Abstract
BackgroundAdaptations to evidence-based substance abuse treatment programs may impact their effectiveness. A qualitative study of MET/CBT-5 implementation in community agencies treating adolescents found that the majority of the agencies made adaptations and that the most frequent adaptation was to provide more than five treatment sessions.MethodsBaseline and outcome data from SAMHSA’s Effective Adolescent Treatment demonstration were analyzed to assess associations between length of treatment, client characteristics, and outcomes at three months.ResultsAdolescents who received more or less than the protocol length of 5 sessions were less likely to be discharged to the community than those who received the 5 session protocol. Those who received more than five sessions were more likely to have higher severity scores at intake but almost 50% of those with more than five sessions had low intake severity scores. Clients who received less than five sessions tended to have lower severity scores than clients who received more than five sessions.ConclusionsLength of treatment tended to vary by site rather than severity of substance problems or frequency of use. There was no significant improvement of substance abuse problems or decrease in frequency of use with longer treatment. Implementation of the MET/CBT-5 component of the Cannabis Youth Treatment trial in the EAT project illustrates the difficulty of adherence to an evidence based protocol in the field.
Highlights
Adaptations to evidence-based substance abuse treatment programs may impact their effectiveness
When measures of substance problems and frequency of use at three month follow-up were tested as outcome variables in multinomial logistic regression analyses that adjusted for possible confounding of other variables there was no relationship to number of treatment sessions received
Most clients were discharged into the community, discharge patterns do not appear to be related to substance problems at three month follow-up but greater frequency of substance use at three month follow-up was significantly related to less likelihood of being discharged to the community
Summary
Adaptations to evidence-based substance abuse treatment programs may impact their effectiveness. Development and implementation of evidence-based treatment for substance-abusing adolescents is critical because adolescents who use drugs are more likely to suffer from dependence in their lifetime [1]. The Effective Adolescent Treatment (EAT) program supported replication and expansion of the most cost-effective model of care – MET/CBT-5 Compatibility with current practice, complexity of the intervention, timing, communication, and the characteristics of the innovation affect implementation [3]. A review of implementation research and the difficulties faced in introducing new programs and determining their impact noted progress in increasing the use of evidence-based practices but “the science related to implementing these programs with fidelity and good outcomes for consumers lags far behind” Programs should optimally choose the strongest intervention that they can implement well
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