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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3031 — How Do Substance Use Disorder Clinicians Implement Evidence-Based Psychotherapies? A Cluster Analysis of Evidence-Based Practice Components

Gifford EV (Quality Enhancement Research Initiative for Substance Use Disorders), Tavakoli S (Quality Enhancement Research Initiative for Substance Use Disorders)

Objectives:
Evidence-based treatments are clusters of interventions or components organized by treatment developers and it is unclear how these practice clusters translate into real world settings. The goal of this study was to develop a disaggregated measure of evidence-based practices in order to characterize clinicians’ component-level evidence-based practices and the relationships among these practices.

Methods:
A web-based survey, the Clinical Practices Survey-Substance Use Disorder (CPS-SUD), was designed to assess clinician practices. Evidence-based treatment components were derived from treatment fidelity measures used to specify critical treatment components in randomized controlled efficacy trials. The web-based survey was conducted with 75 VHA SUD practitioners and 149 non-VHA community-based addiction treatment providers. To determine how evidence- based practices cluster in real-world settings, cluster analyses were conducted using Ward’s hierarchical method. Mojena’s stopping rule for specifying a confidence limit in the agglomeration coefficients helped identify an optimal cluster solution.

Results:
Clinicians’ self-described treatment orientations were significantly related to endorsement of evidence-based practice subscales; however, clinicians used component interventions from a variety of evidence-based treatments. Cluster analysis indicated an optimal seven-factor solution. Clinicians combined and organized interventions from Cognitive Behavioral Therapy, the Community Reinforcement Approach, Motivational Interviewing, Twelve Step Facilitation, and Contingency Management into clusters reflecting treatment engagement and activation, empathy and support, abstinence initiation, 12-step involvement and recovery maintenance, support for medication management, structured family and couples therapy and contingency management.

Implications:
Although clinicians’ self-reported treatment orientations are significantly associated with their orientation’s component practices, clinicians also engage in practices from a variety of evidence-based treatments. Evidence-based practice clusters overlap with treatment theories but are predominantly organized according to other factors such as helping patients initiate abstinence, engage in treatment and recovery directed activities, or maintain recovery gains. These findings may provide direction for promoting EBP implementation and for developing implementation focused approaches to treatment fidelity.

Impacts:
Clinicians organize evidence-based practices according to pragmatic domains as well as underlying theoretical models. Improving our understanding of how clinicians apply evidence-based treatments may lead to more effective evidence-based treatment implementation and more clinically meaningful approaches to treatment fidelity.


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