The present results suggest that substance abuse treatment providers in the San Francisco Bay Area, including addictions counselors, are willing to learn about EBPs and most employ EBPs in their work. Although we did not assess previous formal training in EBPs, the addictions field has increasingly emphasized the importance of higher education and credentialing. A recent survey of substance abuse treatment providers demonstrated that substance abuse counselors are now more educated and have more certifications and substance abuse licenses (Mulvey et al., 2003
). In our sample, 58% of participants were currently licensed or certified in addictions and 50% held advanced degrees. Participants who were currently licensed or certified in the addictions field were less likely to have negative attitudes toward EBPs, compared with those who did not have such credentials. Practitioners may also be more open to providing clinical services with a research base because managed care has encouraged the use of treatment manuals and EBPs (Strosahl, 1998
). In addition, the dissemination activities of federal, state and local agencies (e.g., NIDA Clinical Trials Network [CTN]) have aided addiction counselors in becoming more familiar with EBPs (Ball et al., 2002
). Study findings also indicate that many agencies in the San Francisco Bay Area are using management strategies to support EBPs, and may facilitate adoption of EBPs.
Regarding attitudes toward EBPs, in general, clinicians tend to hold positive attitudes toward treatment manuals and EBPs. They view EBPs as facilitating treatment outcomes, and do not perceive EBPs as artificial or interfering with the client-counselor relationship. Participants tended to hold these positive attitudes regardless of work setting, job responsibility, and discipline. Interestingly, our 2006 sample of substance abuse providers held more positive views toward the use of psychotherapy manuals than a group of psychologists from all over the United Stated surveyed in 1998 (Addis & Krasnow, 2000
). This difference in attitudes may be reflective of the recent dissemination movement toward EBPs in substance abuse treatment within our geographic region.
Our results support previous findings regarding the use of specific EBPs (McGovern et al., 2004
). We showed that clinicians were more likely to use “an amalgam” of Motivational Interviewing, Cognitive-Behavioral Therapy, and Twelve-Step Facilitation rather than, Contingency Management or other EBPs. Poor utilization of Behavioral Couples Therapy, which has very strong research support, has been reported in substance abuse treatment due to being too intensive (i.e., too many sessions) and a stand-alone intervention (Fals-Stewart & Birchler, 2001
). Substance abuse treatment providers may be more interested in using EBPs as an adjunct to traditional treatment (McGovern et al., 2004
). Others conclude that substance abuse treatment agencies may not yet be ready to embrace EBPs, and that programs should address more fundamental aspects of care before trying to implement EBPs (Amodeo et al., 2006
). Recent research suggests that an understanding of the technology transfer process (i.e., variables such as exposure, organizational resources, nature of innovations, and stage of diffusion) is critical to moving evidence-based practices from research settings into standard clinical care (Ducharme et al., 2007
The current study provides descriptive data on readiness to adopt EBPs, experience with EBPs and attitudes toward EBPs by substance abuse treatment providers. Study findings may be limited by missing data, which was higher for specific sets of questions on the post-test: stages of change (29% missing), management strategies (29% missing), attitudes toward EBPs (33% missing) and organizational barriers (34% missing). Participants may have skipped items when their answer was “no” or “not applicable,” selectively answered questions based on their level of understanding, or neglected items due to fatigue. In addition, these items were on the back side of the last page of the questionnaire and may have been overlooked. Analysis comparing demographic and professional characteristics of those who did and did not complete survey items showed no differences, suggesting that missing data was not due to systematic differences on those characteristics. Main findings were that individual participants and their agencies were interested in, were positive about, and were in most cases using one or more EBPs. As the direction of bias associated with missing data is unknown, we have no reason to expect this general pattern of findings is inaccurate. It is possible that more complete responding would result in attenuation, although not reversal, of these findings, and additional and future research will inform on this point.
Next, most of our measurement tools were not examined for validity and reliability in this study. The 12-item scale we created to assess practitioner attitudes and organization barriers showed fair but not optimal internal reliability (alpha = .63), and there were too few items to calculate subscale reliabilities. Further refinement to the instruments is needed to obtain more in-depth information on EBPs. Another limitation was that participants voluntarily attended a conference to learn about and receive training on EBPs and, thus, may have been affected by social desirability response bias. Specifically, participants may have felt some pressure to state they were using, and positive about, EBPs even if they were using them minimally or had reservations. However, responses were anonymous and not linked to individuals, and this may mitigate responding on the basis of social desirability. Finally, we did not directly observe clinical practice, and cannot report actual clinical practices with certainty.
Our findings suggest that dissemination activities in the San Francisco Bay Area are reaching addiction treatment providers, and that agencies are supportive of offering training to their employees on EBPs. We are also encouraged that 86% of participants reported interest in obtaining additional training in EBPs. This study has implications for those in the practice settings such that becoming certified or licensed in addictions may lead to greater acceptance and use of EBPs. In addition, widespread dissemination of EBPs has potential for improving clinical care and changing treatment standards among substance abuse treatment professionals.
The next step for research in this area could involve independent observation of clinicians and addictions counselors who self-report use of EBPs. It is critical to assess how clinicians implement and maintain EBPs once they are trained. Increased dissemination and additional time for professional development may lead to discernable change or use of EBPs if programs are organized to allow counselors to practice new skills (Kerwin et al., 2006