Modifications of evidence-based practices in community-based addiction treatment organizations: A qualitative research study

Objective: This qualitative study funded by the Robert Wood Johnson, Substance Abuse Policy Research Program examined implementation of evidence-based practices (EBPs) in 100 community-based addiction treatment organizations (CBOs) nationwide. The study explored (1) the extent to which EBPs were modified, (2) whether modifications were seen as positive or negative, and; (3) standards used for modifications.

Methods: Data from 100 semi-structured phone interviews with project directors from a random sample of 100 CBOs funded by Center for Substance Abuse Treatment, 2005-2007 were analyzed using qualitative methods.

Findings: The 100 projects implemented 182 different EBPs. Of these 48% were modified. Consistent themes included: 1) modifications were seen as improving the EBP, 2) the most common modifications included adding/deleting sessions or changing the order of sessions; 3) some descriptions suggested major EBP modifications, where fidelity was compromised; 4) most respondents perceived the modifications as minor; 5) primary reason for modifications included EBP not being responsive to specific needs of client group. Implications: The addiction treatment field lacks clear directives on the extent to which EBP modifications can be made without affecting the fidelity of a treatment intervention. Addiction treatment researchers need to test and create standards for EBP modifications. Without such standards, federally funded EBP implementation efforts may result in less than ideal outcomes.

Learning Objectives: 1. Understand organizational perspectives on the how and why of substance abuse treatment modifications to EBPs. 2. Discuss significance of maintaining EBP fidelity for treatment outcomes. 3. Identify policy guidelines for modifying EBPs in CBO addiction treatment.