Financial Barriers to Implementation of Evidence-Based Practices for Alcohol and Drug Treatment

State authorities play a critical role in the delivery of evidence based practices (EBPs) for substance abuse treatment services. However, the increasing expectation that organizational and service delivery policies result in EBP implementation occurs amidst a myriad of possible systems barriers. The National Quality Forum (NQF) endorses five categories of EBPs: screening and brief intervention, psychosocial interventions, use of medication, use of wrap around services, and aftercare and recovery management. To accelerate EBP adoption, the NQF also promotes five implementation strategies: financial incentives and payment mechanisms, regulations and accreditation, education and training, infrastructure development, and research and knowledge translation. In this mixed-methods study, representatives from each state authority (n=51) participated in semi-structured interviews that included quantitative and qualitative indicators for identifying and elaborating on barriers to EBP implementation. SSAs rated financial factors (i.e., provider access to EBP options, financial incentives to promote EBPs, availability of insurance coverage and parity) as more substantial barriers to EBP implementation than SSA organizational factors, health care system factors, oversight factors or research translational factors. Qualitative analysis substantiates and elaborates on SSA reports of (1) the inability to purchase categories of EBPs, (2) perceptions that treatment providers see financial factors as their biggest barrier to EBP implementation, (3) the inability to provide financial incentives to treatment programs for using EBPs, (4) difficulties financially supporting trainings, supervision and workforce development for EBPs, and (5) complicated billing, insurance and reimbursement networks that inhibit organizational efficiency for treatment programs trying to use EBPs.