Barriers to implementing evidence-based practices in addiction treatment programs: comparing staff
This qualitative study explores barriers to implementing evidence-based practices (EBPs) in community-based addiction treatment organizations (CBOs) by comparing staff descriptions of barriers for four EBPs: Motivational Interviewing (MI), Adolescent Community Reinforcement Approach (A-CRA), Assertive Community Treatment (ACT), and Cognitive-behavioral Therapy (CBT). The results show that front-line staff describes different types of barriers to implementing each EBP. For MI, the majority of barriers involved staff resistance or organizational setting. For CBT, the majority of barriers were associated with client resistance, and for ACT, the majority of barriers were associated with resources. The authors conclude that addiction programs proposing to use specific EBPs must consider whether they have the organizational capacity, as well as the community capacity, to meet the demands of that practice. EBP dissemination to programs should include explicit strategies to address such barriers.
Keywords: psychotherapy evidence-based practice community-based substance abuse treatment motivational interviewing (mi) adolescent community reinforcement approach (a-cra) cognitive-behavioral therapy (cbt) module 2 module 4
Amodeo, M., Lundgren, L., Cohen, A., Rose, D., Chassler, D., Beltrame, C., & D’Ippolito, M. (2011). Barriers to implementing evidence-based practices in addiction treatment programs: comparing staff reports on motivational interviewing, adolescent community reinforcement approach, assertive community treatment, and cognitive-behavioral therapy. Evaluation and program planning, 34(4), 382-389
Treating comorbid substance use disorders in schizophrenia
This literature review examines the pharmacological and psychosocial treatment approaches for people with schizophrenia and comorbid substance use disorder(s) (SUD). The results show that despite the high prevalence of comorbid SUD among people with schizophrenia, there is a considerable shortage of rigorously conducted randomized controlled treatment trials. Although there is some evidence for clozapine, and for the adjunctive use of agents such as naltrexone for comorbid alcohol dependence, the available literature largely comprises case studies, case series, open label studies and retrospective surveys. In terms of psychosocial approaches, there is reasonable consensus that integrated approaches are most appropriate. Regarding specific aspects of care, motivational interviewing, cognitive behavioral therapy, contingency management, and family interventions have an emerging supportive literature. The authors state there is no ‘one size fits all’, and a flexible approach with the ability to apply specific components of care to particular individuals, is required. Group-based therapies and longer-term residential services have an important role for some patients, but further research is required to delineate more clearly which patients will benefit from these strategies. The authors conclude that although there is growing evidence that integrated and well articulated interventions that encompass pharmacological and psychosocial parameters can be beneficial for people with schizophrenia and comorbid SUD, there remains a considerable gap in the literature available to inform evidence-based practice
Keywords: psychotherapy treating co-morbid substance use in schizophrenia pharmacotherapy psychological treatment schizophrenia alcohol cannabis cocaine heroin module 1 module 4
Lubman, D. I., King, J. A., & Castle, D. J. (2010). Treating comorbid substance use disorders in schizophrenia. International Review of psychiatry, 22(2), 191-201.