Evidence-based practices in addiction treatment: Review and recommendations for public policy

Abstract

The movement in recent years towards evidence-based practice (EBP) in health care systems and policy has permeated the substance abuse treatment system, leading to a growing number of federal and statewide initiatives to mandate EBP implementation. Nevertheless, due to a lack of consensus in the addiction field regarding procedures or criteria to identify EBPs, the optimal processes for disseminating empirically based interventions into real-world clinical settings have not been identified. Although working lists of interventions considered to be evidence-based have been developed by a number of constituencies advocating for EBP dissemination in addiction treatment settings, the use of EBP lists to form policy-driven mandates has been controversial. This article examines the concept of EBP, critically reviews criteria used to evaluate the evidence basis of interventions, and highlights the manner in which such criteria have been applied in the addictions field. Controversies regarding EBP implementation policies and practices in addiction treatment are described, and suggestions are made to shift the focus of dissemination efforts from manualized psychosocial interventions to specific skill sets that are broadly applicable and easily learned by clinicians. Organizational and workforce barriers to EBP implementation are delineated, with corresponding recommendations to facilitate successful dissemination of evidence-based skills. KeywordsEvidence-based practice; Technology transfer; Addiction; Treatment; Implementation; Dissemination The importance of translating scientific advances in disease-specific interventions into clinical practice has been emphasized throughout the health care system, largely stemming from the consistent observation of a wide gap between research and practice [1]. As a move towards "evidence-based practice" has permeated health care systems and policy, several working groups in the addiction treatment field both within and outside of the United States have considered ways to align with this initiative. In the U.S., these efforts have been channeled through various legislative mandates and programs requiring implementation of evidencebased practices. Concurrently, national-level programs have been initiated outside of the U.S. to implement extensive rollouts of evidence-based treatments (e.g., the Improving Access to Psychological Therapies program in the United Kingdom) [2]. Likewise, the largest 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. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript inter...

Controversies in Knowledge Translation for Community-Based Drug Treatment: The Need to the End Policies of the War on Drugs and Mass Incarceration of Drug Offenders to Achieve Health Equity

“…24 There are many issues to be considered before KT proceeds, or before the implementation of evidence-based practices (EBPs) in real-world addiction treatment settings. 25 There are problems in generalizing findings from efficacy research into real-world settings. 21,25 Optimal processes for disseminating empirically based interventions into real-world clinical settings have yet to be identified.…”

“…25 There are problems in generalizing findings from efficacy research into real-world settings. 21,25 Optimal processes for disseminating empirically based interventions into real-world clinical settings have yet to be identified. 21,25 Cost and staff training are relevant factors.…”

“…21,25 Optimal processes for disseminating empirically based interventions into real-world clinical settings have yet to be identified. 21,25 Cost and staff training are relevant factors. 24 There is also the perception of a gap between providers' experience in real-world settings and that of researchers, so many of "the treatments that receive research attention are resourceintensive interventions studied under rarefied conditions for fixed periods of time" (p. 39).…”

“…There are an increasing number of federal and state initiatives that emphasize the implementation of EBPs in addiction treatment settings; this emphasis is also increasingly held by stakeholders (i.e., health care regulators, payers of behavioral health care), yet there is no consensus regarding what constitute optimal procedures for identifying practices with sufficient empirical foundation for them to be considered evidence-based. 25 In fact, many problems abound with lists of EBPs: there is the danger of overemphasizing in the hierarchy of what constitutes evidencespecific therapy techniques that are overvalued relative to aspects of the therapeutic relationship. Lists vary in the number and types of treatments listed; some lists are not updated, and EBPs on lists may appear for political purposes.…”

“…Lists vary in the number and types of treatments listed; some lists are not updated, and EBPs on lists may appear for political purposes. 25 Regardless, "community-based drug treatment organizations must comply with the directives and regulations of their funders" (p. 40) 20 Noteworthy are resultant perceived violations of the right of the community to determine appropriate interventions for their sociocultural context, given the requirement to select from lists of EBPs. 28 Representatives of community-based drug treatment programs have described how "many clinical trials exclude the classes of patients that are most prevalent in community-based agencies, and consequently findings from such research do not seem relevant when viewed by treatment providers" (p. 38).…”