Site matters: multisite randomized trial of motivational enhancement therapy in community drug abuse clinics.

The effectiveness of motivational enhancement therapy (MET) in comparison with counseling as usual (CAU) for increasing retention and reducing substance use was evaluated in a multisite randomized clinical trial. Participants were 461 outpatients treated by 31 therapists within 1 of 5 outpatient substance abuse programs. There were no retention differences between the 2 brief intervention conditions. Although both 3-session interventions resulted in reductions in substance use during the 4-week therapy phase, MET resulted in sustained reductions during the subsequent 12 weeks whereas CAU was associated with significant increases in substance use over this follow-up period. This finding was complicated by program site main effects and higher level interactions. MET resulted in more sustained substance use reductions than CAU among primary alcohol users, but no difference was found for primary drug users. An independent evaluation of session audiotapes indicated that MET and CAU were highly and comparably discriminable across sites.

Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: a multisite effectiveness study.

Despite recent emphasis on integrating empirically validated treatment into clinical practice, there are little data on whether manual-guided behavioral therapies can be implemented in standard clinical practice and whether incorporation of such techniques is associated with improved outcomes. The effectiveness of integrating motivational interviewing (MI) techniques into the initial contact and evaluation session was evaluated in a multisite randomized clinical trial. Participants were 423 substance users entering outpatient treatment in five community-based treatment settings, who were randomized to receive either the standard intake/evaluation session at each site or the same session in which MI techniques and strategies were integrated. Clinicians were drawn from the staff of the participating programs and were randomized either to learn and implement MI or to deliver the standard intake/evaluation session. Independent analyses of 315 session audiotapes suggested the two forms of treatment were highly discriminable and that clinicians trained to implement MI tended to have higher skill ratings. Regarding outcomes, for the sample as a whole, participants assigned to MI had significantly better retention through the 28-day follow-up than those assigned to the standard intervention. There were no significant effects of MI on substance use outcomes at either the 28-day or 84-day follow-up. Results suggest that community-based clinicians can effectively implement MI when provided training and supervision, and that integrating MI techniques in the earliest phases of treatment may have positive effects on retention early in the course of treatment.

Methamphetamine use among treatment-seeking adolescents in Southern California: participant characteristics and treatment response.

This study examined participant characteristics and treatment response among substance-abusing adolescents who received outpatient treatment (N=305, 70.2% adolescent male, 55.3% White, 33.1% Latino, average age of 16 years). Chart reviews were performed on existing intake and discharge assessments between 1999 and 2003 from two Matrix Institute on Addictions treatment clinics. Analyses comparing methamphetamine (meth)-using (n=90) and non-meth-using (n=215) adolescents revealed that adolescent females and older youth were more likely to use meth. Meth users reported greater psychosocial dysfunction and higher rates of substance use at treatment discharge compared with non-meth users. Suicidal ideation and substance use during treatment were predictors of early treatment dropout among the total sample. Meth-using adolescents may need enhanced treatment programming, because they appear to present for treatment with higher levels of dysfunction. Implications are discussed in terms of developing strategies that minimize drug use and maximize treatment response among substance-abusing adolescents.

When treatment meets research: clinical perspectives from the CSAT Methamphetamine Treatment Project.

Integrating research-based treatments into clinical settings has become a priority in the substance abuse treatment field. This article examines the introduction of research, via manualized treatment (i.e., the Matrix Model), into community treatment settings that participated in the Center for Substance Abuse Treatment Methamphetamine Treatment Project, a multi-site randomized controlled trial (RCT) that provided free treatment to 1016 methamphetamine-dependent individuals. With both empirical (qualitative) and anecdotal data from those involved clinically in the project, the article utilizes the framework of practitioner concerns set forth by Addis, Wade, and Hatgis (1999) to assess the issues realized during the implementation of this manualized treatment. Despite fairly smooth implementation of the model, the authors conclude that introducing manualized treatment in the context of an RCT may not be the best way to bring research-based treatment into the practice world.

MET meets the real world: design issues and clinical strategies in the Clinical Trials Network.

The Clinical Trials Network (CTN) represents a major initiative intended to bridge the gap between research and practice in substance abuse treatment by implementing a range of studies evaluating behavioral, pharmacologic, and combined treatments in community-based drug abuse treatment programs across the country. This article describes the development of CTN protocols evaluating the effectiveness of Motivational Enhancement Therapy and Motivational Interviewing. Design, training, and implementation challenges associated with conducting a clinical trial of brief behavioral treatments in community programs are discussed. Issues requiring attention included the diversity in treatments offered across sites, heterogeneity in the study sample, and training of clinicians drawn from the staff of community programs to deliver the study treatments.

Incorporating brain research findings into standard treatment: an example using the Matrix Model.

One way to promote the goal of broadening the application of research to applied treatment is through the development and dissemination of empirically supported clinical treatment manuals. NIDA and NIAAA have published a series of manuals that delineate specific psychotherapies and/or behavioral approaches designed for the treatment of drug and alcohol abuse. This article describes a manualized treatment approach, the Matrix Model, which incorporates several of these psychosocial interventions with some basic explanations of recent brain research to form a comprehensive, multi-component model of outpatient stimulant abuse treatment. A large multi-site trial sponsored by CSAT compares the Matrix Model of outpatient treatment with treatment as usual in 7 sites where methamphetamine is a significant problem. The translation and adaptation of the Matrix manual for cocaine users in Mexico and methamphetamine users in Thailand will offer opportunities to evaluate this approach with very diverse populations of stimulant users.

The substance abuse treatment system in the U.S. What is it? What does it do? Myths and misconceptions.

The current system of care for treating individuals with substance use disorders evolved during the second half of the 20th century. It has roots in self-help movements and in medical and scientific research findings, and has been shaped by emerging drug trends, public health problems, and uneven treatment financing policies. Currently, the bulk of care is provided by: structured outpatient treatment programs; narcotic treatment programs; variable length residential programs (with and without medical services); and modified therapeutic communities. The majority of the services provided within these organizations meet professional credentialing and/or licensing requirements. The treatment delivery system has made great strides in the past decade to improve quality of care, incorporate outcomes monitoring, and increase the role of empirically supported treatments. Research on the effectiveness of substance abuse treatment indicates that the success rates for these services are comparable to other areas of medical/psychiatric care.