Program administrators and staff in treatment programs participating in the National Drug Abuse Treatment Clinical Trials Network (CTN) completed surveys to characterize participating programs and practitioners. A two-level random effects regression model assessed the influence of Organizational Readiness for Change (ORC) and organizational attributes on opinions toward the use of four evidence-based practices (manualized treatments, medication, integrated mental health services, and motivational incentives) and practices with less empirical support (confrontation and noncompliance discharge). The ORC Scales suggested greater support for evidence-based practices in programs where staff perceived more program need for improvement, better Internet access, higher levels of peer influence, more opportunities for professional growth, a stronger sense of organizational mission and more organizational stress. Support for confrontation and noncompliance discharge, in contrast, was strong when staff saw less opportunity for professional growth, weaker peer influence, less Internet access, and perceived less organizational stress. The analysis provides evidence of the ORC's utility in assessing agency strengths and needs during the implementation of evidence-based practices. IntroductionThe Institute of Medicine's Crossing the Quality Chasm series recommended increased use of treatments with empirical evidence of efficacy and effectiveness for health care (Institute of Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Corresponding NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptMedicine, 2000;Institute of Medicine, 2001) and for the treatment of alcohol, drug, and mental health disorders (Institute of Medicine, 2006). There is, however, a significant lag between science-based treatment innovations and the widespread adoption of those strategies in health care (Balas & Boren, 2000;Institute of Medicine, 2001). A comprehensive review of implementation research identified six core components that must be present to initiate and sustain the use of proven programs in new locations and environments: 1) select staff who can implement the program, 2) train staff, 3) require ongoing coaching, 4) use supervision and fidelity assessments to provide performance feedback to staff, 5) evaluate overall program functioning, and 6) facilitate implementation and sustainability with administrative supports (Fixsen et al., 2005). Many programs neglect one or more core implementation components and struggle to develop the skills required to effectively ...

The relatively traditional beliefs of support staff could inhibit the introduction of evidence-based practices. Programs initiating changes in therapeutic approaches may benefit from including all employees in change efforts.

Objective-Individuals with direct care responsibilities in 348 drug abuse treatment units were surveyed to obtain a description of the workforce and to assess support for evidence-based therapies.Methods-Surveys were distributed to 112 programs participating in the National Drug Abuse Treatment Clinical Trials Network (CTN). Descriptive analyses characterized the workforce. Analyses of covariance tested the effects of job category (counselors, medical staff, managersupervisors, and support staff) on opinions about evidence-based practices and controlled for the effects of education, modality (outpatient or residential), race, and gender.Results-Women made up two-thirds of the CTN workforce. One-third of the workforce had a master's or doctoral degree. Responses from 1,757 counselors, 908 support staff, 522 managerssupervisors, and 511 medical staff (71% of eligible participants) suggested that the variables that most consistently influenced responses were job category (19 of 22 items) and education (20 of 22 items). Managers-supervisors were the most supportive of evidence-based therapies, and support staff were the least supportive. Generally, individuals with graduate degrees had more positive opinions about evidence-based therapies. Support for using medications and contingency management was modest across job categories. Conclusions-The relatively traditional beliefs of support staff could inhibit the introduction of evidence-based practices. Programs initiating changes in therapeutic approaches may benefit from including all employees in change efforts.The National Drug Abuse Treatment Clinical Trials Network (CTN) began in 1999 with support from the National Institute on Drug Abuse. Research centers (currently 17) partner with five or more local alcohol and drug treatment centers (currently almost 150 distinct corporations) to conduct multisite clinical trials that test behavioral, pharmacological, and integrated behavioral and pharmacological treatment interventions in treatment programs with heterogeneous patient populations (1). Successful trials generate evidence of effectiveness and may promote the dissemination and adoption of science-based behavioral and pharmaceutical therapies. The first trials assessed buprenorphine detoxification (2,3), motivational interviewing and motivational enhancement therapy (4), and low-cost incentives for use with patients in methadone and outpatient programs (5,6). Initial results documented the feasibility of collaboration with community drug abuse treatment centers and provided a foundation for expansion and growth.Bridging the gap between practice and research, however, requires more than conducting clinical trials in community settings. Individuals who work in the treatment programs are essential to the introduction, adoption, and sustainability of science-based practices. Unfortunately, there is little current information on the workforce that provides treatment services for substance use disorders and on workers' opinions about the use of evidencebased therapies....

Addiction treatment agencies typically do not prioritize data collection, management, and analysis, and these agencies may have barriers to integrating data in agency quality improvement. This article describes qualitative findings from an intervention designed to teach 23 addiction treatment agencies how to make data-driven decisions to improve client access to and retention in care. Agencies demonstrated success adopting process improvement and data-driven strategies to make improvements in care. Barriers to adding a process improvement and data-driven focus to care included a lack of a data-based decision making culture, lack of expertise and other resources, treatment system complexity, and resistance. Factors related to the successful adoption of process-focused data include agency leadership valuing data and providing resources, staff training on data collection and use, sharing of change results, and success in making data-driven decisions.

Drug abuse treatment programs and university-based research centers collaborate to test emerging therapies for alcohol and drug disorders in the National Drug Abuse Treatment Clinical Trials Network (CTN). Programs participating in the CTN completed organizational (n = 106 of 112; 95% response rate) and treatment unit surveys (n = 348 of 384; 91% response rate) to describe the levels of care, ancillary services, patient demographics, patient drug use and co-occurring conditions. Analyses describe the corporations participating in the CTN and provide an exploratory assessment of variation in treatment philosophies. A diversity of treatment centers participate in the CTN; not Conflict of Interest None of the authors report conflicts of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Medicine, 1998, p. 123). After receiving public testimony and evaluating potential strategies, the Committee proposed that NIDA support a research/ practice infrastructure where investigators and treatment programs collaborate to facilitate adoption of evidence-based practices (Recommendation 1, p. 6). NIH Public Access National Drug Abuse Treatment Clinical Trials NetworkIn 1999, the National Institute on Drug Abuse issued awards to support the National Drug Abuse Treatment Clinical Trials Network (CTN). The CTN uses multi-site clinical trials to test behavioral, pharmacological, and integrated behavioral and pharmacological treatment interventions in a broad range of treatment programs with heterogeneous patient populations. Each node includes community treatment programs in partnership with a research center. In January of 2003, there were 17 nodes and 112 treatment providers. Treatment PhilosophyClinics addressing alcohol and drug disorders vary in treatment philosophies, and that variation may influence the adoption and use of specific treatment strategies. The Institute of Medicine identified three program philosophies or orientations that guide treatment strategies: physiological (addiction is a progressive disease that requires medical intervention including the use of pharmacotherapy), psychological (addiction is a behavioral and emotional problem that responds to intensive group and individual therapy), and sociocultural (addiction is the result of socialization in environments that promote use of alcohol and other drugs and treatment requires environmental restructuring and new social relationships) (Institute of Medicine 1990). These models of care are not mutually exclusive but reflect service priorities.Social model programs, for example, articulate six core beli...