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What is usual about "treatment-as-usual"? Data from two multisite effectiveness trials.
Elizabeth J Santa Ana1, Steve Martino, Samuel A Ball
1Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT 06516, USA. elizabeth.santaana@yale.edu
Journal of Substance Abuse Treatment
|March 14, 2008
Summary
Standard drug abuse treatment often misses opportunities to engage patients early. Empirically supported therapies (ESTs) are rarely implemented in community settings, suggesting a gap between research and practice.
Area of Science:
- Addiction Medicine
- Clinical Psychology
- Public Health
Background:
- There is a push to implement empirically supported therapies (ESTs) in community drug abuse treatment to improve patient outcomes.
- Objective descriptions of standard community-based drug abuse treatment practices are lacking.
Purpose of the Study:
- To objectively describe the standard practices in community-based drug abuse treatment.
- To identify the implementation frequency of interventions associated with ESTs in early treatment sessions.
Main Methods:
- Independent ratings of 379 audiotapes from the "treatment-as-usual" arm of two multisite randomized effectiveness trials.
- Data collected from the National Institute on Drug Abuse (NIDA) Clinical Trials Network.
Main Results:
- Common strategies included assessing substance use and social functioning, open-ended questions, problem discussion, and advice-giving.
- Interventions linked to ESTs were infrequently used in early treatment sessions.
- Moderate success in bridging the research-practice gap was observed.
Conclusions:
- Community drug abuse treatment settings present missed opportunities for early patient engagement and enhanced outcomes.
- Current efforts to integrate ESTs into standard practice show only moderate success.
- Further research is needed to optimize early treatment engagement and bridge the research-practice gap.
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