Transcript Like this? - National Treatment Center Study

Program Emphasis on Spirituality and
Adoption of Evidence-based Practices
J. Aaron Johnson, Ph.D.
Center for Research on Behavioral Health and Human Services Delivery
The University of Georgia
NTCS
at UGA
*
Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation
Background
• Substantial resources devoted to identifying both
barriers to and facilitators of adoption of evidencebased practices in addiction treatment
– NIDA CTN
– SAMHSA ATTC’s
– RWJF Advancing Recovery Initiative
• Previous research found negative relationship
between counselor’s belief in 12-step model and
attitudes toward EBPs, particularly
pharmacotherapies
• Present study examines relationship between other
measures of spirituality and adoption of EBPs
NTCS
at UGA
*
Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation
Research Question
• To what extent are various aspects of spirituality
present in addiction treatment programs affiliated
with the NIDA Clinical Trials Network?
• What impact do different measures of spirituality
have on the likelihood of using evidence-based
practices including medications and behavioral
therapies?
NTCS
at UGA
*
Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation
The National Treatment Center Study
• Monitoring the organization, management,
delivery, and content of addiction treatment in the
U.S.
• Includes Nationally Representative Samples of:
– Privately-funded treatment programs (N=401)
– Publicly-funded treatment programs (N=362)
– Therapeutic Communities (N=380)
• Includes all programs affiliated with NIDA
Clinical Trials Network (N=227)
NTCS
at UGA
*
Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation
NTCS Instrument Design
• Multiple data collection methods used:
– Detailed on-site interviews with program administrator
• Focus - organizational characteristics, services offered, and use
of innovations
– Mail questionnaire from program administrator
• Focus - leadership and management practices
– Mail questionnaire from counselors
• Focus - services received by clients and attitudes toward
innovations
– Brief telephone follow-ups w/ program administrator at six month
intervals
• Focus - changes within the center including adoption of new
EBPs
• Current analyses – data from on-site interviews with
programs in NIDA Clinical Trials Network (N=227)
NTCS
at UGA
*
Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation
Provision of Spiritual Content in Addiction
Treatment Programs (% Offering)
Content Type
Percentage
Required 12-step meeting attendance
39.6
Psycho-educational Groups/Lectures on
Spirituality
68.3
Instruction in or group practice of prayer
17.2
Instruction in or group practice of meditation
49.3
On-site religious worship services
15.0
Individual spiritual direction/guidance
36.1
Spiritual or religious reading material
48.0
NTCS
at UGA
*
Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation
Use of Selected EBPs
(On-site interviews – October 2003 – Jan. 2005)
PHARMACOTHERAPIES
Methadone
33.5%
Buprenorphine
15.8%
Naltrexone
16.7%
BEHAVIORAL THERAPIES
NTCS
at UGA
*
MET
53.5%
Motivational Incentives
37.4%
Matrix Model
17.5%
Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation
Results of Multivariate Logistic Regression Models
Evidence-based Practices
(Pharmacotherapies)
Methadone Naltrexone Buprenorphine
Spiritual Services Offered
+
Client Participation in
Spiritual Services
-
Program Size
(log of FTES)
+
Physician on Staff
+
+
+
Program offers IP Detox
JCAHO Accredited
NTCS
at UGA
*
+
+
Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation
Results of Multivariate Logistic Regression Models
Evidence-based Practices
(Behavioral Therapies)
MET
Incentives
Matrix
Spiritual Services Offered
Client Participation in Spiritual
Services
-
Program Size (log of FTES)
-
% Counselors Masters or
Higher
NTCS
at UGA
*
+
Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation
Conclusions
• Two measures of spirituality within addiction treatment
programs were created – the number of spiritual-based
services offered by the program and the extent of client
participation in spiritual-based services.
• The level or emphasis on spirituality in addiction treatment
programs was expected to have a negative effect on the
adoption and use of EBPs.
• Among pharmacotherapies, methadone was the only EBP
impacted in the expected direction by spirituality
measures.
• Among behavioral therapies, the Matrix model was the
only EBP impacted by the spirituality measures.
• Program emphasis on spirituality is not a significant
deterrent to the adoption of EBPs.
NTCS
at UGA
*
Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation