Contemporary addiction treatment: A review of systems problems for adults and adolescents

McLellan, A. Thomas; Meyers, Kathleen

doi:10.1016/j.biopsych.2004.06.018

Cited by 182 publications

(129 citation statements)

References 23 publications

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“…However, other barriers to integrating effective interventions into widespread clinical use have been described, including the instability of the organizational, administrative and personnel infrastructures of treatment programs (McLellan & Meyers, 2004). Staff and management turnover, facility closures and restructuring and severe financial pressures, particularly for small, stand-alone treatment facilities, are substantial challenges to implementing and sustaining treatment innovations.…”

Section: Discussionmentioning

confidence: 99%

Empirically supported substance abuse treatment approaches: A survey of treatment providers' perspectives and practices

Herbeck¹,

Hser²,

Teruya³

2008

Addictive Behaviors

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To better understand the extent that empirically supported and promising substance abuse treatment approaches are implemented in community settings, treatment providers were surveyed regarding their perceptions and use of several psychosocial and pharmacological treatment interventions. Program directors (n=30) and staff members (n=331) from diverse community settings rated the effectiveness and extent of use of various treatment interventions, and provided information on program and workforce characteristics via self-administered questionnaires. On average, program directors and staff rated the psychosocial treatment interventions as effective, with the exception of vouchers/motivational incentives. About half of the treatment providers did not know the effectiveness of certain pharmacological treatments, including buprenorphine and naltrexone. Respondents from the majority of programs (55%-80%) reported using Motivational Enhancement Therapy, Community Reinforcement Approach, and Supportive Expressive Psychotherapy. The extent that programs used several of the treatment interventions was related to organizational training and information resources. The study findings provide important information regarding training and research dissemination efforts.

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Section: Discussionmentioning

confidence: 99%

Empirically supported substance abuse treatment approaches: A survey of treatment providers' perspectives and practices

Herbeck¹,

Hser²,

Teruya³

2008

Addictive Behaviors

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“…A countervailing force impeding meaningful progress toward this objective, however, is the stubbornly persistent ''treatment gap'': disparity between degree of service need versus degree of service utilization within the ASU population (McLellan & Myers, 2004). Among the approximately 1.7 million adolescents in the United States meeting SUD diagnostic criteria annually, only 7% receive specialized alcohol or drug abuse treatment, and only 25% receive any kind of mental health services (U.S. Department of Health and Human Services, 2011).…”

Section: Market Penetration: Barriers and Solutions To Meeting The Dementioning

confidence: 99%

Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use: Updates and Recommendations 2007–2013

Hogue

Henderson

Ozechowski

et al. 2014

Journal of Clinical Child & Adolescent Psychology

146

120

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This article updates the evidence base on outpatient behavioral treatments for adolescent substance use (ASU) since publication of the previous review completed for this journal by Waldron and Turner (2008). It first summarizes the Waldron and Turner findings as well as those from more recent literature reviews and meta-analytic studies of ASU treatment. It then presents study design and methods criteria used to select 19 comparative studies subjected to Journal of Clinical Child & Adolescent Psychology level of support evaluation. These 19 studies are grouped by study category (efficacy or effectiveness) and described for sample characteristics, methodological quality, and substance use outcomes. Cumulative level of support designations are then made for each identified treatment approach: ecological family-based treatment, group cognitive-behavioral therapy, and individual cognitive-behavioral therapy are deemed Well Established; behavioral family-based treatment and motivational interviewing are deemed Probably Efficacious; drug counseling is deemed Possibly Efficacious; and four integrated treatment models combining more than one approach are deemed Well Established or Probably Efficacious. The remainder of the article (a) articulates fidelity, mediator, and moderator effects reported for evidence-based approaches since 2008 and (b) recommends four enhancements to the prevailing business model of ASU outpatient services to accelerate penetration of evidence-based approaches into the underserved consumer base: pursue partnerships with influential governmental systems, utilize web-based technology to extend reach and control costs, adapt effective methods for linking services across sectors of care, and promote uptake and sustainability by emphasizing return on investment. INTRODUCTIONThis article reviews the evidence base on outpatient behavioral treatments for adolescent substance use (Turner, Muck, Muck, Stephens, & Sukumar, 2004). Because practice guidelines in behavioral healthcare now favor on-site treatment over referral for comorbid disorders (see Sacks et al., 2013), behavioral therapists should be fully prepared to manage common ASU problems that present as a secondary reason for referral or an emergent treatment issue. Thus for behavioral health providers who serve teenage populations in a variety of settings, identifying effective treatments for ASU remains a top priority.The following two sections specify the area of intervention science surveyed in this update and recap the Waldron and Turner (2008) findings that are the launching point for review. The remainder of the article summarizes findings from other literature reviews and meta-analytic studies of ASU treatment published since 2008 and introduces the main contributions of the current review; defines the search parameters and inclusion criteria for identifying the final pool of 19 comparative studies subjected to the JCCAP evidence-based treatment evaluation criteria (Southam-Gerow & Prinstein, 2014); describes the main findings of these ...

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“…Despite evidence of positive and durable outcome (6,7), CBT remains rarely implemented in the range of settings where individuals with substance use disorders are treated (8). There are a number of obstacles to delivering CBT and other empirically validated therapies in clinical practice, including the limited availability of professional and specialty training programs that provide high quality training, supervision and certification in CBT (9), high rates of clinician turnover and lack of a CBT-trained workforce in many treatment settings (10)(11)(12), the relative complexity and cost of training clinicians in CBT (13,14), as well as high case loads and limited resources. Available evidence suggests that while many clinicians report using CBT they tend to overestimate their use of this and other empirically supported therapies (15).…”

Section: Introductionmentioning

confidence: 99%

Computer-Assisted Delivery of Cognitive-Behavioral Therapy for Addiction: A Randomized Trial of CBT4CBT

Carroll

Ball

Martino

et al. 2008

AJP

376

333

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Objectives-To evaluate the efficacy of a computer-based version of cognitive behavioral therapy (CBT) for substance dependence.Methods-This was a randomized clinical trial in which 77 individuals seeking treatment for substance dependence at an outpatient community setting were randomized to standard treatment or standard treatment with biweekly access to computer-based training in CBT (CBT4CBT).Results-Treatment retention and data availability were comparable across the treatment conditions. Participants assigned to the CBT4CBT condition submitted significantly more urine specimens that were negative for any type of drugs and tended to have longer continuous periods of abstinence during treatment. The CBT4CBT program was positively evaluated by participants. In the CBT4CBT condition, outcome was more strongly associated with treatment engagement than in TAU; further, completion of homework assignments in CBT4CBT was significantly correlated with outcome and a significant predictor of treatment involvement.Conclusions-These data suggest that CBT4CBT is an effective adjunct to standard outpatient treatment for substance dependence and may provide an important means of making CBT, an empirically validated treatment, more broadly available.

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Contemporary addiction treatment: A review of systems problems for adults and adolescents

Cited by 182 publications

References 23 publications

Empirically supported substance abuse treatment approaches: A survey of treatment providers' perspectives and practices

Empirically supported substance abuse treatment approaches: A survey of treatment providers' perspectives and practices

Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use: Updates and Recommendations 2007–2013

Computer-Assisted Delivery of Cognitive-Behavioral Therapy for Addiction: A Randomized Trial of CBT4CBT

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