers, of whom 2,120 clicked on the survey link. Of those who clicked on the survey link, 1,316 did not complete the survey and 358 were ineligible to participate (i.e., not currently employed in substance abuse treatment), achieving a sample size of 416 substance use treatment providers who completed the survey. The current analysis examines a subsample of program administrators (n=69) in substance use treatment. Using a multivariate model, we examined the primary outcome, number of barriers to EBP implementation, as a function of organizational capacity as measured by the Texas Christian University Organizational Readiness for Change-Director survey; leadership engagement as measured by the Implementation Leadership Scale-Director; and program characteristics. In the second phase, semi-structured interviews were conducted with 10 substance use providers and administrators knowledgeable in EBP implementation at their program.

Study results suggest that outpatient methadone programs (vs residential) and programs with a stressful climate were significantly associated with a greater number of barriers related to EBP implementation [b=1.96, p<.05; b=.937, p<.05, respectively]. Substance use treatment programs with greater leadership engagement were significantly associated with fewer barriers related to EBP implementation [b=-.857, p<.05]. Over half of the program leaders queried reported being mandated to deliver EBPs. Other program leaders reported facilitators were leadership buy-in, staff motivation, training and supervision, and time. Program leaders described such implementation barriers as a lack of funding, health coverage limits, and provider attitudes towards EBPs.

This study shows that implementing an EBP or innovation depends on a multitude of factors including the capacity of the agency for implementation, the client and staff needs, and resources available to the agency. Of primary importance is leadership engagement in reducing barriers to implementing EBPs in substance use treatment. Improving the understanding of these organizational factors can inform the development of implementation strategies, including strengthening leadership, to support the implementation and sustainability of EBPs over time.