Program Emphasis on Spirituality and Adoption of Evidence-based Practices

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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

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Background

• Substantial resources devoted to identifying both
  barriers to and facilitators of adoption of
  evidence-based practices in addiction treatment
• NIDA CTN
• SAMHSA ATTCs
• RWJF Advancing Recovery Initiative
• Previous research found negative relationship
  between counselors belief in 12-step model and
  attitudes toward EBPs, particularly
  pharmacotherapies
• Present study examines relationship between other
  measures of spirituality and adoption of EBPs

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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?

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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 (N401)
• Publicly-funded treatment programs (N362)
• Therapeutic Communities (N380)
• Includes all programs affiliated with NIDA
  Clinical Trials Network (N227)

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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
  (N227)

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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
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Use of Selected EBPs(On-site interviews
October 2003 Jan. 2005)

PHARMACOTHERAPIES
Methadone 33.5
Buprenorphine 15.8
Naltrexone 16.7
BEHAVIORAL THERAPIES
MET 53.5
Motivational Incentives 37.4
Matrix Model 17.5
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Results of Multivariate Logistic Regression Models
Evidence-based Practices (Pharmacotherapies) Evidence-based Practices (Pharmacotherapies) 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
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Results of Multivariate Logistic Regression Models
Evidence-based Practices (Behavioral Therapies) Evidence-based Practices (Behavioral Therapies) 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
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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.